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Subject: Plastic and Reconstructive Surgery FAQ (PRS-FAQ)

This article was archived around: 19 Jul 1999 19:37:21 GMT

All FAQs in Directory: medicine/surgery
All FAQs posted in: alt.health, misc.health.alternative, sci.med
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Archive-name: medicine/surgery/plastic Posting-Freqency: monthly Last-modified: 1999/06/28 Version: 1.1 Copyright: (c) 1998-1999 Robert A. F. Green Maintainer: Robert A. F. Green <mooncrow@lava.net>
TABLE OF CONTENTS Section A - INTRODUCTION Section B - PRS-FAQ ADMINISTRATIVE SECTION Section C - ERRATA Section D - CHANGES SINCE THE LAST VERSION Section E - GENERAL QUESTIONS Section F - PROCEDURE-SPECIFIC QUESTIONS ----------------------------- Section A - INTRODUCTION A.1 - What is this document? A.2 - What is the purpose of the PRS-FAQ? A.3 - Where can I obtain the PRS-FAQ? A.4 - Copyright, Terms and Conditions of use. ----------------------------- Subject: A.1 - What is this document? This is the Plastic & Reconstructive Surgery Frequently-Asked Questions (PRS-FAQ), a list of often-asked questions (and their answers) on the subject of various cosmetic and reconstructive procedures, as well as related topics. ----------------------------- Subject: A.2 - What is the purpose of the PRS-FAQ? We have compiled these topics to serve as a central informational resource to assist prospective patients (and the general public) in learning about Plastic and Reconstructive Surgery, and related fields. ----------------------------- Subject: A.3 - Where can I get a copy of the PRS-FAQ? The primary site for the PRS-FAQ and its maintainer is at the sponsoring web site at <http://plastic-surgeon.org> It is available here for download in text form. An HTML version will also be available in the future. It is available via e-mail request from the maintainer: mooncrow@lava.net It is posted once per month to the following newsgroups: alt.health misc.health.alternative alt.answers misc.answers news.answers ----------------------------- Subject: A.4 - Copyright, Terms and Conditions of use. This document is Copyright 1998,1999 Robert A. F. Green, all rights reserved. It is freely distributable in its original, unedited form for private use only. No other reproduction, in whole or in part, or as inclusion as part of any larger work, or other form of distribution is authorized without the express permission of the maintainer. Mirroring of the document or linking via the World-Wide Web is welcomed, however please notify the maintainer (so that links and mirrors may be kept up to date with the most correct versions of the PRS-FAQ). ----------------------------- Section B - PRS-FAQ ADMINISTRATIVE SECTION B.1 - DISCLAIMER B.2 - CREDITS B.3 - CONTACT INFORMATION B.4 - VERSION NUMBER AND DATE OF RELEASE ----------------------------- Subject: B.1 - Disclaimer This document is for information purposes only. While every effort is made to ensure the accuracy of the information contained in the PRS-FAQ, we cannot guarantee the accuracy of the information contained here. Additionally, the maintainer is not a physician, and by no means should the information here be taken as medical advice. This document is intended for personal study, and the reader is advised (and in fact encouraged) to consult with a qualified physician for additional information and actual medical advice prior to making any decisions regarding surgery or other health care matters. The maintainer(s), sponsor(s), and contributor(s) of the PRS-FAQ cannot and will not be responsible for any action made based on information contained in this document. ----------------------------- Subject: B.2 - Credits This document is compiled and maintained by Robert A. F. Green (mooncrow@lava.net). The information presented here is based on multiple sources, including (in part) physician interviews, newspaper and other media articles, and the patient education information of various private physicians and professional organizations in the appropriate fields. Credit and thanks must also go the following physicians and organizations: Marco Rizzo, M.D. (who's web site is the sponsor of the PRS-FAQ) The American Society of Plastic and Reconstructive Surgeons, Inc. The American Society for Aesthetic Plastic Surgery, Inc. (Please note that this list is not necessarily complete, and that additional input and information as well as additional questions, are welcomed, and will be appropriately credited wherever possible). ----------------------------- Subject: B.3 - Contact info The PRS-FAQ maintainer is available via e-mail as mooncrow@lava.net. You may also contact the maintainer via the sponsoring web site, <http://www.plastic-surgeon.org> ----------------------------- Subject: B.4 - Version number and release date This is version 1.1 of the PRS-FAQ, dated June 28, 1999. (PRS-FAQ 1.1, 06/28/99). ----------------------------- Section C - ERRATA ----------------------------- Subject: C.1 - Errata none this revision ----------------------------- Section D - CHANGES SINCE THE LAST VERSION ----------------------------- Subject: D.1 - Changes since the last version. - Addition of information regarding trans-navel breast augmentation. ----------------------------- Section E - GENERAL QUESTIONS ----------------------------- Section E Contents E.1 - What is Plastic Surgery? E.1.a - What kind of plastic do you use? E.1.b - Why plastic instead of some other material? E.2 - What is the history of Plastic & Reconstructive Surgery? E.3 - What is the difference between 'Cosmetic' and 'Reconstructive' surgery? E.4 - What parts of the body can you do surgery on? E.5 - What are typical costs of the procedures? E.6 - Is there any visible scarring? E.7 - What is the typical recovery time? E.8 - Will the cost of surgery be covered by my medical insurance? E.9 - How long does _______ take? E.10 - How long will it take to heal? E.11 - What are the risks of _____ ? E.12 - Can you make me look like (fill in name of celebrity here)? E.13 - What are the most common procedures? E.14 - Endoscopes and Plastic Surgery ----------------------------- Subject: E.1 - What is Plastic Surgery? E.1.a - What kind of plastics are used? E.1.b - Why Plastic rather than some other material? Plastic surgery is named from the Greek word "plastikos" which means "to shape", based on the surgeon re-shaping the form of the patient's form through surgery. It has nothing to do with the types of materials used in the surgery itself. In surgery, many different materials may be utilized, depending on the desired results and the type of surgery. Frequently, the surgeon will make use of the patient's own tissues, including tissues from another location of the body, or by reshaping the existing tissues to achieve a better appearance. Historically, many materials have been used in cosmetic and reconstructive surgery, including ivory, wood, and others. In modern times, hard silicone rubber is a popular material. This should not be confused with the gel silicone which has sparked so much controversy through its use as a filler for breast implants. ----------------------------- Subject: E.2 - What is the history of Plastic Surgery? Information being compiled ----------------------------- Subject: E.3 - What is the difference between "Cosmetic" and "Reconstructive" surgery? Generally speaking, if a surgery is done primarily to improve the health of a person, or the function of an organ, it is considered medically necessary. Surgeries such as corrective rhinoplasty to improve air flow through the nose, or eyelid surgery to improve the field of vision by lifting sagging, droopy eyelids might fall into this category. These surgeries may or may not also improve the patient's appearance, but this is a secondary purpose. If a surgery is done with the primary goal of improving the appearance of the patient, this is considered a cosmetic procedure. Usually these procedures must be paid for out of pocket, except in some cases of correcting accidental or congenital deformity. It is worth noting that these lines are often blurry, especially in terms of coverage by medical insurance. As an example, a scar revision for an automobile accident injury may be covered by an auto insurance policy, yet another surgery, identical from a medical standpoint, that resulted from an accident fall injury might not be covered by insurance. Another example is breast reconstruction following breast cancer surgery -- some insurance companies will cover this, while others consider this primarily cosmetic in nature. It goes without saying that this is a hotly contested issue between those insurance companies and the affected patients. ----------------------------- Subject: E.4 - What parts of the body do you do Plastic Surgery on? There are commonly performed cosmetic procedures for virtually every part of the face, including the neck, nose, eyes, ears chin, cheekbones, forehead, as well as the breasts and abdomen. Additionally, scar revision and liposuction surgeries are potentially possible on most areas of the body. ----------------------------- Subject: E.5 - How much does it cost on average? Note that the following are averages of *SURGEON'S FEES ONLY* and you should expect to pay additional fees for almost all of these procedures to cover the costs of surgical and/or hospital facilities, medications, nursing care, anesthesia, etc, and that (for some procedures) these additional costs may total as much or more than the surgeon's fee itself. Source: American Society of Plastic & Reconstructive Surgeons, Inc. Plastic Surgery Information Service AVERAGE STANDARD SURGEON'S FEE 1997 PLASTIC SURGERY PROCEDURAL STATISTICS Abdominoplasty Standard fee $4,050 Combined with suction Standard fee - $4,504 Blepharoplasty (both upper lids) Standard fee - $1,664 (both lower lids) Standard fee - $1,752 (both uppers and lowers lids) Standard fee - $2,905 Breast Augmentation Standard fee - $2,909 using Endoscope Standard fee - $2,917 Breast Reduction Standard fee - $5,230 Breast Lift Standard fee - $3,480 Buttock Lift Standard fee - $4,059 Chemical Peel - full face Standard fee - $1,565 - regional Standard fee - $ 776 Collagen Injections (per 1 cc) Standard fee - $ 312 Dermabrasion Standard fee - $1,581 Facelift Standard fee - $4,783 Fat Injections - head / neck Standard fee - $ 987 - trunk Standard fee - $ 794 Forehead lift Standard fee - $2,429 with Endoscopic Standard fee - $2,738 Gynecomastia Standard fee - $2,513 Laser Resurfacing - Full face Standard fee - $2,719 - Partial Standard fee - $1,284 Malar Augmentation Standard fee - $2,083 Male-Pattern Baldness Plug grafts Standard fee - per plug treatment) $ 745 Strip grafts Standard fee - $1,424 Otoplasty (Ear surgery) Standard fee - $2,508 Rhinoplasty (open) Standard fee - $3,428 (closed) Standard fee - $3,186 Rhinoplasty (Secondary) (open) Standard fee - $3,388 (closed) Standard fee - $3,232 Liposuction (Suction-Assisted Lipectomy) for any single site Standard fee - $1,842 ultrasound technique Standard fee - $2,304 ----------------------------- Subject: E.6 Is there any visible scarring? Any time a cut or incision is made in the skin, there is a scar left behind as part of the normal healing process. Plastic and Reconstructive Surgeons have received special training and have extensive experience with minimizing the size of these scars, creating the least noticeable appearance of then, and locating them in the least conspicuous areas possible. Often the scars will become undetectable to all but the most careful examination over the course of time. ----------------------------- Subject: E.7 - How long is a typical recovery period for most operations? Generally, 1-2 weeks for most procedures, although this varies from one patient to the next, as well as from one procedure to the next. ----------------------------- Subject: E.8 - Will it be covered by my medical insurance? In general, if it is cosmetic, your medical insurance will not cover the surgery or treatment. (See the questions regarding the difference between 'plastic' and 'reconstructive' surgeries for more on this topic). ----------------------------- Subject: E.9 - How long does it take for an operation? On an average, most surgeries take 2-3 hours in the operating room, with the most extensive of multiple procedures lasting several hours. Additional time is often required for preparation before, and rest & recovery time after the surgery itself, particularly when sedation or a general anesthetic is administered. ----------------------------- Subject: E.10 - How long does it take to heal? This varies greatly depending on the procedure in question. For small, non-invasive procedures, such as laser tattoo removal, or collagen therapy, patients are ready to return to normal activity immediately after treatment. For procedures like laser skin resurfacing or blepharoplasty, patients may be ready for most normal activities in 3-6 days, while more extensive surgeries such as abdominoplasty or extensive liposuction may require a more extended convalescence. The body's complete healing process takes longer than this initial recovery time, and may last from several week up to a year or more as incisions heal completely and tissues achieve their maximum recovery. ----------------------------- Subject: E.11 - What are the risks? All surgeries entail risks, such as bleeding, possible infection, etc. Please see the information on the specific surgery, or consult with a qualified surgeon for more detailed information. ----------------------------- Subject: E.12 - Can you make me look like (insert name of favorite celebrity here)? Plastic surgery can achieve impressive results for a patient with realistic expectations and goals. To many, the results may even seem 'miraculous', however to think you can be made over so completely as to look just like another person entirely is still the stuff of Hollywood movies and fiction novels Cosmetic plastic surgery's primary focus on refining a person's appearance, rather than changing it entirely. ----------------------------- Subject: E.13 - What are the most common surgeries? Among the most frequently performed surgeries are: breast augmentation surgery, rhinoplasty, facelift and blepharoplasty (eyelid surgery). ----------------------------- Subject: E.14 - What about the use of endoscopes in plastic surgery? Is this just a sales tool? What is the advantage of using an Endoscope in plastic surgery? What procedures are performed with it? The endoscope is an instrument which allows the surgeon to utilize a very small incision and still see the actual surgical location deep under the tissues. This means that a minimal scar in the axilla can be made, without compromising the results of the surgery. To achieve an equivalent degree of visibility and control without an endoscope, the surgeon would need to make a larger incision in a more visible location. For comparative purposes, this type of procedure is similar in nature to orthoscopic surgeries that have become popular in the media recently for joint surgeries on athletes. This is not to say that a good result cannot be achieved without an endoscope, but it is more challenging for the surgeon, who is operating solely 'by feel'. ----------------------------- SECTION F - PROCEDURE-SPECIFIC QUESTIONS ----------------------------- SECTION F CONTENTS F.1.A - ABDOMINOPLASTY Can abdominoplasty eliminate the 'stretch marks' I have left from after my pregnancy (or other weight gain)? SURGICAL PROCEDURES OF THE BREAST F.2.A - AUGMENTATION MAMMOPLASTY F.2.A.1 - I have heard about breast implants that use soy bean oil as the filler of the implant? Can you tell me more about this? F.2.A.2 - Why textured vs. smooth implants for the breast implants? What is the difference? What are the advantages / disadvantages? F.2.A.3 - What is the advantages / disadvantages of the (axillary / infra- mammary / peri-areolar) approach for breast augmentation? F.2.A.4 - How much enlargement can I get? What is the maximum limit? What determines this limit? AFTER BREAST AUGMENTATION: F.2.A.5 - Will I be able to breast feed? F.2.A.6 - Will my breasts be 'saggy'? F.2.A.7 - Will my breasts become 'saggy' later on? F.2.B.1 - Can plastic surgery correct inverted nipples? Can I enlarge or reduce the size of my nipples? F.2.B.2 - I have heard about breast augmentation through the belly button. Can you tell me more about this? F.3 BLEPHAROPLASTY F.3.A - I have heard the term 'laser eyelid surgery' or 'laser blepharoplasty' before. What does this mean? What is the difference between this and the other blepharoplasty? F.3.B - Will having blepharoplasty affect how my contact lenses fit? F.4 RHINOPLASTY F.4.A - I have heard that some doctors can do nose surgery by making the incision inside the nose (where the scar is not visible). Why aren't all rhinoplasty surgeries done this way? F.5 LIPOSUCTION F.5.A - I have heard the phrase 'tumescent liposuction' used before. What does this mean? F.99 OTHER MISC. PROCEDURES F.99.A PENIS ENLARGEMENT ----------------------------- ABDOMINOPLASTY Subject: F.1.A: - Can Abdominoplasty eliminate "stretch marks" from my pregnancy? If the stretch marks are located in the incision area for the surgery (below the belly button) then they can be removed in the course of abdominoplasty. In locations not at the incision, site, they cannot be removed, although it is sometimes possible to use a different incision location to accomplish this goal. Surgery on just the stretch marks alone will merely trade the stretch marks for an incision scar, and is a generally a poor trade-off considering the cost and effort of surgery. ----------------------------- BREAST SURGERY ----------------------------- Subject: F.2.A.1 - I heard about soy bean oil / peanut oil /hydro gel as a filler material for breast implants. What are those? Currently, only saline-filled implants are approved for general use in the United States. There has been experimentation with soybean oil, peanut oil, and hydro gel as fillers for breast implants, but these are not approved for general use in the USA, and it does not appear likely that any of these will be approved for use in the foreseeable future. ----------------------------- Subject: F.2.A: - What is the difference between textured & smooth breast implants? What are the advantages & disadvantages of each? Softness of the breast following augmentation, along with a natural appearance, are primary concerns to both the surgeon and the patient. The ideal result is one which is natural in all respects. Smooth implants are the softest implant immediately after they are placed, but they require ongoing massage and mobilizing by the patient to maintain this result. Additionally, they may only be placed under muscle layer of the chest. In nearly all patients, within a few years after the surgery, the massaging becomes too inconvenient to continue, and as a result, the breast will lose the softness that gives the most natural result. Textured implants are slightly more firm when initially placed, however they require no special upkeep on the part of the patient to maintain their softness. Additionally, they can be placed either under or over the muscle layer (when appropriate for some patients), which gives the surgeon more control to obtain the best result for the patient. (see "How much can the breast be enlarged?" for more information regarding placement under or over the muscle layer). For this reason, the textured implants are the preferred choice of many surgeons. ----------------------------- Subject: F.2.A.3 - What is the advantage of axillary approach for breast augmentation? The axillary approach has several advantages for most patients. First, it does not invade the breast tissues directly, going underneath instead. Secondly, there is no scar left on the skin of the breast -- instead the scar is located in the armpit area, which is a much less noticeable location. This is the preferred approach for patients who have do not have pendulous (saggy) breasts. ----------------------------- Subject: F.2.A.4 - How much can my breasts be enlarged? What is the limit of this? Why is it limited? The degree of enlargement is based on the anatomy of the patient's body more than any other factor. Saline-filled implants require placement underneath the muscle layer of the chest to achieve a natural result in most patients. The implant must be covered by the muscle layer, and this coverage determines the maximum volume of the implant. The width of the patient's chest, as well as the locations of nerves in the chest and abdomen limit the maximum volume of an implant that can be used, because the total width of the implant must fit underneath the muscle without intruding into the nerve bundles, otherwise numbness of the breast and/or nipples would result. For some patients, placement of the implant may be possible on top of the muscle layer, providing they have a sufficient amount of breast tissue and fatty tissue to give the implant the coverage needed to achieve natural results. Your surgeon can help you determine the best size of implant for you at the time of your consultation. AFTER BREAST AUGMENTATION: ----------------------------- Subject: F.2.A.5 - Will I be able to breast feed? Breast augmentation (under the muscle layer) should not affect your ability to breast feed. For sub-glandular augmentation (under the breast tissue, but over the muscle layer), like any other surgery which disturbs the breast tissue itself, there is a risk of losing the ability to breast feed. ----------------------------- Subject: F.2.A.6 - Will my breasts still be saggy? Sagging of the breast is a factor determined by your body. Some degree of sagging can be corrected with the breast augmentation surgery, but not an excessive degree. For an excessive degree of sagging, a mastopexy or 'breast lift' may be the solution. ----------------------------- Subject: F.2.A.7 - Will my breasts sag later? Again, this is a factor of your body's makeup. In general, if the factors which caused the sagging in the first place (heavy breast tissue, lack of elasticity of the skin, etc), are still present, then the breasts will again begin to sag over time. If correcting this sagging is of primary importance to you, your surgeon can discuss other alternative surgeries which may be done instead of, or in addition to the breast augmentation procedure. ----------------------------- F.2.B.1 - Can plastic surgery correct inverted nipples? Can I enlarge or reduce the size of my nipples? The nipples can be reduced in size, or correction of 'inverted' nipples can be done. This can be done along with breast augmentation, or alone as a separate surgery. With inverted nipples, the problem is that the ducts are short, plus the connective tissue adherence participates. One very effective technique to correct this is four small cuts around the nipple (division of the ducts) and suture support. This heals quite quickly, a week to ten days, and with this technique, recurrence is almost never seen. ----------------------------- F.2.B.2 - I have heard about breast augmentation through the belly button. Can you tell me more about this? This type of procedure is called a 'trans-navel approach'. An incision is made in the umbilicus (belly button) area. An endoscope is placed through this incision, and a tunnel is made to each breast. The implant is placed by rolling it up in a tubular shape and then pushing it through the endoscope to the breast where it is inflated. Pushing the implant through the scope carries an increased risk of damage to the implant, and I am told that implant manufacturers do NOT honor the warranty if this method is used. With the cost of implants alone ranging from $1000 to $1500 this is a very important point. Other comments from surgeons included a significant increase in the length of the surgery (up to 2 hours, according to one surgeon), and a signification reduction in the control of the placement of the implant, A survey approximately 1 dozen reputable surgeons in a major city showed that *none* of them perform this technique, including one surgeon who had done the preocedure with this technique during his surgical training and felt that the more conventional methods were very much superior. ----------------------------- BLEPHAROPLASTY ----------------------------- Subject F.3.A.1 - Regarding blepharoplasty, what methods are used? What about "laser blepharoplasty"? What's the difference? The conventional blepharoplasty utilizes an incision (with creation of the eyelid fold if needed), removal of excessive skin, muscle, and fatty tissue to provide the best, most consistent, and longest-lasting result. Removal of the skin only, without attention to the underlying tissues achieves a smaller degree of correction, and is not as long lasting. "Laser" blepharoplasty is a combination of surgery and light resurfacing of the skin, with no removal of the excessive skin of the eyelid. This primarily treats the fatty tissue deposits without removing excessive skin, so it is most effective for younger patients. Older eyelids require removal of the excessive skin to achieve the full benefit of the surgery. F.3.B - Will having blepharoplasty affect how my contact lenses fit? Blepharoplasty surgery only works on the skin and muscle of the eyelids area -- how your contact lenses fit is based on the sahpe of your eye itself. Although you won't be able to wear contact for the first few days after surgery (to allow time for the healing process to begin without disturbance) blepharoplasty surgery will not change how your contact lenses fit or function. ----------------------------- RHINOPLASTY ----------------------------- Subject: F.4.A.1 - What about nose surgery from inside the nose? ----------------------------- LIPOSUCTION ----------------------------- Subject: F.5.A.1 - What is "tumescent" liposuction? The tumescent technique is a relatively new liposuction method that can reduce post operative bruising, swelling and pain. Also, blood loss is minimized during tumescent liposuction due to the effects of the local anesthetic which is used. In the tumescent technique, areas of excess fat are injected with a large amount of anesthetic liquid before liposuction is performed. The liquid causes the compartments of fat to become swollen and firm or "tumesced." The expanded fat compartments allow the liposuction cannula to travel smoothly beneath the skin as the fat is removed. This can give multiple benefits -- extra precision for the surgeon, reduced loss of blood for the patient, and extended pain relief after surgery, which can reduce the need for pain medication immediately after surgery. ----------------------------- F.99 MISC / OTHER PROCEDURES ----------------------------- F.99.A Penis Enlargement Surgery (Editor's note: although only a handful of specializing surgeons perform this procedure, inquiries to plastic surgery office regarding this procedure are frequent, therefore we include this for information purposes.) The most common surgical procedures for 'penis enlargement' utilize cutting the ligaments which suspend the penis, which is designed to lengthen the externally visible portions of the organ, and by injection of fat or other graft or material to increase the width. According to Mayo Clinic website information: (http://www.mayohealth.org/mayo/9608/htm/penile.htm) "in a vast majority of cases", retraction of scar tissue where the ligament is cut eventually results in a *shorter*, rather than longer penis and injection of fat or other material usally results in a loss of natural form and a "bumpy", "irregular shape" The article goes on to say that data presented at an American Urological Association meeting was met by an "appalled" response with what the presenting surgeon called 'success'. (The surgeon in question subsequently had his medical license suspsended and faced legal proceedings) A related article in _The Journal of Urology_ (Dec 1997) addresses reconstruction of deformities resulting from these procedures. In part, it references that the procedures used to attempt 'enlargement' of normal organs are actually based on techniqeus developed to correct abnormal deformities. The author goes on to say that, while not all surgeries and techniques should be condemned based on a few faulty techniques, but he also notes that frequnetly the patient was not adequate informed of potential complications, and that correcting these complications is difficult and often requires more than one procedure to achieve an adequate reconstruction. Additionally, it is noteworth that the American Urological Association does not advocate or endorse these procedures: Policy Statement of American Urological Association _________________________________________________________________ American Urological Association, Inc. 1120 N. Charles Street, Baltimore, Maryland 21201 o Phone 410-727-1100 Penile Augmentation Surgery The American Urological Association (AUA) considers subcutaneous fat injection for increasing penile girth to be a procedure which has not been shown to be safe or efficacious. The AUA also considers the division of the suspensory ligament of the penis for increasing penile length in adults to be a procedure which has not been shown to be safe or efficacious. Board of Directors, January 1994 _________________________________________________________________ What about implants for the buttocks? What about cheekbone reduction? What about chin reduction?