THE SPECIALTY OF PLASTIC SURGERY

Plastic surgery is the specialty of surgery concerned with the body's form as well as its function. Its origins are among the most ancient in medicine, deriving from efforts at the restoration of body parts after trauma. The specialty matured in the Great Wars and developed an armamentarium of procedures that came to be applied for more purely cosmetic purposes such as retarding the ravages of age and improving upon nature's less favorable endowments. What follows is a sampling of some of the more commonly performed procedures along with a brief discussion of the techniques and convalescences.

OVERVIEW OF PLASTIC SURGERY PROCEDURES

Eyelid Surgery
Face Lift
Nasal Surgery
Lip Surgery
Chin and Cheek augmentation
Ear Surgery
Breast Enlargement
Breast Reduction and Breast Lift
Tummy tuck
Liposuction

EYELID SURGERY (Blepharoplasty)

In simplest form, an eyelid lift or blepharoplasty is an excision of redundant skin and fat from the upper and lower eyelids as occurs with aging. The operation is carried out on an ambulatory basis in office or hospital under either general or local anaesthesia. The eyelid skin heals quickly with the sutures, which are placed in the upper eyelid crease and immedialy below the lower lashes, being removed by the fifth day. The patient generally misses a week from work, sports some bruising on the second week which may be covered with makeup or sunglasses and generally returns to normal social functioning by the third week. In cases when the upper eyelid skin is so excessive as to interfere with vision, surgery may be subject to insurance reimbursement.

FACE LIFT (Rhytidectomy or Meloplasty)

A face lift is no longer just a pulling up of the skin to remove the wrinkles. It is a resuspension of deeper layers to achieve a more prolonged result and a recontouring of the subcutaneous fat of cheeks and chin. Incisions are placed in the scalp where the redundant skin is excised and the procedure may be carried out on an ambulatory basis or with an overnight hospitalization. General or local anaesthesia may be used and the sutures are removed by the 10th. day. Most patients stay home for a week, return to work covering some bruises on the second week and may return to normal social functioning at the end of the third week.

"NOSE JOB" (Rhinoplasty)

A rhinoplasty is a recontouring of the nose to undo the result of a prior injury or achieve a more favorable profile. Airway obstruction may also be treated at the same time and may make the procedure subject to insurance reimbursement. The ethnic character of the nose may also be lessened. The procedure is carried out on an ambulatory basis in the office or hospital under either general or local anaesthesia. An esternal splint remains on the nose for a week. When it is removed, the patient may return to work covering some eyelid bruising with makeup or glasses. Light exercise is allowed for the second week and normal exercise and social functioning resumes by the third week. Contact sports are avoided for six weeks.

LIP ENLARGEMENT OR REDUCTION (Cheiloplasty)

Upper and lower lips may be made smaller or larger under local anaesthesia on an ambulatory basis in either office or hospital. Tissue is either advanced to plump up the lip or removed to make it smaller. The incisions are within the mouth and the sutures dissolve so they need not be removed. For augmentations, the swelling usually resolves in a few days; for reductions, it may persist for weeks. Most patients return to work within a week.

CHEEK AND CHIN AUGMENTATION (Malar augmentation and mentoplasty)

Week chins and flat cheek bones may be improved by intraoral insertion of solid prostheses, generally solid silicone implants. The sutures dissolve and need not be removed and all incisions are within the mouth and therefore invisible. The procedures are generally carried out on an ambulatory basis under local anaesthesia if performed alone. The patient generally sports skin tapes for a week and has very little external bruising when the tapes are removed, returning to work and appearing socially although a "stiff upper lip" or lower lip is common for another week.

EAR SURGERY (Otoplasty)

Prominent ears may be repositioned closer to the head in surgery carried out under local or general anaesthesia on an ambulatory basis in the office or hospital. Sutures are placed behind the ear and are removed by the 10th. day. Little bruising persists after the second week. Insurance coverage is variable.

BREAST ENLARGEMENT (Augmentation Mammoplasty)

Breast enlargement is now carried out with inflattable saline implants being placed either above or beneath the muscle. The approach is most commonly around the pigmented skin surrounding the nipple but an incision beneath the breast or in the arm pit may be used. General anaesthesia is more common but local anaesthesia may be used as well and the procedure is carried out on an ambulatory basis in either office or hospital. Patients usually miss less than a week from work, have their sutures removed by the 10th day and can return to exercise by the third week.

BREAST REDUCTION AND BREAST LIFT (Reduction Mammoplasty and Mastopexy)

Breast reduction is generally carried out on an ambulatory basis in the hospital under general anaesthesia with or without an overnight hospital- ization. Incisions and resulting scars are around the nipple and beneath the breast with a short connecting limb and described as an "anchor" or "inverted-T" pattern. Breast lifting may also be performed in the office under local anaesthesia and usually requires the same incisions. Occassionaly, a concentric circle or "donut mammoplasty" may be done for lesser cases of sagging to result in only a scar around the nipple. The sutures are generally left in about 2 weeks and patients return to work at the end of the second or third week. Insurance covers reduction of breasts to large as to cause syptoms of neck and back pain.

TUMMY TUCK (Abdominoplasty)

An abdominoplasty is an excision of redundant abdominal skin after childbirth or weight loss together with a repair of the weakened abdominal wall beneath. It is a substantial operation performed under general anaesthesia requiring a hospitalization for several days. The incision and resulting scar is a low curving one just above the pubic hair. Sutures are generally removed by the end of the second week and most patients stay home from work for three weeks. Insurance reimburses instances when there is an abdominal wall hernia.

LIPOSUCTION

Removal of localized excesses of fat by application of suction to a reciprocating hollow rigid tube has become one of the most commonly requested surgical procedures today. It is most commonly performed under general anaesthesia on an ambulatory basis but may be performed under local anaesthesia as well either in office or hospital. The incisions are short ones in inconspicuous places. However, the bruising is usuallly substantial and requires several weeks to resolve. Generally the patient is advised to wear a pressure garment on the operated part for the first few weeks. Women most commonly have the hips, lower stomach, inner thighs and knees reshaped while men most often complain of hip rolls or "love handles" in addition to their stomachs.