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THE INS AND OUTS OF COSMETIC PROCEDURES

Cosmetic surgery, reconstructive surgery, plastic surgery: Are they different?
Absolutely yes. The term, Plastic Surgery, comes from a Greek word plastikos, which means to give form to something or to mould it. Whereas, Cosmetic surgery is performed for the purpose of enhancing a person’s appearance and Reconstructive surgery uses some of the same techniques and may often have similar outcomes, but is done for the purpose of repairing a defect or injury.

In practical terms, plastic surgery and cosmetic surgery are used interchangeably however many surgeons prefer to be refered to as a Cosmetic surgeon when it comes to enhancing ones personal appearance.

THE BREASTS

BREAST AUGMENTATION
A breast implant is a prosthesis used to enlarge the size of a woman's breasts (known as breast augmentation, breast enlargement, mammoplasty enlargement, augmentation mammoplasty or the common slang term 'boob job').
There are two primary types of breast implants: saline-filled and silicone-gel-filled implants. Saline implants have a silicone elastomer shell filled with sterile saline liquid. Silicone gel implants have a silicone shell filled with a viscous silicone gel.

The incision
Incisions are made in inconspicuous areas to minimize visible scarring. You and your plastic surgeon will discuss which incision options are appropriate for your desired outcome. Incision options include:

Inframammary incision	Transaxillary incision	Periareolar incision
An incision is placed below the breast in the infra-mammary fold (IMF). This incision is the most common approach and affords maximum access for precise dissection and placement of an implant. It is often the preferred technique for silicone gel implants due to the longer incisions required. This method can leave slightly more visible scars in smaller breasts which don't drape over the IMF. In addition, the scar may heal thicker.	An incision is placed in the armpit and the dissection tunnels medially. This approach allows implants to be placed with no visible scars on the breast and is more likely to consistently achieve symmetry of the inferior implant position. Revisions of transaxillary-placed implants may require inframammary or periareolar incisions (but not always). Transaxillary procedures can be performed with or without an endoscope.	An incision is made along the areolar border and is generally placed around the bottom half of the areola's circumference. Silicone gel implants can be difficult to place via this incision due to the length of incision required for access (~ 5cm). As scars from this method occur on the edge of the areola, they are often less visible than scars from inframammary incisions in women with lighter areolars. There is a higher incidence of capsular contracture with this technique.

Transumbilical (TUBA)
A less common technique where an incision is placed in the navel and dissection tunnels superiorly. This approach enables implants to be placed with no visible scars on the breast, but makes appropriate dissection and implant placement more difficult. Transumbilical procedures may be performed bluntly or with an endoscope (tiny lighted camera) to assist dissection. This technique is not appropriate for placing silicone gel implants due to potential damage of the implant shell during blunt insertion.

Transabdominoplasty (TABA)
A procedure similar to TUBA, where the implants are tunneled up from the abdomen into bluntly dissected pockets while a patient is simultaneously undergoing an abdominoplasty (Tummy tuck) procedure.

Options for Breast Implants
Saline implants are filled with sterile salt water. They can be filled with varying amounts of saline which can affect the shape, firmness and feel of the breast. Should the implant shell leak, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body.

Silicone implants are filled with an elastic gel. The gel feels and moves much like natural breast tissue. If the implant leaks, the gel may remain within the implant shell, or may escape into the breast implant pocket.

A leaking implant filled with silicone gel may not collapse. If you choose these implants, you may need to visit your plastic surgeon regularly to make sure the implants are functioning properly. An ultrasound or MRI screening can assess the condition of breast implants.

Implant manufacturers occasionally introduce new styles and types of implants, so there may be additional options available.

NOTE: Currently Saline implants are FDA-approved for augmentation in women 18 years of age and older.
Currently Silicone implants are FDA-approved for augmentation in women 22 years of age and older.
Saline or silicone implants may be recommended at a younger age if used for reconstruction purposes.

Inserting and placing the implant
After the incision is made, a breast implant is inserted into a pocket either:

A: Under the pectoral muscle (a submuscular placement), or
B: Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)
The method for inserting and positioning implants depends on the type of implant, degree of enlargement desired, your body type, and your surgeon’s recommendations.

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BREAST REDUCTION
Breast reduction is usually performed through incisions on your breasts with surgical removal of the excess fat, glandular tissue and skin. In some cases, excess fat may be removed through liposuction in conjunction with the excision techniques described below. If breast size is largely due to fatty tissue and excess skin is not a factor, liposuction alone may be used for breast reduction. The technique used to reduce the size of your breasts will be determined by your individual condition, breast composition, amount of reduction desired, your personal preferences and the surgeon’s advice.
As with breast augmentation, this procedure is performed most often on women, but may also be performed on men afflicted by gynecomastia.

The incision
You and your plastic surgeon will discuss which incision options are appropriate for your desired outcome. Incision options include:

A circular pattern around the areola



A keyhole or racquet-shaped pattern with an incision around the areola and vertically down to the breast crease



An inverted T or anchor-shaped incision pattern



Removing tissue and repositioning
After the incision is made, the nipple-which remains tethered to its original blood and nerve supply-is then repositioned. The areola is reduced by excising skin at the perimeter, if necessary. Underlying breast tissue is reduced, lifted and shaped. Occasionally, for extremely large pendulous breasts, the nipple and areola may need to be removed and transplanted to a higher position on the breast (free nipple graft).

BREAST LIFT: See breast reduction above

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LIPOSUCTION
Also known as lipoplasty, liposuction slims and reshapes specific areas of the body by removing excess fat deposits, improving your body contours and proportion, and ultimately, enhancing your self-image.

Liposuction techniques may be used to reduce localized fat deposits of the:
Thighs
Hips and buttocks
Abdomen and waist
Upper arms
Back
Inner knee
Chest area
Cheeks, chin and neck
Calves and ankles
In some cases, liposuction is performed alone, in other cases it is used with plastic surgery procedures such as a facelift, breast reduction or a tummy tuck.

What it won’t do: Liposuction is not a treatment for obesity or a substitute for proper diet and exercise. It is also not an effective treatment for cellulite, the dimpled skin that typically appears on the thighs, hips and buttocks, or loose saggy skin.

The incision
Liposuction is performed through small, inconspicuous incisions. First, sterile liquid solution is infused to reduce bleeding and trauma. Then a thin hollow tube called a cannula, is inserted through these incisions to loosen excess fat using a controlled back and forth motion. The dislodged fat is then suctioned out of the body using a surgical vacuum or syringe attached to the cannula.

Problem areas that can be addressed with liposuction:




Once your procedure is completed, a compression garment or elastic bandages may cover treatment areas. These help to control swelling and compress the skin to your new body contours. In addition, small temporary drains may be placed in existing incisions beneath the skin to remove any excess blood or fluid.

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THE FACE
The force of gravity pulls on us so that eyebrows sag, cheeks and neck form wrinkles, and eyelids droop. In a sense, this all makes our face into a disguise instead of an expression of who we are. It creates a look of tiredness, sadness, or crossness that may be at variance with how we actually feel.

FACELIFT OR MID FACELIFT
Technically known as rhytidectomy, a facelift is a surgical procedure to improve visible signs of aging in the face and neck, such as:

Sagging in the midface
Deep creases below the lower eyelids
Deep creases along the nose extending to the corner of the mouth
Fat that has fallen or is displaced
Loss of muscle tone in the lower face may create jowls
Loose skin and excess fatty deposits under the chin and jaw can make even a person of normal weight appear to have a double chin.

Rejuvenation procedures typically performed in conjunction with a facelift are brow lift, to correct a sagging or deeply furrowed brow, and eyelid surgery to rejuvenate aging eyes.

What it won’t do: As a restorative surgery, a facelift does not change your fundamental appearance and it cannot stop the aging process.

The incision
Depending on the degree of change you’d like to see, your facelift choices include a traditional facelift, limited incision facelift or a neck lift.

Traditional Facelift

A traditional facelift incision often begins in the hairline at the temples, continues around the ear and ends in the lower scalp. Fat may be sculpted or redistributed from the face, jowls and neck, and underlying tissue is repositioned, commonly the deeper layers of the face and the muscles are also lifted. Skin is redraped over the uplifted contours and excess skin is trimmed away. A second incision under the chin may be necessary to further improve an aging neck. Sutures or skin adhesives close the incisions.

Limited Incision

An alternative to a traditional facelift uses shorter incisions at the temples, continuing around the ear and possibly within the lower eyelids or under the upper lip.

Neck Lift

Sagging jowls, loose neck skin and fat accumulation under the chin may be corrected with a neck lift. The neck lift incision often begins in front of the ear lobe and wraps around behind the ear ending in the lower scalp.

Repairing sun damage
Fun in the sun presents us with its bill after we reach the age of 40 or so. Leathery skin, extra wrinkles, and irregular coloration all make us look older than we are. But we can dodge the bill with such techniques as:

Microdermabrasion
Laser skin resurfacing
Chemical peels

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EYES AND BROWS

EYELID LIFT
Also known as blepharoplasty, eyelid surgery improves the appearance of the upper eyelids, lower eyelids, or both, and gives a rejuvenated appearance to the surrounding area of your eyes, making you look more rested and alert.

The incision
The incision lines for eyelid surgery are designed for scars to be well concealed within the natural structures of the eyelid region.

	Droopy conditions of the upper eyelid can be corrected through an incision within the natural crease of the upper eyelid allowing repositioning of fat deposits, tightening of muscles and tissue, and/or removal of excess skin.
	Conditions of the lower eyelid may be corrected with an incision just below the lower lash line. Through this incision, excess skin in the lower eyelids is removed. A transconjunctival incision, one hidden inside the lower eyelid, is an alternate technique to correct lower eyelid conditions and redistribute or remove excess fat.

Eyelid incisions typically are closed with:
Removable or absorbable sutures
Skin adhesives
Surgical tape

BROW LIFT
Also known as a forehead lift, a brow lift minimizes the creases that develop across the forehead, or those that occur high on the bridge of the nose; improves what are commonly referred to as frown lines; and repositions a low or sagging brow.

The incision
A brow lift may sometimes be performed using an endoscope (surgical video device) and special instruments placed through small incisions made within the hairline. This allows the tissue and muscle beneath the skin to be repositioned, altered or removed, correcting the source of visible creases and furrows in the forehead.

	Correction of a low-positioned or sagging brow may be made with or without the use of an endoscope through incisions at the temples and in the scalp. This technique may be done in conjunction with incisions hidden within the natural crease of the upper eyelids to eliminate frown lines between the brows, on or above the bridge of the nose.
	An alternative brow lift technique is the coronal brow lift. The coronal brow lift can pinpoint specific regions of the brow to correct. This technique involves an incision from ear to ear, lifting the forehead and removing excess skin from the scalp. Recovery time is often longer than the endoscopic brow lift due to the size of the incision.

The incision lines from a brow lift are well concealed within the hair or natural contours of the face unless they are placed at the hairline to shorten the forehead. Results appear gradually as swelling and bruising subside to reveal smoother forehead skin and a more youthful, restful appearance.

Brow lift incisions typically are closed with:
Removable or absorbable sutures
Skin adhesives
Surgical tape
Special clips

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TUMMY TUCK
Also known as abdominoplasty, a tummy tuck removes excess fat and skin, and in most cases restores weakened or separated muscles creating an abdominal profile that is smoother and firmer.

Although the results of a tummy tuck are technically permanent, the positive outcome can be greatly diminished by significant fluctuations in your weight. For this reason, individuals who are planning substantial weight loss or women who may be considering future pregnancies may be advised to postpone a tummy tuck.

Also, a tummy tuck cannot correct stretch marks, although these may be removed or somewhat improved if they are located on the areas of excess skin that will be excised, generally those treated areas below the belly button.

The incision
A full tummy tuck requires a horizontally-oriented incision in the area between the pubic hairline and navel. The shape and length of the incision will be determined by the degree of correction necessary. Through this incision, weakened abdominal muscles are repaired and sutured and excess fat, tissue and skin is removed.
A second incision around the navel may be necessary to remove excess skin in the upper abdomen.




RISKS & RECOVERY
Risks of cosmetic surgery
Cosmetic surgery has a low rate of complications among board certified plastic surgeons. However, every surgery carries risk. Be sure to discuss the possible risks and complications with your plastic surgeon so you feel fully informed before surgery.
A good candidate for plastic surgery is in good overall health and has the psychological stability to deal with the recovery period. There is often some post-op pain or discomfort, temporary bruising and swelling, some restriction on activity, and some work-time lost.

RISKS
Anesthesia/Sedation Complications:
Some patients have serious reactions to the anesthesia or sedation used during surgery. Most anesthetic complications occur with general anesthesia.

Possible complications:
Abnormal heart rhythm
Airway obstruction - Anesthesia can sometimes irritate air passages, causing the vocal cords to spasm and this can block the airway
Blood clots
Brain damage - Brain damage can occur if blood circulation is depressed at dangerous levels
Death
Heart attack
Malignant hyperthermia - This is a rare complication where body temperature, blood pressure and heart rate all rise to hyperactive levels. If not recognized and treated quickly, can lead to death. This may be inherited
Nerve damage
Stroke
Temporary paralysis - This occurs if muscle relaxants have not fully worn off after surgery. It is easy to detect and easily treatable

Patients who have heart trouble, lung disease or are obese are at greater risk of complications due to anesthesia. To reduce your risk, tell your doctor about any medications you are on and let her know your complete medical history.

Specific Procedure complications:
Skin Death or Necrosis: usually follows an infection or hematoma and is much more likely among smokers. The skin is excised (surgically removed) and this may affect the cosmetic outcome.

Asymmetry: moderate or severe asymmetries may require a second surgery. Mild asymmetry is normal.

Slow Healing: due to age, skin type, failure to follow doctor's advice or factors beyond anyone's control.

Numbness/Tingling: often temporary, sometimes permanent loss of sensation. This results from injury to sensory or motor nerves.

Irregularities, dimples, puckers, and divots: can be due to surgeon error, healing irregularities or body make-up.

Seroma: fluid can collect under the skin and can occur after breast augmentation, liposuction or a tummy tuck

Infection: The risk of infection is less than 1% and antibiotics reduce this risk dramatically. However, if infection does occur, it is very serious. People who smoke, take steroids or have certain vascular conditions are at greater risk. The longer your surgery lasts and the more blood you lose, the more likely you are to have an infection.

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RECOVERY

Every surgery will require some type of recovery. Your recovery will usually take a couple of days to a few weeks. There is a possibility that you will also be prescribed medication to help ease the discomfort. Before any surgery, you will want to discuss with your surgeon a realistic recovery plan so that you can make arrangements as needed.

If you work during the week, you'll want to try and schedule your operation on a Friday. This gives you an extra weekend of recovery.

Purchase two weeks of groceries and household supplies. If you are going to be doing recovery by yourself then you'll want to prepare ahead of time. A good idea is to prepare single - serving meals and freeze them as well as have extra food on hand that takes little preparation.

Anticipate the need to reduce swelling following facial surgery by applying ice and elevating your head. Crushed ice can be placed in a plastic bag, wrapped in a small towel, and freshened regularly. Alternatively, frozen peas are tidy, reusable, and maintain their cold temperature. For elevation of your head, stacked pillows are prone to failure, but a dependable backrest can be purchased. A recliner is a reliable way to elevate your head but may be uncomfortable for sleeping.

Arrange transportation for the day of surgery and for your follow-up appointments. Anticipate that you will not be able to drive on the day of surgery or while you are taking pain medication.

Ask a friend or family member to stay with you during your first night at home. This person should be willing and able to refresh your ice packs, prepare your food, check on you through the night, recognize problems, and call your doctor.

Fill prescriptions for antibiotics and pain medication prior to the day of surgery. You may pick up the prescriptions from your doctor's office before surgery and have them filled when you stock up on groceries.

What to anticipate after surgery
Expect to look worse before you look better. Nearly all cosmetic surgery procedures involve swelling and bruising. As the swelling and bruising fades, you will begin to see your results.

If you had surgery on your face or neck, keep your head elevated for two to three days to minimize swelling and speed recovery. Do not underestimate the importance of elevation: keeping your head elevated will reduce your recovery time, whereas failure to do so will prolong it and may create disturbing asymmetries.

Ask your doctor when you may shower, bathe, and wash your hair. Often this is allowed within a day or two of surgery.

Do not drive while you are taking pain medication.

Consult with your doctor before taking any vitamins or herbal medications that you may believe are harmless. Some of these medications may cause problems.

You may resume exercise once your doctor allows it. Do not exercise before that time, even if you feel able. Exercise may worsen your swelling and confound your final result.

Use extreme caution when exposing yourself to the sun following surgery. During the first year, protect all surgical sites with potent sun block (SPF 30+).

CHOOSING A COSMETIC SURGEON

WHERE TO START
You can start by asking among your friends, acquaintances and other health experts. Their experiences might point you towards or away from certain cosmetic surgeons.

The phone book will give lots of possibilities and you can choose from among those located most conveniently

Internet searches will also turn up lots of possible plastic surgeons. Remember to make your search location-specific, as in: “cosmetic surgeons Cape area”

Once you have a list of possibilities, it’s time to do some homework!!! And remember, the cheapest surgeon around can, in the long run, be the most expensive.

Look at the doctor’s website if you can. This will tell you a lot, such as what procedures this plastic surgeon performs and what they’re like, and whether this surgeon offers a free initial consultation.

Some questions to ask cosmetic surgeons

1. Are you certified by The Association of Plastic and Reconstructive Surgeons of South Africa (APRSSA) and/or The Health Professions Council of South Africa, (HPCSA)?
Not all surgeons offering cosmetic procedures are board certified. NEVER EVER USE A SURGEON WHO IS NOT LOCALLY BOARD CERTIFIED. He/she may hold international certification which means little here at home. He/she may not be able to get local certification due to previous mishaps and if something goes wrong, the APRSSA won't be able to help. Be careful of someone who says they have the equivalant certification. And being a member of a board doesn't always mean they're certified to do a specific procedure.

2. Which hospitals do you have privileges at?

3. Are the surgical facilities where you work accredited?

4. How long have you been doing plastic surgery?

5. Can I speak with some of your previous patients about what it was like?

6. Am I a good candidate for cosmetic surgery?

7. How long have you been doing this procedure? (i.e., the one you’re interested in having)

Don't ever be afraid to ask questions. You're paying a lot of money for your surgeons time and expertise and you have a right to be 100% confidant that you've chosen the right surgeon.
You can also check with the medical board for complaints or malpractice suits against the doctor.

While you’re talking with the cosmetic surgeon, glance around his offices and notice whether they seem to be well organised, clean, and pleasant to be in. Clean being number 1 priority!!!

Does the surgeon answer your questions readily? Does he give you enough time to get clear on everything? You want to choose a plastic surgeon you feel comfortable with, one you feel you can trust. Together you can arrive at a clear understanding of what procedure(s) would be best for you, and why, which is the first step towards achieving a happy outcome.

Information on this page has been taken from the following websites. Check them out for more useful information.

The Association of Plastic and Reconstructive Surgeons in South Africa: http://www.plasticsurgeons.co.za/
The American Society of Plastic Surgeons: http://www.plasticsurgery.org/
Plastic Surgery.co.za: http://www.plastic-surgery.co.za/
Cosmetic Surgery.com: http://www.cosmeticsurgery.com/
Wikipedia: http://www.wikipedia.com

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