Cosmetic surgery continues to grow in popularity in the United States, perhaps stimulated by the impressive physical rejuvenations exhibited by media figures and/or the spate of provocative television shows illustrating the “miracle” of drastic surgical self-transformation. Regardless of the reasons, cosmetic procedures are on the rise—up 34 percent from 2005 to 2006.[rx] According to the 2006 membership survey of the American Academy of Facial Plastic and Reconstructive Surgery,[rx] these increases were largely attributed to non-surgical cosmetic procedures (e.g., Botox injections, microdermabrasion treatments, hyaluronic acid injections, chemical peels, dermal fillers, fat injections).
Cosmetic surgery also referred to as aesthetic surgery, is a surgical procedure which endeavours to improve the physical aspects of one’s appearance to become more aesthetically pleasing.[rx] The continuously growing field of cosmetic surgery is closely linked with plastic surgery, the difference being, cosmetic surgery is an elective surgery with the sole purpose to enhance the physical features of one’s appearance. Plastic surgery is performed in order to rectify defects to reinstate normality to function and appearance.[rx] Cosmetic surgical procedures are generally performed on healthy functioning body parts, with the procedure being optional not medically necessary. The inevitable aim of cosmetic surgery is to enhance one’s image, encompassing reducing the signs of aging and/or correction of a believed deviation on one’s body in turn it is surrounded by controversy.
Types of Cosmetic Surgery
- Also known as breast augmentation, Augmentation Mammaplasty involves the use of breast implants or the transfer of fat tissue to restore and create volume or improve symmetry of the breast.[rx]
- The implants used are most commonly composed of silicone which are inserted underneath the skin/muscle through a small incision.[rx] Breast Augmentation frequently is performed in conjunction with mastopexy.
- Mastopexy common known as a breast lift, involves the reshaping of the surrounding skin and tissue of the breast to produce a more youthful looking breast in appearance. The removal of excess skin along with tightening of tissue results in enhancing the shape of the breast, raising the breast to sit higher.
- The causes of loss of skin elasticity are vast being a result of breast feeding, pregnancy, aging, gravity, genetics and fluctuation in weight. The areola of the breast, (pigmented ring of skin which sits around the nipple), may stretch over a life span, which can be reduced during mastopexy.[rx]
- Also known as a breast reduction, is the removal of breast fat, glandular tissue and skin, resulting in a reduction in the size and weight of the breasts. This type of surgery is frequently used by women who experience discomfort such as back pain due to the in-proportion between body size and breast size and shape.[rx]
- A common term for brachioplasty is an arm lift. This is the reshaping of the dorsal portion of the arm spanning from the upper arm to the elbow. This procedure will reduce the downward sagging of the skin around the area of the triceps, tightening the skin.
- The supportive tissue which emphasises the shape of the arm is remodelled, tightening and smoothing its appearance via the removal of pockets of fat.[rx]
- Lipoplasty also referred to as liposuction is the removal of deposits of fat around specific areas of the body with the goal to enhance the physical contours of the body. Fat can be removed from selected area reducing prominent sections in which the patient finds unpleasing.
- Areas which are commonly focused on by patients are the Thighs, Hips, arms, abdomen, buttocks, inner knee, back, calves, face and chest. This form of surgery is commonly performed alongside other surgical procedures such as abdominoplasty[rx]
- Body contouring is a common procedure in both men and women. The surgery is prominent in those who have undergone significant weight loss resulting in excess sagging skin being present around areas of the body.
- Patients who have lost a large portion of excess weight may experience issues with elasticity of the skin once the fat has been lost. The skin losses elasticity (a condition called elastosis[rx]) once it has been stretched past capacity and is unable to recoil back to its standard position against the body and also with age.
- Body contouring is the removal of this excess skin and fat from numerous areas of the body, restoring the appearance of skin elasticity of the remaining skin, enhancing the contouring an tone of the body.[rx]
- Also known as a tummy tuck, this form of surgery removes the excess skin and fat from the abdominal area. Commonly the surgery will also restore the muscles which have been weakened and/or separated by carrying excess weight for long periods of time.[rx]
- Common in women due to the hairless trend within society, numerous women seek medical treatment to remove visible ‘spider veins’ (Telangiectasia), which appear on the surface of the skin. The small blood vessels spread across the skin which are cause by stress to the vessel itself.
- They can vary in colour, red, blue or purple and also vary in size. They are common on the legs, thighs and ankles. These veins can be caused by prolonged sitting, pregnancy, hereditary, changes in weigh and also due to hormone fluctuation. The vessel is injected with a solution via a needle which causes the vein to collapse and begin to fade, becoming less prominent in colour on the skin.[rx]
- Gynecomastia surgery is a breast reduction surgery for men. The condition Gynecomastia has numerous causes to the growth of breasts in men including obesity, a hormone imbalance, genetic dispositions or the side effect of a medication. This condition is not painful although some suggest there are mental side effects of the condition, hence the availability of surgical correction.[rx]
- Dermal fillers are injected below the skin to give a more fuller, youthful appearance of a feature or section of the face. These fillers deplete signs of aging such as wrinkles by filling and stretching the skin. One type of dermal filler is Hyaluronic acid. Hyaluronic acid is naturally found throughout the human body.
- It plays a vital role in moving Nutrients to the cells of the skin from the blood. It is also commonly used in patients suffering from Arthritis as it acts like a cushion to the bones which have depleted the articular cartilage casing. Development within this field has occurred over time with synthetic forms of hyaluronic acid is being created, playing roles in other forms of cosmetic surgery such as facial augmentation.[rx]
- Implants can be used in order to enhance features of the face. They are used to perfect symmetry and make the appearance of features more prominent such as the cheek, chin and jaw.[rx]
- A common form of cosmetic surgery is Rhytidectomy which is known as a face lift. Patients undergo a face lift to reduce the signs of aging. Sagging skin, wrinkles and loss of skin tones are a few main signs of aging which a face lift can rectify. Numerous factors can enhance the speed of aging such as exposure to the sun, hereditary, gravitational pull and medical conditions.[rx]
- Micropigmentation is the creation of permanent makeup using natural pigments to places such as the eyes to create the effect of eye shadow, lips creating lipstick and cheek bones to create a blush like look. The pigment is inserted beneath the skin using a machine which injects a small needle at a very fast rate carrying pigment into the skin, creating a lasting colouration of the desired area.[rx]
- Ear Surgery is performed in order to improve the look of the ear. Common reasons one feels they require the surgery can be due to dis-figuration caused by injury, birth defects, irregular shape, prominent position of the ear, irregular size being either too small or too large (oversized ears is a condition known as macrotia) in proportion with the head.[rx]
Procedures of Cosmetic Surgery
Injection techniques to combat ageing
- Wrinkles and creases indicate ageing. Some of these can be improved by the local injection of materials to support skin.[rx]
- This is used to temporarily fill out superficial wrinkles and deep creases. Antigenic reactions can occur.[rx]
- This is a synthetic substance of recent development. It is suitable for fine wrinkles, but its effects are short term.[rx]
- Some materials on the market are simple to apply but difficult to remove.[rx]Microspheres of polymethylmethacrylate in a collagen matrix, and cristalline silicone, are used for subdermal injection.[rx,rx,rx ]. Their use is limited to deep folds, depressions, and lip augmentation.
Autologous fat injection
- This is a cheap and safe method for facial depressions, lip augmentation, and deep folds.[rx,rx It usually needs repeating. The medium term effects are encouraging for most patients.
- Botulinum toxin – This selectively paralyses muscles for 3-9 months. It is mainly used to correct glabellar frown lines and occasionally “crow’s feet” overlying an over active orbicularis oculi muscle.[rx]
Surgery and prosthetics
- Surgery to cover bald areas has moved from the use of punch grafts and flaps that bear hair, “balloon” tissue expansion techniques, or microsurgery to the more reliable technique of micrografting.[rx,rx]
- A strip of scalp is harvested from the occipital area of a donor and divided into individual follicles. These are grafted on to the bald area of the recipient. In some centres a powerful cutting laser is used to burn holes in the recipient’s scalp to receive the grafts.[rx] There is no proved benefit from using a laser, but there is the potential for damage to existing hair follicles. A natural density of hair growth is achieved after two or three sessions.
For the face
- Cheek lift
- Chemical peel
- Chin surgery
- Cosmetic dentistry
- Eyebrow/forehead rejuvenation (brow lift)
- Blepharoplasty (eyelid surgery)
- Facial contouring
- Facial fillers
- Facial wrinkles
- Laser hair removal
- Laser resurfacing
- Neck lift
- Otoplasy (ear surgery)
- Rhinoplasty (nose surgery)
- Skin problems (blemishes, spider veins, scar revisions, tattoo removal)
- Wrinkle treatment
For the body
- Abdomen reduction (tummy tuck)
- Arm lift
- Breast augmentation
- Breast lift
- Breast reduction surgery
- Buttock lift (belt lipectomy)
- Circumferential body lift
- Inner thigh lift
- Laser hair removal
- Mentolasty is surgery to the chin. This can involve either enhancing or reducing the size of the chin. Enhancements are achieved with the use of facial implants. Reduction of the chin involved reducing the size of the chin bone.[rx]
Indications of Cosmetic Surgery
- Laser surgery – Laser technology has progressed rapidly,[rx] although one machine for all indications seems impossible to achieve at this stage. For a centre to cover all indications, at least three or four machines are required. This is often prohibitively expensive.
- Red lesions – Red lesions can be treated by a pulsed dye laser with a spectrum of absorption of the colour of haemoglobin.[rx] Photothermal energy conversion coagulates the capillaries, which improves the appearance of the lesions. Laser treatment is the method of choice for port wine stains, which respond well if the patient is young. Other superficial vascular lesions can be treated by laser provided the capillaries are not too wide.
- Telangiectasia – on the legs does not respond to laser treatment. It is still treated by microsclerosis in those patients whose capillaries are wide enough to accommodate a fine needle. I use radiosurgery in patients with capillaries of a small diameter.[rx]
- Tattoo removal – Tattoos can be removed by laser, which breaks down the ink particles into fragments small enough for macrophages to digest.[rx,rx] This Q switched (short pulse length) type of laser is only useful for professional tattoos. Traditional excision techniques are reserved for post-traumatic tattoos—that is, embedded dirt from insufficiently cleaned wounds—and amateur tattoos and for residues left after laser treatment.
- Skin resurfacing – Removing the top layers of the dermis promotes regeneration of collagen, elastine, and epidermis. This rejuvenates the facial skin long term and improves fine wrinkling. Skin resurfacing can also remove superficial blemishes such as the brown spots of ageing, dilated capillaries, and small keratoses.
- Brown lesions – Pulsed dye lasers with the spectrum of absorption of melanin can destroy melanophores responsible for brown lesions.[rx] These lasers only work reliably for superficial pigmentation. Unfortunately, they also remove normal pigment, which may result in bleaching of the skin. Most superficial brown spots can be treated by resurfacing, but there is a risk of topical depigmentation.[rx,rx]
- Bloodless incisions – The carbon dioxide laser is a potentially dangerous instrument for the surgeon to use as there is no tactile feedback—that is, with a laser beam the surgeon can see but not feel what is going on.[rx]As such, radiosurgery is now gaining popularity, and its radiowaves precisely destroy tissue.[rx,rx,rx]
- Hair removal – Although laser depilation is intensively promoted, it is still under development.[rx] Often it leads to permanent hair bleaching without affecting hair density long term. Healing problems after laser depilation of the legs are not unknown.
Cosmetic surgery Reconstructive Surgery
- Breast reconstruction
- Cleft lip and palate
- Pressure ulcers
- Dupuytren’s contracture
- Abdominal wall reconstruction
- Abdominoplasty (tummy tuck)
- Blepharoplasty (eyelid surgery)
- Body contouring
- Breast augmentation
- Breast reduction
- Cancerous and non-cancerous lesion removal
- Facial injury treatment
- Minor burn treatment
- Prominent ears treatment
- Scar revision
- Skin grafting
- Wound surgery
- Facial fillers
- Medical grade skin care products
Contraindications of Cosmetic Surgery
Contraindications include the following
Severe lung or cardiac disease
Collagen vascular disease
Older patient (more than age 65)
Smoker and unwilling to quitCosmetic Surgery
Unstable emotional history
Prior abdominal or thoracic surgery that has interrupted blood supply to the potential flaps
Prior radiation therapy
Advanced breast cancer
Complications of Cosmetic Surgery
Early postoperative complications include
Poor cosmetic outcome
Nipple/breast sensation changes
Implant malposition or displacement
Implant deflation or leak
Capsular contracture which is tightening of the tissue capsule around the implant
Bruising and bleeding
Build up of fluid
Moderate to severe pain
Asymmetry of breast
Loss of sensitivity
Hernia formation at donor site of muscle flap
People who are considering cosmetic surgery need to weigh up the options carefully before going ahead.
Here are some tips
- Choose a reputable surgeon and checking their credentials.
- After obtaining the surgeon’s opinion, make your own decisions, and resist being persuaded to opt for something you did not previously want.
- Get full information about the procedure and weigh up all the pros and cons beforehand.
- Be aware of any risks and limitations, for example, will this need redoing in 6 months?
- Choose the right moment, avoiding, for example, the time around a stressful event, such as changing jobs, bereavement, having a baby, or moving house.
- Never seek cosmetic surgery to please or impress anyone else.
- Do not travel too far for treatment, or if travel is necessary, ensure the arrangements are reliable, especially if opting for surgery abroad.
- Beware of non-refundable deposits, and be prepared to change your mind.
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