Dermatological surgery including cosmetic surgery has been developing rapidly in the last few years. Plastic surgery is competing with ENT surgery and surgical dermatology regarding nose jobs, ear lobe surgery, cosmetic anti-aging surgery and others. Here are a few examples of what is available (the remainder of this chapter is based on practical experience in medicine and various chapters throughout Ref.10).
Plastic and cosmetic surgery in dermatology
(if you don’t find it below, look for links under “Related Topics” on the bottom)
aging face surgery (face lift, see below) : combination of blepharoplasty for eyes, face lift for forehead wrinkles and “neck job” to remove redundant skin and tighten the skin underneath the chin
ear reconstruction (see below): for congenital ear deformities or “pulled through” ear rings
“eye job” (blepharoplasty, see below) : surgeries designed to lift sagging eye lids; or to raise eye browns
hair restoration : mini hair transplants for hair loss
“nose job” (see below) : rhinoplasty for crooked nose (nasal septum deviation) or cosmetically for better appearance
skin excisions : removal of moles or skin cancer in cosmetically sensitive areas such as the face
skin grafts (see below) : covering of skin defects from cancer removal or deep burns
varicose vein surgery or injection : injection of moderate varicosities (sclerotherapy) for varicose veins; if they are severe, first surgical stripping, then sclerotherapy
Z-plasty (see below): a plastic surgeon’s technique to hide scars and improve wound healing by removing tension from wound edges by special cuts
Liposuction : improving skin appearance in abdominal area (particularly for lax skin after pregnancy)
other breast cosmetic surgeries: breast augmentation (“Breast Implants”), breast reduction (“Large Breasts”)
The plastic surgeon or esthetic ENT surgeon can make an aged face look considerably younger (by about 10 years) by changing surgically what we associate with aging: baggy eyes, drooping eyes, saggy skin, eye wrinkles and forehead wrinkles as well as neck wrinkles. Blepharoplasty addresses the eye problem, a facelift the soggy skin on forehead and cheeks and a platysmal lift will tighten the neck.
Examples of cosmetic procedures
Here are a couple of pictures before and after a facelift. Apart from conventional plastic surgery there is a newer plastic surgery procedure, which has been called “space lift”. With aging there is a loss of subcutaneous fatty tissue, which leads to wrinkles and a hollowed out facial appearance. Using a liposuction method where fat tissue is taken from areas of the body where it is abundantly present, this is separated into fatty cells and stem cells and injected into the areas of the face or breasts where it is needed. Here are before and after images for space lift in the face and breast augmentation on Kelly Rowland (an American singer).
Ear deformities can be congenital and cause ear lobes that stand out to the side (=protruding ears) and otoplasty is the name for the corrective surgery. The ENT specialist would do an otoplasty when the ear lobe in the back protrudes more than 2 cm (=4/5 of an inch) from the head. Here are before and after otoplasty pictures. For earlobe splits (caused by pulled through ear rings) a plastic surgery can be applied, the results of which is shown here.
Eye job (=blepharoplasty)
This type of surgery takes care of a fat pad that often leaks on the bottom of the eye socket and causes baggy looking eyes. The redundant skin of the upper eye lid is also carefully removed. Another add-on to this, the eyebrow lift is eye brow surgery that corrects a sagging eye brow. This changes the appearance back to a more youthful face, but at the same time less depressed face. Here is a link to a more detailed site that explains blepharoplasty, before and after.
Some people are born with a “crooked nose”, others sustain it after a nose fracture from an accident or a fight. The end result is a nasal septum deviation where the separation wall between the right and left nose is deformed. Patients often snore and complain having difficulties breathing through the nose. This can be surgically corrected in a small surgical procedure, called rhinoplasty surgery.
Other persons have been born with a nose the shape of which is not to their lining and they want it surgically corrected. Here is a link, which explains this in more detail and shows before and after rhinoplasty pictures of Angelina Jolie.
Infected skin wounds often heal with a skin defect that needs covering. Burn wounds or mole removals are other examples where there may be not enough local skin to cover and close the wound. This is where the plastic surgeon can do a skin transfer or skin graft with the same patient being the donor. The graft is taken from an inconspicuous area with healthy skin. Scar removal often involves z-plasties as well.
This is a surgical procedure is called so because the surgical line looks like the letter “Z”. The full surgical name is “triangular flap repairs“, but it goes by “Z -plasty“, which is much easier to picture in your mind. This technique has a wide application around fingers for repair of stenosing tendinitis cases (De Quervain) with contractures. It is also used for large unsightly scar revisions anywhere in the body and for congenital lip deformities as shown through the link below. The following is a link to a site that shows the use of this surgical technique to repair congenital cleft lip defects. Pictures before and after the use of Z- plasty are shown under this link.
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2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 117.
3. Cotran: Robbins Pathologic Basis of Disease, 6th ed.,1999, W. B. Saunders Company
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7. Richard J. Lewis, M.D. at the 42nd Annual St. Paul’s Hosp. CME Conf., Nov.1996, Vancouver/BC
8. Jerry Shapiro, Prof. Dermatol., UBC, at 45th Annual St. Paul’s Hosp. CME Conf., Nov.1999, Vancouver/BC
9. D Seager Int J Cosmet Surg Vol 6, No. 1, 1998: 27-31.
10. Townsend: Sabiston Textbook of Surgery, 16th ed.,2000, W. B. Saunders Company
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12. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
13. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008