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Plastic reconstructive and aesthetic surgery

By: Dr. Júlio Matias

[email protected]

EVEN THOUGH everyone has heard or spoken about “plastic surgery” for many years, it is a young and innovative specialty. Due to the rapid development of microsurgery, we now have the chance to cure patients with large defects that could not be treated 50 years ago.

The word comes from the Greek plastikos, which means to mould or form. Plastic surgery operations are mostly a matter of shifting or moving tissue to change forms or create new ones. In a breast reconstruction, after a mastectomy, a new breast can be created from the adipose tissue of the stomach. In a reduction rhinoplasty (aesthetic nose surgery) the cartilage is shaped and the bony hump is resected to create a new form.

Plastic surgery is not merely a matter of aesthetic surgery – reconstructive surgery is at least as equally important.

How can two disciplines as different as aesthetic and reconstructive surgery be placed in the same category? The reason is that the techniques used are the same, or at least very similar. For example, the technique of skin loosening and lifting in a face lift is similar to that found in finding the facial nerve to correct facial paralysis or safely excising a parotid gland tumour.

This medical speciality encompasses every region of the body and includes a variety of pathologies of different aetiologies (meaning causes), which can be summarised into five major groups:

Traumatology

Trauma situations necessitate urgent attention and include lesions of the soft tissue and bones of the face and hands, burns and loss of bulk of any part of the body. Examples are cases of fractures of the nose or jaw or wounds of the hands, which include nerve or tendon involvement.

Tumours

Includes the two large groups of lesions: Benign tumours, such as cutaneous moles, which are located in important anatomical regions like the lips or eyelids, as well as lipomas (fat masses under the skin), mandibular (jaw) cysts, tumours of the salivary glands, synovial cysts of the hand, which are cysts of the membrane that protects the joints and contains their lubricating liquid. Malignant cutaneous tumours (Melanoma, Basocelular or Spinocellular Carcinoma) when a lot of tissue is lost, due to the need for an enlarged resection and the closing of the incision, requires skin flaps (localised plastic surgery with inserts) or grafting.

Acquired pathologies

Encompasses a large variety of situations, such as correction of scars from accidents (torn ear lobes) or previous surgery, mammary reconstruction with the use of expanders, prosthesis or tissue from the patient, animating a face after a paralysis, carpal tunnel syndrome, Dupuytren contractions, problems of the hand due to rheumatoid arthritis, pressure ulcers (sores) that are still unfortunately frequent in bedridden patients.

Congenital or development lesions

Habitually exists from birth, such as haemangiomas that are like ball of little blood vessels, syndactyly (fusion of the fingers or toes), facial clefts, bat ears, breast hypoplasia and breast asymmetry (Poland Syndrome).

Aesthetic surgery

Involves the whole of the body and includes procedures with minimal invasion (such as “Botox” and soft tissue fillers) normally used in the face for correction of superficial wrinkles, filling of lips or nasojugal (nasolabial) sulcus and more invasive operations for obtaining long lasting results, such as facial rejuvenation with blepharoplasty (correction of skin excess of the eyelids and underneath the eyes), minilifting and the classic cervico-facial lifting. Aesthetical breast surgery is very important and it englobes three techniques including enlargement (through using silicone implants), reduction and lifting. Corporal remodelling can be attained through lipoaspiration (lipoplasty, lipostulpture, vibrolipoaspiration, ultrasonic lipoaspiration …) with small incisions (three to five millimetres) or when there is an excess of cutaneous tissue, which require larger incisions (and resulting scars) to return desired form and firmness such as in the case of abdominoplasty (stomach), brachioplasty (arms and axilla) and cruroplasty (medial thighs).

Aesthetic surgery can be very attractive, but it is very important for safety reasons to choose an accredited specialist and to be aware of some of the misleading marketing campaigns. Training in aesthetic surgery is inseparably related to reconstructive surgery. This is why many European nations only allow plastic surgeons to perform aesthetic surgery. All over occidental Europe the minimum requirement is to obtain a specialist degree in the surgeon’s country of residence or a European Board of Plastic Reconstruction and Aesthetic Surgery (EBOPRAS). Exam submission and approval is generally gained after six years of residency in an appropriate department.

Dr. Júlio Matias is apecialist in Reconstructive and Aesthetic Plastic Surgery and a Member of the Portuguese National School of Specialities and Member of EBOPRAS.