Cosmetic
Procedures

AWAKE Abdominoplasty procedures, also known as the "tummy tuck", involves the use of a diluted solution of local anesthetic and other medications to remove excess skin from the middle and lower abdomen while tightening the abdominal muscles and fascia of the abdominal wall. Most stretch marks are typically taken out along with the skin removal.

AWAKE Abdominoplasty is an outpatient procedure, avoiding a costly hospital charge under General Anesthesia. Since the patient remains awake during the surgery, the patient will see the results before the completion of the surgery.

AWAKE Tumescent Abdominoplasty has an unprecedented safety record and allows the surgeon to efficiently remove both deep and superficial excess layers of fat with little discomfort, faster recovery and improved cosmetic results. Patients see fewer skin irregularities, less bleeding, and reduced bruising.

The Procedure

• To begin the procedure, the doctor injects a solution into the fatty tissue that anesthetizes the area. It causes the area to become firm and swollen, which enables the surgeon to extract fat more accurately and uniformly.
• Small incisions are made in the skin around the treated area.
• After these incisions are made, a cannulas is inserted through these small openings and the fat is removed.
• Once the maximum benefit of liposuction is achieved, an elliptical incision to directly above the pubic area is made. A second incision is made around the belly button.
• Excess skin is removed with caution given to specifically resect only the dermis and preserve the subcutaneous structures
• Once resection is complete, the incisions are closed with Quill™ SRS wound closure sutures.
• The wounds are then covered with sterile gauze pads and elastic support garments are placed. The areas of the liposuction procedure may stay numb for 36 hours without further injection of lidocaine or other pain killers.
• After 30 minutes of observation, the patient is allowed to leave.

AWAKE surgeries are based on the Klein Technique, which uses lidocaine to numb tissue in order to perform surgery. The term AWAKE Breast Augmentation is a term created by Dr. Anil Gandhi.

It has been shown that this technique has an extraordinary and unprecedented safety record when used as directed and has few of the side effects or risks associated with using General Anesthesia. A secondary benefit to using this procedure is that since the patient is "AWAKE", she can determine whether to increase or decrease the volume as desired, prior to closing the incisions. This is the ONLY technique that gives the patient the opportunity to make an informed consent as to the final size of her augmentation during the surgery.

In 2008, Dr. Novoa studied with Dr. Gandhi and completed training in AWAKE Liposuction, AWAKE Breast Augmentation and AWAKE Lipoabdominoplasty (Tummy Tuck). Since this date, Dr. Novoa has performed hundreds of AWAKE Breast Augmentation, Liposuction and Lipoabdominoplasty procedures.

In January 2012, Dr. Novoa presented a research paper at the Fifth World Congress of the International Society of Cosmetogynecology (ISCG) and the American Academy of Cosmetic Surgery (AACS). The paper, Tumescent Breast Augmentation Surgery (TABS), is the first and largest research paper discussing AWAKE Breast Augmentation without the use of any sedation. This paper, along with Dr. Novoa's instructional video on AWAKE Breast Augmentation found on YouTube.com, has been recognized nationally and internationally as a reference for AWAKE Breast Augmentation.

The Procedure

• Prior to the start of the procedure, the patient is given only Extra Strength Tylenol without any sedative.
• To begin the procedure, tumescent anesthesia (lidocaine, epinephrine & sodium bicarbonate) is injected in subcutaneous tissue of the breasts while the patient is "awake" to numb the area.
• Once the anesthetic has taken effect, inframammary incisions are made for insertion of the impants. This the most commonly employed incision and after healing, the scar tends to be well hidden under the new breast crease. The scar, however, will be more visible if the patient is lying down. The length of the incisions depends on the type of implants that are chosen. Typically, saline implants will require a smaller incision as opposed to silicone implants.
• After the incisions are made, a surgical tool is used to create subpectoral pockets so that the implants can be inserted.
• Once the pockets are created, the implants are inserted under the pectoralis major muscle.
• Once the implants are inserted, the patient is placed in an upright position so she can preview the look of her new breasts. At this time, any additional determinations regarding size, placement, or profile of implant can be made. The advantage of saline implants becomes very apparent during this step. Since the patient is awake, she can determine whether to increase or decrease the volume as desired prior to closing the incisions. Saline implants can be adjusted in size in the event that one breast is larger than the other. Silicone implants cannot be incrementally adjusted with the flexibility of saline implants. To compensate for common asymmetry in the breasts using silicone implants, the surgeon must preoperatively estimate the difference in size and insert two different size implants to compensate for the asymmetry during surgery.
• After final adjustments have been made, the incisions are closed using absorbable sutures.
• The patient is then bandaged and supporting garments are placed.
• After 30 minutes of observation, the patient is allowed to leave.

Buccal Fat Pad Removal surgery is a cosmetic procedure aimed at reducing the fullness of the cheeks by excising the buccal fat pads, which are located in the lower part of the cheeks. This procedure is typically sought by individuals looking to enhance facial contours, achieve a slimmer facial appearance, or alleviate the effects of aging. The surgery is performed under local anesthesia with sedation and involves making small incisions inside the mouth, allowing for minimal visible scarring. Recovery usually involves some swelling and discomfort, but most patients can return to normal activities within a week.

The Procedure

• The patient is given local anesthesia (numbing medication) injected into the inside of the cheek with a needle.
• While completely numb, a small incision will be made inside the cheek.
• The visible soft buccal fat pad will be grasped by forceps (a tweezer-like instrument) and removed through the incision opening. The desired amount of buccal fat pad is then removed to achieve the desired result.
• The incision is closed with dissolvable sutures.
• The process is repeated on the other cheek.

The buccal fat removal procedure takes about 45 minutes.

AWAKE Brazilian Butt Lift (BBL) surgery is a cosmetic procedure that enhances the shape and size of the buttocks by using liposuction to remove excess fat from other areas of the body, such as the abdomen, thighs, or flanks, and then injecting that purified fat into the buttocks. This technique aims to create a fuller, more contoured appearance while simultaneously reducing volume in the donor areas, resulting in a more balanced body shape. The procedure has gained popularity for its natural-looking results compared to traditional implants.

The Procedure

• To begin the procedure, the doctor injects a solution into the fatty tissue that anesthetizes the area. It causes the area to become firm and swollen, which enables the surgeon to extract fat more accurately and uniformly.
• Small incisions are made in the skin around the treated area.
• After these incisions are made, a cannulas is inserted through these small openings and the fat is removed.
• Once the fat is collected, it's processed to separate healthy fat cells before being strategically injected into various points of the buttocks to achieve a desired contour.
• Once complete, the incisions are closed with Quill™ SRS wound closure sutures.
• The wounds are then covered with sterile gauze pads and elastic support garments are placed. The areas of the liposuction procedure may stay numb for 36 hours without further injection of lidocaine or other pain killers.
• After 30 minutes of observation, the patient is allowed to leave.

Cellulite Reduction surgery is a minimally invasive procedure aimed to diminish the appearance of cellulite in the body, which is the dimpled skin caused by fat deposits pushing through the connective tissue beneath the skin. The typical areas addressed are in the buttocks or back of legs.

The procedure requires more than one treatment and may produce some reduction in the appearance of cellulite but may not completely eliminate it and results can vary based on individual factors.

Chin Liposuction (submental liposuction) permanently removes excess fat from under the chin (the submental area) jowls and jawline via a small thin tube called a cannula.

Chin lipo is an easy, fast, efficient, and minimally painless way to address the appearance of a double chin caused by the presence of submental fat. The presence of submental fat is due to a variety of reasons, most often associated with above average weight and a common familial trait. However, even if you are very thin, a double chin may still be present and may worsen over time or with an increase in body weight.

Dr. Novoa performs chin liposuction as an AWAKE procedure, using tumescent lidocaine as a local anesthetic. The procedure takes less than 10 minutes and requires less than 24 hours of rest or downtime. You may return to work or the job on the same day as the procedure.

Chin liposuction can be performed with other procedures such as fat transfer to the face, BOTOX, Fillers, Sculptra or the use of PDO threads.

Although changes may be immediately apparent, the final appearance usually takes up to 6 weeks.

What is involved?

C-section scar revision surgery is a surgical procedure aimed at improving the appearance of a scar resulting from a cesarean delivery. This involves a technique using an incision, excision, and a dermatological procedure to minimize the visibility of the scar. This procedure is intended to enhance the overall aesthetic outcome of the scar's appearance.

The surgery can be performed for cosmetic reasons or to alleviate any physical issues that may arise from the original incision.

Dorsocervical Fat Pad Removal surgery, often referred to as "buffalo hump" surgery, is a cosmetic or reconstructive procedure aimed at excising excess fat that accumulates at the back of the neck, commonly associated with certain medical conditions like Cushing's syndrome or as a side effect of medications such as corticosteroids. The procedure typically involves making an incision to access and remove the fatty deposit, thereby improving the contour of the neck and back. It can enhance aesthetic appearance and potentially alleviate discomfort associated with the fat deposition.

This procedure is performed while the patient is awake using tumescent anesthesia.

Fat Transfer surgery, also known as fat grafting or lipofilling, is a cosmetic procedure that involves the extraction of fat from one part of the body through liposuction and then injecting it into another area to enhance volume or contour.

Common areas for transfer include the face, breasts, and buttocks. This technique is popular for adding fullness and restoring a more youthful appearance while using the body's own tissue, reducing the risk of rejection and allergic reactions associated with synthetic fillers.

The process typically involves assessing the donor site, extracting the fat, purifying it, and then injecting it precisely into the target area.

AWAKE Liposuction (also known as Tumescent Liposuction) involves the use of a diluted solution of local anesthetic and other medications to fill the fatty layer of the skin prior to removing the excess fat. This causes the tissue to become swollen and firm, allowing for excellent control. General anesthesia is not required, eliminating potential complications. This involves sculpting the bulging areas for the appearance of more attractive contours.

AWAKE Liposuction is an outpatient procedure, avoiding a costly hospital charge under General Anesthesia. Since the patient remains awake during the surgery, the surgeon can ask you to change positions which leads to better sculpting of the targeted areas.

Tumescent liposuction has an unprecedented safety record and allows the surgeon to efficiently remove both deep and superficial excess layers of fat with little discomfort, faster recovery and improved cosmetic results. Patients see fewer skin irregularities, less bleeding, and reduced bruising.

The Procedure

• To begin the procedure, the doctor injects a solution into the fatty tissue that anesthetizes the area. It causes the area to become firm and swollen, which enables the surgeon to extract fat more accurately and uniformly.
• Small incisions are made in the skin around the treated area.
• After the incisions are made, a cannulas is inserted through these small openings and the fat is removed.
• The incisions are closed with Quill™ SRS wound closure sutures.
• The wounds are then covered with sterile gauze pads and elastic support garments are placed. The areas of the liposuction procedure may stay numb for 36 hours without further injection of lidocaine or other pain killers.
• After 30 minutes of observation, the patient is allowed to leave.

What are PDO Threads?

Polydioxanone (PDO) threads are a type of medical-grade thread commonly used in surgical procedures. In terms of cosmetic surgery, they are used to rejuvenate the skin and promote collagen production. They are made of a biodegradable polyester suture that is safely dissolved by the body over a 6-month period of time.

Dr. Novoa uses PDO threads to lift and tighten skin and can be used in combination with other procedures such as chin liposuction, facial fat transfer, Botox, Hyaluronic Acid Fillers and Sculptra.

Dr. Novoa places PDO threads as a non-surgical AWAKE procedure using tumescent lidocaine and ropivacaine. The procedure takes less than 10 minutes, requires no downtime and the patient may return to work the same day. Although results may be immediately apparent, results may take a few weeks to be seen.

How are PDO Threads placed?

• Dr. Novoa exclusively uses NovaThread PDO sutures. NovaThread PDO sutures are pre-loaded in a hollow needle.
• After local anesthesia has been applied, a PDO thread is inserted in the interstitial tissue at the subdermal level, parallel to the surface of the skin and then the needle is removed.
• The PDO thread remains in place under the skin and is used to retract the skin after placement for skin tightening and for collagen stimulated growth and facial rejuvenation.
• No cuts or incision are needed, and the point of insertion is small enough to close without sutures and without leaving a mark.

* REFERENCE: NovaThreads | The n°1 Absorbable PDO Threads