Plastic Surgery Indications, Complications

Plastic Surgery Indications/Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It can be divided into two categories. The first is reconstructive surgery which includes craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. The other is cosmetic or aesthetic surgery.^[rx] While reconstructive surgery aims to reconstruct a part of the body or improve its functioning, cosmetic surgery aims at improving the appearance of it. Both of these techniques are used throughout the world.

Types of Plastic Surgery

The most popular aesthetic/cosmetic procedures include:

• Abdominoplasty (“tummy tuck”) –  reshaping and firming of the abdomen
• Blepharoplasty (“eyelid surgery”) – reshaping of upper/ lower eyelids including Asian blepharoplasty
• Phalloplasty (“penile surgery”) – construction (or reconstruction) of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes
• Mammoplasty
  • Breast augmentations (“breast implant” or “boob job”) – augmentation of the breasts by means of fat grafting, saline, or silicone gel prosthetics, which was initially performed to women with micromastia
  • Reduction mammoplasty (“breast reduction”) – removal of skin and glandular tissue, which is done to reduce back and shoulder pain in women with gigantomastia and for men with gynecomastia
  • Mastopexy (“breast lift”) – Lifting or reshaping of breasts to make them less saggy, often after weight loss (after a pregnancy, for example). It involves removal of breast skin as opposed to glandular tissue
• Buttock augmentation (“butt implant”) – enhancement of the buttocks using silicone implants or fat grafting (“Brazilian butt lift”) and transfer from other areas of the body. lifting, and tightening of the buttocks by excision of excess skin
• Cryolipolysis – refers to a medical device used to destroy fat cells. Its principle relies on controlled cooling for non-invasive local reduction of fat deposits to reshape body contours.
• Cryoneuromodulation – Treatment of superficial and subcutaneous tissue structures using gaseous nitrous oxide, including temporary wrinkle reduction, temporary pain reduction, treatment of dermatologic conditions, and focal cryo-treatment of tissue
• Calf Augmentation – done by silicone implants or fat transfer to add bulk to calf muscles
• Labiaplasty – surgical reduction and reshaping of the labia
• Lip enhancement – surgical improvement of lips’ fullness through enlargement
• Cheiloplasty –  surgical reconstruction of the lip
• Rhinoplasty (“nose job”) – reshaping of the nose
• Otoplasty (“ear surgery”/”ear pinning”) – reshaping of the ear, most often done by pinning the protruding ear closer to the head.
• Rhytidectomy (“face lift”) – removal of wrinkles and signs of aging from the face
  • Neck lift – tightening of lax tissues in the neck. This procedure is often combined with a facelift for lower face rejuvenation.
  • Browplasty (“brow lift” or “forehead lift”) – elevates eyebrows, smooths forehead skin
  • Midface lift (“cheek lift”) – tightening of the cheeks
• Genioplasty – augmentation of the chin with an individual’s bones or with the use of an implant, usually silicone, by suture of the soft tissue^[rx]
• Cheek augmentation (“cheek implant”) – implants to the cheek
• Orthognathic Surgery – altering the upper and lower jaw bones (through osteotomy) to correct jaw alignment issues and correct the teeth alignment
• Fillers injections – collagen, fat, and other tissue filler injections, such as hyaluronic acid
• Brachioplasty (“Arm lift”) – reducing excess skin and fat between the underarm and the elbow^[rx]
• Laser Skin Rejuvenation or laser resurfacing – the lessening of depth in pores of the face
• Liposuction (“suction lipectomy”) – removal of fat deposits by traditional suction technique or ultrasonic energy to aid fat removal
• Zygoma reduction plasty –  reducing the facial width by performing osteotomy and resecting part of the zygomatic bone and arch^[rx]
• Jaw reduction – reduction of the mandible angle to smooth out an angular jaw and creating a slim jaw^[rx]

The most popular surgeries are Botox, liposuction, eyelid surgery, breast implants, nose jobs, and facelifts.^[rx]

Plastic Surgery Indications

Plastic surgery is a broad field, and may be subdivided further. In the United States, plastic surgeons are board certified by American Board of Plastic Surgery.^[rx] Subdisciplines of plastic surgery may include:

• Aesthetic surgery – Aesthetic surgery is an essential component of plastic surgery and includes facial and body aesthetic surgery. Plastic surgeons use cosmetic surgical principles in all reconstructive surgical procedures as well as isolated operations to improve overall appearance.^[rx]
• Burn surgery – Burn surgery generally takes place in two phases. Acute burn surgery is the treatment immediately after a burn. Reconstructive burn surgery takes place after the burn wounds have healed.
• Craniofacial surgery – Craniofacial surgery is divided into pediatric and adult craniofacial surgery. Pediatric craniofacial surgery mostly revolves around the treatment of congenital anomalies of the craniofacial skeleton and soft tissues, such as cleft lip and palate, craniosynostosis, and pediatric fractures.
• Hand surgery – Hand surgery is concerned with acute injuries and chronic diseases of the hand and wrist, correction of congenital malformations of the upper extremities, and peripheral nerve problems (such as brachial plexus injuries or carpal tunnel syndrome). Hand surgery is an important part of training in plastic surgery, as well as microsurgery, which is necessary to replant an amputated extremity. ^[rx]
• Microsurgery – Microsurgery is generally concerned with the reconstruction of missing tissues by transferring a piece of tissue to the reconstruction site and reconnecting blood vessels. Popular subspecialty areas are breast reconstruction, head and neck reconstruction, hand surgery/replantation, and brachial plexus surgery.
  Pediatric plastic surgery – Children often face medical issues very different from the experiences of an adult patient. Many birth defects or syndromes present at birth are best treated in childhood, and pediatric plastic surgeons specialize in treating these conditions in children. Conditions commonly treated by pediatric plastic surgeons include craniofacial anomalies, Syndactyly^[rx] (webbing of the fingers and toes), Polydactyly (excess fingers and toes at birth), cleft lip and palate, and congenital hand deformities.

Plastic and Reconstructive Surgery

Contraindications of Plastic Surgery

Contraindications include the following

• Severe lung or cardiac disease
• Collagen vascular disease
• Obesity
• Older patient (more than age 65)
• Smoker and unwilling to quit
• Unstable emotional history
• Prior abdominal or thoracic surgery that has interrupted blood supply to the potential flaps
• Prior radiation therapy
• Advanced breast cancer

Complications of Plastic Surgery

The risk of complications is low; however, there are known potential problems, and no implant is considered a lifetime device.[rx][rx][rx] Implants can rupture at any time or last a lifetime after placement. However, many surgeons will estimate a 15 to 20-year lifespan for the implants. Presently there is no established uniform recommendation to replace implants at a set time interval. Some surgeons will recommend routine replacement at 10 to 15 years after initial placement and others will recommend waiting until the implants break or deflate before replacing. Early postoperative complications include:

• Infection
• Scarring
• Asymmetry
• Hematoma
• Seroma
• Breast pain
• Poor cosmetic outcome
• Nipple/breast sensation changes
• Implant malposition or displacement
• Implant deflation or leak
• Capsular contracture which is tightening of the tissue capsule around the implant

Immediate

• Bruising and bleeding
• Build up of fluid
• Tissue necrosis
• Moderate to severe pain
• Asymmetry of breast

Long-term

• Loss of sensitivity
• Fat necrosis
• Unevenness
• Undesirable scar
• Hernia formation at donor site of muscle flap
• Cancer recurrence

References

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