Edward Owen Terino M.D.


Procedures
Introduction

Making a Change



The word plastic comes from the Greek word Plastikos, which means “to mold or give form.” Plastic surgery enables us to mold or reform the human body and face. A cosmetic plastic surgeon who is certified by the American Board of Plastic Surgery has specialized training which enables him to master both reconstructive and aesthetic (cosmetic surgery).

Statistics show that each year millions of people elect to undergo aesthetic procedures to enhance a particular feature or reduce visible signs of aging. Aesthetic surgery is rapidly growing in popularity among both men and women.

Many people choose aesthetic surgery to give themselves added confidence in social or work situations or simply to help them to look as young as they feel. Improving a feature of your face or body will provide a boost in self-esteem, an enhancement in self-image that can help you make positive changes in many areas of your life. Having realistic expectations about aesthetic surgery will increase the probability that you will be happy with the results. If you recognize a specific area in which your appearance can be improved and have a strong personal desire to make a change, then you may be an ideal candidate for aesthetic plastic surgery.

Procedures:

Facial Contouring
Facial Implants – cheeks, chin, jawline
Midface “SOMME” Vertical Lift
Face Lift
Neck Lift
Brow Lift
Eyelid Lift
Nose Reshaping
Lip Augmentation
Liposuction – body contouring
Lip Augmentation
Skin Resurfacing – peels, photofacials
Breast Augmentation
Breast Uplift
Breast Reduction
Tummy Tuck
Ear Pinning
Botox
Collagen
Alloderm
Blue Peels
Latest Injectibles

Facial Contouring


Facial Contouring and Chin & Cheek Augmentation - Facial Contouring and using unique anatomically styled implants for the cheeks, chin and jawline region are the super sub-specialized procedures which have given Dr. Terino both national and international recognition.

Dr. Terino creatively customizes each operation from a combination of his own personal methods of evaluating the aesthetic needs of a patient’s face to achieve harmony and balance as well as by using his publicly acclaimed and patented special design facial implants.

The contours of your face may be enhanced by a variety of techniques. Chin augmentation, also called genioplasty or mentoplasty, strengthens the appearance of a receding chin by increasing its size and projection. Similarly, the cheek bones can be made fuller, creating a more sculpted look by using implants. Facial implants provide a permanent and predictable result. Sometimes fat may be injected into specific areas to restore a more youthful fullness to your face. However, treatment with fat injections often need to be repeated to maintain improvement and smoothness of contour in the area of injections is less predictable.

The goal of chin augmentation is to improve your profile by creating a better balance between your chin and other facial features. Increasing the projection of your chin will not affect your bite, jaw function, speech, or dental relationships. There are two approaches for adding prominence and contour to your chin. One is performed through an incision inside the mouth. A more common approach involves insertion of a chin implant through a small incision underneath your chin. The latter approach usually leaves only a faint scar that is barely visible underneath the chin. The under the chin approach is often necessary because of the need to remove fat or tighten or sculpture muscles in patients with aging changes of the neck or who inherit a weak chin and jawline.

To permit proper healing following chin augmentation, you may be placed on a liquid diet for a day or two.

Augmentation of your cheekbones is achieved by placing one of Dr. Terino’s specially designed implants over them. The procedure usually is performed through an incision inside the mouth but it may also be done through a lower eyelid approach.

After a chin or cheek augmentation which requires only about one hour, you will be up and about the same day, but your activities will be reduced from a few days to one week.After surgery, your face will have a more attractive balance and more pleasing contours.

Dr. Terino’s facial contouring procedures and implant surgeries are the subject of his 350 page medical textbook for plastic surgeons, “The Art of Alloplastic Facial Contouring”. He has also been requested to present his work in this field in no less than 15 book chapters and over 100 talks at both national and international plastic surgery meetings.

Back to Top


Facial Implants – cheeks, chin, jawline


The era of changing facial contours or “sculpturing faces”, has arrived. The use of facial implants by plastic surgeons began in the 1950s. In the late 1980s, facial implant technology progressed into anatomically and aesthetically designed implants which produce natural, attractive facial contours. Using such implants to alter the shape of the cheek and jawline region, as well as other less important areas of the face is called facial contouring. They are also very effective when combined with other aesthetic surgeries such as a face lift, nasal contouring and forehead procedures.

What are the standards for beautiful faces in the 2000s?

The contemporary ideal masculine image has strong cheek bones, strong straight noses and jutting jawlines. Examples are seen in the images of Tom Cruise, Silvester Stalone, Arnold Schwartzenaeger, and Brad Pitt. For women, the sophisticated sexy, exotic and erotic looks of Kim Bassinger, Sharon Stone, Cindy Crawford and Michelle Pfeiffer are “definitely in”. In addition to the fullness of their lips, these ladies are popular for their full sensuous cheeks and well defined jawline contours.

Can these images be imitated by facial implants in the 2000s?

Almost! And it is not a miracle, it is reality! Today’s facial implant surgery can easily contour faces without radical bone surgery. The technique involves using the most popular facial implants which are composed of a type of silicone rubber. Silicone has been used harmlessly on human bodies for medical purposes for the past 45 years. To the present, all research has disproved any scientific evidence of damaging effects from this inert material. The new facial implants, many of which have been designed by Dr. Terino, are contoured to imitate mother nature’s natural anatomic structure. There is also a variety of shapes and locations which can emphasize certain specific regions of the jawline and cheek.

Today, plastic surgery and patients alike are fortunate to have this new implant technology which can improve and alter faces to be more attractive. Facial contouring by implants is not only for the youthful. In older individuals, they significantly compliment and enhance the results of other facial cosmetic surgery. Excellent bone structure makes the aging process wear well. Aging beauties, such as Linda Evans, Joan Collins, Jacqueline Smith, and Sophia Loren attest to the fact that strong cheek contours and jawlines enhance the beauty of the mature face. This principle also applies to men, as evidenced by Kirk Douglas, Charlton Heston, Cary Grant and Gregory Peck.

Redraping and tightening the soft tissues of the face are essential elements for facial rejuvenation surgery. However, enhancing and improving facial contours by using implants on the facial bone structure is the very foundation for the architecture of beauty enhancement. Most people are highly conscious and analytical about their own facial contours. They are aware of structures which are excessive or deficient, such as a prominent nose, or weak chin, flat cheek bones, a round face or a pointed jawline. They also have an inborn wisdom about the way they feel that their facial contours could be better. An exciting fact about this new era of facial contouring by implants is that for the first time in the history of plastic surgery, various changes can be made by selecting different size and shape implants according to the patient’s desires.

What are the medical facts about these surgeries?

The majority of plastic surgeons perform facial implant procedures under general anesthesia. Each operation requires approximately 30 minutes to 1 hour of anesthesia time depending on the complexity of the alteration. Facial contouring procedures are easy for the patient to endure. They create minimal or no pain and discomfort. There is, however, persistent swelling in the operated area which requires many months and even one year before the final contour emerges.

Nasal refinement and sculpturing may require up to two hours because of the complexity of nasal anatomy and the subtlety of contour change which the patient may need or desire. Today’s nose operation should not have a standard post-operative “nose job” appearance. Instead, they can be tailored to the patient’s total and unique facial image desires. Frequently this involves consideration of ethnic characteristics. A small scooped out pugged nose appearance is not in demand for the 2000s. Most patients desire a strong, straight profile in conjunction with strong chin and cheek prominences.

A competent plastic surgeon, certified by the American Board of Plastic Surgery, can help patients differentiate facial characteristics and understand the limitations of their own facial structure. Facial contour is the art and science of applying plastic surgery techniques and implant technology for altering the relative balance of these architectural facial elements to enhance beauty. These building blocks of the facial skeleton are the foundation for facial cosmetic surgery of the 2000s and the future.

Back to Top


Midface "SOMME" Vertical Lift


Upper and Midface Vertical (SOMME) Lift – These letters mean: SubOrbital or beneath the eye; Mimetic Muscle, meaning muscles that cause facial expression; Elevation, which is done by lifting all the tissues of the upper and midface that have sagged and drooped from aging. It, therefore, counteracts all the significant aging changes which concern patients, even in young age groups. It lifts the outside of the eyebrow into an attractive position. It can lift the corner of the eye and the lower eyelid into a more almond shape, such as Sophia Loren or Raquel Welch, and it can importantly improve the hollow and sagging tired look underneath the eyes. It even has the benefit of being the best operation to improve the smile line droop or pick up the corner of the mouth slightly. Yes, it really is SOMME lift! Often the need for cheek enhancement with implants is unnecessary when this mid and upper face, vertical lift is performed. However, frequently, a big more exotic cheek contour can be created when a small silicone rubber cheek implant of Dr. Terino’s design is used. The lasting results of the upper-midface vertical lift are confirmed by many years experience. The lower face and neck often need secondary lifting anywhere from five to fifteen years later, but changes in the upper and midface around the eyes are mostly permanent.

Skin Resurfacing, Blue Peels, TCA Peels and Dermabrasion – Skin resurfacing provides significant and long-lasting improvement of sun damaged, unevenly pigmented, or finely wrinkled facial skin. With these techniques you may need only a single procedure, rather than a series of treatments commonly, recommended for milder skin rejuvenation techniques.

Chemical peels containing Phenol or Trichloracidic Acid (TCA) may be used on your entire face (avoiding your eyes, eyebrows and lips), or only on a limited area, such as the lines around your mouth.

TCA is the most frequently used peeling agent at this time. TCA has less bleaching potential than phenol and often is recommended for patients with darker complexions. TCA can be applied to your neck, upper chest and other areas of skin damaged by sun exposure.

Phenol, which generally is the strongest peeling agent, may be recommended if you have fair skin, severe sun damage, and deeper wrinkles. Variations in the phenol formula can create a milder solution for broader and safer use.

Dermabrasion uses a small rapidly spinning wheel with a roughened surface similar to a fine grained sand paper to abrade the skin, removing its upper layers. This resurfacing technique is often used for the treatment of facial scars and more often for the wrinkles around the mouth and chin. The treated area blends well with the surrounding skin so there is usually little, if any, noticeable difference in pigmentation.

Several days following a peel or dermabrasion, your new skin emerges. Its pink color will fade over the next few weeks. In the meantime, it may be covered by makeup. You should be able to return to work after a week or less.

Back to Top


Face Lift


Face Lift (Rhtyidectomy) – A face lift tightens loose skin on your face, neck and jowl areas. It tightens underlying tissues and removes excess fat. Your bone structure, heredity and skin texture, all play a role in how many “years” a face lift can “remove” and greatly influence how long it will last. Dr. Terino will emphasize the special factors which will influence your individual result.

There are many variations to the face lift procedure and the placement of incisions. The goal of every face lift technique to keep the incisions hidden as much as possible. Following Dr. Terino’s surgery, scars will be nearly invisible and will be concealed by your hair or with makeup. Dr. Terino will free your facial skin from its underlying tissues and trim off the excess. In most instances the deeper tissues will be repositioned to restore a more youthful contour to your face. A small incision beneath your chin permits the removal of fat and the essential tightening of the loose cord like muscles in your neck. If you do not have a significant amount of excess skin, you could be a candidate for a “minimal incision” lift. This minimally invasive procedure requires small incisions that are placed inconspicuously according to Dr. Terino’s individualized surgical plan for you.

When facial sagging in the midface/cheek area is pronounced and there is sagging or hollowness under the eyes, a procedure called a Midface Vertical Lift may be performed. Incisions are often made inside the lower eyelid or maybe located in another area that provides easy access to the cheek and midfacial region.

After facelift surgery, you will experience temporary skin discoloration and feelings of tightness or numbness in your face and neck. Since your skin will remain somewhat sensitive for a few months, protection from the sun, including daily use of a sun block is essential. You can wear cosmetics a few days following surgery and patients often are back to work within two weeks. A face lift improves visible signs of aging of the deep cheek folds, the jowls and the loose skin under the front and around the sides of your neck and jaw.

Dr. Terino will design incisions to suit your particular needs. Your face lift incisions may be placed within the hairline and within natural contours in front of and behind your ears. Modified incisions may be used if, for example, you need correction of only your neck and lower face.

Loose skin is pulled upward and back and the excess is removed. Underlying loose muscle structures are tightened. Unwanted fat may be removed.

After surgery, the skin on your face and neck will look smoother, firmer, and fresher.

Back to Top


Neck Lift


Neck Contouring – Excess skin and fatty tissues beneath the chin and jaw can be unattractive and often represent an hereditary double chin deformity. The condition also may be a result of the aging process. Patients with this problem in the younger age groups can be treated by liposuction of the excess fat alone. Often, however, there is also a necessity to tighten and sculpture the muscles. In these cases direct excision of the fat and treatment of the muscles is accomplished through a small inconspicuous incision beneath the chin. This approach allows fat removal from the neck and jowl region. Tightening of the muscles creates a better angle between the neck and jawline. If there is too much loosening and sagging of the neck skin and muscles a lower neck lift/face lift procedure is necessary to properly correct the changes.

Neck contouring procedures require only an hour of operating time.

Back to Top


Brow Lift


Temple or Brow Lift – A temple lift, sometimes called a brow or forehead lift, corrects sagging of your eyebrows and hooding of your upper eyelids, especially in the outer portion. It also may soften the creases across your forehead. It minimizes vertical frownlines at the top of your nose and between your brows. The result is a more relaxed, refreshed and younger appearance.

A brow lift is mostly performed along with a face lift or facial rejuvenation procedures. Some people have inherited appearances that cause them to have a brow lift as early as their 20s or 30s.

One common technique for performing a brow lift requires an incision across the top of the scalp, beginning above your ears. The incision may be placed toward the middle of the scalp where it is hidden within your hair. Through this incision Dr. Terino can modify or remove parts of the muscles that cause wrinkling and angry frown lines and lift your temple or eyebrows to a more pleasing position.

Some patients are good candidates for a minimal incision brow lift technique which requires only several very small incisions in the scalp. Through the smaller incisions Dr. Terino can see and work on the various internal structures of the forehead. After surgery, you will have temporary puffiness and discoloration that may involve your eyelid and cheek areas as well. You may experience numbness and itchiness of your scalp for several weeks.

A temple lift corrects drooping eyebrows and eyelid tissues and improves forehead creases and frown lines that can make you look worried or angry. The forehead skin is gently pulled upward and outward. Some of the underlying muscles are modified as needed.

After surgery your temple will be elevated, your forehead will be smooth and you will look younger, relaxed, and refreshed.

Back to Top


Eyelid Lift


Eyelid Lift (Blepharoplasty) – Cosmetic eyelid surgery flattens or removes bulging fat and smoothes drooping skin of the upper eyelid that can make you look constantly tired or sad. It also eliminates bags under your eyes and therefore create a younger, more alert, and rested appearance.

Eyelid surgery is often performed along with a face lift or other facial rejuvenation procedures. Some people have inherited traits that cause them to have eyelid surgery as early as their 20 or 30s.

Some fat and loose skin are removed from your upper eyelid area through an incision that is hidden within the natural eyelid fold. The incision extends slightly beyond the outside corner of your eye where it easily blends into existing laugh lines or other creases. If your upper eyelid problem is aggravated by sagging of your eyebrows, then Dr. Terino may recommend a temple or even a brow lift.

Treatment of the lower lids often requires an incision that is hidden just below your lower lashes. Through this incision excess fat is removed or adjusted; sometimes fat may be repositioned to eliminate the puffiness or bulges. If your lower eyelid skin is not excessive, Dr. Terino may decide to use a different technique that flattens the fat through an incision placed inside the lid. A chemical application is sometimes used, if necessary, to resurface the lower eyelid skin and to achieve a small degree of skin tightening and removal of fine lines and wrinkles.

After surgery, swelling may persist for a week or longer. Your vision may be somewhat blurry for a few days, and you may want to wear dark glasses to protect your eyes from wind and sun. Within a week you can wear makeup to conceal any remaining discoloration. You should be back to work within five to ten days.

Eyelid surgery corrects puffy bags under your eyes and drooping skin, hooding of your eyelashes or upper lids.

Incision lines fade and blend into natural creases almost invisibly. After surgery, your appearance is brighter, more alert and rested.

Back to Top


Nose Reshaping


Nose Reshaping (rhinoplasty) – The goal of rhinoplasty is to reshape your nose so that it compliments your other facial features. The earliest recommended age for rhinoplasty is the mid teens when the nose is near full development. As long as you are in good health, there is no upper age limit for nose reshaping.

Contouring your nose is generally done through incisions inside your nostrils. In some instances there may also be a need for an incision on the under side of your nose between your nostrils. This approach is used generally for second or more procedures and when there are certain factors that make the successful accomplishment of a symmetrical, attractive nose more difficult.

Sometimes patients want the nostrils of their nose to be narrowed or the size reduced. This can be done by removing small wedges of skin at the base of your nostrils. The resulting scars fade and ultimately are almost invisible.

Your nose can be reduced or built up by adjusting its supporting structures. Adjustments can be made to improve your nasal airway for breathing problems. This can be done at the same time as improvements to the external shape and appearance of your nose.

After surgery there is minimal to no discomfort or pain. Some swelling and bruising can be expected. Bruising disappears rapidly within 7 to 10 days. You will have a cast or “splint” on your nose for 7 to 10 days. You can begin wearing cosmetics when it is removed. Your routine will be severely restricted for only a day or two but for the first two weeks bending, lifting and exercise are prohibited because of the possibility of bleeding at that time. As long as you job does not involve these activities or anything else which raises your blood pressure, you may return to work in one week. Some swelling of the nose persists for up to a year but this is often not noticeable to others or to yourself. The final results of rhinoplasty are apparent at the end of one year to 18 months.

Rhinoplasty can reshape your nose to remove a hump and reduce a broad, bulbous or enlarged tip. It can also improve the angle between your nose and forehead or your nose and upper lip.

Incisions usually are made inside your nose to provide access to the cartilages and bone which can be cut and reshaped to alter the external appearance. The nasal bridge can be narrowed by moving the bones inward. In some instances an “open technique” which requires an incision on the under side of your nose between your nostrils, may be advised by Dr. Terino.

Following surgery, your nose will compliment your other facial features.

Back to Top


Lip Contouring/Augmentation


Lip Contouring/Augmentation – Fuller, plumper lips can be achieved by a variety of lip augmentation techniques several of which Dr. Terino has pioneered. Dr. Terino will help you to select the lip augmentation method that is best for you. The technique chosen will depend on individual patient factors and your goals for the procedure as well as Dr. Terino’s recommendation.

Lip Augmentation is in an evolutionary phase. There are many, many injectible and either permanent or semi-permanent substances which are used in other countries but which need approval for their safety and efficacy in the United States. These substances are under investigation by the FDA (Food & Drug Administration) and otherwise are illegal to perform until they are approved.

Surgical methods of lip augmentation offer another alternative. There are a variety of materials derived from other sources that can be implanted requiring only tiny incisions for placement. Some of these materials eventually become integrated with your natural tissues. Stitches are removed after a few days. Swelling may last longer, and there may be some initial discomfort when eating or drinking. You are able to return to work within a week or less.

Dr. Terino’s presently preferred method for over five years is the placement of large pieces of Alloderm into the upper and lower lips through small invisible incisions inside the corners of the mouth.

This purified collagen, a derivative of human skin, has a lasting quality and natural appearance even though it significantly shrinks over the first year. It has a perfectly natural consistency and is not palpable.

This procedure requires 30 minutes of operating time under only local anesthesia. A socially acceptable appearance is achieved within 2 to 4 days.

The simplest technique for lip augmentation is injection with fat or collagen. For fat injection, a tiny amount of fat is taken from another area of your body, using a small needle attached to a syringe. Sometimes patients who are undergoing liposuction will ask their surgeon to use some of the suction fat to augment their lips. After processing to remove excess fluids, the fat is injected to create a fuller, rejuvenated lip. Following lip augmentations with fat or collagen, your lips may be swollen for a few hours, but you should be able to return to work or social activities quickly. Results are temporary and repeat treatments are necessary to maintain the desired effect. There are other natural and synthetic materials that can be injected into the lips to create volume. These substances come from a variety of sources. Each has its own particular benefits and disadvantages. Dr. Terino can review the current options with you.

Thin, poorly defined lips may be hereditary and often are the result of aging.

After lip augmentation your lips will be fuller, better contoured and more youthfully attractive.

Back to Top


Liposuction - body contouring


Liposuction – Liposuction, also called lipoplasty, removes localized collections of fatty tissue to contour specific areas that will result in creating a smoother and slimmer appearing body contour. For best results, you should be relatively normal in weight and have unwanted and often hereditary fat deposits localized in specific areas such as the hips, outer thighs, inner thighs, knees and abdomen. liposuction may also be effective in specific patients for fat deposits on the back, legs, arms, face and neck.

Lipoplasty is neither a substitute for proper diet and exercise, nor a method for overall weight loss and total alteration of the body contours. It cannot eliminate or reduce cellulite or correct loose and hanging skin. In fact the best results from liposuction are achieved with healthy elastic skin that has the capacity to shrink evenly after surgery. This elastic capacity can be present even in patients into their 50s and 60s.

If for reasons, your skin has lost considerable elasticity, a skin tightening procedure such as a tummy tuck, arm lift, or total body lift may be indicated. Total body lifts are not performed by Dr. Terino at The Plastic Surgery Institute of Southern California. They are very extensive and specific procedures with conspicuous scars and are performed only by certain specialized surgeons. Dr. Terino will be happy to recommend one of these doctors to you. Liposuction of a considerable proportion is performed under general anesthesia. Very limited liposuction may be achieved using local anesthesia or local anesthesia with intravenous sedation and anesthesiologist supervision.

Dr. Terino and most plastic surgeons use a Tumescent Technique that involves loosening up the fat through the injection of a large volume of normal biologic saline solution. This enables the removal to be more even and requires less forceful techniques. Swelling, bruising and pain are, therefore, minimized.

There are other variations to conventional liposuction which use, for example, ultrasound energy or power driven vibrating instruments to assist loosening the fat. For the average ordinary patient and their liposuction needs none of these variations are necessary and only create additional potential problems and expenses. Dr. Terino will discuss the advantages and disadvantages of all contemporary liposuction techniques with you.

Following surgery you will wear a snug girdle or garment night and day for two weeks. A comfortable department store garment will then be worn for two weeks only during the day. These garments promote skin shrinkage and encourage minimum swelling and bruising as you gradually resume normal activities. You may return to work within several days to a week. This time period partly depends on the amount of discomfort experienced by patients. Most patients do not find liposuction to be an extremely painful procedure other than ordinary soreness and tenderness in the operated upon areas.

Lipoplasty helps to eliminate unsightly bulges by removing localized unwanted fat deposits. Collections of fat are removed through tiny invisible incisions discretely placed. A long, thin, hollow tube called a cannula with openings at one end are inserted through the small incisions. The tubes are connected to a long plastic hose which is attached to a vacuum pressure suction machine to remove the fat after it is loosened up by the Tumescent liquid and the back and forth motions of the surgeon using the cannula.

After surgery your body contour will appear slimmer and more attractive in the operated upon areas.


Skin Resurfacing

Skin Resurfacing, Blue Peels, TCA Peels and Dermabrasion – Skin resurfacing provides significant and long-lasting improvement of sun damaged, unevenly pigmented, or finely wrinkled facial skin. With these techniques you may need only a single procedure, rather than a series of treatments commonly, recommended for milder skin rejuvenation techniques.

Chemical peels containing Phenol or Trichloracidic Acid (TCA) may be used on your entire face (avoiding your eyes, eyebrows and lips), or only on a limited area, such as the lines around your mouth.

TCA is the most frequently used peeling agent at this time. TCA has less bleaching potential than phenol and often is recommended for patients with darker complexions. TCA can be applied to your neck, upper chest and other areas of skin damaged by sun exposure.

Phenol, which generally is the strongest peeling agent, may be recommended if you have fair skin, severe sun damage, and deeper wrinkles. Variations in the phenol formula can create a milder solution for broader and safer use.

Dermabrasion uses a small rapidly spinning wheel with a roughened surface similar to a fine grained sand paper to abrade the skin, removing its upper layers. This resurfacing technique is often used for the treatment of facial scars and more often for the wrinkles around the mouth and chin. The treated area blends well with the surrounding skin so there is usually little, if any, noticeable difference in pigmentation.

Several days following a peel or dermabrasion, your new skin emerges. Its pink color will fade over the next few weeks. In the meantime, it may be covered by makeup. You should be able to return to work after a week or less.

Back to Top


Breast Augmentation


Breast Enlargement “Augmentation Mammoplasty” – Breast enlargement, also called augmentation mammoplasty, can increase the size of smaller, undeveloped breasts and also restore your breast volume when it decreases as a result of having children.

Most women who have their breasts enlarged receive saline-filled implants because they are approved by the FDA (Food & Drug Administration). Silicone implants can also be used in situations where problems exist or have been created through previous augmentation surgeries or for reconstructions following breast cancer.

In our office Dr. Terino places the incision within the lower edge of your areola (the pigmented skin surrounding your nipple). This produces the least visible and nearly invisible scar. A pocket is created for the implant behind your breast and between the muscle and your chest wall. Rarely it may be indicated to place implants from underneath the breast. Following surgery, you will briefly wear a wrap-around elastic dressing and in several days start using a sports bra. There will be some swelling and perhaps minimal discoloration that will gradually disappear. You should not engage in vigorous activities, especially raising your arms for up to two weeks. You can return to work within a week. Full vigorous exercise and sports activities can be resumed at four weeks.

There is a great deal of scientific evidence supporting the long-term safety of breast implants. During your consultation, Dr. Terino will discuss with you the known possible problems associated with implants, as well as your specific desires regarding shape and size. Be prepared by choosing magazine images that demonstrate your “do’s and don’ts, as well as your “ideal scene.”

If you are in the appropriate age group for mammographic screening, having breast implants will not change your recommended exam schedule. The presence of breast implants requires modified mammographic techniques and additional x-ray views that are well known and understood by the majority of radiology centers.

Following surgery, your breasts will be fuller and more attractive. You will feel more self-confident about your appearance.

PHILOSOPHY ON BREAST AUGMENTATION

The goal and purpose of aesthetic plastic surgery is to improve a person's feelings about themselves by surgically changing their physical body. Imitating Mother Nature is of primary importance in achieving successful surgical results. This is equally true whether we operate on faces or on figures.

The ultimate ideal is a natural appearing breast, which is soft, shapely and moves in a completely harmonious way when lying down, sitting up, walking or running. Beautiful natural appearing breasts are rare in Mother Nature and occur mainly only in very young females.

Childbearing as well bodily aging negatively affects female breasts. Weight loss and weight gain also deteriorates breast size and shape by stretching the skin of the breast and shrinking the volume and mass of the breast tissue.

Natural asymmetry of breasts is nearly universal. These asymmetries vary from minor to major differences of size and shape.

My role as an aesthetic breast surgeon is to take into account all of these factors, in order to select the correct method to augment a patient's breasts that will fulfill their individual needs. This includes the type of implant, and the adjustment of the space size underneath the breast, a necessary step to allow an artificial implant to have a natural and aesthetic flowing form.

Compensating for God-given asymmetries is one of the most difficult tasks for the plastic surgeon and one, which often will not result in perfectly equal breasts because of the limitations of the patient's body tissues.

Breast augmentation using implants started in the 1970s, producing a radical cultural change in our society. An augmented breast is now often thought to be more desirable than a softer natural somewhat flatter, and tear drop shaped breast. Patients vary widely in their ideas about breast beauty and their wishes for size and shape.

My most important job is to satisfy the patients' fantasy. Therefore I have to know the following:

1) all the various implant types and sizes

2) how to create the necessary internal environment for the implant to fit properly to produce the shape and size desired by the individual patient.

3). What specific size and shape a patient wishes to acquire. Therefore they must supply me with photographic examples.

In summary, my philosophy is to assist my patients to achieve their own personal aesthetic goals for their breasts.

Click below for additional breast augmentation examples

Slide1 | Slide2 | Slide3 | Slide4

Slide5 | Slide6 | Slide7 | Slide8

Slide9 | Slide10 | Slide11 | Slide12

Slide13 | Slide14 | Slide15 | Slide16

Back to Top


Breast Uplift

Breast Lift (Mastopexy) – A breast lift, also called mastopexy, lifts and recontours loose, droopy breasts. You may decide that you would like a breast lift because you lost volume and tone in your breasts after having children. Another frequent reason for having this procedure is the loss of a significant amount of weight.

A breast lift improves the appearance of your breasts in several ways. It elevates your breast tissue. Excess skin is removed from the lower portion of your breasts to reshape a new skin brazier. At the same time your nipple and areola (the pigmented skin surrounding your nipple) are lifted to a higher position. If your areolas have stretched over time, they can be reduced in size. Women who have their breasts lifted often may decide to also have breast implants in order to improve the fullness, especially in the upper breast area. When this is the case, an implant is placed behind the breast tissue and chest muscle.

A commonly performed breast lift technique uses incisions that follow your breasts natural contour. The resulting scar is permanent but will fade considerably over time. Incisions are normally placed along the crease underneath the breast.

There are other breast lift techniques that may eliminate the horizontal incision, the vertical incision, or both. These are useful only in very special circumstances. The use of a particular pattern of incisions depends on the individual patient’s breast conditions in order to determine Dr. Terino’s best recommendation for optimum improvement.

Following surgery, your breasts will be wrapped in elastic dressing or placed in a surgical bra. You will be instructed to wear a supportive bra for several weeks. Swelling and less likely discoloration are to be expected but will rapidly subside. You may experience decreased breast or nipple sensation which usually is temporary. You should be able to return to work within one or two weeks.

A breast lift elevates and reshapes loose, sagging breasts.

After surgery your breasts will be positioned higher and feel firmer, especially when an implant is also added. The resulting scars are permanent, but will fade to a great extent over time.

Back to Top


Breast Reduction

Breast Reduction Mammoplasty – Breast reduction, also called reduction mammoplasty, enhances your overall appearance by making your breast proportional to the rest of your body.

Large, sagging breasts often interfere with normal physical activities. They can cause back pain, postural problems, deformities of the back and shoulders, skin rashes and breast pain. For these reasons, breast reduction is generally considered a reconstructive plastic surgery procedure. In addition to alleviating possible physical problems, it improves the shape of your breasts.

The operation is performed under general anesthesia and may be done in an outpatient basis. During the procedure, excess breast tissue and skin are removed. Your nipple and areolas (the pigmented skin surrounding the nipple) are lifted and the remaining breast tissue is reshaped.

The most common breast reduction technique using incisions that encircle the areola and then extend vertically down the breast and horizontally along the crease underneath the breast. There are other breast reduction techniques that may eliminate the horizontal incision, the vertical incision, or both. These techniques can only be used in special circumstances. The use of any particular pattern of incision depends on individual patient factors and Dr. Terino’s recommendation.

After surgery, your breasts will be wrapped in an elastic dressing or placed in a surgical bra. You will be instructed to wear a supportive bra for several weeks. A change or decrease of breast or nipple sensation is possible, but is usually not permanent. You should avoid strenuous exercise and overhead lifting for five to six weeks. You should be able to return to work within one or two weeks.

Breast reduction surgery can relieve the painful, physical symptoms caused by large breasts.

After surgery, your breasts will be more proportional to the rest of your body. The resulting scars are permanent but will fade considerably, especially after one or two years.

Back to Top


Tummy Tuck (Abdominoplasty)


Tummy Tuck – Abdominoplasty is designed to give you a smoother, flatter abdomen. The procedure tightens the muscles of the abdominal wall frequently stretched by pregnancy or aging. It may also be performed following significant weight loss which leaves loose skin and muscle weakness.

Abdominoplasty may be done on an outpatient basis or with a brief extended recovery. A horizontal incision is made just within or above the pubic area, designed to fit the patients needs for wearing bikinis or brief undergarments. The resulting scar is permanent but when placed within the lines of bathing suits or panties it will be inconspicuous and fades significantly over time.

Where there is loose skin above the naval (belly button), it is not possible to achieve a total correction in that area. When there are stretch marks on the lower abdomen a portion of these will be removed as long as they do not extend up to or above the naval. Remaining stretch marks are flattened and look better, but don’t expect dramatic improvement.

Many times a modified abdominoplasty or a less invasive operation can be performed that will give just as good a result as a major abdominoplasty with a lot less potential for problems, risks, complications and recovery difficulties. With a modified abdominoplasty, the lower abdomen is tightened and excess skin and fat removed without relocating the naval and having a scar around it. Liposuction is often indicated primarily or secondarily to reduce the bulk and unattractiveness of the abdominal contours. The decision regarding liposuction and when it should be performed is a matter of individual factors that will be discussed and advised by Dr. Terino.

Following surgery you will be encouraged to get out of bed for short periods on the first day. A support garment will be worn for several weeks. Strenuous activity must be avoided for 4 to 6 weeks. Most often you may return to work within 7 to 10 days.

After surgery you will have a firmer, flatter abdomen. The resulting scars are permanent but will fade considerably over time and will be placed in order to be camouflaged by clothing.

Back to Top


Ear Pinning


Ear Pinning – Otoplasty improves the shape and position of your ears. Although it cannot reduce the size of your ears by repositioning them closer to your head when they protrude more than normal, they will be more natural in appearance and less noticeable.

Ear surgery is often recommended for children when they approach near total ear development at age 5 or 6. Correction of the ears prior to a child entering school helps to eliminate potential psychological damage from the teasing of classmates. Adults often also have their ears reshaped, as long as you are in good health there is no upper age limit for the surgery.

The supporting tissues in the ears, cartilage, is reshaped to position your ears closer to your head. This is accomplished through incisions in the crease behind your ears. The scars are concealed and invisible.

After surgery you will wear an elastic head bandage for several days to hold your ears in their new corrected position. A supportive head band is necessary for weeks, particularly during sleep to ensure that the ears heal solidly in this new corrected position. Strenuous exercise and contact sports must be avoided for several weeks. Non-strenuous normal activities can be resumed within a week.

After surgery your ears will have a nearly normal or normal appearance.

Back to Top


Lastest Injectibles

Botox

Botox – Botox, Collagen, and fat injections are popular non-surgical techniques for treating facial lines and wrinkles. Patients usually are pleased with the results of these minimally invasive procedures. Injectible wrinkle treatments, however, cannot correct facial sagging or achieve the same results as a face lift, eyelid surgery, brow lift, or skin resurfacing.

Botox is most effective in treating the type of lines and wrinkles caused by muscle contraction during facial expression such as frowning or squinting. Common areas for Botox injections include horizontal forehead furrows, vertical lines between the eyebrows, and “crow’s feet” around the eyes. Botox is injected directly into the muscles in these areas to reduce their activity. Usually within a few days after your injections, the expression lines in the treatment areas will appear noticeably softer.

The improvement from Botox lasts from a minimum of 3 months to a maximum of 6 months. The average is 4 months.

Back to Top


Collagen

Collagen – Collagen is another substance used for treatment of frown lines, “crow’s feet,” and smile lines. Collagen is a major building block contained within the tissues of our bodies. Bovine or Collagen removed from cows has been the standard injectible wrinkle filler for the last 25 years.

Injectible collagen contains a local anesthetic to alleviate discomfort during and following treatment. Injections are performed with a tiny needled directed into the wrinkle crease or depression. Collagen pumps up the soft tissues filling the lines and depressions by replacing the natural collagen which is lost from your skin over time or in areas where the muscles are active to produce creases.

A very small percentage of patients are allergic to Collagen and, therefore, a pre-treatment skin test is necessary one month before your first treatment.

Back to Top


Alloderm

Alloderm – Alloderm is a soft tissue filler material taken from human sources. Therefore, there is no possibility of an allergic reaction. Alloderm is also made in an injectible form called Cymetra. Injections of Cymetra leave residual elements of alloderm in the tissues and, therefore, may accumulate volume over a long period of time.

Alloderm is a natural biologic component of human skin. It, therefore, is soft, pliable, and non feelable after it heals. Alloderm can be used for increasing the fullness of lips or beneath smile creases. It may often be used in contouring the shape of noses and filling other depressions about the face or body. It has been successfully used in the treatment of severe burns in thousands of patients over the past 15 years.

The initial size of an augmented area using Alloderm or Cymetra shrinks over time. When used in lip augmentation there is most often an improvement which is satisfactory of the patients at the end of one year or longer and even permanently. Some patients are so happy with their alloderm augmentations that they will request additionally filling after a year or more.

Botox, Collagen, fat injections and other soft tissue fillers are, to varying degrees, temporary treatments that need to be repeated to maintain results. Some soft tissue fillers, such as alloderm, may have results that are permanent or may also reduce to the point that patients wish to have further treatment. Injectibles and wrinkles remedies are popular because they produce instant results and involve virtually no down time. Following treatments, you can return to work and social activities immediately.

Back to Top


Blue Peels

The Blue Peel is an exciting alternative, which can only be performed by an M.D. It is an in-between, medium depth peel, which requires only five to seven days of healing with only a light pink, healthy-looking color change for only a few weeks afterwards. The early application of makeup, sunscreen and skin products is appealing to most patients. The number of blue peels being performed at The Plastic Surgery of Southern California by Dr. Terino has greatly increased over the last year.

Only one Blue Peel treatment is not sufficient for radical, dramatic skin changes. Two or more peels in a year, however, will gradually and predictably alter the skin and its underlying anatomic structures to tighten wrinkles, stimulate new circulation and reestablish collagen formation from sun damage and aging. The expense, comfort level and the time expenditure of experiencing a Blue Peel treatment is compatible with the needs of most southern California women.

When combined with other available soft tissue treatments, such as Botox, Dermalogen, injectible Allodern and older Bovine Collagen, Blue Peels may well be the most practical means to rejuvenate your skin in a conservative, gradual manner, and with long-term effectiveness.

Back to Top