Publisher: Robert L. Cucin, M.D.
EDITORIAL POLICY
With
rare exception, coverage will be limited to plastic surgical topics. However,
the subjects are deliberately chosen to be controversial and the views
given in this internet newsletter are exclusively those of the publisher.
Your feedback is welcomed.
Give me your thoughts on
one of these topics or submit another you would like me to discuss.
BOTOX
The
muscles of the forehead and those at the outer corner of the eye can be
paralyzed with an injection of bacterial toxin to eliminate forehead wrinkling
and crow's feet at the corners of the eyes. However, the injections
must be repeated after 3-6 months to sustain the effect and some patients
may experience a little general malaise on the day of injection.
SUN EXPOSURE
There
is probably no such thing as a really safe sun tan and both UV A
and UV B irradiation are causes of photoaging.
Hence even the newer tanning beds are unsafe. It has been calculated that
it takes six sunburns to create a skin cancer. So that peeling nose
at the beach will become that ulcerated basal cell carcinoma requiring
an excision and repair with a local flap. While we can't all carry
around parasols, sun blocks with SPF 6 or better are certainly in
order during prolonged sun exposure to avoid becoming a member of the core
of elderly sun worshipers every plastic surgeon has in his practice who
return year after year with new skin cancers in those sun exposed areas.
Although most of these patients are among the fair-skinned blondes and
those of Irish origin, no race or skin type is immune.
HIGH CHEEK BONES
That
"high fashion look" of prominent cheek bones may be attained by placement
of shaped solid silicone implants above the zygomata in a short intraoral
surgical procedure (malar augmentation)
performed under local anaesthesia. There are no external scars and
the sutures placed in the mouth dissolve. The patient wears some
external tapes for 5 days with little residual bruising or swelling after
that time.
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LIP ENHANCEMENT
Collagen
injections into the muscle are frowned upon by the F.D.A but injection
at the vermilion border to alleviate fine smoker's wrinkles (perioral rhytides)
and mimic a pouty or "Paris lip" provides a dependable although temporary
(6-9 month) augmentation. Augmentations with implanted materials
such as autogenous tendon (the patient's own), fascia lata (the patient's
own or someone else's), gortex or other materials are all too frequently
eventually accompanied by problematic skin erosions and scarring. The patient's
own tissues are better tolerated than those of others or foreign materials,
but areas of active motion and scant skin coverage like the mouth are poor
places for long term survival of implanted materials. Complications of
these materials are disastrous and difficult to treat. Permanent enhancement
with cheiloplasty, in which the
patient's own tissue is shifted outwards to make the lips appear fuller,
can reliably effect a modest augmentation in a small procedure carried
out under local anaesthesia that may be repeated for greater effect. Injectable
elastin is being developed for a more permanent, albeit still temporary,
injectable alternative.
LIPOTOME® LIPOSUCTION
A
patented
new technology for suction assisted lipectomy
(SAL) soon to be on the market facilitates more precise and
speedy surgical contouring with its reciprocating skinny twin
cannula design. Besides enabling the use of finer cannulas which
cause less tissue trauma and shorten convalescence, it incorporates simultaneous
cautery to further minimize bleeding and bruising without need for
tumescence or ultrasound. Ultrasonic liposuction (UAL)
has fallen somewhat in disfavor due to the significant incidence of seromas,
dyschromia and burns. Most surgeons restrict its use to treatment
of the more difficult cases of gynecomastia and flank liposuction. Lipotome®
liposuction promises to give liposuction the convenience and precision
mechanical dermatomes have given modern skin grafting.
BREAST AUGMENTATION
The
silicone gel controversy has not lessened the popularity of breast
augmentation with safe inflatable implants containing saline.
The most frequent complication is that of capsule formation which can make
the implants firm. The possibility of this occurrence is best minimized
by making sure the breast implants have an adequate cover of normal breast
tissue, i.e. staying with the smaller sized implants and using specially
textured implants. Sometimes placing the implants under the muscle
can be of value as may small amounts of intraprosthetic steroids. |
LASER RESURFACING
Recently
touted as a wrinkle panacea, laser treatment of rhytides is indeed
effective at lessening their depth and severity.
However, the post-treatment redness can persist for weeks or even months
and the treatment is not really any more effective than any a well performed
traditional dermabrasion which possesses the same efficacy without
the prolonged erythema or redness. Deep (phenol,
tricholoracetic acids) and superficial peels (glycolic, pyruvic
acids) are alternative methods of attacking the same problem. The former
group lessen the skin pigmentation with a "bleaching" effect while the
latter do not affect skin color but are less effective and require repeat
application.
OUT DAMNED SPOT!
Patients
frequently consult dermatologists and plastic surgeons with questions about
skin spots, growths and blemishes. They wonder which ones are dangerous
as opposed to being merely unsightly. The characteristics of those
growths which should be promptly tended to are: irregular margins, satellite
lesions, variegated pigmentation, ulceration, bleeding, and sudden change
or growth. While the treatment depends on the nature of the lesion
in question, most growths require excision of the deeper dermal elements
to lessen the likelihood of recurrence and provide pathology for examination
of malignant potential.
CHOOSING YOUR PLASTIC SURGEON
Make
sure he is board-certified, a member of the American
Society of Plastic and Reconstructive Surgeons (ASPRS),
has a teaching appointment at a university hospital, spends enough time
with you to answer all your questions regarding the risks and nature of
the planned procedure, and is willing to show you before and after
pictures of comparable patients with a similar problem. If he plans
office surgery, make sure his operating room is accredited by the American
Association for Accreditation of Ambulatory Surgical Facilities.
BREAST REDUCTION
Some
women are plagued with neck and back pain and shoulder grooving by brassiere
straps caused by overly large breasts. These breasts can be lifted,
shaped and reduced in a mammoplasty.
Since there is a large functional component to this operation, insurance
is usually applicable to all the larger reductions. The inverted-T
scars are readily accepted by the symptomatic patients who require this
operation which is usually performed under general anaesthesia in the hospital.
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