Imperfect Results
April 15th, 2009
Cosmetic surgery is a complex blend of art, medicine and surgery. As such, imperfect results and complications do occur. Physicians and patients alike feel badly when things do not turn out perfect. However, there are many reasons for these events to occur, which neither the surgeon nor the patient have any control.
The healing process is complicated. All of us heal a little differently. When some scars resolve, they can be wider or thicker than others. Swelling sometimes takes longer than expected to completely dissipate. Scar tissue may build up under the skin, which detracts from the desired result, particularly after nose surgery. These differences may contribute to the final result.
Surgeons go to great lengths to create detailed instructions for patient care after surgery. The instructions are based on years of training and experience with their surgical techniques. Careful attention to the instructions is essential in providing the patient with the best result and reduce the risk of complications.
There is a common misconception that we are exactly the same on each side of our body. This is not true. Small differences in symmetry are present in all of us. It is the expression of these subtle differences which will often embody unique beauty. We turn to cosmetic surgery when differences are perhaps too great and it interferes with our self-esteem.
Anatomy cannot be predicted with 100% accuracy. There is variations in how we as humans are put together. Nerves and blood vessels can be in locations which are simply different than most other people. This phenomenon is referred to as anatomical variation. Slight birth defects can result in structural differences in anatomy. Just last week I cared for a patient who did not have part of her pectoralis (pec) muscle. This anomaly was taken into consideration in the way we chose to design her surgery.
One of the few guarantees I can make about cosmetic surgery is there will be differences when each side is compared to the other after surgery. I recommend revision surgery to my patients only if the differences are significant.
Face Transplant
April 14th, 2009
Wow, a second US face transplant was completed at Brigham and Women’s Hospital last week. This is a true improvement in the way plastic surgeons reconstruct patients suffering massive, deforming facial injuries. In this particular case, most of the mouth was restored. The surgery will go a long way in allowing the recipient to eat and drink again. In addition, the physical appearance will be better than the results of any of the other reconstructive techniques we have available.
Transplant surgery is no stranger to plastic surgeons. Skin, bone and cartilage are use by all plastic surgeons in reconstructive and cosmetic surgery. Of course, this is usually comes from a patent’s own tissue. When the first kidney transplant was done in 1954, the transplant surgeon was Dr. Joseph E. Murray, a plastic surgeon. The donor was the recipient’s identical twin brother. Dr. Murray received a Nobel Prize for this surgery in 1990.
With the advent of greater understanding of transplant drugs and transplant rejection, transplant surgery has come full circle back to plastic surgeons. Before this time it was felt that external transplanted donor tissue would heal poorly, if at all. It was also feared that external injury would not be tolerated in the face, resulting in possible graft rejection. Plastic surgeons are once again on the cutting edge of transplant surgery.
We are a long way form the movie Face/Off. External donor transplants for hands and face are still in their infancy, but making great strides. The risks of anti- rejection drugs can only be justified when significant functional improvement can be shown. It will be decades until these new techniques can be applied to elective cosmetic surgery.
Follow Us!
