Dermatologic
A wrinkle is a ridge or crease on the surface of the skin. Skin wrinkles typically appear as a result of aging processes. It is caused by habitual facial expressions, aging, sun damage, smoking, poor hydration, and various other factors.
The skin that has wrinkles may appear tough and leathery, especially if the person has had extreme exposure to the sun.
Treatments Available
12. Skin lesions, Moles, Skin Cancer
A skin lesion is a superficial growth or a patch of the skin that does not resemble the area surrounding it. There are two types of skin lesions: primary and secondary. Primary skin lesions such as moles or birthmarks are usually present at birth or they may be obtained as a result of infectious diseases, such as acne, warts or psoriasis, allergic reactions such as hives, or environmental agents, such as sunburn, temperature or pressure extremes. Secondary skin lesions, on the other hand, are changes in the skin that result from the primary skin lesions. These may be a natural progression of the primary lesion or because the person scratched or picked at the lesion.
Moles, cysts, warts, or skin tags are known as skin lesions. Most of the skin lesions are benign. If a skin lesion is suspected to be malignant, a biopsy is done and checked for any signs of cancerous cells.
Skin cancer, such as basal cell carcinoma, squamous cell carcinoma, malignant melanoma, and Kaposi’s sarcoma are recognized by their lesions.
Treatments Available
- Laser Surgery
- Surgical Procedures
- Topical Antibiotics
- Oral Medications
- Punch Biopsy
- Shave Excision
- Excisional Surgery
Benign vascular lesions are overgrown enlarged blood vessels or multiple small vessels. The two common types of vascular lesions are port wine stains and hemangiomas.
Port wine stains tend to grow with the patient, usually infants, darken in color and will never go away if left untreated. Hemangiomas, on the other hand, grow very rapidly after birth but often go away with time. Some, however may impair vision or breathing and should be treated before they are allowed to advance to this stage. In addition, warts, red and raised scars and inflammatory lesions such as psoriasis can be treated by targeting their rich vascular supply.
Treatments Available
- Vascular Specific Laser Treatment
- Carbon Dioxide Laser Treatment
PLASTIC & RECONSTRUCTIVE SURGERIES
Breast reconstruction is a surgical procedure to restore the appearance of a breast for women who have undergone a mastectomy. The surgery rebuilds the breast contour and if desired, the nipple and areola. For most mastectomy patients, breast reconstruction dramatically improves their appearance and quality of life.
Procedure
Skin Expander with Breast Implant
This is the simplest of all Breast Reconstruction procedures and is known to have the shortest recovery period.
This is done in two stages using tissue expanders. First, the tissue expander is placed under the skin and muscles of the chest wall. When the incisions have healed, saline is added on a weekly basis to the expander. This helps the skin to stretch and accommodate the expander as it inflates due to the gradual addition of the saline. Second, since the skin is now adequately stretched, the tissue expander is removed and replaced with a permanent breast implant.
Latissimus Dorsi Myocutaneous Flap
This procedure involves moving the latissimus dorsi muscle and overlying skin from the back, channeling it to the chest creating a new breast mound. If necessary, a breast implant is placed under the flap to even out the difference in appearance.
Rectus Abdominus Myocutaneous Flap
This procedure is the most complicated one of the three. It takes about 4 to 5 hours of surgery. It can be done either as a "pedicle" flap or as a "free" flap. In the pedicle flap, one of the rectus abdominus muscles along with its blood supply is placed along with the overlying skin up to the chest. In the free flap, a part of the rectus abdominus muscle along with its overlying skin is taken from the lower abdomen. The artery and vein are surgically reattached to an artery and vein on the chest wall near the location of the mastectomy. The breast mound is then made to look like the opposite breast.
It may be necessary to donate your own blood before surgery to use as blood transfusion may be required during the procedure. Breast implants are not needed for this procedure. The tissue is usually enough to match the size of the other breast. Patients must stop smoking six weeks before and after surgery. Failure to comply may result in the death of the flap.
A synthetic mesh is placed on the areof the abdominal wall where the muscle is removed to minimize the chance of hernia formation and strengthen the abdominal wall.
Recovery
You may feel tired or sore in the chest and abdomen for about a week or two after the procedure. Your doctor will prescribe the necessary medications to control any discomfort.
You may need to stay in the hospital for 2 to 5 days after the procedure, although this is dependent on the extent of your surgery. Drains may be required to remove excess fluids from the surgical sites after the operation. These are usually removed 1 to 2 weeks after surgery. Stitches are usually taken out in 7 to 10 days.Risks
There is a possibility that an infection will develop within the first two weeks after surgery. In some instances, the implant may need to be removed for several months until the infection clears, and then a new implant can be inserted.
Capsular contracture may occur if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant causes the breast to feel hard. It may require either the removal of the scar tissue or even the removal or replacement of the implant.
Other possible complications specific for Breast Reconstruction are:
- Loss of breast skin requiring the removal of the implant. This procedure is not advisable for smokers or those who have undergone radiation due to the increased risk of skin loss.
- Noticeable implant outlines due to capsule formation or thin breast skin.
- Hardness or firm feel of the reconstructed breast due to capsule formation.
- Inadequate symmetry or implant position compared with the remaining breast.
- Decreased back strength from loss of shoulder muscle.
- A scar on the back.
- A collection of fluids (seroma) under incision requiring needle aspiration.
- Inadequate tissue that would require the use of a breast implant.
- Poor circulation to the flap resulting in tissue loss.
- Weakness or herniation of the abdominal wall.
- Infection, in particular of the mesh, requiring surgery for removal.
Nipple reconstruction is most commonly done 3 to 6 months after breast reconstruction allowing time for the breast mound to heal and settle into its final shape and position. This allows the surgeon to position the nipple in line with the nipple on the natural breast. This is an outpatient procedure performed for under two hours with local or general anesthesia.
Various techniques to reconstruct a nipple and areola are used. One technique is to use tissue from the breast mound or opposite nipple to create the new nipple. The areola may be created by tattooing or by using a pigmented skin graft from the upper thigh area. Tattooing is the most commonly used method.
The reconstructed breast or nipple will not have the same sensation as a natural breast. Nipple reconstruction is a relatively minor surgery, with the main problems related to partial graft failure, loss of projection of the reconstructed nipple or mismatched color.
This is a surgical treatment to repair deformities or trauma of the head and face (craniofacial) for those who have suffered birth defects and deformities, injuries to the head and face and tumors. There are four major bones of the face: the maxilla, the zygoma, the mandible, and the frontal bone of the cranium. Surgery specifics depend on the type and severity of deformity or injury.
Pieces of bone (bone grafts) may be taken from the pelvis, ribs, or skull to fill in the spaces where bones of the face and head have been moved. Small metal screws and plates may be used to hold the bones in place. The jaws may be wired together to hold the new bone positions in place.
Procedure
Time required: 4 - 12 hours
Anesthesia: General
Side Effects
Temporary swelling of the face, mouth, or neck. Temporary blockage of the airway requiring tracheotomy.
Risks
Possible risks that are associated with this type of surgery are bleeding, infection, nerve damage (cranial nerve dysfunction), permanent scarring and partial or total loss of bone grafts. Follow-up surgery may be needed for this.
Recovery
Depending on the extent of surgery and need for close monitoring of the airway, the first 2 days after surgery may be spent in the intensive care unit. Without complications, most patients are able to leave hospital within 1 week.
Complete healing: Up to 6 weeks.
4. Hand Surgery
Hand surgery is a broad term that incorporates a vast array of different types of surgery on the hand. Plastic surgeons who perform hand surgery attempt to restore not only the function of the hand, but also try to maximize the cosmetic appearance of the hand.
Procedures
Hand surgery encompasses a broad range of procedures that are used to correct:
- Hand injuries
- Carpal Tunnel Syndrome
- Rheumatoid Arthritis
- Dupuytren's Contracture
- Congenital defects
Procedures involved in hand surgery can include:
Skin grafts
Replacing or attaching skin to a part of the hand that has missing skin.Skin flaps
This is like a skin graft, however, with a skin flap, the skin that is retrieved has its own blood supply. The section of skin used includes the underlying blood vessels, fat, and muscles.Closed reduction and fixation
This type of surgery realigns fractured bone and then immobilizes the area during the healing phase.
Tendon repair
Tendon repair may be classified as primary, delayed primary, or secondary. Primary repair of an acute injury is usually completed within 24 hours of the injury. Delayed primary repair is usually performed a few days after the injury while there is still an opening in the skin from the wound. Secondary repairs may occur two to five weeks or longer after the injury. Primary repairs usually involve direct surgical correction of the injury, while secondary repairs may include tendon grafts (inserting tendons from other areas of the body in place of the damaged tendon) or other more complex procedures.
Nerve repairs
There are three main nerves in the hand, the ulnar nerve, the median nerve, and the radial nerve. Damage to these nerves from injury may result in decreased ability to move the hand and experience feeling. Some nerve injuries may heal on their own, while others require surgery. If severed, the nerve may be repaired by reattaching it directly to the other end of the nerve, or by using a nerve graft.
Fasciotomy
This treats compartment syndromes - a compartment is a three-dimensional space in the body that is surrounded by fascia or bone and contains arteries, nerves, and veins. A compartment syndrome is a condition that arises when there is an increase in intracompartmental tissue pressure within a space in the body, usually caused by trauma, which can interfere with the circulation to the body tissues and destroy function.
Surgical drainage and/or debridement
Infections of the hand are a common reason people seek treatment. The treatment for infections to the hand may include rest, use of heat, elevation, antibiotics, and surgery. Surgical drainage may be used if there is an abscess in the hand to help remove the collection of pus. Debridement, or cleansing of a wound to prevent further infection and to help promote healing, may be used if the infection or wound is severe.
Arthroplasty
Also known as "joint replacement", may be used in people with severe arthritis. This involves replacing a joint that has been destroyed by the disease process with an artificial joint. The artificial joint may be made out of metal, plastic, silicone rubber, or the patient's own body tissue (such as a tendon).
Procedure
Time required: Variable depending upon the particular procedure and specifics of the individual case.
Anesthesia: General anesthetic for the main operation. Follow-up procedure may only require local anesthetic.
Risks
There may be infection, incomplete healing, loss of feeling or movement of the hand or fingers and formation of blood clots.
RecoveryMild to severe pain may be experienced following surgery since the hand is a very sensitive part of the body. Normal activities may be resumed depending on the type and extent of surgery and on how fast the healing occurs.
Physical therapy under the direction of a trained hand therapist may be recommended to enhance recovery.
