Robert Bryan Roach, J.R. D.D.S.
Diplomate of the American Board of Oral and Maxillofacial Surgery

1202 E. Sonterra Blvd. Suite 801 San Antonio, TX 78258
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Procedures

Facial Cosmetic Surgery

Facial Liposuction  Chin Surgery  Cheek Implant  Eyelid Surgery  Blepharoplasty  Brow Lift
Rhinoplasty  Otoplasty   BOTOX® Cosmetic Injections  Restylane

Facial Liposuction

Liposuction is a very common, popular procedure.  It is designed for the permanent removal of fatty tissue, commonly referred to as “cellulite.”  It is an elective procedure that allows the cosmetic surgeon to remove undesirable, subcutaneous fat in isolated areas that do not respond to diet and exercise. 

Liposuction is most successful in people with good skin tone who have fatty deposits.  It is not a treatment for obesity. If weight gain occurs following liposuction, the fat will be deposited in areas that have not been treated. The procedure can be repeated, if necessary.  To maintain the safety of the procedure, there is a limit on how much can be done at one time.

A variety of factors can affect the results: Physical condition, genetic makeup, diet, exercise, smoking, alcohol intake, and skin elasticity.

Facial contours made irregular by fat can be improved by this procedure; it cannot correct contours that are irregular for other reasons, such as muscle weakness or hernia.  However, combined with other procedures, liposuction can correct these other deformities with good results.

The Procedure

Facial Liposuction is done under IV sedation or general anesthesia on an outpatient basis in our in-office OR suite or a hospital. The surgeon makes small (less than 1/2 inch), discreet incisions in the areas to be treated.  A cannula is inserted in a small incision and attached to a suction machine. The procedure may take an hour or more, depending on how many areas are involved. 

Recovery

Recovery from liposuction is relatively easy.  Expect a fair amount of swelling and bruising in the following two weeks.  You will wear special garments provided to apply pressure, minimize swelling and provide support while healing.  These garments also assist in retraction of the skin. Stitches will be removed in a week to 10 days. 

"Results are recognizable almost immediately and will continue to improve as swelling subsides. "

The day after surgery you should be up and walking around. Increase your activity daily until full activity is resumed at 2-4 weeks. You will be ready to return to office work in 3-5 days and more active employment at 10-14 days. Avoid the sun until all bruising has subsided. A sunscreen should be used routinely; it is easy to get sunburned during recovery because of decreased sensation.

The results of liposuction are permanent. If you were to gain a large amount of weight you might note rippling in the treated areas, depending on your skin elasticity. 

Possible Complications

As with any surgical procedure, complications can occur. Cosmetic complications include contour irregularities, skin discoloration, asymmetry, scar tissue, tape burns, collection of blood or fluid under the skin. Uncommon complications include loss of sensation, skin breakdown, fat embolism, serious infection or shock.
Following liposuction, the scar will go through a maturation process. During the first 8-12 weeks the scar(s) may be red and possibly raised. They will mature over 6-12 months and become pale, flat and soft. You may experience numbness, burning, tingling around the incision site. These symptoms are almost always temporary.

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Chin Surgery (Genioplasty)  

Mentoplasty can increase or reduce the size of the chin. The best candidate for chin surgery is the individual with a receding or protruding chin and a normal dental bite. For those whose bite needs correction, jaw surgery in conjunction with mentoplasty may be necessary. There are two basic procedures used in mentoplasty: one involves moving the chin bone forward or backward and the other involves the use of an artificial chin prosthesis to add size to a receding chin. To move the bone forward or backward, the surgeon cuts through the chin bone. The lower portion of the bone is then moved forward or backward and wired or fixed to keep it securely in position. A chin prosthesis can also be used to create a more prominent jaw. Using this technique, a prosthesis, similar in consistency to the natural chin and sized to fit the patient, is placed in front of the bone to increase the chin's prominence.  

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Cheek Implant (Malar Augmentation)

Malar augmentation can give definition to a face that has a flat contour because of underdeveloped cheekbones. The best candidate is the individual with a long narrow face or very round face and flat cheeks. This surgery can help to create the appearance of higher, more prominent cheekbones. During the procedure an incision is made either inside the mouth or immediately below the lower eyelids. Most frequently, using the internal approach, the surgeon makes an incision between the upper gums and the cheek. The surgeon then elevates the soft tissue, creating a small pocket over the cheekbone. A prosthesis, similar in consistency to the natural cheekbone and usually triangular in shape, is then inserted and placed over the cheekbone.

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Eyelid Surgery

As we all know, the eyes are a prominent facial feature. Although the eyes are expressionless structures, the surrounding skin conveys emotion. The tissue, muscle, fat, hair and lashes all contribute to the wide array of expressions. Unfortunately, wrinkles and deep lines as well as puffiness under the lids develop as you age. In addition, exposure to the sun as well as hereditary factors contribute to the aging process, all resulting in changes of expression. In many cases, people may look fatigued, worn out and older than their true age. Beyond possible visual impairment, these changes in your appearance can cause stress and anxiety.

Our surgeons are trained in several surgical procedures, such as blepharoplasty and brow lift, in order to eliminate the majority of these problems.

Before Surgery

To better understand your overall health, we will evaluate your medical history prior to surgery. In addition, a complete examination of your eyes and face are made in order to take the most effective surgical approach. The amount, distribution and type of excess skin to be removed are carefully reviewed.

Dr. Roach will provide you with pre-operative instructions that may include the elimination of specific drugs containing aspirin several weeks before surgery to minimize excess bleeding. Antibiotics may also be prescribed to prevent infection.

The areas that will be excised are marked and digital photographs and computer imaging is performed in order to determine the amount of improvement after surgery.

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Blepharoplasty

We can perform blepharoplasty to correct sagging eyelids, bags or pouches beneath the eyes, as well as excess folds around the eyes. This surgical procedure involves the removal of excess skin and fat on upper and lower eyelids and is often performed in conjunction with other surgical procedures including facelifts, eyebrow and forehead lifts. Blepharoplasty can be done under general anesthesia (with you asleep) or under IV Sedation. Both are very comfortable options. Pre-medication is utilized prior to surgery to decrease swelling after the operation.

"Our surgeons are trained in several surgical procedures, such as blepharoplasty and brow lift"

One of our surgeons will trace the natural lines and creases of your face and make incredibly fine incisions from the inner to the outer edge of the eyelid. Surgery on the upper eyelid is performed first with the incision made in the fold of the lid. Any excess fat and skin are removed from the underlying compartments. The amount of fat excised is determined by the degree of protrusion of fat when pressure is applied to the area. Small sutures are used to close the incision and special ointments and dressings may be applied. The surgery can take up to 2 hours. In certain cases, lower eyelid incisions are made inside the lid. Laser may be used at the same time to reduce wrinkles.

Post-Operative Information

Initially, drying of the eyes can occur after blepharoplasty. This condition can be alleviated with medication. In addition, you may be sensitive to bright light and wind for a period of time. Numbness and itching may also occur during the healing process. A final evaluation may occur within several months from the initial surgical procedure.

Insurance

Your insurance company may pay for part of the cost of surgery if the procedure is performed as a result of visual impairment. Because every insurance carrier is different, it is recommended that you check with your own insurance company to determine the level of coverage.

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New Minimally Invasive Brow Lift

Dr. Roach performs Brow Lifts to raise eyebrows, thus creating a smoother, more youthful appearance. This procedure can be performed in conjunction with a blepharoplasty.

This technique allows the surgeon to perform a brow lift through a single, upper lid incision used for a conventional blepharoplasty. Using a resorbable material, the brow is lifted and secured in its new position. Now the patient has an opportunity to regain a youthful, beautiful appearance around the eyes, without undergoing the more traditional brow lift.

Post-Operative Information

Antibiotics may be prescribed for several days following surgery. Sutures are generally removed within one week. Swelling and some bruising may occur, but they should subside within the first week. Our doctors will prescribe ice compresses and eye exercises to reduce swelling and regain mobility. Women will be allowed to resume eye cosmetics approximately two weeks after surgery. You can proceed with your normal daily activities within 1 week.

Insurance

Your insurance company may pay for part or all of the cost of surgery if the procedure is performed as a result of visual impairment. Because every insurance carrier is different, it is recommended that you check with your own insurance company to determine the level of coverage.

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Rhinoplasty

Dr. Roach performs rhinoplasty in order to reshape the nose. Appearance can be improved for those people who are dissatisfied with the shape and size of their nose. Nasal reconstruction was one of the first cosmetic procedures ever developed and is among those most frequently performed today. Rhinoplasty is a surgical procedure in which deformities of the nose are corrected by removing, rearranging or reshaping bone or cartilage.

Reasons for Surgery

Reasons include reducing the size of the nose, removal of bumps as well as improving the angle of a nose. Conditions may be natural or due to external trauma to the face. This operation will also help patients who have difficulty breathing. The operation can be performed on all age groups, including teens and the elderly.

Before Surgery

A medical history along with a careful examination is conducted in order to evaluate your general health. We will discuss with you the way your nose can look in relation to your other facial features. Digital photographs and computer imaging allow our surgeons to evaluate the appropriate procedure to achieve the desired results. Pre-operative instructions may include the elimination of certain drugs that contain aspirin in order to minimize the possibility of excess bleeding. Antibiotics may be prescribed before surgery to prevent infection.

Method of Surgery

Surgery is usually performed under IV sedation or general anesthesia. In most cases involving a reduction in shape or size of the nose, or removal of a hump, the skin of the nose is separated from the underlying skeleton of bone and cartilage. The bone and cartilage are then reshaped and the skin re-draped over the surface. Patients who have a deviated septum may benefit by correction of this problem. The incisions are placed inside the nose, unless the surgeon uses an open approach, in which case the incisions are made across the tissue between the nostrils. In cases where the nostrils flare, the surgeon may make an incision at the junction between the nose and the skin of the upper lip to narrow the flared appearance. It is not unusual to combine rhinoplasty with chin augmentation to improve the profile.

Post-Operative Information

The recovery takes 1-2 weeks. Most people resume their normal activities within a week or two. Following surgery, a lightweight splint is applied to maintain the new shape of the nose. The splint is removed within a week. Internal nasal splints may be inserted at the time of surgery to protect the septum. These are removed within a week. There is always some stuffiness of the nose, especially when work has been done on the nasal septum.

Pain is minimal and is controlled with medications. Bruising occurs around the eyes, but begins to fade within a few days. Discoloration usually disappears in two weeks.

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Otoplasty

In cases of protruding or over-developed ears, the procedure of otoplasty may be an option. Otoplasty is commonly referred to as "pinning back" of the ears. It is available for children once their ears have stopped developing around the age of six. Over-developed ears can be the cause of psychological stress and trauma and should be treated at a young age before it becomes a serious issue.

"Dr. Roach is trained in several surgical procedures, in order to eliminate the majority of the problems related to protruding ears."

Before Surgery

To better understand your overall health, we will evaluate your medical history prior to surgery. In addition, a complete examination of your ears is made in order to take the most effective surgical approach. All issues such as shape and types of anesthesia used will be discussed.

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BOTOX® Cosmetic Injections

BOTOX® Cosmetic treatment is a revolutionary approach to reversing the affects facial wrinkles. Crow's feet, worry lines, and laugh lines can all be a thing of the past. These are referred to as dynamic wrinkle lines and all are treatable with this procedure. Cosmetic denervation is the process of injecting BOTOX® Cosmetic into the tiny facial muscles that create the wrinkles. 

Before Treatment

To better understand your overall health, we will evaluate your medical history prior to treatment. In addition, a complete examination of your eyes is made in order to decide the most effective injection sites. All issues and concerns will be discussed.

The areas that will be treated are marked and digital photographs are taken in order to determine the amount of improvement after treatment.

The BOTOX® Cosmetic Procedure

BOTOX® Cosmetic injections are performed without anesthesia because it is virtually painless but anesthesia is available if patient desires it. Only a very small sting is felt when the injections are made. The effects are not permanent and may need to be repeated two to three times per year to retain the effects. Research has suggested, however, that long term use of the injections leads to a longer duration of each treatment's effect. Patients over the age of 65 may not experience as dramatic of results. BOTOX® Cosmetic is only useful in treating expression lines and cannot be used to repair sagging skin caused by aging.

Post-Treatment Information

After the treatment, patients may experience slight bruising around the area that quickly fades. Normal activities can be performed immediately. Possible side effects are temporary weakness of nearby muscles or in rare cases an eyelid may droop. BOTOX® Cosmetic is completely reversible so any side effect is only a temporary condition. The doctor will explain all risks associated at the time of your consultation.

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RESTYLANE

What is Restylane?

Restylane is a safe and natural cosmetic dermal filler that restores volume and fullness to the skin to correct moderate to severe facial wrinkles and folds, such as nasolabial folds.

What is Restylane made of?


Restylane is the first and only cosmetic dermal filler made of non-animal based hyaluronic acid. Hyaluronic acid is a natural substance that already exists in the human body and is used to provide volume and fullness to the skin.

What can you expect?

Restylane is injected directly into the skin in tiny amounts by an ultrafine needle, resulting in minimal discomfort. The procedure is simple and convenient and results are practically instantaneous. If you would like to discuss Restylane procedure with one of our surgeons please contact us.

What should patients do prior to treatment?

Restylane requires no pretesting, but you should take a few precautions before being treated. Avoid using aspirin, non-steroidal anti-inflammatory medications (Advil), St. John's Wort, or high doses of Vitamin E supplements prior to treatment, because they may increase bruising or bleeding at the injection site. Also if you have previously suffered from facial cold sores, there is a risk that the needle punctures could contribute to another recurrence.

Is Restylane safe?

Yes. Restylane has been used safely by dermatologists and plastic surgeons since 1996 worldwide. Because Restylane is non-animal-based and fully biocompatible, allergy testing is not required. There is virtually no risk of animal based disease transmission or allergic reaction. The most commonly reported side effects were temporary redness and swelling at the injection site. These effects typically resolve within two to three days.

Can Restylane be used anywhere on the face?

Restylane has been used in more than one million treatments in over 60 countries to correct a variety of wrinkles and to enhance the appearance and fullness of lips. However, it is currently only indicated in the U.S. only for the treatment of moderate to severe facial wrinkles.

How long does Restylane last?

Studies have shown that the average treatment results last 6 months or even longer. This unique technology helps maintain the cosmetic effect until the injected material is nearly gone.

How often should I have Restylane treatments?

Restylane last twice as long as collagen, so treatments are typically scheduled twice a year.

How is Restylane different from botox?

Restylane is a natural cosmetic filler. In contrast, Botox is a drug that blocks nerve transmission and relaxes the underlying muscles. Many patients have been very pleased after receiving treatment with both products.

How is Restylane different from bovine collagen?

Restylane is proven to deliver a longer-lasting effect than traditional collagen, with virtually no risk of animal-based disease transmission or allergic reaction. In addition, bovine collagen is derived from animals and requires an allergy test.

Do the injections hurt?

Restylane is injected directly into the skin in tiny amounts by an ultrafine needle, resulting in minimal discomfort. The procedure is simple and convenient, and results in practically instantaneous. To optimize your comfort during the procedure, your physician may anesthetize the treatment area.

How much do Restylane treatments cost?

Restylane is a customized procedure based on your specific needs, so the cost will vary from patient to patient. In general, the cost of Restylane is comparable to the cost for similar procedures. Because Restylane is longer lasting, it proves to be very economical over the long term. Please consult your physician to determine the best recommendation for your particular needs.

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