Other Cosmetic Surgery

In recent years, minimally invasive procedures have become increasingly popular within the fields of cosmetic surgery and cosmetic medicine. In particular, cosmetic injectable treatments have become a mainstay of aesthetic procedures. Cosmetic injectables can be classified as filling agents and relaxing agents, both of which are generally used to reduce the appearance of wrinkles, creases, furrows or scars. Filling agents include Restylane, Juvaderm, Radiesse, and Artecoll and work by injection of a volume of these products under or within a targeted skin region such as a wrinkle thereby lessening its appearance. Relaxing agents include Botox and work by relaxing a muscle group that, by virtue of involuntary muscle tension, causes overlying skin to crease, furrow, or wrinkle. The choice of which product to use is based on which area of the face is being treated. In general, the upper third of the face, including the horizontal wrinkles on the forehead, the furrows between the eyebrows, and the "crow's feet" lines that are found at the outside corners of the eyes are best treated using Botox. Fillers do not provide as dramatic a result in these areas. Conversely, the nasolabial folds (the creases on the cheeks running from the nostril to the corner of the mouth) and the "marionette lines" (the creases running from the corner of the mouth down the side of the chin) are best treated with filler products. The specific type of filler product to be used is often based on physician preference in terms of which product a particular MD feels works best and is most comfortable injecting.

A common question I am asked by cosmetic surgery patients is if it is possible to use plastic surgery to remove scars. The short answer is "no". Cosmetic surgeons and plastic surgeons are trained to use meticulous, careful techniques to minimize scars and to place scars in inconspicuous areas on the body but we are unable to remove scars. Several treatments are available to improve the appearance of scars such as cortisone and laser treatments, but to date, full removal of scars is not possible.

Aside from the well known ill-effects of cigarette smoking, nicotine use can lead to major complications following plastic and cosmetic surgical procedures. Cigarette smokers will inevitably wake from general anesthetic procedures with extra build up in their chests and throats. This can lead to coughing and straining which can disrupt sutures and even cause surgical incisions to start bleeding in the immediate post-operative period. Even more important is the impact cigarette smoke has on blood flow. Nicotine is an extremely potent vasoconstrictor which causes the flow of blood to be severely restricted to tissues. Under normal, everyday circumstances, this effect may not be noticeable to an average smoker. But when a surgical incision is healing, tissues need robust blood flow into the healing areas as it is blood flow that brings oxygen and other factors vital to healing into the area. The constriction of blood flow caused by even a single cigarette can push a wound "over the edge" and create an environment in which not enough circulation is reaching the healing zone. This can lead to enormous problems with healing such as dead skin (necrosis), infection and poor scarring.

1. Leave the head dressing on and dry.
2. You can bath or sponge bath but avoid wetting the bandages.
3. Keep your head elevated at all times and place 2 or 3 pillows under your head when lying down.
4. Expect bruising. Bruising can "migrate" and end-up around your eyes or even on your neck or upper chest. This is normal.
5. You may find that your face or mouth feel weak or that your facial movements or smile are asymmetric. This will pass.

Vitamin E is often used after plastic surgery and cosmetic surgery to minimize scarring. A scar is the "glue" that our bodies create to heal wounds, be they traumatic lacerations or plastic surgery incisions. The composition of scar tissue includes blood vessels and collagen amongst other substances. The blood vessels in scar tissue gives scars their characteristic redness which makes the scar stand out against the generally lighter skin. The collagen component of the scar is the major component that provides strength and closes a wound or plastic surgery incision. Fine, desirable scars occur when only a minimal amount of blood vessels and minimal amount of collagen is laid down in the scar during the healing process. When blood vessels and collagen are minimal, a scar will typically appear close to skin tone (and hence blends well into the skin) and will also be narrow, flat and fine. The major role of vitamin E ointments is to minimize the amount of collagen that is laid down in the scar during the healing process. The precise value of vitamin E has never been conclusively proved in scientific studies but many plastic surgeons prescribe it. This is because there may be a real role for these ointments to minimize scars (albeit unproved) and there is also minimal to no risk with vitamin E use other than the very rare possibility of allergy.