Understanding Aesthetic Surgery
Aesthetic Surgery is considered an important part of plastic surgery. In fact, it is part of every plastic surgery. When we operate on a patient who has facial palsy and can not eat without letting saliva slip or close his/her eyelid, no matter how good his/her mouth and eyelid functions have improved, he/she will not be absolutely satisfied if his/her overall appearance has not also improved significantly.
Whatever the reconstruction may be, the plastic surgeon should also worry with the aesthetic results. When we make a breast reconstruction, we ought to make is as harmoniously as possible, because the patient not only wants her organ back, but also she wants her breast to be beautiful. Therefore, aesthetic surgery takes part in every surgery: plastic, aesthetic or reconstructive.
There are a few surgeries that are purely aesthetic. Among these we can name the facial rejuvenating surgery, also called lifting that intends to return to the patient the aspect he/she possessed years ago. Other purely aesthetic surgery is the correction of protruding ear. This surgery objects to reposition the structures that form the ear. As it does not change the hearing function it is solely aesthetic. The rhinoplasty, the surgery of the nose, is usually uniquely aesthetic as well, seeking a harmonious face profile. The liposuction, an important conquest of plastic surgery, has brought an enormous help to the plastic surgeon in treating the localized adiposities. As in all medicine, plastic surgery has had amazing progress within the last few years. The techniques have developed a lot, so have the anesthetic drugs that are now safer. All of this has improved the results of plastic surgery by drastically diminishing the risks.
Despite all the progress made, plastic surgery, as any medical specialty, has several determining aspects that can contribute to the final results. It is extremely important that the plastic surgeon talks to his/her patient in details, trying to understand the motivation, expectation and restlessness regarding the requested surgery. Some patients deposit exaggerated expectation on the procedure results that will surely frustrate him/her.
Other aspect that must be emphasized is the scar. Although many patients believe that plastic surgery does not leave scars, this is an incorrect idea. Plastic Surgery will always leave scars that will vary in aspect according to the patients individual scaring characteristics. Some factors involved in the scaring process are not yet fully understood. Many patients with previous good-looking scars may develop stretched, enlarged or hypertrofic scars or even keloids.
However, amongst the factors involved in plastic surgery one of the most important one is the knowledge by the plastic surgeon of the patient’s expectations and to let the patient know the actual possibilities of reaching those expectations with the set surgery. But more important than that is the patient to know that the human body is very complex and that many times the expected results can not be achieved despite the use of the most modern techniques or the plastic surgeon’s scientific knowledge.
Most wanted aesthetic surgeries
The reduction in size of the mamma is one of the most wanted surgeries in our country. Several techniques have been developed in order to provide a pleasant shape of the mamma as well as small scars. Six years ago, we saw a Pectoralis Muscle tape being used by Daniel to oppose to gravity and diminish its effects on the mamma and consequently the tendency of the mamma to drop again. After 15 days, the patient must start exercising that muscle.
Regarding the scar, we have been using 3 alternatives, areolar, vertical or inverted T-shape scar, according to the skin flabbiness and hypertrophy of the mammae. All material withdrawn is sent to anatomo-pathological analysis allowing us to make early diagnosis of small nodules or other affections of the mammary gland.
The anesthesia is local with sedation performed by licensed anesthesiologist. The patient is released on the same day and after 10 to 15 days he/she can return to work.
The suture is made with absorbable surgical, therefore, with no need to be removed. Exercises and sun bathe are permitted after 60 days.
Augmenting Mammoplasty (Silicone)
Very popular surgery nowadays is the augmenting of the mamma with silicone implant. This procedure is also performed with local anesthesia and sedation made by licensed anesthesiologist. The scar is placed in the axillary cavity avoiding scars on the mammae. The patient is released on the same day and after 7 to 10 days he/she can return to work but should not elevate the arms until the 15th day.
The size and shape of the prosthesis will be selected according to upper body shape and the patient’s preferences.
Abdominal Surgery (abdominoplasty)
This procedure is indicated for patients who want to correct skin flabbiness and diastasis (separation) of the abdominal muscles. This surgery is popular amongst women who have had children. It is performed with epidural anesthesia and sedation. The patient is admitted for 1 day and remains with aspirating drains for 2 to 5 days. The patient must remain curved forward for 15 days to prevent the scar to tear. Exercises and sun bathe are permitted after 60 days.
Facial Refreshing (Facial Lifting)
One of the most wanted surgeries is the facial lifting.
With aging there are basically two alterations in the forehead. The first one is the appearance of horizontal lines in all forehead and vertical lines between the eyebrows. The second is the fall of the eyebrows.
Furrows are due to the muscle contraction under the skin. They can be resolved by resection of muscle tissue making its action on the skin smaller. Years ago, this resection was made as an open surgery, meaning that the scalp was cut ear to ear, the skin was flipped over and part of the frontalis muscle was resected.
After the introduction of the endoscopic technique this resection began to be done with a source of light and optic fiber inside three incisions of 2 cm long that allow visualization of the entire region. This treatment is more effective and lasting.
An alternative, simple and non-surgical way is the injection of botulism toxin, known commercially as Botox. The injection of this material into the muscle makes a temporary paralysis of the muscle fibers. The greatest disadvantage of this method is short duration of the results. The muscle remains paralyzed in average for 3 months. Occasionally this period can be longer up to 6 months.
Other aspect that should be analyzed is the fall of the eyebrows. With time, the face tissues suffer a fall. The fallen eyebrow determines accumulation of skin on the upper eyelid and a bigger effort of the forehead muscles to elevate the eyelid at all times. This provides a tired aspect to the face with increasing of the horizontal furrows of the forehead.
The eyebrow can be lifted endoscopically or with the suspension of threads. The withdrawal of skin next to the hair line also promotes the repositioning of the eyebrow. The patient must be very well analyzed because if the distance between the hair line and eyebrow is too big we can cut in this region. If, on the other hand, the distance between the hair line and the eyebrow is too small, it is preferable to put the incisions in the scalp.
The facial and cervical (neck) flabbiness is corrected by unsticking the skin and reposition of the muscles.
Facial lifting is done under local anesthesia with sedation. It can be made simultaneously with the blepharoplasty (eyelid surgery) and the frontal lifting (forehead surgery). The patient is admitted for 12 to 24h and should rest for 10 days. Exercises and sun bathe are permitted after 60 days.
Rhinoplasty (Nose surgery)
The plastic surgery of the nose is performed with local anesthesia and sedation. The patient is released on the same day and remains with an immobilizing splint for 7 days, that substitutes for the cast. After this period the splint is removed and a micropore draping is placed that stays for other 7 days. All the incisions are internal in most cases but sometimes a small incision in the bottom of the columela may be necessary. When this procedure is associated with correction of the nasal septum, the patient remains with a nasal tampon for 3 days. This combined procedure is performed with general anesthesia.
The nose is swollen for 2 to 3 months and the definitive result is after 6 months.
Blepharoplasty (Eyelid Surgery)
The eyelids are one of the first parts to indicate aging.
The upper lid accumulates skin, the eyebrow drops slowly and sometimes the protrusion of fat bags occurs.
The lower lid behavior varies from person to person. Some patients have an early increase of the infraorbital groove, that is, the evident mark of the infraorbital margin. Another sign of aging is the increase of the fat bags that along the years suffer a anterior projection due to the weight of the ocular globe. Besides, the lower lid as well as the upper lid can present with flabbiness and excess of the skin and the orbicularis oculi muscle. The treatment of this area is extremely important to a good result in refreshing the face. The lower lid plasty is more complex but the treatment of the protrusion of the fat bags and the removal of surplus skin and muscle can be done.
More recently, a fibroadipose structure has been discovered between the periosteum and the orbilar muscle. This tissue has been named SOOF. The most recent techniques include the mobilization of this tissue because this improves the aspect of the infraorbital groove. Moreover, this procedure avoids touching the fat bags. The simple elevation of that thicker tissue of the lower lid allows the surgeon to replace the fat bags in the orbital cavity. The results are more natural and lasting. The postoperative cares include compresses with cold saline and rest for three days. The sutures are removed within three or five days and the patient is advised not to sun bathe for two months.
Surgery for “crow’s feet”
One of the first signs of aging is the appearance of wrinkles around the eyes while smiling, known as “crow’s feet”.
The injection of the botulism toxin has substantially improved these wrinkles. However, this procedure has two disadvantages that are the short lasting effects and the elevated price of the substance.
An alternative solution that is both effective and lasting is the partial myomectomy of the orbicularis oculi muscle.
The surgery can be associated with the facial lifting or the blepharoplasty. A resection of a rectangular stream in the vertical direction is made; the removal of the muscle determines a hollow that is filled with fat tissue graft.
The results are lasting and bring great satisfaction to the patients.
Liposuction / Vibrosuction / Liposculpture
The liposuction, liposculpture or lipoplasty is a technique to remove fat through small holes (4 a 10 mm) with equally thin cannulae.
Its greatest indication is what is called localized fat because it has genetic preponderance and it never disappears completely with diets or physical exercises. This procedure is not indicated to treat obesity or to promote weight loss. The liposuction reduces the volume and alters the body shape.
The weight loss is not the main goal of the liposuction but in our experience, we have verified a progressive and gradual weight loss after the surgery that varies from person to person.
The patient should not demand miraculous results with the liposuction. The results vary according to the case, amount of fat to be withdrawn and the body part to be treated.
Also, the liposuction is not entirely indicated to treat “cellulite”. Although some grade 3 cellulite can benefit from the procedure it is best taken care of with endermology.
There are several factors that determine the liposuction results such as technique used, postoperative cares, patient’s cooperation, appropriated dietetic measures and physical exercise.
In some cases, a finishing touch can be necessary or even subsequent liposuctions to improve the final outcome. There are situations where more than one session of liposuction is required.
The definitive results can usually be achieved in 3 to 12 months, depending on what kind of surgery was performed. But generally a huge improved is observed at the end of 3 to 4 weeks.
The small scars should not be exposed to sun light for two months.
The type of anesthesia depends on the extension of the body to be aspirated. Most liposuctions are performed with local or epidural anesthesia and discharge on the same day.
It is important that in all kinds of surgery an early mobilization occurs.
The use of compression and postoperative massage is prescribed individually.
Vibroliposuction is the most recent technique to perform liposuction/liposculpture. The aspirating cannula is connected to a small apparel that trough compressed air moves the cannula back and forth in a 6 to 9mm excursion. It promotes the flocculation of the fat to be aspirated and allows greater precision, less undulation and blood loss and the quantity of fat withdrawn seams to be bigger than the ones utilizing other techniques. The postoperative pain also seams to be smaller.
The fat removed can be injected in other areas. This process is called liposculpture. One of the most wanted areas for the injection of fat is the buttocks and above the riding breeches.