Sometimes after multiple pregnancies or large weight loss, abdominal muscles
weaken, and skin in the area becomes flacid. Abdominoplasty can tighten the
abdominal muscles and, in some instances, improve stretch marks. In both men
and women, the procedure will remove excess skin and fat. Generally, an
incision is made across the pubic area and around the umbilicus (navel).
When skin laxity and muscle weakness is confined to the lower part of the
abdomen, a modified abdominoplasty that limits tissue removal and muscle
repair to the area below the umbilicus may be performed. This usually leaves
a shorter scar and no scarring around the navel.
Breast augmentation is typically performed to enlarge small breasts,
underdeveloped breasts or breasts that have decreased in size after a woman
has had children. It is accomplished by surgically inserting an implant
behind each breast. An incision is made either under the breast, around the
areola (the pink skin surrounding the nipple) or in the armpit. A pocket is
created for the implant either behind the breast tissue or behind the muscle
between the breast and the chest wall.
Frequently, a woman elects this surgery after losing a considerable amount
of weight, or losing volume and tone in her breasts after having children.
The plastic surgeon relocates the nipple and areola (the pink skin
surrounding the nipple) to a higher position, repositions the breast tissue
to a higher level, removes excess skin from the lower portion of the breast
and then reshapes the remaining breast skin. Scars are around the areola,
extending vertically down the breast and horizontally along the crease
underneath the breast. Variations on this technique, in some cases, may
result in less noticeable scarring.
The shell of textured-surface breast implants are made with the same
silicone elastomer that is used for the shell of other types of breast
implants, but a special manufacturing process creates a textured surface.
Breast reduction is normally classified as a reconstructive procedure,
since oversize breasts interfere with normal function and physical activity.
However, there is an important aesthetic component to the operation, since
the plastic surgeon can improve the shape of the breasts and nipple areas.
Breast reduction involves removing excess breast tissue and skin,
repositioning the nipple and areola (the pink skin surrounding the nipple)
and reshaping the remaining breast tissue.
Buccal fat pads are located above the jawline near the corner of the mouth.
They can be removed in individuals with excessively round faces to give a
more contoured look, sometimes referred to as the "waif look." However,
plastic surgeons warn that, in some individuals, removal of the buccal fat
pads can lead to a drawn, hollow-cheeked look as aging progress.
A hollow tube attached to a high-vacuum device used to remove fat through
liposuction. The plastic surgeon manipulates the cannula within the fat
layers under the skin, dislodging the fat and "vacuuming" it out.
Capsular contracture is the most common problem associated with breast
implants. It occurs when naturally forming scar tissue around the implant
shrinks and tightens, making the breast feel firmer than normal and
sometimes causing pain and an unnatural appearance of the breast.
Cellulite is the dimpled-looking fat that often appears on the buttocks,
thighs and hips. While there is no treatment that will eradicate this
problem, aesthetic plastic surgeons are exploring new techniques which may
improve the condition. One method is to cut the fibrous tissue that binds
the fat down in these areas and creates the lumpy appearance, and then to
inject fact withdrawn from elsewhere in the body to smooth out the
unevenness. Another technique, called the cellulite lift, surgically removes
excess skin and fat, leaving a thin scar that may extend around the full
circumference of the abdomen but is placed discreetly within bikini lines.
Fine lines and wrinkles around the mouth and on the forehead and cheek areas
may be improved with a wide range of skin treatments. A chemical peel
solution is applied to the entire face or to specific areas to peel away the
skin's top layers. Several light to medium-depth peels can often achieve
similar results to one deeper peel treatment, with less risk and shorter
recovery time. Peel solutions may contain alpha hydroxy acids,
tricholoracetic acid (TCA) or phenol as the peeling agent, depending on the
depth of peel desired and on other patient selection factors.
Chin augmentation can strengthen the appearance of a receding chin by
increasing its projection. The procedure does not affect the patient's bite
or jaw. There are two techniques: one is performed through an incision
inside the mouth and involves moving the chinbone, then wiring it into
position; the other approach requires insertion of an implant through an
incision inside the mouth, between the lower lip and the gum, or through an
external incision underneath the chin.
Collagen is an injectable protein that can be used to treat facial wrinkles.
Patients to be treated with collagen should first be tested for any allergic
reaction. The results of collagen injections are not permanent, and
treatments must be repeated periodically to maintain results.
A simple, 30-minute procedure, earlobe reduction can be performed in a
plastic surgeon's office or at the same time as a facelift operation. The
earlobe should not comprise more than 25 percent of the total length of the
ear. In cases where it exceeds this dimension, an L-shaped wedge is cut
away, the earlobe edges are brought together and sutured.
Aesthetic eyelid surgery can brighten the face and restore a more youthful
appearance by reducing the fat that causes bags beneath the eyes and
removing wrinkled, drooping layers of skin on the eyelids. Blepharoplasty is
often performed along with a facelift or with other facial rejuvenation
procedures. Incisions follow the natural contour lines in both upper and
lower lids, or can be done through the lining of the lower eyelid, providing
access to skin and fatty tissue. The thin surgical scars are usually barely
visible and blend into the eyes' natural lines and folds.
A facelift can reduce sagging skin on the face and neck. Incisions are
placed in the hairline and then pass in front of and behind the ears; the
exact design of incisions may vary from patient to patient and according to
the surgeon's personal technique. For younger patients, more limited
incisions may be appropriate. When necessary, removal of fatty deposits
beneath the skin and tightening of sagging muscles is performed. The slack
in the skin itself is then taken up and the excess removed. Scars can
usually be concealed by hair and makeup.
Fat withdrawn from one body site can be injected into another -- for
example, to smooth lines in the face or build up other features such as the
lips. In most cases, a percentage of injected fat is resorbed by the body,
and the procedure must be repeated. Injection of fat to enlarge the breasts
is a dangerous procedure and is not recommended because of the possibility
of dense scarring that may seriously hinder accurate interpretation of both
breast self-exams and mammograms.
The forehead lift is designed to correct or improve skin wrinkling, as well
as loss of tone and sagging of the eyebrows that often occurs as part of the
aging process. The procedure may also help to smooth horizontal expression
lines in the forehead and vertical frown lines between the eyebrows.
Incisions are placed behind the hairline above the ear and pass over the top
of the head. In some cases, incisions may be placed in front of the
hairline. Some patients may have the procedure performed with the use of an
endoscope, requiring much shorter incisions. Improvements are made beneath
the skin and on the deep muscles; skin and muscle are then tightened to give
a fresher, more youthful appearance.
Lasers can be effectively used to eliminate surface blood vessels on the
face that become reddened and enlarged due to sun exposure. The problem is
most often seen in fair-skinned individuals who cannot tan or have
difficulty tanning. The use of lasers for skin resurfacing is effective in
reducing the effects of sun damage. Laser resurfacing is an alternative to
chemical peel for some patients.
A permanent method of augmenting the lips is accomplished by surgically
advancing the lip forward, with incisions placed inside the mouth. A
dermal-fat graft, taken from the deeper layers of the skin, may then be
positioned under the mucosa (the lining of the lip) to add additional
"plumpness." Injecting fat collagen or other substances for lip augmentation
is another alternative. The correction is not permanent, and injections must
be repeated periodically to maintain results.
A technique that surgically lifts the corners of the aging mouth can
eliminate the pronounced droop and unhappy facial expression that often
develops with advanced age. By cutting away small diamonds of skin just
above the corners of the mouth, the vermilion (border of the lips) is raised
into a slight smile.
To reduce the lips, a small strip of the mucosa (the lining of the lip) is
surgically removed to narrow the lips to the desired proportion. The small
scars on the outside of the lips are barely noticeable.
Lipoplasty allows the plastic surgeon to remove localized collections of
fatty tissue from the legs, buttocks, abdomen, back, arms, face and neck
using a high vacuum device. The procedure leaves only minute scars, often as
short as one-half inch in length or less. The use of refined equipment
allows removal from delicate areas such as calves and ankles. Lipoplasty
removes fat, but it cannot eliminate dimpling or correct skin laxity. If a
patient's skin has lost much of its elasticity, the plastic surgeon may
recommend a skin tightening procedure such as a thigh lift, buttock lift or
arm lift, all of which leave more extensive scars.
The ears are positioned closer to the head by reshaping the cartilage
(supporting tissue). This is usually accomplished through incisions placed
behind the ears so that subsequent scars will be concealed in a natural skin
crease. Otoplasty can be performed on children as early as age five or six.
The chemical phenol is sometimes used for full-face peeling when sun damage
or wrinkling is severe. It can also be used to treat limited areas of the
face, such as deep wrinkles around the mouth, but it may permanently bleach
the skin, leaving a line of demarcation between the treated and untreated
areas that must be covered with makeup.
The open rhinoplasty technique can sometimes benefit patients who need more
complex correction or are undergoing a secondary rhinoplasty procedure. A
small incision is made outside the nose across the columella (the tissue
that divides the two nostrils). This enables the plastic surgeon to turn the
outer tissue of the nose back, providing visualization of the structures
inside. Additional incisions, like those used in the traditional closed
approach, are made inside the nose as well. The scar resulting from the
incision on the outside of the nose eventually becomes barely visible.
Rhinoplasty is usually performed to alter the size and shape of the bridge
and tip of the nose. Reshaping is generally done through incisions inside
the nose, but there may also be an incision passing across the central
portion of the nose between the nostrils. It is sometimes necessary to
narrow the base of the nose or reduce the size of the nostrils, which
involves removing small wedges of skin at the base of the nostrils. The nose
is reduced, or sometimes built up, by adjusting its supporting structures,
which is done either by removing or adding bone and cartilage. The skin and
soft tissues then redrape themselves over this new "scaffolding."
The superficial musculoaponeurotic system (SMAS) is a layer of tissue that
covers the deeper structures in the cheek area and is in continuity with the
superficial muscle covering the lower face and neck, called the platysma.
Some facelift techniques lift and reposition the SMAS as well as the skin.
Trichloroacetic acid is used for peeling of the face, neck, hands and other
exposed areas of the body. It has less bleaching effect than phenol, and is
excellent for "spot" peeling of specific areas. It can be used for deep,
medium or light peeling, depending on the concentration and method of
Transconjunctival blepharoplasty (eyelid surgery) is performed by making an
incision from inside the lower eyelid. It avoids any scarring on the lower
lid. It is a useful technique when only fat, and not skin or muscle, needs
to be removed from the eyelid area.