Terracina Surgical Arts

What to Expect: Breast Implants in Inland Empire

It’s normal and natural to consider doing something about your breasts, whether it’s a reduction, lift, or augmentation. Change in the breast can occur after time whether due to age or weight loss, post-pregnancy, or by simply just feeling self-conscious about your figure. After all, our climate and culture it is expected to have an appealing shape. An appealing breast shape reflects good health and vitality in women. These are just some reasons Dr. Punjabi performs breast implants, breast reductions, and breast reconstructions in the Inland Empire at our Terracina Surgical Arts. As a breast enhancement specialist, Dr. Punjabi has years of experience and is qualified in helping women achieve the look they desire through breast implant surgery.

Dr. Punjabi can help you have larger, firmer, and fuller breasts. Women choose Dr. Punjabi for their breast implant surgery for his skill and dedication to achieving excellent results.


After you come in for your consultation Dr. Punjabi creates a surgical plan for your breast augmentation based on your body size and shape as well as your cosmetic goals. Together, you will decide on several details, including the incision location, implant placement, size of the implant, and the type of implant that is used during surgery.

The breast implant procedure will last approximately an hour to 90 minutes, and you’ll spend about 1-2 hours in recovery before going home. While intravenous anesthesia is Dr. Punjabi’s preferred method for breast implant surgery, he discusses all options that are available to you.

Dr. Punjabi uses a short incision (approximately 1 inch) for most breast augmentation procedures this may be around the areola, along with the crease beneath the breast, or in the pit of your arm. Then Dr. Punjabi will create a pocket in which the implant will sit. Once your breast implants are properly placed, your incisions will be closed and necessary bandages are applied.


During the first 2 days following your procedure, you can expect moderate discomfort you should be able to control with prescribed medication. You may notice pain when you use your arms or get up from a lying or sitting position. You may also see some bruising and swelling which is completely normal in the beginning. It is important to limit your activity during this time and be patient throughout the initial healing to ensure a smooth recovery.

What to Expect When Recovering from a Broken Jaw

Life happens and it’s nearly impossible to know when something horrible would happen, such as breaking or fracturing your jaw. There are many different ways an individual could break their jaw, while unlucky coincidences do happen you are more likely to break your jaw by:

  • Falling off of a bike or motorcycle
  • Being hit in the face with a ball from any sport
  • Being involved in a car accident
  • Being involved in a physical altercation

While there are dozens of other ways that individuals have broken or fractured their jaws doing normal everyday activities such as taking a simple fall, we have found that the 3 mentioned above are the most common cases we see. Unfortunately, jaw fractures can be extremely painful, but should only be treated by a board-certified maxillofacial surgeon to ensure that your jaw is healing correctly.

If your jaw is broken or fractured it is very common to have your jaw wired or bandaged shut during surgery during the recovery time. For minor fractures or dislocations, it is more common to see bandages used for recovery. If the jaw was completely broken or if the patient is suffering from a large fracture it is much more common to see only wiring used to shut the jaw during recovery. Depending on the severity of the jaw fracture it is normal for patients so have their jaws wired shut from anywhere from 6 to 10 weeks. While not every patient’s recovery time is the same it’s important to listen to your doctor and respect your limitations.

Warning Signs of Complications

If you have any of the following complications or signs of infection it’s detrimental to contact your doctor as soon as possible. Infection or complications can lead to much worse consequences if not properly assessed quickly.

  • Increased swelling
  • Redness
  • Bleeding inside of the mouth
  • Fever or chills
  • Bad smell coming from the mouth
  • Increased or excessive pain that is not treatable by ibuprofen

Facial traumas such as jaw fractures in the Inland Empire are serious injuries and should be treated as such. It’s important to visit your doctor or your local Emergency Room as soon as possible to determine the extent of the damage that was done. Dr. Punjabi is a board-certified maxillofacial surgeon and has treated hundreds of patients that suffered from fractured jaws. If you or your loved one has recently suffered from a jaw fracture or a broken jaw, give our staff at Terracina Surgical Arts a call to schedule your consultation with Dr. Punjabi.

Juvederm Fillers In The Inland Empire

If you are looking to replace lost volume, dermal fillers are your best option to enhance less prominent features. Fillers are injected beneath the skin to smooth lines, give volume, soften creases, or enhance facial contours. Fillers have become very popular over the past few years, that most individuals have chosen this facial rejuvenation treatment as a cost-effective way to look younger without surgery or downtime.

What is Juvederm?

Juvederm is a clear gel formulation of hyaluronic acid that is specifically formulated to act like your body’s own naturally-produced hyaluronic acid. This helps to visibly correct moderate to severe facial wrinkles and folds, including the lines that run from your nose toward the corners of your mouth (nasolabial folds) and the lines that run from the corners of your mouth toward the chin (marionette lines).

Where Can Juvederm be Injected?

Juvederm can be injected into:

  • Lips: To enhance the volume.
  • Around mouth: To get rid of your smile lines and add volume.
  • Cheeks: To add a more contoured look with fullness.
  • Under eyes: To minimize dark circles.

Procedure for Juvederm

Juvederm involves no incisions and can be done in your doctor’s office. This is usually done under local anesthesia to minimize any discomfort that you may experience during the procedure. Local anesthesia temporarily numbs the small area on your body that is being injected to ensure you will have the most comfortable experience when receiving your fillers.

Depending on which procedure you are getting done, Juvederm injections typically take anywhere from a few minutes to a half-hour.

The Juvederm procedure can be broken down into several steps:

Step 1: The doctor will clean the area that is being treated, and target the areas that need to be injected.

Step 2: After, the doctor and you will decide how much Juvederm is needed to meet your aesthetic needs.

Step 3: Lastly, the doctor will inject the Juvederm under your skin using an ultrafine needle.

What you can Expect After Juvederm

The healing time will depend on the extent of the treatment that you got done. However, results are usually visible within minutes of the initial treatment. After treatment, some patients may experience swelling, bruising, or slight redness where the Juvederm is injected. These side effects usually will fade within 12-24 hours depending on the procedure you received.

It is important to remember that Juvederm is not permanent, so if you would like to maintain the best results, you should follow up with your doctor about when the best time to go in for a follow-up treatment. A follow-up, second treatment is usually recommended every 6-18 months to maintain the look you desire.

Thinking About Dental Implants?

When thinking about what kind of teeth replacement solution to go with, dental implants are an excellent choice; but how long do they last? Factors that affect how long dental implants last depend largely on the patient’s lifestyle and overall hygiene. So, how long do dental implants last, and what would be the reasons for them to fail?

The fair answer is: dental implants can last for several years, but it all depends on how well the patient takes care of them. With that being said, dental implants are the best and most comfortable option when looking for a long-term solution to replace missing tooth/teeth. According to recent studies, when done correctly, dental implants show a 98% success rate, compared to a bridge or dentures which have a much lower success rate and often cause discomfort when wearing. Most dentists estimate that dental implants can last up to 25 years, or even a lifetime if cared for properly while maintaining proper hygiene.

Dental Implant Definitions

  1. Implant: The implant is the titanium post that will be surgically inserted into the patient’s jawbone to act as a root for the crown.
  2. Abutment: This is attached to the implant and holds the crown in place.
  3. Crown: The crown is secured onto the abutment and is designed to look like a natural tooth.

Dental Implant “All-On-4” Phases

  1. Once you are adequately sedated and anesthetized so that you don’t experience any discomfort during the course of treatment, our experienced surgeon will start preparing your mouth to receive dental implants. This involves the removal of all of your remaining teeth that will be replaced by implants, followed by the rigorous “cleaning out” of any diseased, chronically infected tissue from your jaw and gums. We then commence the placement of dental implants.
  2. Two dental implants placed near the front of your jaw. Another two implants are placed at a 45° angle near the back of the jaw. The angulations enable the implants to reap greater support from the jawbone, at the same time, avoiding damage to vital oral structures.
  3. Once the implants have been placed, we will bring the surgery to a close-by thoroughly cleaning the surgical sites and suturing up all incisions. You will then be wheeled to our private recovery room where you will be given some time to relax and awaken completely from the effects of sedation or anesthesia.

After you are rested from surgery, our prosthodontist will put the final touches on your customized provisional (temporary) prosthetic dental bridge. Dr. Punjabi will then attach your new set of teeth to your implants and adjust it for comfort, bite, and fit. When you are happy with the fit and feel of the implants, you can then admire your new smile in a mirror.

Factors That Can Cause Dental Implants To Fail

Dental implants are meant to provide long-term sustainability when cared for in the correct manner, but there are several different reasons that can cause implants to fail. The following are factors that may be in the patient’s control, while others are not.

Some of these factors include:

  • Patients who suffer from diabetes
  • Cancer patients
  • Patients who are frequent smokers
  • Patients who suffer from periodontal disease
  • Implants that were not placed correctly

Like regular teeth, dental implants need to be maintained through regular great oral hygiene even though they cannot get cavities. It is crucial to keep up with consistent dental visits so that your dentist can provide you with the best tools to keep your implants maintained.

Thinking About Dental Implants?

If you are considering dental implants, you need to see the best dentist possible. Our prosthodontist, Dr. Punjabi, and a team of implant specialists use the finest and latest technology to achieve outstanding results for all of his patient’s individual needs. You will be in the best hands while receiving a smile that you’ve always dreamt of.

Give our office a call at (909) 798-9950, or email us at [email protected] to set up a complimentary consultation to see Dr. Punjabi. We look forward to speaking with you and helping you achieve the smile you love.

Different Types of Injectable Fillers: Restylane vs Fat Transfer

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 Transfer

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.

All about Wisdom Teeth Extraction

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.

Why Are Dental Implants Better Than Dentures Or Bridges?

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
● Comfortable
● 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

Jaw Fractures: What is it, what to expect, and how to help the healing process

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.
• Inflammation
• Swelling
• 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.

Jaw Tumors in the Inland Empire

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
  • Swelling
  • 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 for Men in the Inland Empire

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!