Cosmetic Surgery

Cosmetic surgery is a type of plastic surgical intervention with the primary aim to improve a person’s physical appearance.

Cosmetic-surgery

Cosmetic surgery is a constantly growing surgical procedure all over the world, especially in the last few decades. To look fit, young, and attractive is everyone’s evergreen wish. Medical science has also evolved to meet this demand and numerous new techniques and innovations have taken place.

Cosmetic surgery procedures can be done on almost any part of the body to make it look more attractive or make it more in tune with the whole body. But the decision to undergo cosmetic surgery should be taken only after understanding all the pros and cons of the procedure. The results are close to natural but never makes one younger. Results are also usually permanent, so one should be sure about the decision.

A minor number of patients may be suffering from Body Dysmorphic Disorder (BDD) which may not be cured with any cosmetic surgery procedure. BDD causes a person to believe that there is something bad with the appearance when there is not.

Reconstructive surgery is also a type of plastic surgery with a cosmetic aim. This is done to give a normal appearance and/or function to a part of the body that may have been damaged due to injury or disease, like the reconstruction after a mastectomy for cancer.

Types and uses of Cosmetic surgery

Different types of aesthetic/cosmetic procedures can be done for various parts of the body. The most popular aesthetic/cosmetic procedures are:

Abdominoplasty (“tummy tuck”): is reshaping the abdomen and firming of the skin of the abdomen with the removal of extra fat and skin from the middle and lower abdomen. Usually done after pregnancy or weight loss.

Blepharoplasty (“eyelid surgery”): reshaping or tightening of the skin of the upper or lower eyelids. A with the tissues elsewhere, the skin surrounding the eyes become lax. The upper eyelids droop and the lower lids develop bags under them. Surgery to the eyelids can be functional, cosmetic, or both. Removing excess skin and fat with or without tightening of muscles and tendons in the vicinity may give younger look to the face.

Phalloplasty (“penile surgery”): construction, reconstruction, or modification of the penis by surgery

Mammoplasty: surgical modification of breast to improve physical appearance. Usually done in case of if a woman feels the breasts are too small, if the two breasts have major size differences, or not satisfied with the appearance of the breasts may be due to loss of elasticity with age or if they are saggy. These can be:

Breast augmentations (“breast implant” or “boob job”): augmentation or increase in the size of the breasts with fat grafting, saline, or silicone gel implants, purely for cosmetic purposes. Breast enlargement may help self-esteem and improve sexuality.
Reduction mammoplasty (“breast reduction”): decreasing the size of overgrown breast in females and for gynecomastia in males. Apart from cosmetic reasons a reduction in breast size can relieve physical discomfort and reduce the risk of breast cancer in women at high risk.
Gynaecomastia : in males can be done with liposuction or open incisions around the nipple and areola.
Mastopexy (“breast lift”): removal of the breast skin and glandular tissue & tighten the skin to provide firm breasts. Breast lift is often done after weight loss, old age. Mastopexy can also be combined with an implant which depends on how much one has lost weight.

Buttock augmentation (“butt implant”): To enhance the appearance of buttocks by making them larger surgically. Silicone implants may be used or fat (“Brazilian butt lift”) transfer from another part of the body for enhancement of the buttocks. Excess skin from the lower part of the body like hips, buttocks, and thighs are removed to tighten and lift them. Like other body contouring procedures, these procedures are also often combined with other procedures like abdominoplasty in patients who have lost a significant amount of weight after weight loss or bariatric surgery.

Cryolipolysis: localized reduction of fat deposits under the skin to reshape the body contours with the use of special equipment and with non-invasive methods. The device causes the controlled cooling of the fat cells and their destruction.

Cryoneuromodulation: With the use of nitrous oxide gas superficial and subcutaneous tissue are treated for wrinkle reduction, pain relief, skin conditions, and localized cryo-treatment of tissues.

Calf Augmentation: to add bulk to the calf by silicone implants or fat transfer to the calf muscles.

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Vulvovaginal surgery

Labiaplasty: Labioplasty, labia minora reduction or labial reduction is the surgical reduction of the elongated inner labia (vaginal lips) and its reshaping is usually done with vaginoplasty.

Lip augmentation: to make the lips more fuller with inserting implants surgically or with injectable fillers.

Cheiloplasty: a reconstructive surgical reconstruction of the lip.

Rhinoplasty (“nose job”): reshaping of the nose for cosmetic reasons with or without improving breathing due to structural defects or after injury. Commonly it involves reducing the hump at the upper aspect and pointing the tip. Straightening of the asymmetrical or crooked nose is also done.

A nose job is usually done after the skeletal maturity of the patient unless there is an obstruction in breathing. These are done with well-hidden incisions often inside the nostrils to avoid scars.

Otoplasty (“ear surgery”/”ear pinning”): reshaping of the outer ear or pinna, usually by pinning the pinna closer to the head. Done for prominent or misshapen ears. May involve reshaping of the cartilage also. One or both ears can be done at about 5-6 years of age.

Rhytidectomy (“facelift”): multiple procedures to remove wrinkles, sagginess, and other signs of aging from the face.

Incisions are carefully done inside the hairline in the temple area and front of and behind the ears. Skin is lifted, tightened, and sutured back carefully. The remaining excess skin is removed.

The tissues and skin of the face and neck may also be tightened to give a more uniform and natural appearance. Surgery to the eyelids may also be done at the same time.

Neck lift: often done along with facelift procedure by tightening of lax tissues in the neck.

Browplasty (“browlift” or “forehead lift”): reducing wrinkles and smoothening of the forehead skin with an elevation of drooping eyebrows. The signs of aging or worry lines removal can be combined with other procedures.

Midface lift (“cheek lift”): reducing wrinkles and tightening of the cheeks.

Genioplasty: enhancement of the chin with the use of an implant or bone graft or by tightening of the soft tissue

Mentoplasty: either surgically enhancing or reducing the size of the chin. Enhancement is usually done with the use of facial prosthetic implants or reshaping of chin bones. Reduction of the lower jaw bone is done to reduce the size of the chin.

Cheek augmentation (“cheek implant”): implants insertion into the cheek on top of the cheekbones to make it more prominent.

Orthognathic Surgery: Correcting the upper and lower jaw alignment with teeth alignment by surgical alteration of the upper and lower jaw bones.

Brachioplasty (“Arm lift”): tightening of the sagging tissues of the arm with reduction of excess skin and fat from the underarm to the elbow.

Liposuction (“suction-assisted lipectomy”): use of thin cannulas or thin metal tubes for suction of fat with ultrasonic, mechanical, or laser destruction of fat from under the skin to achieve the desired shape. This is usually done to the abdomen, neck, buttocks, back of arms, thighs, and hips. Can also be used for male breast reduction in cases of gynecomastia.

The amount of fat that can be removed is limited to prevent complications. A small to moderate amount of fat can be safely removed as a daycare procedure but higher quantities of fat removal from multiple areas need monitoring and supervision under admission.

Liposuction should not be considered as a weight-loss procedure. The primary purpose is to improve the shape and contour of the body and remove localized fat deposits.

Zygoma reduction plasty: removal of bone from the zygoma and its arch to reduce the facial width.

Jaw reduction: making jaw slim by reducing the angle of the mandible.

Buccal Fat Extraction: slimming the face by extracting the buccal pads fat.

Body contouring: with advancing age the skin loses elasticity and its ability to recoil back or after it has been stretched beyond a limit. This condition is called elastosis. Saggy skin is seen in these people or those who have lost significant weight in a short duration. Body contouring is the surgical process of removal of this extra skin and restoring normal appearance.

Sclerotherapy: visible spider veins just under the surface of the skin are removed.

Micropigmentation: A machine equipped with a very small needle is used to inject natural pigments under the skin. This is used as permanent makeup. This can be used to create lasting eye shadow, lipstick, or blush.

grafts-and-laser-treatment

Peels, fillers, injections, grafts, and laser treatment

Peels, fillers, injections, grafting, and laser treatment are less invasive cosmetic procedures.

Peels

Acne, pockmarks, scars, or wrinkles can be treated by several active agents called chemical peels.

Alpha Hydroxy Acids (AHAs) such as glycolic, lactic, or fruit acids are used as superficial or light peels to treat the superficial layers of the skin. Recovery time is minimal as this only affects the outermost layers of the skin.

TCA (tri-chloroacetic acid) in different concentrations are used for medium peels. These compounds penetrate the outer and deep layers of the skin and go deeper than the light peels. The recovery takes a long time and pain is more significant than the lighter peels. Flaking of the skin and redness may persist for several days to weeks.

Phenol is used for the deep peel. This penetrates the skin to the deepest tissues. This action at the deepest layers has the best result for resurfacing the skin. The recovery time is also the longest and can lead to scarring and skin lightening.

These chemical peels are both safe and effective for both dark and lighter skins.

Botox or Botulinum toxin

The toxin produced by the bacteria Clostridium botulinum (C. botulinum), commonly known as Botulinum toxin or Botox was first used for muscle spasm.

In cosmetic surgery, it is used to remove wrinkles and facial creases.

Botulinum toxin acts by blocking the signals from nerves to the muscles which are injected. These muscles can no longer contract, or tighten, as vigorously as before. This causes a controlled relaxation of the muscles and the overlying skin.

It is beneficial in the treatment of the frown lines on the forehead, crow’s feet, or wrinkles around the eyes. Botulinum toxin can also be used to treat excessive sweating from the armpits.

Dermal fillers

Soft tissue fillers, or dermal fillers, are FDA approved medical compound implants to form a smoother, fuller appearance to the face.

Hyaluronic acid is a natural compound found in human tissues. It is also one of the common dermal fillers. These are compounds that are injected just under the skin to make it fuller and young in appearance, a feature or part of the face. Synthetic forms of dermal fillers are now widely used in face augmentation.

These fillers can be used at nasolabial folds, in cheeks, and lips, and can also be used to increase the volume of the back of the hand.

These can help reduce wrinkles, lines, and scars, and enhance soft tissue contours. These are not permanent but lasts for a long time. they are metabolized by the body and hence lose effect with time. Repeat treatments may be needed to maintain the effect.

Apart from hyaluronic acid, poly-L-lactic acid (PLLA), calcium hydroxyapatite, and polymethylmethacrylate beads (PMMA) are also used and are commercially available.

These compounds come in gel formulations. These are injected into the deeper layers of the skin and underlying soft tissue with the use of fine needles. Collagen injections are no longer used because some patients developed allergic reactions, few of them serious.

Fat injections and fat grafting

Fat is collected from one part of the patient’s body using liposuction, and it is injected into another where augmentation is needed. Usually done to the face, especially lips, hands, and other depressions in skin contour.

These filings are generally safe and last long. This comes with the additional benefit of removing fat from where it is not wanted. The fat is removed and then carefully re-injected after washing with specially designed needles. May need to repeat the procedure to get the desired results.

Stem-cell enriched fat grafts have been in trial for quite some time. The results are promising for reconstructive surgery. Further studies are warranted to establish long-term safety.

Lasers and light-based facial treatment

Laser skin resurfacing or rejuvenation or laser skin treatment utilizes concentrated, pulsating beams of light to reduce fine lines, wrinkles, and abnormal pigmentation, such as sunspots. This is also used for the removal of dead and damaged outer layers of skin or exfoliation with the use of lasers. This also lessens the depth of facial pores.

Hair transplant

Hair transplant surgery can help regain hair growth for those with hair loss.

Hair follicle grafts are harvested from the back and sides of the scalp, where the hair is denser and immune to the effects of hormones, the main cause for the loss. These islands of hair graft are transplanted to the areas of the front and top of the scalp, the area of hair loss.

Patients may need to undergo multiple sessions of hair transplant for desired results. After about 6 weeks, the transplanted hairs will fall out, but almost 3 months later, new permanent hair will appear.

As a thumb rule, anyone who is planning to undergo cosmetic surgery or any other surgery should stop smoking or use of tobacco in other forms several months before surgery. Tobacco interferes with wound healing.

The most popular cosmetic procedures are Botox, liposuction, eyelid surgery, breast implants, nose jobs, and facelifts.

Cosmetic surgery in India and mental health issues

Studies have found that people who consider cosmetic surgery are more likely to have psychological issues, such as depression and body dysmorphic disorder (BDD).

According to one study women with breast augmentation surgery had a higher risk of suicide.

One should carefully understand the pros and cons of the cosmetic procedure they are planning.

Complications

Just like any other surgical procedure, cosmetic surgery also has its risk of complications.

A patient must seek medical attention at once if they notice any of the following symptoms during or shortly after surgery:

- unusual pain
- visual disturbances
- white skin near an injection site
- signs of stroke