Learn about breast enlargement in Prague, breast augmentation abroad and various types of silicone breast implants. Breast enlargement or breast implants are an ideal solution for many women with small breasts.

Breast augmentation abroad, also known as breast enlargement, involves the surgical placement of an implant behind each breast to increase its volume and enhance the breast’s shape. Breast augmentation is requested by women who perceive their breasts to be too small or sagging.

Types of breast implants

Basic types of breast implants by shape:

Basic types of breast implants by filler:

Nowadays novelties in the implant fillings field occur regularly. Various substances are being tried and used as fillings, including soya-gel and hydrogel. These new types of implants aren’t in regular use yet.

Basic types of breast implants by surface:

Basic types by profile:

• moderate
• high

The size of the breast implants is indicated in mililitres. The choice doesn’t depend on size but on dimension. The selection depends on many factors, such as the woman’s figure, height, width of her chest, figure proportion, size of pelvis, size of mammary gland and of course, the patient’s wishes. The most popular sizes in the Czech Republic are 200 – 300ml. (Implants from about 100ml to 1000ml are available.)

To see what size might be right for you, use a plastic bag that can be filled with liquid or boiled rice. Put it into your bra to help you choose the correct implant size.

Most commonly used brands of silicon breast implants are:

• McGhan/Inamed

• Mentor
• Polytech

• Eurosilicon

All implants have their own passport – a document that states the number and size of the implant. This passport is given to every patient after the surgery.

What does the breast implant look like?

The implant is formed with an outer pocket made from polymerized silicone gum, which is very firm and elastic. The pocket contains one more inner layer, which guarantees a higher resistance to rupture and the minimum permeability of particles. The surface can be smooth, although at present implants with textured surface are preferred. They have pores of a certain size and depth and now also have a smaller risk of capsular contracture creation. A titanium film may be on the surface of the implant (which lends itself to good tolerance with the body) or polyurethane. Inside the pocket there is soft cohesive silicone gel, saline, combination of both or even one of the other substances mentioned above. The cohesiveness of silicone gel particles enables the implant to keep its shape, lowers the risk of permeability of silicone micro-particles through the pocket and avoids the possible leakage of silicone in the event the cover ruptures. The silicone gel filled implant is used most often because of the reduced harmfulness risk on the body from silicone.

Price of breast implants

The price of breast implants ranges from about 18,000 to 50,000 CZK depending on the type of implant and the producer. For round shapes, the price ranges from 18,000 to 28,000 CZK and from 40,000 to 50,000 CZK for anatomic shapes. Prices are independent of size.

Breast augmentation abroad

When choosing a surgical procedure consider the following options.

The placement of the incision:

The choice depends on the desire and preference of the patient and on the usual practice of the clinic.

The placement of the implant:

Both methods (under the muscle and under the mammary gland) have their advantages and disadvantages. The choice depends on the quality and size of the gland, the quality of the skin and the subcutis, as well as the strength and quality of the muscle. The implant coverage has to be sufficient. If it is not sufficient, the implant can be visible and won’t look aesthetically pleasing. The pre-surgery consultation is intended to harmonize the patient’s ideas with real possibilities in regards to their body proportion, and with the advice of the surgeon.

For more information about breast enlargement abroad or breast augmentation in Prague please take a look at the linked pages.

The process of breast augmentation

In most cases, breast augmentation will be performed under general anesthesia. The surgery usually takes one to two hours and one to two days stay in hospital may be needed.

The method of inserting and positioning your implant will depend on your anatomy and your surgeon’s recommendation.
The three-four cm long incision can be made either in the crease where the breast meets the chest, through the dark skin surrounding the nipple or in the armpit. Every incision is made carefully so resulting scars will be as inconspicuous as possible.

A pocket in which the implant is inserted is created through blunt tissue preparation.

Some of the clinics abroad even use endoscopic technique by augmentation. The access for this technique is through an incision in the armpit or in the navel area.

The pocket will be filled with the implant either directly behind the breast tissue or underneath the chest wall muscle.

The size of implants must be carefully chosen in order to be fully covered by the breast tissue. Otherwise the edges of the implants can be easily seen and makes for a very unnatural look.

The cessation of bleeding is very important to avoid further complications – an undesirable capsule, a scar or poor coverage of the implant.

Drainage tubes may be used for several days following the surgery; it depends on the practice of the clinic and on the surgeon.

To close the wound, different sutures are used (mostly intradermal, eventually separate;) they are removed seven to 10 days after the surgery.

How the wound is covered is also up to the practice of the clinic. After the surgery, the breasts are fixed day and night with a special bra. It is recommended to wear this bra four to eight weeks after the surgery. For one month after the surgery, sleeping on your back and limiting sport activities is also recommended.

Are you a good candidate for breast augmentation?

Breast enlargement by means of implants is a very effective procedure. It is suitable for women with insufficiently developed breasts or when the mammary gland system is shrinking, as may be the case following breast feeding or a significant weight loss.

The optimal age limit for surgery varies. It is generally done after the development of the mammary glands is complete, which is usually after the age of 16.

It is certainly better to insert the implants into breasts that won’t change by potential breast feeding. Although it doesn’t eliminate the possibility to undergo breast augmentation before pregnancy; you have to take into account that lactation and pregnancy will change the size and quality of the mammary gland and therefore the surgery will probably need to be redone. It is better to undergo breast augmentation at least one year after the delivery and breast feeding.

Breast implants have no influence on the fetus and they do not expose it to any danger. The presence of implants does not hinder the ability to breast-feed. Studies done worldwide have not found an increased content of silicone in breast milk.

Some women request the implants to be placed as close to each other as possible to create a sexy line between the breasts. Unfortunately this effect is caused by the body’s constitutionand by the distance between the mammary glands therefore it is not possible to create it on demand.

Before breast enlargement

During your initial consultation, your surgeon will explain the surgery in detail. He will explain which surgical technique is most appropriate for you based on the condition of your breasts and skin tension. He/she will also show you before and after pictures and different types of implants.

If your breasts are sagging, the surgeon may also additionally recommend a breast lift. The surgeon will also inform you which implants he or she will use and which size is appropriate for you to achieve the best result.

Because it is a surgery performed under general anesthesia a pre-surgical examination including a laboratory examination and EKG by a general doctor or internal specialist is necessary. The exam should also include a detailed health history i.e. family diseases, diseases that you have had, allergies etc. At some clinics it is possible to have these examinations done in the morning the same day of the surgery.

Before the surgery it is also necessary to eliminate the possibility of breast illness by ultrasound (sonogram) or mammogram examination depending on the patient’s age. They are performed by special oncological and gynecological clinics. This is mostly done if you are a high risk patient due to a family history of breast cancer.

Your surgeon will give you instructions to prepare for surgery. You should avoid drinking and eating 6 hours before the planned surgery. Any medication containing acetylsalicylic acid (such as Aspirin, Acylpyrin, Alnagon, Mironal etc.) can increase bleeding during and after surgery They therefore shouldn’t be taken for about a week before the planned surgery. It is not good to undergo the surgery during menstruation, although it is not a reason to postpone the surgery. It is appropriate to consult your gynecologist concerning quitting birth control. Today’s opinion is to keep taking birth control pills and preventively taking medication against blood coagulation – low molecular heparin (e.g. Fraxiparin, Clexan, Fragmin.)

It is assumed that no acute illness (viral illness, cold, etc.) will have occurred in the period at least three weeks before the planned operation. Report any illness to your doctor.

If you smoke, plan to quit at least one or two weeks before your surgery and do not resume for at least two weeks after your surgery.

The day of the surgery you should come with your armpits shaved, if the surgical method has been agreed upon.  Bring any medication that you take with you for 2-3 days, hygienic items, shoes, pyjamas, ID papers, and an elastic bra without wire support that’s the same size as the chosen implants. Some clinics have them for sale. Clothes that need to be put on over the head are not suitable for the hospital stay. Putting on such clothes after the procedure might be very painful.

While making preparations, be sure to arrange for someone to drive you home after the surgery and to help you out for a day or two if needed.

The costs of the surgery are usually paid for on the day of arrival, before the procedure. An advance deposit is paid at the booking date. Everything depends on the rules of each particular clinic. Since it is an elective surgery, it’s not covered by insurance companies. It is also necessary to take some days off of work because it is not possible to receive a sickness leave.

After breast enlargement

You are likely to feel pain for a few days following your surgery. The pain is more intense when the implant is placed under the muscle. You will take painkillers for two to five days following the surgery; the pain will slowly recede.

You will probably be released from the clinic after one or two days. Before you leave, the bandages may be changed and the drains removed. That will depend on the clinic and your surgeon. The sutures are usually removed during the check-up in seven to ten days.

It is recommended to wear an elastic bra. You will usually get it at the clinic where the procedure is performed. The length of time to wear it is decided by the surgeon. It is usually 4-8 weeks after the surgery and following that, during sport activities. The surgeon may sometimes recommend a medical belt. It is usually used if the implant was inserted through the armpit, and so it squeezes the formed canal. It can also be used if placement of the implant was under the muscle, so that it pushes it downwards, and generally in other situations when the bra is insufficient. The need and length of time to wear it is again set by the surgeon.

The recommendations of breast massages after the surgery vary, depending on the clinic and the type of implant. Some surgeons don’t recommend them at all. On the contrary long lasting pressure massages of the scars are recommended. It is recommended to wash the breasts only after the wound is healed.

Stay relaxed and quiet during the first week following surgery. Have someone help you with the house and kids for the first few days.

You can resume routine activities and lighter house work in 10-14 days. It also depends on the feeling of pain. Avoid lifting your arms over a horizontal line for 6 weeks.

Heavier work, lifting heavy loads, exercising, weightlifting and other sport activities are recommended gradually after two months following the surgery and while wearing the elastic bra. Intimate intercourse should be done very carefully within the first month after the surgery.

It is possible to visit a solarium or sun tan 14 days after the surgery, it is better though not to rush these activities too much. The scars must be covered with plaster or treated with a high SPF sunscreen for a minimum half a year following the procedure.

You should be able to return to work within 10-14 days, depending on the level of activity required for your job.

The result of the augmentation is considered permanent after three months.

If the breast skin is dry after the surgery, you can apply hydrating creme several times a day. Be careful not to tighten the skin while doing any specific movements and avoid contact with the stitched area.

You should see your surgeon immediately if your breast shape changes, the consistency changes (your breast becomes hard) or any inflammation appears. A visit to your surgeon is also recommended after any severe trauma to your breasts (car accident, fall etc.) Regular check-ups are done after one month, after three months and after one year. A check-up after 10 years also includes an ultrasound examination. The check-up system depends on each clinic. Some clinics have no check-ups at all.

Always be sure to follow your doctor´s instructions.

The implant covers approximately 20% of the mammary gland tissue during a mammogram. That’s why it is a good idea to consider another examination technique such as a sonogram (ultrasound) or magnetic resonance.

Patients that have undergone breast augmentation with implant placement must not undergo diathermy (medical organ heating through high frequency electric current.) The implant could become extremely hot and could cause inner burns and eventually the rupture of the implant.

General complications

Each surgical procedure has its possible complications and we have to consider them, although they appear in a low percentage of cases. General anesthesia has certain risks, which will be explained to you by your anesthesiologist before the planned procedure.

There are complications concerning the healing and possible infection of the wound around the area of the implant. There have been documented cases when the implant had to be removed because of infection.

Another surgical complication might be bleeding. That’s why a laboratory examination of blood clotting before the surgery is essential. Also staying in a calm environment after the procedure is important. Another problem can be scar healing.

A serious complication that can occur in any surgery in which the patient is under general anesthesia is a so-called pulmonary embolism – blocking of the pulmonary artery with a blood clot. For prevention, doctors use elastic bandages on the legs and movement soon after the surgery, the best is the first day. Hormonal birth control raises the risk of thrombosis, so it is possible to stop it or take medication against blood coagulation – low molecular heparin (e.g.Fraxiparin, Clexan, Fragmin.)

Some patients are more likely to receive so-called keloid or hypertrophic scars. Sometimes a correction may be necessary, which is relatively difficult in these types of scars.

Breast augmentation is performed with the arms stretched. Patients can sometimes feel pain shooting into the forearm and hands after the surgery. It is caused by the tension of nerves running from the armpit to the arms. These problems are temporary and fade away after few days or weeks.

Complications concerning the implant placement

Capsular contracture

It is the most often described and feared complication of breast augmentation. A fibrous cover – capsule is always formed around the implant. The tissue reacts naturally to the foreign element of the body. The capsules form in all patients and they can be thin or thick. Its creation is individual. In 5% of cases the capsule can start to shrink – this is capsular contracture around the implant. It is accompanied by pain and a firmness to hardening of the breast. This phenomenon can occur in one breast or both breasts. There are ways to avoid the forming of a capsule or at least minimize its creation. It is for example important to ensure a sufficient size of the cavity for implant placement. Also implants with a textured surface reduce the risk of capsular contracture. The shrinking capsule often has to be treated surgically. There have been documented repeated cases of capsular contractures around the implants and sometimes the rigidness can repeat so that the only possibility is the removal of the implant .

Prolapse (expulsion) of the implant

The skin is in permanent tension in the area of the wound. The size of the implant can also cause a progressive thinning to breakage of the skin and therefore the prolapse of the implant. This complication is more common in patients whose skin has been damaged in any way or scarred for example by irradiation from tumor disease.

Serom

This is the creation of liquid around the implant immediately after the surgery or later. It is manifested by pain and breast enlargement. The reason is most often physical strain after the surgical procedure, excessive sport activity or injury.

Blood coagulation around the implant – hematoma

A collection of blood around the implant is mainly caused by disobeying the relazation orders after the surgery or defective blood coagulation.

Burst and penetration of the implant

The approximate durability of an implant set by the producer is around 10-15 years. The implant slowly wears out and its surface thins, which can cause it to burst. The breast can change its shape and will hurt. In such case a change of the implant is necessary. A breast rupture can also be caused by injury, accident or extreme sport activity. Microscopic particles of silicone can penetrate through the  gel filled implant’s external cover. These particles have been found around the implant and even in other parts of body. No harmfulness has been proved.

Shrinkage of the implant

The shrinkage of the implant cover is manifested by small folds that can be touched under the skin. It can be painful and big folds can irritate the surrounding tissue. It is a problem for skinny patients with a thin skin layer, very small mammary gland and in cases of implant placement under the gland.

Sensitiveness of nipples

The change of sensitiveness of nipples, either increased or decreased is often described by women after the surgery. In most cases it gets back to normal in several months to one year. The change can be sometimes permanent.

Breasts asymmetry

Even breasts enlarged with an implant can droop or sag after some time. Also asymmetries may occur, when one side droops more than the other. It can be caused by disobeying instructions after the surgery but also for other reasons. The implant can change its position through the movement of breast muscle right after the surgery. A higher risk of such a shift is threatened by teardrop implants.

Calcification

Small particles of calcium may appear around the implant. They can be confused with a beginning stage of breast cancer.

Tiny thrombotic vessels

Tiny vessels in the armpits or under the abdominal wall blocked by thrombus may appear after the surgery. They disappear naturally within several months.

Can silicone implants be harmful for body?

There have been made many studies concerning the harmfulness of breasts implants. All the substances that form the implant have been gradually studied and examined. This includes silicone, polyurethane, which is part of the cover of some implants, and platinum, which is used by polymerization of silicone gel. None of these substances showed explicit carcinogenic effect, i.e. ithey don’t cause tumor malignancy. Further studies have been done for any relation between implants and rheumatic and autoimmune diseases, again none have been proved. Elementary silicone occurs normally in parts of the blood, breast milk, connective tissue and most organs. Its content in the body depends on a person’s diet, geographic conditions, quality of drinking water or beer consumption. Also mothers that breast feed with silicone implants do not present any risk to their babies. Silicon is part of nursing bottles, dummies, spoons and other medical products.

How long will the effects of breast augmentation last?

The final breast augmentation is permanent, if there is no change in weight and proportion of breasts (see the above mentioned pregnancy.) Regarding the change of quality of the implant after 10 to 15 yearsor the increased possibility of an implant rupture (burst), it is necessary to consider the possibility of implant replacement. Breast augmentation is a personal, serious decision, and a permanent one. If you have planned carefully, worked with your doctor and followed his instructions, then your surgery should be a successful one!

The future of implants

At Illinois University in Chicago stem cells isolated from bone marrow were stimulated to grow along the supportive skeleton, which is made out of biologically tolerant material. Due to this form the cells have reproduced into previously selected shapes. Such cultivated forms from fat tissue has already been tested on mice. It is assumed that these implants grown from stem cells will be a safe alternative to silicone implants.

Breast enlargement by filling it wiht a person’s own fat or by transplantation of their own muscle has already been performed at some clinics worldwide. There haven’t so far been any experiences with such a technique in the Czech Republic.

Do you like close-fitting clothes but can not wear them because of unsightly fat layers on your abdomen or thighs? UltraShape is the first safe, effective, surgery-free (non-operative) body contouring treatment which breaks down subcutaneous fat layers and smooths out skin with celulitis on places that are difficult to shape with exercise or diet. This method is completely painless, effective, with no surgery and no undesirable side effects and its results can be actually measured.

What happens during treatment

The treatment uses focused ultrasound waves selectively breaking membranes of fat cells lying 1,5 cm under skin surface. After one treatment there is an average reduction of a six-milimetre layer of subcutaneous fat deposits. The fat cells are ultimately processed by the body´s immune system. The neighboring tissues as blood vessels, nerves and muscles remain intact as well as the skin which does not show signs of any possible damage caused by the treatment.

Who is it for

Suitable candidates for the treatment are men and women with subcutaneous fat layer thicker than 1,5 cm. Ultrashape can also provide a long lasting remedy for clients with celulitis.

Contra-indications for treatment are pregnancy, liver diseases, heavy metabolic derangements, metabolic errors of blood lipids, derangement of coagulation, illnesses of connective tissues and heart pacemaker. The UltraShape treatment focuses mostly on flanks, abdomen and thighs (inner and outer sides) – places which are difficult to shape with other methods. This treatment is however not the same as surgery liposuction and is therefore not suitable for obese people. UltraShape can not reduce your weight but helps you to change and improve your body contour.

Before treatment

During an obligatory consultation before the treatment, the physician is going to decide whether UltraShape is suitable for the patient, examine the area to be treated as well as its size and set the price for treatment.

Treatment

The physician first marks the treatment area directly on the skin and covers surrounding parts with towels. He/she enters required data to a computer system and starts the treatment. Using a sophisticated tracking system, focused ultrasound energy (pulses) selectively targets fat cells in the chosen body area, ensuring that each treatment point is covered. This tracking system ensures an even treatment without unwanted irregularities on the skin. Treatment is comfortable, painless, you can even read or make telephone calls during it. The procedure usually ranges between one and two hours, depending on the size of the treated area.

One session is usually enough, but if you want to get rid of more than 6mm of subcutaneous fat layer, it is possible to repeat the treatment, no sooner than after one month. And the result? After a single procedure there is an average reduction of 1,5 – 2 centimeters in treated area circumference.

After treatment

A very comfortable manual lymphatic drainage follows immediately after treatment and helps the body to process the disrupted fat cells by its own lymphatic system. For best results, it is recommended to be on a diet with low fat and sugar intake for a period of 4 days after treatment and do plenty of exercise. Final results can be seen after approximately 3-4 weeks.

How long do the effects last

Human body has a final number of fat cells, it means that no new ones are formed after removal of some of them.

Hair has always been a symbol of beauty and an important part of one’s appearance. Thinning or the loss of hair can be very frustrating to many people. Cosmetic surgery may have an answer: hair replacement.

What is hair replacement?

Hair replacement – or a hair transplant – involves the transplantation of your own hair grafts or micro-grafts to fill places left bald because of missing or thinning hair. The treatment is best for men who have conventional hair loss, after hair loss or thinning has slowed or stabilized. Hair loss is caused mostly by ageing, changes in hormonal processes or a hereditary predisposition.

Hair loss can be also caused by burns or traumas. In such cases the treatment is considered to be reconstructive and therefore is usually covered by an insurance company.

If you and your doctor have decided that a hair transplant is right for you, you can rest easy knowing that this operation has been done for more than 30 years. If you are considering hair replacement, the following text can help you understand the operational procedure, provide information about preparing for the surgery and expected results of hair replacement surgery. It isn’t possible to answer all questions concerning hair transplants as each person’s situation is different. If you have additional questions, speak with one of our hair replacement Prague surgeons.

Why hair replacement Prague?

Prague has many attractive features for those considering a hair transplant abroad. Its location in Central Europe is easy to access; its mild climate is conducive to healing and its experienced clinics and hair replacement surgeons ensure you’ll receive the best possible care. Hair transplant Prague costs are often much more affordable than in the UK or with the NHS. For more information about getting to and around the Czech Republic, please visit our handy cosmetic surgery Prague info guide.

Hair loss in women

Some doctors estimate one in every five women experience some type of hair loss, usually caused by ageing, illness or hormonal changes. Women´s hair usually will thin slightly all over the head and does not disappear completely in one place as is common in men. Because this thinning is distributed all over the head, transplantation is very difficult however, medication can be useful. The efficiency of these medications is different for each client, but basically, they prevent further hair loss but don’t help new hair to grow.

If you are considering a hair transplant, it is necessary to realize that it is impossible to achieve the same hair density as before the loss. Hair replacement can however cover thin places and fill empty ones.

Hair transplant surgery

Hair replacement is done under local anesthesia and is relatively time consuming. It lasts quite a few hours, but naturally, it depends on the area which is being transplanted. The operation begins with a cut of hair graft with good hair cover from the nape area. The size of this graft depends on the size of the bald place which will be covered. Usually it is 1.5 x 10 cm. Immediately before the surgery, just the hair where the hair graft will be done, is cut to 2mm in length. It is not necessary to cut any other hair. The edges of the site of the hair graft are subsequently stitched together and only a discrete scar remains on the nape.

In the next phase, the skin graft with quality hair is divided by a scalpel into small grafts containing either 1 – 3 (micro-grafts) or 3 – 6 (mini-grafts) hair roots. Micro-grafts are used to treat the future front hairline, it helps to give a natural look. The formerly used grafts containing more hair roots cause an unnatural look of new hair cover. You could compare it to the hair of a doll, because a lot of hair grew from one point and between these bunches of hair there were places without hair.

During the most common method of hair replacement surgery used nowadays, the grafts with hair roots are inserted with the help of micro-forceps into incisions in the area to be transplanted. These cuts are usually done with a special scalpel and their size should correspond to the size of grafts to be inserted. In the new area, the inserted transplanted hair has the same characteristics as in the original place of the hair graft. The hair grows naturally, it can be cut, dyed etc. It is however necessary to realize that real hair growth begins later after the treatment and the results of the hair transplant cannot be assessed for about five to six months after the treatment. You can view before and after photos of hair transplants here.

Laser hair transplant

It is possible to use a laser to make the incisions for inserting the hair grafts. A laser is used to create these incisions (in this case small openings) in the area to be transplanted. However only the most efficient laser device can produce rays with high energy and a very short time of impact, made up from the different pulses. This is necessary to evaporate the tissue at the impact point of the laser, but leave other tissue unaffected by the temperature. There are important advantages to this method compared to the traditional procedure, for example, the incisions do not bleed, which makes the hair transplant go faster and much smoother. On the other hand, inter-stitial fluid infiltrates into the incisions, “glues” the inserted graft into the incision and therefore fixes it firmly into this gap. The size of the gap corresponds to the size (diameter and depth) of the graft, therefore the surrounding tissue can not oppress the graft. These grafts are not pushed out from the incisions when new grafts are being inserted. In addition to this, because the grafts are not pressed, hair which is contained in them does not spread out during the healing process. Therefore the hair cover looks much more natural.

There is another advantage. The laser device is controlled by a computer and can make more regular gaps with a higher density of precise depth, diameter and angle which is natural for subsequent growth of transplanted hair. The device’s equipment enables the surgeon to define the size (diameter) of the gap to correspond precisely with the size of inserted grafts. And one equally important advantage – the duration of the surgery is reduced by up to two thirds compared to the common method.

In most cases, if the client is healthy, a special examination before hair replacement surgery is not needed. The hair transplant is done either sitting or lying down; whichever is more comfortable for the client during the treatment which does last several hours.

After the hair transplant

After the hair replacement operation, a sterile elastic bandage is put on. This not only protects the stitched incision at the original place of the hair graft in the nape area and inserted grafts, but also prevents large swelling at the place of the transplant. The bandage is removed usually the second or third day after the treatment and then the patient can wash his/her hair. Small crusts will appear at the place of the hair grafts, they will fall off naturally after 14 days. The patient should relax at home for about five days following a hair transplant. The sutures in the nape area are removed approximately two weeks after the surgery.

When the crusts fall off, the small grafts will have a slightly pink colour, similar to other scars. This colour however will return to a normal skin tone after a few weeks. A large part of the hair from the inserted grafts may fall out after the treatment, but the hair roots subsequently regenerate and the hair will start to grow. That is why you won’t see final results for about five to six months, after true hair growth has begun. Because it is necessary to leave some space between the gaps for hair grafts (approximately 2 – 3 mm), many patients decide to have their new hair cover densified. Densification is not always necessary and depends on the patient.

As we age, gravity often takes its toll on our bodies. Sometimes this results in loose and excess skin on our face and neck. Unfortunately when this happens around our eyes, it can make us look old and tired. Sometimes drooping eyelids are not only a cosmetic problem, but a health one, as in many cases excess skin can interfere with one´s vision. Eyelid surgery may offer you a solution.

What is eyelid surgery (blepharoplasty)?

Eyelid surgery is a cosmetic change of upper and lower eyelids. Blepharoplasty solves mostly ptosis (drooping of eyelid), fat prolapses or combination of both defects. The surgeon removes excess skin and so-called fat bags (prolapses). If necessary he/she removes also some parts of increased oblique eye muscle. The patient can undergo the upper and lower eyelid surgery at the same time. If there are only fat bags in the lower eyelids and it is not necessary to remove excessive skin, the operation can be done from the inner-conjunctival side of the lid. This is called the transconjunctival version of the eyelid surgery.

If you have droopy or baggy lids, medical specialists recommend undergoing eyelid surgery as soon as possible. The results are then much better and will last longer. Usually, eyelid surgery is done for clients older than 35 years of age, but in some cases, it can be done earlier, usually because of a genetic predisposition of the client. In the case of younger clients, operation of the lower eyelids is done mostly from the inner–conjunctival side of the eye.

Eyelid surgery can improve your look, but do not expect people to treat you differently. It is therefore important to consider what your expectations are from eyelid surgery. Eyelid surgery can be done together with face-lift or browlift.

Why eyelid surgery Prague?

Prague has many attractive features for those considering eyelid surgery abroad. Its location in Central Europe is easy to access; its mild climate is conducive to healing and its experienced clinics and eyelid surgeons ensure you’ll receive the best possible care. Eyelid surgery Prague costs are often much more affordable than in the UK or with the NHS. For more information about getting to and around the Czech Republic, please visit our handy cosmetic surgery Prague info guide.

How is eyelid surgery done?

Before the surgery

First, the consultation with the eyelid surgeon is very important. It is necessary to speak openly about the reasons for the operation and to decide if it is desirable to operate on all four eyelids or just the upper or just the lower. The surgeon will explain the operational procedure and the process of anesthesia. Do not be afraid to ask questions, especially if you have any doubts or are unsure about something. You can also get more information in our blepharoplasty forum.

Avoid the use of medications such as Acylpiryn, Aspirin, Alnagon or Mironal before the eyelid surgery, as they can increase bleeding during and after the procedure.

Eyelid surgery can be only done if the patient is in a general state of good health. Your surgeon will define the extent of pre-operational examinations needed.

While making pre-operation preparations, be sure to arrange for someone to drive you home after your eyelid surgery and help out for a few days, if needed.

Presurgical examination

If you decide to undergo the surgery under local anesthesia, a presurgical internal examination is not necessary. You are sent to eye department, where quality and field of vision will be checked, pressure inside the eye will be measured and your eye will be examined microscopically with slit lamp (all these examinations are part of normal examination at ophthalmologist).

Blepharoplasty is not performed if your lacrimal aparat does not function sufficiently. Functional tests of lacrimation serve for evaluation (e.g. Schirmer’s test: A small piece of paper with high absorbable features is inserted on the edge of lower eyelid, distance of its moistening is read after certain time). Further the surgeon evaluates various eye parameters:

Size of palpebral fissure: It is a separation between central edge of upper eyelid and the edge of lower eyelid. The palpebral fissure is narrowed, if the distance is less than 10 mm.

MRD1: It is a separation between middle of pupil in the straight position and middle of upper eyelid.

MRD2: It is the same distance between pupil and lower eyelid. Both these distances should measure more than 4 mm.

Distance between eye fold and centre of pupil.

Exceptionally the surgeon requests CT to eliminate pathologic processes in the back part of eye socket.

On contrary functional tests of eyelid levator are common. The upper eyelid is turned and the patient is asked to look upwards. If the levator is in function the eyelid should turn back. The second test checks the elevation of eyelid by elimination of frontalis muscle out of function.

Anesthesia

Eyelid surgery is usually performed under local anesthesia. However, the surgeon or patient may prefer to use general anesthesia. In case of general anesthesia, you will not be allowed to eat, drink and smoke for about six hours before the operation. If local anesthesia is used, the patient can leave for home after the surgery, however general anesthesia requires the patient to stay in hospital.

The surgery

Blepharoplasty usually takes about one hour. The incision of the upper lids is made in a place to allow the scar to be hidden in the eye´s natural folds. The incision of the lower lid is made approximately 2mm under the eyelashes along the edge of the eye. On the base of prior measurements and layout, excess skin and fat bags are removed during the treatment. Then the cut is closed with precise stitches. After the operation, the eyes may be covered with pads and slight elastic compression. According to your needs, the surgery is done on the upper and lower lids simultaneously or separately and can be combined with other cosmetic surgeries of the face.

Upper eyelid surgery

Indications to this procedure are:

Ptosis: It is drooping of upper eyelid, which interferes beyond the border of cornea. Ptosis can be congenital or caused during life. Mostly it is caused by underdevelopment of muscle that raises the eyelid or by damage of innervation of this muscle. Often also so-called pseudoptosis occurs, when the eyelid does not droop but is covered with skin fold. Pseudoptosis can be also caused by facial asymmetry and therefore is resembles look of a patient with ptosis.

Solution: At first we check the function of eyelid levator. The surgeon fixes the eyebrow with index finger. It disables function of frontalis muscle that works as adjoining muscle to eyelid elevation. After that he/she checks the movement of eyelids. If the movement is greater than 10 mm and ptosis is up to 3 mm, it means that the levator is in good condition.

Fasanell-Servat surgery (Müllerectomy) – Solution to moderate ptosis up to 2 mm with functional eyelid levator. The surgeon turns over the eyelid and cuts out part of conjunctiva and tiny adjoining muscle (Muller’s muscle) and it is sewed to levator. It shortens and reduces the ptosis.

Aponeurosis of levator palpebrae superioris (levator muscle of upper eyelid) – Solution to ptosis greater than 2 mm when the levator’s function is preserved. The surgeon folds the tendon of levator on the smooth cartilage that thickens upper lid.

Resection of musculus levator palpebrae (eyelid levator) – Solution to moderate ptosis with non-functional eyelid levator. The surgeon can choose either approach through skin (transcutaneous) or approach through interior of eyelid (transconjunctival). In case of transcutaneous approach the incision is lead in natural skin fold, so that the final scar is minimally visible. After that part of the muscle is lifted and the rested parts are sewed.

Frontalis suspension – Solution to non-functional levator and/or heavy ptosis. The surgeon makes two short incisions above the eyelashes of upper lid and two incisions above eyebrows. He/she creates tunnel between holes on lids and forehead and laces through them thin fascia artificial or own to the body (firm and flexible muscle cover). Patient after this surgery opens and closes eyelid with the help of frontalis muscle. He/she learns to control the eyelid with this method during rehabilitation.

Fat prolapses, dermatochalasis, and increased oblique muscle: The incision on the upper eyelids and therefore even final scar is lead so that it is hidden in the skin fold of the lid. This way the surgeon gets into the subcutis. After removal of fat prolapses he/she gets to the muscle. Reduction of muscle fibres is not performed commonly, only in case the muscle is too big. By cutting the muscle the surgeon penetrates into fibrous septum, which separates the orbit (part of the cranial cavity containing eyeball) from its external part. It also avoids the transfer of infection to the interior of orbit. Cutting this septum can remove fat that prolapses behind the eyeball. Greater effect can be achieved if the surgeon presses slightly on the eyeball. At the end of the surgery the muscles are sutured. The fibrous septum does not have to be sewed. During the procedure after previous measurement and draft excessive skin is removed. The surgeon must be careful not to remove too much skin, the lid won’t close then.

Lower eyelid surgery

Indications for lower eyelid surgery are similar to upper eyelids. They can be performed in two surgical approaches. By the first one the surgeon leads the 2 mm incision below eyelashes (subciliary approach), by the second approach is the incision lead from the conjunctival side of lid with laser (transconjunctival approach). The process is similar to upper eyelid surgery. The aim is the same to remove extra skin and fat. Covers on cornea and pads into eyelid are often used by the transconjunctival approach to eliminate unpleasant feelings during fat extraction under local anesthesia. Advantage of this procedure is mainly invisible scars. Although they cause more often complications that the eyelid lifts from the eyeball (Ectropion).

Blepharoplasty can be completed with a surgery correcting the width of palpebral fissure, the height of corners of the eye or their stabilization (canthopexy, canthoplasty).

Canthopexy: It is a surgery of outer canthus that fixes it. It completes blepharoplasty and can be done through same incisions. The surgeon fixes the ligament of outer corner to the ligament that covers parietal bone (periosteum).

Canthoplasty: It is a surgery similar to canthopexy and these terms are often mixed. By canthoplasty the ligaments of outer corner are loosened. After that the surgeon transfers the ligament and sutures it to periosteum. It changes also the shape of eyeball. Also this surgery presents additional procedure to blepharoplasty. Bandages and light elastic compressions are inserted after the procedure. There are new processes, when the excessive fat is not removed but it is shaped into desired shape. Through this method it was achieved to prevent often darker circles below the eyes after blepharoplasty. Sometimes carboxytherapy is recommended for visible eye circles. You can find out more in the articles: Carboxytherapy and How to solve bags and circles below eyes.

In some cases blepharoplasty is not recommended. It is especially when your eyes have small amount of tears or if you suffer from eye infection. If the skin is too short or if you have lagophthalmos (the inability to close the eyelids completely).

After eyelid surgery

Before you go home, you will receive detailed instructions about necessary care and also receive some painkillers. It is recommended to keep your head higher than the body while sleeping. For at least a week, you should avoid physical activities which raise your blood pressure as this is undesirable following eyelid surgery. The first few days after the surgery, the lids will be swollen and small bruises may occur, especially in the area of lower lids. There are many agents that help to moderate bruises and swellings and they therefore accelerate the recovery process. Wobenzym is recommended that moderates swellings. The best is to take Wobenzym second or third day after the surgery and three times a day. It is only an additional treatment; the state improves even without it. A similar effect has also ointment Auriderm, which is applied on the eyelids two times a day. It is good to start to apply it already 10 days before the surgery. There are many of such agents; it is good to talk about their usage with the surgeon. Eyes may be more sensitive to light, and it is usually recommended that patients wear sunglasses. Most people are able to read and perform their normal activities within a few days.

The stitches will be removed at the latest ten days after eyelid surgery, depending on the how the lids were sutured. Most swelling disappears during the first couple of days after surgery, if you carefully apply the compresses. Most clients return to work seven or ten days following eyelid surgery.

Complications

If you consider undergoing the eyelid surgery you should know about various complications that can be associated with this surgery. One of them is oculo-cardial reflex caused by pressure in the eyeball. It is manifested by reduction of blood pressure and pulse. This state can be very severe, although usually it is only small pressure reduction. Sometimes we can see separation of the wounds after taking out the stitches.

Most severe complication is so-called ectropion. It is a state when the eyelid is turned outwards and/or when the conjunctiva is separated from the eye. The patient has permanent tears and the skin around the eyes is constantly moist and irritated. One has the feeling of foreign element in the eye. The eye is then too sensitive and easily infected. Ectropion appears soon after the surgery as a consequence of the swellings, such ectropion is temporary and it improves with absorbing of the swellings. Permanent ectropion is caused by removal of excessively big part of the skin or by complication of deep scars in the area of muscles and ligament.

Therapy: It is not simple. If ectropion is caused by excessive removal of skin, muscle or fat and it is visible even during the surgery, an immediate transplantation of removed skin is then recommended. If such state is visible after the surgery, a skin transplanted from the back of the ear lobe replaces the removed skin. Within conservative therapy also a pressure massage and suspension of the eyelid are recommended. Sometimes even a surgical method canthopexy is used (fixation of outer eyelid).

Another possible and severe complication is feeling of dry eye.

Therapy: It is treated by conservative way with the help of artificial teardrops.

We often encounter with lagophthalmos. It is manifested by inability to close eyes completely, especially during sleep.

Therapy: Treatment is conservative because in most cases the improvement is reached without medical help. It is important that the eye doesn’t dry up too much. That is why artificial teardrops and eye creams during night are used. Sometimes it is good when the eyelids are covered with moistured plaster. Exceptionally a surgical treatment is performed.

Swellings and hematomas cause ptosis after the surgery. It is healed automatically during several days. Sometimes the levators of the eyelid can be damaged or innervated during the surgery. That causes permanent ptosis.

Therapy: Following therapy is surgical with the help of frontalis suspension, which is mentioned in therapy of congenital ptosis.

Very rare complication present visible scars, where the ligaments are reproduced. If you already have such scar on your body, consult it with your surgeon immediately after first session.

We usually encounter with hyperpigmentation (increased darkening) of treated area.

Therapy: If the hyperpigmentation is too visible it can be corrected with laser, although earliest half a year after the procedure.

Among very frequent complications that are not too severe belong milia. Those are tiny white formations localized in the scars. They are formed by damage and closing of the apertura of tiny glands.

Therapy: Easy treatment, when the milium is punctured with thin needle and the content is pushed out. If milia are formed repeatedly they can be cut off.

Asymmetry of palpebral fissure doesn’t have to be caused by the surgery. If the patient before the surgery was without asymmetry it means probably asymmetric removal of fat prolapses.

Therapy: The state is treated with reoperation.

The state is often complicated with infections that have very slight progress.

Blindness after the surgery is very rare. It is caused by bleeding behind the eyeball. Pressure of effusion of blood causes mortification of the retina. Symptoms of such bleeding are insidious; it is a tension inside the eye, pain and firm eyeball.As we age, gravity often takes its toll on our bodies. Sometimes this results in loose and excess skin on our face and neck. ses the same incisions; the procedure is simpler than the first surgery. Before and after photos of previous patient’s eyelid surgery can be seen here.

Laugh lines and other character wrinkles aren’t always funny or welcome on our face. The effects of gravity, exposure to the sun, and the stresses of daily life can all be reflected in our ageing faces. Usually they take the form of loose and sagging facial skin and skin folds in the neck; along with the appearance of wrinkles. One way to brighten your look and lessen the signs of ageing could be the face lift.

What is a face lift (rhytidectomy)

Wrinkles can take hold in different parts of the face on different people. Some people develop deep creases between the nose and mouth, while others see the skin around their lower jaw and neck is getting weak and loose. These changes can be effectively removed by having surgery of the face and neck, more commonly known as a face lift.

By removing excess facial skin, as well as any excess fat, and then tightening the underlying muscles and tissues, a reformation of the skin on the face and neck can be achieved. This can lead to the removal or lessening of the above mentioned signs of ageing.

Face lifts can be done alone, or in conjunction with other procedures such as eyelid surgery. Another option for you may be a feather face lift APTOS.

If you’re considering a face lift, the following information will give you a basic understanding of the procedure, when it can help, how it’s performed, and what results can be expected. You can post questions about face lifts in our forum. The actual procedure may more or less differ from this information, since a lot depends on the individual attitude of the patient and his relationship to his face lift doctor. A good result is always influenced through good understanding and cooperation between the patient and the surgeon. Therefore do not hesitate to ask your surgeon about anything you don’t understand.

Why facelift Prague?

Prague has many attractive features for those considering facelift surgery abroad. Its location in Central Europe is easy to access; its mild climate is conducive to healing and its experienced clinics and face lift surgeons ensure you’ll receive the best possible care. Face lift Prague costs are often much more affordable than in the UK or with the NHS. For more information about getting to and around the Czech Republic, please visit our handy cosmetic surgery Prague info guide.

The process of a face lift operation

Anesthesia

Face lift surgery can be done under general anesthesia or under so-called analgosedation, which is a combination of analgesics (painkillers) and sedatives. Most surgeons prefer this type of anesthesia but when deciding which type of anesthesia to use it depends on the patient. No matter what type of anesthesia will be used, people are requested not to eat, drink or smoke for a minimum of six hours before the surgery. The patient must also plan for a minimum one day stay in hospital.

Facelift – the surgery

A facelift usually takes 1.5 to 3 hours; if you’re having more than one procedure done, it can take longer. For extensive procedures, most surgeons prefer to schedule two separate sessions.

Every surgeon approaches the procedure in his or her own way. The exact placement of incisions and the sequence of events depends on your surgeon’s technique, although in most cases it doesn’t vary that much.

The incision usually begins above the hairline at the temples, extends in a natural line just inside the cartilage at the front of the ear, and continues behind the earlobe to the lower scalp. If the neck needs work, a small incision may also be made under the chin.

The surgeon gently loosens the skin around the temples and neck, and after an exact measurement he/she removes the excess. In case of a deeper fat layer, especially around the neck and chin, the procedure may be combined with a gentle liposuction. For a long lasting result it is necessary to tighten the subdermal musculoaponeurotic system tzv. SMAS lifting as well as the skin. The incisions are usually closed with intradermal absorbable sutures.

Under the skin of the neck and cheeks a drain may be placed on both sides. The drain will collect any liquid in order to prevent its accumulation which could significantly complicate the healing process. At the end of the surgery the surgeon usually uses an elastic bandage to fix the area of cheeks and neck.

Are you a good candidate for a face lift?

Face lifts are popular among women, and lately interest is growing among men as well. The main indication if a face lift would be right for you is loose skin in the face and neck. A natural condition is an overall healthy patient. Most patients are in their forties to sixties. A face lift can be done on younger patients, if the above mentioned ageing effects have appeared sooner than expected. The surgery can also be considered by older people, if they fulfill the medical requiremenrs. Face lifts can make you look younger and fresher and the result should never lead to an unnatural look. Before you decide to have face lift surgery, think carefully about your expectations and discuss them with your surgeon. Also, view before and after face lift photos to see the results from face lift surgery that you can expect.

Before your facelift surgery

If you decide to have a facelift abroad, your surgeon will explain the surgery process and the chosen anesthesia to you; he or she should also inform you about the risks involved. Don’t hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results. Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain medications. Carefully following these instructions will help your facelift to go more smoothly and you to heal without troubles. Before the planned surgery you should arrange for someone to drive you home after your surgery, and to help out for the first days if needed.

After your face lift surgery

The inserted drainage tube will be removed a day after the surgery and the patient can go home, but further treatment may be required.

In individual cases, a longer hospital stay may be necessary. The head bandage is usually removed three to five days after the surgery and nonabsorbable sutures, if used, are removed seven to ten days after the face lift. The convalescence period takes usually from one to two weeks. Any abnormal physical strain is not recommended for one month.

There usually isn’t significant discomfort after face lift surgery. If there is, it can be lessened with pain medication prescribed by your surgeon. Severe or persistent pain or a sudden swelling of your face should be reported to your surgeon immediately.

Some numbness of the skin is quite normal and it will disappear in a few weeks or months.

In the first phase after the surgery you should be prepared for both large and small swelling and sometimes even bruises. It is not possible to expect your final look right after the surgery, you will have to wait for it with patience.

The final effects can be expected to last for five to ten years. The procedure can be repeated as needed.

Skin rejuvenation that is drooping and aging. This revolutionary method uses plasma flow of ionized nitrogen that regenerates skin from depth but does not damage it. It can remove scars after acne, bags around eyes and other problems. You do not even have to restrict your activities even immediately after the procedure.

What is plasma and how does the Portrait device function?

Plasma is a fourth state of matter (beside liquid, solid and gas) which is formed by free electrons of atom that form inert gas. Nitrogen is used as a source of gas thanks to its ability to oust oxygen from the surface of he skin. This way we can avoid heating of the skin, burns and creation of scars. Nitrogen is not inflammable, therefore there is no risk of sparkle or explosion.

Plasma causes controlled thermal damage of the upper layer of old skin and stimulates creation of collagen fibers and therefore creation of new skin. There is no direct contact with the skin, however the thermal energy is transported right into the tissues.

Plasma skin regeneration – PRS uses portrait device.

The Portrait device is formed by radiofrequency generator that makes inert nitrogen gas, which is then placed into the adapter with a jet at the end in form of millisecond stream right on the skin. Immediately after the contact with the skin the energy changes into heat that won’t damage the epidermis. Plasma appears as a characteristic heat/flame, which changes in yellow light. The distance between the jet and the skin should be approximately 5 mm, in case of high energy the distance should be 1 cm to prevent creation of border lines. The pulse should flow in one direction not from left to right. The area and depth of the thermal effect depends on the selected energy and the size of adapter. The energy can be selected between 1 – 4 J per pulse. This technology can be used for different selected energies, that is associated with the depth of the treatment.

Peel of the epidermis to heating into depth is possible.

The resurfacing of the skin with the usage of plasma has 4 recommended schemas of treatment:

What areas can be treated by Portrait plasma?

It is mainly used for facial skin rejuvenation: wrinkle removal and general skin lift, removal of odds and unwanted pigmentation. Also for rejuvenation of skin on the neck, chest and back side of hands. The portrait device can treat also areas around mouth and eyes.

Anesthesia

Local anesthesia was used with the combination of anesthetic cream, which was applied on the treated area. At present usage of the cream is sufficient, although its application must have the right timing, i.e. it must be applied only on small areas and stepwise on the others according to already finished treatment.

What to do after the treatment of plasma portrait?

Care after the procedure of skin regenaration with plasma is minimal in case of usage of low energy. In high energies it is relatively simple. You should avoid sun exposure and apply sensitive cream on the treated spots frequently after the procedure during the healing process of the skin.

In case of usage of low energy the redness of the skin stays 2 – 3 hours. When using high energy redness and rough skin appearance is visible. The healing process takes 5 – 10 days, during this period the old epidermis peels away. It is important for the patient not to peel the skin by her/himself and wait until it separates. Not to intervene in the process of healing.

Undesired effects after plasma resurfacing

Redness and itching several days after the procedure is common. Itching can be avoided by application of ice on the treated spots. Creation of scabs can appear in case of usage of high energy. A sensitive lotion is good then. Dark spots on the skin might appear caused by low or high energy, they usually absorb within several weeks or months.

Financing the portrait skin regenaration

The price ranges from 5000 – 35000,- CZK depending on the size of treated area and the intensity of the procedure.