Agnesian HealthCare Know & Go Showcase: Options in Plastic Surgery
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Transcript of Agnesian HealthCare Know & Go Showcase: Options in Plastic Surgery
Plastic Surgery Options
RICHARD B. SCHAEFER, MDAgnesian Plastic Surgery & Cosmetic Surgery
Fond du Lac * Ripon * Waupun
What Is Plastic Surgery?
Surgery of the skin and all of its contents
What Is Plastic Surgery?
• Craniofacial surgery - Cleft lip and palate• Hand surgery• Microsurgery• Transplant surgery• Cosmetic surgery• Dermatologic surgery• Oculoplastic surgery• Burn surgery
What Is Plastic Surgery?
• Craniofacial surgery
• Hand surgery - Finger replantation• Microsurgery• Transplant surgery• Cosmetic surgery• Dermatologic surgery• Oculoplastic surgery• Burn surgery
What Is Plastic Surgery?• Craniofacial surgery• Hand surgery
• Microsurgery – Free tissue transfer• Transplant surgery• Cosmetic surgery• Dermatologic surgery• Oculoplastic surgery• Burn surgery
What Is Plastic Surgery?• Craniofacial surgery• Hand surgery• Microsurgery
• Transplant surgery - J. Murray ‘54, Nobel ‘90• Cosmetic surgery• Dermatologic surgery• Oculoplastic surgery• Burn surgery
What Is Plastic Surgery?
• Craniofacial surgery• Hand surgery• Microsurgery• Transplant surgery
• Cosmetic surgery - Facelift, tummy tuck• Dermatologic surgery• Oculoplastic surgery• Burn surgery
What Is Plastic Surgery?
• Craniofacial surgery• Hand surgery• Microsurgery• Transplant surgery• Cosmetic surgery - Facelift, tummy tuck• Dermatologic surgery - Skin cancer• Oculoplastic surgery• Burn surgery
What Is Plastic Surgery?• Craniofacial surgery• Hand surgery• Microsurgery• Transplant surgery• Cosmetic surgery - Facelift, tummy tuck• Dermatologic surgery - Skin cancer
• Oculoplastic surgery - Eyelid surgery• Burn surgery
What Is Plastic Surgery?• Craniofacial surgery• Hand surgery• Microsurgery• Transplant surgery• Cosmetic surgery - Facelift, tummy tuck• Dermatologic surgery - Skin cancer• Oculoplastic surgery - Eyelid surgery• Burn surgery - Skin grafting
Aging
• Muscles – Repeated skin folds - wrinkles
• Volume Loss– What was once full, becomes deflated
– Grape to raisin - wrinkles
Aging
• Skin changes– Texture
– Loss of elasticity - wrinkles
– Sun damage
• Gravity– Downward drift
See How the Face Ages
Aging• Muscles
– Repeated skin folds - wrinkles• Volume Loss
– What was once full, becomes deflated
– Grape to raisin – wrinkles
• Skin changes– Texture
– Loss of elasticity - wrinkles
– Sun damage
• Gravity– Downward drift
Anatomy
• Rhytids - wrinkles– Skin as fabric– Dynamic – Static
Wrinkle Treatment
• Botox temporarily stops dynamic wrinkling• Lasts three to four months• $200 to $800 per treatment
Botox®
• Bacterial protein• Relaxes muscles• Dynamic wrinkles• FDA approved
– Glabellar lines
Botox®
• Off label
• ASPS 2004
• Shaping
• Concensus
Forehead Crow’s feet Neck
Lips Nose Brow
Forehead
Crow’s Feet
Crow’s Feet
Neck Banding
Aging• Muscles
– Repeated skin folds - wrinkles
• Volume Loss
– What was once full, becomes deflated
– Grape to raisin - wrinkles• Skin changes
– Texture
– Loss of elasticity - wrinkles
– Sun damage
• Gravity– Downward drift
Volume Loss
• Restoring volume by plumping up an area that has deflated over time
• Filler treatment – Lasts 9 to 15 months– $599 to $1,495
• Use your own fat– Expense– Donor site pain– Reliability
Juvederm & Restylane®
• Dermal Filler• Biodegradable• HA gel• Injected
Very fine needle to minimize discomfort
Photo courtesy of Q-Med Note: Volume injected depends on patient, location, and degree of correction required.
Restylane® Results
Nasolabial folds before treatment
After treatment with one 1 mL syringe
Individual results may vary.
Restylane® Results
Nasolabial folds before treatment
After treatment with two 1 mL syringes
Individual results may vary.
Restylane® Results
Nasolabial folds before treatment
After treatment with three 1 mL syringes
Individual results may vary.
Restylane® Results
Nasolabial folds before treatment
After treatment with two 1 mL syringes
Individual results may vary.
Restylane® Results
Nasolabial folds before treatment
After treatment with three 1 mL syringes
Individual results may vary.
Restylane® Results
Nasolabial folds before treatment
After treatment with two 1 mL syringes
Individual results may vary.
Restylane® Results
Nasolabial folds before treatment
After treatment with two 1 mL syringes
Individual results may vary.
Lips
Glabella
Glabella
Face
Facial Rejuvenation
Facial Rejuvenation
Aging• Muscles
– Repeated skin folds - wrinkles
• Volume Loss– What was once full, becomes deflated
– Grape to raisin – wrinkles
• Skin changes
– Texture
– Loss of elasticity - wrinkles
– Sun damage• Gravity
– Downward drift
Skin Care
• Cleanse
• Restore– Hydrate
– Repair
• Sun protection
Cleansing
• Removes grease, dust, makeup and sweat• Do not modify skin or penetrate• Normal skin
– Vitamin C, Urea, Saponins• Dry skin
– Vitamin E, glycerin, seed oils, plant extracts
Restoring - Hydration
• Occlusive agents– Vegetable oils and fatty acids– Lanolin, stearic acid, phospholipids
• Moisturizers– Creams or lotions (oil in water)– Glycerin, PCA, lactic acid, urea, ceramides
Restoring - Repair
• Alpha-hydroxy acids – Glycolic– Lactic– Malic– Citric– Tartaric
• Tretinoin
• Improves– Dryness– Texture– Acne– Rosacea– Photodamage– Melasma– Hyperpigmentation– Wrinkles– AK’s
Sun Protection
• Zinc oxide• Titanium dioxide• Parsol 1789• Apply before makeup• Reapply if outdoors
Anti-Oxidation
• Vitamin C – 5% to 20%
• Collagen synthesis• Neutralizes free radicals• Reduces inflammation• Brightens skin
• Surface texture• Fine wrinkles• Tactile roughness• Coarse rhytids• Skin laxity• Sallowness
Other Antioxidants
• Vitamin E• Co-enzyme Q-10• Squalene• Data incomplete or not statistically
significant
Bleaching Agents
• Hydroquinone• Kojic acid
• Age spots• Sun damage• Irregular pigments• Melasma
Results
Light-Based Treatments
• Intense Pulsed Light (IPL)• Laser
– Hair removal– Vein ablation– Resurfacing
• Ablative • Non-ablative
How Do Light Therapies Work?
• Specific target in skin absorbs energy• Non-target tissue remains unaffected• Target
– Stimulate– Contract– Destroy
IPL – Photo-Rejuvenation• Photo damaged skin• Age spots• Irregular skin pigments• Telangectasia (small blood vessels)• Redness of rosacea• Fine hair• No downtime• Rapid treatments
IPL – Facial Pigments
IPL - Telangectasias
IPL for Sun Damage
Upper Chest
Aging• Muscles
– Repeated skin folds - wrinkles• Volume Loss
– What was once full, becomes deflated– Grape to raisin – wrinkles
• Skin changes– Texture– Loss of elasticity - wrinkles– Sun damage
• Gravity– Downward drift
Body Contouring
• Fat• Skin• Muscle• Scars
Body Contouring
• Fat - liposuction• Skin• Muscle• Scars
Body Contouring
• Fat• Skin - excisional therapies• Muscle• Scars
Liposuction• Minimal scars• Vacuums out fat• Minimal skin tightening• Can use internal energy sources to breakdown
fat prior to suctioning– Ultrasound– Laser– Cool sculpting
Ultrasound Assisted Liposuction
• Ultrasound– Breaks down fat– Individualize Settings– Sensitive Areas
• Smooth results – Even shape and contour
Neck
Abdomen & Flanks
Abdomen & Flanks
Abdomen & Flanks
Men Too!
Breasts
Abdomen & Breasts
Abdomen
Excisional Therapies
• Tummy tuck • Belt lipectomy
– Massive weight loss patient• Breast lift• Arm lift
Belt Lipectomy
Belt Lipectomy
Total Body Rejuvenation
Breast & Arms
Back
Facial Reshaping
• Face lift• Neck lift• Rhinoplasty - Nose job• Blepharoplasty - Eyelids• Brow lift
Face & Neck
Rhinoplasty
Blepharoplasty - Eyelids• Upper
– Relation to brow• Lower
– Relation to cheek• Skin• Muscle• Fat
Upper Blepharoplasty
Transconjunctival Blepharoplasty
Four Lid Blepharoplasty
Four Lid Blepharoplasty
Brow & Upper Lids
Breast
• Reduction
• Augmentation
• Lift (mastopexy)
Reduction
• Neck pain• Back pain - Upper, lower and mid• Shoulder grooving • Numbness/tingling in arms• Skin rash/breakdown beneath breasts• Difficulty exercising• Insurance
Reduction
Hypomastia
• Small breasts• Breast smaller than desired • Cosmetic
Breast Implants
• Saline Filled– Small incision– Some ability to adjust
volume– Ruptures obvious - deflation
• Gel (silicone) Filled– Incision related to implant size– Ruptures silently
Augmentation
Breast Reconstruction• After cancer removal the breast may be
partially or completely altered.• Reconstruction may be done at the time of the
removal or at anytime thereafter.• There are a variety of surgical options that can
correct these deformities.• The other breast can also be adjusted to
match.
Hand Surgery• Soft tissue of the hand
– Tendon repair– Ganglion cysts– Skin contracture– Trigger finger
• Nerve release– Endoscopic carpal tunnel release– Ulnar nerve transposition
Varicose Veins
• Leg pain• Leg swelling
– Sock marks• Varicosities
Vein Valve Failure
Normal vein: valve open and closed Dilated vein with non-functioning valve
Varicose Vein Treatments
• Endovenous Radiofrequency Ablation • Has replaced stripping
– Local anesthetic– In-office– No significant activity restrictions or pain
Micro or Stab Phlebectomy
Pre-treatment: Varicose anterior accessory saphenous vein
Post-treatment: Very minimal incision sites
Sclerotherapy
• Injection of material to injure vessel causing fibrosis
• Advantages– Short office procedure– Effective– Can be redone
• Disadvantages– Allergy– Ulceration– Pigmentation
Edema and Hyperpigmentation
• Lower leg edema and hyperpigmentation are common presentations with venous insufficiency.
• CEAP 4 - Edema and skin changes from venous disease.
Image courtesy of Rajabrata Sarkar, MD
Stasis Dermatitis• Stasis dermatitis appears as
itchy, scaly patches on the lower extremities
• Hyperpigmentation occurs as a result of red blood cell extravasation and hemosiderin deposition
• CEAP 4 - skin changes from venous disease
Progression of Venous Stasis
• Poor skin nutrition and oxygenation
• Subcutaneous fat necrosis– Lipodermatosclerosis– CEAP 6 - Venous stasis
ulceration• Will recur unless underlying
venous insufficiency is treated
Amor Khachemoune, Catharine Lisa Kauffman: Management Of Leg Ulcers. The Internet Journal of Dermatology. 2002. Volume 1 Number 2.
Skin Cancer• Basal Cell Carcinoma• Squamous Cell Carcinoma• Melanoma• Excision• Reconstruction
Mission Work
• Philippines– Bulacan– Pampanga
• Peru– Trujillo
Patient Wards
Facilities
Sterile Processing
Labor & Delivery
Drying Rack for Gloves
Questions?
Thank You!