Cleveland Jewish News
The latest trends in plastic surgery involve minimally invasive techniques,
improving safety, and preservation of function.
Rhinoplasty. Modern techniques in rhinoplasty (nose reshaping) reflect the
overall evolution of plastic surgery. Contemporary techniques strive to
preserve individual familial and ethnic characteristics so that the nose
looks refined, natural, beautiful, not artificial. The function of the nose
as an airway is also addressed with adjunctive procedures that correct
internal blockage, so that breathing is improved by surgery.
Facelift. The traditional facelift remains useful and powerful, but less
invasive procedures like the midface lift (elevation of the cheeks and
jowls), endoscopic brow lift (using telescopes through small incisions), or
neck lift may be used instead of, or in addition to, a facelift in
appropriately selected patients. The so-called "one-hour" or internal
suture lifts have not yet gained general acceptance because results seem
temporary. Nonsurgical enhancements can also complement the facelift.
Treatment is tailored to the patient's needs, so that natural, lasting
improvement can be achieved.
Laser resurfacing and nonsurgical techniques. The newest additions are
nonsurgical enhancements, like Botox®, Hylaform®, and Retin-A®. These
modalities can eliminate the need for surgical intervention in some
patients or complement surgery in others. Fillers are injected into
wrinkles to restore thickness to the skin, partially erasing the wrinkles.
Botox® is selectively injected into specific facial muscles to paralyze
them so that they can't form frown lines. Retin-A® is applied topically; it
increases skin cell turnover, thereby reversing sun-damage and diminishing
wrinkles. Laser resurfacing treats fine wrinkles and color irregularities
in the skin. The popularity of these procedures has validated their
Liposuction and tummy tuck. The basic technique for liposuction remains
unchanged: suction fat through limited incisions. The tumescent technique
has been popular for several years; it involves injecting a high volume of
dilute anesthetic solution to minimize pain and blood loss. Because it is
safe and effective, the tumescent technique is considered the standard for
most liposuction cases.
Ultrasonic liposuction uses an internal probe or an external handpiece to
administer sound waves to the fat cells, theoretically to help break them
up and facilitate their removal. This was very popular several years ago.
But further study suggests that it offers little benefit over conventional
liposuction and adds some risks, so it is less commonly used. It remains
useful for certain cases, like gynecomastia (male breast) correction.
Abdominoplasty (tummy tuck) involves removal of excess belly skin and
tightening of the underlying muscle layers to reshape the belly and
waistline. This is one of the most effective and popular plastic surgery
procedures. It is often combined with liposuction.
Breast augmentation. Current trends in breast augmentation include using
minimal (small) incisions, smooth-shelled implants, and placement under the
pectoralis (chest) muscle, to give a more natural, longer-lasting result
than when placed on top of the muscle. The under-the-muscle approach has
been used for years; but an accumulating body of evidence suggests it has
significant advantages long term.
The Food and Drug Administration is currently evaluating the safety of
silicone gel implants, but advisory panels have suggested limited approval.
Currently they can be used for reconstruction when patients are enrolled in
experimental protocols. The evidence that silicone gel causes medical
complications is tenuous, but saline (salt water) filled implants are
versatile and safe.
In medicine, new is often better. However, new can also mean unproven,
untested. When new trends are supported by experimental studies and the
collective experience of national medical societies, they can be taken
seriously. Deciding whether to try a new therapy is like choosing a medical
specialist: The first task is to gather information.
For cosmetic surgery, make sure the physician is certified by the American
Board of Plastic Surgery and is a member of the American Society of Plastic
Surgeons. Qualified physicians may be certified by other specialty boards,
but the patient has a right to know exactly what kind of training the
physician has in cosmetic procedures; a weekend course in liposuction is
--Steven A. Goldman, M.D.
Interim chief of plastic surgery
University Hospitals of Cleveland Case School of Medicine
Article copyright the Cleveland Jewish News.