Brow-lifting
Operations of Ear Lobes
Botox is a common term for Botulotoxin A, a highly effective toxin produced by Clostridium botulinum bacteria. Because of its high toxicity (it causes muscle paralysis) it has always been one of the most feared natural products and was analyzed to be used as a possible biological weapon.
In the last 20 years, Botox has changed into a medical help that is able to influence some neurological diseases – otherwise hardly treatable – as all kinds of spasmodic conditions linked to involuntary jerks especially in the face, around the lips and eyes, in patients with poliomyelitis, with multiple sclerosis, after strokes, furthermore in some types of headaches and backaches, in excessive sweating, and in ophthalmology to treat strabismus.
Botox broke into the esthetic medicine in the last 6 years, literally with lightning speed. It started to be used especially to correct the wrinkles around eyes and at the bridge of the nose, and to correct excessive sweating, especially in the region of armpits and palms. The effect is achieved by temporarily eliminating the specific muscles from their function by blocking the neuromuscular transmission.
In 2001, over 1,600,000 applications of Botox have been performed in the USA which is 20% of all the applications ever made, an increase of 2,356% over the year 1997! Thus, Botox gained a safe 1st place in the approval ratings of esthetic medicine not only in the USA but in whole Western world.
Why so successful?
It is primarily due to its easy applications, total safety when the recommended dosage is used, minimal limitations for patients in their lives and, especially, its effectiveness where the other methods have failed so far.
Cult of youth and success has dominated the whole present-day “civilized” world we live in where tired, angry look with wrinkles around the eyes is taken largely negatively. However, it is not well possible to remove these wrinkles by surgeries or injections since these wrinkles are dynamic as they have to do with the movements of the mimic muscles and gravitation. Thus, for example, the eyelids sag down and into the bridge of the nose resulting in deep wrinkles between the eyebrows. In case we paralyze the muscles casing the sagging, the eyebrows will move slightly up, the wrinkles disappear and the face gains a much happier expression. It is similar with wrinkles on the sides of the eyes.
Botox is applied with a very thin syringe straight into the locations that we want to influence, e.g. around eyes. Several shots take about 5 minutes and the client can then go back home without any limitations. The effect will take place within several days. People are often afraid of unnatural expression – immobilization – of that part of the face but this is not warranted; the effect is usually very inconspicuous and natural. That’s why Botox is very popular even with men.
There are only two drawbacks of Botox: (1) the effect is time-limited; the full effect lasts about three months and fades within 6 months; (2) the price of Botox is relatively high.
Face Lifting
Face Lifting is one of the oldest and most common operations, sometimes being regarded as the queen of the esthetic surgery. Thanks to ever better surgical procedures, we can achieve a substantial rejuvenation of face, even with elderly women. Excessive skin of face and neck can be removed and then made tight, which helps to achieve a younger and fresh look which in turn boosts the psyche of the patient who literally gets younger in front of our eyes.
The procedure itself is performed under a complete anesthesia or under sedation with analgesics. The hair is washed (not cut), the operation area is disinfected and then an incision is made from the area of temples, perpendicularly down in front of the ear lobe, and then it turns up around the ear lobe and behind the ear where it ends in the hairy part at the back of the head. The skin of the face and neck is step by step made loose from its base so that it could be made naturally tight and thus the wrinkles could be partially flattened. As part of the operation we lift up the deeper layer made up of fascia and mimic muscles, which substantially influences the overall look of the patient after the operation. Another part that often has to be made tight is the area outside the corners of the eyes; an old sad look is this way changed into a joyful, active and even a youthful look.
The dressing is removed 4–5 days after the operation, the patients can wash their hair, and then they are treated without any need of dressing. Within 10–14 days all stitches are removed. The healing is an individual thing, including swelling. The first result is usually visible 2–3 weeks after the operation, definitively 2-3 months after when small puffiness subsides and subcutaneous growing of connective tissue proceeds further.
Liposuction is a surgical procedure; we suck off fat from places with its excessive amount, and then we model the shape according to the wish of the patient.
In no way does liposuction solve obesity, but at present we can use it to substantially model the shape of the body which is followed by a suitable adjustment of the diet. However, liposuction does not constitute a dietary regimen.
Ideal candidates for this type of operation are patients with good skin quality and elasticity and who have excess of fat in different parts of their body.
After the detailed consultation with a plastic surgeon, the operation is performed on the scheduled date under complete or local anesthesia. The fat is sucked off by means of cannulas inserted through small, several millimeters long incisions; the location being first filled up with tumescent Klein's solution.
Right after the procedure the patients put on elastic underwear that was recommended to them by the surgeon before the operation. Patients usually stay a night in the hospital and go home after re-bandaging. Rest regime is recommended for 7–10 days, including only a limited walking. In case of rest violation there can be swelling, higher secretion, fevers. The elastic underwear must be worn 24 hours a day for the period of 1 month (except for personal hygiene or washing the underwear). The operated areas must be massaged daily by a roller.
The maximum effect will be evident after 3 months. After this time the success of the procedure can be evaluated; the effect will stay permanently – if the patient maintains the same weight. This happens in case there are no complications in the healing process. Of course, the procedure is highly individual and is dependent not on the surgeon only but on the patient, as well.
It is mostly women who want a cosmetic adjustment of their abdomen, mostly after repeated pregnancy or high loss of weight when the skin has lost the ability to revert to the original state and size because its elasticity is not sufficient.
The procedure includes hospitalization. The incision is done, under complete anesthesia, in the pubic region so that the scar will be hidden in the underpants. The excessive skin is removed and the scar is stitched in several layers.
In some cases, the operation can be combined with liposuction that makes it possible to shape the region of hips and epigastrium.
After the operation, the patients must wear an abdominal belt or elastic panties that help with shaping and satisfactory healing.
Nose is a dominant part of the face and the differences in its shape are either inborn or gained. A change of the shape of the nose could be accompanied by its impaired function (breathing). The first mentions about nose operations are several thousand years old. A progressive development of surgery shows its complexity and an interest of plastic surgeons to make a “perfect” shape of a nose.
A patient should consult his plastic surgeon before each operation. He should tell him about the problems that lead him to an operation and also about his expectations; whether the cause is esthetic, functional or psychological.
Each rhinoplasty is an individual matter. An optimum age is at the time after the growth ceases, i.e. at about 16-18 years of age and up to 30.
This is an operation of two types. Rhinoplasty of the so-called soft nose, i.e. correction of the tip of the nose without correction of the bone structure. In the second group, there are nose operations with corrections of the nose bones, i.e. the rhinoplasty of the so-called hard nose. Sometimes the shape of the nose must be adjusted with the so-called bone graft.
Smaller procedures are usually done under local anesthesia, major ones either in combination with sedation with analgesics or under a complete anesthesia that is usually better for the patient. The operation is finished by nasal tamponade a and with a plaster cast that fixes the new shape of the nose. In the post-operative period, the patients have to breathe through their mouth only. The tamponade is removed from the nose most often on the third day and patients have to clean their nostrils several times a day by wet swabs.
The hospitalization lasts until the second day after the operation. It takes on the average ten days for the swelling and hemorrhages around the eyes to subside. The plaster cast is usually removed on the 10th day after the operation. All sport activities are forbidden for 2-3 months to prevent any injury of the nose and damage of its shape. It takes about one year for the nose tissue to stabilize. However, the length of this time period can differ and the result is dependent on sticking to the advice of the surgeon and the co-operation between the physician and the patient.
The operation of the upper and lower eyelids is the most common one in the esthetic surgery. Patients usually seek the surgeon because of the sagging skin of their eyelids and wrinkles around their eyes.
Women come more often than men, although this is starting to change and men are finding ever more courage to regain their former “spark in the eye”.
It is usually a day surgery under local anesthesia. The excess skin is removed, including the fat bags, the so-called prolapses, around the eyes that can cause cosmetically unsuitable eyelid deformations.
The corrections of both the upper and the lower eyelids can be done during one surgery.
The post-operative care consists in putting on cold compresses on the eyelids and the patients do this by themselves at home. After the operation, we recommend wearing darker sun-glasses as a protection against sharp light and sun rays. The stitches are removed 4-6 days after the operation.
Due to the age, pregnancies and breastfeeding the breasts sag, there is an excessive skin and the volume of the gland is reduced. This negative development can be influenced by surgery only.
During the operation, the surgeon puts the nipple out and up and reduces the excessive skin of the breasts to achieve their optimal shape. In case the breasts are too large, the fat tissue and mammary gland can be reduced. The beautiful shape of breasts is achieved at the cost of scars that heal very well at most patients and within one year they are only slightly noticeable. It is necessary to state, nevertheless, that neither the surgeon nor the patient can substantially influence the scar healing since this depends on the organism itself.
The operation is done under a complete anesthesia, takes about 3 hours, the hospitalization is required for 2-3 days and the recovery at home takes about 2 weeks.
Since the pregnancy influences the shape of the breasts and can substantially change it, it is important to take this fact into view if this type of surgery is being considered before the delivery.
Augmentation – or breast enlarging solves the problem of small breasts, although this term is a rather subjective one. The breast implants can further be used to correct slightly sagging breasts and to enlarge their volume. If there is an excessive skin often linked to an atrophy of the mammary gland breast augmentation together with modeling should be considered.
To enlarge the volume, we use silicone implants from the two biggest American companies, Mentor and McGhan, and French PIP, since these products are of the highest quality.
Over the long time, the silicon implants have been used no influence on development of any disease have been found. Since this is a foreign body, negative reaction of the organism cannot be completely ruled out.
The operation is done under a complete anesthesia; the hospitalization takes 1–2 days. After consultation with the patient, the surgeon will choose a suitable size of the implant, its location and the shape of the incision to insert the implant.
The incision can be done in three ways – under the arm, under the breast or around the nipple. The implants are then inserted under the mammary gland or breast muscle. The positioning of the implant is a very individual matter that depends on the quality of the skin, gland, size of the breasts and their ptosis (sagging). That’s why a detailed consultation with a plastic surgeon is required, best in two sittings before the operation.
The convalescence after the operation is gradual. The important thing is the fixation of the implant by a bra and breast belt right after the operation so that the implant is not put out of its position. The choice of the size of the implant is an individual matter; most often it is around 250 ml. Possible complications could be a hematoma, infection or movement of the implant into an undesirable position. In rare cases so-called capsula can develop that covers the implant leading to the deformations of the shape of the modeled breast.
For hair transplants, especially in men, a special technique was developed where mini and micro grafts are used. With this technique thinning hair can be made thicker or in several phases with a time lapse hair cover can be regained. Hair seedlings from the back of the head are used. Mini-grafts contain 3-8 hair follicles, micro-grafts contain 1-2 hair seedlings. These are planted into prepared punctures on the affected part of the skin of the head. The surgical dressing must be worn for 2-5 days. At the spots of implanted seedlings there will be tiny scabs that will fall off after some time, and it is only after 3-6 months that the growth of the transplanted hair follicles can be seen.
The operation is done under a local anesthesia, or if the patient wishes, under a complete anesthesia. This is usually a long procedure taking several hours. It is necessary to warn about the selling of the place of implantation that can extend all the way to the region of the eyes; the absorption can take several days. The usual success rate of the operation is around 70-80% of seedlings.
At present, this type of operation is required very often, both by young and middle-aged women. The results are as a standard very good.