Plastic Surgery Options

RICHARD B. SCHAEFER, MDAgnesian Plastic Surgery & Cosmetic Surgery

Fond du Lac * Ripon * Waupun

What Is Plastic Surgery?

Surgery of the skin and all of its contents

What Is Plastic Surgery?

• Craniofacial surgery - Cleft lip and palate• Hand surgery• Microsurgery• Transplant surgery• Cosmetic surgery• Dermatologic surgery• Oculoplastic surgery• Burn surgery

What Is Plastic Surgery?

• Craniofacial surgery

• Hand surgery - Finger replantation• Microsurgery• Transplant surgery• Cosmetic surgery• Dermatologic surgery• Oculoplastic surgery• Burn surgery

What Is Plastic Surgery?• Craniofacial surgery• Hand surgery

• Microsurgery – Free tissue transfer• Transplant surgery• Cosmetic surgery• Dermatologic surgery• Oculoplastic surgery• Burn surgery

What Is Plastic Surgery?• Craniofacial surgery• Hand surgery• Microsurgery

• Transplant surgery - J. Murray ‘54, Nobel ‘90• Cosmetic surgery• Dermatologic surgery• Oculoplastic surgery• Burn surgery

What Is Plastic Surgery?

• Craniofacial surgery• Hand surgery• Microsurgery• Transplant surgery

• Cosmetic surgery - Facelift, tummy tuck• Dermatologic surgery• Oculoplastic surgery• Burn surgery

What Is Plastic Surgery?

• Craniofacial surgery• Hand surgery• Microsurgery• Transplant surgery• Cosmetic surgery - Facelift, tummy tuck• Dermatologic surgery - Skin cancer• Oculoplastic surgery• Burn surgery

What Is Plastic Surgery?• Craniofacial surgery• Hand surgery• Microsurgery• Transplant surgery• Cosmetic surgery - Facelift, tummy tuck• Dermatologic surgery - Skin cancer

• Oculoplastic surgery - Eyelid surgery• Burn surgery

What Is Plastic Surgery?• Craniofacial surgery• Hand surgery• Microsurgery• Transplant surgery• Cosmetic surgery - Facelift, tummy tuck• Dermatologic surgery - Skin cancer• Oculoplastic surgery - Eyelid surgery• Burn surgery - Skin grafting

Aging

• Muscles – Repeated skin folds - wrinkles

• Volume Loss– What was once full, becomes deflated

– Grape to raisin - wrinkles

Aging

• Skin changes– Texture

– Loss of elasticity - wrinkles

– Sun damage

• Gravity– Downward drift

See How the Face Ages

Aging• Muscles

– Repeated skin folds - wrinkles• Volume Loss

– What was once full, becomes deflated

– Grape to raisin – wrinkles

• Skin changes– Texture

– Loss of elasticity - wrinkles

– Sun damage

• Gravity– Downward drift

Anatomy

• Rhytids - wrinkles– Skin as fabric– Dynamic – Static

Wrinkle Treatment

• Botox temporarily stops dynamic wrinkling• Lasts three to four months• $200 to $800 per treatment

Botox®

• Bacterial protein• Relaxes muscles• Dynamic wrinkles• FDA approved

– Glabellar lines

Botox®

• Off label

• ASPS 2004

• Shaping

• Concensus

Forehead Crow’s feet Neck

Lips Nose Brow

Forehead

Crow’s Feet

Crow’s Feet

Neck Banding

Aging• Muscles

– Repeated skin folds - wrinkles

• Volume Loss

– What was once full, becomes deflated

– Grape to raisin - wrinkles• Skin changes

– Texture

– Loss of elasticity - wrinkles

– Sun damage

• Gravity– Downward drift

Volume Loss

• Restoring volume by plumping up an area that has deflated over time

• Filler treatment – Lasts 9 to 15 months– $599 to $1,495

• Use your own fat– Expense– Donor site pain– Reliability

Juvederm & Restylane®

• Dermal Filler• Biodegradable• HA gel• Injected

Very fine needle to minimize discomfort

Photo courtesy of Q-Med Note: Volume injected depends on patient, location, and degree of correction required.

Restylane® Results

Nasolabial folds before treatment

After treatment with one 1 mL syringe

Individual results may vary.

Restylane® Results

Nasolabial folds before treatment

After treatment with two 1 mL syringes

Individual results may vary.

Restylane® Results

Nasolabial folds before treatment

After treatment with three 1 mL syringes

Individual results may vary.

Restylane® Results

Nasolabial folds before treatment

After treatment with two 1 mL syringes

Individual results may vary.

Restylane® Results

Nasolabial folds before treatment

After treatment with three 1 mL syringes

Individual results may vary.

Restylane® Results

Nasolabial folds before treatment

After treatment with two 1 mL syringes

Individual results may vary.

Restylane® Results

Nasolabial folds before treatment

After treatment with two 1 mL syringes

Individual results may vary.

Lips

Glabella

Glabella

Face

Facial Rejuvenation

Facial Rejuvenation

Aging• Muscles

– Repeated skin folds - wrinkles

• Volume Loss– What was once full, becomes deflated

– Grape to raisin – wrinkles

• Skin changes

– Texture

– Loss of elasticity - wrinkles

– Sun damage• Gravity

– Downward drift

Skin Care

• Cleanse

• Restore– Hydrate

– Repair

• Sun protection

Cleansing

• Removes grease, dust, makeup and sweat• Do not modify skin or penetrate• Normal skin

– Vitamin C, Urea, Saponins• Dry skin

– Vitamin E, glycerin, seed oils, plant extracts

Restoring - Hydration

• Occlusive agents– Vegetable oils and fatty acids– Lanolin, stearic acid, phospholipids

• Moisturizers– Creams or lotions (oil in water)– Glycerin, PCA, lactic acid, urea, ceramides

Restoring - Repair

• Alpha-hydroxy acids – Glycolic– Lactic– Malic– Citric– Tartaric

• Tretinoin

• Improves– Dryness– Texture– Acne– Rosacea– Photodamage– Melasma– Hyperpigmentation– Wrinkles– AK’s

Sun Protection

• Zinc oxide• Titanium dioxide• Parsol 1789• Apply before makeup• Reapply if outdoors

Anti-Oxidation

• Vitamin C – 5% to 20%

• Collagen synthesis• Neutralizes free radicals• Reduces inflammation• Brightens skin

• Surface texture• Fine wrinkles• Tactile roughness• Coarse rhytids• Skin laxity• Sallowness

Other Antioxidants

• Vitamin E• Co-enzyme Q-10• Squalene• Data incomplete or not statistically

significant

Bleaching Agents

• Hydroquinone• Kojic acid

• Age spots• Sun damage• Irregular pigments• Melasma

Results

Light-Based Treatments

• Intense Pulsed Light (IPL)• Laser

– Hair removal– Vein ablation– Resurfacing

• Ablative • Non-ablative

How Do Light Therapies Work?

• Specific target in skin absorbs energy• Non-target tissue remains unaffected• Target

– Stimulate– Contract– Destroy

IPL – Photo-Rejuvenation• Photo damaged skin• Age spots• Irregular skin pigments• Telangectasia (small blood vessels)• Redness of rosacea• Fine hair• No downtime• Rapid treatments

IPL – Facial Pigments

IPL - Telangectasias

IPL for Sun Damage

Upper Chest

Aging• Muscles

– Repeated skin folds - wrinkles• Volume Loss

– What was once full, becomes deflated– Grape to raisin – wrinkles

• Skin changes– Texture– Loss of elasticity - wrinkles– Sun damage

• Gravity– Downward drift

Body Contouring

• Fat• Skin• Muscle• Scars

Body Contouring

• Fat - liposuction• Skin• Muscle• Scars

Body Contouring

• Fat• Skin - excisional therapies• Muscle• Scars

Liposuction• Minimal scars• Vacuums out fat• Minimal skin tightening• Can use internal energy sources to breakdown

fat prior to suctioning– Ultrasound– Laser– Cool sculpting

Ultrasound Assisted Liposuction

• Ultrasound– Breaks down fat– Individualize Settings– Sensitive Areas

• Smooth results – Even shape and contour

Neck

Abdomen & Flanks

Abdomen & Flanks

Abdomen & Flanks

Men Too!

Breasts

Abdomen & Breasts

Abdomen

Excisional Therapies

• Tummy tuck • Belt lipectomy

– Massive weight loss patient• Breast lift• Arm lift

Belt Lipectomy

Belt Lipectomy

Total Body Rejuvenation

Breast & Arms

Back

Facial Reshaping

• Face lift• Neck lift• Rhinoplasty - Nose job• Blepharoplasty - Eyelids• Brow lift

Face & Neck

Rhinoplasty

Blepharoplasty - Eyelids• Upper

– Relation to brow• Lower

– Relation to cheek• Skin• Muscle• Fat

Upper Blepharoplasty

Transconjunctival Blepharoplasty

Four Lid Blepharoplasty

Four Lid Blepharoplasty

Brow & Upper Lids

Breast

• Reduction

• Augmentation

• Lift (mastopexy)

Reduction

• Neck pain• Back pain - Upper, lower and mid• Shoulder grooving • Numbness/tingling in arms• Skin rash/breakdown beneath breasts• Difficulty exercising• Insurance

Reduction

Hypomastia

• Small breasts• Breast smaller than desired • Cosmetic

Breast Implants

• Saline Filled– Small incision– Some ability to adjust

volume– Ruptures obvious - deflation

• Gel (silicone) Filled– Incision related to implant size– Ruptures silently

Augmentation

Breast Reconstruction• After cancer removal the breast may be

partially or completely altered.• Reconstruction may be done at the time of the

removal or at anytime thereafter.• There are a variety of surgical options that can

correct these deformities.• The other breast can also be adjusted to

match.

Hand Surgery• Soft tissue of the hand

– Tendon repair– Ganglion cysts– Skin contracture– Trigger finger

• Nerve release– Endoscopic carpal tunnel release– Ulnar nerve transposition

Varicose Veins

• Leg pain• Leg swelling

– Sock marks• Varicosities

Vein Valve Failure

Normal vein: valve open and closed Dilated vein with non-functioning valve

Varicose Vein Treatments

• Endovenous Radiofrequency Ablation • Has replaced stripping

– Local anesthetic– In-office– No significant activity restrictions or pain

Micro or Stab Phlebectomy

Pre-treatment: Varicose anterior accessory saphenous vein

Post-treatment: Very minimal incision sites

Sclerotherapy

• Injection of material to injure vessel causing fibrosis

• Advantages– Short office procedure– Effective– Can be redone

• Disadvantages– Allergy– Ulceration– Pigmentation

Edema and Hyperpigmentation

• Lower leg edema and hyperpigmentation are common presentations with venous insufficiency.

• CEAP 4 - Edema and skin changes from venous disease.

Image courtesy of Rajabrata Sarkar, MD

Stasis Dermatitis• Stasis dermatitis appears as

itchy, scaly patches on the lower extremities

• Hyperpigmentation occurs as a result of red blood cell extravasation and hemosiderin deposition

• CEAP 4 - skin changes from venous disease

Progression of Venous Stasis

• Poor skin nutrition and oxygenation

• Subcutaneous fat necrosis– Lipodermatosclerosis– CEAP 6 - Venous stasis

ulceration• Will recur unless underlying

venous insufficiency is treated

Amor Khachemoune, Catharine Lisa Kauffman: Management Of Leg Ulcers. The Internet Journal of Dermatology. 2002. Volume 1 Number 2.

Skin Cancer• Basal Cell Carcinoma• Squamous Cell Carcinoma• Melanoma• Excision• Reconstruction

Mission Work

• Philippines– Bulacan– Pampanga

• Peru– Trujillo

Patient Wards

Facilities

Sterile Processing

Labor & Delivery

Drying Rack for Gloves

Questions?

Thank You!