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Definitions:
Cosmetic vs. Reconstructive Surgery
Although the outward effects may be similar or even identical, the terms
cosmetic and reconstructive surgery are not interchangeable. The plastic surgeon
performs cosmetic surgery to reshape normal structures of the face or body in
order to improve the patient’s appearance and self-esteem. Reconstructive
surgery is performed to correct abnormalities of facial or body structures
caused by congenital defects, developmental abnormalities, injuries, previous or
concurrent surgeries, infection, tumors or other disease. The purpose of
reconstructive surgery is generally to improve function, but it may also be used
to restore a normal appearance.
These distinctions have implications for insurance coverage. Nearly all
insurance carriers cover reconstructive procedures for functional restoration,
but not those performed purely for cosmetic reasons. In general, the
classification as cosmetic or reconstructive depends upon the reason that the
surgery is performed. For example, rhinoplasty to change the shape of the nose
is considered cosmetic. However, rhinoplasty to change the shape of the nose
following traumatic deformity is reconstructive.
Corrective surgery to remove or minimize the effects of scarring usually
provides cosmetic improvement. Insurance carriers, however, may recognize these
procedures as reconstructive in nature because scars are abnormal formations
that develop on the body as a result of injury or illness.
Origins of Cosmetic Surgery
Cosmetic surgical techniques originally evolved from reconstructive procedures,
and some techniques are the same, whether they are used for cosmetic or
reconstructive purposes.
Suction-assisted lipectomy, commonly known as liposuction, is a procedure used
to remove lipomas (fatty tumors), defat flaps and remove fatty deposits in
various reconstructive procedures, but it has a much wider application as a
cosmetic technique to streamline the body by suctioning away localized deposits
of unwanted fat.
Many other procedures that today are more widely used to enhance appearance
began as solutions to reconstructive problems. The relationship between the two
types of procedures is so close that surgeons well-versed in reconstructive
procedures are most likely to also have the background and training required for
cosmetic surgery.
Background on Common Procedures
The following descriptions provide basic information on the most common
reconstructive and aesthetic surgical procedures.
Abdominoplasty (Tummy-Tucks)
A tummy-tuck is a major surgical procedure to flatten the abdomen by removing
excess skin and fat from the lower abdominal region and tightening the muscles
of the abdominal wall. The best candidates for tummy-tucks or abdominoplasty,
are men or women who are in relatively good shape but who are bothered by large
fat deposits or loose abdominal skin that won’t respond to diet or exercise. The
surgery is particularly helpful to women who, through multiple pregnancies, have
stretched their abdominal muscles and skin beyond the point where they can
return to normal. Loss of skin elasticity in older patients, which frequently
occurs with slight obesity, can also be improved.
Complete abdominoplasty usually takes two to three hours, depending on the
extent of work required. Partial abdominoplasty may take an hour or two. Most
commonly, the surgeon will make a long incision from hipbone to hipbone, just
above the pelvic area. A second incision is made to free the navel from
surrounding tissue. With partial abdominoplasty, the incision is much shorter
and the navel may not be moved, although it may be pulled into an unnatural
shape as the skin is tightened and stitched.
Next, the surgeon separates the skin from the abdominal wall all the way up to
the ribs and lifts a large skin flap to reveal the vertical muscles in your
abdomen. These muscles are tightened by pulling them close together and
stitching them into their new position. This provides a firmer abdominal wall
and narrows the waistline.
The skin flap is then stretched down and the extra skin is removed. A new hole
is cut for the navel, which is then stitched in place. Finally, the incisions
will be stitched, dressings will be applied, and a temporary tube may be
inserted to drain excess fluid from the surgical site.
For the first few days after surgery, the abdomen will probably be swollen and
some pain and discomfort may occur which can be controlled by medication.
Depending on the extent of the surgery, the patient may be released within a few
hours or remain hospitalized for two to three days.
The doctor will give instructions for showering and changing. And though it may
be difficult to stand at first, walking as soon as possible is suggested.
Surface stitches will be removed in five to seven days, and deeper sutures will
come out in two to three weeks. The dressing on the incision may be replaced by
a support garment.
Breast Augmentation
Breast augmentation is performed to balance a difference in breast size, improve
body contour or as a post-surgery reconstructive technique. Silicone shells
filled with saline solution are implanted either directly under the breast
tissue or beneath the chest wall muscle, giving breasts a fuller and more
natural contour.
While a relatively straight surgical procedure, there can be discomfort
associated with breast augmentation, such as scar tissue around the implant
tightening over time. This tightening, known as capsular contracture, sometimes
can be remedied by removing or scoring the scar tissue.
The methods for inserting and positioning implants depend on the patient’s
anatomy and doctor recommendations. Incisions are made in an inconspicuous an
area as possible – usually the armpit, around the areola (nipple area), or under
the breast itself – to minimize visible scarring. Working through these
incisions, the doctor lifts the breast tissue and inserts the implant. It is
then centered beneath the nipple, either under or above the pectoral muscle.
Possible risks include bleeding, infection, wound disruption, scarring, capsular
contracture, sensory change or loss and implant rupture or failure.
After a post-surgical recovery period of 24 to 48 hours and an additional
reduced-activity period of a few days, patients will likely experience soreness
and swelling for a few weeks. Exercise and normal activity can resume at the
direction of the surgeon.
Breast Reconstruction
Breast reconstruction is performed on mastectomy patients, allowing women who
have lost breasts to cancer to preserve their natural profile and aid in their
psychological healing. Breast reconstruction surgery is an effective way to
rebuild the breast.
After the doctor assesses a patient’s situation, he or she explains surgical
options appropriate for the patient’s age, health, and goals for appearance.
Most cases of reconstruction will require more than one operation, but the
process can begin right after the mastectomy has been performed. This can spare
the patient some trauma associated with loss of the breast.
Depending on the surgeon’s evaluation of the many factors affecting a patient’s
case, he or she can use a variety of techniques to reconstruct the breast. The
most common technique combines gradual expansion of chest tissue (commonly
called the tissue expansion technique) with the use of breast implants. With
skin expansion, a balloon expander is inserted beneath the skin and is inflated
with injections of salt-water solution over a period of weeks. After the breast
area is sufficiently stretched, the expander is removed and replaced with a
permanent implant. The nipple is then reconstructed in a subsequent procedure.
An alternative to skin expansion is the flap reconstruction technique. This
involves creation of a skin flap using tissue taken from another part of the
body such as the abdomen or back. The flap is attached to the chest area to
create a pocket for an implant or used to build up an actual breast mound.
Flap surgery allows for single-stage breast reconstruction, which may allow some
women to wake from their mastectomy surgeries with a fully reconstructed breast,
rather than having to undergo several stages of reconstructive surgery.
After completion of the reconstruction process, doctors may recommend further
operations on the healthy breast to match it to the re-built one. The ultimate
result helps restore the patient’s physical appearance and improve her
self-confidence.
Breast Reduction
Techniques for breast reduction vary, but the most common procedure involves an
anchor-shaped incision that circles the areola, extends downward, and follows
the natural curve of the crease beneath the breasts. The surgeon removes excess
glandular tissue, fat, and skin, and moves the nipple and areola into their new
position. He or she then brings the skin from both sides of the breast down and
around the areola, shaping the new contour of the breast. Liposuction may be
used to remove excess fat from the armpit area. In most cases, the nipples
remain attached to their blood vessels and nerves. However, if the breasts are
very large or pendulous, the nipples and areolas may have to be completely
removed and grafted into a higher position. (This will result in a loss of
sensation in the nipple and areolar tissue.)
Stitches are usually located around the areola, in a vertical line extending
downward, and along the lower crease of the breast. In some cases, techniques
can be used that eliminate the vertical part of the scar. And occasionally, when
only fat needs to be removed, liposuction alone can be used to reduce breast
size, leaving minimal scars.
After surgery, the patient will be wrapped in an elastic bandage or a surgical
bra over gauze dressings. A small tube may be placed in each breast to drain off
blood and fluids for the first day or two. Some pain might occur for the first
couple of days--especially when moving around or coughing-- and some discomfort
for a week or more. The surgeon will prescribe medication to lessen the pain.
The bandages will be removed a day or two after surgery, though the patient will
continue wearing the surgical bra around the clock for several weeks, until the
swelling and bruising subside. The stitches will be removed in one to three
weeks.
Chemical Peel
The chemical peel is a non-invasive technique that is designed to restore
wrinkled, blemished, unevenly pigmented or sun-damaged facial skin. Using a
chemical solution usually of phenol, trichloroacetic acid or alpha-hydroxy
(fruit acid), the skin’s top layers are peeled away, allowing for new cells to
grow that produce a smoother, tighter, younger-looking skin surface.
Phenol -- Phenol is the strongest of the chemical peel solutions. It is mainly
used to treat patients who have blotches on the skin caused by pregnancy, sun
exposure, birth-control pills or illness, or on people with coarse facial
wrinkles, severe sun damage or pre-cancerous growths. Because it lightens the
treated areas of the skin, phenol is most often used for full-face peels.
However, in patients with fair, unfreckled skin, phenol can be used on specific
facial regions, where the contrast with the untreated areas won’t be obvious.
Phenol is used primarily on the face, scarring may result if it is applied
elsewhere.
Trichloracetic Acid (TCA) – TCA peels employ a milder chemical formula than
phenol peels. A TCA peel is used primarily to treat fine surface wrinkles,
superficial blemishes or pigment problems. Because TCA peels do not produce the
same bleaching effect as phenol peels, they may be preferred by darker-skinned
patients for partial peels on specific regions of the face. The results of a TCA
peel are usually less dramatic and much shorter-lasting than those gained from a
phenol peel. In fact, sometimes more than one TCA treatment may be needed to
achieve the desired result. However, a TCA peel treatment requires less time
than a phenol peel, and the recovery from a TCA peel is usually shorter than
with a phenol peel.
Glycolic Acid -- Is the mildest of the peel formulas. This type of peel,
sometimes called an alpha-hydroxy acid peel or “fruity” acid peel, can provide
smoother brighter-looking skin in people who can’t spare the time needed to
recover from a phenol or TCA peel. Patients who have glycolic acid peels are
usually seeking only a fresher look and have only minor skin problems, such as
fine wrinkling, areas of dryness or uneven pigmentation. When glycolic acid is
applied to the face at a concentration of about 70 percent, it is considered a
“peel,” even though the acid solution doesn’t penetrate the skin as deeply as it
does for a phenol or TCA peel. Treatments are usually performed in a series –
perhaps one peel a week for about six weeks. Glycolic acid can also be mixed
with facial wash or cream at a concentration of about 10-14 percent and used as
part of a daily skin-care routine to improve the skin’s texture.
Because chemical peels involve some risks and long-term considerations regarding
exposure to the sun, prospective patients should take care to find a
properly-trained plastic surgeon. After the patient’s preparation for surgery,
which may involve several weeks’ use of Retin-A or fruit acid on the area to be
treated, the doctor will apply the chemical solution to the skin area to be
treated. The chemicals will usually cause a stinging sensation, depending on
which solution is used. After the treatment, which can last up to two hours for
a full-face treatment, the doctor applies petroleum jelly or another occlusive
compound to help with the healing process.
After the peel, patients should expect considerable swelling. After seven to ten
days the swelling subsides and new skin begins to form. Complete maturation of
the new skin and lightening of the pinkness may take up to six months when using
phenol, and patients must take care to avoid exposure to direct sunlight as it
can cause blotching on the treated area. During recovery, patients maintain a
regime of medication to speed healing and can apply makeup to camouflage the
treated area.
Cleft Lip and Palate Surgery
A child born with a separation in the upper lip is said to have a cleft lip; a
similar separation in the roof of the mouth is called a cleft palate. One of
every 800 babies is born with one of these congenital deformities. Medical
professionals have made great advances in treating children born with clefts,
allowing patients to lead normal, healthy lives. In repairing a cleft lip or
palate, plastic surgeons work with other specialists to address the medical and
psychological concerns a patient can face. This cleft lip and palate team may
consist of a plastic surgeon, a pediatrician, a dentist, a speech and language
specialist, a social worker, a hearing specialist, an ear-nose-and-throat
specialist, a psychologist, a nurse and a genetic counselor.
The most common initial difficulty of cleft lip or palate surgery is asymmetry,
when one side of the mouth and nose does not align with the other side. The
objective is to either close the separation in the patient’s lip or the opening
in the roof of the mouth, allowing proper speech and eating while improving
physical appearance.
Of prime importance in these surgical procedures is timeliness – most often,
cleft lip surgery is performed when the child is about 10 weeks old. Cleft
palate repairs are done before the child begins speaking. Repairs involve making
incisions on either side of the cleft, then drawing the tissue together and
stitching it into a normal position.
After surgery, the resources of the other cleft lip and palate team members are
utilized by helping young patients with eating and speaking, monitoring their
healing and ensuring a healthy recovery.
Endoscopic Plastic Surgery
Endoscopy is a surgical technique using a special instrument – an endoscope –
which allows the surgeon to see inside the body via small incisions. A long-used
technique in a number of medical procedures such as orthopedic surgery,
endoscopy is now being successfully employed by plastic surgeons. While further
testing is required to establish the effectiveness of endoscopic surgery, it is
being used on a limited basis for both aesthetic and reconstructive procedures.
The endoscope, a tubular probe fitted with a small camera and tiny light,
transmits video images of the body’s internal structures to a television monitor
in the operating room. The endoscope is exclusively a viewing device, giving the
surgeon a detailed look at the part of the body he or she will then operate on
with special instruments such as scalpels or forceps.
Due to its minute entrance point, usually less that one inch in length,
endoscopic surgery often means small, barely noticeable incisions and scars.
Shorter incisions may also mean less risk of nerve damage, minimal bleeding and
swelling and potentially quicker recovery time.
Some of the aesthetic procedures being performed today already benefit from the
advantages of endoscopic surgery. These include abdominoplasty (tummy-tucks),
breast augmentation, facelifts and forehead lifts. The technique also benefits
reconstructive procedures such as flap surgery, placement of tissue expanders,
sinus surgery and carpal tunnel release.
Eyelid Surgery (Blepharoplasty)
Eyelid surgery is a procedure to remove fat, and sometimes excess skin and
muscle, from the upper and lower eyelids. It is used to correct drooping upper
lids and puffy bags below the eyes that can make a prospective patient look
older and tired. It is not, however, a corrective procedure for crow’s feet,
other wrinkles, dark circles under the eyes or sagging eyebrows. It is simply
used to remedy the sagging skin and weakened muscles that occur around the eyes
over time. It is important that patients check with a qualified plastic surgeon
and an ophthalmologist to evaluate possible surgical difficulties that could be
caused by existing medical conditions such as low tearing, high blood pressure,
glaucoma or a detached retina.
Patients can expect a one to three hour procedure consisting of the surgeon
making incisions above and below the eye tissue. These incisions follow the
natural folds of the eye and allow the surgeon to separate the underlying fatty
tissue and muscle. The surgeon then removes the fat and often trims the sagging
skin and muscle.
After surgery, the patient’s head is kept elevated and cold compresses are
applied to the treated area to reduce swelling and bruising. Initial recovery
takes anywhere from two weeks to one month, with discomfort subsiding gradually
to reveal a youthful, more alert look after just a couple of weeks. The complete
healing process takes up to six months as scars slowly fade to thin,
nearly-invisible white lines.
Facelift
A facelift is a surgical procedure designed to reduce the visible signs of aging
such as creases in the face, slackness in the jawline and accumulation of fat
around the neck. Most patients who consider facelifts are in their 40s to 60s
but it can be successfully performed on people in their 70s and 80s as well.
Surgeons have different approaches to facelift techniques, so it is important
that the patient work with a qualified, experienced surgeon with whose technique
they feel comfortable. A facelift usually takes several hours. The surgeon
usually begins by making small incisions above the hairline at the temple,
extended in a natural line in front of the ear and following down to the bottom
of the ear, around the earlobe and into the hairline behind the ear. The skin is
then separated from the muscle below and pulled back. The surgeon then trims the
excess tissue and tightens the underlying muscle; stitches, then secures the
layers of tissue and closes the incisions. Surgeons will also often wrap the
head loosely with bandages to minimize bruising and swelling, although facelift
surgery does not usually cause too much discomfort. Any resulting scars from the
surgery can usually be hidden under the hairline or in the natural creases of
the face so long-term evidence of the surgery is relatively invisible.
During the recovery, it is important to follow surgeon’s guidelines for
appropriate activity, diet and exposure to the sun. Usually, the recuperation
requires plenty of rest, and minimal time in the sun for several months is
suggested. After one to five days, the bandages are removed. Stitches soon
follow and, in a few weeks, swelling and puffiness subside to reveal a
younger-looking face.
Hair Replacement Surgery
Whether due to aging, hormonal change, or circumstances such as burns or trauma,
hair loss can often be remedied by hair transplants.
Performed for more than three decades on both men and women, hair replacement
surgery utilizes existing hair to fill in bald areas. Several surgical sessions
may be needed to achieve the level of hair fullness desired by the patient. The
sessions may consist of grafting hair from the donor area to the thinning area,
expanding hair-bearing tissue over the bald area directly or using tiny “plugs”
of follicles to restore the hairline. It is essential that candidates for this
procedure have healthy hair growth on other parts of the head to serve as donor
areas. While many factors, such as hair texture or color can contribute to the
aesthetic result of a transplant, there are several transplant techniques that
can be used to improve the hair’s fullness and head coverage.
While hair replacement is normally a safe procedure, individual reactions to the
techniques can vary. The outcome is never completely predictable, so it is
essential that a prospective patient discuss the options with a qualified
plastic surgeon in order to be certain of the most appropriate approach.
Furthermore, the patient should find a doctor who is familiar with the many
different replacement techniques to be certain he or she will find the one
best-suited to satisfying his or her hair-replacement needs.
Surgeons watch patients closely during the recovery period, helping to ensure
healthy scalp circulation and skin strength. While follow-up procedures are
usually required, the ultimate result should be new hair growing in a previously
bald area at the rate of about a half-inch per month.
Hand Surgery
A delicate and specialized surgical procedure, hand surgery has greatly advanced
in recent years in part due to the expertise of plastic surgeons. Treatments for
patients with injuries, degenerative disorders and birth defects of the hand
have become increasingly improved, benefiting both the function and the
appearance of the hand.
Techniques being used by surgeons in hand surgery include grafting (transfer of
skin, bone or nerve tissue from other parts of the body), flap surgery (moving
skin from a healthy site to a damaged site) and replantation (the restoration of
accidental finger or hand amputations using microsurgery). All of these
approaches are used to repair injuries to tendons, nerves, bones and damage
caused by burns, cuts or other severe trauma.
Another increasingly common ailment remedied by hand surgery is carpal tunnel
syndrome. When pressure builds up in the carpal tunnel of the wrist, nerves in
the tunnel can be subject to tension that causes tingling in the hands. Cutting
away the tissue and compressing the nerve can relieve the symptoms.
Rheumatoid arthritis, an inflammation of the hand’s joints, may also be
repairable by hand surgery. Surgeons can repair or reconstruct almost any area
of the hand or wrist by removing the inflamed tissue and repositioning tendons
or even implanting artificial joints. This may result in a considerable
improvement in hand function, appearance and comfort.
Surgery can also reverse the effects of Dupuytren’s contracture, a disorder of
the hand’s skin that occurs when thick, scar-like tissue forms under the palm.
If not treated, Dupuytren’s contracture can extend to the fingers, pulling them
toward the palm and restricting motion. Surgeons can cut out the bands of
thickened tissue, freeing tendons for better finger movement and may
occasionally graft new skin over the repaired areas to restore normal
appearance. Hand surgery can also correct birth defects of the hand such as
fused, short or deformed fingers.
Because of the hand’s extreme sensitivity, surgeons will often recommend a
regime of rehabilitation to speed healing and maximize hand function. The end
result is a hand of maximally restored physical appearance and optimal
dexterity.
Laser Skin Resurfacing
Men and women of all ages can benefit from laser resurfacing. The ideal patient
for this procedure has fair, healthy, non-oily skin. Patients with olive skin,
brown skin or black skin may be at increased risk for pigmentation changes no
matter what type of resurfacing method is recommended. The plastic surgeon will
evaluate the patient’s skin characteristics and make recommendations
accordingly.
Also, individuals who have taken accutane in the past 12-18 months or are prone
to abnormal (keloid-like) scarring, or those with active skin infections on the
treatment area, may not be appropriate candidates for this procedure.
Having laser resurfacing can help enhance the patient’s appearance and
self-confidence, but it won’t completely remove all facial flaws or prevent
aging.
Laser surgery is a relatively quick procedure. It usually takes anywhere from a
few minutes to one and a half hours, depending on how large of an area is
involved. When the imperfections are especially deep, the surgeon may recommend
that the resurfacing be performed in two or more stages.
During the procedure, the activated laser is carefully passed back and forth
over the skin until the surgeon reaches the level that will make the wrinkle or
scar less visible.
When the procedure is over, the surgeon may choose to treat the resurfaced skin
with applications of protective creams or ointments until healing is complete.
Some surgeons choose to apply a bandage over the treated areas, which will cover
and protect the healing skin for the first five to ten days.
Liposuction
Liposuction is a technique to remove unwanted fat deposits from specific areas
of the body such as the face, abdomen, buttocks, thighs, and elsewhere. It is
not a substitute for weight reduction, but a way to remove localized fat that is
unresponsive to diet and exercise.
In the procedure, surgeons make an incision in the area to be treated just large
enough for the insertion of a hollow tube called a cannula. The cannula is
attached to a machine that creates a strong vacuum and is then manipulated by
the surgeon deep within the fat layers of the patient’s skin. The vacuum breaks
up the fat and sucks it out from under the skin. Sometimes several incisions are
made to allow the surgeon complete access to the fat deposits in the area being
treated. Patients must realize that, in addition to fat deposits, they also lose
body fluid in the procedure. Because of this, patients are given fluids
intravenously during the operation; they may also need a blood transfusion.
After the operation, patients can expect a recovery period of up to three weeks.
During this time, patients will likely have to wear a body-compression garment
on the treated area; this helps minimize the swelling and fluid accumulation.
The post-operative effects subside quickly, however, and the result is a slimmer
physique that can increase a patient’s comfort and self-confidence.
Skin Cancer Removal
With more than 500,000 new cases reported each year, skin cancer is the most
common form of cancer in the United States. More than 80 percent of these cases
occur on the face, head or neck, where they can be disfiguring, as well as
dangerous. Caused primarily by ultraviolet radiation, skin cancer can affect
anyone, particularly those with fair skin, people with a family history of skin
cancer and those who spend a lot of time outdoors.
The two most common types of skin cancer include basal cell carcinoma and
squamous cell carcinoma, however if caught early enough they have a 95 percent
cure rate. Malignant melanoma is the most dangerous and potentially deadly form
of skin cancer. Other, non-cancerous skin growths include moles (heavily
pigmented clusters of skin cells), and solar or actinic keratoses (rough, red or
brown scaly patches of skin). While benign, these growths can become cancerous
if subjected to constant irritants. The key to recognizing the various types of
skin cancer and growths is regular examination of the skin; unusual changes
should be checked by a doctor.
A doctor can diagnose skin cancer by removing samples of a growth and examining
the cells under a microscope. Once determined to be cancerous, the growths can
be surgically removed by a plastic surgeon. The procedure usually leaves no more
than a thin, barely visible scar. Only in very extreme cases, such as a large
tumor in a difficult to reach area or widespread growth to the lymph glands, is
major surgery required in skin-cancer cases. After surgery, reconstructive
techniques can repair scarred tissue or rebuild body parts to restore a
patient’s physical appearance.
Surgery of the Ear
Ear surgery, or otoplasty, is usually done to set prominent ears closer to the
head or to reduce the size of large ears. Ear surgery can also replace ears lost
due to injury or correct ear problems such as awkward folding, unusual smallness
or absence of natural folds and curves. When performed by an experienced,
qualified surgeon, complications in ear surgery are infrequent and usually
minor.
The operation usually takes two to three hours and requires the surgeon to make
a small incision behind the ear to expose ear cartilage. The cartilage is then
sculpted to bend the ear back toward the head. An alternative technique involves
folding the cartilage back onto itself, allowing the ear to reshape itself
without removal of the cartilage. To pin the ears back, surgeons can sew
non-removable stitches concealed behind the ear.
Ear surgery does not usually require an overnight hospital stay, and patients
can be up and around within a few hours after the procedure is completed.
Patients might experience a mild ache for a few days after surgery, but it
usually can be remedied with medication. The overall recovery time is about five
days for adults and seven days for children. After this time, they can return to
work or school, taking care to avoid bending their ears for about a month.
Surgery of the Nose
Nose surgery, or rhinoplasty, can enhance appearance and self-confidence, but it
won’t necessarily change looks to match the ideal. The best candidates for
rhinoplasty are people who are looking for improvement, not perfection, in the
way they look. Age may also be a consideration. Many surgeons prefer not to
operate on teenagers until after they’ve completed their growth spurt--- around
14 or 15 for girls, a bit later for boys.
Rhinoplasty usually takes an hour or two, though complicated procedures may take
longer. During surgery the skin of the nose is separated from its supporting
framework of bone and cartilage, which is then sculpted to the desired shape.
The nature of the sculpting will depend on your problem and your surgeon’s
preferred technique. Finally, the skin is redraped over the new framework.
Many plastic surgeons perform rhinoplasty from within the nose, making their
incision inside the nostrils. Others prefer an “open” procedure, especially in
more complicated cases; they make a small incision across the columella, the
vertical strip of tissue separating the nostrils.
When the surgery is complete, a splint will be applied to help your nose
maintain its new shape. Nasal packs or soft plastic splints also may be placed
in your nostrils to stabilize the septum, the dividing wall between the air
passages.
Tissue Expansion
Tissue expansion is a procedure that allows the body to produce extra skin for
use in other operations. A silicone balloon expander is inserted under the skin
near the part of the body to be repaired and gradually filled with salt water
over a period of time. This causes the skin around the balloon to stretch and
grow, restoring natural appearance to the reconstructed area.
The advantages of tissue expansion include: a near perfect match of the treated
area’s color; texture and hair-bearing qualities; continuous connection to the
donor area’s blood and nerve supply; and often less scarring. Tissue expansion’s
initial drawback is that the balloon insertion is often visible for periods
ranging from several weeks to several months (generally the amount of time
required to successfully stretch the tissue).
Despite this short-term drawback, however, tissue expansion remains one of the
best ways to reconstruct damaged tissue. The operation to insert the balloon
expander takes less than two hours. After the balloon has been filled with
salt-water injections, it is removed and the new tissue is put in place during a
follow-up procedure. The temporary discomfort resulting from the insertion or
removal from the final process usually occurs within one to two weeks.
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