Dear Dr. von Maur,

I have had 3 children and my body has changed so much. As much as I work out I still have a lot of excess skin on my tummy and my breasts are droopy and loose. What can I do to get rid of all this skin and get my figure back? I am so FRUSTRATED and want something done!!!! Is a Mommy Makeover what I need?

Dear Nicole,

I am glad you asked these questions your problem is very common and not unique. We specialize in Mommy Makeover Surgery which addresses all of your issues. Your tummy can be tightened and your breasts can be lifted, tightened and enlarged if needed.  If you have problem areas that aren’t going away with exercise we can help you there also.

As a specialist in Mommy Makeover Surgery your goals can be accomplished in one operation using general anesthesia. This is an out-patient operation so that you do not have to be hospitalized. Patients are so HAPPY and THRILLED with their results.

Please call our office with any further questions you may have regarding this amazing procedure.

If you are considering eyelid surgery

Orange County Eyelid surgery (blepharoplasty) is a procedure which can improve the appearance of your eyes by removing excess skin and excess fat of your upper eyelids, tightening your lower eyelids, and smoothing bags of your lower eyelids as well.  Occasionally upper eyelid skin interferes with vision.  It may be done in conjunction with other facial surgery procedures such as a facelift or browlift.  All individuals are different and your surgeon will discuss tailoring the eyelid procedure to your specific needs and expectations.  Be sure you ask your surgeon any questions about the procedure which you may not understand.  Eyelid blepharoplasty can enhance your appearance and significantly improve your self-confidence and self-esteem.  Before you decide to do eyelid surgery, make sure you discuss with your surgeon your expectation.  Usually the best candidates for eyelid surgery are patients who are physically healthy and emotionally stable.  There are certain diseases which may make eyelid surgery a little risky; including dry eyes, diabetes, or hyperthyroidism and also included is a history of retinal detachment or glaucoma.  Complications from eyelid surgery when performed by a qualified, board-certified Plastic Surgeon are quite rare.  Initially after surgery you may have some difficulty completely closing the eyes and it is common to have blurry vision for two or three days.  Also after a few weeks some small white bumps may appear along the scar.  These are small whiteheads where the stitches were placed and these are easily removed.  Your surgeon will discuss your eyelids in detail and any other significant medical history that you have.  He may require that you visit your local optometrist or ophthalmologist for specific examination and measurements.  Your expectations, goals, and questions should be answered thoroughly and your surgeon should offer before and after photographs of eyelid surgery which he has performed in the past.  Eyelid surgery can be performed under local or general anesthesia depending upon the extent of the surgery and the patient=s desires.  Blepharoplasty is usually performed as an outpatient in a certified surgery center with a board-certified anesthesiologist available if necessary.  For upper and lower eyelid surgery together, blepharoplasty normally takes one to three hours, depending upon the complexity.  Sometimes the lower eyelid is lax or loose and needs to be tightened with canthopexy which is a method of tightening the ligaments to keep the eyelids firm.  There are times when there are circles beneath the eyes that are a bothersome problem for patients and in these particular cases it may be necessary to soften these circles by releasing structures internally and transferring fat to fill the defect.  In this case the operation takes a little bit longer but the results are quite satisfying.  The surgeon makes incisions which follow the natural creases of your eyes for your upper eyelid and usually along the eyelashes of your lower eyelid.  These incisions commonly extend into the crow=s feet areas in the corners of your eyes.  Occasionally patients have puffy bags beneath the eyes but have tight skin.  In these cases the puffy fat bags can be removed without leaving an external scar.  Afterwards you will be instructed regarding cleaning your eyes, using lubrication, keeping your head elevated, and using cool packs.  You will be followed very closely by your surgeon in the first few weeks after surgery to make sure the healing is appropriate and the stitches are removed in time.  It is not uncommon to have blurry vision as previously mentioned.  This usually lasts a few days. 

If you wear contact lenses, you should wait two weeks before you try to reinsert the contacts.  Most patients are Arestaurant ready@ within ten days or so with makeup.  There may still be some swelling and bruising which will subside with time.  Your activities after surgery should be kept to a minimum as healing occurs and one should avoid active impact sports, strenuous activity, or heavy lifting initially.  As in all surgeries, healing is gradual and scars take time to mature.  They may initially be pink for several months but eventually they will fade and become very thin over time.  You will experience exciting positive results with your eyelid surgery which creates a more youthful look which lasts for many years.

LIPOSUCTION SPECIALIST-Dr. Burr von Maur

Serving Newport Beach, Mission Viejo, and Orange County 

Liposuction is the second most common cosmetic procedure performed on women in the United States.  There were 287,932 liposuction performed in 2007 according to the American Society of Plastic Surgeons.  Liposuction is to remove unwanted fat as well as to precisely sculpt your figure.  Removing unwanted fat from specific areas such as the abdomen, love handles, hips, thighs, neck, chin, cheeks, and arms is also know as suction-assisted lipectomy.  Many patients have benefited tremendously from the precision procedures that are performed today using micro power-assist liposuction and combining this with the superwet techniques.  Dieting and exercise are important; however many areas do not disappear unless they are treated mechanically with liposuction.  Your surgeon will provide a brochure to help you understand more fully all the nuances of this procedure. 

The best candidates for liposuction are patients who have expectations that are realistic and wish to improve their confidence and appearance and have satisfactory skin tone.  If the patient is normal weight and has excellent elastic skin tone with localized pockets of excess fat in certain areas and is physically healthy, then these would be the best candidates.  Patients with diminished skin elasticity are also satisfactory candidates if they continue to exercise and diet appropriately.  When your surgery is planned, your general health will be assessed by your surgeon and different body contouring methods will be discussed including the possibility of a tummy tuck if there is excessive redundant skin in your tummy.  Your consultation with your physician should be frank about your desires and expectations and you should be able to get the answers that you need.  The Plastic Surgeon will assist you in deciding the right approach tailored specifically for you and he will discuss the appropriateness of your needs, effectiveness of the procedure, and safety at the same time.  Your Plastic Surgeon will assist you in the appropriate judgment that needs to be made for this procedure.  You are encouraged to choose a physician who is certified by the American Board of Plastic Surgeons which would assure that this physician has graduated from an accredited medical school and has had many years of additional training, specifically in general surgery and plastic surgery.  Prior to your surgery you should avoid excessive alcohol and smoking.  Your surgery should be performed in an accredited outpatient surgical facility with board-certified anesthesiologists.  Sometimes when smaller pockets of unwanted fat are removed, local anesthesia is possible; however, for larger contouring areas it is more advisable to use general anesthesia.  The actual time required for liposculpture depends on the size of the areas being contoured.  The superwet technique assists tremendously in assisting with shaping and decreased blood loss.  With todays power-assist techniques, smaller cannulas are used and precision is much more accurate.  The superwet or Atumescent procedures are utilized routinely because they assist both in shaping and decreasing blood loss.  A small amount of local aesthetic is also utilized at the same time which reduces postoperative pain. 

himself.  The scars from liposuction are minimal and usually do not require revision.  After your procedure you will experience discomfort and most likely a large amount of drainage.  This drainage is encouraged as it is desirable to reduce the buildup of excess fluid.  Right after surgery you should expect to feel swollen and bloated and there may be some pain, burning, and swelling, and do not expect to feel great immediately after your surgery.  You must allow time and nature to reduce the swelling and soreness.  Getting back to normal is a gradual process.  You will begin walking the first day and your activity will increase as you begin to feel better.  Strenuous and vigorous impact activity should be avoided initially but as time goes by then you will be able to move up your program of activity.  You will notice an immediate difference in the way your body looks after surgery; however, over time, usually six to eight weeks, improvement increases as swelling subsides and bruising decreases.  You will find that after about three months or so your clothes will fit more comfortably and you need to be aware of the importance of healthy diet and regular exercise afterwards.  In general liposuction is a procedure which is extremely helpful and carries a high degree of satisfaction with improved self-esteem and confidence.

Newport Beach Breast Augmentation Specialist

-If you are Considering Breast Augmentation

Breast augmentation is the most frequently performed cosmetic surgical procedure on women with 291,350 procedures performed in the United States in 2007 according to the American Society of Plastic Surgeons.  Augmentation mammoplasty enhances the size and shape of a womans breast.  This accomplishes many things for you including improvement of your body contour for personal reasons and to help balance differences in breast size which may occur.  It is effective to reduce the size of breasts following pregnancy and may be used in reconstructive surgery after mastectomy. 

Please ask your surgeon if there is anything you do not understand about augmentation mammoplasty.  The mammary implants are usually placed behind the pectoralis major muscle but occasionally placed directly behind the breast gland itself.  You may increase your bust line by one or more cup size and this can enhance your appearance and your self-confidence.  You should discuss your expectations thoroughly with your physician and be comfortable with your Newport Beach surgeon.  The best candidates for Newport Beach breast augmentation are women who wish to improve their appearance and women who are healthy and have realistic expectations.  If you wish to improve the way you look, then a breast augmentation is very helpful. 

The FDA has determined that the new gel implants are safe and effective as well as saline implants.  Our preference in most patients is to use silicone gel fill breast implants, although some patients prefer saline and we use those as well.  During your consultation for your Newport Beach Breast Augmentation we discuss all the different surgical techniques and decide which technique is the best personally for you.  If your breasts are sagging, your doctor may recommend a breast lift.  You should be open with your physician and discuss all of your expectations.  Frequently your Orange County surgeon will ask you to try on implants inside your bra to give you an idea of the size you wish to become after the implants are inserted.  This is very helpful to give you a visual of the size and also to help you feel more comfortable.  Most insurance companies consider breast augmentation as not medically necessary and this procedure is generally not covered by insurance.  When you have your surgery, you should make arrangements to have someone drive you to and from the surgery center in Newport Beach.  The surgery is generally performed using general anesthesia with board-certified and experienced anesthesiologist.  The procedure takes about 1 to 12 hours to perform, and after your surgery, you will be up and around in about 12 to 24 hours or so.  The dressings are changed the day after the operation.  You are placed into a specific surgical bra and the stitches are removed in about one week.  Getting back to normal after the breast augmentation depends on your activity.  We ask that you avoid extreme impact activity such as aerobics, running, tennis, and marshal arts, etc. for about six weeks.  You can work your way up through various non-impact physical activity including walking, stationary bicycle, and elliptical cross-trainer.  It is recommended that your physician follow you regularly after the surgery for at least one year and that you comply with all the instructions.

If you are considering Rhinoplasty

Orange County Rhinoplasty is all about reshaping the nose.  The nose is the aesthetic center of the face and rhinoplasty can reduce or increase the size of your nose, improve any bump on your nose, or refine the tip as well.  Your surgeon will give you basic information brochures to help answer some of your questions. 

Be sure to ask your surgeon about anything that you do not understand.  The best candidates for plastic surgery are those who wish to enhance their appearance, self-esteem, and self- confidence and those who have realistic expectations.  Many patients have an idea of how they wish to look and are encourage to bring photographs of their ideal nose to the doctor to discuss the possibilities.  The best candidates for rhinoplasty are those who wish improvement and are not looking for absolute perfection.  The rhinoplasty should be directed at both improving the aesthetic goals as well as correcting any breathing difficulties that may be present.  Most surgeons agree that operating on younger people such as teenagers is appropriate. 

The age range for girls is around 14 to 15 years of age and for boys slightly later.  It is important to have a strong relationship with the patient’s parents and discuss with the them all considerations including emotional adjustments.  Rhinoplasty should be performed by a qualified Plastic Surgeon.  Complications are infrequent and are usually minor.  These would include infection and nose bleed or reaction to anesthesia.  Sometimes small blood vessels may appear on the surface of the skin after rhinoplasty and these can be treated with laser.  Rhinoplasty is performed either as an opened or closed procedure.  Today the open procedure is becoming more popular because of accuracy and control.  There is a tiny scar at the base of the nose which is well hidden and is not usually a concern afterwards. 

One must be aware that secondary revision rhinoplasty occurs in about one out of ten patients even with the most skilled surgeons.  The corrective surgery is usually minor.  When you plan your rhinoplasty surgery, during your consultation you should ask for a thorough explanation of the procedure, to see all before and after patient photographs available, and discuss all of the technical and clinical aspects of the surgery and what you can expect afterwards.  Most rhinoplasty procedures are performed as an outpatient under general anesthesia with local anesthesia assisting.  Some surgeons prefer local anesthesia only with sedation.  Do not hesitate to ask your doctor any questions that you might have regarding your expectations.  Your surgeon will instruct in preparing for your surgery regarding diet, medications, and vitamins and you should arrange to have someone drive you to and from the surgery facility.  It is recommended that a board-certified anesthesiologist perform both sedation and general anesthesia medication and that the procedure is performed in a certified surgery center.  Orange County Rhinoplasty in general takes about one to three hours to perform depending upon the complexity of the procedure and the nature of the sculpting and reshaping of the nose.  Sometimes small incisions are made around the edges of the nostrils to reduce nostril flaring.  A splint will be applied on the outside of your nose and packs will be on the inside of your nose.  These are left in place for a variable period of time.  Afterwards you will feel stuffed up and puffy and you will probably have a runny nose which may have a small amount of bleeding which is normal and generally stops.  Sometimes patients have short-term headaches and it is advisable to stay in bed with your head and shoulders elevated after surgery to allow the swelling to subside.  Gradually the swelling goes down and the bruising, which is variable, around your eyes improves after three or four days.  Cold compresses are very helpful.  After your surgery you will be up and around within the first two days or so.  Basically you may return to sedentary work or school in about a week or so after the splint and packs are removed.  Your normal activity schedule will gradually come into play as time improves healing.  It is recommended that jogging, swimming, and lifting be avoided for four to six weeks afterwards.  If you wear glasses it is sometimes advisable to tape them to your forehead until all the swelling is down and you are healed.  The doctor will followup closely with you after your surgery.  Your appearance will improve with time.  Initially your face will be swollen with some bruising and as time passes you will look better and better.  Healing is a slow process and very gradual.  We usually inform patients that most of the swelling is gone in three or four weeks but it takes an entire year for the swelling to completely resolve and sometimes even longer depending on the thickness of your skin.  Rhinoplasty is a very gratifying experience for patients and can do wonders for your self-esteem and self-confidence.

As people age the effects of stress, sun exposure, gravity, and genetics all affect the way the skin drapes along the cheeks, jaw line, and neck.  Some people age more rapidly than others and begin aging at an earlier age regardless of their lifestyle or exposure to the elements.  The mini facelift is designed specifically for patient who want to look more refreshed but do not have excessive laxity in the neck.  These are patients who began to notice early cheek and jaw laxity but are basically otherwise quite youthful. 

The mini facelift is an operation which leaves the scar well hidden within the ear and hairline and recovery is usually within ten days.  The best candidates for the mini-lift are women or men who have noticed early sagging or laxity or have noticed some loss of elasticity and wish to look more youthful without undergoing the a major facelift surgery that is required for more extensive facial laxity and aging.  Before you decide to have a mini facelift you should consult a qualified Plastic Surgeon who has experience and can show you before and after photographs of his own work.  Facelifts are tailored to the individual. 

During your consultation your surgeon will recommend what he feels is the best procedure for you, given your expectations as you expressed them.  Your general health needs to be evaluated to be sure that you do not smoke and if you have high blood pressure it is under control.  If you do smoke, you need to discontinue smoking at least two weeks before surgery.  The mini facelift is generally done under local anesthesia with a certified anesthesiologist providing sedation and monitoring.  Sometimes it is done with general anesthesia.  Before the surgery you should be in optimal health with a healthy diet and no smoking.  If your hair is very short, you should allow your hair to grow somewhat.  The mini facelift is generally performed in a certified outpatient facility with full monitoring of all your vital signs.  Again, local anesthesia with sedation is preferred by some patients and other patients and physicians prefer general anesthesia.  The mini facelift usually takes about two hours to perform and the incisions are placed in the temporal hair and extend to within the ear, beneath the earlobe, and into the crease behind the ear.  The looser tissues beneath the skin are tightened as well as the skin to ensure that the jowls smoothen and remain so and also to ensure that the look is natural. 

After surgery there is not significant discomfort.  Standard oral pain medication is sufficient.  There may be some numbness in the cheek areas which disappears in several weeks.  Patients are asked to keep their head elevated with cool packs early on.  Most of the stitches will be removed within a week or so.  You should be up and around in a few days and restaurant-ready within about ten days.  You can gradually return to your normal activities but should avoid strenuous or vigorous impact activities for about a month.  You may rinse and wash your hair with baby shampoo after a few days and it is a good idea to avoid sauna baths and steam baths for a couple months.  Initially your face will look puffy but this resolves fairly rapidly.  The scars are placed in well-hidden normal skin lines.  By the third week you will look and feel significantly better and chances are that you will be extremely happy with your results.  The mini facelift is a very satisfying procedure for both the patient and the Plastic Surgeon because it basically creates rejuvenation with minimal downtime and back-to-normal activities quite soon.  The mini lift, just like a standard lift, does not stop the clock but rather it sets the clock back.  Your face, of course, will continue to age as it normally would.  The mini facelift improves self-confidence and self-esteem and is highly recommended for specific patients.  It should be performed by Board-Certified Plastic Surgeon.

Dr. Burr von Maur

Orange County Facelift

A facelift in Orange County is an operation which is designed to improve and rejuvenate the lower two-thirds of the face.  The usual concerns the patients have are those of loose neck and jowls, and upon presentation to the Plastic Surgeon, these concerns are expressed. 

During the consultation process, a comprehensive evaluation by your Plastic Surgeon should include evaluation of not just the neck and jowls but the entire face including the cheeks, brows, and eyelids as well as any other bothersome areas that the patient expresses.  The facelift itself is designed to firm up the neck and lower cheek area but frequently the cheeks themselves have descended along with skin of the jowls and neck and it is not uncommon that lifting the midface area along with the lower face is an exciting and useful adjunct and is usually performed with the facelift itself; furthermore, if the patients require forehead rejuvenation, this can be accomplished at the same time and is done so in many of the patients.  The ideal candidate for facelift is a patient who has realistic expectations and who is healthy and does not smoke cigarettes.  If the patient smokes, they should stop two or three weeks ahead of time.  Ideally skin tone and muscle tone should be satisfactory in order to create a younger and fresher look.  It is rare to have complications after facial rejuvenation surgery. Sometimes hematoma (a small collection of blood that must be removed) can occur.  Numbness is common in the cheek areas.  Healing difficulties usually are not a problem unless the patient has a history of smoking.  Any underlying individual medical problems need to be addressed and corrected prior to the surgery. These would include but are not limited to correction of high blood pressure.  Most facelift procedures are performed as an outpatient in a certified surgical facility with a board-certified anesthesiologist.  It can be done with either general anesthesia or local anesthesia with sedation depending on the preference of the physician and in full discussion with the patient.  Aftercare facilities are available, and since this is an outpatient procedure, it is highly recommended that skilled aftercare personnel be involved in the patients care.  The facelift operation itself is a longer procedure than a mini facelift.  It may take four hours or more depending on how many additional procedures are done.  For example, if a mid-facelift is recommended simultaneously and/or a brow-forehead lift, then this adds more time.  The reason that the procedure takes as long as it does is that there are elements of meticulous suturing and dissection that are performed in order to be precise with this procedure.  The exact placement of the incisions is usually within the hair, within the edge of the ear, and then behind the ear and into the hair behind the ear.  They are well positioned and hidden so that when they heal they are not noticeable. 

It is not infrequent that along with loose skin and laxity of the neck there are pockets with excessive fat that need to be trimmed.  This can be performed with direct removal or frequently with facial liposuction for better neck contouring.  Usually small drain tubes are inserted overnight to remove any excess fluid that accumulates with time.  Postoperative pain with facelift surgery is not common.  There is discomfort that is controlled with oral pain mediation.  Numbness of the cheeks is seen frequently but subsides over many weeks.  It is recommended that the patients keep their head elevated and cool packs applied the first 24 to 48 hours or so.  Most sutures are removed in about a week to ten days.  The recovery period of about three weeks is usually satisfactory for feeling comfortable in public. Patients are up and about in a few days.  The healing of a facelift and the diminution of swelling is gradual as is the decrease in bruising gradual.  As time passes and the swelling decreases and bruising decreases, the patients continue to improve in their appearance.  This should be thoroughly discussed with the patient ahead of time and reinforced after surgery.  Initially the patients face may feel rather different or strange but over time as facial movements improve and swelling decreases and the bruising goes away the appearance becomes more normal.  The scars from the facelift and mid-facelift are well hidden in normal facial lines and after they mature are barely visible.  Chances are that you will be thrilled with the results of your facelift.  The goal is to give you a new lease on life.

ADDENDUM: When you visit the Plastic Surgeon in consultation about your Orange County Facelift, be sure you ask as many questions as possible.  You may wish to visit the doctor a second or even a third time.  The facelift operation itself is not simply a skin operation but rather an operation that tightens the underlying deeper tissues and muscles which assist in holding the skin up and in a youthful position.  This is important because the effect is more natural and also a longer lasting result.

Dear Dr. von Maur my wife and I are concerned about our 5 year old son who has pertruding ears. He is starting kindergarten next year and we are worried that other children may tease him. When is the best time to correct his ear problem?

Dear Sam,

Those are excellent questions and concerns. At age 5-6 is usually the best time that we prefer to correct pertruding ears because it avoids unnecessary and embarrassing teasing by classmates and friends. Your child surgery can be done in an outpatient facility. This surgery is called (Otoplasty) or Ear Surgery. It leaves a small scar in the crease behind the ear. Please contact us if you have further questions.

Dr. von Maur

Breast augmentation is done under general anesthesia in an out-patient facility and is safe and effective.

Some patients prefer saline implants while others prefer silicone-gel implants. Silicone-gel implants feel more natural and are preferred by most of our patients.  Patients are able to return to light work within 1 week. I would Love to discuss Breast implants with you.

Dr. Burr von Maur