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 the most common procedures performed by

DR. ANDREW PICHLER            

(click on a procedure)           (Before & After Gallery)

Laser Skin Resurfacing
Facelift
Eyelid Tucks
Rhinoplasty
Glycolic Acid Peels
Obagi "Blue Peels"
Microdermabrasion
BOTOX Cosmetic
Forehead & Eyebrow Lifts
Cheek & Chin Implants
Otoplasty
Lip Enhancement
Radiesse
Restylane
Thread Lift, ( FeatherLift, APTOS, Contour)

DR. PICHLER

 uses the most advanced, tried and true facial plastic surgery techniques available today serving the greater Sacramento area in Carmichael, California. Facelift, rhinoplasty, brow lift, lip enhancement and eyelid tucks are the most commonly performed procedures.  Using a variety of techniques that include surgical incision and excision, electrosurgery, chemosurgery, laser surgery and minimal incision endoscopic surgery, Dr. Pichler gets the results you desire!

The practice also offers a full line of facial cosmetic and enhancement products such as cosmoceuticals, injectable fillers (Restylane, Perlane, Radiesse) and Botox(R) as well as the newly FDA approved Dysport(R).

Specializing in facial plastic and facial cosmetic surgery exclusively, facelifts, rhinoplasty ("nose job") and eyelid tucks (blepharoplasty) along with lip augmentation and brow lifts are the mainstay and strength of the practice.

Feel free to browse our Before & After Gallery.  Follow the links above for more information on the procedures themselves.

In the past twenty years, the field of plastic surgery has witnessed numerous advancements, both in techniques and instrumentation, enabling surgeons to perform a wide variety of beauty enhancing surgeries in a safe manner. Following is a sampling of what is available today:

Laser Skin Resurfacing:

Laser skin resurfacing is the most revolutionary skin rejuvenation procedure available. There are several different type of lasers but in general, the deeper the treatment the better the result but also longer the recovery. The procedure removes skin blemishes, acne scars, age spots and wrinkles layer-by-layer. Using either general or light sedation and local anesthesia, the procedure is performed in an outpatient surgery setting. The UltraPulse 5000C Aesthetic Laser is particularly effective for deeper lines, acne scars and other blemishes. It gently paints away years, giving you smoother, fresher, younger looking skin.

Peri-oral CO2 laser resurfacing

Note marked improvement of wrinkles around mouth (peri-oral rhytids)

Note improvement of wrinkles upper lip
 

Severe acne scars. Note improvement after one CO2 laser resurfacing session.

Click here for more information on Laser Skin Resurfacing

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Facelift:

As we age, gravity, the elements and nature all conspire against us to work unattractive changes in our skin. A facelift helps to regain a more natural, more youthful and less tired appearance. A facelift will lift and reposition sagging skin and underlying muscles of the face and neck area. This procedure is often done in conjunction with brow or forehead lifts and eyelid tucks.

The actual facelift operation is usually performed in an outpatient surgery center under an intravenous "twilight sleep" anesthesia. A two to three week healing period is usually required before the patient can return to normal activities.

Patient had facelift and upper and lower eyelid tuck

Facelift (including neck lift), lower eyelid tuck and brow lift.

     Facelift (including neck), upper and lower eyelid tuck, brow lift, upper lip  lift, and rhinoplasty ("nose job").

Note improvement of boxyness of nose tip, disappearance of jowls and shortened distance between nose and upper lip

Facelift, and lower eyelid tuck

Click here for more information on Facelifts

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Eyelid Tucks:

Your eyes account for a large part of your facial expressions. With the passage of time, the skin around the eyelids begins to loose its elasticity and sag. This condition can obstruct vision and cause an increase in the fullness of the upper eyelids and bagginess in the lower lids.

The eyelid tuck (blepharoplasty) procedure is performed on both the upper and lower eyelids through an incision made in the natural creases around the eyes, making them virtually unnoticeable after the healing process has taken place. Sometimes a "no-incision" (so-called transconjunctival) approach maybe appropriate for lower eyelid "bags".

The eyelid tuck procedure is usually performed in an outpatient surgery center under an intravenous "twilight sleep" anesthesia. Most people are able to return to normal activities after seven-ten days.

  Upper and lower eyelid tuck (blepharoplasty).

Note disappearance of "bags"

Lower eyelid tuck (blepharoplasty).
 

Upper and lower eyelid tuck (blepharoplasty)

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Rhinoplasty:

Nasal reconstruction, or rhinoplasty, is a surgical correction to enhance the appearance of the nose, improve profile or to correct a previous nasal injury. The surgery involves reshaping the underlying bone and cartilage of the nose through incisions made inside the nose. Occasionally, small external incisions are utilized that heal inperceptibly.

The rhinoplasty operation is usually performed in an outpatient surgery center under an intravenous "twilight sleep" anesthesia. Most people are comfortable appearing in public about ten days after surgery.

Rhinoplasty ("nose job").

Note removal of large "hump" on top

Rhinoplasty ("nose job").

Note improvement of profile with slight elevation of tip.

Rhinoplasty, lip lift, facelift and eyelid tuck (blepharoplasty)

Rhinoplasty ('nose job")

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Glycolic Acid Peels:

Usually part of an ongoing skin maintenance program, this procedure is an effective treatment for reducing fine lines, opening deep pores and repairing sun damaged skin. Glycolic peels can also eliminate blotchy pigmentation, improve acne, and reduce precancerous conditions.

The peels use medical strength glycolic acid, an alphahydroxy acid derived from sugar cane. This acid increases the turnover of cells, stimulating the formulation of new collagen.

Glycolic acid peels should be applied in a series of three treatments, which are virtually non-irritating. Make-up can be applied immediately after the procedure and there is no recuperation time needed.

Click here for more information on Glycolic Acid Peels.
 

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Obagi "Blue Peel":

Utilizing TCA, or trichloroacetic acid, this well-tested and traditional compound is combined with a remarkable blue solution to lessen the recovery period and make the skin rejuvenation process extremely safe.

The Obagi Blue Peel is considered a "medium depth" facial peel because it is stronger than the popular Glycolic Acid Peel and requires less recovery time than a full Laser Resurfacing, therefore falling in-between the two treatments with respect to results and recovery time.

The nature of the process allows us to custom-tailor each treatment according to the amount of damaged skin we wish to remove. It is an office procedure requiring little or no anesthesia and full recovery is usually less than 7-10 days.

Click here for more information on the Obagi "Blue Peel."
 

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Microdermabrasion:

Microdermabrasion has gained popularity in recent years as a "no recovery", "lunch time", "heavy duty" facial. It is a superficial micro sanding of the epidermis, or top layer of the skin. It removes the thickened, dead layers from the stratum corneum or uppermost layer of the skin leaving a younger fresh skin to be exposed. The result is not unlike a superficial, light chemical peel, such as a glycolic (alpha hydroxy) peel. Some patients prefer and may respond better to one or the other approach. It is usually given in a series of 5-7 treatments seven to ten days apart to achieve the optimal result. The treatment is not painful. It requires no anesthesia and other than slight pinkness there is no side effect or recovery. Certain skin care products pending on customized needs, and an ongoing skin care program should accompany microdermabrasion.

Click here for more information on Microdermabrasion.

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BOTOX Cosmetic(R):

BOTOX Cosmetic treatment is a simple, non-surgical procedure that smoothes the deep, persistent facial lines, such as, deep frown or crow's feet. It relaxes the overactive muscles whose repeated contractions cause these lines.Unlike surgery, BOTOX Cosmetic is fast, simple and minimally invasive with no down time or recovery. One ten-minute treatment- a few tiny injections- relaxes the muscles that cause those lines to form and keeps them relaxed up to four months. The results are dramatic and apparent within days and patients report looking more natural and relaxed. BOTOX Cosmetic has been widely tested, safe and is FDA approved.

Click here for more information on BOTOX Cosmetic.

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Forehead Lifts & Eyebrow Lifts:

The forehead lift also known as a brow lift, can minimize visible signs of drooping eyebrows, frown lines and forehead furrows that come naturally with age. The resulting smooth forehead can enhance the overall appearance and open the eyes to create a more youthful look. There are a number of different approaches , each customized to the patient's needs and desires.

The forehead lifts and brow lifts are usually performed in an outpatient surgery center under an intravenous "twilight sleep" anesthesia. Most patients can return to normal activities within ten to fourteen days after surgery.

Click here for more information on Forehead Lifts

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Cheek Implants & Chin Implants:

Cheek augmentation, or malar augmentation, gives women the high cheek bones that they desire. This surgery is not designed for everyone, but it can give definition to a face that has a flat contour because of underdeveloped cheek bones.

Chin augmentation, or mentoplasty, is a surgical procedure that has helped thousands of people improve their appearance by altering the contours of their face. It is designed to add size or to move forward a receding chin. It particularly improves the profile line.

Both cheek and chin implants are usually performed in an outpatient surgery center under an intravenous "twilight sleep" anesthesia. Bandages are usually removed after a few days, however, patients are up and about the first day proceeding surgery. A one to two week healing period is usually required before the patient can return to normal activities.

                                 Cheek implant before                       after

                                   chin implant before                         after

Click here for more information on Cheek Implants & Chin Implants.
 

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Otoplasty:

Protruding (or "lop") ears often run in families. Sometimes the development of the ears stops short during prenatal development. Ear surgery, or otoplasty, can correct this problem, offering dramatic results. While otoplasty can be performed anytime after four or five years of age, it is often recommended in the preschool years to avoid the emotional scars that often come from the ridicule and teasing of school mates.

The procedure is usually performed in an outpatient surgery center with minimal risks. Most patients recover in about two weeks.

                                       Side view before                     after

                                    Front view before                         after

                                     Back view before                        after

Click here for more information on Otoplasty (Ear Surgery).
 

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Lip Enhancement & Lip Augmentation:

These types of procedures are ideal for those born with thin lips that have a tendency to flatten and disappear with age, and for individuals who just desire a fuller, more eye-catching lip to enhance the face.

The aging process does not discriminate in the areas of the mouth. The older we get the colored part of the lip becomes more thin and the arch of the upper lip - known as the "Cupid's Bow" - flattens out. The aging process also tends to make the corners of lips droop, making people look older or more unhappy than they feel. To maintain a youthful mouth and sensuous lips, the following procedures are recommended:

• COLLAGEN: This has been around the longest and used to be one of the most popular options for lip augmentation surgery. The procedure involves collagen (a protein derived from cows) injections directly into the lip for added volume and fullness. It should be noted that this procedure is not considered permanent; after about three to six months, the collagen is absorbed and the lips and mouth return to their normal state. Skin testing is needed. 
  
   
• LIP ADVANCEMENT (Vermillion Advancement or Sub-nasal lift): This procedure offers a more permanent solution for many people. It involves a simple incision made either along the border of the lip where the colored line meets the skin or just below the nose. A small portion of white skin is removed and the red lip is advanced outward and stitched permanently into place. The incision heals in a few weeks and scars are usually unnoticeable. The distance between the nose and upper lip is decreased which makes for a more youthful, friendlier looking mouth.
   

  

  

  
   
• LIP IMPLANT(Gortex/Alloderm/Fat and the newest: PermaLip(R)(soft silicon): Lip implants are mostly utilized for those who have naturally thin lips. The surgery involves threading a synthetic material directly into the lips using a specialized instrument. This implant adds bulk and restores fullness that has thinned with the aging process or due to hereditary factors. The recovery period for this procedure is usually about a week and most patients do not experience bruising or other side effects. Gortex and PermaLip are permanent (but can be removed) while Alloderm can last 1-2 years. Fat implants have variable survival and often require more than one treatment for permanence. (See also "What's New" for special on PermaLip(R) )

Click here for more information on Lip Enhancement

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Restylane(R)/Perlane(R):

What if we told you that there was a new method for smoothing wrinkles and enhancing lips that was completely natural with no risk of allergic reaction. What if we also told you that the effects would last for 4-8 months and then dissolve into water and depart from your body without leaving a trace. Well, it's all true, and it's called Restylane(R) or Perlane (R). This is a non-animal based product derived from hyaluronic acid (present in all living organisms) in the form of a clear gel. Restylane(R) is injected beneath the skin's surface adding natural volume and lift to smooth wrinkles and folds. Best of all, Restylane(R) treatment is relatively painless (with local anesthesia) and takes on the average less than 30 minutes to perform in the office. It is FDA approved.

Click here for more information on Restylane.

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Radiesse(R):

Radiance or Radiesse (calcium hydroxapatite), which has been approved by the FDA for use in the human body, is a smooth, thin cream that can be injected with a syringe (similar to Collagen). Injections of Radiesse lasts approximately four to five times longer than collagen, 2-3 times longer than restylane and does not require a skin test.  Repeat injections of Radisse thus may not be required for 1 to 1 1/2 years. Patients not only benefit because they don't have to schedule appointments as often but also because this treatment is more cost effective.
So, Radiesse, may actually provide the best option for patients who want correction of deep facial wrinkles and who desire a longer lasting result with less downtime. It is now FDA approved.

Click here for more information on Radiesse.

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ThreadLift (AptosLift, ContourLift, FeatherLift)

These are somewhat less invasive procedures which can lift, contour and suspend the sagging tissues of the face, brow and neck. The ThreadLift procedure can provide quick and relatively bloodless lifting for selected patients with minimal incisions who may need only a little to moderate rejuvenation. These threads are placed carefully in predetermined areas of the face and the tissues are thus lifted. Although initially it was intended to be much less invasive than traditional mid-face, face and brow lifts, recent modifications prompted by lack of desired longevity of results has made it somewhat more involved. Thus the recovery period now approaches that of traditional surgery and therefore Mini-lifts may be a longer lasting and better alternative for most patients considering this procedure. 

Click here for more information on ThreadLift.

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For a free consultation, or to learn more about other procedures, call 916-965-FACE (3223) or 800-322-3766.