Frequently asked questions about Parungao Plastic Surgery

Q. What's the difference between cosmetic and reconstructive plastic surgery?

A. Cosmetic surgery is performed on normal body structures. (Example: a facelift.) The goal is to approve a person's appearance and self-esteem. Cosmetic surgery is not typically covered by insurance.

Reconstructive surgery is performed to correct abnormalities. (Example: Breast reconstruction following a mastectomy) The goal is to improve function or restore a normal appearance. In many cases, reconstructive surgery is covered by insurance.

Frequently asked questions about
financing and insurance

Q. Does insurance cover plastic surgery?

A. Insurance will generally cover reconstructive plastic surgery to repair facial or body wounds or injuries, or procedures that are medically necessary. Our staff can help you determine what benefits your plan will pay. We can also assist you in submitting the documentation needed for pre-approval for insurance benefits.

Q. What determines whether plastic surgery is cosmetic or reconstructive?

A. Plastic surgery is considered reconstructive—and thus may be covered by health insurance—when it corrects abnormal body structures. Examples include panniculectomy and breast reduction and in some cases, labiaplasty. If you have developed back pain, chronic skin rashes or infections due to heavy, pendulous breasts, for example, many insurance plans will cover the cost of a breast reduction.

On the other hand, if the surgery you're considering is strictly cosmetic—that is, performed on normal body structures to approve their appearance—it is not typically covered by insurance. If breast augmentation is performed on normal, healthy breasts, for example, it is considered cosmetic surgery. But if a woman has breast augmentation following a mastectomy, the surgery would be considered reconstructive.

Q. I've lost 75 pounds after having lap-band surgery and now I have a lot of excess loose skin. Will insurance cover plastic surgery to correct that?

A. Some insurance plans will cover a panniculectomy to remove the apron of loose abdominal skin following bariatric surgery. However, insurance typically will not cover arm lifts or plastic surgery procedures to remove excess skin from other parts of the body after massive weight loss. Our staff can help you determine what benefits your insurance will pay and submit the necessary paperwork to your insurance company.

Silicone gel implant FAQ

Q. Who can get the new silicone gel implants?

A. The FDA has approved silicone gel breast implants for cosmetic surgery in women age 22 and older, and for reconstructive surgery in women of all ages. “The age restriction for cosmetic surgery is so teenage girls will not get the implants until their bodies have fully developed,” said Dr. Daniel Schultz, director of the FDA Center for Device and Radiological Health.

Q. How do silicone gel implants compare with saline implants?

A. Silicone gel implants are widely regarded as looking and feeling more natural than saline implants. In Europe, where silicone gel implants have been widely available, they quickly replaced the saline-filled alternatives.

Q. How are today's silicone gel implants different from those banned in 1992?

A. The filling of the new silicone gel implants is thicker than that of the implants made in 1992 and before. Today's implants are filled with what is called cohesive gel, a substance with the consistency of a jellybean's filling. Even if the implant ruptures, the gel holds together, as shown in the photo to the right. And the shell of the new implants is also thicker to help prevent ruptures.

Silicone gel implants were taken off the market in 1992 by then-FDA Commissioner Dr. David Kessler due to safety concerns, such as how often the implants ruptured in a woman's body and whether leaking silicone could lead to diseases as some women claimed.

Q. What does the FDA say about the safety of cohesive silicone gel implants?

A. After rigorous review, the FDA can offer a “reasonable assurance” that today's silicone implants are “safe and effective,” said Donna-Bea Tillman, director of the FDA Office of Device Evaluation. Studies have found no association between silicone implants and cancer or other life-threatening diseases, although the FDA is continuing to monitor for these risks.

The FDA is also requiring each of the two manufacturers of silicone gel implants, Inamed Aesthetics and Mentor Corp., to study 40,000 women for 10 years to assess potential health problems. These studies will help answer questions on the implants' long-term safety.

Q. What happens when an implant ruptures?

A. One of the biggest differences between silicone gel and saline implants is what happens when they rupture.

• If a saline implant ruptures, the implant deflates almost immediately and the saline, or saltwater, is absorbed into the body. The rupture is immediately apparent from the loss of breast volume.
• A cohesive silicone gel implant may develop a “silent” rupture—one that is not noticeable and perhaps cannot even be felt. A woman may have a ruptured implant and never know it until she has a screening mammogram or MRI. A ruptured silicone implant should be removed as soon as possible.
  

Q. What follow-up care does the FDA recommend for women with silicone implants?

A. To help detect silent ruptures, the FDA recommends that women with silicone implants get an MRI screening three years after breast augmentation surgery, and every two years thereafter. Because these MRIs are not typically covered by health insurance, it is important to factor in the cost of the MRIs when considering silicone gel implants.

Laser hair reduction FAQ

Q. Does laser hair reduction hurt?

A. When the pulse of light is delivered to the hair, you may feel a mild sting or pinch similar to the snap of a rubber band. No local anesthesia or pain medication is required.

Q. Are there any side effects?

A. Possible short-term side effects include:

• Slight reddening of the skin
• Local swelling which goes away within a few days.
• Rarely, some blistering

Q. Are there any restrictions on my activities?

A. You can return to work the same day and resume all regular activities. You should limit exposure to the sun following a treatment.

Q. What about special care before a treatment?

A. For best results, it's best to follow these recommendations before a treatment:

• Do not tan the skin before, immediately after or
  between treatments.
• Moisturize areas to be treated daily.
• Avoid any products that cause skin irritation.
• Do not shave the area to be treated.
• Do not take Accutane.

Q. How should I care for my skin after a treatment?

A. It's best to:

• Moisturize treated areas and wear sun screen.
• Avoid using ice on the treated area.
• Apply a cold, wet compress to treated areas several times
  a day.
• Avoid waxing, tanning or shaving the treated area for four to five days.
• Keep regularly scheduled appointments for
  maximum results.

Arm lift FAQ

Q. How do I know if I need just liposuction or an arm lift?

A. If you have loose, hanging skin or poor skin elasticity, liposuction will actually make the problem worse by removing fat from the area. An arm lift removes the excess hanging skin and tightens the upper arms to make your upper arms slimmer and more shapely.

Q. How long will I have to be off work after an arm lift?

A. Most patients can go back to desk work about a week after arm lift surgery. You will need to stay away from lifting as you heal, and will need to wear a compression garmet for about four weeks.

Labiaplasty FAQ

Q. When is the right time for labiaplasty?

A. It's best to plan your labiaplasty for a time when you will be able to take it easy for a few weeks. Just before an out-of-town vacation or right before pregnancy are not good times for this surgery.

Q. What if I plan to have children?

A. Labiaplasty should not interfere with having children, although pregnancy may cause a recurrence of excess labial tissue.

Q. Is labiaplasty cosmetic or reconstructive surgery?

A. That depends on each woman's case. If large or uneven labia are causing medical problems such as trapped moisture resulting in skin rashes and irritation, labiaplasty may be considered reconstructive. If the procedure is done solely for aesthetic reasons, it is considered cosmetic surgery.

Q. Is labiaplasty covered by insurance?

A. If the surgery is medically necessary, it is normally considered reconstructive and may be covered by health insurance. Check your insurance policy to see what benefits you may qualify for if you are considering labiaplasty. Dr. Parungao's office can help you submit the necessary pre-operative paperwork to apply for benefits.

If the surgery is simply cosmetic, insurance will not pay
for labiaplasty.

Liposuction FAQ

Q. How much fat can you remove during liposuction?

A. The generally accepted limit for a single liposuction session is five liters—or about 11 pounds. If a patient needs more than this, it is best done in stages. Anything more than five liters in one session would likely require at least an overnight stay in the hospital to monitor fluid and electrolytes, cardiac status and hydration status. Removing too much fat can cause scars, lumpiness, permanent irregular coloration or death of the overlying skin.

Q. If I've had liposuction, can the fat ever come back?

A. Yes. Having liposuction doesn't mean you can eat whatever you want and not gain weight. If you're not careful about diet and exercise after you've had liposuction, your remaining fat cells can enlarge and you can regain the inches you lost.

Q. If I have liposuction on my stomach, will I gain weight elsewhere in the future?

A. Not likely. If you gain weight after liposuction, your body will handle it the way it has always done—which is simply the way your body is programmed to do.

Q. How long will I be in pain?

A. After surgery, you will experience discomfort for 2-3 days, with the pain lessening each day. The amount of discomfort you experience depends on the number of areas treated.

Q. When will I see results?

A. The most dramatic reduction in swelling occurs in the first two months, with changes occurring up to 12 months after surgery.

Q. Where are the scars?

A. The tiny scars, most less than 5-6 mm in size, are hidden in skin creases/folds or underneath areas usually covered by swimwear or undergarments.

Q. Will I have bruising?

A. Some, but this usually disappears in 7-10 days, depending on the number of areas treated.

Q. How long until I can return to normal activities
or work out?

A. Usually 1 week, depending on the number of areas treated.

Q. Will my skin sag?

A. It depends on whether you have loose skin to begin with. If you do, the skin likely will be even looser after liposuction. A tummy tuck, arm lift or thigh lift may be necessary. Other factors determining whether your skin will sag include your age, race, skin type and genetics.

Q. Will I still have cellulite?

A. Yes. Liposuction is not a treatment for cellulite. More helpful: diet and weight loss.

Panniculectomy FAQ

Q. Isn't a panniculectomy just a tummy tuck?

A. No—there's an important distinction between the two. A panniculectomy simply removes the overhanging skin and fat from the lower abdomen.

A tummy tuck removes excess abdominal skin and fat as well—but unlike a panniculectomy, it also tightens the muscles of the abdominal wall and repositions the navel.

Q. What determines whether a panniculectomy or a tummy tuck is the right choice for me?

A. That all depends on your individual case. When I evaluate you during your consultation, I will explain my recommendations for you. Even for patients who need a panniculectomy, I sometimes do the full tummy tuck or abdominoplasty to get a more pleasing result.

Q. Will I have pain after my surgery?

A. Yes, you will experience some discomfort. The pain usually lasts up to seven days. We have “pain pumps” you can use to significantly decrease your pain following surgery.

Q. Is a panniculectomy considered cosmetic surgery or a reconstructive procedure?

A. The American Society of Plastic Surgeons considers a panniculectomy a reconstructive procedure when it is performed to correct or relieve structural defects of the abdominal wall and/or chronic back pain due to a functional weakness of the front abdominal wall.

Tummy tuck FAQ

Q. Will insurance cover a tummy tuck?

A. In most cases, no. A tummy tuck, with very few exceptions, is considered cosmetic surgery and is not medically necessary—and thus, not covered by insurance.

Q. What determines whether a panniculectomy or a tummy tuck is the right choice for me?

A. That all depends on your individual case. When Dr. Parungao evaluates you during your consultation, he will explain his recommendations for you. Even for patients who need a panniculectomy, he sometimes does the full tummy tuck or abdominoplasty to get a more pleasing result.

Q. Will I have pain after my surgery?

A. Yes, you will experience some discomfort. The pain is most noticeable in the first 48 hours after surgery, and then eases up. We have “pain pumps” you can use to significantly decrease your pain following surgery.

Q. Is a tummy tuck considered cosmetic surgery or a reconstructive procedure?

A. In nearly every instance, a tummy tuck is considered cosmetic surgery. It may be considered reconstructive in cases where it is performed in conjunction with a medically necessary hernia repair.

Q. I've had previous abdominal surgery. Can I still have a tummy tuck?

A. Yes. You can still have a tummy tuck even if you have had abdominal surgery in the past. In some cases, a tummy tuck incision can be made through an existing Caesarean section scar. In other instances, Dr. Parungao can replace the low vertical midline scar from previous abdominal surgery with a finer, transverse scar that can be hidden under bikini bottoms.

Breast lift surgery FAQ

Q. Is breast lift surgery only for large-breasted women?

A. No. Breasts of any size can be lifted. However, the results are more long-lasting for women whose breasts are smaller and lighter. Large-breasted women may be candidates for breast reduction surgery

Q. Does insurance cover breast lift surgery?

A. In most instances, insurance companies will not pay for breast lift surgery. However, coverage may be provided in certain cases.

For example, if a breast reconstruction is performed after mastectomy, and the newly reconstructed breast doesn't match the opposite breast, an insurance company may pay for a breast lift on the opposite breast to achieve symmetry. Before surgery, your insurance company may require a letter of pre-determination. Dr. Parungao's office staff will help you with insurance matters related to the procedure.

Q. When are implants typically used along with a breast lift?

A. Combining breast implants with breast lift surgery may be useful, especially for patients who would like fullness in the upper half of the breast. Using an implant may decrease the amount of lifting—and the amount of scars—needed. This depends on the degree of ptosis, or breast droop.

Q. Are there any disadvantages to combining implants with a breast lift?

A. Yes. Adding implants to a breast lift procedure increases the rate of complications. The lift moves the breast and areola up, while the implant applies downward force due to the weight of the implant and the effects of gravity.

Q. Will a breast lift affect my ability to breastfeed?

A. Possibly. Whether you will be able to breastfeed following breast lift surgery depends on the amount of lifting done during the procedure. The more lifting, the more invasive the procedure—and the greater chance that your ability to breastfeed will be adversely affected.

Q. Will I be in pain after surgery?

A. You will have discomfort. The pain usually lasts 2-3 days. We have “pain pumps” you can use to significantly decrease your pain following surgery.

Q. How long before I return to work or working out?

A. Most patients are back to work within a week to 10 days after surgery, and can return to working out in about four weeks.

Q. Will my breasts eventually sag again?

A. Yes, gravity will continue to pull on your breasts. Also, with age, the skin loses its elasticity and thus, sags.

Q. Will I have to wear a special bra after surgery?

A. You will need to wear a sport bra for 2-4 weeks following your breast lift procedure.

Breast augmentation FAQ

Q. My breasts sag. Will implants help?

A. Breast augmentation alone might not give you the results you want if your breasts have begun to sag due to pregnancy, weight loss or just the pull of gravity over time. In this case, Dr. Parungao will likely recommend a breast lift in combination with breast augmentation surgery.

Q. Will breast implants interfere with mammograms?

A. No. However, when you go for your mammogram, be sure to inform the technician that you have breast implants. There is a special mammography method known as the Eklund technique for women with implants. This technique, which has improved the ability to visualize more of the breast tissue in women with implants, is available at every accredited mammography facility in the U.S.

Q. Can implants affect my ability to breastfeed?

A. Yes. Your incisions may adversely affect your breastfeeding ability if they are located in the periareolar area (around the circle of dark tissue surrounding the nipple). If you plan to have children after breast augmentation surgery, placing the incisions in the inframammary fold beneath the breasts is a better option.

Q. Is silicone dangerous?

A. No, there has been no conclusive scientific link between silicone gel breast implants and any diseases.

Q. Do implants need to be replaced every 10 years?

A. No. This is a popular myth and is not true. There is no expiration date on the implants. However, we do know that they are not lifetime devices. Just like the car you drive today is not going to last forever, neither will your implants.

Q. Will everybody know I have breast implants?

A. It depends on the style of clothes you wear. And of course, the larger the implants, the more the breasts will look augmented.

Q. Are breast implants heavy?

A. It depends on the size you choose. Bigger implants weigh more. On average, they may add a pound or two.

Q. What if my implants leak?

A. If they ever leak, they will need to be replaced.

Q. Will I be in pain after surgery?

A. You will have discomfort. The pain usually lasts 2-3 days. We have “pain pumps” you can use to significantly decrease your pain following surgery.

Q. How long before I return to work or working out?

A. Most patients are back to work within a week to 10 days after surgery, and can return to working out in about 4 weeks.

Breast reduction FAQs

Q. Will insurance cover breast reduction surgery?

A. Some insurance companies will pay for breast reduction to relieve medical symptoms. However, coverage may depend on a significant amount of breast tissue being removed. Your insurance company may require a letter of predetermination before you have surgery. Dr. Parungao's office staff will be happy to help you with insurance matters related to this surgery. If you are seeking a purely cosmetic change in your breast size, you will be responsible for paying for the procedure yourself.

Q. Can my breasts ever get large again after breast reduction surgery?

A. Yes. Your breasts may enlarge due to pregnancy or weight gain.

Q. Is lifting of the breasts part of breast reduction?

A. Yes. Your breasts will be moved higher on your chest during breast reduction surgery, and your nipples will be repositioned higher as well.

Q. How much scarring does breast reduction involve?

A. Breast reduction surgery produces more noticeable scars than procedures such as breast augmentation. Fortunately, all the scarring will be at the level of the nipples and below, so you don't have to worry about the scars showing, even when you are wearing low-cut clothing.

Q. Can I breastfeed after having a breast reduction?

A. It's definitely not guaranteed. If you plan to breastfeed, you should wait to have breast reduction surgery until you are finished having children.

Eyelid surgery FAQ

Q. Can eyelid surgery take away the dark circles under
my eyes?

A. No. Dark circles are caused by thin skin under the eyes that allows onlookers to see the network of blood vessels underneath. This gives the lower eyelids a bluish hue. No surgery, laser or beauty cream can get rid of those dark circles. Vitamin K, however, has been reported to help.

Q. Is eyelid surgery covered by insurance?

A. Sometimes. If sagging upper eyelids are obstructing your vision, insurance may cover eyelid surgery. Without documentation that your vision is being obstructed, blepharoplasty is considered a cosmetic procedure.

Q. Is fat always removed from the lower eyelids?

A. Not always. It depends on each patient's case. Sometimes, only loose skin is removed.

Q. How are fat injections used in the lower eyelid area?

A. In cases where a patient forms a “tear trough” (a groove between the lower eyelid and the cheek fat), Dr. Parungao can inject fat into the trough to soften the junction between the lower eyelid and the cheek.

Q. Can an eyelid lift be done under local anesthesia?

A. Yes. During your consultation, Dr. Parungao will explain your anesthesia choices.

Facelift FAQ

Q. Can a facelift get rid of wrinkles?

A. While a facelift will certainly smooth out your facial skin, there are some wrinkles-such as crow's feet around the eyes-that respond better to non-surgical treatments like IPL photofacials or microdermabrasion. Many patients choose to incorporate these treatments as a follow-up to a facelift.

If you have significant wrinkling or sagging skin around the eyes, Dr. Parungao may recommend that you have eyelid surgery in combination with a facelift for best results.

Q. Will a facelift remove the hollows under my eyes?

A. No, you may need a mid-facelift, an eyelift, or fat injections in the area to soften the hollows. Dr. Parungao can advise you on the procedures he recommends for you during your consultation.

Q. Will a facelift remove the nasolabial fold?

A. No. A facelift usually softens this fold, which runs from the nose to the corners of the mouth, but will not remove it. You may need a hyaluronic acid facial filler, like Juvéderm in addition to your facelift to further soften the nasolabial fold.

Q. How long does a facelift last?

A. The answers depends on many factors, including your age, race, skin type, genetics, smoking history and sun exposure.

Q. Can a facelift make me look 20 years younger?

A. No. The goal of a facelift is to give you a freshened appearance, without the over-operated look that was common many years ago.

Q. Will my facelift scars be visible?

A. Again, the answer depends on many factors, including your age, race, skin type, genetics, smoking history and sun exposure, etc. Usually, the scar hides nicely in the grove between the ear and cheek skin. It is much more difficult for a man to disguise facelift scars.

Q. Will a facelift eliminate a turkey neck?

A. The facelift may improve a turkey neck, but sometimes it requires additional procedures, such as a neck lift or platysmaplasty . Dr. Parungao will advise you on what he recommends for your specific needs.

Mini-facelift FAQ

Q. Is a thread lift the same as a mini-facelift?

A. No. A thread lift—sometimes also called a suspension lift or Contour Thread Lift®—is a non-invasive procedure that uses barbed facial suspension sutures to lift the skin. Because no loose skin is removed during a thread lift, the results are less predictable than those of a mini-facelift.

Also, thread lifts do not do anything to lift the underlying muscle and fat—they simply suspend the skin higher. Results can be expected to last up to two years.

Other variations of this technique include Loop Lift from Surgical Specialties Corp. of Reading, Pa., and the APSOS lift or Feather lift from Kolster Methods, Inc. of Anaheim, Calif.

Q. If I have a mini-facelift, does that mean I can't have a full facelift in the future?

A. No. Having a mini-facelift today will not rule out the option of having a full facelift—or another mini-facelift—in a few years.

Q. Will a mini-facelift remove the nasolabial fold?

A. No. A mini-facelift usually softens this fold, which runs from the nose to the corners of the mouth, but will not remove it.

Q. How long does a mini-facelift last?

A. The answers depends on many factors, including your age, race, skin type, genetics, smoking history and sun exposure. It is realistic to expect a mini-facelift to last about five years.

Q. Can a mini-facelift make me look 20 years younger?

A. No. The goal of a mini-facelift is to give you a refreshed, rejuvenated look. Remember that it is not realistic to expect the same degree of results from a mini-facelift as you could from a full traditional facelift.

Q. Will my mini-facelift leave a noticeable scar?

A. Whenever the skin is cut, it heals with a scar. Dr. Parungao will do everything he can to make your mini-facelift scars as inconspicuous as possible. Much depends on your body's ability to heal.

Please let Dr. Parungao know prior to surgery if you have a history of keloid or poor scarring. Your earlobes may also be pulled or stretched after a mini-facelift.

Q. Will a mini-facelift eliminate a turkey neck?

A. No. Although a mini-facelift can smooth out minor sagging of the neck skin, it cannot be expected to eliminate a turkey neck. A turkey neck would require a full facelift, and perhaps additional procedures such as a neck lift or platysmaplasty. Dr. Parungao will advise you on the procedure(s) he recommends for your specific needs.

Male breast reduction FAQ

Q. Will insurance cover breast reduction surgery?

A. Most often, male breast reduction surgery is considered cosmetic-and thus is not covered by health insurance.

Q. Can my breasts ever get large again after breast reduction surgery?

A. Yes. If you gain a significant amount of weight after having surgery, your breasts can again become enlarged. If your gynecomastia was caused by medication side-effects, the condition could recur after surgery if you continue taking the same drugs.

Q. Will liposuction be enough to treat my gynecomastia?

A. It can be in many instances, depending on how much fat or loose skin you have over your pectoral muscles.

Q. How much downtime should I expect?

A. If you have liposuction only, you can have the procedure done on a Friday and be back to work on Monday. If you have male breast reduction surgery, you can expect to be off work for five to seven days.