Due to the rise in number of non-invasive and mini-invasive procedures, patients now demand optimal results after less-aggressive, lower-risk, brief-recovery surgeries. Plastic Surgery has evolved in the last decade regarding surgical techniques and development of new technologies. Reduced-scar, liposuction-combined surgeries, represent now less traumatic procedures, delivering better results at a deep and superficial level, remodeling neighboring areas at the same time. On facial surgery, procedures are now combined with synthetic or fat grafting, botulin toxin application, CO2 or laser resurfacing, elevation of eyebrow, etc. Breast implants have also evolved in their material, choice of available sizes and projections. Moreover, new techniques like vaginal rejuvenation / genital surgery have appeared on scene for both genders.
A. M. - 66 years - lower face lift and upper eye lid surgery
Selection of an optimally capacitated, board-certified surgeon, well trained on evaluating valid combinations of technologies and techniques, will influence on satisfactory outcome with minimal surgical risk.
NON-INVASIVE AND MINI-INVASIVE PROCEDURES
There has been a rise in the number of the non-invasive and mini-invasive procedures. Fat transfer and fillers, botulin toxin injection, radiofrequency, ultrasound cavitation, are some examples. With these options available, patient expectations on surgery have risen. Patients demand optimal results with less-aggressive, less-traumatic, lower-risk, short-recovery procedures. An increase in patients’ work-demands, and the amount of patient information available on the Internet, are also determining factors. In the last decade, plastic surgery has also evolved to satisfy those demands. Surgical techniques have evolved at the time new technology development and evolution has occurred. Surgeons have to remain objective, with clear medical criteria, avoiding false promises. In general there has been a rise of 700% on the frequency of non-invasive procedures with only a 25% rise on esthetic surgery. Other factors also influenced plastic surgery. Scar location and size on breast and abdominal surgery have adjusted to cloth size and shape (a difficult challenge sometimes) in order to render them hidden. Even hair styling has influenced scar modeling.
Abdominoplasty
The MACS (Minimal Access Cranial Suspension (Tonnard & Verpaele, 2002) facelift is a good example of a technique that allows patients to be treated, with a less aggressive, more natural result and less scars. Associations with fat grafting performed by a specialist have shown excellent results. Other associations can be made to include resurfacing with CO2 fractional laser to treat perioral folds or a phenol based deep peeling procedures, botulin toxin for forehead and periocular wrinkles, and elevation of eyebrow tail with suspensor threads.
M. P. - MACS Facelift, 6 month post-op - July 2010
Similar trends are observed with abdominoplasties, where now a smaller, lower scar, is performed. Correction of separation of the rectum abdominal muscles should be considered in every case for good results. The introduction of Lipoabdominoplasties (Saldanha O., 2001), combining liposuction with conventional abdominoplasty, made results on this approach, even more satisfactory lowering risks and complications at the same time.
Superficial liposuction (Souza Pinto E. 1982), allowed treatment of the back, arms, internal aspect of thigh and sacral areas with minimal cutaneous retraction, avoiding the use of ultrasound or laser technology, although these still remain an excellent alternative.
Liposuction techniques have also evolved. They became more selective and more precise, less painful and are nowadays performed with almost no blood loss. Thinner cannulas result in smaller scars. Laser technology allows treating lipodystrophy in a fast, less aggressive, fast recovering, manner allowing patients to resume normal activities in shorter times. Attention should be paid not to treat excessively large areas, or patients with a BMI higher than 30. Hydro-electrolytic disorders or extensive burning can occur in such cases. On these patients, laser can still be used associated to conventional techniques. Wavelength for laser technology comes now in 980 or 1210 nm on the same equipment, rendering better treatment of adipose tissue with optimal cutaneous retraction. All these procedures can be performed in an ambulatory setting, with 24-48 h. immediate follow-up.
There has also been a rise in the use of fat grafting. Facial, gluteal and breast use are excellent examples. The possibility to combine these with growth factors has optimized the results and durability of treatments. In some cases, gluteal fat grafting results are good enough to replace implant placement for the same area. Associating liposuction of neighboring areas like hips and waist to gluteal treatment further enhances patient satisfaction. The term “liposculpture” describes the procedure that takes place when excess of fatty tissue is removed from an anatomic location to be immediately placed in another, thus “sculpturing” human shape. On the contrary, on breast surgery, implants are still dominating, but fat grafting is an option to be considered for patients without a familiar history of breast cancer. Precise and adequate indication, allow the face to be treated volumetrically with fat grafts, without incisions, and good results.
All of these techniques have been questioned in the last 20 years. Today nobody has doubts about their value as individual treatment choices or enhancing others.
Implants for breast augmentation and breast enhancement have improved their design and incorporated more options, allowing further personalized indications. For an example, some implants exist in 9 to 12 different shapes for a given size.
S.S. - 23 years - 400 cc round high profil submuscular, periareolar scar - Dic. 2010
The optimization of surgical techniques, their prudential combination and the association to low-invasive or non-invasive procedures, have widely favored esthetic results. Is important to choose a well-trained, matriculated surgeon, which combines knowledge with good criteria, offers valid choices, does not create false expectations, and aims for the lower possible risk treatment.
Contact Ocean Clinic to learn more about those plastic surgery procedures.
www.oceanclinic.net/plastic-surgery
