Due to the rise in number of non-invasive and mini-invasive procedures, patients now demand optimal results after less-aggressive, lower-risk, brief-recovery surgeries. Esthetic surgery such as plastic surgery has evolved in the last decade regarding surgical techniques and development of new technologies. Reduced-scar, liposuction-combined surgeries, represent now less traumatic procedures, delivering better results at a deep and superficial level, remodeling neighboring areas at the same time. On facial surgery, procedures are now combined with synthetic or fatty grafting, botulin toxin application, CO2 or laser resurfacing, elevation of eyebrow tail with barbed sutures, etc. Prosthetic implants have also evolved in their structure, variety size and projections. Moreover, new techniques like intimacy surgery have appeared on scene for both genders.
Selection of an optimally capacitated, matriculated surgeon, well trained on evaluating valid combinations of technologies and techniques, will influence on satisfactory outcome with minimal surgical risk.
NON-INVASIVE AND MINI-INVASIVE PROCEDURES
There has been a rise in the number of the non-invasive and mini-invasive procedures. Fatty and synthetic fillers, botulin toxin injection, barbed sutures, medical depilation, radiofrequency, ultrasound cavitation, are some examples. With these options available, patient expectations on surgery have risen. Patients demand optimal results with less-aggressive, less-traumatic, lower-risk, short-recovery procedures. An increase in patients’ work-demands, and the amount of patient information available on the Internet, are also determining factors. In the last decade, plastic surgery has also evolved to satisfy those demands.
Surgical techniques have evolved at the time new technology development and evolution has occurred. Surgeons have to remain objective, with clear medical criteria, avoiding false promises. In general there has been a rise of 700% on the frequency of non-invasive procedures with only a 25% rise on esthetic surgery. Other factors also influenced plastic surgery. Scar location and size on breast and abdominal surgery have adjusted to cloth size and shape (a difficult challenge sometimes) in order to render them hidden. Even hair styling has influenced scar modeling.
MACS (Minimal Access Cranial Suspension (Tonnard & Verpaele, 2002) is a good example of a technique that allows younger patients to be treated, with a less aggressive, more natural result. Barbed Sutures also help to rejuvenate face and neck on a less aggressive manner. Associations with fat grafting performed by a specialist, have excellent results. Other associations can be made to include resurfacing with CO2 fractional laser on perioral shrinking, botulin toxin for forehead and periocular shrinks, and elevation of eyebrow tail with suspensor threads.
Similar trends are observed with abdominoplasties, where now a smaller, lower scar, is performed. Correction of separation of the rectum abdominal muscles should be considered in every case for good results. The introduction of Lipoabdominoplasties (Saldanha O., 2001), combining liposuction with conventional abdominoplasty, made results on this approach, even more satisfactory lowering risks and complications at the same time.
Superficial liposuction (Souza Pinto E. 1982), allowed treatment of the back, arms, internal aspect of thigh and sacral areas with minimal cutaneous retraction, avoiding the use of ultrasound or laser technology, although these still remain an excellent alternative.
Liposuction techniques have also evolved. They are more selective for fat, less painful and are performed with reduced blood loss. Thinner cannulas result in smaller scars. Laser technology allows treating lipodystrophy in a fast, less aggressive, fast recovering, manner allowing patients to resume normal activities in shorter times. Attention should be paid not to treat excessively large areas, or patients with a BMI higher than 30.
Hydro-electrolytic disorders or extensive burning can occur in such cases. On these patients, laser can still be used associated to conventional techniques. Wavelength for laser technology comes now in 980 or 1210 nm on the same equipment, rendering better treatment of adipose tissue with optimal cutaneous retraction. All these procedures can be performed in an ambulatory setting, with 24-48 h. immediate follow-up.
There has also been a rise in the use of fat grafting. Facial, gluteal and breast use are excellent examples. The possibility to combine these with growth factors has optimized the results and durability of treatments. In some cases, gluteal fat grafting results are good enough to replace implant placement for the same area. Associating liposuction of neighboring areas like hips and waist to gluteal treatment further enhances patient satisfaction.
The term “liposculpture” describes the procedure that takes place when excess of fatty tissue is removed from an anatomic location to be immediately placed in another, thus “sculpturing” human shape. On the contrary, on breast surgery, implants are still dominating, but fat grafting is an option to be considered for patients without a familiar history of breast cancer. Precise and adequate indication, allow the face to be treated volumetrically with fat grafts, without incisions, and good results.
All of these techniques have been questioned in the last 20 years. Today nobody has doubts about their value as individual treatment choices or enhancing others.
Breast implants have improved their design and incorporated more options, allowing further personalized indications. For an example, anatomic implants exist in 9 to 12 different shapes for a given size.
The optimization of surgical techniques, their prudential combination and the association to low-invasive or non-invasive procedures, have widely favored esthetic results. Is important to choose a well-trained, matriculated surgeon, which combines knowledge with good criteria, offers valid choices, does not create false expectations, and aims for the lower possible risk treatment.
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