|
Update on Operative Procedures |
|
FOREHEAD
OR BROW LIFT |
For
the past few years, most procedures of
this type have been preformed with the
endoscopic method. By making five small
incisions in the scalp, the forehead tissue
is completely undermined down to behind
the brows and cheekbones, removing chunks
of depressor muscles. This enables the
elevator muscle system to pull the brow
upward thus improving saggy brows.
On patients who have
a plethora of wrinkles on the forehead,
the conventional method of cutting two
inches behind the hairline from ear
to ear is still the preferred and the
most successful method to employ.
|
FACELIFT |
|
Plastic surgeons have
recently been implementing the ingenious
technique of double layer lifting. This
is not the traditional method of skin
lifting, but a newer method that achieves
better and longer lasting results and
is more effective in improving laugh lines
and the jowls.
Although lifting of the
skin for this method basically remains
the same, new methods of lifting the muscles
of the face and platysma muscle systems
of the neck are utilized.
There
are some modifications of traditional
facelift to eliminate undesirable hairline
changes in front and the back of the ear. |
MID-FACELIFT |
This
is a newer operation for improving the
laxity of the tissue between the lower
eyelids and the upper lip. It is also
effective for improving the lines between
the cheek and the upper lip (nasolabial
lines). It can be performed with the
facelift of as a separate procedure.
The approach is through an incision
in the lower eyelid or through a combined
approach of temporal area and the inside
of the mouth. The procedure may also
improve the hollowing of the lower eyelid.
|
BLEPHAROPLASTY
(Cosmetic Eyelid Surgery) |
This
procedure has undergone many improvements
and modification over the past few years.
The most recent advance is in the area
of lower blepharoplasty. As you may know,
this procedure is most often utilized
to alleviate puffiness, which is corrected
by removal of excess fat in the eye socket
through an incision below the lash line
or through the inside tissue of the lower
eyelids (eliminating the outside scar).
The
new concept is that any removal of fatty
tissue from orbital regions may cause
different levels of enophtalmus (sunken
eye), an effect that may worsen as the
patient ages. To avert this problem,
the excess eye socket fat is not removed;
it is partially removed or conservatively
removed with the remaining pulled downward
and repaired to the bony structures
of the eye socket. This not only corrects
puffiness by reducing the fatty tissue
of the lower eyelid but also abates
the depression between the eyelids and
cheeks.
An
even newer concept perceives puffiness
of the lower eyelids as a herniation
process that would only require repair
of the fascia in front of the socket
to improve herniation without manipulation
of fatty tissue. This procedure, however,
is still in the experimental stages
and is not widely accepted at the time.
Asian
blepharoplasty, of which I do a great
deal, has not yielded any new concepts
except that the natural line of the
upper eyelid is made approximately 5-6
mms form the upper eyelid lash line
rather than the more standard of 8-9
mms. This adjustment results in a more
natural appearance and increase in patient
satisfaction.
|
RHINOPLASTY–
(Cosmetic
Nose Surgery) |
Although
open rhinophasty is not a new operation,
it was once used for correction of deformities
after the second, third or fourth surgeries,
it was uncommon in primary rhinoplasty.
I
along with many other plastic surgeons,
have been incorporating the techniques
of open rhinoplasty into practice for
the past few years. In my opinion, this
procedure is the best improvement in
rhinoplasty, since the results are much
more predictable and, best of all, more
desirable in certain cases.
|
LASER
SURGERY |
In
the past few years, laser surgery has
become the panacea for many skin problems
ranging from sun damage and spider veins
to tattoo removal, pigmented lesions
and hair removal. The following delves
into each of these areas and the pros
and cons therein.
|
LASER
RESURFACING |
Dermabrasion,
chemical peels and other procedures were
once the only choices for removing superficial
layers of the skin damaged by the sunrays
or aging. But today the state-of-the-art
use of laser resurfacing has improved
the method of resurfacing, although in
many cases microdermabrasion and chemical
peel can be used. The advantages of laser
resurfacing are as follows: |
1. |
The
procedure is much cleaner, without
splash of skin material and blood. |
| 2. |
The
depth of abrasion can be controlled
more precisely and properly depending
on the thickness and character of
the skin on different areas of the
face. |
|
These
factors could not be controlled as efficiently
with chemical peel and posed even more
dangers with dermabrasion of thin skin
such as that of the eyelids. The major
disadvantage of laser resurfacing is that
it is a more expensive procedure. |
NON-ABLATING
(NON ABRADING) LASER TREATMENT |
For
the last few years, non abrading laser
or intense light have been tried, expecting
to improve the facial lines and quality
of the skin without resurfacing and, as
a result, no down time. But recent reports
have shown that these types of treatments
do not meet most patient expectations. |
LASER
TREATMENT FOR SPIDER VEINS |
The
smaller the varicose veins, the more difficult
it is to inject them with sclerosing agents.
When spider veins are too small for injection,
laser works quite will, although sclerotherapy
by injection is still the treatment of
choice for larger veins. |
LASER
TREATMENT FOR TATTOO & PIGMENTED LESIONS |
Certain
pigmented lesions and tattoos can be removed
with laser, but patient has to be realistic
and understand that tattoo removal many
take several procedures, and complete
eradication may not be possible. |
LASER
HAIR REMOVAL |
Different
types of laser as well as filtered non-laser
lights are popular treatments for hair
removal. Physicians must be acutely aware
of different skin types to properly adjust
the treatment to prevent change in skin
color and other potential complications.
Although this procedure does not remove
all the hair permanently, it reduces the
number of hair follicles in three or four
sessions and make the remaining hair in
the area thinner and much less noticeable. |
LASER
FOR CUTTING & OPERATIVE PROCEDURES |
Despite
the popularity and success of laser, the
American Society of Plastic and Reconstructive
Surgeons still recommends that the best
way to cut the skin and the tissue is
by a sharp, cold surgical blade. Like
any other new technology, the laser has
been extolled for promotion and marketing
purposes but nothing thus far has replace
the surgical blade cutting procedure.
While there are certainly advantages to
laser cutting, including hemostasis, a
mayor drawback is tissue destruction during
resulting in more inflammation and scarring. |
BREAST
AUGMENTATION |
Gel
filled implants are back. In my opinion,
and opinion of plastic surgeons, gel filled
implants are still the best implants used
for augmentation mammoplasty when allowed
to be used by the F.D.A.
Gel
filled implants are not yet approved for
use in patients who undergo the procedure
for the first time, unless certain conditions
such as breast laxity or chest deformity
exist, but they may be used in patients
who have certain complications after the
use of saline filled or get filled implants.
Gel
filled implants of today are more durable
that the older ones and are available
in either smooth or textured surfaces.
They have less potential complications
of skin rippling and unnatural feeling
on palpation than saline filled implants.
Most importantly, the FDA could not prove
any health risks from cause by them.
Does
it really make a difference using round
or teardrop and other so called anatomic
shape implants? Scientific studies indicate
that it really makes no difference except
the anatomic shape implants are more expensive,
and have the risk of rotation and misshaping
the breasts. These studies were published
in the Journals of Aesthetic Surgery and
were presented at the Aesthetic Plastic
Surgery meetings. |
BREAST
REDUCTION & LIFT |
Recently
a method of liposuction of breast tissue
has been used in some specific cases of
large breast to reduce their size with
almost no scarring. This procedure can
be tried only in selected cases. |
ABDOMINOPLASTY |
There
is nothing new about this procedure, except
lateral tension method, which applies
the tension on the outer portion of the
abdomen, preventing elevation of the pubic
hairline and improves the loose skin of
front portion of upper thighs and groins.
Also considering the entire trunk as one
unit, which means that liposuction of
the hip areas, waistline and upper abdomen
may be performed at the same time. The
result from this method is more uniform
and pleasing to the patient. |
LIPOSUCTION |
| There
are two techniques that are most successfully
utilized by physicians in today’s
medical practices. They are: |
| 1. |
Tumescent
and wet technique. Prior to the
beginning of the liposuction procedure,
certain amount of fluid is injected
into the tissue. This solution contains
a small amount of local anesthetic
and Epinephrine (constrictor of
blood vessels). This procedure improves
the pain post operatively and eliminates
blood loss during surgery. Today
bleed transfusion is almost never
used in liposuction. |
| 2. |
Use
of ultrasonic systems in which a
machine generates 2500 vibration
per second and is transferred to
the suction cannula. The procedure
results in melting the fatty tissue
before suctioning, decreasing the
amount of blood loss and post-operative
bruising in selective areas of the
body where fatty tissue is firmer
and more difficult to suction. Ultrasonic
system can also be used in reducing
breast size of makes and females,
and is more effective in repeat
surgeries of liposuction. |
|
MICRODERMABRASION |
Microdermabrasion
is a technique that offers many benefits
of dermabrasion, chemical peel and laser
resurfacing in a lesser degree without
significant complications. It is effective
in treatment of sun-damaged skin, fine
wrinkles, age spots, large pores and acne
prone individuals. The skin becomes smother,
softer and more uniform in color and texture.
Microdermabrasion is not effective in
deep wrinkles and acne scars, but it works
well with fine lines around the eyes,
mouth, neck, chest and hands. The most
commonly treated areas is skin of the
face…For the best results, it may
have to be repeated every two weeks for
one to two months. Acid peel and other
more extensive procedures may augment
the results. It can be used on all skin
colors.
The
procedure takes about 45 minutes and is
performed in the office without the need
for anesthesia. You may feel like fine
sandpaper is being gently rubbed on your
skin. No preoperative preparation is required.
Following microdermabrasion, you may experience
a tightness or sunburn sensation for a
day or two. Redness, if any, resolves
in a few hours. You may apply moisturizer
and make-up after the procedure. |
