Plastic SurgeryWith Dr. Steven Bernard

Jillian Krebs

Wound CareAll surgeons close wounds, however occasionally some wounds are large, jagged, or cannot be covered by the skin the patient has left. This is where a plastic surgeon comes in, using various methods to close wounds and leave as minimal scarring as possible.

Skin Grafts: The surgeon takes healthy skin from a different part of the patient’s body and uses it to cover

the wound. Most commonly used when there is a lack of adjacent skin; for example, burn victims.

Tissue expansion: A balloon is inserted under the skin and tissue then filled with saline. This stretches the skin until there is enough to close the wound. Most commonly used for breast reconstruction

Flaps: The surgeon removes skin, muscle, and sometimes even bone from one part of the body to use in another. This flap is kept alive with its own blood blood vessels being reconnected to those in the new area using microsurgery. Most commonly used to treat cancer and trauma patients.

RhinoplastyAlso known as nose reshaping, rhinoplasty improves proportions of nose and create facial harmony. This

procedure can change nose size in relation to the face, width of bridge to proportion of nostrils, a nose profile with bumps or depressions at the bridge, nasal tip of unproportional shape or size, and nasal asymmetry.

Although this is usually a cosmetic surgery, rhinoplasty can also correct a deviated septum (one of the most

common causes of impaired breathing) and improve the airflow of the patient through the nose.

 

 

Trigger FingerTrigger finger is a condition where a finger gets stuck in the bent position. The finger may straighten with a snap--like a trigger being pulled and released. This

occurs when inflammation narrows the space of the sheath that surrounds the tendon in the affected finger. It is usually more common in women and people with diabetes. Treated with a steroid shot near or directly into the tendon sheath (sometimes temporarily, sometimes permanently depending on the patient). If more than 3 steroid shots are required, surgery is usually performed to cut the sheath creating space.

RhytidectomyStemming from the greek roots meaning wrinkle and

excision, rhytidectomy is the surgical removal of wrinkles, most commonly known as a face lift. Face lifts are cosmetic procedures used to improve visible signs

of aging in the neck and face such as loose and sagging skin, creases around the eyes, nose, and

mouth, and loss of skin tone in the lower face. Other rejuvenation procedures usually performed in

conjunction with face lifts are a brow lift, to correct a sagging brow, and eyelid surgery to rejuvenate aging

eyes.  

 

After a MastectomyBreast Cancer is the 2nd most common cancer in women in the

United States and often leads to full removal of one or both breasts. After this procedure, there are many options for Reconstruction.

Silicone Breast ImplantsThis implant is a cohesive silicone gel inside its shell. After an

expander has stretched the skin, the surgeon surgically inserts the silicone implant into the pocket made in the breast area.

Advantages: Most natural-feeling implant, short and easy procedure, rippling is rarely an issue.

Disadvantages: Scarring, infection, could incite foreign-body reaction, possibility of rupture.

Nipple ReconstructionThe nipple cannot be saved during a mastectomy. However, after

the implant surgery has been fully healed, a nipple can be reconstructed with the skin surrounding the area in which the nipple

is desired.

Advantages: Real, 3-D nipple made with patient’s skin(no risk of foreign-body reaction.

Disadvantages: Another surgery under anesthetics.

Form-stable “Gummy Bear” ImplantsFirm, tear-drop shaped implants in which the gel inside holds its

shape even when implant is cut in half. Surgically inserted after an expander has been used.

Advantages: match the shape of a natural breast, less chance of wrinkling, small chance of rupture.

Disadvantages: Firmer and less natural feeling, must be careful how inserted, possible rotation leads to thicker part on top, scarring,

infection, could incite foreign-body reaction.

*Another option is having a nipple tattooed. It looks real and 3-D however it is simply a flat tattoo. No anesthetics required however

could be painful and may fade with time. Performed by a tattoo artist, not a doctor.

Expander ImplantTemporary implant usually inserted immediately following the

mastectomy. Empty when inserted but gradually filled with saline starting about 2-3 weeks after surgery to create a soft pocket for

the permanent implant.Advantages: Create a pocket so implant looks more natural,

variety of shapes and sizes.

Disadvantages: Do not look or feel like a natural breast(but they’re temporary so thats okay!), more than one surgery, infection, could

incite foreign-body reaction.

Free TRAM Flap ReconstructionThe surgeon takes tissue from the abdomen while preserving the

blood vessels. The tissue is completely removed from the body and transferred up to the breast, and blood is supplied through microscopic reconnection of the preserved blood vessels.

Advantages: Feels and moves like a real breast, does not incite foreign-body reaction, usually combined with mastectomy to be one

surgery(no need for expander), bonus abdominal rejuvenation.

Disadvantages: Technically exacting, extra 6 to 8 hours under anesthesia, large scar on the abdomen(however it is covered by

most swimsuits and pants).

**All implants are also used for breast augmentation, a cosmetic surgery, without the use of an expander.

Facial Transplants

In this difficult series of procedures completed less than 3 dozen times world-wide, surgeons work together to restore

severe facial deformities which cannot be corrected using standard reconstructive

procedures.

In this procedure, both form (how the skin, bones, and underlying muscle look) and function of remaining tissues

(eyelids, lips, jaw, and nose still intact) need to be

considered. Some issues can be resolved with previously established reconstructive techniques. However, if there

is a combination of deformities, the patient might not have enough of his or her own tissue for total reconstruction. In

these cases, a face transplant is considered.

This is an example of a potential facial reconstruction patient taken with a High Definition spiral CT scan with computer reconstruction.

Potential patients need to undergo many more processes than any average transplant. They need to be screened

for psychological health, family support, understanding of complications, and medicine compliance. Because the

face is such an integral part of what makes us human, the doctors want to be sure that, should anything

complications occur, the patient has the ability to cope and have support at home from family and friends.