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Cosmetic & Plastic Surgery

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Dr. Ashok Tandon

MBBS, MS (General Surgery), M. Ch. (Plastic Surgery)

Sr. Consultant

Plastic Surgery

Cosmetic & Plastic Surgery

What is Plastic Surgery?

Plastic surgery is a specialized branch of surgery concerned with the correction of defects and deformities which affect appearance and function. These may be the result of accidents, burns, cancer, surgery or anomalies present since birth

Plastic Surgery has two broad divisions-

  • Reconstructive Plastic surgery
  • Cosmetic surgery

Reconstructive Plastic surgery is performed to correct defects caused by burns, injuries, congenital and developmental abnormalities, infections and diseases such as cancer. It is usually performed to bring back form and function of a body part to normal or near normal.

Cosmetic Plastic surgery includes optional procedures that are performed on normal parts of the body with the only purpose of improving a person’s appearance to bring it close to a perceived ideal and/or removing signs of ageing.

In short, Reconstructive surgery aims to bring subnormal parts to normal whereas Cosmetic surgery aims to bring normal parts to perfection.

What is the Spectrum of Plastic surgery procedures?

The following list includes common Plastic surgery procedures.

Aesthetic/Cosmetic surgery

Head & Neck

  • Rhinoplasty [nose job] – Correction of nose
  • Blepharoplasty- correction of Baggy eyes
  • Face lift, Mini Face Lift, Neck lift &Brow lift
  • Hair Restoration for baldness
  • Bat ear correction/li>
  • Dimple Creation

Breast

Male Breast-

Enlargement [Gynecomastia] is corrected with tumescent liposuction, Keyhole surgery or ultrasonic liposuction.

Female breast–

  • Increase in size [Augmentation] is generally done with Implants.
  • Heavy breasts causing distress can be reduced [Reduction].
  • Sagging breasts can be lifted up [Mastopexy].
  • Breasts removed in cancer surgery can be restored although that is reconstructive procedure

Body

  • Tummy tuck [Abdominoplasty] It removes excess skin often ridden with stretch marks along with fat and lax muscles are plicated. The result is a flat tummy. Lesser procedures also exist where the navel is left untouched.
  • Liposuction Liposuction helps to create normal contours and silhouette in select patients. It can be done as tumescent technique [SAL] or by power instruments [PAL] or by ultrasound [UAL] or lasers [LAL]. Ideal candidate is a relatively young person with localized far deposits. Scars are barely visible and recovery is quick. The removed fat is lost forever. It is the surest method for spot reduction.
  • Massive weight loss body contouring Body contouring is required after massive eight loss to remove lax skin & soft tissues. The weight loss may occur after medical treatments or bariatric surgery.

Genitalia

Male-

  • Phalloplasty to increase the length and girth of penis.
  • Combination procedures aim to do both.
  • Anciliary procedures include correction of webs at base of penis and liposuction of mons area.

Female-

  • Lipo injection of labia majora
  • Excision of labia minora
  • Vaginal tightening [ vaginoplasty], vaginal and perineal tightening [ colpo perrineorraphy]
  • Hymenoplasty [revirginisation] . Fillers for vaginal wall.
  • Monsplasty by surgery or lipo injection

Aesthetic /Cosmetic Medicine

These procedures have become very popular because of minimal downtime and risk although there is a limit to the benefits achieved. Some of these procedures are called lunchtime procedures because they are over in a few minutes and leave no tell tale signs of intervention.

  • Botox is used for dynamic lines.
  • Fillers are used for fine static lines and plumping of individual parts like cheeks or lips.
  • Peels remove signs of ageing and produce younger looks. There are several types of peels depending on choice of chemical and depth.
  • Autologous Fat Injections can restore volume without using foreign compounds. The procedure can be repeated, if desired. Vampire Face lift uses PRP [platelet enriched plasma] from a blood sample to restore youthful looks.
  • Lasers are used for hair removal, rejuvenation and removal of nevi, hemangiomas prominent veins and tattoos. It can also be used for laser vaginal tightening.
  • Radio frequency can be used for scars and rejuvenation of ageing face.
  • HIFU – this high intensity focused ultrasound can be used as a means of non surgical face lift. Results last for one to three years after this simple clinic based procedure which is done without anesthesia.
  • Cryolipolysis is used for non operative body contouring.

Reconstructive Plastic Surgery

It includes the following specialties-

Birth defects & anomalies

  • Clefts of lip & Palate are very common and eminently correctable by timely surgery.
  • Ear reconstruction for small malformed ears [microtia] is done by borrowing cartilage from rib cage.
  • Hypospadias is another common problem in male infants where the urinary opening is located on the undersurface of penis– it is treated by surgery after one year of age.
  • Other common birth defects treated by plastic surgeons are hairy Nevi and hemangiomas.
  • Congenital absence of vagina is treated by various vaginoplasty procedures
  • Chest and abdominal wall deformities may also require Plastic surgery corrections.

Burns

Pouring water for 15 –20 minutes on all thermal burns can limit the extent of damage. After that the burnt area should be wrapped in a clean cloth and the person brought to the hospital. Acute thermal, electric & chemical burns are best treated by Plastic surgeon from day one for optimal results. Early excision of deep burns which cannot heal on their own leads to decrease in mortality and morbidity.

Post Burn deformities like scars and contractures which produce cosmetic & functional disturbances are also treatable by Plastic surgery.

Hand Surgery

  • Children born with Extra digits, small digits & fused fingers and constriction rings at fingers and more complex birth deformities are treated by Plastic Surgeon.
  • All injuries from those involving finger tip injuries to ghastly factory injuries in industrial workers as also brachial plexus injuries require timely intervention by plastic surgeon to restore function.
  • Other problems like Carpal tunnel syndrome, Dupuytren’s contractures and rheumatoid and paralytic hand deformities also require plastic surgery.

Microsurgery

  • Replantation & Revascularization of Amputated body parts like fingers &toes, limbs, scalp and penis is possible. Time is of essence. Put the amputated part in a clean polythene bag and put it in a second bag full of ice and call the hospital helpline for an emergency appointment.
  • Free flaps are required for complex reconstructions or skin coverage in difficult areas.
  • Vasectomy & tubectomy reversal under microscope has best chances of success.

Trauma Surger

  • Soft tissue injuries of face and fractures of facial bones [jaws, nose, cheek & forehead] need the attention of Plastic surgeon. Poor and inept suturing can produce disastrous results and permanent damage. Fractures can be fixed with mini plates and screws for accurate reduction and early restoration of function.
  • Crush Injuries, avulsion injuries & compound fractures of limbs need treatment by skin grafts, flaps, vascularized bone transfers etc. Involvement of the Plastic surgeon from the very outset is essential for best results.

Scar Revisions

Revision of scars and contractures due to injuries, surgery infections & burns can be improved by many revision procedures. Procedures range from simple to the most complex but in the end the results are generally gratifying.

Tissue expansion

Here balloon like devices called expanders are inserted under the skin and gradually inflated to make available more skin for coverage of defects. This is especially suitable for areas of bald patches on the scalp or extensive scars on the face, body or extremities which cannot be covered by normal means.

Skin Cancers, Lumps and Bumps

All skin cancers are best treated by Plastic surgeons to prevent recurrence and deformity. Solid swellings and cysts which produce lumps and bumps are also preferably treated by Plastic surgeons to minimize scarring.

Reconstructions after ablative cancer surgeries

They are required to reconstruct the breast, facial soft tissues and jaw bones as well as defects in other parts of body. The cancer resection is done by the Oncosurgeon and then the Plastic surgeon steps in to reconstruct the defect.

Orthognathic surgery

It can improve facial symmetry when the problem lies in the lack of harmony of upper and lower jaws or chin The upper and lower jaws and chin can be set back or brought forwards to correct their alignment and projection.

Difficult wounds

These include diabetic foot ulcers, bed sores, failed flaps and post infective wounds. Which can be treated by NPWT[ negative pressure wound therapy] also known as VAC [Vacuum asssited closure]

Craniofacial surgery

It is a subspecialty of Plastic surgery which deals with congenital and acquired defects of skull, face and jaws. Diseases include craniosynostosis, rare craniofacial clefts, acute and chronic sequelae of facial fractures, cleft lip and palate, Treacher Collins Syndrome, Apert’s Syndrome, hemi facial microsomia etc. It is practiced only in a few specialized centers in India.

Gender reassignment surgery

This surgery is done in transsexuals. Whereas sex represents physical characteristics of male or a female body, gender is the psychological perception of self as a male or female. When there is a dichotomy between the two, the person is known as a transsexual. They are people who are dissatisfied with their assigned sex and feel they are trapped in a body of the opposite sex. The only way out is to do a ‘sex- change’ surgery to bring their body sex in harmony with their gender.

Male to female surgery

Involves construction of vagina [vaginoplasty] and facial feminization surgery and breast augmentation as well as removal of testes. Female to male surgery involves construction of penis through phalloplasty or metoidoplasty and surgery for removal of breasts, uterus and tubes.

Besides surgery, a lot of complex legal and psychiatric issues plague the problem. The surgery is undertaken only after a minimum period of successful real life experience as living as a member of the opposite sex. A team of medical specialists besides Plastic surgeon are involved in the entire process.

Others

  • Removal of Moles is a common procedure .Moles should be removed when they look disfiguring or when they enlarge, ulcerate or bleed to rule out cancerous change.
  • Torn ear lobules can be corrected by lobuloplasty.
  • Removal of fat deposits [Xanthelesma] around eyelids is possible with minimal discomfort
  • Submucous fibrosis which results in diminished mouth opening needs flaps for correction.
  • Vitiligo patches resistant to medical treatment can be treated by skin grafting.