FAQ

Cosmetic surgery: the questions to be asked

The cosmetic surgery procedure is no simple matter. Questions must be asked beforehand to determine the motivations of the procedure and the determining factors for avoiding failure.

THE COSMETIC SURGEON AND HIS PATIENT

When a woman consults a cosmetic surgeon for the first time he must bear in mind that she is, above all, in search of Beauty and Harmony. This is why the surgeon’s consultation room must provide an atmosphere for repose of the soul and must represent a safe haven for the patient. In fact, the aim is to help the patient take the best possible decision in terms of her expectations. She will often be accompanied by her husband or a friend when attending this first interview.

The quality of the admission and dialogue

In this context where the male or female patient undertakes this sometimes intimidating step the support of the patient is therefore desirable, and it is the responsibility of the nursing staff and the medical secretaries who make up the team of the practitioner to take the drama out of the operating procedure.

As soon as the patient is admitted, privileged links must be established to allow the patient to easily express her fears, Whether before or after the operation, in the consultation room or simply on the telephone,  she must always be able to benefit from a sympathetic ear. At no time should she be left to face her concerns alone.

Once in the consulting room of the surgeon the latter must help the patient overcome her apprehension to allow her to express her real motivations.

A common sensitivity, an understanding, a dialogue must little by little put the patient at her ease, for she alone will take the decision to realise her cosmetic project.

Once the practitioner has ascertained her personality and fully evaluated her motivations, he can then consider the operation in a more technical light and explain to her its challenges and risks. In no case should the decision as an emergency measure.

As for the information to be given to relatives, it is important to prevent the patient from being immediately surrounded so that on return to the clinic the patient avoids being an object of curiosity of his family or work colleagues. For this reason the practitioner will advise to take a few days’ holiday for the time it takes for the bruises and swelling to disappear.

Consultations before cosmetic surgery

At least two consultations are desirable before surgery. This time will be spent on preparing the patient psychologically for the operation and for a more detailed discussion of her cosmetic project. Very often, even before the first interview, the patient has already consulted people who have already undergone the same type of operation she is considering. She may also exchanged advice with other patients who have attended the clinic for postoperative care. Above all it is important that the patient fully understands the surgical procedure itself and the result that may be obtained. For this purpose we can use, if necessary, a digital camera that can take a face-on, side and three-quarter view of the patient. The device is then connected to a computer to enable the surgeon to carry out simulations, especially for rhinoplasty or profiloplasty cases. The surgeon can also show the patient a catalogue of photographs of various operations “before” and “after” and explain the preoperative examinations and postoperative care.

The operation must take place in a clinic or a hospital, and the practitioner cannot operate without prescribing a preoperative anaesthesia examination. According to a recent directive, the surgeon must provide a detailed estimate of the operation (fees of the surgeon and the anaesthetist, hospital expenses, equipment, products, etc.).

In accordance with ethical and professional rules, the plastic surgeon must not exert any influence on the choice made by the patient and does not carry out a procedure until he receives the written agreement of the patient through the surgical informed consent, except in cases of emergency.

The surgeon may refuse to perform certain operations when, for example, he realizes that the patient gives a disproportionate impact of a defect or it waits for a miraculous result of cosmetic surgery.

Finally, the surgeon always arranges a postoperative follow-up, graciously accepting minor adjustments to an operation. It is always possible for a patient to postpone or cancel a decision to operate,  at no cost except for the consultation fee.

HOW TO CHOOSE YOUR SURGEON COSMETIC?

Just over 600 plastic surgeons registered with the National Medical Council have performed some 500,000 cosmetic procedures in France each year. This figure is approximate because it is impossible to make an exact count of the number of procedures performed.

In fact, whilst it is easy to survey operations performed by plastic surgeons, it is more difficult to do so for all other doctors who conduct them.

In France there are few practitioners who would exceed their competence. A general practitioner would not dare remove an appendix from one of his patients, just as a surgeon would take care not to treat a perimenopausal woman.

In the field of cosmetic surgery, however, many general practitioners whose training was not attested by a national diploma as a Cosmetic Surgery Specialist do not hesitate to conduct a cosmetic procedure.


How to choose your plastic surgeon?

This question is not as trivial as you might think. Indeed, imagine a woman who, after careful consideration, considers resorting to appeal to cosmetic surgery for a facelift, a rhinoplasty, a liposuction or any other surgery. There is always the question: “Who will I consult, who will operate on me?”

The patient must then find the surgeon who will not only understand the wishes of the patient, but is also a master of the science and art of his practice, and for whom the patient feels a sense of goodwill and trust. What sources of information are at her disposal? How should she talk about herself? In whom should she put all her trust?

  • Word of mouth:Word mouth remains the best way of finding addresses and information on cosmetic surgery. Among friends confidence and trust will play an important part, although two similar procedures on two different people will give different results. Be that as it may, a high proportion of a surgeon’s clientele consists of a chain established by word of mouth. The disadvantage of this method of obtaining information collected from a friend is that it does not necessarily guarantee the professional quality of the practitioner.
  • The beauty professionals:All professions relating to beauty and “welfare” can provide their clients with information on cosmetic surgery based on the testimonies of those operated on, who have no hesitation in sharing their experience. The downside is that these testimonies disseminated to potential patients may be exaggerated and distorted in a positive as well as a negative way. A second source of information will be very useful: the staff working in a cosmetic surgery environment. Through their profession they keep up to date with everything connected with their job b reading journals, through regular contact with plastic surgeons and by observing the development of cosmetic surgery on a daily basis.
  • Media:The press has become a serious competitor to the word of mouth. This is especially the case of magazines targeted at women, which each year, in spring and summer, dedicate many columns to cosmetic surgery that supply increasingly reliable, accurate information. The articles sometimes use technical terms that are not understood by readers who are not always au fait with the subject but they nevertheless provide an excellent introduction to it. As for television programmes about cosmetic surgery, they are more numerous and do not hesitate to show the operating sequences that may impress the viewer. At the same time these images have the advantage of raising viewer awareness that these are surgical procedures in their own right with everything that is associated with them. Similarly, some programmes describe the daily routine of the postoperative period, whilst others focus on the psychological aspects, the opinions of those surrounding the patient and impact on social and professional life. Surgeons interviewed have a duty to provide clear, accurate and complete information of a non-commercial nature. Finally, as in fields, the Internet weaves its web and a number of sites can now be found. Legislation on this source of information is required.
  • The health professionals:The GP or family doctor has always been tending towards specialisation. The patient now goes to him to inquire about the competence of a paediatrician, a cardiologist and often the latter is recommended directly by the doctor. Why not gather information from him on cosmetic surgery?
    The downside is that all GPs are not yet fully trained in this or necessarily instructed in the practice and techniques of cosmetic surgery. Nevertheless, the general practitioner has the option of informing the patient of the name of a plastic surgeon, a hospital or specialist clinic.
  • The Medical Council: This leaves the Medical Council, the supreme authority for medical practices in France, it rarely provides information on the cosmetic surgery practices but can give the address of a qualified, competent plastic surgeon (in the legal sense of the term) in the patient’s region. Only the Council is qualified to recognise professional competence.

Are there surgeons specialising in a particular cosmetic surgery procedure?

Some plastic surgeons, having been trained initially in ENT (ear/nose/throat) medicine, or even in ophthalmology, are conversant with the principles of cosmetic surgery of the eyes or the eyelids. However, they may lack training in the other fields. They are therefore only qualified in the anatomical field concerned. Only plastic surgeons who have complete training in general surgery are officially authorised to conduct all possible cosmetic operations. However, a skilful plastic surgeon, experienced and having a cosmetic “eye”, is generally capable of achieving good results in all types of operations.

How to choose where you have your operation?

Be operated in a warm atmosphere that is a world away from normal hospital conditions. The decoration and atmosphere of a place can help the patient overcome the fear of an operation. In clinics which perform exclusively cosmetic surgery the willingness of the medical and paramedical teams to listen to the patient are unique to this type of operation. The nurses do not have to give priority to patients operated on for therapeutic reasons to the detriment of cosmetic patients. On the other hand, these institutions have the advantage of not having to file through operating rooms for pathologies that are sources of infection (appendicitis etc.), as in large hospitals.

IS COSMETIC SURGERY EFFECTIVE?

This is an interesting question that has long been the focus of cosmetic surgery. Indeed, in its early days, some people were rather circumspect about the results of cosmetic procedures. It must be said that the resources and techniques were not the same as today and that the fight against the effects of aging was not all that effective. This was the classic period of tight facelifts which removed all expression from faces given women a fixed look.

At that time, there was a conviction that science was all-powerful, that nothing was impossible for it, including eternal youth. We soon had to accept the fact that ageing was inexorable, on its inevitable march, and the most cosmetic surgery could do was slow it down. However, for those who had invested in the hope of staying young and beautiful, the disappointment was great and they became rather suspicious of this practice which promised more than it could deliver. Today these operations are infinitely more controlled and infinitely less aggressive: facial rejuvenation and rejuvenation of facial expression, etc.

In fact, the real question to be asked about the effectiveness of cosmetic surgery rather relates to its limits in terms of both indications and time. Nevertheless there are major principles without which a cosmetic procedure would not be effective. These principles are now well-known among plastic surgeons and are psychological in nature.

The patient must not over-invest in the desired procedure. Thus if the patient thinks that reshaping his/her nose and her breasts or undergoing a facelift will enable him/her to find another job, regain the love of a spouse or general appreciation, the surgeon must dissuade her from going through with the operation. In extreme cases, the surgeon is wary of patients are subject to dysmorphophobia. 2 The patient must be well informed about the procedure he/she will undergo, the potential risks, disadvantages of convalescence and possible changes well after the procedure. It is therefore up to the surgeon to understand the desires of his patient and determine the correct indication.

The patient should be the one to decide to undergo the operation. Thus, if the surgeon discovers that the operation is only desired by the spouse, for example, their request will not be met because we know that the patient will never be satisfied for this reason. If these three conditions are met by the patient there is every chance that the operation will succeed.

Besides the “patient’s aspect there is also the question of the surgical procedure. For it to be fully effective, only the physician’s experience will allow him to adapt the operating technique perfectly to each individual case. However, there are

also rules to be followed and which are peculiar to each operation. Let us look at some of them.

To ensure the maximum effectiveness of all liposuction operations the skin must be good quality, which is not always the case. Thus if the skin is soft and elastic, which is the case in the youngest patients, it adapts even better to the new shape after the procedure; however, if the skin has aged prematurely by the sun, or if the patient is no longer young and his/her skin has been poorly maintained, liposuction will be less effective and the result may be less satisfactory, sometimes leaving hollows” or ” waves ” which a good plastic surgeon must know how to avoid. To achieve this an attempt is made to combine with the operation a cosmetic treatment for correct skin preparation.

For practically all operations, but more specifically for the most delicate operations, such as those performed on the face, it is necessary to prepare the body of the patient by avoiding taking certain medications several days beforehand. Operating when aspirin has been taken is therefore contraindicated because this product is known for its anticoagulant action.

Finally, the cosmetic surgery procedure must be considered in a time context. Human tissues age whatever happens, and the rate of ageing may vary according to the care the patient takes of his/her body. Today we know that the earlier a facelift is undertaken the more effective it will be, exactly as with wrinkle treatment.

We also know that the life span of a conventional facelift is limited to 10 years. But it is imperative to maintain the benefits of the operation and this also makes it possible to improve the effectiveness of an operation (example: do not expose the scars to sunlight for the first year, wear a bra during certain activities that provide the breasts with a good support, watch your diet and take care of your skin after liposuction).

DOES COSMETIC SURGERY INVOLVE RISKS?

The question may be reformulated: is cosmetic surgery dangerous?

This is a question which may legitimately torment candidates for the operation as long as the slightest incident or accident that occurs following a cosmetic surgery operation is stigmatised, publicised in the media and demonised. To understand the reaction of the press and public who are moved and shocked, keep in mind that surgery “must” only be resorted to when absolutely necessary, and that undergoing an operation when a patient is in good health may appear to be against nature. However, we must inform readers that there are no more complications in cosmetic surgery than in general surgery.

Let us make a distinction between what may happen to the patient because of a procedure or medical error and what may happen because of his/her state of health. It is obvious that there will be more deaths in a trauma department of a large hospital than in a dermatology department. Taking into account this factor, there are proportionally far fewer accidents in cosmetic surgery.

But it is likely that in this field there are more dissatisfied patients and more claims.

For example, a person suffering multiple traumas from a road traffic accident will not take to court a surgeon who done his best to reshape his/her face or has amputated a limb to save his/her life. On the other hand the female patient of a surgeon may not be satisfied with his remodelled nose or her breast implants. However, although it is incorrect to say that cosmetic surgery is “dangerous”, there is no such thing as zero risk. In fact, any operating procedure requires the use of products which are used in the best possible conditions, certainly, but they cannot be totally harmless.

Finally, cosmetic surgery is a procedure in its own right, with all the normal risk associated with it deriving both from the reactions of the body and the procedure itself.

For example, prolonged use of a suction cannula during liposuction can cause unsightly depressions in the curve of a thigh; excessive skin excision from the eyelids may give rise to a slightly surprised look. In these cases this is a fault on the part of the surgeon, who may be encouraged to repair the aesthetic damage suffered by the patient.

Today the preoperative examinations, just as the anaesthesia consultation, provide a very good knowledge of the state of health of the patient to determine what his/her reactions to certain pharmaceutical products, his/her disorders or weaknesses may be (problem of coagulation or healing).  These risks have been assessed to the maximum degree to ensure that this applies to safety. The patient will therefore be asked to stop taking aspirin (which has an effect on blood coagulation) at least fifteen days before and after the operation, unless this forms part of a background medical treatment, in which case the operation is delayed. On the other hand, in order to protect patients from exceptional anaesthetic accidents, the anaesthetist must inspect the anaesthesia equipment thoroughly before each used. Fortunately, the reactions of the human body are well known, and even if zero risk does not exist, the protocols to counteract the effects of operating accidents are well controlled.

There is a certain analogy between the operating room and the cockpit of an airliner.

Indeed, when the crew is in perfect harmony, and having trained together, the problems that may arise are infinitely less dangerous. Everyone knows what to do and there is little risk that a serious accident will occur.
Similarly, a surgeon must learn to surround himself with very good nurses for post-operative care, train, inform, motivate and monitor them. A solid surgeon-nurse team accustomed to working together for many years is a guarantee of safety for the patient. Finally, for better coordination of postoperative follow-up, the surgeon can send an information letter to the treating physician or, depending on the cases, the gynaecologist or dermatologist.

WHAT TO DO IF YOU ARE NOT SATISFIED WITH HER WORK?

It is quite possible that the cosmetic operation, once completed, does not completely satisfy the patient who has undergone it. This patient satisfaction is what the practitioner should aim for as a priority.

We have seen that the cosmetic surgery has essentially a psychological dimension. It is therefore logical that the dissatisfaction of the patient also has such a dimension. To understand its nature we must briefly return to the motivation of the candidate for cosmetic surgery.

The operation may therefore be a restoration operation which, as its name suggests, restores a previous physical condition. The facelifts, certain mammoplasties and certain liposuctions form part of this. The patient then tries to regain the physique he/she has lost.

The other category consists of “creative” operations, those which create a new form. Rhinoplasty is typically a creative operation, just as the fitting of breast implants.

A certain type of operation corresponds to each stage of life: with advancing age there is more recourse to restoration operations, whilst at difficult times of life, such as a divorce, unemployment or retirement, will be conducive to creative operations. It is well understood that a woman who wishes to regain a self-image she once knew is likely to be less dissatisfied than another who imagines what it will be like to have a new nose or a new face. This dissatisfaction may, however, be perfectly justified if the operation failed or if is debatable whether this is a matter of taste.

Be that as it may, the approach is always the same: never pass judgment immediately after the operation. The oedemas have not been absorbed, the area operated on is often and the final results are often difficult to see. For each operation the waiting period varies, and it may be quite long, as for noses, where the final shape is obtained in a few months only. The doctor  should inform the patient before surgery. Another requirement: strictly follow the postoperative care prescribed by the surgeon.

For example, it is essential to remove the locks placed in the nose after rhinoplasty because they interfere with breathing, and all the more so as the plastic surgeon cannot be held responsible for any problem. If, after the waiting time, the result is still not satisfactory, it is then important not to hesitate to talk to the surgeon who operated on you rather than going to another doctor.

In all cases the surgeon will consider the complaints and, if they are well founded, and even if they are subjective, he will agree to adjust the procedure by means an additional minor operation, if necessary.

If, after all, the result is unattractive, it is still possible to take the advice of another plastic surgeon, especially if the first surgeon considers it necessary to repeat the procedure, different from the first, and therefore pay an additional fee. Finally, if it is considered that there is fault or prejudice, it is possible to take the matter to court. An independent expert will be appointed and will examine the record to determine whether the practitioner is liable. Under current case law, there is no obligation of performance, and only the obligation of means is taken into account.

Informed consent of the patient is also an important concept that requires the physician to provide the patient with all necessary information, including information relating to the risks. It is up to the physician to demonstrate that he has provided such information, but the judges do not always take this into account. You should also know that procedures can take several months or even years, and that compensation has nothing to do with that seen in the United States, where extraordinary sums can be achieved.

LASERS AND AESTHETIC MEDICINE?

The principle of the LASER (Light Amplified by Stimulated Emission of Radiation) is based on the action of light.

The interest in this stimulation is twofold:

  • On the one hand it generates considerable power in a very short time (up to one billionth of a second)
  • On the other hand, it does not diverge, i.e. the light beam does not expand like a flashlight;it can therefore be focused, concentrated on a small point. For the rest, it is only the heat that burns what the beam touches. Indeed, the concentration of power in a short time converts practically to vapour the targeted points before the heat spreads further. This prevents charring of the surrounding tissues that were not required to be treated.

The concept of the laser was developed in 1916 by Albert Einstein. The first laser appeared in 1960. The first human trials were held in 1964 for dermatological medical indications. There are four main areas of medicine where lasers have assumed a prominent position:

  • Dermatology
  • Ophthalmology
  • The field of vascular indications
  • The field of cosmetic medicine

However, laser technology can be found in other specialties such as ENT, urological surgery, gynaecological surgery or lung surgery, for example. Since mid-1995, a certain type of laser has been introduced into cosmetic surgery, in addition to facial rejuvenation procedures that include the different facelifts.

The multiplicity of medical indications and technical progress on laser devices over the past decade have made ​​them virtually indispensable tools in the therapeutic arsenal of many specialties. There is also another feature of the laser which has not yet been fully explained, but which is considered very useful for the surgeons: it is the retracting effect.

Indeed, it acts a little like a facelift on the skin, and its effect, more particularly in the hollows of wrinkles, results in the production of collagen and elastic fibres which in some way fill the wrinkle. The use of the laser in this area has been very successful in treating wrinkles around the mouth, eyes, crow’s feet , small spider veins, sun spots or birthmarks. Several types of LASER are available, each having a specific use within its power range and frequency – do not forget that this is a radiation transmission.

All facial wrinkles can therefore be treated if they are not too pronounced. This treatment may cause a rash that can last several months and can be camouflaged with cosmetic products. Nevertheless the laser is now considered an extraordinary and powerful tool whose applications are developing year on year.

In view of the ever increasing number of medical and surgical indications and the very high specificity of the devices on the market, the technique of long-term laser hair removal has now been developed. This indication was discovered by chance following the observation of the delay in repelling hair growth in an area that had previously been subject to laser treatment for the removal of tattoos.

HYALURONIC ACID

What is hyaluronic acid and how does it act?

Hyaluronic acid occurs naturally in our body. It is used to maintain a good level of hydration of our skin by capturing water and retaining it in the deep layers of the dermis. Hyaluronic acid is a molecule that acts somewhat like a sponge.

Wrinkle treatment based on hyaluronic acid involves injecting a viscous gel in small quantities. Once infiltrated into the skin the gel retains water and mixes with natural hyaluronic acid in the dermis. The voluminising effect restores skin to its original appearance and the wrinkle is absorbed.

It is a biodegradable and absorbable product which depletes naturally in the body. So you will have to repeat the operation in order to benefit from its effects in the long term.

How long should I plan for an injection session?

Depending on the number of wrinkles to be processed, a session lasts between 15 and 30 minutes.

How often must I renew my injections?

Since hyaluronic acid degrades naturally in the body, the effect of the injection is variable and depends on several factors:

  • Type of skin of the patient,
  • Severity of the wrinkle to correct
  • Filling product used
  • Injection area,
  • Volume injected.

The duration of the effect of the injection ranges from 12 to 18 months, but may extend up to 36 months if a denser, more voluminising acid is injected and when the injection is made in certain areas of the face such as the sulcus and cheekbone.

After an injection, what side effects may occur?

Although hyaluronic acid is a natural constituent of the dermis, an injection of hyaluronic acid can cause skin reactions.

They involve:

  • redness, bruises, ecchymoses, swelling, itching, mild pain at the injection site which may occur following the injection and disappear between 24 hours and 8 days and indurations or nodules that may appear at the injection site between 15 days and 3 months after the injection,
  • reversible colorations of the injection area.

Note that these side effects are rare and disappear quickly.

Are the injections painful?

The injections are performed using microneedles a few millimetres thick, rendering the treatment almost painless. The pain felt varies with the injected area and individual tolerance. In some people highly sensitive to pain your doctor will prescribe for you a Lidocaine based anaesthetic cream to be applied 45 minutes before treatment for a session held in total comfort.

Are the effects visible immediately?

The effect of hyaluronic acid is visible immediately. At the end of the session, your wrinkles will have already receded, but the final result is optimal 10 days after injection. This is the time it takes for the body to fully absorb the acid.

Hyaluronic acid is an absorbable molecule, thus its effects are temporary and last an average of 6-8 months (and can last up to 36 months in the best case).

What are the contraindications of injections and what precautions should I take?

The use of hyaluronic acid is not recommended in case of:

  • Pregnancy and Lactation
  • Antibiotic treatment with aminoglycosides (Amiklin, Gentalline, Streptomycin)
  • Recent anticoagulation treatment
  • Recent anti-inflammatory treatment
  • Known hypersensitivity to Botox A
  • Myasthenia gravis
  • Lambert-Eaton syndrome

Patients who are taking medication should report this; the concomitant administration of certain drugs must be avoided (aminosides).

After a session of injections the wearing of hats or caps that are too tight, saunas and steam rooms and flying should be avoided within 24 hours of treatment.

Although hyaluronic acid is the safest injectable anti-wrinkle product on the market, inflammatory effects may occur. This allergy risk has been reported, but it is extremely low (1 case in 2000 of a hypersensitivity reaction was reported in 2000).

After an injection, I risk being marked – how can I avoid swelling and bruising?

You must not take aspirin or an anti-inflammatory for eight days prior to treatment to prevent the occurrence of small haematomas.

If your skin tends to mark easily, we recommend taking an Arnica tablet 2-3 days before the session and overnight to reduce the risk of hematoma.

BOTOX

What is botulinum toxin and how does it work?

Botox® is a molecule derived from botulinum toxin whose paralysing effect can significantly reduce the activity of a muscle and thus treat the cause of the formation of a wrinkle.

Long used in the context of ophthalmic medicine, botulinum toxin is now used for aesthetic purposes: injected in small quantities on the surface or more deeply into the dermis, it helps treat wrinkles and fine lines.

The effects of treatment begin to appear 24 to 48 hours after the injections, the optimal effect is achieved after 1-4 weeks and lasts five to seven months according to the reaction of the body.

How often should I renew my injections?

The action of the product is not permanent and lasts between 5 and 7 months. During this period the wrinkle will recede.  By repeating the injections, without waiting for muscular contraction to be totally restored, you will see a more lasting improvement. The interval between treatments is generally 3 to 6 months.

Wrinkle treatment with Botox will be more effective if it is performed before the formation of wrinkles, as early as possible, as a preventive measure.

After an injection, what side effects may occur?

In general, adverse reactions are observed within the first few days following injection and are transient. As with any injection, tingling or slight burning may be felt at the time of injection. Sometimes a transitional haematoma may occur at the injection site and mark the face for 2 or 3 days after the injection.

In very rare cases temporary drooping of the eyelid (ptosis), headaches and some redness may occur. Many of these side effects can be managed and some may disappear spontaneously over time.

In case of doubt or concerns, do not hesitate to contact us, your doctor will answer all your questions as soon as possible.

Are the injections painful?

The injections are performed using microneedles only a few millimetres thick which render the treatment really painless. However, for some people highly sensitive to pain your doctor will prescribe an anaesthetising cream applied 45 minutes before treatment for a session held in total comfort.

Are the effects and results immediately visible?

You must wait a few days, sometimes a week, before you see the relaxation of muscles and a considerable reduction of wrinkles.

 What are the contraindications of injections and what precautions should I take?

The use of Botox is not recommended in case of:

  • Pregnancy and Lactation
  • Antibiotic treatment with aminoglycosides (Amiklin, Gentalline, Streptomycin)
  • Recent anticoagulation treatment
  • Recent anti-inflammatory treatment
  • Known hypersensitivity to Botox A
  • Myasthenia gravis
  • Lambert-Eaton syndrome

Patients who are taking medication should report this; the concomitant administration of certain drugs must be avoided (aminosides).

After a session of injections the wearing of hats or caps that are too tight, saunas and steam rooms and flying should be avoided within 24 hours of treatment.

If your skin tends to mark easily we recommend that you take Arnica in tablet form 2 to 3 days before the session and the night before in order to reduce the risk of haematoma.

 

BREAST AUGMENTATION: IMPLANTS

It is said that the implants need to be replaced every ten years, is that true?

The estimated life of an implant is fifteen to twenty years; there is no reason to replace an implant before it ruptures. In the case of rupture of a saline implant the breast will lower in a few days because the water that flows through the perforation is reabsorbed by the body and eliminated. In the case of a silicone gel implant, rupture does not manifest itself by a loss of volume: it is often during a mammogram or an ultrasound that the diagnosis is made.

Is the replacement of a ruptured saline implant a complicated procedure?

In the case of a ruptured saline implant it can often be replaced under local anaesthetic. Although the implant empties within a few days the chamber that has formed after a number of years does not reclose quickly. This therefore necessitates giving a local anaesthetic at the site of the scar, accessing the ruptured implant, replace it with a new one and filling this implant with saline solution. The postoperative pain will be limited to the area of the incision; no pain will be felt in the breast.

Are implants guaranteed?  

Two companies sell their implants in Canada, namely Mentor (Johnson & Johnson) and Allergan (formerly Inamed and before that McGhan). The companies give guarantees on saline implants. However, patients must pay for the surgery. It must be borne in mind that these additional costs will not be incurred by the average patient for fifteen to twenty years. Studies conducted by Mentor estimate the incidence of premature rupture in the first seven years to be 3% for smooth-walled saline implants (the most commonly used).

On the Internet there is reference to smooth implants and textured implants. What is the difference?

The smooth implant has the appearance of a transparent plastic and a textured implant may be reminiscent of frosted glass because it has a surface with thousands of spicules the purpose of which is to make it harder for the body to form too active a scar envelope. This is a question that is still being debated at our congresses and in medical journals; opinions are divided.

I heard that there were different types of implants: moderate profile, high profile, water drop etc. How do you choose between these?

The choice is up to your doctor after he has examined you and considered your needs. In almost 90% of cases, it is the MP (Moderate Profile) implant that will be used. A woman with a narrow chest and wanting quite a large volume will benefit from the HP (High Profile) implant, with has a narrower base and prevents the breast from overflowing to the side. The water drop implant is little used because most patients want a curve at the top of the breast, and this should be noted, the impact may turn in on itself slightly during the healing phase and the water drop is then in a skewed position.

I am afraid that will turn out to be too big.

Our philosophy is to meet your criteria: patients must make an assessment of their needs in the privacy of their homes. We recommend that you obtain a thin bra with a full cup in the intended size. Also obtain two thin plastic film bags such as those used for fruit and vegetables in grocery stores. Start by inserting 250 ml of uncooked rice, close the bag loosely, insert it into the cup and mould it to give roundness to the breast. Put on an adjusted garment and look at yourself in the mirror. Add or remove the rice to obtain the desired effect, then pour the rice into a measuring cup and note the amount. We will talk about

your choice before surgery and we will help you decide if in doubt. However, as you yourself have tested the volume, you will not end up with an unexpected result.

There are different types of incision and I even heard that you could inject into the navel?

In almost 70% of cases, the incision is made under the breast: 10% in a semicircle at the lower edge of the areola and 20% in the armpit. We do not use the armpit approach.  through the armpit. The choice of areola or the area of the natural fold takes account of the requirements of the patient and technical considerations. In cases where you have to move the areole upwards to centre on the new breast, it will often be more appropriate to limit the incisions around the areola rather than adding a second in the natural fold under the breast.

On the muscle, under the muscle, why?

From 1991 until recently, the saline implant was our only option. When a patient leans on his or her side the water in the implant moves temporarily to the side and the bag contains less water in the region of the sternum: if the implant was only located under the breast folds may be observed in the temporarily unoccupied implant. The pectoral muscle that runs from the sternum to the shoulder enables these transitions to be concealed in the cleavage area. It has also been demonstrated that there would be fewer hardening phenomena for saline implants than for silicone implants because the implantation area is constantly massaged by each movement of the arms.

Will I be able to continue participating in sports?

After six weeks it is considered that you will be able to resume normal life without restrictions.

What about returning to work?

The majority of people having an office job will be able to return to work within ten days; physically demanding jobs (hairdressing, cooking, housekeeping, patient care, etc.) will require a little more time.

It has long been said that the silicone was dangerous to health. Is that true?

No. Numerous scientific studies conducted over the last fifteen years have all come to the conclusion that there was no more risk (chronic fatigue, arthritis, immune disease, cancer, etc.) than for a saline implant.

I am not sure whether to choose a saline or silicone implant?

In most cases where there is an adequate layer of subcutaneous and mammary tissue, the close relationship being provided by these elements will render the implant impalpable. Recent publications on the last generation of silicone gel implants in a retropectoral position report a slower rate of hardening than those in a located in front of the muscle. This was not the case with gel implants of the 1990’s located in front of the muscle, where the fibrous capsule rate was of the order of 15-20%. However, a thin patient with small breasts risks palpating the bag of saline solution on the periphery of the breast. In this case the choice of a silicone implant must be considered.

When to change breast implants?

Doctor’s reply: In the case of physiological serum rupture of the implant wall, expressed as a loss of volume in the breast, may be expected. The implants will be changed at that time. In the case of silicone gels, radiological monitoring (digitised mammography, IRM) is required after fifteen years. When signs of wear appear a replacement will be necessary.

Do breast implants increase the risk of breast cancer?

Doctor’s reply. No. Statistically it has been shown that patients with breast implants receive better radiological and gynaecological care, with consequently earlier detection of possible breast cancer lesions. The prognosis is therefore better.

Do silicone gel implants increase the risk of autoimmune disease?

Doctor’s reply: This is one of the suspicions which led to the banning of implants from 1995 to 2001. Major Anglo-Saxon studies showed that there were no more autoimmune pathologies in patients with silicone gel implants than in women with no breast implants.

Are silicone gel implants currently available safer than before?

Doctor’s reply: The first silicone gel implants date from 1962. Currently gels are cohesive, that is much less liquid, which explains why, when the wall ruptures due to wear, the risk of migration of the silicone gel into the mammary glands is low. Moreover, the anti-perspiration walls of the last few generations of implants limit the diffusion of silicone molecules.

What are the different types of breast implants?

Doctor’s reply: Currently there are two types of implants:

  • Implants with silicone gel where the main interest is very natural consistency.
  • Implants with physiological serum (saline), whose main interest is total harmlessness but which give the breast an unnatural consistency. As a result these implants are disappearing.

How do you choose the volume of an implant?

Doctor’s reply: The volume of an implant depends on several criteria such as the wishes of the patient, but also on the size and shape of the thorax. It is clear that for a given volume the result will appear very different in a patient 1.55 mm tall from a patient who is 1.70 m tall.

Following the installation of transplants can breast sensitivity occur?

Doctor’s reply: Sensitivity disorders in the form of tingling or insensitivity are typical for the first few months after the operation. Normally these disorders disappear within 6 months.

How long does the operation last?

Doctor’s reply: Depending on the approach adopted (armpits or nipples), the operation can last between 45 and 60 minutes.

Are there methods other than a surgical operation to augment the breasts?

Doctor’s reply: Hormone therapy can moderately increase breast volume (this is particularly common in  transsexuals). However, this hormone therapy significantly increases the risk of cancer. The lipofilling techniques (injection of autogenous fat) are possible, but the effect of fat on the triggering or development of cancer remains to be studied. Finally, a laboratory has recently been offering absorbable hyaluronic acid for injection into the breast. The lack of feedback and the rule that states that chronic inflammation (resorption) engenders cancer, would lead us to strongly advise against the use of this technique.

Can breast implants be rejected?

Doctor’s reply:  The phenomenon of a shell or hard breast exacerbates a normal scar reaction. This may be reinforced by the existence of small haematomas in the implant pocket, minor asepsis (staphylococcus epidermies) and a pro-inflammatory diet. There are cases where, despite all the precautions taken, a shell develops requiring reoperation.

What is the length of hospitalization?

Doctor’s reply: 24 hours.

Why fit a drain (Redon drain) postoperatively?

Doctor’s reply:  Statistically small bruises increase the risk of hard breasts.  The evacuation of minor bleeding that can last the night following the operation therefore seems to us to be essential.

Are the scars visible?

Doctor’s reply: As soon as the scars turn white, i.e. 6-12 months after surgery, they become extremely discrete (except for pathological scarring).

Is pregnancy possible after the fitting of breast implants?

Doctor’s reply: Yes, absolutely. The breasts will develop in the same way as a woman without an implant.

What is the advantage of positioning breast implants behind the pectoral muscle?

Doctor’s reply: there appears to us to be a dual advantage: Firstly the retromuscular position of the implants reduces the risk of hard breasts, and secondly the muscle acts a little like an internal bra and breast support seems to us to be more stable over time.

What precautions should be taken during the first few weeks after surgery?

Doctor’s reply: Raising your arms in the air should be avoided for a fortnight afterwards. One month of sporting inactivity is required.

RHINOPLASTY

How long does the operation last?

Doctor’s reply:  A rhinoplasty can last between 45 minutes and 2 hours.

How long will I be in hospital?

Doctor’s reply: answer: Usually 24 hours but in some cases it may be an outpatient procedure, in which case the patient only attends for the time of the operation.

How long does it take for it to look presentable?

Doctor’s reply: In most cases, wearing a splint restraint and the presence of periorbital bruising require a period of 8-15 days.

Are the after-effects of rhinoplasty painful?

Doctor’s reply: Normally the after-effects are not painful. On the other hand, wiring the nostrils together is inconvenient because it is impossible to breathe through the nose.

How long do you keep the plaster on?

Doctor’s reply: 8-10 days.

How long does it take to get a final result?

Doctor’s reply. Most results are visible in 2-3 months, but minor refinements and modifications are observed up to 1 year after the operation.

Are adjustments common?

Doctor’s reply: his is a delicate operation in which the internal scarring phenomena can alter the expected outcome. Taking all rhinoplasties together, 20 to 25% involve adjustments, which may be carried under local or general anaesthetic.

How long must you wait before an adjustment can be carried out?

Doctor’s reply: you have to wait between 6 and 12 months.

Are there visible scars?

Doctor’s reply: No. In most cases, the incisions are made inside the nostrils. Sometimes incisions in the columella or in the fold of the nostrils are combined but  quickly become extremely discreet.

Is preoperative computer simulation reliable?

Doctor’s reply: These simulations allow the surgeon, above all, to determine the extent of the changes you want while remaining within the limits of what is reasonable and practicable. Although it is by no means a case of “before – after”, these simulations are fairly reliable.

What types of anaesthesia are used for this operation?

Doctor’s reply: Depending on the surgical procedure considered, the anaesthetic may be a purely local one or general. Thus if the medications relate to the tip of the nose and a very small bump, the procedure may certainly be performed under local anaesthetic. Conversely, in the case of a septal deviation, a major bump or deviated nose, a general anaesthetic is required.

What precautions should be taken after a rhinoplasty?

Doctor’s reply: The nose will remain fragile for several months and trauma must of course be avoided at this level.

Will I be marked after the operation?

Doctor’s reply: Periorbital bruises are typical and require protection from the sun until they completely disappear.

How long do I keep the wicks in?

Doctor’s reply: Depending on the type of operation and the condition of the nasal septum, the wicks are kept in for 24 to 72 hours.

BLEPHAROPLASTY

 

I do not want to end up with spaniel eyes

Two factors may cause tension on the lower eyelid. One is a lack of energy in the eyelid due to ageing; this phenomenon varies from one individual to another. How is this evaluated? Gazing straight ahead, pull down the eyelid and relax it. If it quickly moves back into contact with the eye, this a good sign, but if you have time to count two, three or four seconds for it to return, the eyelid must be retightened during surgery.

The other factor relates to the quantity of skin that can be removed. During the operation the skin is often released as far as the bone of the eye socket and the surgeon spreads it out like a sheet is spread on a bed. What exceeds the incision

can be removed, but the surgeon cannot increase the tension to remove more of it. If wrinkles remain, the patient will have to learn to live with them because their presence is much more acceptable than a detached eyelid (ectropion) or one that is pulled down.

I would not want to give the impression of having seen a ghost

To refine the upper eyelid it is sometimes necessary to remove skin from it. If the eyebrows are too low, raising the forehead is sometimes the only practical option, because removing skin from the upper eyelid will have no effect. If the eyebrows are the right height, and the surgeon performs a frontal lift, this risks giving the patient a bewildered appearance. There is no question that surgery produces this effect and a good surgeon will avoid this trap.

I would not want almond eyes because that is not me

An excessive facelift, performed simultaneously, could result in this change, but surgery limited to the eyelids would not do this.

ABDOMINOPLASTY

Can a surgical operation remove stretch marks?

A stretch mark is a fracture of elastic fibres of the skin which occurs when the tension has exceeded the critical point determined by your genes. For some people this critical point is reached when putting on 30 pounds (14 kg), and for others when putting on 70 pounds (32 kg). age has exceeded the critical point determined by your genetics. For some people, this critical point is reached with the capture of 30 pounds (14 kg) and for others, with the 70 pounds (32 kg).

Some techniques used in dermatology, such as microdermabrasion or certain lasers, can alleviate a little redness, but the marks stay where they are.

When an abdominoplasty is performed a wide ellipse of loose skin is removed between the navel and the pubic area, from one hip to the other. Stretch marks in this skin will no longer be present because, once released from its attachments, the skin at navel height will be lowered to the level of the pubic area.

If I became pregnant again after the abdominoplasty, what would happen?

In fact, if your abdomen has been reduced to the tension it had when you were 18, it will again be capable of being stretched to allow the growth of the baby.

I heard that muscles can be repaired. What does it mean?

When observing a “mister muscle”, a bodybuilder, you can see a hollow line that separates the abdomen from the sternum to the pubic area. During pregnancy, the tension can stretch the line width and create a space sometimes up to two or three

 inches (5 to 7.5 cm). When he repairs the muscles, the surgeon makes sure that he brings them closer together.

Will the surgery really give me a waistline?

The abdominoplasty has above all a vertical effect, rather like pulling down a blind. Bringing muscles together helps reduce sagging of the stomach at the end of the day, but it will not sculpt a waistline.

FACELIFT

 

I do not want the drawn look of some actresses you see on the TV.

Let us mention first of all a first surgery on someone who has aged fairly well, does not involve this kind of deformation. After several lifts there is a risk a certain degree of rigidity may be established in the facial expression, because the skin is more scarred and lacks flexibility. The facial muscles are therefore less successful in entraining the skin, which gives the facial expressions the appearance of a mask.

Basically, I just want to look rested and I do not want those around me to notice that I have undergone an operation.

If you look in your forties and the signs of aging are not too marked, a new hairstyle may mystify some and is enough to see in this the reason for your well-rested look. However, the jowls are quite visible if the fold between the upper lip and cheek (nasolabial fold) is prominent, if the neck skin is withered or sagging, or if vertical stripes are seen on each side of Adam’s apple, a successful surgery makes such a difference that it is difficult to hide it. There must be an acceptance of the need to talk about and not feel guilty for having dared to do so.

I have smoked for a long time and I have smoker’s wrinkles on the upper lip. What is the treatment indicated and is it lasting?

As wrinkles are pronounced, the appropriate treatment must be given. Whether sanding, laser or chemical peeling are the techniques used, the treatment will be sufficiently deep to cause the formation of crusts that will persist for just over a week. When the crusts have fallen off the area will be pink, like burns from an oven on the forearm. It may be possible to camouflage it with foundation, but the procedure is really worth the effort and the result obtained will be lasting.

How long does it take before returning to work?

If a complete is performed (eyelids, face and neck), three weeks off work is usually sufficient. In the case of a face or neck lift,  two weeks is a realistic recovery time.

One of my friends had a lift done a few months ago and the skin was sagging compared to the beginning of treatment.  Why did the surgeon not pull the skin further?

After freeing the skin the surgeon tightens it to determine the excess and what will have to be removed. He has no equipment capable of measuring exactly what he can remove. It is therefore on the basis of his experience that he will apply the maximum that would not risk causing a rupture of the suture stitches. In the postoperative months, and with everything depending on the elasticity of the skin, a certain amount of sagging will occur. If the person wants to take the correction further it is sometimes useful to conduct a limited detachment of the area in question, under local anaesthetic, to achieve the optimum result.

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