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Agnesian HealthCare Know & Go Showcase: Options in Plastic Surgery
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Transcript of Agnesian HealthCare Know & Go Showcase: Options in Plastic Surgery
![Page 1: Agnesian HealthCare Know & Go Showcase: Options in Plastic Surgery](https://reader038.fdocuments.us/reader038/viewer/2022103016/554ae81fb4c905852a8b4e0b/html5/thumbnails/1.jpg)
Plastic Surgery Options
RICHARD B. SCHAEFER, MDAgnesian Plastic Surgery & Cosmetic Surgery
Fond du Lac * Ripon * Waupun
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What Is Plastic Surgery?
Surgery of the skin and all of its contents
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What Is Plastic Surgery?
• Craniofacial surgery - Cleft lip and palate• Hand surgery• Microsurgery• Transplant surgery• Cosmetic surgery• Dermatologic surgery• Oculoplastic surgery• Burn surgery
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What Is Plastic Surgery?
• Craniofacial surgery
• Hand surgery - Finger replantation• Microsurgery• Transplant surgery• Cosmetic surgery• Dermatologic surgery• Oculoplastic surgery• Burn surgery
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What Is Plastic Surgery?• Craniofacial surgery• Hand surgery
• Microsurgery – Free tissue transfer• Transplant surgery• Cosmetic surgery• Dermatologic surgery• Oculoplastic surgery• Burn surgery
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What Is Plastic Surgery?• Craniofacial surgery• Hand surgery• Microsurgery
• Transplant surgery - J. Murray ‘54, Nobel ‘90• Cosmetic surgery• Dermatologic surgery• Oculoplastic surgery• Burn surgery
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What Is Plastic Surgery?
• Craniofacial surgery• Hand surgery• Microsurgery• Transplant surgery
• Cosmetic surgery - Facelift, tummy tuck• Dermatologic surgery• Oculoplastic surgery• Burn surgery
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What Is Plastic Surgery?
• Craniofacial surgery• Hand surgery• Microsurgery• Transplant surgery• Cosmetic surgery - Facelift, tummy tuck• Dermatologic surgery - Skin cancer• Oculoplastic surgery• Burn surgery
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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
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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
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Aging
• Muscles – Repeated skin folds - wrinkles
• Volume Loss– What was once full, becomes deflated
– Grape to raisin - wrinkles
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Aging
• Skin changes– Texture
– Loss of elasticity - wrinkles
– Sun damage
• Gravity– Downward drift
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See How the Face Ages
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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
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Anatomy
• Rhytids - wrinkles– Skin as fabric– Dynamic – Static
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Wrinkle Treatment
• Botox temporarily stops dynamic wrinkling• Lasts three to four months• $200 to $800 per treatment
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Botox®
• Bacterial protein• Relaxes muscles• Dynamic wrinkles• FDA approved
– Glabellar lines
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Botox®
• Off label
• ASPS 2004
• Shaping
• Concensus
Forehead Crow’s feet Neck
Lips Nose Brow
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Forehead
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Crow’s Feet
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Crow’s Feet
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Neck Banding
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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
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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
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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.
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Restylane® Results
Nasolabial folds before treatment
After treatment with one 1 mL syringe
Individual results may vary.
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Restylane® Results
Nasolabial folds before treatment
After treatment with two 1 mL syringes
Individual results may vary.
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Restylane® Results
Nasolabial folds before treatment
After treatment with three 1 mL syringes
Individual results may vary.
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Restylane® Results
Nasolabial folds before treatment
After treatment with two 1 mL syringes
Individual results may vary.
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Restylane® Results
Nasolabial folds before treatment
After treatment with three 1 mL syringes
Individual results may vary.
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Restylane® Results
Nasolabial folds before treatment
After treatment with two 1 mL syringes
Individual results may vary.
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Restylane® Results
Nasolabial folds before treatment
After treatment with two 1 mL syringes
Individual results may vary.
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Lips
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Glabella
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Glabella
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Face
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Facial Rejuvenation
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Facial Rejuvenation
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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
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Skin Care
• Cleanse
• Restore– Hydrate
– Repair
• Sun protection
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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
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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
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Restoring - Repair
• Alpha-hydroxy acids – Glycolic– Lactic– Malic– Citric– Tartaric
• Tretinoin
• Improves– Dryness– Texture– Acne– Rosacea– Photodamage– Melasma– Hyperpigmentation– Wrinkles– AK’s
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Sun Protection
• Zinc oxide• Titanium dioxide• Parsol 1789• Apply before makeup• Reapply if outdoors
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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
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Other Antioxidants
• Vitamin E• Co-enzyme Q-10• Squalene• Data incomplete or not statistically
significant
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Bleaching Agents
• Hydroquinone• Kojic acid
• Age spots• Sun damage• Irregular pigments• Melasma
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Results
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Light-Based Treatments
• Intense Pulsed Light (IPL)• Laser
– Hair removal– Vein ablation– Resurfacing
• Ablative • Non-ablative
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How Do Light Therapies Work?
• Specific target in skin absorbs energy• Non-target tissue remains unaffected• Target
– Stimulate– Contract– Destroy
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IPL – Photo-Rejuvenation• Photo damaged skin• Age spots• Irregular skin pigments• Telangectasia (small blood vessels)• Redness of rosacea• Fine hair• No downtime• Rapid treatments
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IPL – Facial Pigments
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IPL - Telangectasias
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IPL for Sun Damage
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Upper Chest
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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
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Body Contouring
• Fat• Skin• Muscle• Scars
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Body Contouring
• Fat - liposuction• Skin• Muscle• Scars
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Body Contouring
• Fat• Skin - excisional therapies• Muscle• Scars
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Liposuction• Minimal scars• Vacuums out fat• Minimal skin tightening• Can use internal energy sources to breakdown
fat prior to suctioning– Ultrasound– Laser– Cool sculpting
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Ultrasound Assisted Liposuction
• Ultrasound– Breaks down fat– Individualize Settings– Sensitive Areas
• Smooth results – Even shape and contour
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Neck
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Abdomen & Flanks
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Abdomen & Flanks
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Abdomen & Flanks
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Men Too!
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Breasts
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Abdomen & Breasts
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Abdomen
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Excisional Therapies
• Tummy tuck • Belt lipectomy
– Massive weight loss patient• Breast lift• Arm lift
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Belt Lipectomy
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Belt Lipectomy
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Total Body Rejuvenation
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Breast & Arms
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Back
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Facial Reshaping
• Face lift• Neck lift• Rhinoplasty - Nose job• Blepharoplasty - Eyelids• Brow lift
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Face & Neck
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Rhinoplasty
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Blepharoplasty - Eyelids• Upper
– Relation to brow• Lower
– Relation to cheek• Skin• Muscle• Fat
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Upper Blepharoplasty
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Transconjunctival Blepharoplasty
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Four Lid Blepharoplasty
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Four Lid Blepharoplasty
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Brow & Upper Lids
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Breast
• Reduction
• Augmentation
• Lift (mastopexy)
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Reduction
• Neck pain• Back pain - Upper, lower and mid• Shoulder grooving • Numbness/tingling in arms• Skin rash/breakdown beneath breasts• Difficulty exercising• Insurance
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Reduction
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Hypomastia
• Small breasts• Breast smaller than desired • Cosmetic
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Breast Implants
• Saline Filled– Small incision– Some ability to adjust
volume– Ruptures obvious - deflation
• Gel (silicone) Filled– Incision related to implant size– Ruptures silently
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Augmentation
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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.
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Hand Surgery• Soft tissue of the hand
– Tendon repair– Ganglion cysts– Skin contracture– Trigger finger
• Nerve release– Endoscopic carpal tunnel release– Ulnar nerve transposition
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Varicose Veins
• Leg pain• Leg swelling
– Sock marks• Varicosities
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Vein Valve Failure
Normal vein: valve open and closed Dilated vein with non-functioning valve
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Varicose Vein Treatments
• Endovenous Radiofrequency Ablation • Has replaced stripping
– Local anesthetic– In-office– No significant activity restrictions or pain
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Micro or Stab Phlebectomy
Pre-treatment: Varicose anterior accessory saphenous vein
Post-treatment: Very minimal incision sites
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Sclerotherapy
• Injection of material to injure vessel causing fibrosis
• Advantages– Short office procedure– Effective– Can be redone
• Disadvantages– Allergy– Ulceration– Pigmentation
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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
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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
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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.
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Skin Cancer• Basal Cell Carcinoma• Squamous Cell Carcinoma• Melanoma• Excision• Reconstruction
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Mission Work
• Philippines– Bulacan– Pampanga
• Peru– Trujillo
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Patient Wards
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Facilities
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Sterile Processing
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Labor & Delivery
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Drying Rack for Gloves
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Questions?
Thank You!