Aesthetic

Surgery
UST-FMS Department of Surgery: Plastic and Reconstructive Surgery
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(Magboo C2015 from Schwartzs Principles of Surgery 9 Edition)

Cosmetic Surgery Possible complications: hematoma, lower lid
"Surgery performed to reshape normal structures of the body to retraction, and injury to ocular muscles.
improve the patient's appearance and self-esteem." o Hematoma in the retro-orbital region: surgical
Most important outcome parameter: patient satisfaction emergency Permanent vision loss can occur if it is
not immediately decompressed
Rhytidectomy Brow ptosis, judged relative to the superior orbital rim,
can be corrected through a number of incisions
Face Lift
Signs of advancing age in facial appearance
o Sagging of facial skin Rhinoplasty
o Wrinkle formation
Correction of jowls, nasolabial folds, and redundant
neck skin can
Procedure:
o Removes skin
o Tightens the superficial musculoaponeurotic
system (SMAS) layer.
Lies deep to the subcutaneous tissue
Contains the muscles of facial expression
Incisions
o Preauricular with extension into the temporal
hairline superiorly
o Into the retroauricular region posteriorly and
inferiorly
Most common complication: hematoma

Keep in mind the function of the nasal airways
Nasal airway obstruction from structural problems
Deviated septum can severely impede airflow
Problems with the internal nasal valve
Cottle sign: Obstruction at the internal nasal valve,
which is the junction of the upper lateral cartilage and
septum, can be identified by applying lateral traction
on the cheek skin to open the valve and observing
whether airflow improves
Aesthetic deformities:
Incisions for cervicofacial Rhytidectomy
Flat Nose

Nasal Tip Deformity
Broad alar rims
Unsatisfactory nasolabial angle Procedures:
Nasal hump Silicone augmentation
Nasal deviation Resection of lower lateral alar cartilage
Repositioning of nasal bones
Procedures: Nasal septal resection
Osteotomies: repositioning and rasping of nasal bones
Nasal septal resection
Silicone augmentation
Tip of the nose: reducing the width of the lower lateral
Blepharoplasty and Browlift cartilages and/or sewing the cartilages together to
reduce tip width
Excess skin and adipose deposits Small tips: cartilage grafts harvested from septum or
o Atony of eyelid skin auricle
o Hypertrophy of eyelid skin
o Lower eyelid bags
o Intraorbital fat herniation
o Eyebrow ptosis
Upper eyelid
o Incision based on the supratarsal crease
o Excision of a strip of orbicularis muscle
o To accentuate the supratarsal fold
o Fat deep to the orbital septum: resected
selectively
Lower eyelid Complications:
o Subciliary incision Induction of new nasal airway obstruction
o Fat may be either excised or repositioned Aesthetic deformities

Procedure:
Removal of excess eyelid skin and orbicularis oris
Subtotal fat excision
Browlift
 Mentoplasty
Chin bone prominence or retrusion
Procedure:
o Trans-oral chin augmentation
o Trans-oral chin reduction
o Facial bone deformity or dental malocclusion
requires osteotomy and repositioning

Otoplasty
Prominent ears, lack of sufficient definition of anti-
helical folds
Procedure:
o Incision done behind the ear
o Cartilage is cut or abraded
Minimum age: 5 years old or 85% ear growth

Dermabrasion Dermis replenishes the skin
Incisions for augmentation mammaplasty. A, Inframammary; B,
Removes superficial acne scars, minor kin
axillary; C, periareolar.
irregularities, fine facial wrinkles

Power driven rotary device
Subglandular (A) or Subpectoral Position (B)
Dermabraded areas: antibiotic ointment, no direct
Also called Pocket
sunlight, sunscreen (2-3 mos)
Leave dermis behind
Dermabraded area is pink (raw wound) apply
Carbon dioxide antibiotics
laser - burns Pigmentation is a common problem in Filipinos
superficial skin, Mechanical: bloodier
allows dermis to
replenish skin
Laserbrasion
Removes superficial acne scars, minor skin
irregularities, fine facial wrinkles
CO2 laser
Laserbraded area: antibiotic ointment, no direct
sunlight, sunscreen (2-3 mos)
Leave dermis behind

Same as dermabrasion but uses burning Subpectoral: provides greater soft tissue coverage in the upper pole of the
breast and can hide contour irregularities related to the implant. (More
Hair Transplantation popular among surgeons)
Late onset male pattern baldness (best candidates)
Punch grafts/cut grafts with hair follicles from the Potential complications
occiput grafted to areas of alopecia High likelihood of a second operation to address an
Grafts or flaps of hair strips have sharp demarcations implant problem.
Tissue expanders Rupture of the device
From occiput: hair lasts the longest o Saline implants: rapid deflation
o Silicone gel implants: rupture may be not be
Mammaplasty obvious and can be confirmed by MRI
Asymmetrical breasts Capsular contracture, which results in a tight envelope
of scar that can distort the shape of the implant and
Augmentation/Reduction mammoplasty
cause pain in severe cases
Gynecomastia
Rippling in the upper pole of the device
o Normally occur at puberty 70% regress during
late teens o More common in saline devices
o Subcutaneous mastectomy in liposuction Distort of breast shape (due to malposition)
o Require reoperation
Ptotic breasts

o Mastopexy
o Nipple is lifted and Remove excess skin Reduction Mammoplasty
Decreased breast tissue (due to breast feeding) Reduction Mammoplasty Treat symptoms of macromastia
Hypertrophic breasts o Triad:
Psychologic problems, backache, kyphosis, shoulder pain,
Upper back pain
Augmentation Mammoplasty inability to participate in sports
Procedure:
Bra strap grooving
Hypoplastic Breasts - nipple preservation on a pedicle
- amputation of lower sections of the breast Rashes under the fold of the breasts
Silicone Prosthesis -tailoring the akin envelope
o Psychologic problems, backache, kyphosis,
o Silicone gel filled - liposuction
shoulder pain, inability to participate in sports
o Saline filled Can adjust amount of
saline injected to breast
Procedure:
Three commonly used incisions
Reshaping the skin envelope in three dimensions
o Inframammary (Submammary)
Moving the nipple to a new location on a vascularized
o Periareolar
tissue pedicle
o Axillary
Classic "keyhole" Wise pattern reduction technique
Skin resection: designed to create a conical shape,
Procedure
- approach: submammary, axillary *Liposuction
Pocket: subpectoral, subglandular

Mammoplasty
- asymmetrical breasts
- augmentation/reduction mammoplasty
- gynecomastia
- normally occur at puberty, 70%
 Brachioplasty (Arm Lift)
Leaves a visible longitudinal scar on the upper arm
Complications
Distal seroma
Wound separation
Paresthesias in the upper arm and forearm: secondary
to injury of sensory nerves passing through the
resection area
Scar contracture in the axilla: may limit shoulder
excursion

Thigh and Buttock Lift
Commonly referred to as a circumferential lower body lift
Inner thighs can be contoured by lifting the skin and
placing the incisions along the groin crease
Firmly anchoring the deep thigh fascia to Colles' fascia is
essential to help prevent spreading of the labia
Severe excess skin on the inner thighs: a long vertical
incision is necessary
Complications
Vertical reduction mammaplasty, Lejour technique. A. Markings for vertical
Seroma
reduction. B. Purple area is region to be de-epithelialized. C. Dark blue
region represents inferior pole to be resected. The shaded regions are the Wound separation
lateral and medial segments that are to be undermined; these areas can Skin necrosis
also be liposuctioned. The superior pedicle is de-epithelialized and
dissected to the chest wall. The tissue and parenchyma from the inferior
Change in the shape of the genital region
pole are resected. The pillars from the lateral and medial segments are o With possible sexual dysfunction
sewn together. The nipple is transposed on its pedicle to its new position.
D. Closure of the vertical mammaplasty. There is bunching up of skin and

tissue along the vertical limb that will resolve over time; in addition, the
new inframammary fold will declare itself superior to the original one. Suction Lipectomy
Liposuction
Complications: Tool for contouring prominent adipose depots
Decreased nipple sensation o Abdomen, arm, thigh, hips, buttocks, back, chin
Nipple loss (rare) Not considered a weight loss treatment
Skin necrosis The best candidates: Individuals who are close to their
Hematoma goal weight and have focal adipose deposits that are
Fat necrosis resistant to diet and exercise

Mastopexy
Three-dimensional reshaping of the breast
No or minimal volume removal
May involve excision of just a crescent of skin from
above the areola or a periareolar ("donut") resection
Wise keyhole pattern: used for larger skin excisions


Excisional Body Contouring
Significant skin laxity Skin excision Procedure:
Trade of excess skin for scar Removal of adipose tissue through minimal incisions
Usually after weight loss using a hollow suction cannula
Thighplasty, Brachioplasty, Buttock reduction o Several port areas that access the areas to be
contoured
o Infiltration of tumescent fluid in area to be
Abdominoplasty/Panniculectomy liposuctioned
Abdominoplasty Most common body-contouring procedure Fat is being removed without skin tightening
Lax skin, striae, abdominal fat excess, abdominal muscle diasthesis
Procedure: Limited-incision skin removal in the lower abdomen o Relies on the patient's inherent skin elasticity to
Major
- transverse ellipticalsegment of skinskin
andexcision
fat of the w ith tabdomen
lower ransposition
is excisedof the umbilicus provide retraction over the treated adipose depot
- plication of rectus fascia
- umbilicus relocated and placation of the rectus muscles to further enhance o Compression dressings
- liposuction assisted
contour Needs maintenance by diet and exercise
Concurrent vertical incision: to remove skin in two
vectors
May be liposuction assisted
Body contouring
Possible complications: - excision of excess fat and redundant skin using incisions that are inconspicuous
Skin necrosis Liposuction- body fat contouring: abdomen, arms, thighs, hips, buttocks, back ,chin
Persistent paresthesias of the abdominal wall Procedures
- infiltration of tumescent fluid to area to be liposuctioned
Seroma - liposuction cannulas suction out fats through several ports that access the areas ti be
Wound separation contoured- compression dressings
- needs maintenance by diet and exercise
- not a substitute for weight reduction