Bardia Amirlak M.D.

What is Blepharoplasty? Blepharoplasty (eyelid surgery) is a plastic surgery procedure for correcting sagging or drooping eyelids. The eyelid, because its skin is much thinner than that in other parts of the face, is often one of the first facial areas to exhibit signs of aging. Eyelids that sag or droop can affect peripheral vision, making daily activities such as driving more difficult. Blepharoplasty may become necessary when various factors, which include aging, sun damage, smoking and obesity, cause the muscles and tissue that support the eyelids to weaken. Reasons for Blepharoplasty Blepharoplasty tightens the eyelid’s muscles and tissue, and removes excess fat and skin. Blepharoplasty eliminates the drooping of skin into the visual field, greatly improving peripheral vision. It is also performed for strictly cosmetic reasons. Functional Blepharoplasty If the eyelids begin sagging into the field of vision, a functional blepharoplasty may be required. The procedure may be covered by medical insurance if it is deemed medically necessary. A determination of how much vision is affected is done by checking the peripheral visual field with an instrument called the Humphrey Visual Field (HVF) Analyzer. Cosmetic Blepharoplasty Blepharoplasty can be performed on either the upper or lower eyelid, or on both, for cosmetic purposes. For a lower eyelid that needs fat rather than skin removed, a transconjunctival blepharoplasty is performed. During transconjunctival blepharoplasty, an incision is made inside the lower eyelid, so there are no visible scars, and the fat is removed. This procedure has no effect on vision, but results in a person’s looking younger and more refreshed. It is important for a patient to have realistic expectations before undergoing cosmetic blepharoplasty. Although the procedure can enhance appearance and improve self-confidence, it does not radically alter the face. Candidates for Blepharoplasty The best candidates for blepharoplasty are those who are in good overall health, do not smoke, do not have any serious eye conditions, and have healthy facial tissue and muscle. People with eye disease, including glaucoma or retinal detachment, thyroid disorders, diabetes, cardiovascular disease or high blood pressure are not good candidates for blepharoplasty. The Blepharoplasty Procedure Blepharoplasty is typically performed as an outpatient procedure requiring local anesthesia and sedation. General anesthesia may be used for anxious patients. Patients can choose to have this procedure on their upper or lower eyelids, or both. The procedure can take anywhere from 45 minutes to 2 hours, depending on whether both the upper and lower eyelids are operated on. If the upper eyelid is being operated on, an incision is typically made along its natural crease. Once the incision is made, fat deposits are repositioned or removed, muscles and tissue are tightened, and excess skin is removed. For the lower eyelid, an incision is usually made just below the lash line so that excess skin can be removed. After the procedure, the incisions are closed with sutures, tissue glue or surgical tape, and usually loosely covered with gauze so the area can heal. Recovery After Blepharoplasty After blepharoplasty, patients may be advised to apply lubricating drops/ointment and cold compresses to aid in healing and minimize side effects. Most patients return to work within a few days to a week, but should avoid exercise and strenuous activities for at least 2 weeks. Stitches are usually removed after 3 or 4 days. Most swelling and other side effects typically subside within 2 weeks. Contact lenses and eye makeup may not be worn for 2 weeks after surgery. Patients are typically advised to wear dark sunglasses outside or in bright light for 2 weeks to protect their eyes from sun and wind. Risks of Blepharoplasty Although there may be swelling and bruising around the surgical site, they will subside on their own, and the eyelids will improve in appearance for up to a year. Uncommon side effects include infection, reaction to anesthesia, and double or blurred vision. Eyes may be irritated and dry due to a temporary change in tear distribution. Side effects such as uneven healing and permanent scarring are rare but, if they occur, may require surgical correction. The scars from blepharoplasty are well-concealed, and usually fade with time until they are virtually undetectable. Although the eyelids are still subject to aging, blepharoplasty produces long-lasting results. Blepharoplasty FAQ What is blepharoplasty? What can a blepharoplasty do? Who is a good candidate for a blepharoplasty? How is a blepharoplasty performed? What is recovery from a blepharoplasty like? What are the results of a blepharoplasty?

What is a Breast Augmentation? Breast augmentation (mammaplasty) is performed to increase breast size and/or fix breast asymmetry. Candidates include women who want larger breasts, and those who want to restore the breast volume often lost as a result of pregnancy or significant weight loss. Breasts can be enlarged with breast implants or by fat transplantation. Breast augmentation is not a substitute for mastopexy, which is a procedure to “lift” breasts that sag significantly. If you are interested in breast augmentation in Dallas TX and surrounding areas, call Amirlak Plastic Surgery to schedule a consultation today. Breast Augmentation with Breast Implants Silicone and saline are the two types of breast implants most commonly used in a breast augmentation. Silicone breast implants feel more like natural breasts than saline breast implants. However, if a saline implant ruptures, the saline is naturally absorbed by the body, whereas if a silicone implant has an extracapsular rupture (a rupture to the outer capsule), silicone filler leaks into the body, possibly resulting in inflammatory nodules or enlarged lymph glands. During a breast augmentation, breast implants are placed behind each breast, underneath either breast tissue or the chest-wall muscle. The breast augmentation procedure lasts 1 to 2 hours and is typically performed with general anesthesia, although local anesthesia combined with a sedative may be used. Incisions are made in inconspicuous places (in the armpit, in the crease on the underside of the breast, or around the areola) to minimize scar visibility. The breast is then lifted, creating a pocket into which the implant is inserted. Advantages of placing breast implants behind the chest-wall muscle include a possible reduced risk of capsular contracture (hardening of scar tissue around the implant) and less interference during mammograms. Disadvantages include the possible need for drainage tubes and a longer recovery period. Advantages of placing breast implants beneath breast tissue include that the breasts move more naturally as the patient uses her chest muscles, and that slight breast sagging is corrected. Other types of breast implants utilized during breast augmentation include “gummy bear,” round, smooth and textured. Breast Augmentation with Fat Transplantation Breast augmentation with fat transplantation (fat transfer) uses liposuction to harvest excess fat from other parts of the body; the fat is then injected into the breasts. Breast augmentation is appropriate for women who are not looking for a dramatic increase in breast size and want breasts that look and feel as natural as possible. For a number of weeks prior to breast augmentation, tissue expanders may be placed below the muscles of the chest wall to expand the breasts, and increase the amount of fat they can hold. When the tissue has expanded enough, your breast augmentation using fat transfer can begin. First, fat is removed using liposuction, in which a cannula (a thin, hollow tube) is inserted through small incisions, and then moved back and forth to loosen excess fat, which is suctioned out using a vacuum or a cannula-attached syringe. The harvested fat cells are then purified. In the second procedure, which takes place on the same day, the fat is injected into the breast through small incisions. The procedure takes approximately 4 to 5 hours. Recovery for Breast Augmentation After a breast augmentation with breast implants, drainage tubes may be inserted; incisions are stitched, taped and bandaged. A surgical bra is typically put over the bandages to minimize swelling and support the breasts. For a few days postsurgery, most patients feel tired and sore, but many returns to work within a week. Stitches are removed in 1 week to 10 days; postoperative pain, swelling, and sensitivity diminish during the first few weeks. Scars begin to fade in a few months. After a breast augmentation with fat transplantation, recovery time is short, with normal activities being resumed as soon as the patient feels comfortable. Compression garments are typically worn over the areas that received liposuction. Breast Augmentation Risks In addition to the risks associated with surgery and anesthesia, those related to breast augmentation using breast implants include the following: Asymmetry Capsular contracture Implant leaks and ruptures Implant deflation or shifting Irregularities in breast contour/shape Partial or total loss of nipple/areola Temporary or permanent change in nipple/breast sensation The risks related to breast augmentation using fat transplantation include those related to liposuction, as well as the following: Calcification Fat embolism Fat necrosis Oil cysts Loss of volume Because of the loss of volume that occurs when fat is reabsorbed by the body, touch-up injections of fat are often necessary. Injections can be performed using local anesthesia.

What is Abdominoplasty? Abdominoplasty (tummy tuck) helps flatten the abdomen by removing excess fat and skin, and tightening muscles. The best candidates for abdominoplasty are in good physical condition, with pockets of fat or loose skin that have not responded well to diet and exercise. Abdominoplasty can also be appropriate for slightly obese people whose skin has lost some of its elasticity, and for women with skin and muscles stretched from pregnancy. Anyone planning on losing a significant amount of weight, and women planning on having (more) children, should wait before undergoing abdominoplasty. The Abdominoplasty Procedure Abdominoplasty takes approximately 2 to 5 hours to perform; the patient is placed under general anesthesia. Two incisions are made: one from hipbone to hipbone close to the pubic area, and another around the navel. Skin is separated from the abdominal muscles, which are then pulled together and stitched into place for a firmer abdomen and narrower waist. The skin flap is then stretched down over the newly tightened muscles, excess skin is removed, and the navel is reattached where it looks natural. The incisions are then closed, and sterile surgical dressings are applied over the sutured areas. Recovery After Abdominoplasty After surgery, a temporary tube may be inserted to drain excess fluid from the surgical site. An overnight hospital stay may be necessary. Recovery time ranges from 2 weeks to 2 months. Abdominoplasty leaves a scar spanning the lower abdomen from hip to hip, although it is low enough to be concealed by a bikini. Maintaining weight with a balanced diet and regular exercise provides long-lasting results. Risks of Abdominoplasty In addition to the usual risks associated with surgery and anesthesia, risks associated with abdominoplasty include the following: Asymmetry Poor aesthetic result Unsightly scarring Loose skin Numbness in skin sensation Need for revisional surgery Patients who have had previous abdominal surgery may find that their old scars look more raised, have stretched or are more noticeable in general. Undergoing a scar revision may minimize their prominence.

What is Laser Skin Rejuvenation? Laser skin rejuvenation is designed to improve the skin’s appearance by treating wrinkles, sun damage, sagging skin, brown spots, spider veins and more. Laser skin rejuvenation has a number of advantages over other resurfacing procedures, including chemical peels and microdermabrasion, in that it significantly reduces or eliminates side effects such as discomfort, bleeding and bruising. Different types of laser treatments are used to treat different skin conditions. Common types of laser treatments include intense pulsed-light (IPL) skin rejuvenation; photodynamic therapy (PDT); nonablative laser rejuvenation; and ablative laser resurfacing. Laser Skin Rejuvenation Results Results from laser treatments are usually not immediate, taking several months to appear, and a number of treatment sessions may be needed to achieve the desired results. Although safer than traditional resurfacing procedures, there are some risks, including scarring and unwanted lightening/darkening of the treated skin, associated with laser skin rejuvenation.

Migraines and chronic headache treatment with migraine surgery nerve decompression and target BOTOX with Dr. Amirlak’s own technique “Anatomical Regional Targeted“ BOTOX injection. Surgical deactivation of migraines is a novel surgery targeted to treat forehead, sinus, temple and occipital migraines, occipital neuralgia, and New Daily Persistent Headaches. Dr. Amirlak is one of the world’s leading authorities on migraines surgery and BOTOX treatment with multiple lectures and symposiums, book chapters and articles published in this area. Surgical Options for Migraine and Persistent Headache Relief Migraine and daily persistent headaches impact nearly 28 million Americans, often presenting with intense pain, nausea, light sensitivity, visual aura, appetite loss, dizziness, and fatigue. These symptoms can significantly disrupt daily life, affecting work, education, and personal relationships. Anatomical Regional Targeted BOTOX injection ( ART) Anatomical Regional Targeted (ART) BOTOX® Injections for the management of migraine headaches, occipital neuralgia, and chronic daily headaches by Dr. Bardia Amirlak. Lessons learned from migraine surgery and cadaver dissections resulted in Dr. Bardia Amirlak doing research in the area of BOTOX injections and modifying previous injection techniques.

What is BOTOX Cosmetic? BOTOX® Cosmetic is a prescription drug that, when injected, temporarily paralyzes muscles. It contains a purified and safe form of botulinum toxin A, which is produced by the microbe that causes botulism. Manufactured by Allergan, Inc., it is used to treat permanent furrows and deep wrinkles in the skin that are formed by the continual contraction of facial muscles. In addition to its cosmetic applications, it is used to treat a number of medical problems, including excessive sweating, overactive bladder, neck spasms, crossed eyes, chronic back and jaw pain, and migraines. Applications for BOTOX Cosmetic Although originally approved by the U.S. Food and Drug Administration for the treatment of eye and muscle spasms, BOTOX Cosmetic was quickly recognized for its cosmetic value. Properly placed injections of BOTOX Cosmetic block nerve impulses sent to muscles, weakening them to the point where they cannot contract, and temporarily eliminating moderately severe furrows and lines. BOTOX Cosmetic is used to treat the following: Forehead furrows Frown lines Crow’s feet Skin bands on the neck According to Allergan, BOTOX Cosmetic has been “extensively researched, with approximately 2500 studies. BOTOX Cosmetic Procedure and Results Using a very fine needle, BOTOX Cosmetic is injected directly into facial muscles that are causing furrows and lines. Receiving the injections requires no anesthetic, but some doctors choose to numb the area to be injected with ice packs or a topical anesthetic cream. Results can usually be seen within a few days of treatment, and typically last up to four months, although areas that are treated on a regular basis may retain results longer. Injections should be given only by qualified medical professionals. Side Effects of BOTOX Cosmetic Injection-site side effects of BOTOX Cosmetic are usually mild and temporary, and include the following: Pain Infection Inflammation Tenderness Swelling Redness Bleeding Bruising Normal activities may be resumed immediately after receiving injections.

Burns that penetrate below the superficial layer of the skin, or epidermis, can leave patients with scars and disfigurements. Serious scarring not only results in negatively altered appearance but often has detrimental psychological consequences. When burns are severe enough, they damage muscular, bone, or nerve tissue, affecting mobility, strength, and sensation. Physicians can do much to repair the damage suffered by burn victims through a variety of procedures, including burn reconstruction. What types of Burn Reconstruction options do you offer? Burn reconstruction is performed to improve the patient aesthetically and psychologically. Most burn scars become less noticeable over time, but serious burns may leave scars that are unattractive, draw unwanted attention, or are disfiguring. Burn treatments typically involve skin grafting and cosmetic reconstruction. While some may be performed in an emergency setting soon after the damaging event, many treatments will take place after the original burn has healed, as much as 9 months to 1 year later. Compression Bandages After a serious burn, tight bandages are often required in order to prevent heat and moisture from escaping from the wound, decrease sensitivity, collect wound drainage, prevent infection, and keep the area in an appropriate position for healing. Skin Grafts Burn reconstruction may involve grafting of skin or other tissue, creation of skin flaps or the use of injectable fillers to normalize the appearance of the skin. Such methods may also correct functional problems, enabling the patient to move more freely. Skin for skin grafts may come from the patient or may be harvested from pigs or from the donated skin of cadavers. Skin grafts are sometimes only temporary to keep fluids in place until further healing takes place. Debridement Debridement is the medical removal of dead, or necrotic, tissue, in order to promote healing. Debridement may be done surgically or with the help of chemicals. Surgical Cutting A burn scab, or eschar, that completely surrounds a limb causes tightness, impeding blood circulation. An eschar that goes completely around the chest, for example, can make breathing difficult. In such a case, surgical cutting of the eschar in several places is required to relieve pressure and increase mobility. Plastic Surgery In addition to any surgery necessary to repair damaged skeletal, muscular or neurological tissue, plastic surgery if often necessary after a serious burn injury. Plastic surgery can improve the appearance of burn scars and increase the flexibility of joints affected by scarring. Plastic surgeons use various techniques, such as laser resurfacing, microdermabrasion and chemical peels to smooth out scarred tissue and normalize its appearance. Patient Aftercare for Burns In addition to the medical care and physical therapy necessary after serious burns, patients can assist in their own aftercare. It is important for patients to continue to be active and to exercise affected areas since otherwise, they may suffer a contracture, a tightening and thickening of scar tissue that impedes mobility. The application of various ointments and creams may also be helpful in keeping the affected skin well-hydrated.

New fat grafting techniques have improved the immediate and long-term results of facial, breast and hand rejuvenation. Structural Fat Grafting Fractional Fat Grafting Nano Fat / Stem Cell Grafting Learn More Select a link below to learn more: Fat Injection to the Buttocks & Breasts Fat Injection to the Hands and Face

Endoscopic Facial Rejuvenation The endoscopic procedures results in faster recovery and less scars. Endoscopic brow and mid face lift requires three to five small incisions that are made across the forehead, at the hairline or inside the hairline. CoolSculpting: Nonsurgical Body-Contouring Treatment Some people have fat cells that are resistant to diet and exercise. These cells often settle around the trunk area. This type of fat is commonly referred to as back fat and love handles. CoolSculpting is a treatment Dr Amirlak offers to help patients contour their abdomens, backs, and sides, eliminating stubborn fat without surgery. There is no down time or pain with this alternative. Ulthera – Facial Rejuvenation and Nonsurgical Facelift Ultherapy/Ulthera is a nonsurgical option that uses proven technology in a new way to rejuvenate the face and neck. UT Southwestern Medical Center was among the first plastic surgery centers in the United States to evaluate how this technology performs among various ages and types of patients. Dr Amirlak has found that Ultherapy/Ulthera is an effective, nonsurgical facial rejuvenation process to address early signs of aging such as excess eyelid skin, sagging cheeks or jowls, and loose skin on the neck.

Sex Change Surgery in Dallas TX Lili Elbe (1882–1931), was among the early recipients of sex reassignment surgery Sex Reassignment Surgery (SRS) or Gender Confirmation Surgery (GCS) or Gender Affirmation Surgery (GAS) Dr. Amirlak offers male to female (MTF) and female to male (FTM) top surgery for the breasts, as well as facial surgery for feminization or masculinization in accordance with the WPATH guidelines for treatment in Dallas, Texas. Dr. Amirlak works with endocrinologists and psychologists both at UTSW and Children’s hospitals, as well as other Dallas communities. Contact us for more information on transgender surgery options at Amirlak Plastic Surgery in Dallas TX. Do I Need to Do Anything Prior to Scheduling a Consultation with Dr. Amirlak for Transgender Surgery? transgender surgery dallas txIf you are planning on using health insurance, documentation for hormonal therapy as well as a letter from a mental health therapist confirming the diagnosis of gender dysphoria based on the WPATH (World Professional Association for Transgender Health) criteria is necessary. In certain cases, your insurance company may require letters from two separate mental health professionals. Dr. Amirlak is a member of the WPATH and adheres to their guidelines with patient evaluation and surgeries. We strive to provide the best patient experience and the greatest aesthetic outcome. Dr. Amirlak has trained with renowned transgender and aesthetic facial surgeons and has mastered the art of transgender top surgery and facial feminization surgery in Dallas TX. We have teamed up with adult and pediatric endocrinologists, gynecologists, and mental health therapists to provide the best comprehensive care for our patients. What Should I Expect from Recovery from Surgery? You should avoid strenuous activity such as aerobic and weight lifting exercises for 2-3 weeks for both FTM and MTF top surgery. This includes swimming in pools, lakes, or hot tubs, as well as refraining from any sexual activity. Following FTM surgery, you can wash your hair or the lower part of your body as long as you do not get the chest dressing wet. Following MTF surgery, you can shower on the same day of your surgery. Patients can return to work as soon as they feel well enough, with the restriction of limiting strenuous physical activity. Generally, patients will take one to two weeks off from work to allow time for proper healing. Although some surgeons may push earlier return to work, we would like to optimize our aesthetic outcomes and minimize complications. In standard MTF breast augmentation patients have less discomfort than FTM patients. How Much Does Transgender Top Surgery Cost? Most insurance companies are covering these surgeries. In case of denials or lack of insurance, the price ranges from $5,000-15,000 depending on the type and extent of the transgender surgery. Keep in mind that each surgery is patient-specific and these prices will vary from patient to patient. Gender Affirmation Bottom Surgery We offer a comprehensive team approach for facial and top breast surgery for our transgender patients. We feel that gender affirmation bottom surgery should be done in a center that has a dedicated microsurgery team with extensive training and experience in this area. Although we have world experts in each of these categories, we would like to develop a more comprehensive and cohesive approach before we offer these surgeries to our transgender patients. At this time, we refer patients interested in bottom surgery to a specific center that we collaborate with that has a team that we feel provides the best care to our patients. Nevertheless, the UT Southwestern team is in the process of developing the requirements to offer transgender bottom surgery to our patients in the future. We feel that the experience and expertise in top and facial surgery are at the highest level at UT Southwestern. We welcome patients to visit our clinic and we hope to achieve the best personal and aesthetic outcomes for our transgender patients.