The Four Basic Steps in Plastic Surgery- #2







Hoar Frost on Lake Minnetonka, across from my Surgery Center.

Step 2: Dissection.

Once the skin has been divided, access to the underlying tissues is possible.   Some degree of dissection is necessary to proceed with the next step of surgery.   Dissection is simply the division or separation of underlying structures.   Either a combination of skin and fat is released or skin, fat and muscle are released.   It all depends on the type of cosmetic surgery.   Liposuction releases skin and fat from the underlying fat and muscle.   Breast enlargement releases skin, fat, breast tissue and muscle from ribs and muscle.

Please check back next time for Part 2 of this series and coming soon:                     Lisa’s Rhinoplasty  surgery (nose job) blog.

The most serious complication of this step is excess bleeding.   As the saying goes, “If it was not for bleeding, anyone could do surgery.”   An exaggeration to be sure, but there is some truth to it.   If excessive bleeding is not carefully controlled, serious complications can result from the uncontrolled bleeding.   If there is too much blood loss, life can be threatened.   Bleeding after a facelift or tummy tuck also can lead to skin death, which causes terrible scars.   Bleeding after breast enlargement often leads to breast firmness, called capsular contracture.

There are three variables that determine the amount of bleeding during surgery. They include dissection technique, dissection plane and the use of vasoconstricting medications.   It is my experience that a blunt dissection technique although fast, leads to the greatest amount of bleeding.   I prefer to take a little extra time and complete dissection with surgical scissors or electro-cautery, done under direct visualization.   Planes or spaces separate many structures in the body.   These spaces allow normal movement of body parts relative to each other.   The planes are traversed by few blood vessels.   When dissection is performed within these planes, it disrupts fewer blood vessels, which in turn reduces bleeding.   Some surgeries such as breast enlargement, take full advantage of this principle.   The space between the ribs and pectoralis muscle (where we usually put breast implants) is one of these planes with limited blood vessels.   Dissection within tissues following administering a vasoconstricting (blood vessels get smaller or thinner) medication, also results in far less bleeding.   This practice has been proven to be invaluable during liposuction procedures and it is the cornerstone of the tumescent liposuction technique.

Please check back next time for Part 3 of this series and coming soon:                     Lisa’s Rhinoplasty  surgery (nose job) blog.



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