EAR RECONSTRUCTION FOR MICROTIA
Microtia is a condition characterized by an undeveloped external ear in a newborn child. It occurs as the result of a growth interruption during the embryonic stages of development. It is a manifestation of what in broader terms is called the first and second branchial arch syndrome. It is from these embryonic structures that the recognizable human ear forms. This is a much rarer congenital deformity than cleft lip or cleft palate. What results is a small nubbin of tissue on the side of the head with a variable amount of tiny twisted cartilage, attached to a high riding earlobe. The external ear canal is usually absent.
Fortunately plastic surgery techniques have been developed by which an ear can be reconstructed using living cartilage. If the surgeon has expert sculptural ability, the patient's own cartilage, taken from a portion of the rib cage , can be carved into a framework which closely matches an original ear cartilaginous framework. The pioneer surgeon of this technique was Dr. Radford Tanzer. Although refinements to Dr. Tanzer's technique have been added, the concepts which he proposed have stood the test of time, and provide the best reconstructed ears possible today by modern plastic surgery techniques. Your sculptor/ surgeon may even make castings of the opposite ear and model a plan for the new ear in preparation for the surgery.
If you have a child who has microtia, there are certain facts you need to consider before choosing a course of treatment for reconstruction. First and foremost, you must avoid ANY reconstruction in which the surgeon recommends using a synthetic material (plastic, silicone, polyethylene, etc.). Although the initial result may be pleasing to the eye, the material will eventually extrude through the thin skin layer and an infection will ensue. The synthetic framework will have to be removed in order to clear the infection.
You may ask how then could a surgeon recommend using such a device. The answers are simple. The devices are marketed, and the surgeon lacks the sculptural ability to carve a cartilage framwork at the operation table. The carving process is tedious and exacting, and --face it-- few surgeons have the ability to do it. The synthetic route is quick and easy, but it eventually leads to an infection when it extrudes. This generally slams the door shut on doing a living reconstruction. Think about it; afer removal of the synthetic feamework and curing the infection, what are you left with? You guessed it ; a dense mass of unworkable scar tissue.
What are your options after a failed ear reconstruction? The patient must either live without an external ear or get an an external "stick-on" prosthesis, or fake ear. You must consider the fact that you have ONE chance to get a good result, and that is the first time. Revisionary procedures are fraught with problems which --except for rare exceptions-- cannot be overcome. This is not an operation to be performed by by the untrained, the inexperienced, or the less than skillful surgeon. It is important that you as parents of a child born with microtia do your homework carefully before choosing a program, because it is your decision which will affect your child's ultimate result.
Fortunately you have time to do your research. The sequence of operations for microtia do not begin before the child is six or seven years of age. It is at this age when the specific area of rib cartilage has grown large enough to create an ear framework. Fortunately there is an area in the rib cage where two rib cartilages fuse. This is called a synchondrosis; it is this specific area which can provide the necesary width to create a living ear. The reconstructive process requires three or four stages depending upon how complete and detailed you as a parent want the reconstruction to be. If your child has an inner ear capable of receiving sound waves, and transmitting them, surgery for making an external ear canal, and any middle ear surgery should be delayed until after the external reconstruction is complete.
Remember to do your homework and choose your surgeon wisely. You may need to travel out of state to do this. Decline the services of any surgeon who recommends the use of synthetic materials. Do not allow someone to casually amputate your child's microtic ear, and tell you to get a prosthesis. A prosthetic ear is the Last resort, not the first. There will be financial considerations, but you have time to save for your child so that he or she can lead a normal life.
For more information, please visit us at http://www.fairbanksplasticsurgery.com/saltlakecity/utah/procedure/microtia-ear-reconstruction-and-cosmetic-ear-surgery/.
Saturday, February 5, 2011
Thursday, April 29, 2010
Cheek Implants and Chin Implants
FACIAL IMPLANTS: Cheek implants and chin implants provide your surgeon the ability to create subtle changes in facial contour to enhance a given patient's appearence. Facial implants can be biologic, such as tissue taken from the patient themselves (cartilage or bone), or implants can be produced commercially. For the cheeks and chin, solid silicone works well and have a long success record. When it comes to implants in the nose, however, living biologic material is preferable. Custom implants created for traumatic loss of a portion of the skull (cranioplasty) can be made from a variety of materials.
FACIAL BEAUTY: The main points of beauty of the face are the nose, the cheeks, and the chin. It is the relationship between these prominences which historically has defined facial beauty. This must be balanced with soft tissue structures such as the forehead, the lips, the eyes and the neck. It is this balance in contour that artists and sculptors have been aware of for centuries. Ideal facial proportions were worked out in classical Greek times. Famous Greek sculptors such as Phidias, Praxitiles, Myron, Polycliltis, and others followed rules of anatomic design in order to create their sculptured masterpieces in marble, which are timeless, and continue to be admired today. It is important that Plastic Surgeons have the same artistic skills when it comes to sculpturing the human face.
THE OPERATIONS: Changing the shape of any part of the face requires knowledge of the anatomy and being able to apply that knoqwledge to obtain the best result possible for the patient. For example, cheek implants are generally placed through an incision in the hollow area behind the upper lip where the lip meets the upper jaw. This is called the upper lip sulcus. Once an incision is made, the surgeon must create a pocket by dissecting directly on bone, so as to keep all the soft tissue over the implant. Using special soft tissue elevators, the dissection is angled toward the cheek bone prominence. Once the highest point is reached, an elevator with greater curvature is introduced to extend the dissection aroung the cheek bone (Zygoma). This must be a meticulous and exacting dissection. The nerve of sensation to the upper lip is close by, and this must be protected. A non-reactive implant of silicone which has been chosen by your surgeon for size, is next carefully inserted. The implant has a concave back, so it can conform to the cheek bone. Exltra care must be taken to assure equal placement of the right and left sides. Once properly placed, the wounds are closed, and the patient will be on antibiotics for a number of days to prevent an infection.
Placement of a chin implant is a more simple operation. It can be performed either through the mouth (lower lip sulcus) or through the skin immediately below the chin through a scar that no one sees. If performed through the oral route, there may be temporary muscle weakness to the lower lip. Again, care must be taken to avoid nerve damage, this time to the sensory nerve of the lower lip. In both cases accurate placement of the implant is essential, and the surgeon's artistic judgement must be relied on for size determination. Prevention of infection is paramount; if an inferction were to occur, the implant must be removed in order to resolve it. Displacement of the implant can best be prevented by avoiding trauma or pressure on the area of operation. For example sleeping on the side of one's face after surgery can displace a cheek implant. Once three weeks has gone by the implant will be fixed in position by scar tissue. Knowing the potential risks is important in order to prevent them.
RESULTS: Cheek implants and chin implants are an effective resource to Plastic Surgeons who seek to help patients concerned about contour improvments to their face. The results can be enormously satisfying to the patient accentuating their existing beauty in a subtle but powerful way. For the patient who is considering changing their facial contour for the enhancement of appearence, consultation with a board certified Plastic Surgery specialist is essential. During your consultation, you will become knowledgable about the procedure best suited for you, the alternatives, and the pros and cons of each. For additional information, and to view examples, go to our web page, (http://www.fairbanksplasticsurgery.com/saltlakecity/utah/procedure/facial-implant-surgery/) or call the office at (801) 268-8838 for a consultation. Your surgeons at Fairbanks Plastic Surgery have extensive experience in the area of facial implant surgery.
FACIAL BEAUTY: The main points of beauty of the face are the nose, the cheeks, and the chin. It is the relationship between these prominences which historically has defined facial beauty. This must be balanced with soft tissue structures such as the forehead, the lips, the eyes and the neck. It is this balance in contour that artists and sculptors have been aware of for centuries. Ideal facial proportions were worked out in classical Greek times. Famous Greek sculptors such as Phidias, Praxitiles, Myron, Polycliltis, and others followed rules of anatomic design in order to create their sculptured masterpieces in marble, which are timeless, and continue to be admired today. It is important that Plastic Surgeons have the same artistic skills when it comes to sculpturing the human face.
THE OPERATIONS: Changing the shape of any part of the face requires knowledge of the anatomy and being able to apply that knoqwledge to obtain the best result possible for the patient. For example, cheek implants are generally placed through an incision in the hollow area behind the upper lip where the lip meets the upper jaw. This is called the upper lip sulcus. Once an incision is made, the surgeon must create a pocket by dissecting directly on bone, so as to keep all the soft tissue over the implant. Using special soft tissue elevators, the dissection is angled toward the cheek bone prominence. Once the highest point is reached, an elevator with greater curvature is introduced to extend the dissection aroung the cheek bone (Zygoma). This must be a meticulous and exacting dissection. The nerve of sensation to the upper lip is close by, and this must be protected. A non-reactive implant of silicone which has been chosen by your surgeon for size, is next carefully inserted. The implant has a concave back, so it can conform to the cheek bone. Exltra care must be taken to assure equal placement of the right and left sides. Once properly placed, the wounds are closed, and the patient will be on antibiotics for a number of days to prevent an infection.
Placement of a chin implant is a more simple operation. It can be performed either through the mouth (lower lip sulcus) or through the skin immediately below the chin through a scar that no one sees. If performed through the oral route, there may be temporary muscle weakness to the lower lip. Again, care must be taken to avoid nerve damage, this time to the sensory nerve of the lower lip. In both cases accurate placement of the implant is essential, and the surgeon's artistic judgement must be relied on for size determination. Prevention of infection is paramount; if an inferction were to occur, the implant must be removed in order to resolve it. Displacement of the implant can best be prevented by avoiding trauma or pressure on the area of operation. For example sleeping on the side of one's face after surgery can displace a cheek implant. Once three weeks has gone by the implant will be fixed in position by scar tissue. Knowing the potential risks is important in order to prevent them.
RESULTS: Cheek implants and chin implants are an effective resource to Plastic Surgeons who seek to help patients concerned about contour improvments to their face. The results can be enormously satisfying to the patient accentuating their existing beauty in a subtle but powerful way. For the patient who is considering changing their facial contour for the enhancement of appearence, consultation with a board certified Plastic Surgery specialist is essential. During your consultation, you will become knowledgable about the procedure best suited for you, the alternatives, and the pros and cons of each. For additional information, and to view examples, go to our web page, (http://www.fairbanksplasticsurgery.com/saltlakecity/utah/procedure/facial-implant-surgery/) or call the office at (801) 268-8838 for a consultation. Your surgeons at Fairbanks Plastic Surgery have extensive experience in the area of facial implant surgery.
Friday, February 19, 2010
Fat Injection Grafting
The Procedure
The careful transfer of fat from one part of the body to another is a technique which has become increasingly popular. It has been shown to be effective in correcting defects from areas where fat has atrophied or diminished. An added benefit is that the transferred fat in micro droplets is frequently seen to improve the overlying skin. This is believed to be the result of the presence of adult stem cells in the transferred fat. Only one kind of fat, however, can be used -- it must come from the same person who is undergoing the fat transfer grafting. This is termed autogenous fat as in an autogenous tissue transfer. The procedure is most frequently performed as an out-patient procedure under local anesthesia with sedation.
Where is the Fat Used?
Common locations for fat injection grafting include the lips, cheeks, back of the hand, breasts, and in locations where a patient has been over liposuctioned, leaving a localized indentation. It has been particularly useful in patients who have had a mastectomy for breast cancer followed by irradiation. The tight hard radiated skin will frequently be seen to soften when injected with autogenous fat. It has also been remarkably effective in correcting the atrophic, wrinkled labia majora, giving a full and youthful look.
Comparison to Common Fillers
The careful transfer of fat from one part of the body to another is a technique which has become increasingly popular. It has been shown to be effective in correcting defects from areas where fat has atrophied or diminished. An added benefit is that the transferred fat in micro droplets is frequently seen to improve the overlying skin. This is believed to be the result of the presence of adult stem cells in the transferred fat. Only one kind of fat, however, can be used -- it must come from the same person who is undergoing the fat transfer grafting. This is termed autogenous fat as in an autogenous tissue transfer. The procedure is most frequently performed as an out-patient procedure under local anesthesia with sedation.
Where is the Fat Used?
Common locations for fat injection grafting include the lips, cheeks, back of the hand, breasts, and in locations where a patient has been over liposuctioned, leaving a localized indentation. It has been particularly useful in patients who have had a mastectomy for breast cancer followed by irradiation. The tight hard radiated skin will frequently be seen to soften when injected with autogenous fat. It has also been remarkably effective in correcting the atrophic, wrinkled labia majora, giving a full and youthful look.
Comparison to Common Fillers
Autogenous fat grafting must be viewed in perspective and compared to other filler materials of which there are many on the commercial market. The advantages to the use of autogenous living tissue are obvious, nevertheless, a brief review is in order.
- There is no chance for an allergic reaction or rejection
- The amount of fat which survives is permanent, living tissue
- The cost over time is less when one considers the cost of repeat injections of the commercial fillers
Comercial fillers, however, are quite convenient. As everyone knows, the commercial filler materials are heavily marketed. The reason is obvious; there is a financial incentive. No commercial company can market your own adipose tissue (fat). It is therefore expedient for the patient to become knowledgeable and choose what procedure is right for them in the long run.
The advantage of the commercial fillers is that they can be taken off the shelf and injected directly.
Preparation of the Graft
In comparison to the commercial fillers, autogenous fat must be harvested by a non-destructive modality of liposuction (i.e. no Laser-Lipo -- by whatever catchphrase name, such as "Stupid Lipo," and no ultrasonic liposuction; both of which kill fat).
Following the careful harvesting of autogenous fat, the fat must be separated and concentrated so that only pure living fat cells are available to be injected in micro amounts into the living tissues in the appropriate locations. Care is taken to avoid placing a large amount of fat in a single location. The f at must be carefully interspersed in order to insure an adequate blood supply so the injected fat will live. One can expect approximately 50% or more survival of the injected fat by volume in most cases, depending on the care taken during the procedure.
In the Breast
If large amounts of fat are desired -- as in autogenous breast augmentation -- then repeat procedures are necessary to gain the desired volume. By comparison, breast augmentation using a prosthetic implant, is a one stage procedure. Fortunately, each time injection grafting is performed, the patient can expect to have more living tissue, which will then provide an ever increasing blood supply to nourish the newly injected fat.
In the Face and Lips
In the sallow face with wrinkled lips, fat injections are invaluable to plumping up wrinkled and sunken structures and provide a more youthful appearance. This may be combined with an effective dermabrasion to reduce the lip wrinkling. While there is a significant amount of swelling, in a few days the patient will find themselves acceptable to go out in public. By three months, the patient will be able to appreciate their result, even though there will be more swelling to resolve in time. The lips will eventually become soft and natural. If fuller lips is what the patient desires, this may be the best procedure for them.
In the Hands
In the dorsum (back) of the hand, when the tendons are so visible, the skin very thin, and veins appear overly large, fat injection grafting works wonders. There is a definite and predictable change, which occurs in the skin texture. Th aging appearance of the back of the hands gives way to more youthful hands with supple skin. There was a time when the age giveaway on a patient who has been made to look twenty years younger by the deep plane face lift into the release zone, was the appearance of the hands. That problem has been effectively solved by microfat injection grafting.
Are You a Candidate?
If you are considering soft tissue enhancement using filler materials, it is important to understand that your own fat is not only the ideal material, but far superior in comparison to all other fillers on the market. Augmentation of localized defects by fat injection grafting is a highly successful procedure, and can bring lasting satisfaction to patients who choose to proceed in this direction.
Your surgeons at Fairbanks Plastic Surgery have extensive experience in the area of fat injection grafting. If this has been helpful to your understanding about fat grafting, and you wish to learn more, feel free to visit our web site at http://www.fairbanksplasticsurgery.comparison and come into our office for a consultation.
Friday, December 11, 2009
Labiaplasty (Female Cosmetic Genital Surgery)
Cosmetic plastic surgery of the female genital region has been performed for years, but has been less than adequately discussed. With current trends toward more openness of information, professionals are at greater liberty to discuss what was once a taboo subject.
This is fortunate for the patient who has a problem with her genitalia, but doesn't know what solutions are available and was too embarrassed to ask.
There are a number of problems encountered, for which there are surgical solutions available. Whether there is a problem on not, depends upon what the patient wishes to achieve.
Unlike other areas of the body, the artistic ideal appearance of the female genital region has not been categorically defined. Although the anatomy is well illustrated in medical textbooks, variations exist which patients can find disturbing, both from the standpoint of appearance and function.
The most common deformity is excessively large labia minora, which protrude from the confines of the labial cleft. This deformity is more apparent when the woman has small labia majora, which lack fullness. The patient with large, hanging, wattle-like labia minora can develop irritation from abrasion or rubbing. They may be visible through some clothing, and can be an embarrassment. They can be unattractive without clothing, and there is the propensity for pain during sexual intercourse. The correction is commonly called "labiaplasty."
The surgeon who evaluates and treats deformities of the female genitalia must have not only an artistic aptitude, but also know precisely the right amount of tissue to be removed, and not too much. This comes from experience. The surgeon must treat these delicate tissues with the utmost care and the most meticulous techniques in order to achieve the optimal result for the patient.
Deformities of the female genitalia, which can be successfully treated utilizing specialized plastic surgical techniques, include:
This is fortunate for the patient who has a problem with her genitalia, but doesn't know what solutions are available and was too embarrassed to ask.
There are a number of problems encountered, for which there are surgical solutions available. Whether there is a problem on not, depends upon what the patient wishes to achieve.
Unlike other areas of the body, the artistic ideal appearance of the female genital region has not been categorically defined. Although the anatomy is well illustrated in medical textbooks, variations exist which patients can find disturbing, both from the standpoint of appearance and function.
The most common deformity is excessively large labia minora, which protrude from the confines of the labial cleft. This deformity is more apparent when the woman has small labia majora, which lack fullness. The patient with large, hanging, wattle-like labia minora can develop irritation from abrasion or rubbing. They may be visible through some clothing, and can be an embarrassment. They can be unattractive without clothing, and there is the propensity for pain during sexual intercourse. The correction is commonly called "labiaplasty."
The surgeon who evaluates and treats deformities of the female genitalia must have not only an artistic aptitude, but also know precisely the right amount of tissue to be removed, and not too much. This comes from experience. The surgeon must treat these delicate tissues with the utmost care and the most meticulous techniques in order to achieve the optimal result for the patient.
Deformities of the female genitalia, which can be successfully treated utilizing specialized plastic surgical techniques, include:
- Excessive labia minora
- Lack of fullness in the labia majora
- Laxity of the labia majora
- excessive hooding of the clitoris
- Malposition of the clitoris
- Drooping of the vulva (the entire pubic mons and genital area)
If you suffer from any of these deformities, and are considering correction, we recommend you visit our website at http://www.fairbanksplasticsurgery.com/saltlakecity/utah/procedure/female-genital-surgery-labiaplasty/, and learn more about what options are available to you, and how to arrange a consultation.
Monday, September 21, 2009
Tummy Tuck: Getting the Most From Abdominal Cosmetic Surgery
Cosmetic surgery of the abdomen comes under a number of names; however, all procedures are not the same. "Tummy Tuck" is a name which implies a minimal operation, yet it refers to one of the more extensive operations that plastic surgeons perform, hence the title "tummy tuck" is misleading.
Abdominal cosmetic surgery, better known as Abdominoplasty, is a safe operation when properly done. Wide margins of error, however, do not exist. Done safely, it can be immensely gratifying to the patient. Done poorly, it can endanger a patient's health. Also, deformities from a less than well-done abdominoplasty can rarely be improved by corrective surgery.
Who Needs Abdominoplasty?
The usual patient seeking abdominoplasty is a woman in her 30's to 40's who has finished childbearing and wants to improve the appearance of her stretched out abdomen. Her abdomen may be protruding (pouching out) especially in the lower portion. There is usually excess skin that didn't bounce back, and extra fat as well. There may be stretch marks (striae) from pregnancy. There may be separation of the abdominal muscles (diastasis), which does not respond to exercise. In fact, many women have tried tirelessly to improve their abdomen with diet and exercise, but to no avail. For these people, abdominoplasty is a logical answer.
What Scars Does it Leave?
The scars should be low down in the abdominal crease and hardly noticeable. You cannot expect to have skin removed without leaving a scar; however, using careful techniques, the scar can be very fine. The scar does not have to have cross-hatching suture or staple marks, and it can be low enough to be covered by a bikini. The loss of the stretch marks in the lower abdomen is a good trade-off for the narrow scar resulting from abdominoplasty. Within 6 to 12 months, the scar will turn your normal skin color and be difficult to see.
The Procedure
The plan of cosmetic abdominal surgery is to remove excess skin and fat, and tighten the remaining skin so that it will resemble how you looked before having children. Any prior surgical scars in the lower abdomen will be removed in the process. A skillful plastic surgeon can alleviate the abdominal skin and subcutaneous tissue off the abdominal muscular wall and bring it down -- like you were pulling down a blind -- then cut off the excess and re-attach the cut edges. Sound simple? it's a little more complex than that, but you get the idea.
Before suturing everything together, however, the surgeon must repair the muscle separation in order to tighten the abdominal wall and bring it in, correcting the out-pouching.
What Happens to the Naval?
The naval, (belly-button, or umbilicus) needs to stay in it's normal position. A circular incision is made around it, and it is left in place. When the abdominal skin is pulled down in the form of a flap, a fenestration, or window, is made at the exact level in the midline, and the naval is brought through and re-secured in it's new location to look normal. Taking the extra time to make it look attractive, the surgeon can suture it down to the fascia in order to give it the proper degree of indentation. This is easier said than done. You may have heard of people who ended up with their belly-button in the wrong place. You're right, this shouldn't happen. With a few accurate measurements, according to human anatomic design, it can be done right!
What Can Go Wrong?
Good question; and an important one. Remember, this is a big operation from the standpoint of body surface involved. All sorts of things can go wrong, unless the surgeon and patient make plans to avoid them. Careful planning is essential. Knowing the possible complications of abdominoplasty is key to preventing them; however, taking the extra time necessary may be more than some surgeons want to spend. It can either be done fast, or it can be done right. You cannot have it both ways. Placement of the incision in the proper location is all important.
What if it is done too fast. One way a surgeon can do it fast is to make the incision high in the mid abdomen just below the naval instead of down in the bikini line. The surgeon will not have to dissect as far; therfore it becomes a shorter operation. The problem is, that the patient has to live with an objectionable high and visible scar for the rest of her life. Such a scar cannot be corrected regardless of how much money the patient is willing to pay.
The second most common way to perform an abdominoplasty quickly is for the surgeon to do the dissection with the electro-cautery machine, burning the tissue as he goes. Sure, there's a little less bleeding at the time, but what happens to burned tissue? It weeps fluid (serum). In such cases, the patient has to put up with the presence of suction drains for 2 to 3 weeks to avert a seroma, and the risk of infection is higher due to the long indwelling drains.
A seroma is a collection of fluid beneath the abdominal flap, and it prevents the flap from sealing and healing down to the abdominal wall like it is supposed to. This is the most common complication of "tummy tuck" surgery, and it is easily preventable. If the surgeon performs the dissection with a sharp scalpel and scissors, the risk of seroma formation is almost nil. After sharp dissection, the drains can safely be removed at 3 days and seromas rarely occur.
What is the Worst Thing That Can Happen?
Well, death, of course. As with flying, the worst thing that can happen is the plane can crash. Remember, this is a big operation. If you don't add another operation to it, you'll be as safe as it gets. The last thing you want to say to your plastic surgeon is, "while you're at it, doctor, would you add...?" If you add liposuction to the surgery, for example, you'll be playing with life and death . . . yours! For a cosmetic surgical procedure, it is simply not worth it!
When you read in the newspapers about someone dying from plastic surgery, it is almost always a combination of abdominoplasty and something else, such as liposuction. Combinations with abdominaplasty do more than add to the risk, they multiply the risks. The physiology is well known, so avoid the "while you're at it syndrome." If you want to avoid serious complications, say "no" to combinations!
Are There Other Operations to Improve the Abdomen?
Of course there are, and each one has its place. Liposuction alone, for example, can in many instances improve the abdominal shape if the fat is located external to the abdominal wall. One can count on skin retraction afterward; especially in the younger years. After age 40, however, we begin to lose our elastic fibers, and the skin doesn't snap back as well.
Despite the amount of hype you may be subjected to, avoid unproven procedures that go by catch-phrase names. A "Mini Tuck" for example r "Mini Abdominoplasty" means removing just a little bit of lower abdominal skin and fat. It rarely provides the result that you are looking for. It does not tighten skin above the naval, but it leaves a shorter scar. The mini operation provides a mini result. With a Mini Abdominoplasty, the expectations a patient has are all too frequently much greater than the actual results.
Panniculectomy is another option reserved for the obese patient with a huge overhanging apron flap hanging over their thighs, creating functional problems of every kind for them. This big chunk of useless skin and fat is another structure making demands on the patient's circulatory system and heart muscle. It needs to be amputated, both for cleanliness, and to take a load off the heart. The operation leaves an enormously long scar; however, it improves the patient's hygiene and health, and is well worth it. Although a panniculectomy does improve a patient's appearance, it is not considered to be a cosmetic procedure.
Plastic surgery of the abdomen cannot be successfully performed in the patient who has a great deal of internal abdominal fat (omentum and bowel mesentery). Weight loss is essential before cosmetic abdominal surgery can be carried out successfully in these patients.
What Can I Expect From Abdominoplasty?
For the right patient, choosing the right operation and taking the appropriate safety precautions, you can expect to have a flatter abdomen with a low scar and a normal looking naval. Your lower abdominal stretch marks will be gone, and you'll feel better about yourself in a swim suit. You will need to spend your first two weeks walking in a semi-flexed posture so as not to apply tension on the scar while initial healing occurs; however, when you stand up two weeks later and see your tight flat abdomen, you'll think that it was all worth it.
For more information regarding cosmetic abdominal surgery (abdominoplasty), be sure to visit our web site at http://www.fairbanksplasticsurgery.com/saltlakecity/utah/procedure/abdominoplasty-or-tummy-tuck-cost-and-procedure/.
Tuesday, September 15, 2009
Breast Lift Surgery: Getting the Best Result from Mastopexy
From an Artistic Standpoint
Surgery of the human female breast is true surgical sculpture. The breast is the major visual identifier of the female sex, and as such should be re-created to optimal dimensions at the time of surgery. So, what constitutes optimal? For centuries, artists have painted the human figure, and sculptors have sculpted the female figure. The female breast has historically played a prominent role in art work. Human proportion and anatomical design are key to identification of the ideal, and only when we have identified the ideal, can we seek to recreate it surgically.
The surgeon must have artistic skills to do the best work on the breast, which will show in his surgical results. Placement of scars, position of the nipple and avoiding an unnatural look are all important in achieving a natural appearance in a breast lift (mastopexy). If one considers the breast to be a combination of a dome and a cone, the nipple should protrude at the apex of the cone. Operations which do not do this fail in the art department.
The Nipple -- How Big and Where to Put it
Next is the position of the nipple. There are a number of well-known measurements of proportion, which when properly applied, will tell the surgeon exactly where the nipple should be on the patient's chest. For example, a line drawn from the umbilicus (navel) to the Acromian Process (the bony prominence on the shoulder) will invariably pass through the ideal nipple position. Add two more dimensions, an equilateral triangle, and the surgeon can locate the perfect position! If the surgeon just makes a guess as to the location, it will flaw the result, guaranteed!
Next, consider nipple size and shape. Some nipples are tiny while others are huge. Some are round while others are oval. Some have flattened papilla and others protrude. So, what is normal and what is ideal? Ideally, the nipple is a circle of pigmented skin with a central raised papilla, which protrudes enough, but not too much. The ideal nipple diameter is 4.5 to 4.7 cm. That's just over 1¾ inches; something artists know and surgeons should know.
What about relocating the nipples surgically? Some women have nipples which are too far in, and other women have nipples that are too far out. So what is ideal? The breasts normally diverge at 45 degrees from the midline plane of the body, with the nipples at the apex of the cone/dome as we have observed. The closer we come to this, the better the breasts will appear. This means that if one breast is viewed in profile, the other will be seen in the full round. You can verify this if you buy a magazine with photos of nudes -- yes, such magazines are available -- or take a life drawing art course and see for yourself.
Cleavage
What about cleavage? Cleavage is a function of whatever pushes the breasts together. Clothing, padded bra, arms, hands, dependent position, etc. When a woman lies down on her back, is there any clevage? Nature induced clevage only occurs in woman with a Pectus Excavatum (caved-in chest). In such a breast configuration, the nipples may appear as "owl eyes" or "cross eyes". This can be a problem when wearing a bikini. Operations which place the nipples too far in will have the same problems.
Pre-Operative Preparation
While there are a multitude of breast deformities that the surgeon will encounter over years of practice, keeping the artistic parameters in mind, the surgeon can use his skills to make corrections of deformities, and strive for the ideal. A few principles must be recognized, however, in order to stay out of trouble. Paramount is the cessation of smoking. The next is accurate, pre-surgical measurements and planning. The third is carefulness of technique. The careless use of external, cross-hatching "baseball" sutures, or staples, will result in ugly, telltale scars. Such scars around a nipple will never look normal.
Putting it All Together
The goal of breast lift (mastopexy) surgery is to lift the sagging, drooping (ptotic) breast in order to make "perky breasts" like you may have had in your younger days. The mound of breast tissue must be advanced upward, based on its blood supply, from the underlying muscle. The overlying skin is raised, and is the redraped around the mound in such a fashion as to reproduce the ideal shape ("skin brassiere"). Excess skin (and only skin) is removed, and the closure is done with hidden sutures underneath the skin. With the breast tissue thus carefully raised to a new position, all elements must bond together and heal in the new shape.
Options -- The Bad, and the Ugly, and the Good
Some breast lift procedures lead to an abnormal looking "bottoming out" effect, where the nipple ends up too high and the mound drops down below. This is BAD! Other procedures can give you a broad, flat nipple with wide scars. This is UGLY! Another procedure puts the nipples in the wrong location, and leaves a long, bunched up scar beneath them. Again, this is UGLY!
We freely admit that these procedures are quicker to perform. However, if you want the best possible appearance, these are not for you! Consider the ideals of anatomic design and how to best achieve them. After all, these are your breasts -- two of your greatest assets -- and with breast lift surgery, you've only got one chance to get it right. Be GOOD to them!
To learn more about breast lift surgery (mastopexy) visit our website at http://www.fairbanksplasticsurgery.com/saltlakecity/utah/procedure/breast-lift-surgery/.
Surgery of the human female breast is true surgical sculpture. The breast is the major visual identifier of the female sex, and as such should be re-created to optimal dimensions at the time of surgery. So, what constitutes optimal? For centuries, artists have painted the human figure, and sculptors have sculpted the female figure. The female breast has historically played a prominent role in art work. Human proportion and anatomical design are key to identification of the ideal, and only when we have identified the ideal, can we seek to recreate it surgically.
The surgeon must have artistic skills to do the best work on the breast, which will show in his surgical results. Placement of scars, position of the nipple and avoiding an unnatural look are all important in achieving a natural appearance in a breast lift (mastopexy). If one considers the breast to be a combination of a dome and a cone, the nipple should protrude at the apex of the cone. Operations which do not do this fail in the art department.
The Nipple -- How Big and Where to Put it
Next is the position of the nipple. There are a number of well-known measurements of proportion, which when properly applied, will tell the surgeon exactly where the nipple should be on the patient's chest. For example, a line drawn from the umbilicus (navel) to the Acromian Process (the bony prominence on the shoulder) will invariably pass through the ideal nipple position. Add two more dimensions, an equilateral triangle, and the surgeon can locate the perfect position! If the surgeon just makes a guess as to the location, it will flaw the result, guaranteed!
Next, consider nipple size and shape. Some nipples are tiny while others are huge. Some are round while others are oval. Some have flattened papilla and others protrude. So, what is normal and what is ideal? Ideally, the nipple is a circle of pigmented skin with a central raised papilla, which protrudes enough, but not too much. The ideal nipple diameter is 4.5 to 4.7 cm. That's just over 1¾ inches; something artists know and surgeons should know.
What about relocating the nipples surgically? Some women have nipples which are too far in, and other women have nipples that are too far out. So what is ideal? The breasts normally diverge at 45 degrees from the midline plane of the body, with the nipples at the apex of the cone/dome as we have observed. The closer we come to this, the better the breasts will appear. This means that if one breast is viewed in profile, the other will be seen in the full round. You can verify this if you buy a magazine with photos of nudes -- yes, such magazines are available -- or take a life drawing art course and see for yourself.
Cleavage
What about cleavage? Cleavage is a function of whatever pushes the breasts together. Clothing, padded bra, arms, hands, dependent position, etc. When a woman lies down on her back, is there any clevage? Nature induced clevage only occurs in woman with a Pectus Excavatum (caved-in chest). In such a breast configuration, the nipples may appear as "owl eyes" or "cross eyes". This can be a problem when wearing a bikini. Operations which place the nipples too far in will have the same problems.
Pre-Operative Preparation
While there are a multitude of breast deformities that the surgeon will encounter over years of practice, keeping the artistic parameters in mind, the surgeon can use his skills to make corrections of deformities, and strive for the ideal. A few principles must be recognized, however, in order to stay out of trouble. Paramount is the cessation of smoking. The next is accurate, pre-surgical measurements and planning. The third is carefulness of technique. The careless use of external, cross-hatching "baseball" sutures, or staples, will result in ugly, telltale scars. Such scars around a nipple will never look normal.
Putting it All Together
The goal of breast lift (mastopexy) surgery is to lift the sagging, drooping (ptotic) breast in order to make "perky breasts" like you may have had in your younger days. The mound of breast tissue must be advanced upward, based on its blood supply, from the underlying muscle. The overlying skin is raised, and is the redraped around the mound in such a fashion as to reproduce the ideal shape ("skin brassiere"). Excess skin (and only skin) is removed, and the closure is done with hidden sutures underneath the skin. With the breast tissue thus carefully raised to a new position, all elements must bond together and heal in the new shape.
Options -- The Bad, and the Ugly, and the Good
Some breast lift procedures lead to an abnormal looking "bottoming out" effect, where the nipple ends up too high and the mound drops down below. This is BAD! Other procedures can give you a broad, flat nipple with wide scars. This is UGLY! Another procedure puts the nipples in the wrong location, and leaves a long, bunched up scar beneath them. Again, this is UGLY!
We freely admit that these procedures are quicker to perform. However, if you want the best possible appearance, these are not for you! Consider the ideals of anatomic design and how to best achieve them. After all, these are your breasts -- two of your greatest assets -- and with breast lift surgery, you've only got one chance to get it right. Be GOOD to them!
To learn more about breast lift surgery (mastopexy) visit our website at http://www.fairbanksplasticsurgery.com/saltlakecity/utah/procedure/breast-lift-surgery/.
Monday, August 31, 2009
Facelift Surgery: Getting the Best Results
Looking Younger
The appearance of one’s face is one of a person’s most valuable assets. When a person feels good about their appearance, interaction with others will be more positive. People will frequently ask why so many people come away from having a facelift with simply awful results? The answer lies in the fact that all facelifts are not done in the same way. Conceptually, technically, anatomically, and financially, facelifts vary widely. And, -- buyer beware!-- with the number of procedures being promoted to make a person look younger, one must ask themselves what is truth and what is hype. Those seeking an excellent facelift should know what it’s all about before making a decision.
Truth or Hype
Despite the many procedures being promoted and labeled by catch-phrase names, there are only five basic types of facelift procedures. What to expect from each type is well known in professional circles, but not publicly. Each have their pros and cons, . . . some only cons. Knowing what to expect, devoid of hype or misconception, however, is most important before making your decision. If what you’re being offered sounds too good to be true, you can rest assured that it is. When you are offered a one and one half hour facelift, unless you like disappointment, think again. You may end up paying an exorbitant fee for what amounts to a non-result. If you want an excellent predictable result, the “quickie lift” will not provide it, guaranteed!
What most people do not know is that “mini-lifts” were actually performed in the 1920s. Would you accept a sales-pitch for a 1928 automobile as the latest vehicle for 2009? A mini-lift by any other name is still a mini-lift -- an out-dated procedure -- and will give you a mini result. We would all like to believe that we can get an excellent, long lasting result for a minimum of time and effort. It is wishful thinking.
When deciding on the operation, look at the long term results, and ask yourself whether there are dead-giveaway stigmata which will advertise to everyone that you’ve had a facelift. This doesn’t need to be! If a surgeon offered you a mediocre result with major hair loss, verses a spectacular result with NO hair loss, which would you chose?
Facelift Advances
Facelift surgery has come a long way since the 1920s. Major advances have been made in understanding facial anatomy and how we can use the anatomy to its best advantage. Much more can be done today using that knowledge to achieve prime optimal results.
The human face is made up of layers and planes. The surgeon must be intimately familiar with facial anatomy, and know the specific release zones in the face. The surgeon must be able to dissect and advance the deeper planes to the patient’s advantage, all the while protecting the underlying nerves and blood vessels. By so doing, the jowls will disappear, the neck will become clean, the cheeks will lose their droop in a natural way, and a lateral brows are also lifted to take away that tired look. Most importantly, the patient does not look stretched or unnatural because the tension is on the deeper structures, not the skin.
Who Did What To Whom
How many high profile persons are you aware of who have had horrific facelifts? You wonder why they chose to have such a procedure, and by whom. They have the money. They should have known better.
Face it, they didn’t know what they were getting, and obviously did not personally go to the effort to find out before doing what they did. A person can spend a fortune and get an unfortunate result. The amount of money spent does not determine the quality of the result.
For those patients who get exceptionally good facelifts, however, no one can even tell that they have been operated on. As a result, we tend to judge facelift surgery by those who have had bad results. This leads to false conclusions about facelift surgery. We think, surely high profile people are wealthy enough to get the very best; however, you can rest assured that those who obtained less than optimal results simply didn’t know any better.
Avoiding the Telltale Signs
So what’s the difference? Here is a list of some of the visible telltale signs (stigmata) that announce one has had a mediocre facelift:
The sideburns been elevated to an abnormally high level.
The earlobes tie into the neck as if being pulled downward (so-called Pixie Ears).
You can see directly into the person’s ear canal because the canal cover (tragus) has been amputated.
The eyes look deformed (lower lids pulled down).
The smile looks fake or lopsided.
There are objectionable scars.
The jowls have been left uncorrected.
The person look entirely different from the person you remember.
If you see any of these signs, the patient has not has a good facelift.
Choosing Your Surgeon
All of the problems mentioned above can be prevented! Today’s patient can seek out safe facelift surgery with predictable good results and can anticipate looking up to 20 years younger without looking tight, stretched, or strange. Such results, however, cannot be achieved by “quickie lifts” despite the hype. The patient must seek out qualified surgeons, certified by the American Board of Plastic Surgery, who are capable of performing surgery using the most advanced and meticulous, deep-plane techniques.
For further information on how to achieve the best facelift results, and to view examples of the Fairbanks Facelift for yourself, please contact the Fairbanks Plastic Surgery Center at http://www.fairbanksplasticsurgery.com/saltlakecity/utah/procedure/facelift-facial-rejuvenation/
The appearance of one’s face is one of a person’s most valuable assets. When a person feels good about their appearance, interaction with others will be more positive. People will frequently ask why so many people come away from having a facelift with simply awful results? The answer lies in the fact that all facelifts are not done in the same way. Conceptually, technically, anatomically, and financially, facelifts vary widely. And, -- buyer beware!-- with the number of procedures being promoted to make a person look younger, one must ask themselves what is truth and what is hype. Those seeking an excellent facelift should know what it’s all about before making a decision.
Truth or Hype
Despite the many procedures being promoted and labeled by catch-phrase names, there are only five basic types of facelift procedures. What to expect from each type is well known in professional circles, but not publicly. Each have their pros and cons, . . . some only cons. Knowing what to expect, devoid of hype or misconception, however, is most important before making your decision. If what you’re being offered sounds too good to be true, you can rest assured that it is. When you are offered a one and one half hour facelift, unless you like disappointment, think again. You may end up paying an exorbitant fee for what amounts to a non-result. If you want an excellent predictable result, the “quickie lift” will not provide it, guaranteed!
What most people do not know is that “mini-lifts” were actually performed in the 1920s. Would you accept a sales-pitch for a 1928 automobile as the latest vehicle for 2009? A mini-lift by any other name is still a mini-lift -- an out-dated procedure -- and will give you a mini result. We would all like to believe that we can get an excellent, long lasting result for a minimum of time and effort. It is wishful thinking.
When deciding on the operation, look at the long term results, and ask yourself whether there are dead-giveaway stigmata which will advertise to everyone that you’ve had a facelift. This doesn’t need to be! If a surgeon offered you a mediocre result with major hair loss, verses a spectacular result with NO hair loss, which would you chose?
Facelift Advances
Facelift surgery has come a long way since the 1920s. Major advances have been made in understanding facial anatomy and how we can use the anatomy to its best advantage. Much more can be done today using that knowledge to achieve prime optimal results.
The human face is made up of layers and planes. The surgeon must be intimately familiar with facial anatomy, and know the specific release zones in the face. The surgeon must be able to dissect and advance the deeper planes to the patient’s advantage, all the while protecting the underlying nerves and blood vessels. By so doing, the jowls will disappear, the neck will become clean, the cheeks will lose their droop in a natural way, and a lateral brows are also lifted to take away that tired look. Most importantly, the patient does not look stretched or unnatural because the tension is on the deeper structures, not the skin.
Who Did What To Whom
How many high profile persons are you aware of who have had horrific facelifts? You wonder why they chose to have such a procedure, and by whom. They have the money. They should have known better.
Face it, they didn’t know what they were getting, and obviously did not personally go to the effort to find out before doing what they did. A person can spend a fortune and get an unfortunate result. The amount of money spent does not determine the quality of the result.
For those patients who get exceptionally good facelifts, however, no one can even tell that they have been operated on. As a result, we tend to judge facelift surgery by those who have had bad results. This leads to false conclusions about facelift surgery. We think, surely high profile people are wealthy enough to get the very best; however, you can rest assured that those who obtained less than optimal results simply didn’t know any better.
Avoiding the Telltale Signs
So what’s the difference? Here is a list of some of the visible telltale signs (stigmata) that announce one has had a mediocre facelift:
The sideburns been elevated to an abnormally high level.
The earlobes tie into the neck as if being pulled downward (so-called Pixie Ears).
You can see directly into the person’s ear canal because the canal cover (tragus) has been amputated.
The eyes look deformed (lower lids pulled down).
The smile looks fake or lopsided.
There are objectionable scars.
The jowls have been left uncorrected.
The person look entirely different from the person you remember.
If you see any of these signs, the patient has not has a good facelift.
Choosing Your Surgeon
All of the problems mentioned above can be prevented! Today’s patient can seek out safe facelift surgery with predictable good results and can anticipate looking up to 20 years younger without looking tight, stretched, or strange. Such results, however, cannot be achieved by “quickie lifts” despite the hype. The patient must seek out qualified surgeons, certified by the American Board of Plastic Surgery, who are capable of performing surgery using the most advanced and meticulous, deep-plane techniques.
For further information on how to achieve the best facelift results, and to view examples of the Fairbanks Facelift for yourself, please contact the Fairbanks Plastic Surgery Center at http://www.fairbanksplasticsurgery.com/saltlakecity/utah/procedure/facelift-facial-rejuvenation/
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