Anesthesia for male aesthetic surgery

The male patient for aesthetic plastic surgery should expect to have a good experience, with few, if any complications from anesthesia. Proper planning is essential to the process, from setting up the surgical facility to selection and preparation of patients. Anesthetic techniques should be adapted to the needs of each patient, with his safety and comfort the most important consideration. Anesthesia for plastic surgery has progressed from simple injection of local anesthetics to sophisticated sedation and general endotracheal techniques. Better anesthetic drugs, monitors, and procedures for dealing with complications have made anesthesia a major factor in the advances of the plastic surgery specialty. Male patients frequently have different medical problems than their female counterparts have, including cardiovascular disease, hypertension, and smoking history. Other problems include back discomfort and prostate enlargement, both factors that must be taken into consideration with local sedation anesthesia techniques. The use of basic monitoring equipment has made ambulatory surgery safer for patients and has been instrumental in reduction of medication-related complications. Monitoring standards changed in anesthesia in the late 1980s to include electrocardiogram (EKG), precordial or pretracheal continuous monitoring, blood pressure, and pulse oximetry. In addition, if general anesthesia is used, end-tidal carbon dioxide and temperature monitoring and oxygen analysis of the anesthesia gases are also recommended. General anesthesia is being utilized more frequently in cosmetic surgery procedures and offers many advantages over local and conscious sedation techniques. The modern agents and techniques permit the patient to recover quickly, with minimum postoperative sequelae, and provide obvious comfort during the operative procedure. The traditional anesthesia technique for facial plastic surgery has been local anesthesia supplemented by sedation. This technique requires a combination of skillful local administration, selection of appropriate sedation drugs in proper doses, and a cooperative patient. Ideally, the selection and administration of drugs and monitoring of the patient should be by an anesthetist, who understands drug interactions and synergistic and additive effects of sedation drugs. Facility set-up, professional personnel, and recovery and discharge criteria are essential to good anesthesia care for the male aesthetic patient.     

Emerging trends and techniques in male aesthetic surgery

Cosmetic surgery has witnessed explosive growth over the past few years, and with this has come growth in male aesthetic surgery. Increases have been seen in the number of nonsurgical as well as surgical treatments. Rhinoplasty, hair transplantation, and blepharoplasty continue to be the most common surgical procedures. New trends include rapid growth in nonsurgical treatments, especially Botox Cosmetic and microdermabrasion. New fillers have expanded the options for men, including long-lasting Restylane and Radiesse. Sculptra offers a new option for correction of human immunodeficiency virus-associated lipoatrophy. Fractional photothermolysis and Thermage offer new options in resurfacing.     

Humanitarian aesthetic surgery

Must a face be disfigured by a terrible tropical disease, in order to make us realise that the well being of our gesture is aesthetically acceptable? Must our reparative motivation remain the only trace of our skill and our humanity? During a plastic surgery mission, so-called humanitarian mission, can this surgery be aesthetic? Can aesthetic surgery be humanitarian? We learnt from aesthetic surgery on humanitarian missions, that aesthetic is only a technic to assist the reparation aspect. There is no need to justify aesthetic by reconstruction, because aesthetic belongs, in its entirety, to reparation. There is no need either to feel guilty, when our technical gesture is aesthetic, since what really motivates our intervention is not for us to decide. Is the reparation of the cleft lip of a little Asian girl, a reparation gesture or only an aesthetic approach? You may think that this will be a reparation gesture, because it will be more "popular" or because you will reconstruct the muscular belt. This child will most probably look for a more beautiful or aesthetic lip (in any case, she ignores the intricacies of facial growth principles). Therefore, it will be an aesthetic intervention. Never mind the motivation, since your technic will be the same, and you will try to do your very best and the most aesthetically you can. Only the very intention behind an intervention will decide whether it is an aesthetic or a plastic intervention, whereas your technical gesture will remain the same. All this illustrates that our definitions are of a minor importance, compared with the mere satisfaction of our little Asian girl, which, hopefully, will be a "beautiful" satisfaction. In fact, we have learnt not to do aesthetic surgery, but to give an aesthetic approach to our surgery, even during our humanitarian missions. The form aesthetic surgery will take is very subjective and only the final result will have the last say. Hopefully this surgical result will be aesthetically and humanly acceptable.     

脂肪颗粒注射移植在面部美容外科中的应用

目的:总结脂肪颗粒注射移植在面部美容外科中的应用经验。方法:采用湿性吸脂技术用注射器在适当负压下吸取供区脂肪颗粒,采取脂肪量为准备移植量的2倍,经离心或静置沉淀去除水及液化的脂肪后,作为软组织充填物用2ml注射器经耳后、发际内或口腔内注射孔将脂肪颗粒注射到眉间、额颞部、颊区和鼻唇沟等部位,以达到矫正凹陷畸形或美容的目的。结果:临床治疗218例,手术效果满意,无明显手术后并发症。结论:本手术方法简单,效果肯定,目前可作为用于面部充填的首选方法。     

Mandibular contouring surgery for purely aesthetic reasons

The mandible's contour determines the shape of the lower part of the face and thus influences the appearance of the face and neck. There are two types of operative procedures that can be used on mandibular contour and they do not require orthodontic treatment: mandible angle reduction and genioplasty. We divided the mandible angle reduction group into Types A, B, and C according to the grade of angle protrusion. Type A needs just an angle resection, Type B needs an angle resection and resection of part of the body, and Type C needs resection of the angle, the body, and part of the symphysis. We have performed 258 mandibular contouring procedures. In genioplasty, shaving, advancement, shortening, and lengthening generally can be employed. Furthermore, when vertical lengthening is used, ostectomized mandible angle bone is carved and then grafted between the horizontal osteotomy site. Of the mandible angle reduction cases, 21 were Type A, 186 were Type B, and 28 were Type C. The curved ostectomy is most important in mandible angle reduction cases in order to achieve a more natural curve of the mandible's lower border. A total of 71 patients were very pleased with the results of the combined procedures of genioplasty and angle reduction.     

Advances in aesthetic surgery

The evolution of aesthetic surgery began centuries before the birth of Christ. Since Sushutra's first attempts, surgeons still try to achieve or reconstruct the perfection of individual beauty. Surgeons who are engaged in this field of plastic surgery are called cosmetic or aesthetic surgeons. Aesthetic surgery is not just a specialization concerned largely with the removal of the outward signs of aging, nor is it limited to plastic surgery for improvement by restoration of damaged areas of skin and removal of blemishes. Aesthetic surgery crosses the dividing line between surgery for reconstruction and alteration of deviations (which do not in themselves constitute objective deformities) and is sometimes even performed without medical indication, but just for the gratification of individual vanity. This article summarizes the progress of aesthetic surgery during the last decade in some aspects of the field and tries to estimate its' lasting value.

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Resumen La evolución de la cirugía estética comenzó siglos antes de Cristo. Desde los intentos iniciales de Sushutra, los cirujanos todavía tratan de lograr, o de reconstruir, la perfección de una belleza individual. Los cirujanos involucrados en este campo de la ciruga plástica se denominan cirujanos estéticos o cirujanos cosméticos. La ciruga estética no es sólo la especialización que se ocupa principalmente de la remoción de los efectos del envejecimiento, ni tampoco es sólo la ciruga plástica que se hace para el perfeccionamiento de una persona mediante la restauratión de áreas de piel lesionadas o la remoción de imperfecciones. La cirugía estética cruza la línea divisoria entre la cirugía de reconstrucción y la corrección de desviaciones que de por sí no constituyen deformaciones objetivas, lo cual en ocasiones se realiza sin indicación médica y sólo para gratificación de la vanidad individual. Este artículo resume el progreso de la ciruga estética en el curso del Último decenio en algunos aspectos de su campo y trata de estimar sus valores perdurables.

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Résumé L'évolution de la chirurgie esthétique a débuté plusieurs siècles avant Jésus-Christ. Depuis les premiers essais de Sushutra, les chirurgiens essaient encore de réaliser ou de refaire la perfection d'une certaine beauté. Les chirurgiens qui sont engagés dans le domaine de la chirurgie plastique sont appelés chirurgiens cosmétiques ou esthétiques. La chirurgie esthétique est non seulement une spécialisation largement concernée par la suppression des signes extérieurs de vieillesse, mais c'est aussi la seule chirurgie plastique avec perfectionnement d'une personne, restauration des sites endommagés de la peau et suppression des imperfections. La chirurgie esthétique passe par la ligne de partage entre la chirurgie reconstructive et la correction des défauts qui ne sont pas en eux-mÊmes des malformations pbjectives; elle est quelquefois mÊme accomplie sans indication médicale, simplement pour le plaisir de la vanité personnelle. Cet article résume les progrès de plusieurs aspects de la chirurgie esthétique pendant ces 10 dernières années et essaie de dégager ce qui en restera.

     

Clinical research in aesthetic surgery

Clinical research in aesthetic surgery cannot use traditional objective measures of surgical success. Present research designs and methods used in aesthetic surgery limit the ability to conduct meaningful clinical research. Outcomes research may be ideally suited for assessing patients in aesthetic surgery. A critical aspect of an outcomes-based approach is to select appropriate instruments for investigations. Widely accepted, standardized methods for assessing outcomes would allow for comparison of surgical techniques and provide a common basis for clinical investigations.     

Prophylactic antibiotics in aesthetic surgery

Improvements in infection prevention practices over the past several decades have enhanced outcomes following aesthetic surgery. However, surgical site infections (SSI) continue to result in increased morbidity, mortality, and cost of care. The true incidence rate of SSI in aesthetic surgery is unknown due to the lack of a national surveillance system, but studies of SSI across surgical specialties have suggested that many of these infections are preventable. Patient-related factors-including obesity, glycemic control, and tobacco use-may contribute to the development of SSI following aesthetic surgery. In terms of SSI prevention, proper handwashing and surgical skin preparation are integral. Furthermore, the administration of prophylactic antibiotics has been shown to reduce SSI following many types of surgical procedures. Unfortunately, there are few large, randomized studies examining the role of prophylactic antibiotics in aesthetic surgery. The authors review the medical literature, discuss the risks of antibiotic overutilization, and detail nonpharmacological methods for reducing the risk of SSI.     

Education in aesthetic plastic surgery

This paper deals with the dissemination, at different levels, of information beneficial to the specialty of aesthetic plastic surgery, its practitioners, and their patients.     

Complications of aesthetic laser surgery

Aesthetic laser surgery is not risk free. It behooves the laser surgeon to become intimately familiar with the potential adverse effects of laser use to guard against and to minimize their occurrence. Moreover, patients must be thoroughly, clearly, and honestly educated about the procedure and its risks so that their expectations are realistic and so that any complications that do occur can be recognized early and treated appropriately. This review summarizes basic laser safety and discusses the nature of complications that may occur during continuous-wave, pulsed dye, pigment-specific, hair removal, and resurfacing laser procedures.     

Present status and future prospects for aesthetic plastic surgery

The recent developments and changes in surgical procedures such as rhytidectomy, blepharoplasty, nasoplasty, otoplasty, mammoplasty, mammary reconstruction, and abdominoplasty are briefly reviewed in this article, which is substantially reduced in its overall length from the guest lecture given by the author at the Seventh International Congress of Plastic and Reconstructive Surgery held in Rio de Janeiro in May 1979, in his role as president of the International Society of Aesthetic Plastic Surgery (ISAPS).