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| Suction of fatty tissue (liposuction)
is a surgical method allowing for shaping of the subcutaneous
fatty tissue with only a small skin scares left. This
method is particularly useful in modelling of hips, thighs,
buttocks, abdomen and more rarely – arms or chin. This
operation is performed under local, suprameningeal or
general anaesthetic, depending on its extent. The fatty
tissue is impregnated with great amount of a special solution
that makes the more extensive modelling easier to perform
and minimalize the blood loss (so-called wet, oedema method.
Then the special cannulas connected to the sucking device
are introduced through the cuts of skin of 3-4 mm length.
In course of one operation up to ³ litres of semi liquid
fatty tissue may be sucked this way. The exudates absorbing
dressings are used for a couple of days following the
operation. It is very important to wear the compressing
clothes and take massages for a month after the surgery.
The suction results in permanent reduction of significant
number of fat cells. The areas that were treated that
way will return to previous deformities with more difficulty
even if the overall body mass increases. However it does
not mean that repeated putting on weight is impossible,
so after the operation a patient should obey the diet
recommendations and live in a healthy way. The following
complications after the operation may happen: infection,
haematomas, prolonged serous exudates, fat embolism. These
complications are rare, though, and their correction or
treatment results in positive final result. |
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The full recovery of patient
and return to work is possible after approximately 7 days
since the operation |
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| The abdomen plastics. The
plastic surgery of the abdominal integuments is performed
to eliminate the excessive flabby skin and subcutaneous
tissue resulting from the pregnancies, significant weight
loss or the ageing processes. The operation is performed
under the local or suprameningeal anaesthetic. The surgery
results in increased tension and flattening of the integuments
however the side effect is a one line scar of hypogastrium
or a round scar around the navel. After the operation
a patient should expect the feeling of abdominal integuments
over tension that may be noxious for a first few days
and will maintain with less intensity for further few
weeks. The dressings should be worn for about 2 weeks.
The drains are removed between 2nd and 7th day following
the operation and the sutures – after seven days since
operation. After the surgery the special massages of abdomen,
particularly postoperative scars are made, also with a
use of special softeners. The patient is advised to wear
compressive clothes for 2 months after the surgery. The
possible complications are: infections, prolonged serous
exudates, retarded postoperative wound healing and unsightly
look of the hypogastrium scar that may require further
correction. |
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The average period of leave
at work is 10 days |
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| Breast enlargement. The
contemporary method of breasts enlargement consists in
implantation of internal breast implants. The operation
is performed under general anaesthetic. The implant is
introduced through the cutaneous cut of 2-5 cm length
located in the fold under the breast, under the armpit
or at the border of areola of the mammaand the surrounding
skin. The implant is placed in the site, in a front or
under a greater pectoral muscle. The capsule of prosthesis
,smooth or rough, is made of artificial materials and
their centre is fulfilled with physiological saline, hydrogel,
or with silicone. Drains are usually removed on the second
– the fourth day and the sutures are removed on the tenth-
the fourteenth day after. The dressings are usually kept
about 10- 14 days. Then it is advised to wear a well fitted
bra , for about a month. During the first three months
the independent, intensive massage of breasts as well
as using the special, specimen, softening scars,( ointments,
creams) are advised. The breast -feeding is possible after
this operation. There are possible complications after
this operation like hematoma, infection and production
, around the prosthesis, connecting tissue, ”internal
scar” which in the case of excessive development can cause
the hardening of breasts. Such situation hardly ever happens,
however it forces to start treatment , including also
operation. |
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Return to work is usually
possible after 7 days since operation. |
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| The elevation or diminution of breasts.
Too large breasts can, especially at women with the gentle
constitution lead to strong pains of the spine and shoulders
because of excessive load of the spine .The breasts’deformity
can take a place as the result of hormonal changes connected
with pregnancy and breast- feeding. The operations of
diminution or/and elevation of breasts resulting in achievement
of desired size and shape of the breast are performed
under general an anaesthetic. During the operation the
excessive skin, subcutaneous tissue and gland and the
new shape of breast is modelled with appropriate suturing
of remained tissue. It may be necessary to perform wide
cuts and in consequence to leave relatively long post
operational scars. The edges of the skin are connected
with a delicate sutures. The drains are removed in the
48-96 hours after the operation, and the sutures are removed
gradually after the 7th day following the surgery. The
dressing is necessary for 10 days and for a month a patient
should wear day and night the tight bra. After healing
of the wounds the patient should massage her breasts,
particularly the skin scars with special preparations.
The possible complications of this surgery might be: haematomas,
infection, impaired wound healing, cosmetically unfavourable
scars, which may require further correction. |
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The return to work is usually
possible about 10th day after the operation. |
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| Correction of eyelids.
The relaxation of eyelids is most of all the result of
retrogressive changes in collagen and elastic skin fibres.
The aim of an operation is to remove the upper eyelids
folding, the lower eyelids bags and minor wrinkles around
the eyes. The operation is usually performed under local
anaesthetic also with an assistance of anaesthesiologist
(so called sedation). The skin cuts are run within the
natural folds parallel to the eyelids edges. The excessive
skin is removed and sometimes fragments of perispheral
fat as well. The wound is closed with delicate sutures.
The minor filtration of blood and the oedema is present
after the operation. For a few days the wet, cold boric
acid compresses are required. In first three days following
the operation the eyelids may exhibit defective closure
and the lower eyelid and external eye angle may not fully
adhere the eye ball. These symptoms usually regress in
few days. The sutures are removed in 4th-7th day after
operation. The possible complications are: overgrow of
the scars demanding repeated operation. |
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The return to work is usually
possible after a week. |
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| The correction of the protruding
ears. The ears usually protrude due to the excessive
flattening of auricle cartilage. As the growth of the
auricle is completed about 5h year of human life then
the operation may be performed on the child that hasn’t
attended a grammar school yet. The operation is usually
performed under local anaesthetic also with an assistance
of anaesthesiologist (so called sedation). The cut of
skin is located in the anterior surface of auricle. The
excessive cartilage is removed and its remaining part
properly modelled and located in proper position. He skin
is closed with thin absorbable sutures that do not require
further removal. The post operational dressings are required
for a week after the operation. For few weeks after the
operation the ears should be protected from compression
and freezing and in the night the compression band should
be worn to protect the ears from accidental injuries during
the sleep. In rare cases the scar behind the ear may be
overgrown and in some cases the absolute symmetry is hard
to achieve so these problems may require an repeated operation. |
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The return to work or school is usually
possible after a week. |
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The correction of nose.
The most popular nose deformations are: excessive osteochondral
hump, the widening, duality or protruding of the nose
tip. Sometimes the nasal septum deviation resulting in
breathing impairment is present as well. In particularly
extensive nose deformities the achievement of positive
result in single operation is not possible. The nose correction
surgery is performed under local or general anaesthetic,
depending on the surgery’s extension. He excessive bones
and cartilages are removed from the cut inside of the
nose and the elements of nose skeleton are modelled. The
cuts of skin and mucosa are closed with absorbable sutures
that don’t require removal. The nasal passage is filled
with tampons and the nose is put in modelling stiff plastic
or metal dressing. The tampons are removed within 48 hours
since the operation and the external dressing is kept
for 7-10 days. The oedema and livedos of eyelids and cheeks
after the operation are frequent; also the nose after
removal of the protective dressing may be swelled. Due
to the oedema of mucosa the breathing may be at first
difficult. The sensitivity of nose and upper lip may be
decreased. The possible complications include: excessive
bleedings, infections, and excoriations of skin in the
compression of the stiff dressing. The bone tissue superstructure
and the origin of excessive bulge can exist in the place
of bone’s section.. The implanted bones and cartilages
can get dislocated. Although these complications don’t
exist too often, however they can demand the repeated
operation. On the first day after the surgical procedure
the patient should stay in bed with his head elevated
higher. The application of cold compresses decreases haematomas
and oedemas. Too active removal of the exudates from the
nose shouldn’t be made during the next few days. The skin
can be covered with make-up just after taking off the
dressing. For next three months you should avoid injuries,
overheating and cooling. As the nose after the operation
is especially sensitive for injuries, so you should be
very careful during sport activities and wearing glasses
isn’t advised before expiration of a few weeks. The intensive
massage of the nose, starting since the third week after
the operation is essential because
It gives possibility of faster suppression of oedema and
softening the callosities (internal scars ) which are
often being created. The final form of the nose is achieved
not earlier than after a half of year.
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The return to work is usually possible after
2 weeks. |
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The correction of scars.
The correction of scars is advised in these cases where
the scars are excessively bulged either lead to mobility’s
impairment or to the disorder
of growth of individual body parts as well in the situation
when they aren’t accepted by a patient. Every scar’s correction
including the resection and suture results in the creation
of a new scar .The purpose of operation is to be possibly
useful cosmetically. The operations are performed under
the local or general anaesthetic according to the extent
of scars. In individual cases the simply resection and
precise suture can be sufficient. However, the scar should
be usually lengthened and changed its direction, which
can be achieved with the special surgical techniques The
uneven surfaces of scars can be at least partially flattened
by smoothing of skin (dermabrasis). For 7months after
the operation you should avoid the intensive sunbathing.
There is often used method of treatment of hypertrophied
scars or keloids to give injections of the special pharmalogic
preparations, which cause its softening and flattening.
To prevent from renewed hyperplasia of scars the following
methods are used: intensive massages, external specimens
for rubbing in the scar (they content the onion extract),
the special pressing clothes, the self-adhesive folias
and a number of other supportive methods. It is really
essential to comply with the recommendations on postoperative
procedures. The final effect can be estimated not earlier
than a year after the operation. The possible complications
these are: the infection of wound, haematoma , sutures
dehiscence, not esthetical scars, which can demand the
renewed correction. |
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As far as the small operations are concerned,
the medical certificate of temporary work disability may
not be necessary, but as for the extensive operations,
this medical certificate can include even a few weeks. |
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| Lower limbs varices.
The pathologic venectasia of lower limbs as well these
ones of bigger diameter (varices) as these smallest ones
(netting varices) are of frequent occurrence, usually
in middle-aged women. It is usually connected with the
genetically determined asthenia of venous vessel walls.
The contemporary used pharmalogical treatment is successful
in many cases. However, in advanced phase of disease where
unprofitable complications can occur, it is advised to
make the radical, invasive procedure(operation, obliteration).
The precise resection of small diameter veins is possible
owing to introduction of the miniature surgical instruments.
The smallest changes like netting varices are the domain
of obliteration treatment (injections into vessels which
result in occlusion of a vessel). These operations are
made under general anaesthetic, either epidural or local
one according to the planned extent of them. The possible
complications include: haetoma, infection, skin defect,
not esthetical skin scars. These complications can not
only prolong treatment , but also can demand renewed operation. |
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The return to work is usually possible:
in the case of big varices resection, after about 10 days
since the operation, in the case of the obliteration of
little veins there is no need to take a day off. |
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| The correction of flaccidity of
face and neck skin. The lapse of time results
in degenerative changes within collagen and elastic fibres
of skin, which lead to flaccidity of face skin. The aim
of operation is the resection of the skin excess and shallowing
of wrinkles and folds, especially in lower part of face
and on the neck However, the primary elasticity isn’t
possible to restore with the operation. This procedure
is made under local anaesthetic often adjunct with general
intravenous anaesthetic. The typical skin incision runs
in hairy skin of head , in temporal area, then goes down
in a front of ear concha, surrounds its lower pole and
then runs at the back of ear concha ending in the hairy
skin of head- behind the ear. The skin of face and neck
is separated from deeper tissues and next stretched back-upward
and the excess of skin is removed. In some cases, the
facial mimic muscles surface is also prepared and stretched
(SMAS).The skin margins are sutured precisely. Drains
are removed on 2nd- 7th day ,the sutures are usually taken
off in a few stages: since 5th-14th day after operation.
The dressings are used for about 7- 10 days. The swelling,
little blood efflux, dysesthesia in the close neighbourhood
of scars and on cheeks can occur immediately after operation.
The final effect of operation should be estimated not
earlier than 3 months after operation. The occurrence
of haematoma is rare postoperative complication, but it
sometimes forces to the renewed operation . |
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The absence at work usually lasts about
7 days. |
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| Dermabrasion (the abrasion of epidermis),
laser abrasion. Dermabrasion in other words the
mechanical abrasion of epidermis is used in the case of
the post acne, post burn scars, superficial melanodermas
and tattoos as well little wrinkles in some parts of face.
As far as the acne is concerned, the purulent changes
should be cured before the procedure. The procedure of
dermabrasion is made under local or general anaesthetic,
according to foreseen extent or depth. The superficial
skin layers (epidermis and superficial layer of proper
skin) are removed with the special abrasive apparatus,
remaining deeper layers which include sebaceous and sweat
glands as well hair follicles. The laser CO2 is the modern
instrument enabling the supervised abrasion of epidermis.
The laser abrasions are usually made to shallow little
wrinkles of facial skin. The protective dressings (folic
or ointment) are put on the skin. The restoration of epidermis
follows in 5 to 10 days. In the case of deep post acne
scars, this procedure should be repeated after a few months.
The scars become less visible after dermabrasion or laser
abrasion, however the complete removal of them is impossible.
The reddening of skin usually lasts 2-4 weeks, but in
exceptional cases it can last up to a few months. You
should avoid sunbathing at least for 3 months. |
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The return to work is usually possible in
a week or 2weeks after this surgical procedure. |
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The correction of vesel spiders,
spider angiomas, teleangiectasias. The spider
angiomas, vessel spiders and teleangienctasias which are
the local accumulation of capillary vessels with the delated
lumen and hypertrophied walls. They sometimes make the
serious cosmetic problem, especially at their location
on a face. The treatment of these changes consists in
application of the electro coagulation either the vessel
lasers (argon, pigment, KTP) or the special device emitting
very strong light (photoderm). The surgical procedure
consists in acupuncture of blood vessels through the skin
with the little needle which is the end-part of the device
producing high frequency currents. The thermal energy,
released in this way, let closing the vessel lumen. These
operations are usually made under local anaesthetic with
EMLA cream.
Immediately after surgical procedure cured areas are greased
with the curative antiseptic ointment. It is advised to
wash the face with gentle washing agents and to grease
with the antibiotic ointment, for a few days after the
operation. Healing of changes follows in a few days. The
created little ,spot scars, at first more distinct, with
the lapse of time disappear. As far as larger areas of
vessel changes are concerned, it is often necessary to
operate in recurring several times with 2-4weeks of break. |
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The medical certificate of work disability
is not usually necessary. |
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| The correction with the application
of fillings. The fillings are understood as specimen
of biological or artificial origin, applied as the subcutaneous
or intradermal injections. The most often , small lips,
post-acne or post-traumatic ,excavated scars, little wrinkles
especially between eyebrows, around the lids and lips
are the operative indication. The bovine collagen is the
classical preparations in this group. According to the
type and the place of application, the profitable effect
remains from 6 to 24 months, after this period of time,
the surgical procedure should be repeated. Newer preparations
resulting in similar effect persistence are made on the
base of hyaluronic acid. To achieve more persistent effect,
at present plastics, mainly on the acrylic base in the
form of micro, unsubmitted to displacement and absorption
particles or acrylic hydrogel are added to collagen or
hyaluronic preparations. It is possible to apply own fatty
tissue as the filling. After the operation of application
of intradermal or subcutaneous fillings, the skin is being
covered with the antibiotic ointment . For the first few
days it is necessary to wash the face with gentle washing
agents and then covering it with the ointment. The oedema
can last for 2 to 3 days. The makeup can be made after
three days. |
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There is usually no need to take the day
off. |
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| Peeling (chemical exfoliation of
skin). Peeling it is the supervised chemical
exfoliation of skin as the result of activity of some
substances of biological or chemical origin. You can distinct
following types of peeling: superficial ones (made mainly
in cosmetic rooms); peelings at medium depth and deep(they
must be made by doctors). The most used preparations consist
the trichloroacetic acid, rezolcinol, salicylic acid,
phenol, alphahydroxyacids (fruit acids) Asiatic peeling,
as well different, ready , made in factories , preparations.
The deep peelings create the result of smoothing, strenghtening
of facial skin, remove the little wrinkles and discolouration.
Their profitable effects depend, among other things, on
uniformity and thickening of subepidermal, colagen layer
in the proper skin and reduction of the number of pigment
cells in epidermis. Peeling is also the perfect supplement
to the plastic operation of face and lids, it can also
help with the removal of little wrinkles around lips,
lids or on forehead, these wrinkles that are hard to correct
by strictly surgical methods. The peelings of the whole
face and local operations around the lips, around the
eyes and between the eyebrows and the root of nose are
made. In the case of the deep peelings, the operations
are made under general anaesthetic or sedation. The strong
burning sensation should be expected on the first day
after the operation, then inconvenience because of the
excaudate, the formation and the exfoliation of superficial
crusts. After about seven days there follows the separation
and visualisation of the regenerated skin, which in the
beginning is very dried and sensitive to little abrasions
and insulation. Then the skin should be washed carefully
with gentle washing, moisturising agents (moisturising
creams) .The reddening can last a few weeks, in exceptional
cases it can prolong even up to a few months. For at least
a half of year the insulation should be avoided and you
should use the UV protective preparations. |
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The average leave absence after the deep
exfoliation of facial skin is about 10 days, after the
peeling at the medium depth it is 5-7 days of absence. |
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The nodules of skin and the subcutaneous
tissue. At many people there are different skin
nodules (the pigmented naevus, seborrhoeic warts, fibromas,
calluses, xanthomas) and the nodules of the subcutaneous
tissue (atheromas , lipomas ). The most of the changes
of this type isn’t the operative indication. However,
if these changes disturb patients because of cosmetic
or functional reasons, or are oncologically suspected,
then they should be resected.
The nodules of skin and subcutaneous tissue are removed
by surgical resection. The post resection created, little
defects are being closed with the sutures, and the scars
are usually of the linear shape. The nodules of subcutaneous
tissue are also removed by linear resections. The created
little wounds are being closed with the gentle sutures.
The dressings are usually kept for a week, as well after
this time the sutures are removed. In the case of benign
changes, which don’t make neoplastic suspicion, the surgical
laser treatment is very useful.(so called the evaporation
of tissues. The remained, after the laser operation traces
are( in some locations) more useful cosmetically in compare
to the surgical scares. If the nodules are evaporated
by laser, then the created crust should be washed out
with the salicylis spirit. The crust usually falls off
after a week or two, having remained the circle, flat
scar. For achievement of the best effect it is advised
to use the special preparations with onion extract, after
healing of wound. The systematic, strong rubbing the ointments
or creams in the scars, made even a year after the operation
influences very profitable their appearance. In the case
of the irritated, pigmented nevus, the microscopic, histological
examination of uptaken tissues is advised.
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A few days absence at work can be necessary
after the resection of little nodules of skin and subcutaneous
tissues. |
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