PLASTIC, RECONSTRUCTIVE AND ESTHETICS SURGERY
Plastic and Reconstructive Surgery (Re-making and Reparation Surgery)
Plastic and Reconstructive Surgery is a branch of surgery that corrects congenital or acquired anomalies, eliminate dysfunction and improves body image. Plastic is a Greek word ´´plasticos´´ and it means ´´to shape´´, ´´to fit mold´´. On the other hand reconstructive is a Latin word and it means ´´re-making´´.
Plastic and Reconstructive Surgery is taking care of all the surgery problems that may occur on the body´s surface. Incidents that disrupt the body´s form and functions can be of congenital, traumatic or acquired origin. For example: cleft lips-palates, syndactyl, vascular masses (like hemangiomas) as a congenital ones; burns, facial injuries due to traffic accidents, several incisions and organ ruptures formed as a result of trauma; a variety of skin and soft tissue tumors, chronic wounds as acquired one are all within the scope of this surgical discipline. Bones (especially face, head and hand) and the cartilaginous framework (such as the ears and nose cartilage) losses, deformations, pathological events (tumors, cysts, infection, etc.) are also in the scope of plastic surgery. For this purpose, in addition to conventional surgical methods, microsurgery, laser systems, endoscopy and a variety of chemical agents and drugs can be used and implemented.
In summary, the Plastic and Reconstructive Surgery works to repair any kind of defect (gap) affecting the entire body surface – skin, subcutaneous and bones. In doing this the basic rule is to repair the lost tissues with the similar ones.
The interest areas of plastic and reconstructive surgery are:
Facial deformities- Asymmetry, congenital masses, rare facial clefts
Craniofacial-maxillofacial anomalies (e.g.: deformities, irregularities and deficiencies of jaw, face and skull bones
Orthognathic surgery (jaw closing deformities)
The absence of the pinna, prominent ears and other forms of deformities
Nose defects, tumors, ruptures
Salivary gland problems
Congenital tumors, nevi (moles), masses, vascular malformations, hemangiomas
Face bones and soft tissues traumas
Maxillofacial surgery (Bone defects- fractures- shape and function disorders due to traffic accidents, tumor, etc.)
Head and neck tumors and repair of their defects
Breast absence, asymmetry or breast tissue excess
Breast reconstruction after the cancer
Gynecomasty (big breast with men)
Congenital abnormalities of genital organs (epispadias, hypospadias, vaginal agenesis, etc.)
Repair of the genital organs, replantation of ruptured organs,
Chest and abdominal wall defects
Hand surgery (trauma, tumors, finger transfers, finger repairment-extensions etc.)
Deficiencies and deformities in hands and feet
Peripheral nerve problems (trauma, neuropathies, defects, masses)
Skin and soft tissue tumors
Acute burn and post-burn deformities, convulsions, shrinkage, and soft tissue wounds due to electrical and chemical damage
Skin and subcutaneous injuries formed due to various infections, radiation and other influences
Chronic wounds (pressure sores, venous wounds diabetic foot wounds, etc.)
For repairment in Plastic Surgery the first rule is to choose the simplest and least harmful method. First primary repair of a wound (to suture, etc.) is considered, and if there is a tissue lost than graft (skin patch) should be done. In situation when this method is not appropriate (like a deep and complex tissue loses, open bone and tendon injuries) flaps must be used. According to the state and place of tissue defect, flaps are planned within the right flowchart from the simple local flap (e.g. skin flaps) to the composite flap (containing multiple tissues). The basic rule of plastic surgery is: in order to repair the lost tissue the nearest one should be used. Before both plastic and esthetic surgery, autologous tissue (taken from patient itself) should be appropriate one to use. However if the donor areas for autologous tissue or patient is not suitable it can be referred to other sources (homograft, heterograft and alloplastic materials).
For example, for the wide burns it is preferred to take first the skin grafts (skin patches) from the patient´s healthy areas. If these areas are not enough, skin taken from cadavers (homograft) or even the one taken from animals (heterograft) can be used. Those outside the autografts are used on people as a temporary biological cover, not for keeping the wound. Another example can be given for the bone lost. In case of face bones lose first bone from another body area is taken and applied to defected area. However, if this source is insufficient or not usable, alloplastic materials (porous polyethylene, hydroxyapatite, titanium) can be used.
Esthetic Surgery (Cosmetic Surgery)
It is a side branch within plastic surgery. Esthetic (or cosmetic) surgery is working on operations and initiatives made in order to reach more beautiful and perfect body image. Here the problems are of esthetic rather than medical nature. In media there is more news about the esthetic side of plastic surgery and maybe because of that people are thinking of plastic surgery as only the esthetic one. However plastic surgeons are in majority dealing with reconstructive surgery.
All plastic surgeons experts are also being thought about esthetic surgery during their education so for these operations they are the only authorized surgeons. Long education and experience is needed for esthetic surgery. For these operations both surgery and artistic talent is needed. Esthetic surgery sometimes can solve medical problems, not only the esthetic ones. For example, surgical correction of an obese body or breasts grown till giant size (gigantomas) solves both medical and esthetic problems. Besides the esthetic correction, it is also extremely important to take care of function of corrected organ. For example: in esthetic nose surgery (rhinoplasty), both shape and breathing problems must be corrected in an appropriate manner.
One of the most often made esthetic operations in Turkey are: breast esthetic surgery (augmentation-reduction-lift), nose surgery (rhinoplasty), body contour surgery (liposuction, lipectomy, abdominoplasty), face lift-renewal, eyelid surgery (blepharoplasty), auricular correction (prominent ears).
For esthetic surgery it is necessary to refer to the expert plastic surgeon. Esthetic surgery made by doctors from other branches may cause medical, ethic and legal problems. If the surgery is made by unauthorized individuals instead of solving the problem, it may cause strong complications. Because of this patients with the above mentioned problems should definitely apply to ´´Plastic and Esthetic Surgeons´´ for their own benefits.
Fields in the scope of Esthetic Surgery
Esthetic and functional nose correction (rhinoplasty, septorhinoplasty)
Face renewal (face lifting, revision of eyelid and around mouth, treatment of wrinkles)
Endoscopic face-forehead lifting, brow lifting
Eyelid surgery (Blepharoplasty)
Prominent ear, pinnae and correction of other esthetic problems
Jaw augmentation and reduction operations (mentoplasty),
Elimination of skin scars and irregularities,
Laser applications (face peeling, removal of stains and vascular malformations
Cosmetic breast operations: Augmentation, reduction and lifting
Operations for the reduction of excess skin-subcutaneous fat tissue (liposuction-lipectomy)
Stomach lifting (abdominoplasty)
Leg contour correction (fat removal, injections or with leg implants)
Implants (soft tissue applied prosthesis) contour adjustments (hip and thigh implants, male pectoral (chest) implants, (like leg implants)
To achieve goal in esthetic surgery, operative and non-operative methods can be applied together or separately. For example, in facial rejuvenation first the face lift (rhytidectomy) is done, then chemical peel for fine lines and spots (peeling) and the injection of filler is used. It should be noted that esthetic problem that require operation (like sagging skin, localized fat accumulations, breast hypertrophic) can only be solved by operation method. Instead of operations, methods that are out of plastic surgery scope and not yet scientifically approved (mesotherapy, carboxsytherapy, etc) may not be beneficial.
Except for the above mentioned major operations, esthetic surgery is using peeling methods for spots, fine wrinkles, acne or old scars (with lasers, chemical or mechanic peeling); fat injections for disorders of concavity and contour (lipofilling); depressed scars and wrinkles fillers (collagen, hyaluronic acid); botox application for forehead and eye edge lines, and other helping methods, like various fillers oil injection, are used also for lip thickening.
Turkish Plastic Surgery´s scientific, as well as surgical skills, are very well known in the whole world. All the plastic and esthetic surgeries that are performed in the world are done with the same quality in Turkey. Many foreign patients are coming to Turkey for the treatment or operation.
Specialized side branches of plastic surgery:
Esthetic (Cosmetic) Surgery implies operations done in order for patients to reach more esthetic and proportional body. Based on anatomical and esthetic dimensions, relevant parts of the body (nose, breast, abdomen) are made more perfect and harmonized with the surrounding contour. In this surgery variety of implants and fat injections can be utilized.
Maxillofacial Surgery: It deals with all kinds of facial bone surgery. Facial bone fractures, tumors, orthognathic corrections (taking jaw forward or backward), congenital facial clefts are to be corrected in this surgery branch.
Craniofacial Surgery: It corrects abnormalities in the bones of the skull and deformities. After birth, the noticeable skull deformity (tower head, hammer head, flat head) could have negative effects on brain development .Through craniofacial surgery this can be corrected. Defects formed later in the skull bone can be repaired with various autologous tissue (bone and cartilage taken from elsewhere) or alloplastic materials.
Microsurgery: This is a surgery working on operations made under microscope with special microsurgical instruments. With this surgical technique replantation of severed hands, feet and other tissue can be done. The same as ruptured organ regains its function, due to small vessels and planted nerves; the transfer of tissue from another region to defected one is also possible (free flaps). Today, till diameter of 0.5 mm, blood vessels and nerves can be planted.
Hand Surgery: due to hand surgery the treatment of the following can be made: correction of traumatic hand defects (cuts, bruises, breaks), correction of form and function disorders, correction of congenital disorders (finger anomalies, adherent and more fingers, cleft hand, deformed hands, etc.), repairment of tendons and nerves, hand tumors, hand burns treatment, etc.
Endoscopic surgery: With the help of endoscopic surgery face and forehead lifting, breast prosthesis placement, as well as nerve and vascular surgery have become possible.