Alfonso Barrera, MD, FACS

Products And Services

• Cosmetic Surgery

  Many people choose aesthetic (cosmetic) surgery to give themselves added confidence in social or work situations, a psychological boost or simply to help them look as young as they feel. Often, improving a feature of your face or body will enhance your self-image, and that can help you make positive changes in many areas of your life. Having realistic expectations about cosmetic surgery increases the likelihood that you will be happy with the results. Since 1985, Alfonso Barrera, MD, has been one of Houston’s most prominent and respected plastic surgeons. He is exclusively dedicated to the highest standards of excellence in plastic surgery. Dr. Barrera’s main objective is to achieve a result that is not only attractive but looks natural. If you recognize a specific area in which your appearance could be improved and you have a strong personal desire to make a change, then you may be a candidate for aesthetic (cosmetic) plastic surgery.

  Link: Cosmetic Surgery

• Facelift

  Am I a Good Candidate for Facelift Surgery? The face usually portrays the first visible signs of aging. Both gravity and diminished volume result in the facial features of aging. Most patients requesting evaluation for facelift feel that their facial features do not reflect their youthful spirit and energy level. They are looking for ways to refresh and rejuvenate their appearance. There are many different variations of the facelift procedure that smooth the skin of the face and neck, tighten the underlying tissues and muscle, and remove excess skin. Ultimately, the facelift will allow you to turn back the hands of time to better reflect your youthful spirit. How Will Dr. Barrera Evaluate Me for a Facelift? During the pre-operative consultation, Dr. Barrera will perform a history and physical examination. During your physical examination, your facial bone structure, underlying skin structure, skin thickness, texture, and elasticity as well as the extent of facial wrinkles and folds will be assessed. This information will be used to formulate a surgical plan and the goals of the procedure will be discussed. Generally, a facelift is a very versatile procedure, and Dr. Barrera will explain the technique that he or she feels most comfortable with and that offers the lowest risk. Dr. Barrera will select the surgical technique that he or she feels will obtain the best outcome for you based on your discussions regarding the outcome you wish to achieve. How is a Facelift Performed? The facelift procedure continues to evolve. Over the years, the procedure has changed from simple skin lifting to more complex deeper plane lifting techniques. Today, many different techniques exist, with outcomes that are consistently reliable and durable. The facelift procedure usually involves incisions in front of and behind the ear. The incisions may extend into the scalp. Once the incisions are made, various degrees of undermining of the skin are performed, and the deeper layers of the face are ‘lifted’. Muscle tightening as well as liposuction of the neck and jowls may be performed, and excess skin is either removed or repositioned. The results are a reversal of the effects of gravity and tightening of soft tissues of the face to restore a more youthful contour to the face.

  Link: Facelift

• Eyelid Surgery (Blepharoplasty)

  Am I a Good Candidate for Eyelid Lift Surgery? Any one or combination of the following conditions may indicate that you may be considered a good candidate for eyelid surgery: - Excess skin obscuring the natural fold of the upper eyelids - Loose skin hanging down from the upper eyelids, perhaps impairing vision - A puffy appearance to the upper eyelids, making the eyes look tired - Excess skin and fine, “crepe paper type” wrinkles of the lower eyelids - Bags and dark circles under the eyes - Lower eyelid droopiness Aesthetic eyelid surgery can usually correct these problems, though other treatments may also need to be considered. Some examples follow. If the upper eyelid condition is accompanied by sagging of the eyebrows, then a forehead lift may be recommended. Smoothing of crow’s feet may be accomplished with Botox, chemical peeling or laser resurfacing procedures. Circles beneath the eyes caused by dark pigmentation may be treated with fillers such as Hyaluronic Acid or fat as well as bleaching solution or chemical peel. Your plastic surgeon can provide further information if you have an interest in any of these additional procedures. Results of Your Eyelid Surgery Aesthetic eyelid surgery has the effect of making you look more rested, refreshed and alert. Since the healing process is gradual, you should expect to wait at least several weeks to get an accurate picture of the results of your eyelid surgery. Incisions will fade over a number of months usually becoming barely visible. The results of aesthetic eyelid surgery are usually long-lasting, but they may be affected by heredity and lifestyle factors. Removal of fat from your eyelids, which is usually the cause of puffiness and bags, is permanent, and these conditions generally will not recur. The skin continues to age, however, and skin laxity along with the fine wrinkling of the eyelid area may, at some point, return. Sometimes loss of tone in the forehead causes additional sagging of the eyebrows which mimics a recurrence of drooping upper eyelids. If this happens, correction may require a forehead lift or a secondary eyelid procedure. Even though the aging process continues, patients are usually happy with their appearance for many years following eyelid surgery. Some patients find that they want to make additional improvements at a later time.

  Link: Eyelid Surgery (Blepharoplasty)

• Hair Transplantation

  Over the past two decades Dr. Barrera has dedicated a lot of his time to perfecting the art and technique of hair transplantation. He is well known and respected nationally and internationally for his contributions in the advance of techniques of hair transplantation not only in male and female pattern alopecia but also in the reconstruction of burn injuries, accidents, birth defects, etc. By using very small ( 1, 2, 3 or 4 hair follicular units) and numerous grafts today we can truly and predictably achieve natural looking results in hair transplantation. Often Dr. Barrera will do 1500 – 2500 grafts in a single session, depending on the availability of donor hair and the size of the area to be grafted. A good head of hair as well as an aesthetically pleasing hairline are a very important aesthetic component of the face both on males and females. The hairline not only it frames the face, but defines the proportion of the upper third of the face. Furthermore its design and appropriate hair density are very important as well especially on the frontal (forehead) and temporal (sides) areas. A disproportionately high frontal hairline with or without scars not only can be unsightly but results on an aged and deformed appearance even on a young person. Conversely, a properly positioned hairline with a pleasing design and appropriate density compliments facial aesthetics and contributes to a youthful appearance. Dr. Barrera often encounters in his practice varying degrees of distortion, displacement, erosion, absence as well as scarring deformities of the frontal, temporal, sideburn and retro-auricular hairlines.

  Link: Hair Transplantation

• Tummy Tuck (Abdominoplasty)

  Women and men who have loose abdominal skin and fat that is concentrated in the abdomen can benefit from abdominoplasty. Sometimes these conditions are inherited. In other instances, substantial weight loss may cause abdominal skin to become flaccid. Abdominoplasty also can tighten muscles that have been separated and weakened by pregnancy. The procedure may somewhat improve the appearance of stretch marks, especially those located below the navel. Your Personal Consultation During the consultation, you will be asked about the results you would like to achieve from abdominoplasty. This will help your surgeon to understand your expectations and determine whether they realistically can be achieved. Am I a Good Candidate for Abdominoplasty? You may be a good candidate for abdominoplasty if you have one or more of the following conditions: - excess or sagging abdominal skin - an abdomen that protrudes and is out of proportion to the rest of your body - abdominal muscles that have been separated and weakened - excess fatty tissue that is concentrated in your abdomen If you plan to become pregnant or lose weight in the future, you should discuss this with your plastic surgeon. Scarring from previous abdominal surgery may limit the results of your abdominoplasty. Dr. Barrera may examine your abdomen while you are standing as well as lying down. Your skin tone and the degree of loose skin in the abdominal region will be assessed. Dr. Barrera also will evaluate the amount of excess fat in your abdomen and the condition of your abdominal muscles. You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, pregnancies, previous surgeries and medications that you currently take. It is important for you to provide complete information. How Abdominoplasty Is Performed: Individual factors and personal preferences will determine the specific technique selected to smooth and flatten your abdomen.

  Link: Tummy Tuck (Abdominoplasty)

• Breast Lift (Mastopexy)

  Mastopexy usually takes one and a half to three and a half hours. Several techniques are used, but the most common procedure involves an anchor-shaped incision following the natural contour of the breast. The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola in a vertical line extending downwards from the nipple area, and along the lower crease of the breast. Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for modified procedures requiring less extensive incisions. One such procedure is the “doughnut (or concentric) mastopexy,” in which circular incisions are made around the areola, and a doughnut-shaped area of skin is removed. If you’re having an implant inserted along with your breast lift, it will be placed in a pocket directly under the breast tissue, or deeper, under the muscle of the chest wall. After surgery, you’ll wear an elastic bandage or a surgical bra over gauze dressings. Your breasts will be bruised, swollen, and uncomfortable for a day or two, but the pain shouldn’t be severe. Any discomfort you do feel can be relieved with medications prescribed by your surgeon. Within a few days, the bandages or surgical bra will be replaced by a soft support bra. You’ll need to wear this bra around the clock for three to four weeks, over a layer of gauze. The stitches will be removed after a week or two. If your breast skin is very dry following surgery, you can apply a moisturizer several times a day. Be careful not to tug at your skin in the process, and keep the moisturizer away from the suture areas. You can expect some loss of feeling in your nipples and breast skin, caused by the swelling after surgery. This numbness usually fades as the swelling subsides over the next six weeks or so. In some patients, however, it may last a year or more, and occasionally it may be permanent. Healing is a gradual process. Although you may be up and about in a day or two, don’t plan on returning to work for a week or more, depending on how you feel. And avoid lifting anything over your head for three to four weeks. If you have any unusual symptoms, don’t hesitate to call Dr. Barrera. You will be given detailed instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities slowly. If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact. Dr. Barrera performs all aesthetic surgery procedures including breast lift at his Accredited Ambulatory Surgical Facility (AAAASF) under intravenous sedation and local anesthesia, without the need for general anesthesia (painless during the procedure and minimal pain afterwards). This provides added safety and faster recovery.

  Link: Breast Lift (Mastopexy)

• Breast Reduction

  Patients who undergo breast reduction surgery frequently are seeking relief from physical symptoms caused by the excessive weight of large breasts. Breast reduction usually can solve these problems as well as improve the size and shape of your breasts. Following breast reduction, your breasts will be more proportional to the rest of your body, and clothes will fit you better. Am I a Good Candidate for Breast Reduction? You may be a good candidate for breast reduction if you have one or more of the following conditions: - breasts that are too large in proportion to your body frame - heavy, pendulous breasts with nipples and areolas that point downward - one breast is much larger than the other - back, neck or shoulder pain caused by the weight of your breasts - skin irritation beneath your breasts - indentations in your shoulders from tight bra straps - restriction of physical activity due to the size and weight of your breasts - dissatisfaction or self-consciousness about the largeness of your breasts Breast reduction can be performed at any age, but plastic surgeons usually recommend waiting until breast development has stopped. Childbirth and breast-feeding may have significant and unpredictable effects on the size and shape of your breasts. Nevertheless, many women decide to undergo breast reduction before having children and feel that they can address any subsequent changes later. If you plan to breast-feed in the future, you should discuss this with your plastic surgeon. During the consultation, you will be asked about your desired breast size as well as anything else about your breasts that you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they realistically can be achieved. Where Are the Incisions Placed? Individual factors and personal preferences will determine the specific technique selected to reduce the size of your breasts. The most common method of reducing the breasts involves three incisions. One incision is made around the areola. Another runs vertically from the bottom edge of the areola to the crease underneath the breast. The third incision follows the natural curve of the breast crease. After the surgeon has removed excess breast tissue, fat and skin, the nipple and areola are shifted to a higher position. The areola, which in large breasts usually has been stretched, also is reduced in size. Skin that was formerly located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour under the arm. One common breast reduction technique removes excess breast tissue, fat and skin through the incisions shown. The nipple and areola remain attached to the underlying tissue but are shifted to a higher position. The size of the areola is often reduced at the same time. Usually, the nipples and areolas remain attached to underlying mounds of tissue, and this allows for the preservation of sensation. The ability to breast-feed may also be preserved by this method, although this cannot be guaranteed. Skin that formerly was located above the nipple is brought down and together to reshape the breast.

  Link: Breast Reduction

• Breast Augmentation

  Breast augmentation plastic surgery is one of the most common procedures performed annually by members of the American Society for Aesthetic Plastic Surgery. Women may choose to under go breast enlargement surgery for various reasons. These personal reasons may center around breasts that are perceived to be under developed, or because of differences in the sizes of the breasts or from changes after pregnancy or breast feeding. Some women may be happy with their breasts but just want them made fuller. Often after weight loss, aging or childbirth a woman’s breast volume and shape may change. This too can lead to a woman to seek a breast augmentation. Breast implant surgery performed by cosmetic plastic surgeons is the most popular way to improve breast shape and size. Breast enhancement using breast implants can give a woman more proportional shape and may improve self esteem. Am I a Good Candidate for Breast Augmentation? One or more of the following feelings or conditions may indicate that you are a good candidate for breast augmentation: - you are bothered by the feeling that your breasts are too small - clothes that fit well around your hips are often too large at the bustline - you feel self-conscious wearing a swimsuit or form-fitting top - your breasts have become smaller and lost their firmness after having children - weight loss has changed the size and shape of your breasts - one of your breasts is noticeably smaller than the other During the consultation, you will be asked about your desired breast size and anything else related to the appearance of your breasts that you feel is important. This will help Dr. Barrera to understand your expectations and determine whether they realistically can be achieved. Additionally, to minimize stress regarding the size, we will have you try various implant sizes under a special bra, so you can select the size you like. Breast augmentation is designed to increase the size of small or underdeveloped breasts. Breast surgery can also restore and enhance your breast volume if it has decreased as a result of pregnancy and breastfeeding. In addition, breast implants can serve one or more of a number of purposes; breast cancer victims can use breast implants for reconstructive purposes after mastectomy, or women with asymmetrical breasts may use a single breast implant to balance the difference in size. What Type of Breast Implants Can Be Used for Breast Augmentation? The implant is placed in a pocket either directly behind the breast tissue, or over the muscle (right) or underneath the pectoral muscle (under the muscle) which is located between the breast tissue and chest wall. Dr. Barrera prefers to make the incision at the crease underneath the breast ( 4cm) where it generally hides completely and usually places the implant over the pectoralis muscle. Why over the muscle? Because normally the breast tissue is over the muscle, not underneath. Only if the patient is extremely skinny then Dr. Barrera does it under the muscle, a personal preference based on his professional experience. Additionally, there is a lot less pain after surgery when done over the muscle plus as the patient contracts the muscle the shape of the breast is not altered. Conversely, when it is under the muscle each time one contracts the muscle the shape changes in an un-natural way in Dr. Barrera’s opinion. When surgery is completed, your breasts will be wrapped in gauze dressings or a surgical bra. Our patients are able to go home almost as soon as we finish the surgery with minimal discomfort. The size and type of breast implant recommended for you will be determined by your goals for breast enhancement, your existing body frame, and mass, your existing breast tissue, and the preferences you and your plastic surgeon discuss. All breast implants include a solid silicone rubber outer shell, called a lumen. Breast implant options include: - Saline breast implants: Filled with sterile salt water. Saline implants may be pre-filled to a predetermined size. Saline may also be filled at the time of surgery to allow for minor modifications in implant size. - Silicone filled breast implants: Filled with soft, elastic gel. All silicone breast implants are pre-filled and may require a longer incision for implant placement.

  Link: Breast Augmentation