Agnesian HealthCare Know & Go Showcase: Options in Plastic Surgery

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Dr. Richard Schaefer, a plastic surgeon at Agnesian HealthCare's Plastic Surgery & Cosmetics Services Center presents about the latest developments in plastic surgery & cosmetic services.

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  • Page 10
  • Page 36
  • These pre- and post-treatment photos show a very good outcome
  • Varicose veins are a common local condition that causes edema and skin discoloration. - These conditions can cause inadequate return of blood to the heart. - The resulting increased back-pressure in the veins forces fluid to leak into the interstitial tissue spaces, where the retained excess fluid is recognized as edema. - Hyperpigmentation occurs as a result of underlying vein disease and is a very common finding with Stage II venous insufficiency. [Source: http://www.medicinenet.com/edema/page2.htm]
  • Stasis dermatitis has an estimated prevalence of 6% to 7% in adults over the age of 50. In the United States, this is thought to be between 6 and 7 million people. [Source: http://circ.ahajournals.org/cgi/content/full/111/18/2398]
  • Lipodermatosclerosis: hardening of the legs in patients with venous insufficiency. It is characterized by induration, hyperpigmentation, and depression of the skin. A venous ulcer is a chronic defect in the skin that fails to heal spontaneously, and is caused by chronic venous disease
  • Agnesian HealthCare Know & Go Showcase: Options in Plastic Surgery

    1. 1. Plastic Surgery Options RICHARD B. SCHAEFER, MD Agnesian Plastic Surgery & Cosmetic Surgery Fond du Lac * Ripon * Waupun
    2. 2. What Is Plastic Surgery? Surgery of the skin and all of its contents
    3. 3. What Is Plastic Surgery? • Craniofacial surgery - Cleft lip and palate • • • • • • • Hand surgery Microsurgery Transplant surgery Cosmetic surgery Dermatologic surgery Oculoplastic surgery Burn surgery
    4. 4. What Is Plastic Surgery? • Craniofacial surgery • Hand surgery - Finger replantation • • • • • • Microsurgery Transplant surgery Cosmetic surgery Dermatologic surgery Oculoplastic surgery Burn surgery
    5. 5. What Is Plastic Surgery? • Craniofacial surgery • Hand surgery • Microsurgery – Free tissue transfer • • • • • Transplant surgery Cosmetic surgery Dermatologic surgery Oculoplastic surgery Burn surgery
    6. 6. What Is Plastic Surgery? • Craniofacial surgery • Hand surgery • Microsurgery • Transplant surgery - J. Murray ‘54, Nobel ‘90 • • • • Cosmetic surgery Dermatologic surgery Oculoplastic surgery Burn surgery
    7. 7. What Is Plastic Surgery? • • • • Craniofacial surgery Hand surgery Microsurgery Transplant surgery • Cosmetic surgery - Facelift, tummy tuck • Dermatologic surgery • Oculoplastic surgery • Burn surgery
    8. 8. What Is Plastic Surgery? • • • • • • • • Craniofacial surgery Hand surgery Microsurgery Transplant surgery Cosmetic surgery - Facelift, tummy tuck Dermatologic surgery - Skin cancer Oculoplastic surgery Burn surgery
    9. 9. What Is Plastic Surgery? • • • • • • Craniofacial surgery Hand surgery Microsurgery Transplant surgery Cosmetic surgery - Facelift, tummy tuck Dermatologic surgery - Skin cancer • Oculoplastic surgery - Eyelid surgery • Burn surgery
    10. 10. What Is Plastic Surgery? • • • • • • • Craniofacial surgery Hand surgery Microsurgery Transplant surgery Cosmetic surgery - Facelift, tummy tuck Dermatologic surgery - Skin cancer Oculoplastic surgery - Eyelid surgery • Burn surgery - Skin grafting
    11. 11. Aging • Muscles – Repeated skin folds - wrinkles • Volume Loss – What was once full, becomes deflated – Grape to raisin - wrinkles
    12. 12. Aging • Skin changes – Texture – Loss of elasticity - wrinkles – Sun damage • Gravity – Downward drift
    13. 13. See How the Face Ages
    14. 14. Aging • Muscles – Repeated skin folds - wrinkles • Volume Loss – What was once full, becomes deflated – Grape to raisin – wrinkles • Skin changes – Texture – Loss of elasticity - wrinkles – Sun damage • Gravity – Downward drift
    15. 15. Anatomy • Rhytids - wrinkles – Skin as fabric – Dynamic – Static
    16. 16. Wrinkle Treatment • Botox temporarily stops dynamic wrinkling • Lasts three to four months • $200 to $800 per treatment
    17. 17. Botox® • • • • Bacterial protein Relaxes muscles Dynamic wrinkles FDA approved – Glabellar lines
    18. 18. Botox® • Off label • ASPS 2004 • Shaping • Concensus  Forehead  Crow’s feet  Neck  Lips  Nose  Brow
    19. 19. Forehead
    20. 20. Crow’s Feet
    21. 21. Crow’s Feet
    22. 22. Neck Banding
    23. 23. Aging • Muscles – Repeated skin folds - wrinkles • Volume Loss – What was once full, becomes deflated – Grape to raisin - wrinkles • Skin changes – Texture – Loss of elasticity - wrinkles – Sun damage • Gravity – Downward drift
    24. 24. Volume Loss • Restoring volume by plumping up an area that has deflated over time • Filler treatment – Lasts 9 to 15 months – $599 to $1,495 • Use your own fat – Expense – Donor site pain – Reliability
    25. 25. Juvederm & Restylane® • • • • Dermal Filler Biodegradable HA gel Injected  Very fine needle to minimize discomfort Photo courtesy of Q-Med Note: Volume injected depends on patient, location, and degree of correction required.
    26. 26. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with one 1 mL syringe
    27. 27. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with two 1 mL syringes
    28. 28. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with three 1 mL syringes
    29. 29. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with two 1 mL syringes
    30. 30. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with three 1 mL syringes
    31. 31. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with two 1 mL syringes
    32. 32. Restylane® Results Nasolabial folds before treatment Individual results may vary. After treatment with two 1 mL syringes
    33. 33. Lips
    34. 34. Glabella
    35. 35. Glabella
    36. 36. Face
    37. 37. Facial Rejuvenation
    38. 38. Facial Rejuvenation
    39. 39. Aging • Muscles – Repeated skin folds - wrinkles • Volume Loss – What was once full, becomes deflated – Grape to raisin – wrinkles • Skin changes – Texture – Loss of elasticity - wrinkles – Sun damage • Gravity – Downward drift
    40. 40. Skin Care • Cleanse • Restore – Hydrate – Repair • Sun protection
    41. 41. Cleansing • Removes grease, dust, makeup and sweat • Do not modify skin or penetrate • Normal skin – Vitamin C, Urea, Saponins • Dry skin – Vitamin E, glycerin, seed oils, plant extracts
    42. 42. Restoring - Hydration • Occlusive agents – Vegetable oils and fatty acids – Lanolin, stearic acid, phospholipids • Moisturizers – Creams or lotions (oil in water) – Glycerin, PCA, lactic acid, urea, ceramides
    43. 43. Restoring - Repair • Alpha-hydroxy acids – – – – – Glycolic Lactic Malic Citric Tartaric • Tretinoin • Improves – – – – – – – – – Dryness Texture Acne Rosacea Photodamage Melasma Hyperpigmentation Wrinkles AK’s
    44. 44. Sun Protection • • • • • Zinc oxide Titanium dioxide Parsol 1789 Apply before makeup Reapply if outdoors
    45. 45. Anti-Oxidation • – 5% to 20% • Collagen synthesis • Neutralizes free radicals • Reduces inflammation • Brightens skin • • Vitamin C • • • • Surface texture Fine wrinkles Tactile roughness Coarse rhytids Skin laxity Sallowness
    46. 46. Other Antioxidants • • • • Vitamin E Co-enzyme Q-10 Squalene Data incomplete or not statistically significant
    47. 47. Bleaching Agents • Hydroquinone • Kojic acid • • • • Age spots Sun damage Irregular pigments Melasma
    48. 48. Results
    49. 49. Light-Based Treatments • Intense Pulsed Light (IPL) • Laser – Hair removal – Vein ablation – Resurfacing • Ablative • Non-ablative
    50. 50. How Do Light Therapies Work? • Specific target in skin absorbs energy • Non-target tissue remains unaffected • Target – Stimulate – Contract – Destroy
    51. 51. IPL – Photo-Rejuvenation • • • • • • • • Photo damaged skin Age spots Irregular skin pigments Telangectasia (small blood vessels) Redness of rosacea Fine hair No downtime Rapid treatments
    52. 52. IPL – Facial Pigments
    53. 53. IPL - Telangectasias
    54. 54. IPL for Sun Damage
    55. 55. Upper Chest
    56. 56. Aging • Muscles – Repeated skin folds - wrinkles • Volume Loss – What was once full, becomes deflated – Grape to raisin – wrinkles • Skin changes – Texture – Loss of elasticity - wrinkles – Sun damage • Gravity – Downward drift
    57. 57. Body Contouring • • • • Fat Skin Muscle Scars
    58. 58. Body Contouring • Fat - liposuction • Skin • Muscle • Scars
    59. 59. Body Contouring • Fat • Skin - excisional therapies • Muscle • Scars
    60. 60. Liposuction • • • • Minimal scars Vacuums out fat Minimal skin tightening Can use internal energy sources to breakdown fat prior to suctioning – Ultrasound – Laser – Cool sculpting
    61. 61. Ultrasound Assisted Liposuction • Ultrasound – Breaks down fat – Individualize Settings – Sensitive Areas • Smooth results – Even shape and contour
    62. 62. Neck
    63. 63. Abdomen & Flanks
    64. 64. Abdomen & Flanks
    65. 65. Abdomen & Flanks
    66. 66. Men Too!
    67. 67. Breasts
    68. 68. Abdomen & Breasts
    69. 69. Abdomen
    70. 70. Excisional Therapies • Tummy tuck • Belt lipectomy – Massive weight loss patient • Breast lift • Arm lift
    71. 71. Belt Lipectomy
    72. 72. Belt Lipectomy
    73. 73. Total Body Rejuvenation
    74. 74. Breast & Arms
    75. 75. Back
    76. 76. Facial Reshaping • • • • • Face lift Neck lift Rhinoplasty - Nose job Blepharoplasty - Eyelids Brow lift
    77. 77. Face & Neck
    78. 78. Rhinoplasty
    79. 79. Blepharoplasty - Eyelids • Upper – Relation to brow • Lower – Relation to cheek • Skin • Muscle • Fat
    80. 80. Upper Blepharoplasty
    81. 81. Transconjunctival Blepharoplasty
    82. 82. Four Lid Blepharoplasty
    83. 83. Four Lid Blepharoplasty
    84. 84. Brow & Upper Lids
    85. 85. Breast • Reduction • Augmentation • Lift (mastopexy)
    86. 86. Reduction • • • • • • • Neck pain Back pain - Upper, lower and mid Shoulder grooving Numbness/tingling in arms Skin rash/breakdown beneath breasts Difficulty exercising Insurance
    87. 87. Reduction
    88. 88. Hypomastia • Small breasts • Breast smaller than desired • Cosmetic
    89. 89. Breast Implants • Saline Filled – Small incision – Some ability to adjust volume – Ruptures obvious - deflation • Gel (silicone) Filled – Incision related to implant size – Ruptures silently
    90. 90. Augmentation
    91. 91. Breast Reconstruction • After cancer removal the breast may be partially or completely altered. • Reconstruction may be done at the time of the removal or at anytime thereafter. • There are a variety of surgical options that can correct these deformities. • The other breast can also be adjusted to match.
    92. 92. Hand Surgery • Soft tissue of the hand – Tendon repair – Ganglion cysts – Skin contracture – Trigger finger • Nerve release – Endoscopic carpal tunnel release – Ulnar nerve transposition
    93. 93. Varicose Veins • Leg pain • Leg swelling – Sock marks • Varicosities
    94. 94. Vein Valve Failure Normal vein: valve open and closed Dilated vein with nonfunctioning valve
    95. 95. Varicose Vein Treatments • Endovenous Radiofrequency Ablation • Has replaced stripping – Local anesthetic – In-office – No significant activity restrictions or pain
    96. 96. Micro or Stab Phlebectomy Pre-treatment: Varicose anterior accessory saphenous vein Post-treatment: Very minimal incision sites
    97. 97. Sclerotherapy • Injection of material to injure vessel causing fibrosis • Advantages – Short office procedure – Effective – Can be redone • Disadvantages – Allergy – Ulceration – Pigmentation
    98. 98. Edema and Hyperpigmentation • Lower leg edema and hyperpigmentation are common presentations with venous insufficiency. • CEAP 4 - Edema and skin changes from venous disease. Image courtesy of Rajabrata Sarkar, MD
    99. 99. Stasis Dermatitis • Stasis dermatitis appears as itchy, scaly patches on the lower extremities • Hyperpigmentation occurs as a result of red blood cell extravasation and hemosiderin deposition • CEAP 4 - skin changes from venous disease
    100. 100. Progression of Venous Stasis • Poor skin nutrition and oxygenation • Subcutaneous fat necrosis – Lipodermatosclerosis – CEAP 6 - Venous stasis ulceration • Will recur unless underlying venous insufficiency is treated Amor Khachemoune, Catharine Lisa Kauffman: Management Of Leg Ulcers. The Internet Journal of Dermatology. 2002. Volume 1 Number 2.
    101. 101. Skin Cancer • • • • • Basal Cell Carcinoma Squamous Cell Carcinoma Melanoma Excision Reconstruction
    102. 102. Mission Work • Philippines – Bulacan – Pampanga • Peru – Trujillo
    103. 103. Patient Wards
    104. 104. Facilities
    105. 105. Sterile Processing
    106. 106. Labor & Delivery
    107. 107. Drying Rack for Gloves
    108. 108. Questions? Thank You!

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