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Plastic surgery, Laser surgery, Aesthetic surgery

Ecto Derma Polyclinic - Dental - Medical - Laser  Educational and Research Center

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postheadericon Plastic surgery

  • Facial reconstruction, facelift
  • Ear corrections
  • Nose corrections
  • Eyelid plasty
  • Labial plasty
  • Double chin surgery
  • Breast surgery (lift, augmentation, reduction)
  • Implantation surgical interventions
  • Laser surgery plastic operations
  • Face-neck unwrinkling, filling-up
  • Elimination of snoring by laser operation
  • Treatment of veins
  • Tummy tuck
  • Liposuction
  • Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. While famous for aesthetic surgery, plastic surgery also includes a variety of fields such as craniofacial surgery, hand surgery, burn surgery, microsurgery, and reconstructive surgery. The word "plastic" derives from the Greek "plastikos" meaning to mold or to shape; its use here is not connected with the synthetic polymer material known as plastic.


    History of plastic surgery

    Reconstructive surgery techniques were being carried out in India by 2000 BC. Sushruta (6th century BC) made important contributions to the field of Plastic and Cataract surgery. The medical works of both Sushruta and Charak were translated into Arabic language during the Abbasid Caliphate (750 AD). These Arabic works made their way into Europe via intermediaries. In Italy the Branca family of Sicily and Gaspare Tagliacozzi (Bologna) became familiar with the techniques of Sushruta.

    British physicians traveled to India to see Rhinoplasty being performed by native methods. Reports on Indian Rhinoplasty were published in the Gentleman's Magazine by 1794. Joseph Constantine Carpue spent 20 years in India studying local plastic surgery methods.[ Carpue was able to perform the first major surgery in the Western world by 1815. Instruments described in the Sushruta Samhita were further modified in the Western world.

    The Romans were able to perform simple techniques such as repairing damaged ears from around the 1st century BC. Due to religious reasons they didn't approve of the dissection of both human beings and animals, thus their knowledge was based in its entirety on the texts of their Greek predecessors. Notwithstanding this Aulus Cornelius Celsus has left some surprisingly accurate anatomical descriptions, some of which -for instance, his studies on the genitalia and the skeleton- are of special interest to plastic surgery.

    The Egyptians were also one of the first people to perform plastic cosmetic surgery.

    In 1465, Sabuncuoglu's book, description, and classification of hypospadias was more informative and up to date. Localization of urethral meatus was described in detail. Sabuncuoglu also detailed the description and classification of ambiguous genitalia (Kitabul Cerrahiye-i Ilhaniye -Cerrahname-Tip Tarihi Enstitüsü, Istanbul) In mid-15th century Europe, Heinrich von Pfolspeundt described a process "to make a new nose for one who lacks it entirely, and the dogs have devoured it" by removing skin from the back of the arm and suturing it in place. However, because of the dangers associated with surgery in any form, especially that involving the head or face, it was not until the 19th and 20th centuries that such surgery became commonplace.

    Up until the techniques of anesthesia became established, all surgery on healthy tissues involved great pain. Infection from surgery was reduced once sterile technique and disinfectants were introduced. The invention and use of antibiotics beginning with sulfa drugs and penicillin was another step in making elective surgery possible.

    In 1792, Chopart performed operative procedure on a lip using a flap from the neck. In 1814, Joseph Carpue successfully performed operative procedure on a British military officer who had lost his nose to the toxic effects of mercury treatments. In 1818, German surgeon Carl Ferdinand von Graefe published his major work entitledRhinoplastik. Von Graefe modified the Italian method using a free skin graft from the arm instead of the original delayed pedicle flap. In 1845, Johann Friedrich Dieffenbach wrote a comprehensive text on rhinoplasty, entitled Operative Chirurgie, and introduced the concept of reoperation to improve the cosmetic appearance of the reconstructed nose. In 1891, American otorhinolaryngologist John Roe presented an example of his work, a young woman on whom he reduced a dorsal nasal hump for cosmetic indications. In 1892, Robert Weir experimented unsuccessfully with xenografts (duck sternum) in the reconstruction of sunken noses. In 1896, James Israel, a urological surgeon from Germany, and In 1889 George Monks of the United States each described the successful use of heterogeneous free-bone grafting to reconstruct saddle nose defects. In 1898, Jacques Joseph, the German orthopaedic-trained surgeon, published his first account of reduction rhinoplasty. In 1928, Jacques Joseph published Nasenplastik und Sonstige Gesichtsplastik.

    The first American plastic surgeon was Dr. John Peter Mettauer, who in 1827 performed the first cleft palate operation with instruments that he designed himself.

    In World War I a New Zealand otolaryngologist working in London, Sir Harold Gillies, developed many of the techniques of modern plastic surgery in caring for soldiers suffering from disfiguring facial injuries. His work was expanded upon during World War II by one of his former students and cousin, Archibald McIndoe, who pioneered treatments for RAF aircrew suffering from severe burns. McIndoe's radical, experimental treatments, led to the formation of the Guinea Pig Club. In 1951 Gillies carried out the first male-to-female sex change operation.

    Plastic surgery as a specialty evolved tremendously during the 20th century in the United States. One of the founders of the specialty, Dr. Vilray Blair, was the first chief of the Division of Plastic and Reconstructive Surgery at Washington University in St. Louis, Missouri. In one of his many areas of clinical expertise, Blair treated World War I soldiers with complex maxillofacial injuries, and his paper on "Reconstructive Surgery of the Face" set the standard for craniofacial reconstruction. He was also one of the first surgeons without a dental background to be elected to the American Association of Oral and Plastic Surgery (later the organizations split to be renamed the American Association of Plastic Surgeons and the American Association of Oral and Maxillofacial Surgeons) and taught many surgeons who became leaders in the field of plastic surgery.


    Reconstructive plastic surgery

    "Reconstructive" redirects here. For other uses, see Reconstruction.

    Reconstructive Plastic Surgery is performed to correct functional impairments caused by:

    • burns
    • traumatic injuries, such as facial bone fractures
    • congenital abnormalities, such as cleft lip, or cleft palate
    • developmental abnormalities
    • infection or disease
    • removal of cancers or tumours, such as a mastectomy for a breast cancer, a head and neck cancer and an abdominal invasion by a colon cancer

    Reconstructive plastic surgery is usually performed to improve function, but it may be done to approximate a normal appearance. It is generally covered by insurance coverage but this may change according to the procedure required.

    Common reconstructive surgical procedures are: breast reconstruction for women who have had a mastectomy, cleft lip and palate surgery, contracture surgery for burn survivors, creating a new outer ear when one is congenitally absent, and closing skin and mucosa defects after removal of tumors in the head and neck region.

    Plastic surgeons developed the use of microsurgery to transfer tissue for coverage of a defect when no local tissue is available. Tissue flaps comprised of skin, muscle, bone, fat or a combination, may be removed from the body, moved to another site on the body and reconnected to a blood supply by suturing arteries and veins as small as 1-2 mm in diameter.

    The most common reconstructive procedures are tumor removal, laceration repair, scar repair, hand surgery and breast reduction. According to the American Society of Plastic Surgeons, the number of reconstructive breast reductions for women increased in 2007 by 2 percent from the year before. Breast reduction in men also increased in 2007 by 7 percent.


    Cosmetic surgery

    Cosmetic Surgery defined as a subspecialty of surgery that uniquely restricts itself to the enhancement of appearance through surgical and medical techniques. It is specifically concerned with maintaining normal appearance, restoring it, or enhancing it beyond the average level toward some aesthetic ideal. In 2006, nearly 11 million cosmetic surgeries were performed in the United States alone.

    The number of cosmetic surgeries performed in the United States has increased over 50 percent since the start of the century. Nearly 12 million cosmetic surgeries were performed in 2007, with the five most common being breast augmentation, liposuction, nasal surgery, eyelid surgery and abdominoplasty. The increased use of cosmetic surgery crosses racial and ethnic lines in the U.S., with increases seen among African-Americans and Hispanic Americans as well as Caucasian Americans. In Europe, the second largest market for cosmetic procedures, cosmetic surgery is a $2.2 billion business.

    The most prevalent aesthetic/cosmetic procedures are listed below. Most of these types of surgery are more commonly known by their "common names." These are also listed when pertinent.

    • Abdominal etching, or Ab etching, is used to contour and shape the abdominal fat pad to provide patients with a flat stomach.
    • Abdominoplasty (or "tummy tuck"): reshaping and firming of the abdomen
    • Blepharoplasty (or "eyelid surgery"): Reshaping of the eyelids or the application of permanent eyeliner, including Asian blepharoplasty
    • Mammoplasty
      • Breast augmentation (or "breast enlargement" or "boob job"): Augmentation of the breasts. This can involve either fat grafting, saline or silicone gel prosthetics. Initially performed to women with micromastia
      • Breast reduction: Removal of skin and glandular tissue. Indicated to reduce back and shoulder pain in women with gigantomastia and/or for psychological benefit in women with gigantomastia/macromastia and men with gynecomastia.
      • Breast lift (Mastopexy): Lifting or reshaping of breasts to make them less saggy, often after weight loss (after a pregnancy, for example). It involves removal of breast skin as opposed to glandular tissue.
    • Buttock Augmentation (or "butt augmentation" or "butt implants"): Enhancement of the buttocks. This procedure can be performed by using silicone implants or fat grafting and transfer from other areas of the body.
    • Chemical peel: Minimizing the appearance of acne, pock, and other scars as well as wrinkles (depending on concentration and type of agent used, except for deep furrows), solar lentigines (age spots, freckles), and photodamage in general. Chemical peels commonly involve carbolic acid (Phenol), trichloroacetic acid (TCA), glycolic acid (AHA), or salicylic acid (BHA) as the active agent.
    • Labiaplasty: Surgical reduction and reshaping of the labia
    • Rhinoplasty (or "nose job"): Reshaping of the nose
    • Otoplasty (or ear surgery): Reshaping of the ear
    • Rhytidectomy (or "face lift"): Removal of wrinkles and signs of aging from the face
    • Suction-Assisted Lipectomy (or liposuction): Removal of fat from the body
    • Chin augmentation: Augmentation of the chin with an implant (e.g. silicone) or by sliding genioplasty of the jawbone.
    • Cheek augmentation
    • Collagen, fat, and other tissue filler injections (e.g. hyaluronic acid)
    • Laser skin resurfacing

    In recent years, a growing number of patients seeking cosmetic surgery have visited other countries to find doctors with lower costs.[11] These medical tourists seek to get their procedures done for a cost savings in countries including Cuba, Thailand, Argentina, India, and some areas of eastern Europe. The risk of complications and the lack of after surgery support are often overlooked by those simply looking for the cheapest option.


    Plastic surgery sub-specialities

    Plastic surgery is a broad field, and may be subdivided further. Plastic surgery training and approval by the American Board of Plastic Surgery includes mastery of the following as well:

    • Craniofacial surgery is divided into pediatric and adult craniofacial surgery. Pediatric craniofacial surgery mostly revolves around the treatment of congenital anomalies of the craniofacial skeleton and soft tissues, such as cleft lip and palate, craniosynostosis, and pediatric fractures. Because these children have multiple issues, the best approach to providing care to them is an interdisciplinary approach which also includes otolaryngologists, speech therapists, occupational therapists and geneticists. Adult craniofacial surgery deals mostly with fractures and secondary surgeries (such as orbital reconstruction). Both subspecialities usually require advanced training in craniofacial surgery. The craniofacial surgery field is also practiced by maxillofacial surgeons (see craniofacial surgery).
    • Hand surgery is concerned with acute injuries and chronic diseases of the hand and wrist, correction of congenital malformations of the upper extremities, and peripheral nerve problems (such as brachial plexus injuries or carpal tunnel syndrome). Hand surgery is an important part of training in plastic surgery, as well as microsurgery, which is necessary to replant an amputated extremity. Most Hand surgeons will opt to complete a fellowship in Hand Surgery. The Hand surgery field is also practiced by orthopedic surgeons and general surgeons (see Hand surgeon).
    • Microsurgery is generally concerned with the reconstruction of missing tissues by transferring a piece of tissue to the reconstruction site and reconnecting blood vessels. Popular subspecialty areas are breast reconstruction, head and neck reconstruction, hand surgery/replantation, and brachial plexus surgery.
    • Burn surgery generally takes place in two phases. Acute burn surgery is the treatment immediately after a burn. Reconstructive burn surgery takes place after the burn wounds have healed. Reconstructive surgery generally involves plastic surgery.
    • Aesthetic or cosmetic surgery is concerned with the correction of form and aging. Plastic surgeons usually excel in this field because of their thorough knowledge of anatomy and extensive experience with reconstruction and congenital anomalies correction. Popular operations include amongst other breast augmentation, rhinoplasty, face lift, liposuction and mastopexy.
    • Pediatric plastic surgery. Children often face medical issues unique from the experiences of an adult patient. Many birth defects or syndromes present at birth are best treated in childhood, and pediatric plastic surgeons specialize in treating these conditions in children. Conditions commonly treated by pediatric plastic surgeons include craniofacial anomalies, cleft lip and palate and congenital hand deformities.

    "from wikipedia"


    Facial reconstruction, facelift

    The modern facial reconstruction (facelifting) operations strive for application of procedures affecting several layers of the face, providing long-lasting results in the possibly most natural way, without any cicatrisation expressed by permanent damage. The goal is that the skin, the fatty tissue under the skin, the muscles and the interstitial tissue should as far as possible participate successfully in the correction. Striving has also to be made for avoiding occurrence of sharp borders and, each area has to be treated as a functionally coherent unit. In this manner, correction of crinkles, wrinkles caused by the muscle operation is possible. When no skin redundancy exists, the operations can be accomplished through tiny cuts, either by means of camera, endoscope and other special procedures.

    The bulk of the operations are performed with application of special anesthetization techniques. This is possible with use of creams for superficial operations - such as removal of wrinkles by laser, rejuvenation treatment of the skin surface, etc. - whilst the operations affecting bigger areas are carried out with blockade anesthetization or narcotization.

    A facelift, technically known as a rhytidectomy (literally, surgical removal of wrinkles), is a type of cosmetic surgery procedure used to give a more youthful appearance. It usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient's face and neck. The first facelift was performed in Berlin in 1901 by Eugen Holländer. According to the most recent 2007 statistics from the American Society for Aesthetic Plastic Surgery, facelifts were the seventh most popular aesthetic surgery performed after liposuction, breast augmentation, blepharoplasty (eyelid surgery), abdominoplasty (tummy tuck), breast reduction, and rhinoplasty.

    In the traditional facelift, an incision is made in front of the ear extending up into the hairline. The incision curves around the bottom of the ear and then behind it, usually ending near the hairline on the back of the neck. After the skin incision is made, the skin is separated from the deeper tissues with a scalpel or scissors (also called undermining) over the cheeks and neck. At this point, the deeper tissues (SMAS, the fascial suspension system of the face) can be tightened with sutures, with or without removing some of the excess deeper tissues. The skin is then redraped, and the amount of excess skin to be removed is determined by the surgeon's judgement and experience. The excess skin is then removed, and the skin incisions are closed with sutures and staples.

    Facelifts are helpful for eliminating loose skin folds in the neck and laxity of tissues in the cheeks. The areas not well corrected by a facelift include the nasolabial folds and perioral mounds marionette lines which are more suitably treated with Botox or liposculpture, respectively. A facelift requires skin incisions; however, the incisions in front of and behind the ear are usually inconspicuous. Hair loss in the portions of the incision within the hair-bearing scalp can rarely occur. In men, the sideburns can be pulled backwards and upwards, resulting in an unnatural appearance if appropriate techniques are not employed to address this issue. Achieving a natural appearance following surgery in men can be more challenging due to their hair-bearing preauricular skin. In both men and women, one of the signs of having had a facelift can be an earlobe which is pulled forwards and/or distorted. If too much skin is removed, or a more vertical vector not employed, the face can assume a pulled-back, "windswept" appearance.

    Facelifts are effectively combined with eyelid surgery (blepharoplasty) and other facial procedures and are typically performed under general anesthesia or deep twilight sleep.

    The most common complication can be bleeding which usually requires a return to the operating room. Less common, but potentially serious, complications may include damage to the facial nerves and necrosis of the skin flaps, or infection.

    Contraindications to facelift surgery include severe concomitant medical problems. While not absolute contraindications, the risk of postoperative complications is increased in cigarette smokers and patients with hypertension and diabetes. Patients should abstain from taking aspirin or other blood thinners for at least one week prior to surgery. Patients should consult either an otolaryngologist, maxillofacial surgeon, or a plastic surgeon for more information.

    "From wikipedia"

    Implantation surgical interventions

    More and more safe and perfect implantations made of various materials are available, helping the achieving of the plastic objectives. It is possible to substitute certain missing bone parts (e.g. sunken forehead, broken zygoma) either with use of implantations made of titanium or with application of various osteoplastic materials, but replacements made of silicon are also usable in more and more versatile manner.  Different implantations are also often used during the course of plastic operations of the breast. Here mostly the implantations beneath the glandula substance or the implantations under the muscles are used.

    As special procedure is considered the fill-up procedure (e.g. labium fill-up) during the course of which the material can be injected between the tissues from a syringe, meanwhile controlling the eyes. Filling up of wrinkles can also be made with use of this method. Certain preparations contain own materials of the body, such as hyaluron acid, which absorbs the water in the skin, making it more solid and filled.

    Laser surgery plastic operations

    Unwrinkling, facial rejuvenation can be performed by means of erbium-yag laser. Primarily treatment of fine wrinkles appearing on the face around the mouth and the eyes can be accomplished without traditional plastic surgery (cutting) operation. During the course of application of this procedure the topmost layer of the facial skin, the aged cells can be erased with high accuracy. If earlier scared unevenness occurred due to pimply skin, it also can be smoothed by this procedure.

    Treatment of cicatrices may become necessary due to earlier performed operations, injuries, pimply skin or inflammations.  During the course of the intervention, in case of lesions affecting bigger depths the carbon dioxide laser, occasionally the neodimium yag laser whilst in the superficial cases the erbium yag laser is employed. Often the best result can be expected from the combined laser treatment. Of the lesions of vein origin, primarily the vasodilatation to be found on the face, the capillary vessel formations and occasionally the vein birthmarks are the most frequently occurring ones. The rhinophyma (brandy blossom) occurring on the nose is also lesion occurring very often in the veins. In all treatments lasers of different types (argon, Nd yag, carbon dioxide, diode, Er yag) can be most successfully employed. In removing of pigment spots, old-age brown spots, liver-spots and tattoos the best results are expectable also from a combination of several lasers. The technique to be employed depends on the colour, depth, location of the change and on the general properties of the patient's skin as well.
    Fat drawoff (abdomen, chin, hip, thigh, etc.)