By: Kim Pham & Whitney Edwards

1. Plastic Surgery By: Kim Pham & Whitney Edwards

2. What is Plastic Surgery? Plastic surgery is a general term for operative manual and instrumental treatment which is performed for functional or aesthetic reasons. The word "plastic" derives from the Greek plastikos meaning to mold or to shape; its use here is not connected with modern plastics.

3. Two Different Types of Plastic Surgery There are two broad fields of Plastic Surgery • Reconstructive • Cosmetic

4. Reconstructive Surgery • Focuses on undoing or masking the destructive effects on trauma, surgery, or disease. Reconstructive surgery may include closing defects using sink grafts. • It is estimated that more than 1 million procedures are performed by plastic surgeons every year.

5. Who Has Reconstructive Surgery? • Two basic categories Congenital Deformities - known as birth defects.Examples: birthmarks, cleft-lip, webbed fingers. Those who develop deformities from accidents, infection, disease, or sometimes aging Examples: Burn wounds, lacerations, growths, and aging problems are considered acquired deformities

6. Reconstructive Surgery • The most common reconstructive surgeries would be: • Breast Reduction • Cleft lip and palate surgery • Contracture for burn survivors • Closing skin after removal of tumors in head and neck region • Sex reassignment surgery for transsexual people

7. Cosmetic Surgery Is most often performed in order to change features the patient finds unflattering. In many cases, however, there are medical reasons. Ex: breast reduction when orthopedic problems are present.

8. Cosmetic Surgery Statistics • In the U.S. Alone in 2004 11.9 million cosmetic procedures were performed. • More than 10 million cosmetic procedures were performed in 2005, a 38% increase since 2000. • There are 5000 members on the board-certified plastic surgeons in the world, 94% is found in the U.S.

9. Cosmetic Surgery Critics of plastic surgery note that it is legal for any doctor, regardless of specialty, to perform "cosmetic surgery", but not "plastic surgery". It is thus important to distinguish the terms "plastic surgery" and "cosmetic surgery“ Plastic Surgery is recognized by the American Board of Medical Specialties as the subspecialty dedicated to the surgical repair of defects of form or function. The term "cosmetic surgery" however, simply refers to surgery that is designed to improve cosmetics, or appearance. Thus there is no real art of "cosmetic surgery“. Doctors are not allowed to use the term "plastic surgery".

10. Females Breast Augmentation Breast implant removal Breast Lift Butt lift Botox Cellulite Treatment Males Breast Reduction Chin Augmentation Hair Transplant Otoplasty (Ear) Laser Hair removal Microdermabrasion Most Common Cosmetic Procedures

11. Procedures • ABDOMINOPLASTY(Tummy Tuck) Procedure:Flatten abdomen by removing excess fat and skin and tightening muscles of abdominal wall. Length:2 to 5 hours. Anesthesia:General, or local with sedation. In/Outpatient:Either depending on individual circumstances and extent of surgery. Side Effects:Temporary pain. Swelling, soreness, numbness of abdominal skin, bruising, tiredness for several weeks or months. Risks:Blood clots. Infection. Bleeding under the skin flap. Poor healing resulting in conspicuous scarring or skin loss. Need for a second operation. Recovery:Back to work: 2 to 4 weeks. More strenuous activity: 4 to 6 weeks or more. Fading and flattening of scars: 3 months to 2 years.

13. Procedures • BREAST ENLARGEMENT (Augmentation Mammaplasty) • Procedure:Enhance the size of breasts using inflatable implants filled with saline. • Length:1 to 2 hours. • Anesthesia:Local with sedation, or general. • In/Outpatient:Usually outpatient. • Side Effects:Temporary soreness, swelling, change in nipple sensation, bruising. Breast sensitive to stimulation for a few weeks. • Risks:Lack of implant permanence -- surgical removal or replacement of the implants may be required to treat problems, including: deflation; the formation of scar tissue around the implant (capsular contracture), which may cause the breast to feel tight or hard; bleeding or infection. Increase or decrease in sensitivity of nipples or breast skin, occasionally permanent. Mammography requires a special technique. (Note: Some women have reported symptoms similar to those of immune disorders. Ask your doctor about these and other FDA concerns.) • Recovery:Back to work: a few days. Physical contact with breasts: 3 to 4 weeks. Fading of scars: several months to a year or more. • Duration of Results:Variable. Implants may require removal or replacement.

15. Procedures • BREAST LIFT(Mastopexy) • Procedure:Raise and reshape sagging breasts by removing excess skin and repositioning remaining tissue and nipples. • Length:1 to 3 hours. • Anesthesia:Local with sedation, or general. • In/Outpatient:Usually outpatient. Sometimes inpatient. • Side Effects:Temporary bruising, swelling, discomfort, numbness, dry breast skin. Permanent scars. • Risks:Thick, wide scars; skin loss; infection. Unevenly positioned nipples. Permanent loss of feeling in nipples or breast. • Recovery: Back to work: 1 week or more. Strenuous activities: 1 month. Fading of scars: several months to a year. • Duration of Results:Variable; gravity, pregnancy, aging, and weight changes may cause new sagging. Results may last longer or be enhanced when breast implants are inserted as part of the procedure.

17. Procedures • COLLAGEN / FAT INJECTIONS • Procedure:Plump up creased, furrowed, or sunken facial skin; add fullness to lips and backs of hands. Works best on thin, dry, light-colored skin. • Length:15 minutes to 1 hour per session. • Anesthesia:Collagen: usually none; local may be included with the injection. Fat: local. • In/Outpatient:Outpatient. • Side Effects:Temporary stinging, throbbing, or burning sensation. Faint redness, swelling, excess fullness. • Risks:Collagen: allergic reaction including rash, hives, swelling, or flu-like symptoms; possible triggering of connective-tissue or autoimmune diseases. (A skin test is required before collagen treatment to determine whether an allergy exists.) Both: Contour irregularities, infection. • Duration of Results:Variable; a few months to 1 year.

19. Procedures • DERMABRASION • Procedure:Mechanical scraping of the top layers of skin using a high-speed rotary wheel. Softens sharp edges of surface irregularities, including acne and other scars and fine wrinkles, especially around the mouth. • Length:A few minutes to 1 hour. May require more than 1 session. • Anesthesia:Local, numbing spray, or general. • In/Outpatient:Usually outpatient. • Side Effects:Temporary tingling, burning, itching, swelling, redness. Lightening of treated skin. Acute sensitivity to sun; loss of ability to make pigment (tan). • Risks:Abnormal color changes (permanent). Tiny whiteheads (temporary); infection; scarring; flare-up of skin allergies, fever blisters, cold sores. • Recovery:Back to work: 2 weeks. More strenuous activities: 4 to 6 weeks. Fading of redness: about 3 months. Return of pigmentation/sun exposure: 6 to 12 months. • Duration of Results:Permanent, although new wrinkles may form as skin ages.

21. Procedures • EAR SURGERY(Otoplasty) • Procedure:Set prominent ears back closer to the head, or reduce the size of large ears. Most often done on children between the ages of 4 and 14 years. (Occasionally covered by insurance.) • Length:2 to 3 hours. • Anesthesia:Young children: usually general. Older children or adults: general or local, with sedation. • In/Outpatient:Usually outpatient. • Side Effects:Temporary throbbing, aching, swelling, redness, numbness. • Risks:Infection of cartilage. Excessive scarring. Blood clot that may need to be drained. Mismatched or artificial- looking ears. Recurrence of the protrusion, requiring repeat surgery. • Recovery:Back to work or school: 5 to 7 days.Strenuous activity, contact sports: 1 to 2 months. • Duration of Results:Usually permanent.

23. Procedures • EYELID SURGERY(Blepharoplasty) • Procedure:Correct drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin, and muscle. (Upper-eyelid surgery may be covered by insurance if used to correct visual field defects) • Length:1 to 3 hours. • Anesthesia:Usually locally with sedation or general. • In/Outpatient:Usually outpatient. • Side Effects:Temporary discomfort, tightness of lids, swelling, bruising. Temporary dryness, burning, itching of eyes. Excessive tearing, sensitivity to light for first few weeks. • Risks:Temporary blurred or double vision. Infection, bleeding. Swelling at the corners of the eyelids. Dry eyes. Formation of whiteheads. Slight asymmetry in healing or scarring. Difficulty in closing eyes completely (rarely permanent). Pulling down of the lower lids (may require further surgery). Blindness (extremely rare). • Recovery:Reading: 2 or 3 days. Back to work: 7 to 10 days. Contact lenses: two weeks or more. Strenuous activities, alcohol: about 3 weeks. Bruising and swelling gone: several weeks. • Duration of Results:Several years. Sometimes permanent.

25. Procedure • FACELIFT(Rhytidectomy) • Procedure:Improving sagging facial skin, jowls, and loose neck skin by removing excess fat, tightening muscles, redraping skin. Most often done on men and women over 40. • Length:Several hours. • Anesthesia:Local with sedation, or general. • In/Outpatient:Usually outpatient. Some patients may require short inpatient stay. • Side Effects:Temporary bruising, swelling, numbness and tenderness of skin; tight feeling, dry skin. For men, permanent need to shave behind ears, where beard-growing skin is repositioned. • Risks: Injury to the nerves that control facial muscles or feeling (usually temporary but may be permanent). Infection, bleeding. Poor healing; excessive scarring. Asymmetry or change in hairline. • Recovery:Back to work: 10 to 14 days. More strenuous activity: 2 weeks or more. Bruising: 2 to 3 weeks. Must limit exposure to sun for several months. • Duration of Results:Usually 5 to 10 years.

27. Procedures • FACIAL IMPLANTS • Procedure:Change the basic shape and balance of the face using carefully shaped implants to build up a receding chin, add prominence to cheekbones, or reshape the jawline. • Length:30 minutes to 2 hours. • Anesthesia:Local with sedation, or general. • In/Outpatient:Usually outpatient. Occasionally overnight hospital stay. • Side Effects:Temporary discomfort, swelling, bruising, numbness and/or stiffness. In jaw surgery, inability to open mouth fully for several weeks. • Risks:Shifting or imprecise positioning of implant, or infection around it, requiring a second operation or removal. Excess tightening and hardening of scar tissue around an artificial implant ("capsular contracture"), causing unnatural shape. • Recovery:Back to work: about 1 week. Normal appearance: 2 to 4 weeks. Activity that could jar or bump face: 6 weeks or more. • Duration of Results:Permanent.

29. Procedures • FOREHEAD LIFT(Browlift) • Procedure:Minimize forehead creases, drooping eyebrows, hooding over eyes, furrowed forehead and frown lines by removing excess tissue, altering muscles and tightening the forehead skin. May be done using the traditional technique, with an incision across the top of the head just behind the hairline; or with the use of an endoscope, which requires 3 to 5 short incisions. Most often done on people over 40. • Length:1 to 2 hours. • Anesthesia:Local with sedation, or general. • In/Outpatient:Usually outpatient. • Side Effects:Temporary swelling, numbness, headaches, bruising. Traditional method: Possible itching and hair loss. • Risks:Injury to facial nerve, causing loss of motion, muscle weakness, or asymmetrical look. Infection. Broad or excessive scarring. • Recovery:Back to work: 7 to 10 days, usually sooner for endoscopic forehead lift. More strenuous activity: several weeks. Full recovery from bruising: 2 to 3 weeks. Limit sun exposure for several months. • Duration of Results:Usually 5 to 10 years.

31. Procedures • HAIR REPLACEMENT SURGERY • Procedure:Fill in balding areas with a patient's own hair using a variety of techniques including scalp reduction, tissue expansion, strip grafts, scalp flaps, or clusters of punch grafts (plugs, miniplugs and microplugs). Works best on men with male pattern baldness after hair loss has stopped. • Length:1 to 3 hours. Some techniques may require multiple procedures over 18 months or more. • Anesthesia:Usually local with sedation. Flaps and tissue expansion may be done with general anesthesia. • In/Outpatient:Usually outpatient. • Side Effects:Temporary achy, tight scalp. Unnatural look in early stages. • Risks:Unnatural look. Infection. Excessive scarring. Failure to "take." Loss of scalp tissue and/or transplanted hair. • Recovery:Back to work: usually 2 to 5 days. More strenuous activities: 10 days to 3 weeks. Finallook: may be 18 months or more, depending on procedure. • Duration of Results:Permanent.

33. Procedures • LASER FACIAL RESURFACING • Procedure:Smooth the face and smooth fine wrinkles using a carbon dioxide (CO2) laser device that treats layers of damaged skin. Softens lines around the eyes and mouth and minimizes facial scars and unevenly pigmented areas. • Length: A few minutes to 1 hour. May require more than 1 session. • Anesthesia:Local with sedation, or general. • In/Outpatient:Usually outpatient, unless combined with other surgical procedures that require hospitalization. • Side Effects:Temporary swelling, discomfort. Lightening of treated skin. Acute sun sensitivity. Increased sensitivity to makeup. Pinkness or redness in skin that may persist for up to 6 months. • Risks:Burns or injuries caused by laser heat. Scarring. Abnormal changes in skin color. Flare-up of viral infections ("cold sores") and other infections (rare). • Recovery:Back to work: 2 weeks. More strenuous activities: 4-6 weeks. Complete fading of redness: 6 months or less. Return of pigmentation/light sun exposure: 6-12 • Duration of Results:Long-lasting, but does not stop aging. New wrinkles, expression lines may form as skin ages.

35. Procedures • LIPOSUCTION(Suction-Assisted Lipectomy) • Procedure:Improve body shape by removing exercise-resistant fat deposits with a tube and vacuum device. Can be performed using the tumescent technique, in which targeted fat cells are infused with saline containing solution with a local anesthetic before liposuction to reduce post-operative bruising and swelling. Common locations for liposuction include chin, cheeks, neck, upper arms, above breasts, abdomen, buttocks, hips, thighs, knees, calves, ankles.Length:1 to 2 hours or more. UAL: 20-40 percent longer than traditional liposuction. • Anesthesia:Local, epidural, or general. • In/Outpatient:Usually outpatient. Extensive procedures may require short inpatient stay. • Side Effects:Temporary bruising, swelling, numbness, soreness, burning sensation. Tumescent: Temporary fluid drainage from incision sites. UAL: Larger incisions for cannula. • Risks:Asymmetry. Rippling or bagginess of skin. Pigmentation changes. Skin injury. Fluid retention. Excessive fluid loss leading to shock. Infection. UAL: thermal burn injury caused by the heat from the ultrasound device. • Recovery:Back to work: 1 to 2 weeks. More strenuous activity: 2 to 4 weeks. Full recovery from swelling and bruising: 1 to 6 months or more. Use of tumescent technique or UAL may decrease post-operative bruising and swelling. • Duration of Results:Permanent, with sensible diet and exercise.

37. Procedures • MALE BREAST REDUCTION(Gynecomastia) • Procedure:Reduce enlarged, female-like breast in men using liposuction and/or cutting out excess glandular tissue. (Sometimes covered by medical insurance.) • Length:1 hour or more. • Anesthesia:General or local. • In/Outpatient:Usually outpatient. • Side Effects:Temporary bruising, swelling, numbness, soreness, burning sensation. • Risks:Infection. Fluid accumulation. Injury to the skin. Rippling or bagginess of skin. Asymmetry. Pigmentation changes (may become permanent if exposed to sun). Excessive scarring if tissue was cut away. Need for second procedure to remove additional tissue. • Recovery:Back to work: 3 to 7 days. More strenuous activity: 2 to 3 weeks. Swelling and bruising: 3 to 6 months. • Duration of Results:permanent

39. Procedures • NOSE SURGERY(Rhinoplasty) • Procedure:Reshape nose by reducing or increasing size, removing hump, changing shape of tip or bridge, narrowing span of nostrils, or changing angle between nose and upper lip. May also relieve some breathing problems. (May be covered by insurance.) • Length:1 to 2 hours or more. • Anesthesia:Local with sedation, or general. • In/Outpatient:Usually outpatient. • Side Effects:Temporary swelling, bruising around eyes, nose and headaches. Some bleeding and stiffness. • Risks:Infection. Small burst blood vessels resulting in tiny, permanent red spots. Incomplete improvement, requiring additional surgery. • Recovery:Back to work: 1 to 2 weeks. More strenuous activities: 2 to 3 weeks. Avoid hitting noseor sunburn: 8 weeks. Final appearance: 1 year or more. • Duration of Results:Permanent.

41. Arm Lift (Brachioplasty)$5000-6500  Blue Peel$500-700  Botox$200-400 per area  Breast Augmentation (saline) $5000-6500  Breast Augmentation (silicone) $6000-8000  Breast Lift$5000-6000  Chin or Cheek Implants$3000-4500  Collagen Injection$500-1500 Deep Chemical Peel$3500-5000  Dermabrasion$2000-4000  Eyelid Tuck (upper & lower)$4000-5500  Face Lift$7000-9000  Forehead Lift (Brow Lift)$3500-5000  Hair Removal (Laser)$300-800 Laser (Erbium)$2500-4000  Laser (CO2)$4000-5000  Lip Augmentation$600-2000  Liposuction (1 area)$2500-4500  Liposuction (3 areas)$5500-7000  Liposuction (5 areas)$8000-10,000  Medium Peel$1500-2500 Micro Peel$60-100  Nose Surgery$5000-6000  Pectoral Implants$6000-7000  Permanent Eyeliner$300-1000  Permanent Lip Liner$300-1000  Spider Vein Rx (Laser)$400-1000  Spider Vein Rx (Sclero)$200-500  Tattoo Removal (Laser)$300-800  Tummy Tuck$6000-8000 Average Pricing

42. Appropriate Candidates Two Categories • Those who have a strong self-image, who are bothered by a physical characteristic that they’d like to improve or change. After surgery, these patients feel good about the results and maintain a positive image about themselves. • Those who have a physical defect or cosmetic flaw that has diminished their self-esteem over time. These patients may adjust rather slowly to the results of their surgery.

43. Inappropriate Candidates • Patients in crisis, such as those who are going through divorce, death of a spouse, or loss of a job. These patients may be seeking to achieve goals that cannot be obtained through an appearance change-goals that relate to overcoming crisis.

44. Post-operative Depression • After surgery, most patients experience mild feelings of unhappiness, some cases might be more severe. After about three days prior to surgery when you may be regaining some of your physical stamina, your results have not begun to improve. Surgeons would call this “the Third-Day Blues”, this may last for a few days to several weeks. This emotional let down may be caused by stress, exhaustion, metabolic changes, or frustration.

45. Effects of Plastic Surgery 3 MAJOR AFFECTS Your wallet Physical Emotional

46. Main Risk The main risks of plastic surgery operation are rejection of implants, sensory change in or around the operation site, decolourisation of the skin, tissue necrosis, asymmetry, infection, formation of bad scar tissue, and allergic reaction on the sedation. These complications can be corrected by one or more additional operations. It is very important to be well informed before under going an operation.

47. Results • They found that 87% of patients reported being satisfied with their cosmetic surgery outcomes. A year after surgery, 97% reported that they would recommend surgery to others and 93% say they would have the surgery again. • A new study indicates that patients experience improved body image after undergoing common cosmetic surgery procedures, but the research did not suggest that participants experience decreased depressive symptoms or improvements in their body image-related quality of life.

48. Addiction Some people appear to become addicted to cosmetic surgery, possibly because of Body Dysmorphic Disorder. Sufficient amounts of repeated cosmetic surgery can lead to irreversible damage to the normal body structure. However, due to the high cost of repeated cosmetic surgery, this disorder is generally one limited to the wealthy. However, others have been known to take out loans for repeat procedures.

49. Body Dysmorphic Disorder • BDD is a mental disorder, which involves a disturbed body image. BDD is generally diagnosed of those who are extremely critical of their physique or self image, despite the fact there may be no noticeable disfigurement or defect. • BDD combines obsessive and compulsive aspects which has linked it to the OCD spectrum disorders among psychologists. People with BDD may engage in compulsive mirror checking behaviors or mirror avoidance, typically think about their appearance for more than one hour a day and in a severe cases may drop all social contact. This disorder is linked to an unusually high suicide rate among all mental disorders.

50. Diagnoses of BDD • The patient is preoccupied with an imagined defect of appearance or is excessively concerned about a slight physical anomaly. • This preoccupation causes clinically important distress or impairs work, social or personal functioning. • Another mental disorder (such as Anorexia Nervosa) does not better explain the preoccupation