Plastic, Reconstructive and Aesthetic Surgery

Plastic, Reconstructive and Aesthetic Surgery; is a field of surgery working body image to be corrected and form and function disorders, congenital or subsequent anomalies to be removed. "Plastic" is a word originating from the Greek "plasticos" word and means "shaping", "to fit a mold".   "Reconstructive" is a latin-originated word and means "redo".

Plastic, Reconstructive and Aesthetic Surgery; deals with all types of surgical problem occurred on the entire body surface. Cases disrupting the form and functions of the body may be traumatic or acquired origin. For instance, cleft lip/palat, conjoined fingers (syndactyly), vascular bulks (such as hemangiomas) occurring congenital; burns occurring traumatic, facial injuries depending on traffic accidents, various incisions and organ ruptures; a variety of skin and soft tissue tumors occurred as acquired are in this surgical discipline area.

Bone (especially face-head and hand bones) and losses on the cartilage (such as ear and nose cartilages), deformities, pathological events (tumor, parasites, infection, etc.) are in the interest of plastic surgery. Microsurgery, laser systems, endoscopy as well as classic surgical methods and a variety of chemical agents and medicines may be benefited for this.

In summary; Plastic, Reconstructive and Aesthetic Surgery works to repair all kinds of defect (gap) effecting subcutoneous bones on the entire body surface. Basic rule is to make repairment with tissues similar to lost tissues when carrying out this.

Aesthetic Surgery (Cosmetic Surgery) is a sub-branch in plastic surgery. Aesthetic (or cosmetic) deals with the operation and attempts made to provide aesthetic (or cosmetic) surgical body image more beautiful and perfect. There are much more aesthetic problems rather than a medical problem. There are many news for aesthetic aspects of plastic surgery in the media and therefore perhaps public knows plastic surgeons as persons, who performs aesthetic surgery. However, plastic surgeons deal with repairment surgery (reconstructive surgery) at a larger proportion in clinics.

All plastic surgeons are the only competent surgeons in performing operations and receive Plastic surgery training at the same time during expertise trainings. Plastic surgery requires a long training and experience. Such operations require both surgical and artistic talent. In plastic surgery, not only aesthetic problems are solved but also sometimes medical problems are solved. For example, surgical correction of in giant sizes of breasts (gigantomastia) and an obese body solves both medical and aesthetic problems. In addition to aesthetically correction of this organ, its function is also extremely important. For example: in the aesthetic nose surgery (rhinoplasty) is corrected with form and breathing problems.

Field of Interests of Plastic, Reconstructive and Aesthetic Surgery

• Facial deformities
• Asymmetry, congenital masses, rare facial clefts
• Cleft lip-palate craniofacial- maxillofacial anomalies (eg., jaw, face and skull bone deformities, irregularities and deficiencies)
• Orthognathic surgery (jaw closing disorders)
• Tragus absence, prominent ear and other deformations (lobe, bowl, pointy ears) ,
• Nasal defects, tumors, ruptures
• Salivary gland problems
• Congenital tumors, nevi (moles), masses, vascular malformations, hemangiomas
• Facial bone and soft tissue traumas
• Maxillofacial surgery (traffic accidents, tumors and bone defects-breaks occurring due to other reasons, form and function disorders, jaw surgery)
• Head and neck tumors and repair of these defects
• Breast lack, asymmetry or excess breast tissue
• Breast reconstruction after cancer
• Gynecomastia (large breasts in men)
• Congenital abnormalities of the genital organs (epispadias, hypospadias, vaginal agenesis, etc.)
• Chest and abdominal wall defects
• Hand surgery (trauma, tumors, finger transfers, finger-extension repairs, etc.)
• Hand and foot deformities and deficiencies
• Peripheral nerve problems (trauma, neuropathies, defects, masses)
• Skin and soft tissue tumors
• Acute burns and deformations occur after burning, contractions, shrinkages, the damages on soft tissues caused by electrical and chemicals substances
• Wounds which occur on skin and derma by various infections, radiation and other effects
• Chronic wounds (pressure sores, venous wounds, diabetic foot wounds etc.)

Fields in Aesthetic Surgery

• Aesthetic and functional nose reshaping (Rhinoplasty,septorhinoplasty)
• Facial Rejuvenation ( rhytidoplasty,- circumoral and eyelid revisions, treatment of wrinkles)
• Endoscopic face-forehead lifting, lifting eyebrow,
• Eyelid surgery (blepharoplasty),
• Treatment of prominent ear and other problems in tragus,
• Chin augmentation and reduction operations (mentoplasty),
• Removal of skin scar and irregularities,
• Hair transplantation-replacement
• Laser applications (Facial peeling, the removal of marks and vascular malformations)
• Operations related to reduction of skin-subcutaneous fatty tissue fatty tissue (liposuction- lipektomi)
• Abdomen lifting (Abdominoplasty)
• Leg contour regenaration ( liposuction, with injections or leg implants)
• Contour regeneration (hip and thigh implants, male pectoral (breast) implants-leg implants) with implants ( prostheses applied to soft tissue)

Skin Care and Interventions

Operative or non-operative methods can be consulted separately or together to reach the aim in aesthetic surgery. For example face lifting (rhytidectomy) is firstly performed in face rejuvenation then chemical peeling and filling material injection for lines and skin blemishes can be performed. I should not be forgotten that aesthetical problems which require operation (such as; sagging skin, regional lipoidosis, hypertrophic breast) can only be treated by operative methods. Some methods, which have not scientifically proven yet, (mesotherapy, carboxytherapy etc.) and generally applied by plastic surgeons do not provide a significant benefit.

Such assistive methods as: peeling methods (by laser, chemicals or mechanic peeling) for skin blemishes, thin wrinkles, acne or old scars; fat injections (lipofilling) for fossa and contour disorders; filling materials for depressed scars and wrinkles (such as: collagen, hyaluronic acid); botox application for forehead and eye around lines, fat and various filling material injections for thicking lips are also performed in aesthetic surgery apart from the major operations listed above.

Sub-branches specialized in Plastic Surgery:

Aesthetic (Cosmetic) Surgery

They are the operations which are performed for patient's having a more aesthetic and proportional body. Relevant part of the body (nose, breast, abdomen) is made to be more excellent and concordant to surrounding contours by basing on anatomic and aesthetic dimensions. Fat injections and a variety of implants may be benefited in this surgery.

Maxillofacial Surgery: it deals with all kinds of facial bones surgery. Facial bone fractures, tumors, orthognathic regenerations, ( placing bacward or forward of jaw), treatments of congenital facial clefts are included in this field.

Craniofacial Surgery

It deals with the abnormalities and deformities in the parietal bone. Parietal deformities realized after the birth (tower head, hammer head, flat head) are treated by craniofacial surgery because it will negatively affect the brain development.

Microsurgery

It is surgery performed under the operation microscope with special microsurgical instruments. Replantation of severed hand, foot and other tissues can be performed with this surgical technique. Transfer of tissues from other area to a defect (free flaps) is also possible as well as the severed organ can be regained its function thanks to suture of small vein and nerves. Today, thin vessels and nerves up to 0.5 mm can be sutured.

Hand Surgery

The traumatic defects on hand (cuts, bruises, ruptures), treatment of deformities and function disorders, treatment of congenital disorders (finger abnormalities, syndactyl, supernumerary fingers, cleft hand, hand deformity etc.) generation of tendons and nerves, hand tumors, hand burns treatment can be performed thank to hand surgery.

Endoscopic Surgery

Face and forehead lifting, placing breast prosthesis, vein and nerve surgery have become possible with the help of endoscope.

Aesthetic Breast Reduction Surgery

What is the aesthetic breast reduction surgery? Who are the appropriate candidates for this surgery? Although aesthetic breast reduction surgery seems to be one of cosmetic surgeries performed to improve the external appearance of the woman, it is essentially a reconstructive operation not an aesthetic one. Sagging breast caused by massiveness may cause back and neck pain and lead to kyphosis in the woman. Numbness may occur depending on pressure of brassiere towards nerves of neck.

There may be difficulty in breathing. There may be intertrigo and wounds in inframammary fold as a result of continuous rubbing of breast and chest skin.

The daily activities may be limited. In addition, while the fleshy breast causes difficulties in cloth choice, woman's not being at peace with herself cause social and psychological problems. An operation for the reduction of breast gives a natural appearance to the breasts, the problems mentioned above are removed and thus it facilitates the life of the person. Breasts may be big because of different reasons. Fleashy breasts which are not proportional to body size may occur as a result of genetic factors, hormonal changes or some diseases.

The existing problem may increase by weight changes, breast feeding and gravity effect. The increase of breast tissue and fleashy breast depending on this may be seen in young girls.

Aesthetic Mastopexy Surgery

What is aesthetic mastopexy surgery? Who are the people appropriate for this surgery? Breasts may be saggy because of many reasons. The bonds keeping breast tissue in its place may loose. There may be inconsistency between breast tissue and the surrounding skin by depending on the weight changes, breast-feeding and gravity effect. The problems may occur in breast tissue, skin or both of them. In the end there may be a saggy breast almost looking as hollow.

Pre-Operative

You should discuss with your doctor about why you want to have this operation and what you expect from this surgery like in the other breast surgeries. If you have breast disease or cancer, smoking drug habits or systemic disease in your family, please share this with your doctor. Please, consult your doctor for operation method and possible problems.

Surgery?

In the aesthetic mastopexy surgery, the saggy breast tissue is regenerated, excess skin is removed. Nipple is placed to the area it should locate. The surgery is performed by general anesthesia in hospital conditions at hospital. The surgery lasts 1, 5-2 hours. There may be scars in different forms according to the ptosis level. It is inevitable to have a scar on the nipple no matter which method of mastopexy surgery is performed. If a mastopexy surgery is performed by cutting around nipple, the scar around nipple may be more apparent. In the other mastopexy surgeries, there may be a 4-5 cm scar extending from the middle of below part of nipple downwards in addition to the scar in the nipple. In the appropriate patients, the ptosis can be removed by only using breast prosthesis. In this case, the surgery scar is hidden in the joint area between brownish skin of nipple and white skin of breast and it becomes minimal. There is no mastopexy surgery which does not leave a scar. However, these are the scars which are apparent in the beginning and unapparent in time.

Postoperative Period?

Post operative period generally passes comfortably. The pain mostly does not constitute any problem. If the breast prosthesis is used during surgery, there may be limitations in the arm movements for several days. A dressing similar to brassiere is applied on the breasts. A separate dressing is placed on nipple. The dressing is unrolled after 2 days and the wound is checked. The dressing is unrolled and after 7 days. The stitches of the patient are removed after 7-10 days. A sports brassiere is dressed to the patient for 6 weeks and the massage is advised. There may be swelling, numbness on nipples and color changes on skin in the early period. These disappear spontaneously in short time.

Get back into circulation?

The patient can go back to work in 3-4 days. The patient is advised to stay away from heavy sports for 3 months. Mastopexy surgery is generally a surgery which gives good and permanent results and improves the patient and her husband’s mental health and increases their conduct of life. Regenerated breast becomes stable for a long time; however weight changes, pregnancy and gravity effect may cause new ptosis.

Aesthetical Blepharoplasty

What is Aesthetical Blepharoplasty?

The relaxation, excess, sagging on eyebrows and upper and lower eyelids and in addition, bags especially caused by forward herniation of fatty tissue under lower eyelids may occur. The vision may be prevented by saggy upper eyelids closing in front of the eye in addition to deteriorate aesthetical appearance.

The excess skin is removed by aesthetical blepharoplasty and the membrane in front of the herniation fatty tissue is strengthened and/or the fatty bulk seen as excess is removed. By this way, both good appearance and visual efficiency is increased.

A scar remains along upper eyelid. However, this scar is only seen when it is nearly looked because it is adapted to crasis of eyelid. There will be a scar below the eyelash in lower eyelid; the rest of the scar seems as a normal skin line on side. The eyelids are the regions of the body which leaves the least scar.

Who are good candidates for this surgery?

Generally people, which are above 35 years of age, and begins to have ptotis and bags on the lower and upper eye lids and have no other health problems, are the candidates for this surgery.

Surgery?

The surgery is performed in hospital conditions under doctor supervision of anaesthesiologist. The local anesthesia and intravenous sedation (intra venal narcotizing) is preferred. Upper or lower eyelids or both lower and upper eyelids can be operated at the same time depending on the patient’s existing complaints. The surgery lasts averagely 1-1, 5 hours. It is possible to go home in the same day.

Post-operative Period?

The post operative period mostly passes very comfortably. Swelling and bruising may occur around the eyes. Dryness, burning feel, blurred vision may occur in eyes. Tear may increase; eyes may be disturbed by light. The patient may not completely close her/his eyes in the first days. These are the expected issues which remove simultaneously. The suture is removed after 3-5 days.

Get back into circulation?

The surgery gives good results. Rarely, revision (surgical reintervention) may be required. The patient can go back to work after 3 days. If the patient uses contact lenses, he/she can use them. The new form of the eyelids may last sometimes lifetime and sometimes for few years depending on patients’ structures because the eyelids will be affected by gravity.

Aesthetical Nose Surgery (Rhinoplastly)

Aesthetical nose surgery (Rhinoplastly) or reshaping surgery of nose is the most common aesthetical surgeries. Aeshetical nose surgery may make your nose smaller or bigger, reshape the nose tip or nasal septum, narrow the nostrils or reshape the angle between your nose and upper lip. At the same time, congenital deformity or a deformity caused by an injury can be regenerated or the problems preventing breathing can be removed.

• When aesthetical nose surgery is beneficial?
• How is it performed?
• What can you expect as a result?

If you deal with aesthetical nose surgery, this page may not answer all of your questions. Please consult your doctor if there is anything which you do not understand.

Most appropriate cases for Rhinoplastly

Aesthetical nose surgery may beautify your appearance and enhance your self confidence. However, this does not mean that your appearance will definitely match with the appearance in your dream and the other people will behave differently to you after the surgery. Before deciding to surgery, please ask yourself why you want this surgery and what you expect from this surgery and think carefully then discuss the situation with your doctor. The most appropriate patients for aesthetical nose surgery are no

not the ones who look for perfection but the ones who expect beautification and improvement in their appearance.

Aesthetical Temporal Side and Forehead (Lifting Eyebrows) Lifting Surgery

On the forehead, there are normally transverse lines which vary depending on the person. These lines become vertical between eyebrows. Forehead skin begins to be relaxed and sag in parallel with aging like the face skin and the existing lines become deeper. In time, the eyebrows move down and a tired-looking face occurs. Malnutrition, smoking, irregular life styles, stress, air pollution, inadequate skin care or even not- made skin care, gravity effect and mimes facilitate this case which disturbs aesthetically.

Who are appropriate candidates for this surgery?

This surgery is mostly performed for the men and women over the age of 40 and do not have another health problem. The lines in forehead are minimized by lifting forehead surgery. The eyebrows sagging towards the eyes are placed to the area where they should be by lifting and the patient is provided with a fresh vision. At the same time, some of the lines around eyes partially are removed. If you have large amounts of sagging skin and the skin is required to be removed and the classical forehead lifting method is performed. In the classical method, a scar like a crown remains 4-5 cm behind of the hairline; however this scar is hidden into the hairy skin. However, when this method is performed, there will be a temporary loss of sensation in hairy skin for a long time. The eye brow lifting method, which is perfomed to bring the eyebrows in their normal place, is intertwined with a forehead lifting surgery. There is no need for a separate eyebrow lifting operation. The eyebrow lifting method, which is perfomed by only accessing from the temporal region and partially lifting of forehead method, is not a preferred method.

Surgery?

Forehead lifting surgery can be performed by endoscopic methods in recent years. It has become possible to get the same results with 3 or 4 pieces of 2-cm incisions from behind of the hairline to hairy skin in the patient not requiring removal of excess tissue. This method is performed most of the patients. The post-operative period passes more comfortably and the numbness in the hairy skin does not occur or becomes minimal in this method. The surgery is performed in the hospital conditions under anesthesiologist supervision in the operating room. The local anesthesia or intravenous sedation (intra venal narcotizing) methods can also be performed in addition to general anesthesia. It lasts 1, 5-2 hours. It is possible to go home in the same day. It can be performed simultaneously with the other aesthetical surgeries if it is necessary. In this case, the surgery and hospitalization duration becomes longer.