The growth of Plastic Surgery has largely been spurred by technological advancement, skill improvement and overall economic development in society. This is evident by the large number of patients opting for Aesthetic surgery now. However, this by no means undermines the importance of Reconstructive Surgery in Trauma and Cancer patients, which not only restores anatomy, but also initiates psychosocial and occupational rehabilitation.
Hence, in a nutshell the keywords are Reconstruct, Restore, Rejuvenate & Rehabilitate.
Aesthetic surgery deals with improvement of appearance, which in turn translates into improved self esteem and confidence, and perhaps, performance in professional life. However, it is important for patients seeking aesthetic surgery to have realistic expectations and understand the limitations of the procedures.
Most of the Aesthetic procedures are day care surgery with aftercare on an OPD basis.
AESTHETIC FACIAL SURGERY : Rhinoplasty
Deals with reshaping of the nose, which can be an open or closed procedure. Open procedure is imperative for tip correction and in patients with Cleft lip nose deformity. The closed approach suffices where there is no or minimal tip correction required. Rhinoplasty is a custom-made surgery, demanding a unique plan for each patient, with need for extensive preoperative counseling.
Face, neck & brow lift
Essentially constitutes tightening of the skin and supporting underlying soft tissues which have sagged owing to aging and gravity, with imperceptible scarring. Overnight hospital stay is required. Smokers and patients on anticoagulants (like Aspirin, Clopidrogel, warfarin) have to stop consuming the same for at least a week prior to surgery. Smoking is prohibited for 3 weeks postoperatively to facilitate healing. The commonest complications are bleeding and nerve injuries.
Fillers, botulinum toxin, Liposuction & Fat injection and implants help in facial contouring, as per the requirements and expectations of the patient. They may be office or day care procedures. While fillers and Botulinum toxin injections are temporary (lasting 6-9 months), others are permanent.
Surgical rejuvenation of baggy eyelids, with minimal scarring. Postoperative swelling of the lids persists for a week.
Facial scar revision, repair of split ear lobule and excision of small moles and warts are performed as OPD procedures, under local anaesthesia
Liposculpting & Body Contouring
Liposuction is the commonest and one of the safest cosmetic procedures, if performed by trained personnel. It is permanent at the site of suction. Most patients are counselled to discipline their diet, lifestyle and exercise regime prior to undergoing liposuction to enable them to maintain the results obtained by the procedure. Approximately, 10% of body weight equivalent in volume can be safely removed in a single session of 2-3 hours. The sucked fat can be sedimented and injected in areas which are deficient to achieve better contouring. Results are usually visible after 4-6 weeks, during which it is mandatory to use elastic compression garments. Body contouring has assumed greater application after the popularity of Massive weight loss (bariatric) surgery. There is a need to contour the bodies of these patients once they have lost weight appreciably for them to look better. Lower body and truncal lifts are common in these patients.
Abdominoplasty involves removal of excess, sagging lower abdominal skin and tightening of the abdominal muscles to create a narrow waistline. It is desirable to have a waist-hip ratio of 0.7, which is attractive to the observer. Liposuction is usually combined to achieve better contouring. The scars are hidden within the underwear/ bikini line. During abdominoplasty, the umbilicus is repositioned and reshaped too. Smoking reduces chances of uneventful healing.
Thigh & arm lift
Contouring of the thighs & arms involve liposuction with / without lax skin excision to achieve desirable results. However, the patient has to accept long scars following skin excision. These scars tend to become less prominent with pressure therapy and time.
AESTHETIC BREAST SURGERY : Breast augmentation
Unmarried girls with small breasts and post-childbirth mothers are usually the patients who avail of this procedure. The other indications are in sex change (gender reassignment) surgery and post- resection breast cancer patients. The newer generation silicone gel implants are relatively safe, long-lasting and give the most natural feel. It is a day care procedure and the local discomfort is pronounced for the first 2-3 days. The dreaded complications related to implants are infection, capsular contracture, rupture and leak. However, these are rare if proper intra-operative and postoperative care is taken. Fat grafting after liposuction is a new modality to augment breasts. However, results are unpredictable and further experience is required to satisfy patients. No heavy exercise, weight lifting or aerobics is recommended for at least 3 weeks postoperative.
Breast lift & reduction
Large breasts can be socially embarrassing and can cause neck and shoulder pain. Reduction of size, reshaping of the breasts and lifting the nipple-areola complex (NAC) to the normal level are the aims in this procedure . The procedure involves a single day hospital stay and the patient can shower from the next day. Continuous Breast support is mandatory for 3-4 weeks. Although nipple sensation and lactation cannot always be guaranteed after the procedure, the newer techniques ensure restoration of the same.
Male breast surgery (Gynaecomastia)
Usually in puberty the breast tissue regresses in males. Persistence of the same leads to presence of female-type breasts with variable amount of fat and breast tissue. Liposuction with or without breast disc excision (through imperceptible scars) as a day care surgery is the treatment of choice, depending on the clinical assessment of each patient. Pressure garment is mandatory for 1-3 weeks postoperative, depending on the size of the gynaecomastia removed.
Reconstructive surgery is, in its broadest sense, the use of surgery to restore the form and function of the body. Reconstructive surgery is also performed by Plastic Surgeons on trauma and cancer patients. The operation attempts to restore the anatomy or the function of the body part to normal. Reconstructive plastic surgeons use the concept of a reconstructive ladder to manage increasingly complex wounds. This ranges from very simple techniques such as primary closure and dressings to more complex skin grafts, tissue expansion and free flaps
Hand & Microsurgery
The human hand is a unique organ that functions as the messenger for the brain. Apart from the prehensile functions, hands express emotions and perform gestures which speak more than a thousand words. For good hand function, sensation, stability, skin cover, mobility and strength are essential. Restoration of the same in injury, birth defects and tumour patients is imperative for rehabilitation of a patient. Microsurgery has made it possible to replant severed limbs and digits as well as reconstruct composite and complex tissue deficit. Already, face and hand transplants, akin to kidney & liver transplant, are being performed in several centres.
Head & Neck Cancer Reconstruction
Microvascular tissue transfer has become the gold standard of reconstruction of bony & soft tissue defects following advanced cancer resection in the head & neck region. Skin, bone, muscle flaps or a combination of the same is harvested with its blood vessels and transferred to the defects by microvascular anastomosis. This helps customize the reconstruction according to the size and nature of the defects. It also hastens healing (being single stage), and, allows early institution of chemoradiation.
Immediate or delayed breast reconstruction in breast cancer and burn patients is gaining popularity. Like tissue from the lower abdomen or buttock is transferred by microvascular technique to reconstruct the breast mound in the first stage. Nipple & areola reconstruction follow after 3 months. The abdomen and buttock donor sites are closed, with minimal morbidity. This helps restore a feeling of femininity in the patients and reduces their dependence on external breast prosthesis.
Chest & Abdominal Wall Reconstruction
The main indications are loss of tissue due to trauma, tumour and infection. Chest and abdominal wall defects can be reconstructed with muscle or skin flaps from the adjoining areas, if available, or from distant areas by microvascular tissue transfer.
Pressure Sore Reconstruction
Pressure sores are common in bed-ridden, critical patients, often associated with neurological conditions. They need to be debrided (surgical removal of dead skin and soft tissue) well and reconstructed with adjoining skin or muscle flaps to rehabilitate these patients.
Reconstruction of the external genitalia for birth defects, injury and malignancy by local and distant flaps is very gratifying. Genital rejuvenation surgery is also becoming popular, with growing demand for the same.
Burns & Post-burn Deformities
While deep burn ulcers are resurfaced in the acute stage, post-burn deformities (scar contracture) of the face, neck, hands, breasts and limbs require corrective reconstructive procedures both for function as well as aesthetics . This is particularly a problem in the lesser developed areas, where no reconstruction of the deep burn ulcers is performed in the acute stage.
Cleft & Craniofacial Surgery
In India, maternal malnutrition is the main cause of Cleft lip and palate. Hence, it is the poorest in society who are born with these defects. Repair of the clefts along with speech therapy, orthodontic care and corrective mid-face surgery constitute comprehensive treatment for these unfortunate children.