Agnesian HealthCare Know & Go Showcase: Options in Plastic Surgery
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Dr. Richard Schaefer, a plastic surgeon at Agnesian HealthCare's Plastic Surgery & Cosmetics Services Center presents about the latest developments in plastic surgery & cosmetic services.
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Agnesian HealthCare Know & Go Showcase: Options in Plastic Surgery
- 1. Plastic Surgery Options RICHARD B. SCHAEFER, MD Agnesian Plastic Surgery & Cosmetic Surgery Fond du Lac * Ripon * Waupun
- 2. What Is Plastic Surgery? Surgery of the skin and all of its contents
- 3. What Is Plastic Surgery? • Craniofacial surgery - Cleft lip and palate • • • • • • • Hand surgery Microsurgery Transplant surgery Cosmetic surgery Dermatologic surgery Oculoplastic surgery Burn surgery
- 4. What Is Plastic Surgery? • Craniofacial surgery • Hand surgery - Finger replantation • • • • • • Microsurgery Transplant surgery Cosmetic surgery Dermatologic surgery Oculoplastic surgery Burn surgery
- 5. What Is Plastic Surgery? • Craniofacial surgery • Hand surgery • Microsurgery – Free tissue transfer • • • • • Transplant surgery Cosmetic surgery Dermatologic surgery Oculoplastic surgery Burn surgery
- 6. What Is Plastic Surgery? • Craniofacial surgery • Hand surgery • Microsurgery • Transplant surgery - J. Murray ‘54, Nobel ‘90 • • • • Cosmetic surgery Dermatologic surgery Oculoplastic surgery Burn surgery
- 7. What Is Plastic Surgery? • • • • Craniofacial surgery Hand surgery Microsurgery Transplant surgery • Cosmetic surgery - Facelift, tummy tuck • Dermatologic surgery • Oculoplastic surgery • Burn surgery
- 8. What Is Plastic Surgery? • • • • • • • • Craniofacial surgery Hand surgery Microsurgery Transplant surgery Cosmetic surgery - Facelift, tummy tuck Dermatologic surgery - Skin cancer Oculoplastic surgery Burn surgery
- 9. 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
- 10. 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
- 11. Aging • Muscles – Repeated skin folds - wrinkles • Volume Loss – What was once full, becomes deflated – Grape to raisin - wrinkles
- 12. Aging • Skin changes – Texture – Loss of elasticity - wrinkles – Sun damage • Gravity – Downward drift
- 13. See How the Face Ages
- 14. 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
- 15. Anatomy • Rhytids - wrinkles – Skin as fabric – Dynamic – Static
- 16. Wrinkle Treatment • Botox temporarily stops dynamic wrinkling • Lasts three to four months • $200 to $800 per treatment
- 17. Botox® • • • • Bacterial protein Relaxes muscles Dynamic wrinkles FDA approved – Glabellar lines
- 20. Botox® • Off label • ASPS 2004 • Shaping • Concensus Forehead Crow’s feet Neck Lips Nose Brow
- 21. Forehead
- 22. Crow’s Feet
- 23. Crow’s Feet
- 24. Neck Banding
- 25. 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
- 26. 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
- 27. 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.
- 28. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with one 1 mL syringe
- 29. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with two 1 mL syringes
- 30. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with three 1 mL syringes
- 31. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with two 1 mL syringes
- 32. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with three 1 mL syringes
- 33. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with two 1 mL syringes
- 34. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with two 1 mL syringes
- 35. Lips
- 36. Glabella
- 37. Glabella
- 38. Face
- 41. 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
- 42. Skin Care • Cleanse • Restore – Hydrate – Repair • Sun protection
- 43. 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
- 44. 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
- 45. Restoring - Repair • Alpha-hydroxy acids – – – – – Glycolic Lactic Malic Citric Tartaric • Tretinoin • Improves – – – – – – – – – Dryness Texture Acne Rosacea Photodamage Melasma Hyperpigmentation Wrinkles AK’s
- 46. Sun Protection • • • • • Zinc oxide Titanium dioxide Parsol 1789 Apply before makeup Reapply if outdoors
- 47. Anti-Oxidation • – 5% to 20% • Collagen synthesis • Neutralizes free radicals • Reduces inflammation • Brightens skin • • Vitamin C • • • • Surface texture Fine wrinkles Tactile roughness Coarse rhytids Skin laxity Sallowness
- 48. Other Antioxidants • • • • Vitamin E Co-enzyme Q-10 Squalene Data incomplete or not statistically significant
- 49. Bleaching Agents • Hydroquinone • Kojic acid • • • • Age spots Sun damage Irregular pigments Melasma
- 50. Results
- 51. Light-Based Treatments • Intense Pulsed Light (IPL) • Laser – Hair removal – Vein ablation – Resurfacing • Ablative • Non-ablative
- 52. How Do Light Therapies Work? • Specific target in skin absorbs energy • Non-target tissue remains unaffected • Target – Stimulate – Contract – Destroy
- 53. IPL – Photo-Rejuvenation • • • • • • • • Photo damaged skin Age spots Irregular skin pigments Telangectasia (small blood vessels) Redness of rosacea Fine hair No downtime Rapid treatments
- 54. IPL – Facial Pigments
- 56. IPL for Sun Damage
- 57. Upper Chest
- 58. 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
- 60. Body Contouring • Fat - liposuction • Skin • Muscle • Scars
- 61. Body Contouring • Fat • Skin - excisional therapies • Muscle • Scars
- 62. Liposuction • • • • Minimal scars Vacuums out fat Minimal skin tightening Can use internal energy sources to breakdown fat prior to suctioning – Ultrasound – Laser – Cool sculpting
- 63. Ultrasound Assisted Liposuction • Ultrasound – Breaks down fat – Individualize Settings – Sensitive Areas • Smooth results – Even shape and contour
- 64. Neck
- 65. Abdomen & Flanks
- 66. Abdomen & Flanks
- 68. Abdomen & Flanks
- 69. Men Too!
- 70. Breasts
- 72. Abdomen
- 73. Excisional Therapies • Tummy tuck • Belt lipectomy – Massive weight loss patient • Breast lift • Arm lift
- 74. Belt Lipectomy
- 75. Belt Lipectomy
- 77. Breast & Arms
- 78. Back
- 79. Facial Reshaping • • • • • Face lift Neck lift Rhinoplasty - Nose job Blepharoplasty - Eyelids Brow lift
- 80. Face & Neck
- 81. Rhinoplasty
- 82. Blepharoplasty - Eyelids • Upper – Relation to brow • Lower – Relation to cheek • Skin • Muscle • Fat
- 87. Brow & Upper Lids
- 88. Breast • Reduction • Augmentation • Lift (mastopexy)
- 89. Reduction • • • • • • • Neck pain Back pain - Upper, lower and mid Shoulder grooving Numbness/tingling in arms Skin rash/breakdown beneath breasts Difficulty exercising Insurance
- 90. Reduction
- 91. Hypomastia • Small breasts • Breast smaller than desired • Cosmetic
- 92. Breast Implants • Saline Filled – Small incision – Some ability to adjust volume – Ruptures obvious - deflation • Gel (silicone) Filled – Incision related to implant size – Ruptures silently
- 93. Augmentation
- 94. 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.
- 95. Hand Surgery • Soft tissue of the hand – Tendon repair – Ganglion cysts – Skin contracture – Trigger finger • Nerve release – Endoscopic carpal tunnel release – Ulnar nerve transposition
- 96. Varicose Veins • Leg pain • Leg swelling – Sock marks • Varicosities
- 97. Vein Valve Failure Normal vein: valve open and closed Dilated vein with nonfunctioning valve
- 98. Varicose Vein Treatments • Endovenous Radiofrequency Ablation • Has replaced stripping – Local anesthetic – In-office – No significant activity restrictions or pain
- 99. Micro or Stab Phlebectomy Pre-treatment: Varicose anterior accessory saphenous vein Post-treatment: Very minimal incision sites
- 100. Sclerotherapy • Injection of material to injure vessel causing fibrosis • Advantages – Short office procedure – Effective – Can be redone • Disadvantages – Allergy – Ulceration – Pigmentation
- 101. 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
- 102. 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
- 103. 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.
- 104. Skin Cancer • • • • • Basal Cell Carcinoma Squamous Cell Carcinoma Melanoma Excision Reconstruction
- 105. Mission Work • Philippines – Bulacan – Pampanga • Peru – Trujillo
- 107. Patient Wards
- 108. Facilities
- 109. Sterile Processing
- 110. Labor & Delivery
- 111. Drying Rack for Gloves
Notas del editor
- Page 10
- Page 36
- These pre- and post-treatment photos show a very good outcome
- Varicose veins are a common local condition that causes edema and skin discoloration. - These conditions can cause inadequate return of blood to the heart. - The resulting increased back-pressure in the veins forces fluid to leak into the interstitial tissue spaces, where the retained excess fluid is recognized as edema. - Hyperpigmentation occurs as a result of underlying vein disease and is a very common finding with Stage II venous insufficiency. [Source: http://www.medicinenet.com/edema/page2.htm]
- Stasis dermatitis has an estimated prevalence of 6% to 7% in adults over the age of 50. In the United States, this is thought to be between 6 and 7 million people. [Source: http://circ.ahajournals.org/cgi/content/full/111/18/2398]
- Lipodermatosclerosis: hardening of the legs in patients with venous insufficiency. It is characterized by induration, hyperpigmentation, and depression of the skin. A venous ulcer is a chronic defect in the skin that fails to heal spontaneously, and is caused by chronic venous disease