This article discusses some of the most common plastic surgery procedures and the various techniques used. The most common procedures are nose jobs, breast lifts, facelifts, and liposuction. Different procedures may be combined into a single operation, though that is considered riskier, as the patient has to be subject to deeper and longer sedation. Terminology
The term 'plastic surgery' is generally used to describe both reconstructive and cosmetic surgery. The difference between reconstructive and cosmetic surgery is one of purpose; reconstructive surgery is carried out to correct defects which are considered to be medical in nature, even though biologically the patient is well, because the defects limit the ability of the patient to be an accepted member of society, and as such may also be the underlying cause of mental health issues.
Reconstructive surgery may be carried out to correct the effects of scarring caused by burns, congenital (inborn) defects such as cleft lips, benign but unsightly tumors, or damage caused by trauma (violent accidents). In recent months, face transplants have been featured in the media. In these cases, the patient was disfigured and the face restored via extensive reconstructive surgery and a face transplant, to allow the patient to lead a 'normal' life.
Cosmetic surgery, meanwhile, is carried out for aesthetic reasons. In other words, the patient - or customer - wishes to enhance his or her appearance. Cosmetic surgery is not necessary for any medical reasons, physiological or mental.
Rhinoplasty
So-called nose jobs are most often carried out to change the appearance of the nose, either to reduce an inherited aquiline appearance (a 'beaked' nose), to add material to straighten the bridge of the nose, or to change the shape of the tip. Here are is a list of common issues.
Some of the more common perceived issues are assymetry of the nose (i.e., a crooked nose), an overly aquiline nose (a 'humped' or 'beaked' appareance), a ridge resulting from a nose fracture, an insufficient bridge, and a tip that is bulbous, oversized, and/or drooping.
The core issue with any type of plastic surgery is usually how to perform the procedure without leaving visible scars. In the case of rhinoplasty, the technique used may be either "closed" or "open." Closed rhinoplasty refers to sculpting the nose after making incisions inside the nostrils. The procedure is termed closed because the surgeon has to perform the surgery while the 'cover' (the skin of the nose) is still in place.
In case of open rhinoplasty, a cut is also made in the columella, the thin strip of skin under the nose and between the nostrils. After the cut, the skin covering the nose can be peeled back, allowing the surgeon to work on the inner structures of the nose with greater freedom. An expert incision in the columella is barely visible after the scar has healed.
While rhinoplasty can be carried out only with local anaesthesia, general anaesthesia is usually preferred. One of the reasons is that patients find the sound of a mallet striking a chisel disconcerting.
During the procedure the surgeon may chisel the bridge of the nose to reduce it's prominence, using rasps (surgical files), scalpels, or chisels and a mallet. Alternatively, a silicone graft may be introduced to enhance the height of the bridge. The cartilage forming the tip of the nose may be cut to form a more desirous shape, or, again, an implant of silicone or cartilage may be used to form a tip.
Following the surgery, a splint (of metal or plastic) or cast is applied on top of the nose, and nasal packing (gauze) is inserted into the nostrils, to support the new structure and to allow it to 'set', i.e. heal without losing its shape. While the splint can be taken off after about a week, it takes months for the nose to heal completely, as cartilage mends more slowly than skin tissue.
Related procedures are septoplasty and alar reduction. Septoplasty refers to the straightening of the septum, the dividing wall between the nostrils, and is carried out to improve the passage of air through the nose and the patient's ability to breathe. Alar reduction, or alar base reduction, is a procedure carried out to reduce the width of the nostrils, which are called the ala. Revisional rhinoplasty refers to the correction of a botched nose job.
More than any other common form of plastic surgery, a successful rhinoplasty is dependent on not just the competence of the surgeon, but also his or her aesthetic sense. In other words, the surgeon sculpting the nose must be an artist capable producing a work of beauty that fits the patient's face, as well as a doctor. While any competent surgeon can perform liposuction satisfactorily, only surgeons with a good sense of design and talent for sculpture can give the customer a natural-looking nose.
Mentoplasty (Chin Augmentation)
The most common form of mentoplasty is the insertion of an implant to correct what is perceived as a "weak" chin. The chin implant will extend the chin outwards along the jawline. The chin implant is usually made of silicone, but may be made of some other material, such as methacrylate, polyethylene, or even hydroxyapatite. The implants are premolded and come in various shapes and sizes.
During the operation, the surgeon will prepare a pocket for the implant, and then determine which size of implant best fits the contours of the customer's face, using standard implants which are temporarily inserted into the pocket. Once the best size has been determined, the final implant is inserted and stitched into place.
The incision can be made in one of two places - in the mouth, behind the lower lip (an 'intraolar' incision), or in the crease under the chin ('submental incision'). The former leaves no visible scar, but poses a higher risk of infection or nerve damage; hence most surgeons prefer the submental approach even though a small scar will remain under the chin.
Rhytidectomy (Facelift)
Facelifts are carried out to restore a more youthful appearance, by removing excess skin (jowls) from the face, tightening underlying tissues, and reversing fat loss. While major wrinkles will be minimized, facelifts cannot eliminate fine lines or problems with the texture of the skin.
Facelifts have become fairly common, and the superficial effect can be mimmicked to an extent with adhesive tape; hence it is often not fully appreciated that a facelift is a highly complex procedure. The old adage which says that it takes 43 muscles to frown, but only 17 to smile, illustrates the fact that a highly complex structure involving a large number of nerves and muscles is at work in the face, no matter which expression we choose to adopt.
While in other forms of plastic surgery the greatest risks are posed by the side-effects of anaesthesia, or complications arising out of infections, in the case of facelifts there is an added risk is facial nerve damage, which causes permanent loss of facial function in a small percentage of patients.
Facelifts can be divided into a lower facelift, a mid-facelift, and an upper facelift, though a surgeon may choose to perform all three at once.
The lower facelift, also known as a two-layer facelift, encompasses an area from the neck and chin to the temples. It involves the procedure most people envisage under the term 'facelift', i.e. a long incision just beyond the hairline, extending from the lower jaw, past the ear, and towards the temples. After the incision has been made, the SMAS (superficial musculoaponeurotic system, a layer of tissues just above the facial muscles) is tightened either by plication (folding it onto itself, and stitching it with permanent sutures) or imbrication (excising a loose portion). A band of skin is then excised from the facial skin before it is reattached to the scalp.
If the client has a double-chin or "turkey gobbler," and a necklift is desired, an additional incision is made under the chin. Excess fat deposits are removed, the platysma (a platelike neck muscle extending from the mouth down into the neck) is tightened by shortening, and overlapping skin is cut away.
A mid-facelift, meanwhile, is a different procedure, and involves placing fat where it should be - high up in the checks. As people age, fat tends to atrophy or migrate downwards, resulting in a sunken, hollow, or skeletal look, and folds in the lower part of the face. Fat grafts correct the problem and restore volume and youthfulness to the face. Fat deposits can be repositioned and raised, using sutures known as suspension sutures to pull the fat up and 'hang' it into place. While an incision can be made from the lower eyelid, an endoscope may be used to reach the cheek from an incision beyond the hairline. The endoscope allows the surgeon to view what is occurring under the skin as the surgeon reach in with a long blunt forceps, used to work on the tissue. An incision is also made behind the upper lip.
An upper facelift, also called a forehead lift or brow lift, may be done in one of several ways.
The coronal facelift is perhaps the most drastic kind of facelift. The scalp is cut from ear to ear across the top of the head, well back from the hairline - in the location where an alice band might be placed. A dissection then takes place, and the skin and the muscles are then peeled away from the skull, exposing the underside of the muscles (see image). Since forehead wrinkles are caused by repetitive muscle movement, the surgeon will then proceed to partially inhibit the function of the muscles in the forehead - the frontalis, corrugator, and procerus muscles - by cutting away lateral strips or cauterizing thin bands of muscle.
Meanwhile, in an endoscopic forehead lift, an endoscope is inserted into the brow from 3 ~ 5 small incisions beyond the hairline, and a long instrument is used to separate the muscle tissue away from the bone. Then, again, as in the case of a coronal forehead lift, thin strips are cut away from the forehead muscles to inhibit their movement. Additionally, the surgeon may also lift the forehead using small teeth, which act like thumbtacks and pin the forehead into a higher position, or using sutures.
A temporal brow lift is a variant of the endoscopic forehead lift. The incisions are made at an angle - the temples - and the result is minimization of crow's feet. Lastly, there is the direct browlift, in which incisions are made immediately above the eyebrows. This method raises the eyebrows, and does not address crow's feet or wrinkles in the forehead.
Abdominoplasty (Tummy Tuck)
Abdominoplasty is not synonymous with liposuction, although liposuction may be performed in conjunction with a tummy tuck. Abdominoplasty is an operative procedure in which excess skin is removed, and abdominal muscles are tightened.
Abdominoplasty leaves a permanent, large scar. One long, curved incision is made just below the bikini line, from hip to hip, skirting the pubic area. This incision will leave the scar.
Then the navel is isolated with a circular incision, and another incision is made downwards from the navel, until it reaches the first incision, creating two triangular 'flaps'. These two flaps are peeled away. The surgeon will then apply horizontal stitches to the abdominal muscles, pulling two sets of abs together.
The abdominal skin is then stretched downwards, and a large amount of excess skin extending below the bikini-line incision is cut away. The incision is then sutured shut. Since the two large 'flaps' will be cut away entirely, the vertical incision from the belly button will not be an issue. However, the navel will be covered by the new skin which has been stretched downwards, leaving the client navel-less, so a hole is cut into the skin, allowing the belly button to resurface.
Liposuction
The liposuction technique has evolved since being invented in the 1970's, and comes in several variants. The most common is tumescent liposuction, in which the fat is prepared using a solution, allowing the fat to be removed with less suction force, smaller tubes, and less bleeding.
A liquid composed of saline, a local anaesthetic (lidocaine), and epinephrine - which constricts the capillary blood vessels, reducing bleeding - is injected into the adipose tissue. The fat deposits are then removed using a thin tube, called a cannula, which the surgeon uses to sweep up the fat using a device which works like a vacuum cleaner.
The incisions made to insert the cannula may be small enough to heal without stitches.
Note that LipoDissolve is not a form of liposuction. LipoDissolve (and other brand names such as Lipostabil or Mesotherapy) refer to the injection of phosphatidylcholine/deoxycholate (PCDC) drugs to 'melt' fat deposits, which is then absorbed by the body. PCDC injections have not been approved by the FDA and numerous organizations, including the ASPS (American Society of Plastic Surgeons) and individuals have warned that the treatment may be unsafe. This may well be the case, since it is unknown how the body processes the drugs injected and the fat thus dissolved.
Mastopexy (Breast Lift)
Breast lifts are performed to reverse the effects of pregnancy, breast-feeding, age, and gravity, which result in ptosis, or the sagging of the breast. Ptosis is classified as minor, moderate, or major/severe, according to how low the areola sags below the inframmary fold (the highest point underneath the breast, where the abdomen meets the breast).
There are essentially three type of incisions used to modify the shape of the breasts. The trans-axillary is the most surprising, perhaps - a cut is made in the armpit (axilla). A cut around the areola (periareolar, if only along the top part of the areola, or circumareolar, around the entire circumference of the areola) is more common, as is the anchor technique. In the anchor technique a long vertical scar is left behind on the lower side of the breast, so it is suitable mostly for subjects with severe ptosis and a light-skinned complexion.
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Contributor's Note
I will be covering breast augmentation, another popular procedure, in a separate article.
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Heavens, no, I am not a doctor. I suppose I should add a disclaimer to all future intel that some or all of the information could be wrong. (I did try to stick to trustworthy sources, though.)
