Aesthetic surgical operations: the vademecum

With this article we would like to provide, clearly and concisely, some fundamental notions in order to try to contribute to the knowledge on a topic, that is generally still unknown. It is a brief compendium on the different and most important aesthetic surgical operations illustrated by the expert – Prof. Giuseppe Sito, aesthetic surgeon – with the different procedures and methodics mostly used by the operators. RHINOPLASTY We appeal to rhinoplasty to correct the shape and volume of the nose. It is important to know that the operation can be carried out under either general or local anaesthesia according to the different cases. A septoplasty can be associated to this operation in case of a concomitant deviation of the nasal septum with respiratory functional alteration. Scars are internal, therefore invisible. The operation is generally painless also in the post-operatory phase. It implies the nose immobilization through a small plaster arch for about one week. Eventual ecchymoses under eyelids are going to reabsorbe completely with no reliquates. A 30 day self-massage (10 minutes a day) and a lymphodrenage cycle are required. MENTOPLASTY Mentoplasty is an operation, that can be carried out autonomously under local anaesthesia or associated to rhinoplasty, aimed to increase or reduce the chin. In the first case it is possible to use prostheses of inert material (silicone gel, goretex) by introducing them either buccally or through a small submental incision. Very seldom there can be a foreign body infection, that may determine the prosthesis expulsion. In order to achieve a chin reduction, according to the different cases, it can be reduced either the fibro-adipose tissue of the chin or the bone. OTOPLASTY We appeal to otoplasty to correct the malformations of the ear pavilion, the most frequent of which is the “flapping ear” or prominent ear: the ear, apparently bigger than normal, is actually more potruding due to the lack of normal folds on the cartilage, often associated to a hyperdevelopment of the ear’s concha. It is possible to undergo the operation at any age, from 6 or 7 up. Scars are situated in the retro-auricular sulcus, therefore they are invisible. A post-operatory swelling can’t be avoided, but it disappears after a few weeks. BLEPHAROPLASTY Blepharoplasty is an operation, generally carried out under local anaesthesia, aimed to correct “bags” under eyes, as well as heavy or wrinkled eyelids. The operation consists in removing skin, fat and orbicular muscle in excess. In some cases it is also possible to modify the shape of the eye. Sometimes it is necessary to raise the eyebrow and to reshape the orbitary musculature. Scars left over after surgery are practically invisible. So-called “crow´s feet wrinkles” can’t be eliminated, but only improved through the effect of the cutaneous tension. The duration of swelling and ecchymoses varies from subject to subject. Sutural stitches can be removed after three to five days. The eye becomes presentable after one week, but the best result is achieved after 3 months. This operation does not interfere at all with visual faculties. Make up is allowed after seven days. FACIAL LIFTING (partial and total) We appeal to facial lifting to treat yielding signs of facial cutis, subcutis and muscular system. The kind of anaesthesia and the times of hospitalization and stitches removal depend on the single case and on the used technique. According to the case, the operation may regard the whole face or some segments of it. The remaining scars are hidden in invisible areas. The wrinkles not eliminated by surgery can be treated separately through different techniques that will be illustrated later on. For the facial lifting it is important to quit smoking for at least one month before the operation because of the high risk of marginal necrosis in heavy smokers. After one week of more or less remarkable inevitable swelling the result becomes satisfactory from the 14th day on. The positive duration of surgery may vary from two to six years, according to the case. Facial lifting does not arrest the natural aging process, but turns the clock a few years backwards. Skin sensitivity, in particular that of the ear lobe and preauricular region, can be alterated for a variable period of time, even for a few months. Sport is allowed again after one month and sun exposure with appropriate protection after about two months. REDUCTIVE MASTOPLASTY AND MASTOPEXY Reductive mastoplasty, that must be carried out under general anaesthesia, is an operation aimed to reduce the volume of an excessively developed breast (hypertrophic). Breast hypotrophy can be of different kind and etiopathogenesis (puberal, post-gravidic or menopausal). The operation consists in removing a more or less big portion of glandular and adipose tissue and in reconstructing the breast with the residual part. Cicatricial results may be more or less evident according to the individual cutaneous reactivity. Eventual skin stretch marks will be reduced on the areas submitted to skin removal (inferior part of the breast), while on the other areas their aspect will be improved through the effect of the tension of the reshaped breast. There is neither correlation between the operation and the eventual appearance of breast pathologies, nor modification of the clinical or instrumental possibilities of early diagnosis. ADDITIVE MASTOPLASTY Additive mastoplasty, to be carried out under general anaesthesia, is an operation aimed increase the volume of a breast of dimensions not adequate to the Patient’s general conformation or personal expectations. The volumetric integration of the breast is possible only through the insertion of a prosthesis into the breast region (into the subglandular or submuscular area, according to different cases) through the periareolar area (if the areolar breadth allows the implant positioning) or the submammary area by making a small incision in the furrow. Presently utilizable prostheses are absolutely harmless respect to any pathology, oncologic or not. Their presence does not preclude any diagnostic check. The implant positioning does not have any effect on the breast height: if breast hypoplasia is associated to a certain degree of ptosis it is necessary to associate the mastopexy to the implant positioning. The sensitivity of skin and, in particular, of the areola-nipple complex can be alterated for a variable period of time, but only exceptionally for ever. Driving is forbidden for one week, while sport is allowed again after one month. Sun exposure, with covered breast, is possible after one month. CORRECTION OF GYNECOMASTIA This operation, that can be carried out under either general or local anaesthesia according to the different cases, corrects men’s excessive breast volume caused by: 1 – an increase of the mammary gland (real gynecomastia) 2 – an excessive accumulation of adipose tissue (false gynecomastia) 3 – an association of these two forms. The operation can be carried out after puberty, however when this defect gives psychological problems to the Patient. The operation consists in removing the excess of mammary gland and/or adipose tissue with different techniques. Residual scars can be either located on the inferior periareolar area or very small (less than 1 centimeter) and lateral; they are practically invisible. ABDOMINOPLASTY This operation, that must be carried out under general anaesthesia and with a three to five day hospitalization, is aimed to correct an excess of skin and fat and/or a relaxation of the abdominal musculature (often post-gravidic) with a real reconstruction of the abdominal wall. Moreover, the operation allows to eliminate scars and defects (stretch marks) on the subumbilical region; the aspect of the stretch marks on the overumbilical region can be improved only through the effect of the cutaneous tension. LIPOSUCTION AND LIPOSCULPTURE This operation can modify the Patient’s volumetric aspect as well as morphological disharmonies and it is the only treatment able to achieve a DEFINITIVE REDUCTION of deposits of “edematous-fibrosclerotic panniculopathy” (PEFS, the old “cellulitis”) and of localized fat (primary regions: hips, thighs, knees, ankles, abdomen, submental area). In practice, PEFS is a pathological manifestation of the subcutaneous adipose tissue; as a result of an alteration of the microcirculation, a chronic degeneration of the connective tissue begins and, if not treated, evolves into progressive sclerosis. In most patients both defects coexist (miscellaneous forms). Liposuction is the only treatment able to achieve a definitive reduction of alterated and/or excessive fat, that will never form again on the treated areas. The kind of local or general anaesthesia and the duration of the operation vary according to the defect degree. Scars are 1 to 1.5 cm. long and hidden, if possible, within the natural folds. Patients can move again immediately or the day after the operation. During the post-operatory phase we suggest as follows: a – wear a snug fitting elastic girdle of body stocking over the treated area for at least one month. b – make a cycle of manual lymphodrenage beginning seven days after the operation. c – avoid sun exposure until ecchymosis persists d – avoid making sport for approximately twenty days. The final result is visible one month after the operation but becomes optimal and definitive after three to six months. CORRECTION OF SCARS Wounds heal up thanks to a biological process consisting of different phases and regulated by natural mechanisms that allow tissue repair. The permanent sign deriving from this process is the scar. The cicatrization process is genetically regulated, that means that a bad scar can also be the result of a perfectly carried out suture in subjects predisposed to an anomalous cicatrization. To make a scar correction it is necssary to wait at least six to twelve months after the operation. A scar revision consists in removing the old scar and making a new suture paying attention to the cutaneous and subcutaneous layers; anyway, the result will be always a scar, but as invisible as possible