KUWAIT CITY, Nov 30: “Conducting plastic surgery is like working on a piece of art as it deals with proportionality and a person’s craving for beauty. It is both a medical and cosmetic field focused on the correction of form and function,” Dr Peter C. Hirsch said in a seminar Saturday at the New Mowasat Hospital in Salmiya. Under the slogan “Caring for the Generations”, the event was held under the auspices of Hirsch — Plastic Surgery Consultant at the hospital and elected full member of the German Plastic Surgeons Association, German Society for Surgery, and German Society for Hand Surgery. He is specialized in breast augmentation/lifting and reduction, liposuction, lip sculpture, Abdominoplasty (tummy tuck), Rhinoplasty and Otoplasty, scars and burns revision, post weight loss surgery, Blepharoplasty and brow lift, face and neck lift, and lip enhancement — Monalisa lips.
During the seminar, Hirsch extensively discussed breast augmentation, reduction and lifting, liposuction, Abdominoplasty, Rhinoplasty, and facelift. On breast augmentation, Hirsch said “breast size is genetically determined. Once developed, breast size may fluctuate due to changes in weight, pregnancy and breast feeding. However, breasts can be made larger by placing an implant either under the breast tissue or behind the muscle on which the breast lies. Implants are usually inserted through incisions in the infra-mammary fold - the fold under the breast. Alternatively, the incisions may be made around the areola (nipple) or in the armpit.” A breast implant is made of an outer layer of silicone but may be filled with silicone gel or with saline solution. While some implants are round, others are shaped more like a natural breast. The manufacturer’s life expectancy of breast implants is 10 or more years, although implants can stay for a much longer period without problems.
Impressive
Although the result may be impressive certain complications can happen to some women. Leakage of silicon can occur either as a slow seepage or following rupture of the implant and can lead to pain, and/or an abnormally hard feel of the implant in the breast. Treatment may be needed and occasional removal of the implant. However, silicon leakage has never been conclusively linked to serious health problems and the newer designs of implants have features to reduce the likelihood of this happening.
Breast augmentation does not usually interfere in breast feeding and there is no evidence of any silicone found in breast milk. The presence of breast implants does interfere in mammography - an X-ray screening method for breast cancer. Special X-ray views can be taken to minimize this interference.
About breast reduction, Hirsch stressed the size of a women’s breasts may be determined by several factors, such as inherited genes, body weight, and hormonal influences.
Breast reduction or reduction mammaplasty is an operation to remove excess fat and skin from the breasts that are reshaped and the nipples repositioned to form newer smaller breasts. There are several different surgical designs to reshape the breasts, reduction mammaplasty may be used to correct asymmetry of the breasts in which one breast is much larger than the other.
However, very few women are able to breast feed following breast reduction surgery as the nipples are separated from the underlying milk ducts and at the time of pregnancy the milk supply will gradually dry up, sometimes with the assistance of hormone treatment. Breast reduction is no contra indication to pregnancy but young women must consider the fact that they are unable to breast feed before embarking on this procedure.
Risks
On the risks of breast reduction, Hirsch warned any major operation that involves general anesthesia carries a small risk of chest infection, particularly among people who smoke and there is also a small risk of suffering from thrombosis in the veins of the leg, particularly for patients who are taking contraceptive pills. Occasionally, heavy bleeding can occur after the operation that may require further operation and a blood transfusion. Infection from germs harboring in the ducts of the breast can be troublesome. This can be treated by antibiotics but it will delay the healing process, scars are likely to be worse and there may be a need to re-stitch them at a later date.
On breast lifting, Hirsch admitted drooping of the breast is a common legacy of motherhood, nursing and the force of gravity taking their toll, and the effect of pregnancy and a distension of the breasts with milk causes the fibrous bands which support the breasts in their youthful shape to break and the skin to stretch. With the subsequent shrinking, the unsupported breasts settle into the stretched skin and gravity pulls them down. Putting on weight and losing it can have the same effect as well as the ageing process. This is why women dislike the appearance of their droopy breasts.
It is possible to reshape the breast into one that looks more youthful and firm and the operation is called ‘Mastopexy’. Pleats of surplus skin are removed from underneath the breast while the breast itself is remodeled into a tighter cone and the nipples are repositioned at a higher level so that they lie at the points of the tightened breasts. Mastopexy can also reduce the size of the areola (the darker skin surrounding the nipple). If the breasts are too small as well as droopy, their size can be increased during the operation by placing silicone breast implants underneath the tightened breasts. The best results are produced with small sagging breasts, although breasts of any size can be lifted. The results may not last as long with heavy breasts.
As with all other breast operations, Hirsch said the consequences of breast lifting tends to be similar. Breast lifting is a good operation to improve the appearance of droopy breasts but there will be scars, probably some numbness of the nipples and those who undergo this procedure might not be able to breast feed again. Mastopexy can be carried out by a number of different techniques and the scars will differ accordingly. The risks of this operation are also similar to those stated above. Breast lift will not last forever and the effects of gravity, pregnancy and weight gain will take their toll as time passes by, Hirsch asserted.
Talking about liposuction, Hirsch clarified this is also known as liposculpture or suction-assisted lipectomy. It is a technique to remove unwanted fat deposits. The unsightly distribution of body fat is usually due to an inborn tendency to deposit fat in one particular area of the body, most commonly the hips. Other areas include the neck, arms, tummy, loins, thighs, inner side of the knees and ankles. The growth of a benign fat tumor (lipoma) can also be a disfigurement, and in men fatty swellings can develop under the nipples to look like breasts (gynaecomastia).
If the patient has a localized area of fat, it is possible to reduce its bulk through liposuction. A narrow metal tube is inserted through a small incision in the nearby skin.
Cautioned
On the consequences of liposuction, Hirsch cautioned one can expect considerable bruising which will be uncomfortable and sometimes painful. The discoloration of this bruising will usually last for about a month but the lumpiness and swelling of deep bruising might take up to six months to disappear, particularly when the abdomen or ankles have been treated, and therefore the full benefit of the operation is not visible for up to six months. If one is anaemic or if treated area is large, the patient may need to take iron tablets for a month and have small scars measuring 1.0 to 2.0 centimeters at the sight of insertion of the suction cannulae.
This procedure tends to last as fat cells are thought not to be regenerated in adult life. The removal by liposuction will give a permanent change in contour and be independent of any changes in body weight. However, it is important to understand that liposuction is not a treatment for obesity as there are limitations to the maximum amount of fat that can be removed in one procedure. Further treatments may be carried out on the same area after six months. In situations where the skin is inelastic and loose, it may be recommended that a skin excision be carried out to correct this, either at the same time as the liposuction or as a second procedure.
The procedure carries with it a small risk of infection and thrombosis of the veins. Heavy bruising can also happen in patients who have a tendency to bleed or have been taking aspirin or anti-inflammatory drugs. Risks will be reduced by choosing an accredited plastic surgeon trained in liposuction. Members of BAAPS are all on the General Medical Councils Specialist Register in Plastic Surgery, Hirsch confirmed.
Meanwhile, Hirsch said abdominoplasty is also called tummy tuck. In this procedure excess skin and fat can be removed, abdominal contours and scars improved, and the muscles tightened. Different combinations are combined in various procedures.
Different
Hirsch also explained the different abdominoplasty procedures. In standard abdominoplasty, the excess skin and fat of the abdominal wall between the pubic area and the umbilicus (navel) is removed leaving the umbilicus in place. The skin of the abdominal wall at the level of the umbilicus is then drawn down to suture it to at the pubic level. The patient is left with a long, usually curved scar across the lower part of the abdominal wall at the level of the pubic hair, in addition to a scar around the umbilicus.
In mini-abdominoplasty, surplus skin below the umbilicus is removed leaving a low abdominal scar at the level of the pubic hair while in the extended abdominoplasty surplus skin and fat of the loins and back are also removed so that the scar extends around the flanks onto the lower back. Endoscopic abdominoplasty is used to tighten the muscles of the abdominal wall to give a better contour and is carried out through a short transverse incision above the pubic hair. On the other hand, apronectomy is a modification of the mini-abdominoplasty for patients who have a large excess of skin and fat hanging down over the pubic area. In this procedure only the surplus skin and fat is removed. The scar is long and transverse extending from one side of the apron to the other.
Although liposuction can be done in combination with some of these procedures, it should sometimes be considered alone as it reduces fat and causes just a little retraction of the skin. Consequences to this operation also continuously persist, where the patient is left with noticeable scars and there is numbness in the lower part of the abdominal wall after surgery. This is usually temporary but it could also be permanent. Usually after the operation, there will be severe pain but pain killers will be provided and over activity will not be possible until up to six weeks, Hirsch added.
Hirsch said Rhinoplasty is a surgery to reshape the nose. It is a very common plastic surgery procedure and it can either increase or decrease the size of the nose. The shape of the tip, the bridge and also the nostrils can be changed as well as the angle between the nose and the upper lip. Sometimes breathing difficulties can be corrected at the same time. As the nose is the central feature of the face, many people are self-conscious of its shape which they may regard as too big, too small or have some other features that they dislike. The characteristics of the nose are inherited from the parents and develop during adolescent years. It continues until the age of 16, when the nose stops growing. It is therefore unwise to operate before this age.
An operation called reduction Rhinoplasty reduces the size of the framework of the nose over which the skin is draped. While augmentation Rhinoplasty is used if the nose or parts of it are increased in shape or if it has to be reconstructed after injury, Septoplasty can be used when there is a difficulty in breathing. The consequences of this operation include bruising and swelling, particularly around the eyes, which can take up to three weeks to completely disappear and a patient would need to wear a firm splint over the nose during a part of this time. Also, like any operation rhinoplasty has risks which can be minimized by ensuring that you are free from cough, cold or sore throat at the time of your operation and, if you have any doubts you should contact your surgeon. In general, the operation tends to be painless, Hirsch assured.
Ageing
As part of the ageing process which happens to all of us sooner or later, Hirsch pointed out our skin progressively loses its elasticity and our muscles are loosen. The stresses of daily life, effects of gravity and exposure to sun can be seen on our faces. The folds and smile line deepens, the corners of the mouth droop, the jaw line sags and the skin of the neck becomes slack. Around the eyes, the eyebrows droop and the skin of the eyelids gather in loose folds. In the skin, the first sign is fine wrinkles developing around the lips, at the outer corners of the eye and lines of expression. Substantial weight loss can produce similar changes in facial appearance.
A facelift works better with skin that has some elasticity and whose bone structure is strong and well defined. It also works better for the lower half of the face and particularly the jaw line and neck. If you have sagging eyebrows and wrinkles on the forehead, you should perhaps consider an endoscopic brow lift. Loose skin with fine wrinkles, freckles and rough areas will benefit more by chemical pee or laser resurfacing. Most scars of a facelift appear around the ear and under the chin, however they are operated in a manner as to not be obvious. After covering all the major plastic surgeries, Hirsch concluded that plastic surgery should be practiced moderately to maintain an individual’s identity and natural appearance. “Plastic surgery is a means to improve one’s appearance and help in decreasing self-consciousness,” Hirsch emphasized at the end of the seminar.
By Rena Sadeghi
Arab Times Staff