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Chapter 1 What to know before undergoing elective cosmetic surgery
Chapter 2 Minimizing the effects of facial ageing
• Face Lifts
• Eyelid Surgery
• Brow Lift
• Chemical Peel and Dermabrasion
• Restylane & Perlane injections
• Botulinum Toxin Injections
Chapter 3 Surgery of the Nose (Rhinoplasty)
Chapter 4 Chin and Cheek Augmentation
Chapter 5 Ear Surgery
Chapter 6 Body Contouring (Liposuction & Liposculpture)
Chapter 7 Breast Surgery
• Breast Reduction
• Breast Lift
• Breast Augmentation
Chapter 8 Abdominoplasty
Chapter 9 The Treatment of Male Pattern Baldness
Chapter 10 Laser Management of Skin Blemishes
Chapter 11 Reconstruction of the Breast
• Planning the surgery of reconstruction
• Surgery that will be performed
• Simple augmentation
• Skin expansion
• Skin flaps
• Donor flaps
• New methods
The word ‘Plastic’ is derived from the Greek ‘plasticos’ which means to mould or reform. Plastic surgery allows us to mould or reform the human body. The speciality of plastic surgery encompasses both reconstructive and cosmetic surgery. Reconstructive surgery helps to restore physical disabilities and reduces disfigurements resulting from birth defects, accidents and disease. Although cosmetic surgery is not essential to health, it can greatly enhance the quality of life by improving the appearance of the normal body and thus the self image. Cosmetic plastic surgery can no longer be considered as vanity surgery, as it was in the past. Its benefit to the patients can be tremendous. The ideal candidate for this type of surgery is a person who recognizes a specific problem in his or her appearance that could be improved. This could be influenced to a certain extent by the individual’s role in society. Psychologically patients receive a powerful boost from such surgery and if they look better they perform better. Whatever the reasons for choosing cosmetic surgery, it is important that the patient has realistic expectations. Improving a feature of the face or body may provide greater self-confidence and add to the sense of well-being, but is not a guarantee of happiness or better relationships with others. This booklet is designed to give the patient, seeking such surgery, better insight as to the available procedures, the results that can be expected and the complications that may occur.
Prof LA Chait MBBCh (Rand), FRCS (Edin), FCS (PLAST) SA Consultant Surgeon to the Plastic Surgery Department Witwatersrand University and The Johannesburg Group of Teaching Hospitals PARKLANE CLINIC JOHANNESBURGFOREWORD
Of the many divisions of Plastic & Reconstructive Surgery which includes congenital abnormalities and reconstructions after trauma and tumour removal, cosmetic and aesthetic surgery deserves in my opinion the most special care and consideration of the patient. One is starting treatment here usually with a physically well and fit patient. The operations may be long and stressful and even the most skillful anaesthetic and gentle surgery may be nullified by some unexpected reaction in the patients body. One of the oldest principles in surgery is never to leave a patient worse off after an operation. This brings me to a vital point: It is not always the operation chosen but “who does it” that determines the safe satisfying success that may involve the future of the whole mind and body. One cannot underline too strongly the need for the patients clear understanding of what the surgeon can offer in response to the patients wishes and beliefs. An explicit and clearly written consent including the mention of possible complications can be invaluable for the future happiness of all concerned. On the patients side there should be the ability to indicate clearly what they consider the defect for correction or the main aim of the desire for something new or different. Dr Chait has, in his information, covered admirably all the important aspects in the main cosmetic operations performed. A final word of warning for many of my patients has been that “Your personality is more important than your disability”.
The face is a composite of structural elements including the chin, cheeks, brow and jaw. It is the relationship between these structural elements that creates a look that is unique. When one of these elements is too big, too small, or too prominent it tends to throw the face out of proportion. Facial contouring is a form of plastic surgery that changes the structure of basic the face and a variety of styled implants can be used to create achieved. One of the most important things that one can do to help the doctor create the results that are expected is for the patient to define what he or she requires. Most patients seeking this type of surgery are younger people interested in a fundamental change in the shape and balance of their face. It may be required in older patients in conjunction with other surgical procedures such as a forehead or face lift to help restore a more youthful look. Preparing for surgery These procedures are often undertaken through the mouth so there must be no evidence of dental infection or mouth sores. Operation This is usually performed under general an aesthetic.
Chin surgery The insertion of a chin implant takes from between 30 minutes to one hour. Incisions are either made inside the lower lip or in the skin just beneath the chin. The skin is then gently lifted off the chin bone and a pocket is made large enough to hold the implant, which may be from 2 to 5 cm wide. The shape and size of the implant will have been determined by the doctor before the operation and test sizes will be used during the procedure to determine the exact fit. The implant is then placed in the pocket and then held in place with stitches. Finally, the incisions are closed and a surgical tape or light compression dressing is applied to the chin to control swelling and give the chin support after the procedure. Following the operation there may be some pain and discomfort for a few hours and the chin may feel stiff and sore for 2 to 3 days. The lower lip may feel stiff and difficult to move for the first week and some swelling and bruising of the chin and upper neck area is evident. If the incision was made in the mouth, a fluid diet would be required for the first week and instructions to rinse the mouth with an antibiotic solution will be given. Stitches are removed at one week.
Cheek surgery Cheek implant surgery usually takes one hour to perform. It may be undertaken at the same time as a face lift or forehead lift, but in may cases is undertaken as a separate operation. The implants may beundertaken at the same time as a face lift or forehead lift, but in may cases is undertaken as separate operation. The implants may be inserted through external incisions in the temporal region hairline, or through an incision made in the upper lip. The doctor will lift the tissue of the cheek away from the cheekbone, creating a pocket. The implant is then inserted into this pocket and held in position with a stitch. The incisions are then closed and the tape and compression dressing are placed over the cheekbone. Pain after this procedure is minimal, but the cheeks may feel stiff and numb for a while. Chewing and yawning will also be uncomfortable. There may be swellingmand some bruising over the cheeks and lower face for a few weeks. Jaw surgery The insertion of implants along the jaw may be undertaken through incisions in the mouth in a similar way to a chin augmentation. In this case the implant is placed in pockets alongside the jaw on either side. The patient will experience marked post-operative swelling immediately following the surgery, but most of this will disappear after several weeks. It may be difficult to smile or move the mouth for several weeks after the operation. Resuming normal activities In most cases one can return to work about a week after facial surgery. Many people, however, do not feel comfortable going out socially until the bruising and swelling has settled 2 to 3 weeks later. Any activity that involves the face getting bumped or jarred should be avoided for at least 6 weeks. It takes this time for scar tissue to form around the implant and hold it securely in place. Complications Facial implants can produce remarkable results, but as with any operation there are risks associated with surgery and some specific complications associated with the procedure. A facial implant will occasionally shift in position after the operation. If it does do this the only way to correct it is to redo the procedure. A small number of patients develop an infection around the implant. This usually occurs a few weeks after the surgery. In some cases the implant may have to be removed for a few months until the infection has subsided. A new implant will then be inserted. Very rarely some patients will suffer some minor injury to the facial nerves, which provide feeling and movement to the lips and chin. This condition is, in most cases, temporary. The new look After these operations an unusual reaction may be experienced from family and friends who do not understand the reason why it was done. It should be kept in mind as to why one decided to have the surgery in the first place. If these expectation have met your goals then the surgery was a success.