Breast Augmentation
What is it?
Breast Augmentation is an operation to increase the size of the breasts using implants.  The implants have a silicone shell that can contain either sterile saline/water or silicone liquid/gel.

The Operation
Depending on the size of the breast, a pocket is surgically created either underneath the breast tissue or underneath the muscle underneath the breast.  The surgery is performed under general anaesthesia. Depending on the type of implant used, it can be performed either through a scar around the nipple, a scar underneath the breast, a scar in the armpit or very occasionally, through a scar around the belly button.

Any Alternatives
In the past, silicone itself was directly injected into the breast tissue but this is not something that is recommended at present.  There are some external suction devices, which can be applied to the breast, and this has been reported to increase breast size following sustained use.  It is not as yet absolutely clear if this is a permanent increase in size.  Sterile derivatives of Soya Oil have also been used as 'fillers' for implants but these should no longer be used.

Before the Operation
It is important for your surgeon to assess the type of breast augmentation that is requested.  It is also important to understand why it is requested, as to whether it is brought about by a change in life circumstances or a problem that has been ongoing for some time.  It is also important to try and understand the patient's expectations as to the outcome and size of breast implants.  There are a large number of breast implants available and the exact type of implant, whether round, shaped, containing saline sterile solution or silicone jelly, would all need to be discussed in detail with your surgeon prior to the operation.  Pre-operative review would also assess how fit you were for surgery.  The type of scar and the exact site and placement of the implant would be discussed in combination with a physical examination of your breasts.  This will indicate the extent of breast tissue that is available and where the implants should be placed.  The size of implants should also be discussed taking into consideration the amount of skin laxity and breast tissue that is present.  If the breasts are very droopy, breast augmentation alone may not be sufficient and corrective surgery may be required in order to place the nipples in a different position.  The site of the scarring would also be agreed.  It is likely that the surgeon may also want to take some photographs prior to surgery.  These are kept in your patient records.  Your surgeon is likely to have the type of implant available for you to feel and understand how it works.  It may also be helpful to get an idea of the type of volume that you require by filling bags of water with various volumes of fluid to gauge the breast size that you might wish for.

After in Hospital
The operation is likely to take around one hour.  On return to the ward you will have dressings around your new breasts and these may be in the form of a comfortably fitting bra, or some wrap-around padded dressings.  It is also likely that there will be drains in each breast.  You may be nursed in a semi-upright position, as this can tend to minimise swelling and hence make you feel more comfortable.  Your chest may feel quite sore following your return to the ward. The nurses will be able to give you painkillers for this, either by injection or tablet form.  You may also feel your breathing somewhat restricted as the surgery to create the pockets to place the implants can often make the chest feel slightly tight.  The nurse will make regular checks and monitor blood pressure, pulse and temperature.  The drains are usually taken out on the day following surgery. Should there be more fluid in the drains than expected, you may well be able to be discharged from hospital and then return to have the drains removed a few days later. 

After at Home
It is important that you rest on your return home.  Excess use of the arms and upper chest area by regular activities which one would normally undertake can cause further irritation and bleeding.  It is best to continue to wear a firm tight fitting bra both night and day for a further two weeks.  The bra may be removed for washing but one should avoid getting the wounds wet for probably one week following surgery.  You should also avoid sleeping face downwards for one month.  It is probably best to avoid doing any heavy activities, particularly lifting the elbows above the shoulder level, or any heavy lifting for a further three to four weeks.  You may also find that your nipples have altered sensation following the surgery but this is likely to improve as time passes.  The scars themselves may be massaged from two weeks following surgery.  However, it is not often necessary to massage the breasts themselves.  It is probably best for you not to drive for at least a week following surgery.  You should then be quite sure that you are able to perform an emergency stop.

Complications
As with any surgical procedure, bleeding can occur but the drains that are left after the operation are usually sufficient to control this.  Very occasionally if bleeding continues to be a problem, it may be necessary to return to theatre to stop the bleeding.  In making a pocket into which is placed the implant, one of the structures that can occasionally be damaged is the nerve supply to the nipple.  This can result in complete loss of sensation to the nipple but more often results in either decreased or very occasionally increased sensitivity.  This increased sensitivity can be uncomfortable.  Any time an object is placed within the body, the body forms a film around it.  This film can occasionally instead of staying nice and loose, increase in thickness, become scarred and occasionally become uncomfortable.  This is known as 'capsule formation'.  This tends to occur in about 10% of patients who have breast augmentation.  It occasionally will only affect one side as opposed to both sides where bilateral breast augmentation has been performed.  The type of capsule can vary from a firm feeling to one where the breast becomes very firm and hard, like a tennis ball.  In these situations the treatment depends on the ongoing problem.  Occasionally it may be necessary to remove the implant entirely and to replace it.  Infection can also occur. If the implant becomes infected then it is likely that the best option is to remove it.
There has been some controversy as to the use of silicone implants.  Many surgeons continue to use silicone implants both for reconstruction and for aesthetic augmentation.  There have been a number of studies which indicate that there is no definite evidence that silicone causes any problems within the body.  However, there are undoubtedly some people who have had breast implants that do have some unexplained symptoms. Most people benefit from having breast augmentation performed.

General advice
Having a bilateral breast augmentation performed can be somewhat uncomfortable.  It is important to avoid driving for about a week following surgery and to be sure that one is able to perform an emergency stop.  If the sensitivity of the nipple has been altered by the surgery, this may take some months to recover and indeed may never fully return to normal.  It is important that placement of the implants is discussed with the surgeon prior to surgery.  The implants will tend to stay where they are placed and will not move around the chest wall, as a normal jelly-like breast would do.  The patient would need to have an understanding about this prior to surgery.                                                                                                             Go back

 

Breast Lift (Mastopexy)
 A breast lift is a surgical procedure to raise and reshape breasts that have sagged as a result of pregnancy, nursing, and the natural force of gravity. Mastopexy is not permanent – since no surgery can permanently delay the effects of gravity but it can reduce the size of the areola, the darker skin surrounding the nipple.

What happens during the procedure?
The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and takes 1½ - 3½ hours, but depending on the extent of the procedure, it can take longer. If you are having more than one procedure, overnight hospitalization may be required.

Breast lift surgery can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health, the extent of the procedure and whether you are having other procedures at the same time. Techniques vary, but the most common procedure involves an anchor-shaped incision following the natural contour of the breast. The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.

Are there risks or potential side effects?
As with all surgeries, there is always a possibility of complications including infection, a reaction to the anesthesia, hematoma, seroma, nerve damage and the occurrence of asymmetries or irregularities. Should infection occur, your surgeon will prescribe a treatment with antibiotics. Bleeding and infection following a breast lift are uncommon, but can cause scars to widen. You can reduce your risks by closely following your physician's advice both before and after surgery. Be sure to ask your surgeon about all of the risks associated with the procedure your considering before you make any decision.

A breast lift does leave noticeable, permanent scars. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Poor healing and wider scars are more common in smokers. The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.

A breast lift will not make breasts firm forever--the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again. Women who have breast implants along with their breast lift may find the results last longer.

What to expect post-procedure?
An elastic bandage or a surgical bra over gauze dressings must be worn after surgery. The breasts will be bruised, swollen, and uncomfortable for a several days, and the level of pain ranges from person to person.

The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep yourself elevated to limit the amount of swelling. Applying cold compresses, or ice packs can reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with frozen berries or peas. Regular icing is the key to relieving swelling.

Within a few days, a soft support bra will replace the bandages or surgical bra. This bra must be worn constantly for several weeks over a layer of gauze. The stitches will be removed after a week or two.

Breast skin can be very dry following surgery, careful application moisturizer several times a day can alleviate this somewhat. Some loss of feeling in your nipples and breast skin can occur, which is caused by the swelling after surgery. Feeling usually returns as the swelling subsides over the following six weeks. In some patients, however, it may last a year or more, and, occasionally, may be permanent.

As with any surgery, it is also sometimes normal to feel anxious or depressed in the days or weeks following the operation. If there is heavy bleeding or increased pain, be sure to inform your surgeon.

How soon does normal life resume?
Healing is individual. Some patients may be up and about in a day or two, but you shouldn’t plan on returning to work for at least two weeks. All patients should avoid lifting anything over your head for three to four weeks.

It is important to follow your surgeons instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities slowly. If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.

Who performs it?
A plastic surgeon normally performs a breast lift.

Are you a good candidate?
While breast lift surgery can improve a woman's body image and self-esteem, it does not remedy pre-existing psychological and personal problems. As with all elective surgery, good health and realistic expectations are prerequisites, however, if you want to change the look of your breasts then this procedure may be appropriate, but:

How to prepare for this procedure?
Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines:


 Breast Reduction

What is it?

Breast reduction is the removal of excess skin and breast tissue with re-positioning of the nipple to a higher situation.  It is most frequently performed for heavy breasts that results in physical problems, rather than for cosmetic appearance.

 

The Operation

The surgery is performed under general anaesthesia.  There are different techniques depending on how big the breasts are and how much tissue needs to be removed.  The surgery is performed with pre-operative marks as guidelines.  In moderate size breasts the nipple is left attached to underlying breast tissue, excess skin and breast tissue is removed and then the nipple is placed in a new higher position.  The remaining skin and breast tissue is sutured together.  The types of scars that commonly arise are, a scar that goes around the nipple at its new position and a scar that extends from the new nipple position downward underneath the breast.  In bigger breasts, there is often a scar that goes underneath the breast from the midline to the side.  Drains are usually required and a supportive dressing is placed after surgery.

  

Any Alternatives

Weight loss can occasionally make breasts smaller but this does not usually lead to re-positioning of the nipple in a higher more youthful appearance.  Weight loss can also cause empty sagging breasts.

 

Before the Operation

Breast reduction surgery takes between two and three hours to do and therefore is a major operative procedure.  It is important that the patient's general health has been assessed and it is advisable to stop smoking.  The surgeon will visit pre-operatively and discuss the size the patient wishes.  Marks will then be placed on the patient's chest according to the type of operative procedure to be performed.  Blood tests may also be taken prior to surgery, as very occasionally a blood transfusion is required.  It may also be necessary to take a course of iron tablets following the surgery.  As the operation takes some time to do, measures to prevent clots in the legs are undertaken usually along the lines of special stockings, improvement of the blood flow in legs during surgery, or the addition of blood thinning agents prior to surgery.

 

After - In Hospital

You may notice a firm bandage around your chest when you wake up.  This may also make your breathing slightly restricted.  It is there to provide comfort and also to decrease swelling around the breasts after surgery.   It is likely that you will be in a semi-upright position following surgery. Again this helps to decrease swelling and pain.  Pain and discomfort following surgery is common and can be treated with pain-killing injections or tablets.  Regular painkillers will be needed on return home along the lines of Paracetamol.  There will be a drain in each breast to remove excess fluid that can accumulate following surgery.  It is also likely that there will be an intravenous drip, which is usually removed when you are able to tolerate diet and fluids comfortably.  The nurse will check your blood pressure, temperature and pulse rate following the surgery and in some operations it will be necessary to check the blood supply to the nipple on a regular basis. After the surgery you will be encouraged to gradually increase your mobility and independence.  Assistance will be given with shallow bathing and general hygiene until you are able to manage this independently.  The dressings usually remain intact for twenty-four to forty-eight hours following surgery at which time the drains are usually removed.  The stitch line will then be cleaned as necessary and a new dressing applied.  It is often useful at this time to have soft support type bra that can accommodate a small dressing.  This gives support to the breast and decreases pain.  Your stay in hospital will be variable and will depend on the type of surgery that has been performed and the amount of drainage from the breasts.  You may expect to go home within two to three days following surgery.

 

After - At Home

You may experience pain and discomfort in your breasts, which is usually adequately treated with simple painkillers.  Should you find increased unexpected pain it will be most important to let the hospital know of your pain and discomfort.  As with any major surgical procedure, you may feel tired following the surgery and may need assistance in doing ordinary daily tasks.  It is important to avoid getting the suture line wet.  It is likely that you will be asked to attend the outpatients if only to review the dressings.  It is probably best to also avoid driving at this time as pain and discomfort may prevent adequate control of the steering wheel.

On most occasions, the sutures that are used to close the breast reduction surgery are of a dissolvable type but occasionally some sutures may need to be removed.  This usually takes place some two weeks following surgery.

 

Possible Complications

Breast reduction surgery takes some time to perform and may be considered a major operative procedure.  As with any major surgery you may bleed during the surgery and very occasionally a blood transfusion may be required.  The drains are placed in the breasts after surgery as there is often some bleeding that can occur.  Very rarely bleeding can continue to such an extent that a return to theatre is required.  This is why it is important to have regular post-operative checks on the ward by the nurses. 
 

Infection can occur in the post-operative phase and this is minimised by good surgical technique. Antibiotics are sometimes given around the time of surgery.  Regular reviews after surgery indicates if there is evidence of infection and occasionally it is necessary to have a course of antibiotics.  Often, due to the extent of the surgery, the skin of the breasts appears red. This is more commonly related to inflammation rather than infection.
 

There is often some irregularities around the scars immediately following surgery but these tend to settle down and get better as the swelling disperses and the skin tightens.  Occasionally there are some areas underneath the breast where the skin does not heal immediately and dressings may be required for up to six to eight weeks afterwards.  This is related to the tension that is needed to reshape the new breast, which the skin does not tolerate.  Very very occasionally, skin grafting may be required if significant skin breakdown occurs.  Personal care and hygiene can be maintained once the wounds have become sealed.  This varies from one to two weeks.  If dressings are required because of minor wound problems, your doctor may still be happy for you to shower, dab the area dry and have it redressed.  Supportive bras, which are not under wired, can keep the breasts comfortable following surgery.  It is sometimes necessary to wear them at nighttime as well for comfort.

 

Return to work can take place from two to three weeks after surgery depending on the physical requirements.

 

When driving it would important to make sure that there is no interference with turning the wheel or areas of pain which may cause some difficulty with the need to perform an emergency stop.

 

Direct trauma onto the breast can cause the wounds to split open.  However, one should wear a safety belt when driving or a passenger in a car.

 

It may take some time for the redness of the skin underneath the breast to settle down.  If the breasts are very big prior to surgery, the ends of the scars may remain prominent.  Should this be the case they may need to be 'tidied up'.  This is a procedure that can usually be performed under local anaesthesia.

 

General Advice

The majority of people who have breast reductions are happy with the size and shape of the breasts following surgery.  It can take six to nine months for the swelling to subside entirely.  The outcome of the surgery that some people are not so happy with is the scarring.  The scars, although they look neat initially, can become red itchy and raised above the level of the surrounding skin.  As well as becoming somewhat unsightly they can also give rise to concern.  Some techniques are available to try and make the scars more comfortable including local silicone sheet dressings, local massage or the occasional use of laser treatment.  The scars may become particularly troublesome close to the midline and most surgeons try and avoid placing scars too close to the midline.  This helps with the problems with the scar formation but also avoids putting scars where the patient may want to show their cleavage.  The breasts tend to remain in a satisfactory position but as time goes by, droopiness of the breasts can occur again.  Excess weight gain or pregnancy can precipitate increased size and therefore droopiness to occur more rapidly.

 

It is not always possible to match the breast sizes following surgery and this may become more apparent when the swelling has decreased.  Depending on the type of breast surgery that has been performed it may be possible to breast-feed if one becomes pregnant.

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Gluteal Augmentation 

Solid-silicone implants are the only realistic choice for amplifying the buttocks, and great things can be done with them

 

In the past few years, gluteal augmentation has been one of the faster-growing aesthetic-surgery procedures. The public wants to learn more about this procedure, but few well-trained surgeons have experience with it and can meet the demands of the patient population. Only recently has peer-reviewed information been available to surgeons interested in the procedure.

 

Early buttock augmentation can be traced to surgeons in Mexico and South America, where buttock appearance is more of a focus of sensuality and beauty than in the United States. Outside the United States, silicone-gel implants are routinely used to augment the buttocks. Gel implants provide a natural, soft feel, along with a pleasing shape.

 

Silicone-gel implants are not available in the United States for gluteal augmentation, and will most likely not be available for many years to come. Currently, no clinical trials are in progress, and no manufacturer appears to be interested in spending the resources necessary to gain US Food and Drug Administration (FDA) approval for buttock gel implants.

  

Implants and Filler Problems        

 

One of the problems with gel implants is their potential to rupture, which can lead to complications such as secondary infection, silicone migration, granulomas, and eventually, additional surgery to remove the gel. Occult rupture is also a problem: Imaging studies using magnetic resonance or sonograms are often needed to determine whether the implant is intact. Another impediment is that seromas and small hematomas cannot be managed with needle aspiration in the presence of a gel implant due to the risk of implant perforation and leakage.

 

Likewise, the use of saline implants for gluteal augmentation is not approved by the FDA. I have seen patients from other countries who had undergone gluteal augmentation with saline implants that needed to be removed because of a poor aesthetic result. In addition, a saline implant is susceptible to rupture from trauma or wear because it is not durable enough to withstand mechanical forces in the gluteal region. For these reasons, solid implants are the only ones available for gluteal augmentation in the United States.

 

Buttock augmentation using transplanted fat has yielded mixed results. In many thin patients, not enough fat is available to significantly increase the projection in the gluteal region. However, in heavier patients, liposuction can provide large amounts of fat that can be injected into the gluteal region.

 

The fate of this transplanted fat varies from complete reabsorption within several months—requiring additional fat grafting—to partial graft survival. However, fat grafting is beneficial for contouring small defects and contour irregularities that do not require an implant.

 

The use of fillers to augment the buttock has produced poor results. Currently, no biocompatible, long-lasting injectable material can be used to augment the gluteal region.

  

Liquid and Solid Silicone

 

Liquid silicone has been used as an “injectable implant” to augment the gluteal region. However, large-volume silicone injections can lead to severe complications, including granuloma formation, skin necrosis, infection, deformity, and silicone migration. These complications are not easily treated and, in some cases, require surgical debridement that produces significant morbidity.

 

The early results from gluteal augmentation using solid implants were mixed. The implants tended to produce a high, unnatural look when they were positioned under the muscle. Subcutaneous implant placement led to capsular contracture and a poor shape. In addition, reports of complications such as infection, scarring, asymmetry, and potential nerve damage left most surgeons in the United States believing that gluteal augmentation was a risky procedure.

 

This perception has changed as mainstream, well-trained plastic surgeons in the United States have reconsidered the procedure and approached it scientifically. As a result, more information on proper technique and postoperative management of gluteal-augmentation patients is now available to surgeons. This focus has led to better surgical outcomes and the standardization of best practices.

  

Candidates for the Procedure

 

The best candidates for gluteal augmentation with solid-silicone implants are normal-weight patients who desire more fullness in the gluteal region and lack central projection. They should have ample soft tissue to provide durable coverage of the implant. The region should be free from chronic skin irritation and infection.

 

However, HIV infection is not a contraindication to this surgery. Many of these patients suffer from HIV-associated lipo­atrophy of the gluteal region and can benefit from gluteal augmentation, provided that their medical condition is satisfactory.

 

The obese patient is not a good candidate for gluteal augmentation with an implant for reasons other than generally poor health. One is that shear force in the buttocks are greater than normal in obese patients, which make seromas more common and wound healing problematic.

 

Patients with uncontrolled diabetes should not undergo gluteal augmentation because of the increased risk of infection. Other contraindications include patients who are noncompliant, have unrealistic expectations, are in poor health, or are not willing to accept the possibility of postoperative complications.

 

In patients with minimal buttock ptosis and good skin elasticity, gluteal implants may improve the appearance of the buttock by creating lift and filling out the involuted region. In patients with greater degrees of ptosis, implants may exacerbate buttock sagging and produce a poor result. These patients are better treated with a buttock lift. In some instances, insertion of a buttock implant with a subsequent infragluteal-fold skin excision can be beneficial.

 

Before the Implantation

 

Preoperatively, the patient is examined and the buttock’s size and shape are evaluated. The need for liposuction of the lower back or hips is considered. Patients with a long buttock may require an oval gluteal implant, whereas patients with a short buttock would normally benefit from a round implant.

 

Almost all male pa­tients are suitable for a round implant. Oval im­plants are more likely to be used in women who have a long buttock that requires inferior-aspect fullness.

 

An array of sizers should be available in the examination room to determine the most appropriate implant (Figure 2). The implant should have the correct base diameter to adequately augment the buttock without providing too much lateral fullness, which, with a solid implant, will be more likely to produce visible edges.

 

The buttock’s height-to-width ratio should be considered when choosing an implant. Placing sizers on the buttock allows the surgeon to determine the implant’s proper shape and the volume needed to augment the gluteal area. In addition, patients are made aware of the available choices.

 

The amount of soft tissue available to cover the implant should be evaluated during the preoperative visit. In men with a paucity of subcutaneous fat and in extremely thin women, consideration should be given to intramuscular implant placement. In patients with ample subcutaneous tissue, subfascial placement of the implant may be appropriate.

 

In patients with a low buttock, it is necessary to place the implant inferiorly; this makes intramuscular-implant placement difficult because of its proximity to the sciatic nerve. In patients with a low buttock, placing the implant subfascially will enable it to be positioned low enough to augment the buttock’s inferior aspect while avoiding injury to the sciatic nerve. Subcutaneous implant placement is not recommended.

 

Patients are given a preoperative antibacterial soap. They are instructed to shower the night before and the morning of surgery, and to apply the soap to the gluteal region. A bowel prep is not required.

  

Outpatient Surgery

 

The surgery is performed on an outpatient basis in a fully accredited surgical facility. Prior to surgery, the size of the chosen implant is outlined on the patient in the standing position. The implant should be centered at the point of maximum projection.

 

General endotracheal or epidural anesthesia is administered. The patient is placed on the operating table in the prone position with adequate padding between the pressure points and the table.

 

Sequential compression devices are applied to the lower extremities and intra­venous antibiotics are administered. Following a routine preoperative surgical scrub, a sterile prep of the buttocks is performed.

 

A 6- to 7-cm vertical midline intergluteal incision is marked superiorly from the tip of the coccyx. The area is then infiltrated with local anesthesia containing epinephrine to aid in hemostasis.

 

An incision is made down to the sacrum, and enough soft tissue is preserved to allow the wound to close. Lateral dissection is then performed away from the midline incision in the subfascial space using a lighted fiber-optic retractor and a long-tip electrocautery.

 

The fibers of the gluteus maximus muscle are divided parallel to their orientation, and an intramuscular pocket is developed with 2 to 3 cm of muscle coverage. A combination of blunt and electrocautery dissection is used. Blunt dissection is recommended inferiorly to avoid injury to the sciatic nerve.

 

If subfascial implant placement is planned, the dissection is continued in the subfascial space until the limits of the skin markings are reached. The newly created periprosthetic space is then packed with laparotomy sponges while the implants are prepared for insertion.

 

The implants are rinsed in saline and povidone-iodine prior to insertion. The laparotomy pads are removed, and hemostasis is obtained. The implants are then inserted into the intramuscular or subfascial space.

 

In the case of intramuscular placement, the gluteus maximus muscle is closed over the implant with a strong, absorbable running suture to provide complete muscle coverage. For both types of implant placement, a closed suction drain is used in most patients to minimize the risk of seroma.

 

The midline wound is closed in several layers to create a tension-free closure. Patients can usually be discharged 1 to 2 hours after surgery.

 

During the postoperative period, patients are encouraged to ambulate to reduce the risk of lower-extremity blood clots and muscle spasm. Oral analgesics are prescribed. Patients are instructed to avoid strenuous activity and pressure on the area for several weeks. The drains are removed when less than 25 mL of fluid is present over a 24-hour period. Com­pression shorts are recommended for the first 2 to 3 weeks after surgery.

  

Medical, Aesthetic Complications

 

In a series of 40 surgeries I performed from 2001 to 2004, the most common complication following buttock augmentation with solid-silicone implants was seroma formation.1 The incidence of this complication was reduced by using closed suction drains liberally in subsequent patients and by extending the time the drains were in place. In several patients who were very active after the drain was removed, it was necessary to reinsert the drain after several weeks.

 

Infection is rare; it occurred in 5% of the patients in the 3-year series.1 A superficial cellulitis can be treated with antibiotics. Periprosthetic implant infection, however, requires periprosthetic-space drainage and implant removal. The implant can be reinserted several months after the infection has resolved.

 

Wound-healing problems, including major wound dehiscence, have been reported anecdotally by several surgeons. This complication can be minimized by tension-free multilayer closure and appropriate implant selection. Capsular contracture is rare and is more likely to occur after the subcutaneous placement of a gluteal implant.

 

Implant migration is a rare complication and can occur as a result of overaggressive dissection of the subfascial or intramuscular space. In patients with very strong gluteal muscles, the implant can be displaced laterally; this condition is difficult to correct.

 

The most common aesthetic complication following gluteal augmentation with a solid-silicone implant is asymmetry due to improper implant placement. The inexperienced surgeon will often place the implant too high. creating too much upper-pole fullness and a hollow inferior pole. The implant may settle over time, but revision surgery may be required to create a better pocket for the implant.

 

Another aesthetic complication is implant ptosis with visible implant edges. This can result from skin laxity from the implant’s weight that develops several months after it has been placed. Moving the implant from the subfascial position to the intramuscular position may improve this condition.

 

Scarring is minimal when the incision is placed in the intergluteal region. However, implant placement through bilateral infragluteal incisions is not recommended. This approach can produce unacceptable scarring and can lead to other complications,  such as inferior displacement of the implants and sciatic-nerve injury.

  

Rewards and Responsibilities

 

Gluteal augmentation with solid-silicone implants can be a rewarding procedure for patients and surgeons when basic principles and best practices are followed. As with all procedures, each surgeon has a learning curve with respect to surgical technique and handling of common postoperative problems.

 

Although many surgeons will not choose to adopt this new procedure, it is important that they are aware of and understand the different options available to meet the needs of patients who seek gluteal augmentation.                                     Go back

 

Buttock, thigh and arm lift
Arm, thigh and buttock lifts are surgical techniques to eliminate loose and sagging skin.

What happens during the procedure?
The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and takes 2-3 hours, but depending on the extent of the procedure, it can take longer. If you are having more than one procedure, overnight hospitalization may be required.

Lift surgery can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health, the extent of the procedure and whether you are having other procedures at the same time.

For an arm lift, incisions are made on the inner and under surface of the arm, often in a zigzag pattern. The surgical opening may run from the armpit to as low as the elbow. As the excess skin and fat is removed, the remaining skin is stretched and sutured into place and the incisions are bandaged. An arm lift usually takes about two hours. After a monitored time in the recovery room, patients can usually go home the same day.

For thigh lifts, excess skin is lifted and removed through incisions made in the inner thigh and/or high upper outer thigh. The incisions are extensive but are usually not visible when clothing is worn. Simultaneous lifting of the thighs and buttocks is done using incisions that follow a French-cut bathing suit line only a bit higher up on the hip. The surgeon lifts and removes the excess skin down to the muscle and removes the thick layer of fat beneath the skin. Drain tubes may be placed at the incision to draw out fluids. The surgery usually takes two to three hours. Your surgeon may recommend an overnight stay in the hospital before being allowed to go home.

A buttock lift is not a common procedure, because it requires leaving scars across the buttock or in the fold. This is usually not desirable and patients opt for liposuction instead.

Are there risks or potential side effects?
As with all surgeries, there is always a possibility of complications, including infection, a reaction to the anesthesia, hematoma, seroma, nerve damage and the occurrence of asymmetries or irregularities. Should infection occur, your surgeon will prescribe a treatment with antibiotics. Occasionally, the superficial lymphatic system in the groin is interrupted during a thigh lift surgery. If this should occur, excessive swelling will probably occur for several weeks as the lymphatic channels form again. This is an uncommon problem, but it requires some patience and understanding if it does occur. Be sure to ask your surgeon about all of the risks associated with the procedure your considering before you make any decision.

What to expect post-procedure?
The areas operated on will initially feel tight and swollen. The swelling is mild to moderate, and peaks at two to three days. Usually, the sutures are covered with adhesive strips (steri-strips), skin tape and surgical gauze. Small amounts of oozing and bleeding are very common but should be no more than a slow staining of the gauze dressing. Because of the location of the incisions for a thigh lift, it is impossible to avoid lying on them. Change position at least every 30 minutes and move as carefully as possible while putting as little stress on the incision lines as possible.

You will probably have several layers of stitches with both arm lift and thigh/buttock/hip lifts. Some will be re-absorbed by the body and some may need to be removed by your surgeon. You will be able to shower on the third day after surgery. Moderate pain can be anticipated after this procedure. Your surgeon may prescribe pain medication for the first few days, after which acetaminophen and/or ibuprofen may be all that you require.

Numbness in small areas on the thighs is possible but usually disappears gradually over several months. Although most bruising and swelling will disappear within 3 weeks, some swelling may remain for 6 months and up to a year. The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep your head elevated, above the level of your heart, when lying down. Applying cold compresses, or ice packs will reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with frozen berries or peas. Regular icing is the key to relieving the swelling.

As with any surgery, it is also sometimes normal to feel anxious or depressed in the days or weeks following the operation. If there is heavy bleeding or increased pain, be sure to inform your surgeon.

How soon does normal life resume?
For the first week following surgery, you will be allowed light activity but you must avoid bending or lifting. Although you may not feel like it, you should try to walk as soon as possible after a thigh lift to reduce swelling and prevent blood clots from forming in your legs. While each case is individual, recovery from arm lift generally takes one to two weeks; you'll be able to return to work in a week, moderate exercise in 10 days to two weeks, more physical contact sports after a month. Thigh and buttocks lift recovery generally takes one to two weeks; you can usually return to work in a couple of weeks, and resume vigorous exercise or contact sports in approximately four to six weeks. Recovering individual and varies from person to person. After an arm or thigh lift, however, you will begin to see a noticeable difference in the shape of your body almost immediately with additional differences occurring the next 4 to 6 weeks as the swelling subsides.

Are you a good candidate?
Women who have had a mastectomy should not have an arm lift. Since the surgery affects the lymphatic drainage, the combined procedures may cause the arm to swell permanently. If you have had phlebitis (inflamed blood vessels) in either of your legs, you may not be a candidate for lift surgery. Most lifts require fairly lengthy incisions and scarring is visible, and each patient should be prepared for this. As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to change the shape of your arms or thighs, then a lift surgery may be appropriate, but: 


How to prepare for this procedure?
Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines: 


Are there alternatives to this procedure?
Arm or thigh liposuction can reduce a reduction in size but liposuction cannot alter skin quality and there may be extra skin once the fat has been removed. Although wearing the compression bands will help to firm the area, this extra skin may sag, especially if your skin was not particularly elastic. Such excess skin would necessitate an arm or thigh lift to reduce the amount of loose skin. Exercise, especially weight lifting, however, can significantly improve the shape and tone of the arms and, to a lesser extent, the thighs including that of the loose skin.                                                                         Go back

 

Chemical Peel
 (AHA, TCA, Phenol, etc.)
A chemical peel can revitalize and resurface skin. It can treat wrinkles and fine lines around the eyes and mouth, sun spots, age spots, freckles, blotchy skin, mild scarring, certain types of acne, pre-cancerous keratoses and scaling patches. Chemical peels cannot, however, remove loose or sagging skin, halt the aging process, change pore size, remove deep scars or broken blood vessels. The different types of peels penetrate to different levels and, consequently, produce different results, but all are similar in that they involve applying a chemical solution to remove the damaged outer layers of skin and allow newer layers to replace the old ones. The deeper a peel penetrates, the more profound the results but the more lengthy the recovery period. Chemical peels can also prove to be an excellent additional treatment following more extensive procedures like a facelift, brow lift or eyelid lift.

Most peels can be performed on the face, neck, chest, hands, arms and legs. Peels vary in intensity and depth depending upon the type and strength of chemical used. Your physician may choose to use a combination of chemicals for your procedure, in effect, tailoring the treatment specifically to your skin type and its needs. Your individual skin type, the condition it is in and the severity of the unevenness or wrinkling will allow your physician to determine which of the following types of chemical peel is appropriate.

Superficial Peels use mild chemical solutions like alpha hydroxy acids (AHAs), glycolic acid , lactic acid, salicylic acid, trichloroacetic acids to lightly peel skin. These peels are so called “lunch hour peels” because there is almost no recovery involved but they must be done repeatedly to maintain results over time.

Medium peels or Trichloroacetic Acid (TCA) Peels can correct pigment problems, superficial blemishes, moderate sun damage, fine lines and weathered skin. TCA peels sometimes require two or more treatments, spaced out over weeks or months, to achieve the best results. The Obagi or “Blue Peel” is a commonly used brand of TCA peel.

Phenol (carbolic acid) Peels are the deepest peels and use the strongest chemical solutions. These are usually one-time procedure and produce the most dramatic, long-term results. They are used to treat wrinkling, brown age spots, mild scarring and pre-cancerous growths. Because phenol peels result in permanently lighter skin, they are not recommended for most patients with very dark skin tones and require that sunscreen be used at all times afterwards.       See also Dermobrasion
 

What happens during the procedure?
The treatment begins with cleansing the skin and removing all traces of grease with rubbing alcohol or acetone. The face is then rinsed with water and blown-dry with a small fan. The physician applies the chemical peeling agent so that all areas of the skin to be treated are covered evenly. A grey-white film, referred to as “frost”, develops on the skin by the end of the application. The peeling solution is left in place for a few minutes and then thoroughly removed with water.

AHA peels are performed in the physician’s office and require no sedation or anesthesia. The process usually takes 10 to 15 minutes and although your face may seem a bit red, you can resume normal activities right away. You can expect the redness to be followed by temporary flaking, dryness and scaling until your skin adjusts to the treatments.

TCA peels are performed in the physician’s office or in an out-patient surgery center. No anesthesia is necessary because the chemical solution actually numbs the skin but you may be given a sedative prior to the treatment. You may feel a warm or burning sensation which is followed by some stinging. Your physician will control the depth to which the chemical penetrates but a full-face treatment should only take about 15 minutes.

Phenol peels are usually performed in an outpatient surgical center, either operated by your physician or a hospital facility. If you are having another procedure, such as a facelift or eyelid lift at the same time, then overnight hospitalization may be required. No anesthesia is necessary because the chemical solution actually numbs the skin. A full-face, deep chemical peel requires a sedative prior to the treatment and an analgesic given intravenously during the procedure. You will be monitored with an EKG during a deep chemical peel. You may feel a warm or burning sensation which is followed by some stinging. A full-face phenol peel generally takes one or two hours, while a phenol peel to a smaller area on the face, such as the upper lip, may take only 10 or 15 minutes.

Are there risks or potential side effects?
As with all elective procedures, there is always a possibility of complications including infection, scarring, temporary or permanent color change in the skin and uneven pigment changes. Phenol may pose a special risk for patients with a history of heart disease and any peel carries the risk of cold sores in persons who have a history of recurring fever blisters or herpes.

Before you undergo a chemical peel, tell your physician if you have a history of cold sores, a tendency to scar unusually, a family history of heart problems, or have undergone radiation or numerous x-rays to the face. Be sure to ask your physician about all of the risks associated with the procedure you are considering before you make any decision.

It is important to note that Asians tend to have a darker skin tone than Caucasians, and as a result, have a different set of complications caused by skin peels. Asians are at a higher risk for hyperpigmentation of the skin (darkening of the skin). Although there is a risk for scarring in Asians who elect to have medium to deep chemical peels, they are at no greater risk than Caucasians when opting for superficial peeling. It is recommended that Asians make sure that they see an experienced physician who has performed chemical peels on Asians, and who is aware of how to treat such skin types.

What to expect post-procedure?
Your physician may recommend a soft diet and suggest that you take it easy and try not to talk too much for a few days. A mild pain medication may also be prescribed. Swelling and crusting of the skin are to be expected. You may be given an ointment to apply to your skin for seven to 10 days following the peel to keep it supple and to help in healing.

At the end of a phenol peel, the treated skin may be coated with petroleum jelly or a dressing, which will be left on a day or two. The treated area will be very swollen. If you have had your face peeled, your eyes may swell shut and you will need to have someone to care for you for 48 hours after the procedure.

How soon does normal life resume?
A TCA peel usually results in swelling and blisters that scab over. Most patients can resume their normal activities in a week to ten days when the rawness has subsided and new skin has emerged. The TCA peel does not lighten the skin, so your skin will still be able to produce pigment again, i.e. tan. It is important, however, that you avoid sun exposure for several months after the peel to protect the newly formed layers of skin. Chlorinated pools should be avoided for a month or so. Daily use of a sunscreen with both UVA and UVB protection is essential. We all know that the sun damage and ages skin prematurely, even more so when a new layer of skin is exposed to it.

With a phenol peel, new skin will begin to form in about seven to ten days. Your face will be very red at first, gradually fading to a pinkish color over the following weeks. After about two weeks, your skin will be healed enough that you can resume normal activities and begin to wear makeup. By the end of four weeks, the redness should fade to pink. To protect this delicate new skin, sunscreen must be used at all times so you do not end up with blotchy, unevenly colored skin. Again, avoid chlorine for a month. A deep peel can be a painful, emotionally difficult process to endure, but the end result is smoother skin that lasts for 15 years or more.

Who performs it?
Chemical peels are usually administered by a plastic surgeon, a dermatologist or an otolaryngologist (ENT).

Are you a good candidate?
As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to reduce refine the texture and pigmentation of your skin without surgery, then a chemical peel may be appropriate, however: 


How to prepare for this procedure?
Your doctor will give you specific instructions to prepare for the procedure. You may prescribed medications to take prior to the treatment to prevent a bacterial infection or fever blisters (herpes simplex) and topical medications to prepare your skin and decrease the risk of post-operative pigmentation changes. You will be asked to limit your sun exposure at least a month before the peel. Here are some general guidelines to follow: 


Are there alternatives to this procedure?
Alternatives to chemical peels include dermabrasion, laser skin resurfacing , and injectable fillers like collagen, etc.. Although chemical peels can have a rejuvenating effect on the skin only a surgical procedure like facelift, eyelid lift or a brow lift can actually tighten sagging skin. Finally, vitamin A, glycolic acid and other topical treatments, known as “skin polishers”, stimulate generation of new skin from underneath and promote filling in of wrinkles and depressed acne scars. These preparations are often used to pre-treat the skin before administering a peel or other resurfacing treatment.

Anything else you need to know?
A “Parisian Peel” is not a chemical peel at all. In fact, it is a brand of microdemabrassion which uses fine crystals, sprayed on in a very fine stream to exfoliate the outer layers of skin, which are vacuumed away. Although it has some effects on skin texture they are very subtle compared to a peel. This is not considered as having any lasting or permanent results and must be repeated frequently.

Another peel which is known by a brand name is the Obagi Blue Peel. This is a TCA-type peel formulated by dermatologist Zein E. Obagi, M.D. A blue coloring is added to the chemical solution to allow for even distribution, slower release of the solution to help reduce irritation, and slower penetration of the chemicals resulting in less of a burning sensation. For deeper exfoliation, an additional number of coats of the chemical can be applied during the procedure. The Blue Peel procedure can be repeated every four to six weeks.

The BioMedic MicroPeel is a type of light AHA peel in a three-step process that takes around 20 minutes. The treatment involves exfoliation of the skin then the alpha hydroxy acid is applied and last carbon dioxide is applied to cool the skin.

                                                                                                                                               See also Dermobrasion

Chin Implants
 (Mentoplasty and Genioplasty)
Chin surgery involves the augmentation, reduction, or general reshaping of the chin. The two most common methods are: chin augmentation, which reshapes the chin by inserting a silicone implant under the skin, and chin reductions, which involve bone reduction with power bone instruments.

A more serious type of procedure, craniofacial surgery, corrects misshapen jaws caused by misalignment of the teeth and jaws (malocclusion), or mild inadequate tissue development (hypoplasia) which can appear as a recessed upper jaw. Patients with a major chin deficiency require bone surgery (osteotomy) where the bone of the chin is moved forward following various oblique bone incisions, thereby reshaping the chin.

In chin augmentation surgery, implants are used to change the underlying structure, which affects the overall balance of facial features. Often chin implants are used together with other facial implants, particularly cheek implants, however, they can be used alone. This operation is often performed in conjunction with nose surgery as well as a facelift and/or liposuction of the face and neck.

Chin implants are made in various shapes and sizes. They are made out of both solid and semi-solid materials.

What happens during the procedure?
Chin augmentation is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility. It takes between 30 and 60 minutes but depending on the extent of the procedure, it can take longer. If you are having more than one procedure, overnight hospitalization may be required.

Chin surgery can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health, the extent of the procedure and whether you are having other procedures at the same time. Before your surgery, routine laboratory tests may be requested including blood counts and blood chemistries.

A small incision is made, usually inside the lower lip, to create the pocket and then the implant is inserted inside the mouth, along the lower lip, directly over the jawbone or in the skin just under the chin area. The implants are made in a variety shapes and sizes. Incisions inside the mouth (intra-oral incision) are closed with sutures (stitches) that dissolve. Removable sutures are used for incisions under the chin and are taken out after five to seven days. To minimize swelling and discomfort, the chin is usually taped for about a week.

Are there risks or potential side effects?
If the surgery involves an incision inside your mouth, it is important that you inform your physician if you smoke or if you have any dental or gum problems.

As with all surgeries, there is always a possibility of complications following chin surgery, including infection, bleeding, a reaction to the anesthesia, hematoma, seroma, extrusion (the implant works its way back up to the skin’s surface), capsular contracture (excess tightening of the scar tissue) which may distort the implant, asymmetry, nerve damage and bone erosion.

Sometimes, a facial implant can shift slightly out of alignment and a second operation may be necessary to replace it in its proper position.

Should infection occur, your surgeon will prescribe a treatment with antibiotics, however, the implant might have to be temporarily removed if the infection does not clear up and replaced at a later date. Other, less-common risks may be associated with certain implants. Be sure to ask your surgeon about all of the risks associated with the procedure you are considering before you make any decision.

What to expect post-procedure?
The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep your head elevated, above the level of your heart, when lying down. Applying cold compresses, or small ice packs will reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with an ounce of frozen berries or peas. Regular icing is the key to relieving the swelling. There is pain and discomfort for several days after surgery and your doctor will prescribe medication to alleviate it.

Some difficulty talking and smiling for several days following the surgery is normal. Patients with intra-oral sutures are sometimes placed on a liquid diet for several days until there is enough healing for food particles to come in contact with the stitches. Your surgeon will instruct you about dental hygiene, eating and any restrictions to your activities after surgery and it is important that you follow all of his or her instructions to minimize risks and help speed-up your recovery.

How soon does normal life resume?
Within the first week, you can be back at work. Although you should avoid strenuous activities, exercise can be resumed in about two weeks. Be careful to avoid contact sports or any activity that may result in the face being jarred or bumped for several weeks. Check with your surgeon about resuming such activities. Although most of the significant swelling will subside over a period of several days, prolonged mild swelling may prevent your final facial contour from becoming apparent for several months.

Who performs it?
Chin augmentation and reduction surgery is usually performed by a plastic surgeon or an otolaryngologist (ENT), while craniofacial surgery is best performed by maxillofacial surgeons and otolaryngologists.

Are you a good candidate?
As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to change your profile or are having nose surgery, a facelift or facial liposuction, then chin surgery may be appropriate, but: 


How to prepare for surgery?
Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines: 


Are there alternatives to this procedure?
An alternative to chin augmentation is submental liposuction, in which excess fatty tissue is removed to redefine the chin or neckline. Orthodontistry can treat a malocclusion and misaligned teeth, which are often at the root of a protruding or recessed jaw.                                                                                                                                        See also Cheek Implants

 

Dermobrasion
 Dermabrasion is like laser skin resurfacing in that it can treat deeper wrinkles and improve the appearance of acne scars or skin discolorations and remove pre-cancerous keratoses. In addition, this treatment is useful in treating unwanted tattoos and scarring caused by chicken pox or injuries. Dermaplaning is a similar treatment but involves deeper planing of skin, which is used for crater-like scars.

Dermabrasion penetrates much deeper than chemical peels and the skimming of the outer layers of skin to the dermis layer causes the skin to produce collagen. Dermabrasion is also performed in conjunction with more extensive procedures like a facelift, brow lift or eyelid lift.

What happens during the procedure?
Dermabrasion is usually performed in a physician’s office or in an outpatient surgical center, either operated by your physician or a hospital facility. If you are having another procedure, such as a facelift or eyelid lift at the same time, then overnight hospitalization may be required. Dermabrasion and dermaplaning are fairly quick procedures, but depending on the extent of the treatment it can take a few minutes to an hour or more. It is not unusual for your physician to recommend that the procedure be repeated or done in stages, especially when treating deep scars or a large area of skin.

The procedure is usually performed under local anesthesia with a sedative to relax you and make you drowsy. First, the skin is thoroughly cleansed with an antiseptic and may be sprayed with a topical anesthetic to numb it. The physician then uses a high speed rotating abrasive brush or diamond-impregnated burr (like a mini-sander) to remove the outermost layers of damaged skin.

The physician controls the depth to which the treatment will penetrate the skin layers depending on the degree of wrinkling or scarring. This abrading action reveals a new layer of smoother skin. At the completion of the procedure, your skin may be dressed with a soothing ointment, a wet or waxy dressing or some combination of these.

In Dermaplaning, an instrument with an oscillating blade called a dermatome is used to evenly skim off layers of skin to make the scarred area more even with the surrounding skin. Dermaplaning is often combined with dermabrasion, chemical peel or a surgical procedures such as facelift.

Are there risks or potential side effects?
As with all elective procedures, there is always a possibility of complications including infection, scarring, temporary or permanent color change in the skin and uneven pigment changes. Any skin resurfacing treatment carries the risk of cold sores in persons who have a history of recurring fever blisters or herpes simplex. Before you undergo dermabrasion, tell your physician if you have a history of cold sores, a tendency to scar unusually.

It is important to note that Asians and people of colour tend to have a darker skin tone than Caucasians, and as a result, have a different set of complications caused by any skin resurfacing treatment like permanent discoloration or blotchiness. Those of Asian, African and Latin origins are at a higher risk for hyperpigmentation of the skin (darkening of the skin). It is recommended that these individuals make sure that they see an experienced physician who has performed dermabrasion on darker skins, and who is aware of how to treat such skin types.

Although age is not a limiting factor in most cases, it is important to recognize that older people heal more slowly. Acne sufferers may not be able to undergo the procedure if their acne is in an active stage due to a greater risk of infection. Be sure to ask your physician about all of the risks associated with the procedure you are considering before you make any decision.

What to expect post-procedure?
For a few days following dermabrasion or dermaplaning, your skin will look and feel like you’ve experienced a bad sunburn. It may be uncomfortable to move the muscles of your face (talking, eating). Your physician may recommend a soft diet and suggest that you take it easy and try not to talk too much for a few days.

A mild pain medication may also be prescribed. Swelling and crusting of the skin are to be expected. You may be given an ointment to apply to your skin for seven to 10 days following the peel to keep it supple and to help in healing.

In one to two weeks after surgery, the newly formed skin, which is pink at first, gradually develops a normal appearance. In most cases, the pinkness will largely fade by eight to 12 weeks.

How soon does normal life resume?
You can expect to be back at work in about two weeks or less in some cases. You can use makeup as soon as the skin has healed. Strenuous activity that might result in a bump to your face should be avoided for at least six weeks. You should not swim in chlorinated water for a month or more.

Your skin will appear lighter for weeks or even months after the procedure, but as the pigment is restored, your skin color will look more normal. To protect this delicate new skin, sunscreen must be used at all times so you do not end up with blotchy, unevenly colored skin. Daily use of a sunscreen with both UVA and UVB protection is essential. We all know that the sun damage and ages skin prematurely, even more so when a new layer of skin is exposed to it.

Who performs it?
Dermabrasion and dermaplaning are usually administered by a plastic surgeon, a dermatologist or an otolaryngologist (ENT).

Are you a good candidate?
As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to reduce refine the texture and pigmentation of your skin without surgery, then a chemical peel may be appropriate, however: 


How to prepare for this procedure?
Your doctor will give you specific instructions to prepare for the procedure. You may prescribed medications to take prior to the treatment to prevent a bacterial infection or fever blisters (herpes simplex) and topical medications to prepare your skin and decrease the risk of post-operative pigmentation changes. You will be asked to limit your sun exposure at least a month before the procedure. Here are some general guidelines to follow: 


Are there alternatives to this procedure?
Alternatives to dermabrasion include chemical peels, laser skin resurfacing, and injectable fillers like collagen, etc. Although dermabrasion can have a rejuvenating effect on the skin only a surgical procedure like a facelift, eyelid lift or brow lift can actually tighten sagging skin. Finally, vitamin A, glycolic acid and other topical treatments, known as “skin polishers”, stimulate generation of new skin from underneath and promote filling in of wrinkles and depressed acne scars. These preparations are often used to pre-treat the skin before administering a skin resurfacing treatment.

Anything else you should know?
Microdermabrasion is not the same as dermabrasion. It is a more superficial treatment which does not produce the same results as dermabrasion. The treatment affects only the outer-most layer of skin, the epidermis, and causes the basal cell layer to increase production of skin cells. Microdermabrasion is not a solution for major acne scarring or tattoos or deep wrinkles. It will not treat the type of complaints that a chemical peel or laser resurfacing will. Results are subtle. Skin is usually described as being more radiant, and make-up goes on better because of the feeling of improved smoothness of the skin.

What happens during the procedure?
The skin is treated with a fine, pressurized stream of crystals, which loosen skin debris and are immediately suctioned away. The pressure at which the crystals are sprayed against the skin can be adjusted. There is minimal discomfort, and skin looks slightly pink. There is no healing time, and no need for dressings or obscuring make-up.

Goggles should be worn to protect the eyes from irritation from the crystals. If contact lenses should be removed. The treatment area is cleaned with water, and an alcohol pad is used to remove any residual dirt and makeup. The physician or assistant passes the wand of the microdermabrasion unit over the skin in smooth, stroking movements, being careful to anchor the skin at the end of the stroke with a finger to prevent the tissue from being drawn into the suction device. The intensity of the treatment can vary, either by varying the amount of crystals used, the pressure used, the length of the session or the equipment.

What to expect post-procedure?
Some redness, which last for an hour or two, will appear right after the treatment. Streaking may occur but usually disappears after one or two days. There can also be swelling in sensitive areas, such as underneath the eyes. Cold compresses will help alleviate it. Finally, the underlying skin color may change compared to untreated areas.

Are there risks or potential side effects?
Patients who are using any kind of exfoliant. particularly alpha-hydroxy products, vitamin A cream, glycolic acid products, salicylic acid or benzoyl peroxide should discontinue use for 2-7 days prior to the procedure, and wait until two days after the procedure to restart use. Sun exposure should be avoided and sunscreens should be used for at least a week after the procedure.

As with chemical peels, laser resurfacing and dermabrasion, microdermabrasion carries certain risks. The reactivation of herpes simplex and an outbreak of cold sores are one such risk. Those with recurrent herpes simplex infections should start anti-viral treatment one day prior to the procedure and maintain anti-viral therapy for 7-10 days afterward. Patients with acne who have been treated with Accutane should have completed such therapy a year prior to having this procedure. Also, this procedure may not be appropriate for anyone who has a history of keloid formation. Some patients may experience pigmentation changes after the treatment, in which case lower pressures should be used in subsequent treatments.  Go back
 

Correction of Prominent Ears (Pinnaplasty)
What is it?
A prominent ear protrudes excessively from the side of the head.  It is frequently a source of teasing, using names like 'Dumbo, FA Cup, Jug Ears, and Wing Nut'.

The Operation
Surgical correction of prominent ears is usually performed under general anaesthesia in children. It can also be done under local anaesthesia. There are many ways of performing this surgery. Most frequently, an incision is made behind the ear, some skin is removed, and the cartilage remaining is marked on the front surface to allow it to bend backwards towards the head.  Dissolving sutures are then used to hold it in the new position.  A dressing is placed to keep the ear comfortable. Many surgeons use cotton wool and a bandage to end up like a turban to avoid disturbing the new position of the ear. The procedure is usually done as a Day Case.

Any Alternatives
The cartilage of the ear is very soft immediately after childbirth and it is possible to have moulds made which can gently re-shape the ear in the first few weeks of life.  Some people get so upset about the prominence of their ears sticking out that they have even used 'super glue' to hold them to the side of their head.

Before the Operation
Sort out any tablets, medicines, inhalers that your child is using. Keep them in their original boxes and packets. Bring them to hospital with you. On the ward, your child may be checked for past illnesses and may have special tests, ready for the operation. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After - In Hospital