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The Board Certified Surgeons at Pacific Northwest Plastic Surgery specialize in the latest surgical techniques resulting in minimized scarring and natural results.



 

facial procedures

Face and neck lifts counteract the problems associated with aging, sun exposure and daily stresses of life by removing fat from the neck and tightening skin and muscles, giving your face and neck a rejuvenated, youthful look. In many cases, we combine the modern SMAS technique (deep tightening of the facial muscles), and the classic extended flap technique to produce the most natural results. The procedure can be combined with a browlift, eyelid surgery or Laser Skin Resurfacing for more harmonious results. The procedure involves in most cases removal of excess skin and tightening/reshaping of the skin and muscle tissues. The underlying muscle may be tightened with the skin, or separately. After the tightening or removal of excess skin, the skin is re-draped and sutured or stapled in place.

Face Lift Types

There are several names and variations associated with the facelift procedure. Patients with varying facial conditions will need different variations on the facelift. Multiple factors including, incision type, number of tissue layers required for treatment, and facial area, affect the type of face lift a patient will require. Our board certified doctors have a deep understanding and experience in performing face lifts, and can explain the best option for you during your initial consultation. Face lift types include deep plane lift or composite lift, SMAS lift, subperiosteal lift, skin lift, mid facelift or feather or thread lift. In general the most dramatic and effective are the Deep Plane and SMAS techniques.


Before After

Deep Plane Face Lift - For patients who wish to see a dramatic and natural change, this procedure treats the underlying tissue layers and muscles to provide the longest facial rejuvenation benefit. During this procedure the underlying tissue layers and muscles in the mid facial region are lifted and repositioned, resulting in improvements in the jaw line and nasolabial folds. The deep plane lift puts less tension on the facial skin itself. Incisions, which are carefully hidden, usually begin above the hairline at the temples, follow the natural line in front of the ear, curve behind the earlobe into the crease behind the ear, and into or along the lower scalp. If the neck needs work, a small incision may also be made under the chin. In most cases, scars will fade with time and should be scarcely visible.

SMAS Lift - The SMAS (superficial musculoponeurotic system) is a thin layer of soft tissue on the face that contributes to facial expression. Over time, the SMAS can become lax and sag, contributing to jowls and deepening of the nasolbial folds. The more common SMAS face lift repositions skin and the underlying muscle of the cheek to correct jowls and skin laxity. The SMAS lift will allow for a less “pulled” look and longer lasting results than a skin-only facelift. An extended SMAS lift goes even further towards the nose to help correct lines around the nose and the mouth. This is the same surgery as the SMAS facelift but with an extended SMAS lift, the SMAS is separated from the underlying structures more extensively towards the nose and upper lip. This can increase the amount of improvement that is possible in the center of the face, especially the nasolabial area.

Mid Face Lift - For patients who experience skin fold in the nasolabial area (soft tissue from around the cheekbones), sagging cheeks, and or facial skin laxity the mid facelift is an ideal procedure. The benefits of a mid facelift include the improvement of nose-to-mouth lines and the roundedness over the cheekbones, restoring a more youthful appearance. The procedure often requires small incisions along the hairline and inside the mouth so that the fatty tissues in the affected areas can be lifted and repositioned. The procedure uses small cuts in the hairline and the inside of the mouth, so scars are practically nonexistent.

After Your Surgery

Facelift patients normally undergo general anesthesia. Time in surgery is approximately 90 to 120 minutes. In some cases, drainage tubes are left in place under certain areas of the skin for several days to reduce post-surgical swelling. Smoking reduces blood flow to areas of the facial skin, so you shouldn't smoke a month before and a month after surgery. Stopping smoking will help the healing process. Immediately after surgery a large fluffy dressing is usually applied. Typically within one day after surgery it is removed and may be replaced with an elastic wrap. There is normally some discomfort following facelift surgery, which can be managed with medications. Some bruising may persist for two or three weeks, however by the third week you will feel much better.

Laser Skin Resurfacing

In laser resurfacing, sometimes called "laser peel," a carbon dioxide (CO2) or Erbium laser is used to remove areas of damaged or wrinkled skin, layer by layer. The high energy, amplified light waves of carbon dioxide (CO2) laser vaporize the top layer of skin instantly, with little or no bleeding and minimal trauma to the surrounding skin. The procedure is most commonly used to minimize the appearance of fine lines and resurface facial skin caused by excess sun exposure, aging, and acne. The treatment is ideal for areas around the eyes (“crow’s feet”) and vertical creases or "lipstick lines" around the mouth. However, it is also effective in treating facial scars or areas of uneven pigmentation. Laser resurfacing may be performed on the whole face or in specific regions. Laser resurfacing can help enhance your appearance and your self-confidence, but it won't completely remove all facial flaws, as such, the procedure is often done in conjunction with another cosmetic operation, such as a facelift or eyelid surgery. The final result from laser resurfacing may take several months to fully appear. However, once the pinkness fades, patients usually notice a significant improvement in the quality of their skin and a fresher, smoother appearance.


Before
After

We employ Pulse Erbium Laser and Scanned Carbon Dioxide Laser modalities for skin resurfacing. The right option for your needs depends on your skin type and will be discussed during your initial consultation.

The Procedure

Laser resurfacing is a relatively quick procedure. It usually takes anywhere from a few minutes to 1 1/2 hours, depending on how large of an area is involved. During the procedure the outer layers of damaged skin are stripped away. Then, as new cells form during the healing process, a smoother, tighter, younger-looking skin surface appears. When the imperfections are especially deep, we may recommend that the resurfacing be performed in two or more stages. Laser resurfacing is most commonly performed under local anesthesia with sedation, especially when it's used to treat localized areas of the face. You'll be awake but relaxed, and will feel minimal discomfort. For more extensive resurfacing, general anesthesia will be used, in which case you'll sleep through the procedure.

After The Surgery

You are likely to experience some mild swelling and discomfort after laser resurfacing. However, this can be controlled with ice packs and medications. If a bandage was applied after your procedure, it may be replaced with a fresh one after a day or two. After about a week or so, your bandage will be removed and a thin layer of ointment may be applied to the skin. After about two weeks or so, most patients can safely apply makeup to conceal this temporary color change. During this phase of healing, it is very important that you not pick the crusts off the treated area or scarring may result. Most patients are free of crusts by about 10 days post-operatively. Redness may persist for several weeks; however, some pinkness may remain for up to six months.

Eyelid Surgery- Blepharoplasty

Combining state of the art techniques, our surgeons rejuvenate the eyelids resulting in a more youthful appearance. During the aging process, the eyelid skin stretches, muscles weaken, and fat accumulates around the eyes, causing bags above and below. The procedure may include removal of excess skin and fat to correct puffy, sagging or tired looking eyes. In select patients, excess fat from the lower eyelid may be transposed or injected below the eyes to correct any undesirable hollow region below. Wrinkles may be improved by direct removal of excess skin and/or muscle or by laser re-surfacing. Though Blepharoplasty is often performed as a single procedure, it may be combined with a browlift, facelift, or skin resurfacing to achieve the best results.

The procedure

During your consultation, we will discuss one of several surgical techniques to improve the appearance of your eyelids. The particular technique best for you will depend on many factors such as the amount of excess fat and skin in the eyelid areas, the position of your eyebrows, and the condition of muscles around your eyelids. In upper eyelid surgery, individual lines and creases of the lids are marked in order to keep the scars as invisible as possible along these natural folds. The incision is made, and excess fat, muscle, and loose skin are removed. Fine sutures are used to close the incisions, thereby minimizing the visibility of any scar.


Before
After

In lower eyelid surgery, the incision is made in an inconspicuous site along the lashline and smile creases of the lower lid. Excess fat, muscle, and skin are then trimmed away before the incision is closed with fine sutures. Eyelid puffiness caused primarily by excess fat may be corrected by a transconjunctival blepharoplasty. The incision in this case is made inside the lower eyelid, and excess fatty material is removed. When sutures are used to close this kind of incision, they are invisible to the eye. They are also self-dissolving and leave no visible scar.

Blepharoplasty usually takes one to three hours, depending on the extent of the surgery.

After the Surgery

After the surgery, eyelids may feel tight and sore as the anesthesia wears off, but any discomfort can be controlled with the pain medication. Most people feel ready to go out in public (and back to work) in a week to 10 days. Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from two weeks to a month.

Brow Lift / Forehead Lift

Browlifts can revitalize and correct sagging or low position eyebrows, which create a tired or sad appearance, deep horizontal creases across the forehead, and frown lines between and across the top of the nose. The procedure may be done in conjunction with other surgeries such as facelift and eyelid to achieve a more harmonious and youthful facial appearance. Additionally younger adults who have a low brow or who already have deep frown lines due to stress or over activity of muscles may benefit from the procedure.

The Procedure

There are a variety of ways to elevate the brows and correct aging changes in the forehead area. There are three commonly used techniques: coronal lift, endoscopic lift, and subcutaneous lift. The doctor will closely examine your entire forehead and upper eyelid region, noting the muscle activity when you assume various facial expressions. The particular surgical technique that he will recommend will depend on many factors such as the position of your eyebrows, the amount of excess upper eyelid skin and the height of your hairline.


Before
After

The most common and long lasting of the techniques is a Coronal Lift, where an incision is made across the top of the scalp, beginning above the ears and hidden within the hair. This incision allows for the muscles (frontalis, procerus, and corrugators) that cause horizontal forehead wrinkles and scowling to be altered. About a 1-2 cm strip of the scalp will be removed and the remaining scalp will be sewn together. The incision is designed to be inconspicuous when healed. Additionally, this process allows for removal excess skin and lifts your eyebrows to a more pleasing level. Although this may sound gruesome, it is the oldest and most reliable technique in brow lift surgery.

You will notice some temporary puffiness and discoloration that may involve the eyelid and cheek areas as well. Typically, swelling and bruising will be almost totally resolved within a couple of weeks. You may use camouflage makeup almost immediately. If incisions were placed in front of the hairline, you should be careful not to apply makeup directly on any stitches. Expect temporary numbness and possibly some itching of the scalp as the nerves heal.

Any head dressings and drain tubes that have been inserted are usually removed one or two days after surgery. Showering and washing your hair will be delayed a day or two later. You will be able to resume most of your normal activities in ten days or less. You will be advised to wait several weeks before resuming strenuous activity and exercise and should temporarily avoid exposure to direct sunlight and, for the long-term, be conscientious about the use of a sunblock to protect your skin.

Rhinoplasty (Nose Surgery)

One of the most common plastic surgery procedures, rhinoplasty is performed to reshape, reduce or augment a person’s nose, remove a hump, narrow nostril width, change the angle between the nose and the mouth, or to correct injury, birth defects, or other problems that affect breathing. Rhinoplasty is usually an outpatient procedure performed under general anesthesia and lasts one to two hours.

Before the nose is altered, a young patient must reach full growth, usually around age fifteen or sixteen. Many patients have chin augmentation in conjunction with rhinoplasty to create a better balance of features.

The procedure

As rhinoplasty is very individualized, our board certified doctors take into consideration multiple factors, including but not limited to skin type, facial dimensions, bone structure and your goals in determining the surgical approach. Generally however, incisions may be confined to the inside of the nose, referred to as closed rhinoplasty, or may involve an additional small incision under the tip of the nose, referred to as open rhinoplasty.


Before
After

The majority of incisions are made inside the nose, where they are invisible. First, incisions are made and the bone and cartilage support system of the nose is accessed. In some cases, an incision is made in the area of skin separating the nostrils. Next, certain amounts of underlying bone and cartilage are removed, added to, or rearranged to provide a newly shaped structure. For example, when the tip of the nose is too large, cartilage in this area can be sculpted to reduce it in size. The angle of the nose in relation to the upper lip can be altered for a more youthful look or to correct a distortion.

The tissues are then redraped over the new frame and the incisions are closed. A splint is applied to the outside of the nose to help retain the new shape while the nose heals. Soft, absorbent material may be used inside the nose to maintain stability along the dividing wall of the air passages called the septum. Alternatively, soft nasal supports that permit nasal breathing post-operatively can be placed.

After the Surgery

Some discomfort can occur during the first couple of days after surgery but can be controlled with pain medication may be prescribed. A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. Within six or seven days after surgery, the splint and stitches are usually removed. Bruising may also occur and should fade so that you feel comfortable enough in social situations by around the tenth day after surgery. Swelling is also common and can take months to fully fade. Patients are typically able to return to work within one to two weeks, though strenuous activities should be avoided for two to three weeks.

Chin Enhancement/Reduction

Also known as Mentoplasty, Chin surgery is a relatively straightforward procedure that can make a major difference to your facial features by providing a more balanced profile. Chin surgery involves reshaping of the chin either by enhancement with an implant or reduction surgery on the bone. As mentioned earlier, we may recommend chin surgery to a patient having nose surgery in order to achieve facial proportion, as the size of the chin may magnify or minimize the perceived size of the nose. Chin surgery helps provide a harmonious balance to your facial features so that you feel better about the way you look. Another possibility for improvement through chin surgery is supplemental liposuction in which excess fatty tissue is removed to redefine the chin or neckline. If you have a double chin with excess skin, fat or muscle cording beneath your chin, then a facelift may not adequately correct this area. To take care of this problem properly, a small incision is made underneath your chin, and the fat in this region is removed using liposuction. The muscles that cause the bands in this area can be also cut or sutured together. This procedure is often performed in conjunction with a standard neck or cheek lift.

The procedure

To augment the chin, an incision is made either in the natural crease line just under the chin or inside the mouth, where gum and lower lip meet. By gently stretching this tissue, a space” pocket” is created where an implant can be inserted. This has the added benefit of tightening the submental neck skin (skin below the chin). The implant, made of synthetic material (silicone) feels much like natural tissue normally found in the chin, is available in a wide variety of sizes and shapes. This allows custom fitting of the implant to the configurations of the patient's face. After implantation, fine sutures are applied to close the incision. When the incision is inside the mouth, no scarring is visible. If the incision is under the chin, the scar is usually imperceptible.


Before
After

In chin reduction surgery, incisions are made either in the mouth or under the chin. The bone is sculpted to a more pleasing size. For orthognathic surgery, the surgeon will make an incision inside the mouth and reposition the facial bones. The procedure, depending on the extent of the work, takes from less than an hour to approximately three hours. Reduction Genioplasty is a form of chin reduction often used to treat an overly developed chin. This surgery aims at altering a protruding chin by removing excess bone from the chin bone. If you have an under-projected chin, our doctors alter it by detaching the tip of the chin bone and sliding it forward to augment the contour. Genioplasty is performed through an incision inside the mouth in the area of the lower lip. The tip of the chin is then carefully detached with a dental saw, moved forward and stabilized with wires and plates. This makes the chin more prominent. The surgery may result in swelling for several weeks to months while the bone heals.

Double Chin Correction

If you have a double chin with excess skin, fat or muscle cording beneath your chin, then a facelift may not adequately correct this area. To take care of this problem properly, a small incision is made underneath your chin, and the fat in this region is removed using liposuction. The muscles that cause the bands in this area can be also cut or sutured together. This procedure is often performed in conjunction with a standard neck or cheek lift. A chin implant may also be added to change the basic shape and balance of the face. It is especially useful in enhancing a profile for people with a receding chin and it can reshape the jawline as well.


Before
After

After the Surgery

Immediately after surgery, the surgeon usually applies a dressing that will remain in place for two to three days. You will experience some tenderness. Post-operative discomfort can be controlled with prescribed medications. Chewing will probably be limited immediately after chin surgery, and a liquid and soft food diet may be required for a few days after surgery. Most patients feel a stretched, tight sensation after the surgery, but this usually subsides in a week.

After approximately six weeks, most swelling will be gone, and you can enjoy the results of your procedure. Rigorous activity may be prohibited for the first few weeks after surgery. Normal activity can be resumed after approximately ten days.

breast procedures

Breast Augmentation

Breast augmentation can give women with small or unevenly sized breasts a fuller, firmer, better-proportioned look through the placement of implants in the breast. Women may elect to undergo breast augmentation for many different medical and aesthetic motivations, including balancing breast size and compensating for reduced breast mass after pregnancy or surgery.

Recovery

We employ the latest surgical techniques resulting in minimal or no scarring and faster post-operative recovery time. Recovery after a breast implant surgery varies by individual, but patients are usually able to return home immediately following their breast implant procedure. A return to light or normal activity is possible as soon as you feel ready, usually within a day or two of surgery. Some patients experience soreness and stiffness for the first days to weeks following surgery. A support bra may be recommended for the first week or two. Any swelling or bruising should subside shortly, and the final results of the breast implants will appear around four to six months after the surgery. The surgery itself takes approximately one to two hours.


Before

Breast Implant Size

The size of the breast implants used depends upon multiple factors, including an individuals desired amount of cleavage, proportion of the patient, and breast implant shape. Our doctors utilize an individualized approach in determining the size needed for your case and the type of implant needed to attain your goals. Implants come in a variety of volumes (cc) and, generally, the larger you want your cup size, the larger the breast implant considered. Another determining factor is the patients current breast tissue. A breast implant that is too large for your tissue can result in excessive stretching of the skin and result in the need for corrective surgeries. In addition, the implant edges may be apparent or visible postoperatively.

Breast Implant Types

There are two accepted and available breast implant fillers: saline and silicone. Both fillers have been FDA approved to be safe fillers for breast implants. The PARS Institute is a Silicone Certified provider and can help you choose the perfect solution for your individual needs. Saline fillers consist of isotonic watery saline solution (has the same concentration as the normal cells of the body and the blood) and present no health risk to the patient even when ruptured. Chances of rupture are very low, however if ruptured, saline implants will need to be manually removed with surgery.

Silicone implants consist of silicone gel, and have become the filler of choice for many patients as these implants generally have a more natural feel and are softer. Todays silicone gel breast implants are made differently than they were in the 1970s and 1980s. Initially, silicone gel breast implants had thick shells and thick silicone gel fills. In the 1970s manufacturers began to use thinner shells, which were more likely to rupture. Today, silicone implants are made with multiple layers of silicone elastomer surrounding the implant. This reduces the amount of gel bleed but can make the implants feel and look somewhat firmer, but much softer than saline. If ruptured, some gel bleed may occur and will need to be manually removed with surgery. Again, as with saline implants risk of implant rupture is very low. Unlike saline breast implants, silicone gel breast implants are pre-filled and are ordered in the requested size. Silicone implants cannot be placed endoscopically through a navel incision. Additionally, silicone implants are more expensive than saline.

Implant Shape

In addition to size, you will also be able to determine if you want to reshape your breast. Some implants give the breast a more rounded appearance, while others create a breast shaped like a tear drop, known as an anatomical implant. The best implant for you depends on your body frame, how much breast tissue you currently have and your goals. In most cases patients and doctors choose round implants.

Implant Profile

The profile is the forward projection of the implant from the chest wall. For the most part, breast implants come in three profiles: moderate, midrange, and high. For a woman with a narrow frame, a moderate or low profile implant that might result in a desired size, may be too wide and carry the implant too far to the cleavage and underarm. By using a high profile implant, this patient can get the larger implant she desires. By the same token, a wide framed patient may find that in order to adequately cover the natural diameter of the breast size, the desired implant would have far too much projection. A low or moderate profile might work better. We can explain the best choice for your body frame during the initial complimentary consultation. In most cases a moderate profile is recommended for patients with wider breasts who want more cleavage and less protrusion, and High profile for those patients with petite body frames and narrow breast width who want more frontal protrusion and less extension to the sides.

Incisions & Procedures

The implant placement refers to where the implant is positioned..under the Pectoralis Major (chest) muscle or over it, which places the implant only underneath the breast tissue. In almost all cases our doctor places the implants under the muscle. The breasts feels much softer and look more natural due to a layer of buffer (the muscle) covering the implant. Other significant benefits include: the long run opposing force of the muscle against the implant keeps the implant from stretching out the breast skin and a significantly less chance of capsular contracture (less chance implants get hard). Sub-muscular placement creates more tenderness for a short period of time post-surgery, but is worth it.

Incisions and Scarring

At The Pars Institute we utilize the latest techniques resulting in minimal or little scarring. The most common incisions include an inframammary incision (near the crease under the breast), an axillary incision (in the underarm area), or a periareolar incision placed at the edge of the areola (the pigmented skin surrounding the nipple). Incision patterns vary based on the type of implant, degree of enlargement desired, patient anatomy, and patient preference.

Breast Reduction

Women with very large, burdensome breasts may experience a variety of medical problems caused by the excessive weight from back and neck pain and skeletal deformities. Bra straps may leave indentation in their shoulders. Those will unusually large breasts may feel self-conscious and introverted. Breast reduction helps alleviate these problems by removing fat and glandular tissue and trims resultant excess skin to produce smaller and rejuvenated breasts that are in a healthier proportion to the rest of the body.

Also know as reduction mammaplasty, breast reduction surgery removes fat, glandular tissue, and skin from the breasts. As such, breasts will be smaller, lighter and firmer; areola may be reduced in size. The goal is to provide breasts in proportion with the rest of the patients body.

Your insurance provider might cover the expenses of breast reduction. Insurance providers stipulate that be medically necessary, not cosmetic.

Incisions & Procedures

Individual factors, such as breast size, shape, and weight will determine the specific technique selected to reduce the size of the breasts and approach. The most common method of reducing the breasts involves three incisions: around the areola, vertically from the bottom edge of the areola to the crease underneath the beast, and following the natural curve of the breast crease. After excess breast tissue, fat and skin are removed the nipple and areola are moved to a higher position, providing a youthful, perky, and rejuvenated look. The areola, which in large breasts usually has been stretched, is also reduced in size. Liposuction may be used to improve the contour under the arm. Our board certified surgeons make every effort to make scars as inconspicuous as possible. It is important to remember that breast reduction results in some scarring which will eventually fade to thin white lines. Fortunately, the scars can usually be placed so that they are covered by low cut tops.

Breast Lift


Before After

A womans breasts often change over time, losing their youthful shape and firmness. Loss of skin elasticity, gravity and other factors such as weight loss, pregnancy and breastfeeding ultimately affect the shape and firmness of your breasts. Patients who are generally satisfied with the size of their breasts can have a breast lift to raise and firm them, resulting in a more youthful contour. Some patients may be unhappy that they have lost a significant amount of breast volume over time. In such cases, implants inserted can increase breast size after the shape and position of the breasts are enhanced.

In general, a breast lift raises and firms the breast by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. Sometimes the areola has become enlarged over time. A Breast lift will give you the option of reducing the areola diameter. The volume of the breast may also be restored by introduction of a breast implant.

Are you a good candidate for a breast lift? Generally, if your breasts lack substance or firmness and/or the nipples and areolas point downward, especially if they are positioned below the breast crease you are a candidate for a breast lift.

Breast Lift Techniques and Incisions

Breast lift procedures vary in technique depending on how much skin needs to be removed. The common techniques include: CRESENT- a small amount of skin is removed above the areola; DONUT the skin is removed from around the entire areola (these types of breast lifts are used for minimal repairs). LOLLYPOP- skin is removed from around the entire areola and then, additional skin is removed through an incision that extends vertically from below the areola to underneath the breast. INVERTED T- the skin is removed from around the entire areola and with additional skin being removed via a lollypop incision line and, then more skin is taken off through a horizontal incision line that is directly underneath the breast. In some instances, it may be possible to avoid the horizontal incision beneath the breast. Sometimes a technique may be used that avoids this horizontal incision as well as the vertical incision that runs from the bottom edge of the areola to the breast crease. Our doctors have extensive experience performing breast lifts and can review the necessary information to make the right decision for your case.

body procedures

Liposuction

One of the most popular cosmetic surgery procedures, liposuction sculpts the body by removing undesirable fat from areas such as the abdomen, waist, hips, buttocks, thighs, knees, neck and upper arms that have not responded to diet and exercise.

Abdominoplasty (Tummy Tuck)

Abdominoplasty is a surgical procedure that helps to flatten and shape the abdomen and waist by removing excess fat and skin and tightening muscles. The best candidates are those with pockets of fat and/or loose skin that havent responded well to diet and exercise.

Abdominoplasty can also be useful for women with stretched skin and muscles from pregnancy With a balanced diet and regular exercise, results are long lasting.

Arm Lift & Thigh Lift

After substantial weight loss, weight gain or simply from the effects of aging, skin on the upper arms and upper inner thighs can become inelastic, loose and flabby. Arm and Thigh lifts, remove that excess skin and fat.