GENERAL QUESTIONS

What is Plastic Surgery? What kind of plastics are used?

Plastic surgery is named from the Greek word "plastikos" which means "to shape", based on the surgeon re-shaping the form of the patient's form through surgery. It has nothing to do with the types of materials used in the surgery itself.

In surgery, many different materials may be utilized, depending on the desired results and the type of surgery. Frequently, the surgeon will make use of the patient's own tissues, including tissues from another location of the body, or by reshaping the existing tissues to achieve a better appearance.

Historically, many materials have been used in cosmetic and reconstructive surgery, including ivory, wood, and others. In modern times, hard silicone rubber is a popular material. This should not be confused with the gel silicone which has sparked so much controversy through its use as a filler for breast implants.

What is the difference between "Cosmetic" and "Reconstructive" surgery?

Generally speaking, if a surgery is done primarily to improve the health of a person, or the function of an organ, it is considered medically necessary. Surgeries such as corrective rhinoplasty to improve air flow through the nose, or eyelid surgery to improve the field of vision by lifting sagging, droopy eyelids might fall into this category. These surgeries may or may not also improve the patient's appearance, but this is a secondary purpose.

If a surgery is done with the primary goal of improving the appearance of the patient, this is considered a cosmetic procedure. Usually these procedures must be paid for out of pocket, except in some cases of correcting accidental or congenital deformity.

It is worth noting that these lines are often blurry, especially in terms of coverage by medical insurance. As an example, a scar revision for an automobile accident injury may be covered by an auto insurance policy, yet another surgery, identical from a medical standpoint, that resulted from an accident fall injury might not be covered by insurance.

Another example is breast reconstruction following breast cancer surgery -- some insurance companies will cover this, while others consider this primarily cosmetic in nature. It goes without saying that this is a hotly contested issue between those insurance companies and the affected patients.

What parts of the body do you do Plastic Surgery on?

There are commonly performed cosmetic procedures for virtually every part of the face, including the neck, nose, eyes, ears chin, cheekbones, forehead, as well as the breasts and abdomen. Additionally, scar revision and liposuction surgeries are potentially possible on most areas of the body.

Is there any visible scarring?

Any time a cut or incision is made in the skin, there is a scar left behind as part of the normal healing process. Plastic and Reconstructive Surgeons have received special training and have extensive experience with minimizing the size of these scars, creating the least noticeable appearance of then, and locating them in the least conspicuous areas possible. Often the scars will become undetectable to all but the most careful examination over the course of time.

How long is a typical recovery period for most operations?

Generally, 1-2 weeks for most procedures, although this varies from one patient to the next, as well as from one procedure to the next.

Will it be covered by my medical insurance?

In general, if it is cosmetic, your medical insurance will not cover the surgery or treatment. (See the questions regarding the difference between 'plastic' and 'reconstructive' surgeries for more on this topic).

How long does it take for an operation?

On an average, most surgeries take 2-3 hours in the operating room, with the most extensive of multiple procedures lasting several hours. Additional time is often required for preparation before, and rest & recovery time after the surgery itself, particularly when sedation or a general anesthetic is administered.

How long does it take to heal?

This varies greatly depending on the procedure in question. For small, non-invasive procedures, such as laser tattoo removal, or collagen therapy, patients are ready to return to normal activity immediately after treatment. For procedures like laser skin resurfacing or blepharoplasty, patients may be ready for most normal activities in 3-6 days, while more extensive surgeries such as abdominoplasty or extensive liposuction may require a more extended convalescence.

The body's complete healing process takes longer than this initial recovery time, and may last from several week up to a year or more as incisions heal completely and tissues achieve their maximum recovery.

What are the risks?

All surgeries entail risks, such as bleeding, possible infection, etc. Please see the information on the specific surgery, or consult with a qualified surgeon for more detailed information.

Can you make me look like (insert name of favorite celebrity here)?

Plastic surgery can achieve impressive results for a patient with realistic expectations and goals. To many, the results may even seem 'miraculous', however to think you can be made over so completely as to look just like another person entirely is still the stuff of Hollywood movies and fiction novels Cosmetic plastic surgery's primary focus on refining a person's appearance, rather than changing it entirely.

What are the most common surgeries?

Among the most frequently performed surgeries are: breast augmentation surgery, rhinoplasty, facelift and blepharoplasty (eyelid surgery).

What about the use of endoscopes in plastic surgery? Is this just a sales tool? What is the advantage of using an Endoscope in plastic surgery? What procedures are performed with it?

The endoscope is an instrument which allows the surgeon to utilize a very small incision and still see the actual surgical location deep under the tissues. This means that a minimal scar in the axilla can be made, without compromising the results of the surgery. To achieve an equivalent degree of visibility and control without an endoscope, the surgeon would need to make a larger incision in a more visible location. For comparative purposes, this type of procedure is similar in nature to orthoscopic surgeries that have become popular in the media recently for joint surgeries on athletes. This is not to say that a good result cannot be achieved without an endoscope, but it is more challenging for the surgeon, who is operating solely 'by feel'.

PROCEDURE-SPECIFIC QUESTIONS

ABDOMINOPLASTY

Can Abdominoplasty eliminate "stretch marks" from my pregnancy?

If the stretch marks are located in the incision area for the surgery (below the belly button) then they can be removed in the course of abdominoplasty. In locations not at the incision, site, they cannot be removed, although it is sometimes possible to use a different incision location to accomplish this goal.

Surgery on just the stretch marks alone will merely trade the stretch marks for an incision scar, and is a generally a poor trade-off considering the cost and effort of surgery.

BREAST SURGERY

I heard about soy bean oil / peanut oil /hydro gel as a filler material for breast implants. What are those?

Currently, only saline-filled implants are approved for general use in the United States. There has been experimentation with soybean oil, peanut oil, and hydro gel as fillers for breast implants, but these are not approved for general use in the USA, and it does not appear likely that any of these will be approved for use in the foreseeable future.

What is the difference between textured & smoothbreast implants? What are the advantages & disadvantages of each?

Softness of the breast following augmentation, along with a natural appearance, are primary concerns to both the surgeon and the patient. The ideal result is one which is natural in all respects.

Smooth implants are the softest implant immediately after they are placed, but they require ongoing massage and mobilizing by the patient to maintain this result. Additionally, they may only be placed under muscle layer of the chest. In nearly all patients, within a few years after the surgery, the massaging becomes too inconvenient to continue, and as a result, the breast will lose the softness that gives the most natural result.

Textured implants are slightly more firm when initially placed, however they require no special upkeep on the part of the patient to maintain their softness. Additionally, they can be placed either under or over the muscle layer (when appropriate for some patients), which gives the surgeon more control to obtain the best result for the patient. (see "How much can the breast be enlarged?" for more information regarding placement under or over the muscle layer). For this reason, the textured implants are the preferred choice of many surgeons.

What is the advantage of axillary approach for breast augmentation?

The axillary approach has several advantages for most patients. First, it does not invade the breast tissues directly, going underneath instead. Secondly, there is no scar left on the skin of the breast -- instead the scar is located in the armpit area, which is a much less noticeable location. This is the preferred approach for patients who have do not have pendulous (saggy) breasts.

How much can my breasts be enlarged? What is the limit of this? Why is it limited?

The degree of enlargement is based on the anatomy of the patient's body more than any other factor. Saline-filled implants require placement underneath the muscle layer of the chest to achieve a natural result in most patients. The implant must be covered by the muscle layer, and this coverage determines the maximum volume of the implant.

The width of the patient's chest, as well as the locations of nerves in the chest and abdomen limit the maximum volume of an implant that can be used, because the total width of the implant must fit underneath the muscle without intruding into the nerve bundles, otherwise numbness of the breast and/or nipples would result.

For some patients, placement of the implant may be possible on top of the muscle layer, providing they have a sufficient amount of breast tissue and fatty tissue to give the implant the coverage needed to achieve natural results. Your surgeon can help you determine the best size of implant for you at the time of your consultation.

AFTER BREAST AUGMENTATION:

Will I be able to breast feed?

Breast augmentation (under the muscle layer) should not affect your ability to breast feed. For sub-glandular augmentation (under the breast tissue, but over the muscle layer), like any other surgery which disturbs the breast tissue itself, there is a risk of losing the ability to breast feed.

Will my breasts still be saggy?

Sagging of the breast is a factor determined by your body. Some degree of sagging can be corrected with the breast augmentation surgery, but not an excessive degree. For an excessive degree of sagging, a mastopexy or 'breast lift' may be the solution.

Will my breasts sag later?

Again, this is a factor of your body's makeup. In general, if the factors which caused the sagging in the first place (heavy breast tissue, lack of elasticity of the skin, etc), are still present, then the breasts will again begin to sag over time. If correcting this sagging is of primary importance to you, your surgeon can discuss other alternative surgeries which may be done instead of, or in addition to the breast augmentation procedure.

Can plastic surgery correct inverted nipples? Can I enlarge or reduce the size of my nipples?

The nipples can be reduced in size, or correction of 'inverted' nipples can be done. This can be done along with breast augmentation, or alone as a separate surgery.

With inverted nipples, the problem is that the ducts are short, plus the connective tissue adherence participates. One very effective technique to correct this is four small cuts around the nipple (division of the ducts) and suture support. This heals quite quickly, a week to ten days, and with this technique, recurrence is almost never seen.

I have heard about breast augmentation through the belly button. Can you tell me more about this?

This type of procedure is called a 'trans-navel approach'. An incision is made in the umbilicus (belly button) area. An endoscope is placed through this incision, and a tunnel is made to each breast. The implant is placed by rolling it up in a tubular shape and then pushing it through the endoscope to the breast where it is inflated. Pushing the implant through the scope carries an increased risk of damage to the implant, and I am told that implant manufacturers do NOT honor the warranty if this method is used. With the cost of implants alone ranging from $1000 to $1500 this is a very important point. Other comments from surgeons included a significant increase in the length of the surgery (up to 2 hours, according to one surgeon), and a signification reduction in the control of the placement of the implant,

A survey approximately 1 dozen reputable surgeons in a major city showed that *none* of them perform this technique, including one surgeon who had done the preocedure with this technique during his surgical training and felt that the more conventional methods were very much superior.

BLEPHAROPLASTY

Regarding blepharoplasty, what methods are used? What about "laser blepharoplasty"? What's the difference?

The conventional blepharoplasty utilizes an incision (with creation of the eyelid fold if needed), removal of excessive skin, muscle, and fatty tissue to provide the best, most consistent, and longest-lasting result.

Removal of the skin only, without attention to the underlying tissues achieves a smaller degree of correction, and is not as long lasting.

"Laser" blepharoplasty is a combination of surgery and light resurfacing of the skin, with no removal of the excessive skin of the eyelid. This primarily treats the fatty tissue deposits without removing excessive skin, so it is most effective for younger patients. Older eyelids require removal of the excessive skin to achieve the full benefit of the surgery.

Will having blepharoplasty affect how my contact lenses fit?

Blepharoplasty surgery only works on the skin and muscle of the eyelids area -- how your contact lenses fit is based on the shape of your eye itself. Although you won't be able to wear contact for the first few days after surgery (to allow time for the healing process to begin without disturbance) blepharoplasty surgery will not change how your contact lenses fit or function.

LIPOSUCTION

What is "tumescent" liposuction?

The tumescent technique is a relatively new liposuction method that can reduce post operative bruising, swelling and pain. Also, blood loss is minimized during tumescent liposuction due to the effects of the local anesthetic which is used.

In the tumescent technique, areas of excess fat are injected with a large amount of anesthetic liquid before liposuction is performed. The liquid causes the compartments of fat to become swollen and firm or "tumesced." The expanded fat compartments allow the liposuction cannula to travel smoothly beneath the skin as the fat is removed. This can give multiple benefits -- extra precision for the surgeon, reduced loss of blood for the patient, and extended pain relief after surgery, which can reduce the need for pain medication immediately after surgery.

This document is Copyright 1998,1999 Robert A. F. Green, all rights reserved. View the complete document here.