Cosmetic Surgery Procedures

AWAKE Abdominoplasty

The Tummy Tuck

AWAKE Abdominoplasty procedures involves the use of a diluted solution of local anesthetic and other medications to remove excess skin from the middle and lower abdomen while tightening the abdominal muscles and fascia of the abdominal wall. Most stretch marks are typically taken out along with the skin removal.

AWAKE Abdominoplasty is an outpatient procedure, avoiding a costly hospital charge under General Anesthesia. Since the patient remains awake during the surgery, the patient will see the results before the completion of the surgery.

AWAKE Tumescent Abdominoplasty has an unprecedented safety record and allows the surgeon to efficiently remove both deep and superficial excess layers of fat with little discomfort, faster recovery and improved cosmetic results. Patients see fewer skin irregularities, less bleeding, and reduced bruising.

The Procedure

1. To begin the procedure, the doctor injects a solution into the fatty tissue that anesthetizes the area. It causes the area to become firm and swollen, which enables the surgeon to extract fat more accurately and uniformly.
2. Small incisions are made in the skin around the treated area.
3. After these incisions are made, a cannulas is inserted through these small openings and the fat is removed.
4. Once the maximum benefit of liposuction is achieved, an elliptical incision to directly above the pubic area is made. A second incision is made around the belly button.
5. Excess skin is removed with caution given to specifically resect only the dermis and preserve the subcutaneous structures
6. Once resection is complete, the incisions are closed with Quill™ SRS wound closure sutures.
7. The wounds are then covered with sterile gauze pads and elastic support garments are placed. The areas of the liposuction procedure may stay numb for 36 hours without further injection of lidocaine or other pain killers.
8. After 30 minutes of observation, the patient is allowed to leave.

AWAKE Liposuction

AWAKE Liposuction (also known as Tumescent Liposuction) involves the use of a diluted solution of local anesthetic and other medications to fill the fatty layer of the skin prior to removing the excess fat. This causes the tissue to become swollen and firm, allowing for excellent control. General anesthesia is not required, eliminating potential complications. This involves sculpting the bulging areas for the appearance of more attractive contours.

AWAKE Liposuction is an outpatient procedure, avoiding a costly hospital charge under General Anesthesia. Since the patient remains awake during the surgery, the surgeon can ask you to change positions which leads to better sculpting of the targeted areas.

Tumescent liposuction has an unprecedented safety record and allows the surgeon to efficiently remove both deep and superficial excess layers of fat with little discomfort, faster recovery and improved cosmetic results. Patients see fewer skin irregularities, less bleeding, and reduced bruising.

The Procedure

1. To begin the procedure, the doctor injects a solution into the fatty tissue that anesthetizes the area. It causes the area to become firm and swollen, which enables the surgeon to extract fat more accurately and uniformly.
2. Small incisions are made in the skin around the treated area.
3. After the incisions are made, a cannulas is inserted through these small openings and the fat is removed.
4. The incisions are closed with Quill™ SRS wound closure sutures.
5. The wounds are then covered with sterile gauze pads and elastic support garments are placed. The areas of the liposuction procedure may stay numb for 36 hours without further injection of lidocaine or other pain killers.
6. After 30 minutes of observation, the patient is allowed to leave.

AWAKE Breast Augmentation

Your Voice. Your Choice.

AWAKE surgeries are based on the Klein Technique, which uses lidocaine to numb tissue in order to perform surgery. The term AWAKE Breast Augmentation is a term created by Dr. Anil Gandhi.

It has been shown that this technique has an extraordinary and unprecedented safety record when used as directed and has few of the side effects or risks associated with using General Anesthesia. A secondary benefit to using this procedure is that since the patient is "AWAKE", she can determine whether to increase or decrease the volume as desired, prior to closing the incisions. This is the ONLY technique that gives the patient the opportunity to make an informed consent as to the final size of her augmentation during the surgery.

In 2008, Dr. Novoa studied with Dr. Gandhi and completed training in AWAKE Liposuction, AWAKE Breast Augmentation and AWAKE Lipoabdominoplasty (Tummy Tuck). Since this date, Dr. Novoa has performed hundreds of AWAKE Breast Augmentation, Liposuction and Lipoabdominoplasty procedures.

In January 2012, Dr. Novoa presented a research paper at the Fifth World Congress of the International Society of Cosmetogynecology (ISCG) and the American Academy of Cosmetic Surgery (AACS). The paper, Tumescent Breast Augmentation Surgery (TABS), is the first and largest research paper discussing AWAKE Breast Augmentation without the use of any sedation. This paper, along with Dr. Novoa's instructional video on AWAKE Breast Augmentation found on YouTube.com, has been recognized nationally and internationally as a reference for AWAKE Breast Augmentation.

The Procedure

1. Prior to the start of the procedure, the patient is given only Extra Strength Tylenol without any sedative.
2. To begin the procedure, tumescent anesthesia (lidocaine, epinephrine & sodium bicarbonate) is injected in subcutaneous tissue of the breasts while the patient is "awake" to numb the area.
3. Once the anesthetic has taken effect, inframammary incisions ^{(Figure 1)} are made for insertion of the impants. This the most commonly employed incision and after healing, the scar tends to be well hidden under the new breast crease. The scar, however, will be more visible if the patient is lying down. The length of the incisions depends on the type of implants that are chosen. Typically, saline implants will require a smaller incision as opposed to silicone implants.
4. After the incisions are made, a surgical tool is used to create subpectoral pockets so that the implants can be inserted.
5. Once the pockets are created, the implants are inserted under the pectoralis major muscle.
6. Once the implants are inserted, the patient is placed in an upright position so she can preview the look of her new breasts. At this time, any additional determinations regarding size, placement, or profile of implant can be made. The advantage of saline implants becomes very apparent during this step. Since the patient is awake, she can determine whether to increase or decrease the volume as desired prior to closing the incisions. Saline implants can be adjusted in size in the event that one breast is larger than the other. Silicone implants cannot be incrementally adjusted with the flexibility of saline implants. To compensate for common asymmetry in the breasts using silicone implants, the surgeon must preoperatively estimate the difference in size and insert two different size implants to compensate for the asymmetry during surgery.
7. After final adjustments have been made, the incisions are closed using absorbable sutures.
8. The patient is then bandaged and supporting garments are placed.
9. After 30 minutes of observation, the patient is allowed to leave.

Click here to see before and after results of AWAKE Breast Augmentation surgery.

AWAKE Labiaplasty

Labiaplasty surgery involves surgically reducing the enlarged or irregularly shaped labia minora. Typically the labia grows abnormally during childbirth or even during hormonal changes in a woman's life.

Large labia can be an embarrassment to some woman while in others the condition can be very uncomfortable. On occasion the labia can protrude and can be noticeable through clothes. In such cases, pain or discomfort can be felt when wearing tight fitting clothes, while exercising or during intercourse.

We offer two types of labiplasty surgery styles, "Peek-a-boo" and "Barbie doll".

The Procedure

1. The surgery is typically minimally invasive based on patient's request and performed under local anesthesia on an outpatient basis.
2. Once the area is numb, the labial tissue is surgically incised and reshaped for a more natural look.
3. The ends are then sutured with Quill™ SRS and the area is cleaned and bandaged.
4. After 30 minutes of observation, the patient is allowed to leave.

Clitoral Hood Reduction

Clitoral Hood Reduction surgery (Clitoropexy) involves surgically reducing the excess tissue surrounding or covering the clitoris. This "hood" covering, which is analogous to a male's foreskin, can become enlarged and protrude making it physically and emotionally uncomfortable for the woman. An enlarged clitoral hood can also have a negative impact on a woman's sexual pleasure during intercourse because of the extra skin desensitizing the clitoris. However, some women may just want to aesthetically change the appearance of their clitoral hood.

Dr. Novoa offers this exceptionally precise surgery for women seeking to improve the aesthetic appearance of their genital area by excising the extra folds of skin lateral to the clitoris. The clitoris itself and its nerves are never touched. This is NOT clitoral mutilation or clitoral un-hooding.

The Procedure

1. The surgery is performed under local anesthesia on an outpatient basis. Once the area is numb, the redundant tissue is surgically excised and removed to allow the clitoris to be more easily stimulated.
2. The ends are then carefully sutured and the area is cleaned and bandaged.
3. After 30 minutes of observation, the patient is allowed to leave.

Click here to see before and after results of Clitoral Hood Reduction surgery.

Vaginal Rejuvenation

Sometimes, a woman will experience vaginal looseness or vaginal relaxation as a result of childbearing, trauma, or simply due to aging. The muscles become relaxed and have poor tone, strength, and control. The internal and external diameters increase. The vagina is no longer at its optimum physiological state. As a result, sexual gratification between a woman and her husband or partner decreases.

Traditionally, gynecologists have only been able to offer pelvic exercises, called Kegels, as a non-surgical technique to improve the strength and tone of the vaginal tissue. However, these exercises have little or no effect on severely relaxed vaginal tissue.

One of the most controversial GYN surgical therapies, Vaginal Rejuvenation Surgery (VRS) involves the surgical modification of the vagina. VRS is a surgical procedure designed to repair and tighten the vagina to a smaller, "pre-vaginal delivery" state.

Upon request, the vagina can even be returned to a virginal size, which is given the term Virginal Size Restoration Surgery (VRSR), also known as Virginal Restoration (VR).

Who wants Vaginal Rejuvenation Surgery?

• The typical patient requesting this type of surgery is aged 30-50 who has completed her child-bearing years.
• Many women want to celebrate their relationship in an extremely special way. This is especially important to women who have recently remarried or entered into a new relationship.

Post Operative Expectations

• The expected recovery time after surgery is at least 6 weeks.
• After surgery both the patient and their partner feel dramatic differences in the vaginal size and tone. Once the initial pain and discomfort of sexual activity resolves, sexual gratification and orgasm is often enhanced and improved. The possibility of having multiple orgasms increases.

Click here to see before and after results of Vaginal Rejuvenation Surgery.