Terracina Surgical Arts
As we age, our faces begin to show the effects of gravity, sun exposure, and years of facial muscle movement, such as smiling, chewing, and squinting. The underlying tissues that keep our skin looking youthful and plumped up begin to break down, often leaving laugh lines, smile lines, crow’s feet or facial creases over the areas where this muscle movement occurs.
Soft-tissue fillers, most commonly injectable collagen or fat, can help fill in these lines and creases, temporarily restoring a smoother, more youthful-looking appearance. When injected beneath the skin, these fillers plump up creased and sunken areas of the face. They can also add fullness to the lips and cheeks. Injectable fillers may be used alone or in conjunction with a resurfacing procedure, such as a laser treatment, or a recontouring procedure, such as a facelift.
In recent years, injectable fillers such as Restylane, Juvederm, Sculptra, and fat transfers have become very popular. Restylane is a safe and natural cosmetic dermal filler that restores volume and fullness to the skin to correct facial wrinkles and folds, such as nasolabial folds. Restylane maintains its shape using the body’s own moisture. The hyaluronic acid in Restylane is hydrophilic or “water-loving.” As hyaluronic acid gradually degrades, each molecule binds to more water, and over time, the same volume can be maintained with less hyaluronic acid. This ability of hyaluronic acid to bind to water is what helps provide lasting results. Injectable fillers are small injections of gel that typically consist of hyaluronic acid which fills in wrinkles and add volume to softer tissue, such as lips, cheeks, eyes and even your jawline. Injectable fillers typically restore lost volume in the face and smooth out deep-set lines. While it depends on how each individual reacts to the treatment, but expect the filler to last roughly between 6 and 18 months. To ensure there is minimal discomfort during the procedure, your medical professional will apply an anesthetic cream before the treatment begins. Your face has many underlying sensitive structures, such as nerves, vessels, and veins that can be damaged if the treatment is not performed by a trained and experienced medical professional.
Fat transfers are another type of injectable filler, which is harvested by the patient’s own body fat and re-administered to enhance facial fullness, fill creases, or build up shallow contours. Fat Transfers are a natural, safe, and non-allergic treatment option to fill in sunken areas or recontour your facial features. Typical areas for the patients “donor-area” consist of the abdomen, thighs, or buttocks; micro-liposuction is used to transfer the fat as a graft to the injectable areas. In most cases, about 50% of the fat injected will survive and will last for a lifetime, but in other cases, multiple fat transfers can be needed to achieve the desired results.
Though many different fillers are available, we have found Restylane and autogenous fat to be the safest and most effective solutions for injectable fillers. If you’re interested in learning more about getting Injectable Fillers or any type of plastic surgery in the Inland Empire, please give us a call at Terracina Surgical Arts in Redlands, CA. (909) 798-9950.
Did you know that less than 2% of the world is born without wisdom teeth? Wisdom teeth, also known as your third molars are teeth that grow at the very back of each corner of your mouth. While not everyone has all 4 wisdom teeth, it is very common to have only 1-2 or even 3 wisdom teeth as well. Getting your wisdom teeth removed is likely something you will need to get done at some point in your life now or in the future. Each year, over 5 million people have their wisdom teeth removed to prevent any symptomatic issues that may arise. While is it most common for wisdom teeth to erupt in young adults between the ages of 17 and 25, some may not have their wisdom teeth erupt until the late 20’s and early 30’s. Unfortunately, it is very common for wisdom tooth pain to be an extensive reason to get most young adults into the dentist’s office to help ease the pain.
As our jaws have gotten smaller, it means there is less room in our mouths to accommodate emerging wisdom teeth. The smaller space doesn’t allow the tooth to come out and it can put pressure on your gums and jaw while eroding the enamel, creating tooth decay and cavities depending on the position the tooth is erupting in. Wisdom teeth that are erupting can cause damage to adjacent teeth making creating the need for fillings or even a root canal. Sometimes the damage is severe enough to need both teeth to be removed and replaced with bone grafting and a single tooth implant.
Gums also really don’t like wisdom teeth either. The ways the wisdom teeth grow and the smaller space makes it easier for bacteria to grow and causes the gums to be inflamed or infected. This can snowball and infections can spread across your mouths making it more and more difficult to treat. It’s important to stay on top of your oral hygiene until you are able to get into an oral surgeon’s office for your wisdom teeth (tooth) extractions.
Most often times patients are numbed with local anesthetic for wisdom tooth removals combined with optional sedation to ease the nerves and anxiety. Local anesthesia is preferred for wisdom teeth extractions because it is a relatively simple procedure and there are much higher risks with anesthesia and getting put to sleep. Oral surgeons will try and work quickly to remove the tooth to prevent any possible complications. After the local anesthetic has worn off after your wisdom teeth removal it is very common to feel uncomfortable or even in pain. It’s important to follow your Doctor’s post-op care instructions to prevent any possible infections or complications for the first initial week after your surgery. Drinking lots of water and staying hydrated is important after your surgery. Stay away from drinking through a straw or anything that involved a sucking sensation with your mouth as it can cause the blood clot to dislodge from the wound and create dry sockets. Dry sockets can be extremely painful and are very susceptible to possible infection.
There is a reason why oral surgeons recommend removing your wisdom teeth before they erupt in your mouth. The younger you are the less possible complications may arise and the easier time you will have healing. Wisdom teeth extraction helps maintain good oral hygiene and a healthy mouth. Give Dr. Punjabi a call at Terracina Surgical Arts at (909) 798-9950 to discuss your wisdom teeth removal treatment options.
What are the Differences Between Dental Implants and Dentures?
Dentures and partials are artificial substitutes that are nothing like original teeth. They are also much larger than the teeth that they replace. Your bite force is reduced by as much as 75% when you have dentures or partials. Eating food becomes a hassle as it takes much longer to chew your food. It is also recommended that you eat soft foods to avoid ruining your dentures over time. After some time, bone deterioration starts to increase, and dentures may begin to slip and no longer properly fit which can cause pain and discomfort.
Deciding on Dental Implants
● Dental Implants are considered to be the most natural-looking to your teeth and provide the greatest comfort and strength option.
● Implants make eating your favorite foods, including meat, possible. Dentures can cause speech problems, but with implants, you will not have this difficulty.
● Dental Implants protect and preserve your underlying bone structure without having to shave down your adjacent teeth.
● With the correct oral hygiene, dental implants can last up to 25 years- or even a lifetime if properly taken care of.
● Although implants are more expensive than the other tooth replacement options, their strength and longevity save you the cost of repair and replacement required by dental bridges in the long run.
Advantages of Dental Implants
● Secure bond to the jawbone, with no slippage or movement
● Low maintenance
● Long-lasting—often a permanent solution
● Look and function like natural teeth
● Preserve the jawbone
● Help to prevent gum and bone deterioration, jawbone recession, and facial collapse due to bone loss
Disadvantages of Dental Implants
● Higher initial cost than dentures, however; our practice offers patients with financial options, including Wells Fargo, Care Credit, and Lending Club financing options to make paying for implants an easy and smooth process.
Advantages of Dentures
● Lower cost (even though they will need to be replaced multiple times throughout a patient’s life).
Disadvantages of Dentures
● Insecure bond causes slippage and movement
● Problems with speaking or pronouncing words
● Problems with eating and chewing
● Discomfort, irritation, and sores
● Regular cleaning required
● Eventual replacement required
● Do not preserve the bone and can further jawbone recession that can cause facial collapse
What is a Jaw Fracture?
One of the most frequent facial injuries that people can endure is a broken jaw or jaw fracture. This type of injury is in direct relationship to one or more temporomandibular joints (TMJ). Some patients with more extensive jaw fractures may need to have their jaw wired shut to promote healthy and proper healing.
Jaw fractures are made up of approximately 70% of most maxillofacial accidents. This is mainly because the mandible has less support from the cranium more than any other region of the face.
The most common ways jaw fractures occur:
• Car Accidents
• Physical Assault
• Industrial Accidents
• Accidental Trip or Falls
• Sport or recreational injury
Signs to look out for that may suggest jaw fractures:
• The jaw will typically crack in two places, at the site of collision and also in the spot directly opposite of the collision site.
• Ache and loss of function to chewing, talking and trouble breathing
• Bruising of the neck and face
• Oral Bleeding
Always remember that when it comes to jaw fractures, any kind of damage targeted towards the mandible bone should be checked out by a medical professional within the first 24 hours of an accident.
The Healing Process
Jaw fractures surgery is a major procedure and is completely different from any other dental procedure. Jaw fractures recovery can be very uncomfortable for the first several days but keep in mind that you have a team of professions helping you during the first section of your jaw fractures recovery. It’s extremely important to take all antibiotics that are prescribed by your doctor. When eating always follow your post-surgery recommendations. Most patients lose weight so remember this is normal. When recovering from jaw fractures always remember to apply ice to the jaw to help control swelling and have a cup handy to help catch the extra drool or blood that might occur. Drooling and swelling is normal so it would be beneficial to keep your head elevated while sleeping. It’s important to keep a positive mind and try to keep to your daily routines. Try taking brief walks throughout the day and keep in touch with family and friends.
If other injuries are present or abnormal bleeding occurs during jaw fractures recovery always remember to contact your doctor of 911 for emergencies.
By virtue of Dr. Punjabi‘s dual board certifications in both Plastic Surgery and Oral and Maxillofacial Surgery he is experienced, skilled and uniquely qualified to manage and treat Jaw Tumors in the Inland Empire. Although jaw tumors are not exceedingly common, cysts and tumors can develop in the jawbone and be completely asymptomatic and discovered on a routine x-ray. While there are other occasions where a jaw tumor can reach a larger size and cause pain, discomfort, swelling or even disfigurement, it does not happen very often.
A jaw tumor or cyst, are growths that develop in the jawbone or within the soft tissues of an individual’s mouth or face. Jaw tumors or cysts are also known as odontogenic tumors and cysts which can vary in size and severity. While most often the jaw tumors or cysts are benign (noncancerous) they can be extremely uncomfortable and aggressively surround the jawbone and teeth and may eventually displace or shift teeth. The most 6 common types of jaw tumors and cysts include but are not limited to, Ameloblastoma, Central Giant Cell Granuloma, Dentigerous Cyst, Odontogenic Keratocyst, Odontogenic Myxoma, and Odontoma. Odontogenic jaw tumors and cysts originate from cells and tissues that are involved in natural normal tooth development. Nonodontogenic jaw tumors develop from other tissues within the jaws and are not always related to the teeth. While there are not many known causes of jaw tumors in the Inland Empire, jaw tumors can often be associated with genetic syndromes.
The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs of the beginning of a pathologic process or cancerous growth:
Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth
- A sore that fails to heal and bleeds easily
- A lump or thickening on the skin lining the inside of the mouth
- Chronic sore throat or hoarseness
- Difficulty in chewing or swallowing
- Pain or Tenderness
- Unexplained Tooth Mobility
These changes can be detected on the lips, cheeks, palate and gum tissue around the teeth, tongue, face and/or neck. Pain does not always occur with pathology, and curiously, it is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.
We would recommend performing an oral cancer self-examination monthly and remember that your mouth is one of your body’s most important warning systems. Do not ignore suspicious lumps or sores. Please contact us at (909) 798-9950 so we may help.
Gynecomastia is a medical term that comes from the Greek words for “women-like breasts.” Though this oddly named condition is rarely talked about, it’s actually quite common. Gynecomastia affects an estimated 40 to 60 percent of men. It may affect only one breast or both. Though certain drugs and medical problems have been linked with male breast overdevelopment, there is no known cause in the vast majority of cases. For men who feel self-conscious about their appearance, breast-reduction surgery can help. The procedure removes fat and or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured.
The temporary effects of breast reduction include loss of breast sensation or numbness, which may last up to a year. The initial consultation with Dr. Punjabi is very important. He will need a complete medical history, so check your own records ahead of time and be ready to provide this information. First, Dr. Punjabi will examine your breasts and check for causes of gynecomastia, such as impaired liver function, use of estrogen-containing medications, or anabolic steroids. Once Dr. Punjabi knows how much fat and glandular tissue is contained within the breasts, he can choose a surgical approach to best suit your needs. Don’t hesitate to ask any questions you may have during the initial consultation- including your concerns about the recommended treatment or the costs involved. Treatment of gynecomastia may be covered by medical insurance–but policies vary greatly. Check your policy or call your carrier to be sure. If you are covered, make certain you get written pre-authorization for the treatment recommended by your surgeon.
Surgery for gynecomastia is most often performed as an outpatient procedure, but in extreme cases, or those where other medical conditions present cause for concern, an overnight hospital stay may be recommended. The surgery itself usually takes about an hour and a half to complete. However, more extensive procedures may take longer. Correction of enlarged male breasts may be performed under general, or in some cases, under local anesthesia plus sedation. You’ll be awake, but very relaxed and insensitive to pain. More extensive correction may be performed under general anesthesia, which allows the patient to sleep through the entire operation. Your surgeon will discuss which option is recommended for you, and why this is the option of choice.
Gynecomastia surgery can enhance your appearance and self-confidence, but it won’t necessarily change your looks to match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them frankly with Dr. Punjabi. The results of the procedure are significant and permanent. If your expectations are realistic, chances are good that you’ll be very satisfied with your new look. If gynecomastia is something that would be beneficial to you, call our office and set up your consultation with Dr. Punjabi, today!
There are a number of possible causes of facial and jaw trauma such as motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work-related injuries. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face. Typically, facial injuries are classified as soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).
By virtue of Dr. Punjabi‘s dual board certifications in both Plastic Surgery and Oral and Maxillofacial Surgery he is experienced, skilled and uniquely qualified to manage and treat Facial Trauma and Jaw Fractures. Injuries to the face and jaw, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving hands-on experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.
Fractures of the bones of the face and jaw are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, the age and general health of the patient. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial and jaw fractures.
One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique of treatment can often allow for healing and obviates the necessity of having the jaws wired together. This technique is called “rigid fixation” of a fracture. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly.
The treatment of facial fractures should be accomplished in a thorough and predictable manner. More importantly, the patient’s facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary, are designed to be small and, whenever possible, are placed so that the resultant scar is hidden.
The proper treatment of facial injuries is now the realm of specialists who are well versed in emergency care, acute treatment, long term reconstruction and rehabilitation of the patient. If you or a loved one ever had to deal with a facial trauma or jaw fracture, call Terracina Surgical Arts at (909) 798-9950 to schedule your consultation with Dr. Punjabi.
By the age of eighteen, the average adult has 32 teeth; 16 teeth on the top and 16 teeth on the bottom. Each tooth in the mouth has a specific name and function. The teeth in the front of the mouth (incisors, canine and bicuspid teeth) are ideal for grasping and biting food into smaller pieces. The back teeth or molar teeth are used to grind food up into a consistency suitable for swallowing. The average mouth is made to hold only 28 teeth. It can be painful when 32 teeth try to fit in a mouth that holds is supposed to only hold 28 teeth. These four other teeth are your Third Molars, also known as your “wisdom teeth.”
Wisdom teeth are the last teeth to erupt within the mouth. When they align properly and gum tissue is healthy, wisdom teeth do not necessarily have to be removed unless they are causing discomfort. Unfortunately, this does not generally happen and the extraction of 1 or more wisdom tooth is necessary when they are prevented from properly erupting within the mouth. Wisdom teeth may grow sideways, partially emerge from the gum and even remain trapped beneath the gum and bone. Impacted teeth can take many positions in the bone as they attempt to find a pathway that will allow them to erupt successfully.
These poorly positioned impacted teeth can cause many problems and pain for individuals. When they are partially erupted, the opening around the tooth allows bacteria to grow and will eventually cause an infection or decay. The result: swelling, stiffness, pain and illness. The pressure from the erupting wisdom tooth may move other teeth and disrupt the orthodontic or natural alignment of teeth as well. The most serious problem occurs when tumors or cysts form around the impacted wisdom tooth, resulting in the destruction of the jawbone and healthy teeth. Removal of the offending impacted tooth or teeth usually resolves these problems. Early removal is recommended to avoid such future problems and to decrease the surgical risk involved with the procedure.
In most cases, the removal of wisdom teeth is performed under local anesthesia, laughing gas (nitrous oxide/oxygen analgesia) or general anesthesia. These options as well as the surgical risks (i.e. sensory nerve damage, sinus complications) will be discussed with you before the initial procedure is performed. Once the teeth are removed, the gum is sutured back together. To help control bleeding, biting down on the gauze placed in your mouth can help form clots and reduce the bleeding. You will rest under our supervision in the office until you are ready to be taken home. Upon discharge, your post-operative kit will include postoperative instructions, a prescription for pain medication, antibiotics and a follow-up appointment in one week for suture removal.
If you have any questions, please do not hesitate to call us at (909) 798-9950.
Our services for wisdom tooth extraction in the inland empire are provided in an environment of optimum safety that utilizes modern monitoring equipment and staff that are experienced in anesthesia techniques.
Dr. Punjabi uses facial implants to improve and enhance facial contours. Frequently, these implants will help provide a more harmonious balance to your face and features so that you feel better about the way you look. Facial implants are used to balance facial proportions to achieve aesthetic harmony. Implants can be used in the cheek, chin, and other parts of the face as needed. These implants are usually made from silicone or polytetraflourethylene. The risks associated with implants include infections, capsular contracture, extrusion and scarring. An alternative to facial implants in some cases is autogenous fat grafting , where fat is transferred from one area of the body to areas of the face where it is needed by a specialized technique. There are many implants available, manufactured from a variety of materials. They may help bring the chin or cheekbones into balance with the rest of the face.
Chin and cheek implants can improve your appearance and enhance your self esteem. If you are looking for improvement, not perfection, in your appearance and are realistic in your expectations, you may find that a facial implant is the right choice for you. Dr. Punjabi will frequently use such implants to bring better balance to the features of a younger patient. For instance, a teenage girl may want her chin brought forward so that her face is better proportioned. The more mature patient may choose to have an implant placed in conjunction with another cosmetic procedure. For example, during a facelift , a patient may wish to have implants placed over the cheekbones to help restore a more youthful appearance. Cheek implants may also be selected to fill out a face that appears “sunken” or tired.
Insertion of a chin implant may take anywhere from 30 minutes to an hour. During the procedure, the surgeon selects the proper size and shape implant to enhance your appearance and inserts it into a pocket over the front of the jawbone. The small incision to create the pocket and insert the implant is placed inside the mouth (along the lower lip) or in the skin just under the chin area. Usually, the chin is taped after surgery to minimize swelling and discomfort. Sutures in the skin will be removed in five to seven days. If an intra-oral incision is used, the sutures will dissolve.
Cheek implant surgery usually takes about 30 to 45 minutes. When cheek implants are being placed in conjunction with another cosmetic procedure, such as a facelift , forehead lift or eyelid surgery , the implants may be inserted through the incisions made for those procedures. Otherwise, an incision will be made either inside your upper lip or your lower eyelid. A pocket is then formed and an implant is inserted. After surgery, a dressing will be applied to minimize discomfort and swelling. The severity and duration of such side effects may vary, especially if another cosmetic procedure was performed at the same time.
You may not be able to accurately evaluate your appearance for weeks, or perhaps even months. Give yourself plenty of time to get used to your new look. You may be surprised to find that most people won’t recognize that you’ve had facial implant surgery — only that you look better. If you’re interested in having a consultation with Dr. Punjabi, give Terracina Surgical Arts a call and set up your appointment today!
Are you looking for cosmetic surgery in the Inland Empire? At Terracina Surgical Arts, our professional staff along with Dr.Punjabi will help you achieve your aesthetic goals and provide cosmetic surgery solutions in the area of Inland Empire California. Dr. Punjabi’s scope of expertise includes cosmetic surgery & reconstructive plastic surgery of the face and body and oral & maxillofacial surgery. Dr. Punjabi and his 5-star team provide the most modern and sophisticated surgical techniques to provide their patients with amazing cosmetic surgery results and minimal downtime. Their philosophy is based upon the concept that a successful result from cosmetic surgery stems from a successful partnership between the patient and the practice. Such a partnership is based on professionalism, trust, education, and understanding. Dr. Punjabi and his staff are dedicated professionals who are committed to achieving the best possible cosmetic surgery for each patient. They work diligently to tailor this approach to suit each individual’s needs and cosmetic goals. They will also take the time to listen to your desires and give you a realistic idea of what can be done for you. With his expertise and artistic touch, Dr. Punjabi brings the knowledge and skill that is necessary for successful results.
Dr. Punjabi graduated from the Government Dental College at Bombay University, India, University of Southern California School of Dentistry, Los Angeles and Case Western Reserve University (CWRU) School of Medicine, Cleveland, Ohio. Dr. Punjabi has completed training in two specialties: oral and maxillofacial surgery at MetroHealth Medical Center Campus of the CWRU and plastic and reconstructive surgery at the University of Miami/Jackson Memorial Hospital, Miami Florida.
Dr. Punjabi has been in practice since 1999, first in faculty practice at Loma Linda University Medical Center (LLUMC) and Riverside County Regional Medical Center (RCRMC) before opening his private practice in Inland Empire. He continues to serve as an Associate Clinical Professor of Plastic Surgery in the School of Medicine and Oral & Maxillofacial Surgery in the School of Dentistry at Loma Linda University. His experience also includes a private practice of dental/oral surgery in Jamaica, West Indies. Dr. Punjabi provides the following surgeries: facelifts, eyelid surgeries, nose jobs, chin reshaping, forehead lifts, facial implants, breast augmentations, reductions and lifts as well as liposuction, tummy tucks, and many other types of cosmetic surgeries.
Skin enhancement services include collagen injections, Botox, chemical peels and laser resurfacing. Full-service skin care is available with a licensed medical aesthetician. Dr. Punjabi’s priority is to provide you with the skill, experience and care that you are looking for in a cosmetic and reconstructive surgeon. You can be certain that his input and interest in your expectations and desired goals will make you feel comfortable and confident that you are in good hands!
Dr. Punjabi appreciates the value of clinical experience, surgical expertise, current innovative technology and consistently delivering excellence in patient care. Because of his unique dual qualifications in medicine and dentistry, Dr. Punjabi’s expertise gives him a distinct perspective in solving complex cosmetic and reconstructive challenges of not only the face, head, and neck, but also the breast, body, and extremities.
Terracina Surgical Arts offers a complete range of surgical and nonsurgical cosmetic procedures provided by our double board certified plastic surgeon, Dr. Punjabi. All your cosmetic goals can be achieved in our well-equipped facility. With over 18 years of experience, we focus on delivering outstanding patient care with top-rated cosmetic plastic surgery results. We treat each patient as a unique individual and discuss all the pre-operative concerns and preferences in great detail prior to treatment. Our overall goal is to provide you with safe, effective, and natural-looking results. We are full of appreciation to be serving the beautiful Inland Empire community. Call now to set up your consultation with Dr. Punjabi and see what options are right for you and your lifestyle. We look forward to meeting you and welcoming you into our family!