Thursday, April 21, 2011 2:39 pm
By Kristin Campbell
When most people think of plastic surgery, the traditional facelift or breast implants may still come to mind. But the field has expanded rapidly in recent years amid advances in technology as well as cultural changes.
Today, cosmetic and reconstructive procedures are common for both men and women, and are performed on almost every area of the human body. Here’s an overview of some of the procedures that are in demand among Central Ohio physicians.
Facelifts remain a cosmetic surgery standard, whether it’s a full repositioning of the facial structures or smaller procedures to freshen a patient’s appearance.
Dr. Steven Robinson of Ohio Plastic Surgeons says eyelifts are one of the most commonly requested procedures among his clients–for both men and women. Even people in their 40s may notice time catching up with them. They develop bags under their eyes and heavy “hooding” of the upper eyelids, and may seek advice from a surgeon.
“It makes them look tired, and look older than they are,” Robinson says. “They are in the job market and may still want another promotion. They can’t look like they are falling asleep all the time.”
An eyelift (also called blepharoplasty) on either the upper or lower lids can be completed in about 60 minutes under local anesthesia in the surgeon’s office. For the upper lids, the lift is done through the natural crease in the eyelid. For the lower lids, the incision is made at the lash line. In either case, scars will be almost invisible, Robinson says.
Patients will experience some post-operative bruising and swelling for a week to 10 days. Blepharoplasty is generally not covered by insurance unless sagging upper lids impede peripheral vision. However, the surgery is one of the more affordable cosmetic procedures: about $1,500 for the upper lids and $1,600 to $1,800 for the lower lids.
While some people are sensitive about the years betrayed by their eyes, others worry about a problem they may have had since childhood–protruding ears. With otoplasty, a surgeon can make the ears lie closer to the head, resolving years of painful self-image issues.
Dr. Jeffrey Donaldson of Donaldson Plastic Surgery says a roughly equal number of men and women request the procedure. Patients who once relied on hats and longer hairstyles to hide their ears can undergo a simple surgery performed under either general or local anesthesia.
“The incision is behind ear, hidden in the crease,” Donaldson says. The surgeon releases the ear cartilage and repositions it with sutures. The procedure takes about 45 minutes per ear. Patients experience swelling and bruising for three to four days, but pain is relatively minor, Donaldson says.
“It’s sort of like the burning sensation you feel when you go outside on a very cold day and your ears get cold,” he says. “I make prescription medication available, but many patients just use over-the-counter pain relievers.”
Patients must wear a chin strap around the clock for about a week, and then at night for an additional month, to keep the ears firmly in place while they heal. The cost of the procedure is about $4,000.
A variety of reconstructive procedures may come into play after a skin cancer diagnosis. Dr. Stephen Smith Jr., director of the Division of Facial Plastic and Reconstructive Surgery at Ohio State University Medical Center, performs many such operations.
“The skin is something we don’t cover up, so [it] gets lot of sun exposure,” Smith says. The nose, lips, cheeks, temples and scalp are commonly affected, but skin cancer can develop in any sun-exposed area, he says. Once the cancerous cells are removed, patients may be left with a scar.
“Most locations absolutely benefit from reconstructive effort,” Smith says. Using flaps, skin grafts and complex geometric formulas, surgeons can make the affected area blend in with the surrounding tissues. Incisions are often placed along existing facial lines to minimize noticeable scars.
Many minor procedures can be done in the surgeon’s office, although more complex efforts, such as reconstruction of the nose, might require an overnight hospital stay. Surgeries take anywhere from 30 minutes to a few hours, and patients can return to normal activities in about a week. Some even go back to work the same day.
“There are minor restrictions,” Smith says. “I don’t want them going home and lifting weights or chopping wood.” Anything that could cause the heart rate to go up and lead to post-op bleeding should be avoided until the surgeon gives the OK. These procedures generally are covered by insurance.
Smith performs another procedure that is purely cosmetic, but loved by patients for more than one reason. Lipotransfer takes unwanted fat cells from one area of the body and injects them elsewhere–often, from the lower abdomen to the face.
Facial aging has three components, Smith says: wrinkling and discoloration of the skin’s outer layer, sagging of the underlying layer and loss of volume. “We can make the biggest impact by restoring that volume,” he says.
“If you look at the younger members in a family photo, they have big, round cheeks and smooth, arcing transitions from one part of the face to another,” Smith says. “The older folks lose volume and begin to look hollow.”
Fat can act as a sort of scaffolding, not only restoring lost volume, but also providing support for facial tissues that might otherwise begin to droop.
Lipotransfer lasts longer than synthetic fillers–sometimes for years–and is more versatile. It looks natural, and is highly successful because the transferred fat connects to the body’s blood supply and becomes self-sustaining.
There are no incisions. The doctor uses a specialized syringe to harvest the fat, then another to insert it into the desired place. The fat is generally processed-Smith says he uses a centrifuge to remove all the extra-cellular fluid and blood so that only fat cells are reinjected. The cells can be placed under the eyes, in the cheeks, jowls, brow, temples–anywhere volume is desired.
Patients can expect some swelling and bruising for up to a week, when they should avoid heavy activity. There is little pain, and the procedure costs between $2,000 and $4,000 depending on the areas treated.
The face isn’t the only area that benefits from lipotransfer. Donaldson takes fat from multiple areas of the body and injects it into the buttocks of patients looking to boost their backside. He says a patient has to have a considerable amount of extra fat to be a candidate.
“We take fat from the arms, flanks and thighs, and we use it all,” he says. Compared to the 15 to 20 cubic centimeter volume required for a facial fat transfer, the buttocks require 500 ccs per side, or about one liter total.
This type of lipotransfer is done under general anesthesia since it’s essentially a full-body liposuction. The fat is harvested and repositioned in the same four- to five-hour procedure. Surgeons have learned to treat fat gently so the cells will survive and thrive. Donaldson says he makes microinjections in a lattice pattern throughout the tissue for optimal results.
During the ensuing two to three weeks, the fat takes on the blood supply of the surrounding area. Patients need to sit on a doughnut-shaped pillow and not sleep on their backs. They must also wear a customized compression garment for three weeks. The procedure costs about $12,000.
More than any other body part, women are perhaps the most self-conscious about their breasts. For Dr. Bivik Shah of the Columbus Institute of Plastic Surgery, breast surgeries are among the most commonly requested. At the top of the list is augmentation.
Breast implants are the most common way to increase a woman’s cup size. A surgeon makes an incision either in the crease beneath the breast, in the armpit or at the edge of the areola. In most cases, the implant–filled with either silicone or saline–is placed under the chest muscle, giving a very natural appearance. “It’s like throwing a big down comforter over someone,” Shah says. “You can’t tell who’s under there. If you put just a thin sheet over someone, you can tell.”
Patients can expect swelling and soreness for four to six days. They will return to work in about a week and be back to normal activities in four to six weeks. The cost runs $5,000 to $7,000.
Some women, on the other hand, wish they had smaller breasts. About 330,000 U.S. women underwent augmentation last year, and another 130,000 had breast reduction surgery.
Women with above-average cup sizes may complain of rashes under the breasts, headaches and pain in the back, neck and shoulders. Shah says a D-cup size could cause such complaints for a small-framed woman, but many patients have much larger breasts, up into the G- and H-cup range.
Shah says a surgeon typically removes one to three pounds of breast tissue per side. Patients will probably need prescription pain medication for about 10 days, and should rest for about two weeks. In two months, they will be back to normal activity levels. Because the surgery is often deemed medically necessary, insurance will cover breast reduction, Shah says.
Breast cancer patients who undergo a single or double mastectomy have several reconstruction options using either implants or their own tissue.
With a procedure called DIEP (deep inferior epigastric perforator) flap, a surgeon takes skin, fat and blood vessels from the patient’s abdomen and builds new breasts. Using a microscope for guidance,
the blood vessels are reconnected to the vascular system.
The DIEP flap procedure is a three-step surgery, with each phase spaced about three months apart. First, breasts are created. Next, they are shaped. Finally, nipples are made by folding and stitching the skin; areolas are created, sometimes by tattooing.
The new breasts feel very realistic, Shah says. Although the sensation is not quite the same for the patient, there is no longer a risk of developing breast cancer since all the breast tissue is gone.
Patients should expect to spend about a week in the hospital for the first surgery, with a week’s recovery time after the two ensuing outpatient procedures.
Dr. Anne Taylor, a surgeon at Ohio State University Medical Center, says there are several other options for reconstruction. One involves removing the breast tissue but sparing the skin. A saline-filled skin expander is put into a pocket in the chest muscle, remaining in place while the patient heals from the mastectomy and perhaps undergoes other cancer treatments.
A few months later, the temporary form is replaced with a permanent gel-filled implant. Gel is preferred over saline because of its more natural feel, Taylor says. The second surgery is minor, and recovery time is just a few days. “Patients can take over-the-counter oral pain medication, but many don’t take any at all,” Taylor says.
A third stage involves nipple reconstruction similar to that used in the DIEP flap procedure.
Another option transplants muscle from the upper back to the chest, where it serves as the soft tissue covering an implant. The latissimus dorsi normally helps rotate the arm, but because it’s one of several muscles that perform that function, it isn’t missed. Patients can expect some soreness, swelling and bruising for two to three weeks and be back to feeling 100 percent in about six weeks.
Although it’s not as openly discussed, men also have breast issues. Ohio Plastic Surgeons’ Robinson says the word is getting out about gynecomastia, or the abnormal development of breast tissue in males. “About 10 percent of teenage boys develop this, and for many it persists into adulthood,” he says.
Many men either live with the condition, wear compression garments or hide it in other ways. Robinson says the cause isn’t known, because those affected have normal hormone levels. But a solution is available.
The surgeon makes a small incision under the nipple, removes the breast tissue then uses liposuction on the entire pectoral area to allow muscle definition to show through. There is no perceptible scar, and patients can be back to work in two to three days. Because it is considered cosmetic, it is not covered by insurance and costs $4,000 to $5,000.
Another procedure that’s becoming more openly discussed is labiaplasty, the reconstruction of a woman’s labia minora. While considered largely cosmetic, the procedure can have a major impact on lifestyle.
“The extra tissue can be pretty disfiguring,” Donaldson says. “A lot of women experience pain. They can’t ride bikes or sit for prolonged periods without adjusting.” Other complaints include not being able to wear tight jeans or bikinis, because the excess tissue shows through. While it can be exacerbated by childbirth, many women are born with the condition.
“It’s very straightforward,” Donaldson says. “The extra tissue just needs to be removed, almost like an eyelid lift.” The procedure takes about an hour, and patients recover in about a week. The cost is about $3,000.
A more visible cosmetic procedure, but one that can have just as big an effect on lifestyle, is the repair of holes left by piercings.
“It’s something I’ve only seen in last several years, and I think it’s directly related to the economic downturn,” Robinson says. “People in their late 20s are deciding to get ‘real’ jobs, and there’s a lot of competition. Lip piercings and ear plugs don’t play so well in job interviews.”
Small holes are fairly simple to repair with a fine suture. Larger holes-like those that result from large-gauge ear plugs-take a little more planning. Using local anesthetic in the office, the doctor employs geometric formulas to fill the space and restore the body part’s normal appearance. It takes about an hour, costs $500 to $1,000 and is done on an outpatient basis.
Kristin Campbell is a freelance writer.
Reprinted from the May 2011 issue of Columbus C.E.O. Copyright © Columbus C.E.O.