Τετάρτη, 30 Ιανουαρίου 2013

Breast implansts,are they safe?


Dr Ioannis Georgiou
Plastic and Reconstructive Surgery

What are Breast Implants?
A breast implant is a medical prosthesis made of medical silicon used to augment, reconstruct, or recreate the physical form of breasts.

How many shapes?
There are two main shapes of breast implants. Anatomical implants looks like a teardrop and they can give the breast a natural shape. They can only be oriented in one way, so the pocket has to be very precise in order to avoid rotation leaving the breast looking misshaped. The implant will feel firmer as it is more solid in order to keep its shape.
Round implants are used more commonly as they feel softer and the orientation does not matter, making the surgery much easier. In very thin patients with little breast volume though will make the breast look unnatural.

Under or over the muscle?
The placement over the muscle is easier and the recovery is more straightforward with less pain. The breast animations due to the muscle movements are eliminated, thus achieving a more natural result.  Never the less edge visibility and palpability can become an issue in thinner patients with little breast volume. The risk for capsular contracture is higher.
The placement under the muscle cause more pain and the recovery takes longer. Contracture of the muscle may cause distortion of the breast during movements. The capsular contracture rate is lower. However is the only option in thin patients with minimal breast tissue.

For how long?
New breast implants do have the possibility of lasting a lifetime. They need to be changed only if you have problems with them. However due to aging, pregnancies and breast feeding, the breast tissue will lose its elasticity and sag, while the implant remains at the original location. That’s why a second operation might need to elevate the breast after several years. In generally we can say that the longer a woman has breast implants, the more likely she is to experience local complications or adverse outcome needing a reoperation. Make sure that your surgeon will be available to follow you also several months or years after the surgery and not just  for a couple of days.

What size?
You should not choose the size based on the size of your best friends implants or your favorite actress. Each breast is unique and needs a unique evaluation. The breast implant is for the whole life and not for a couple of months. The bigger the size the more the complications the less will last. Your plastic surgeon will measure your breast and let you know the most appropriate size for you.

Any serious complications?
The most feared complication is the capsular contracture (hardening of the breast area around the implant). This can cause pain and deform the breasts.  Its frequency may range between 5-15% off all breast enlargements and in severe cases a second operation will be needed to change the implants. Other complications that they may need a second surgery are hematomas (collection of blood), implant displacement and infections. Rupture of the breast implant (a tear or hole in the implant) it’s a rare complication. There are no proven associations between implants and connective tissue diseases, autoimmune diseases, breast cancer or reproductive problems.

Overall breast enlargement is a safe procedure but you should aim for a small natural breast and should assume that you will need to have additional surgeries.

Δευτέρα, 28 Ιανουαρίου 2013

BOTOX, πόσο ασφαλές είναι;


Τι είναι η βοτουλινική τοξίνη (Botox);
H βοτουλινική τοξίνη τύπου Α (ΒΤΑ) είναι μία τοξίνη που παράγεται από το αναερόβιο βακτηρίδιο Clostridium Botulinum . Λειτουργεί μπλοκάροντας κάποιες ειδικές  νευρικές απολήξεις που είναι υπεύθυνες για τις κινήσεις των μυών, προκαλώντας έτσι την αδυναμία η παράλυση τους. Το αποτέλεσμα είναι πλήρως αναστρέψιμο μέσο της επανανεύρωσης των μυών εντός 2-6 μηνών.

Ποιές είναι οι ενδείξεις;
Στην πλαστική χειρουργική ενδείκνυται κυρίως για λόγους αισθητικής. Η θεραπεία με το BTA εμποδίζει την σύσπαση των μυών που προκαλούν τις ρυτίδες έκφρασης, και οι ρυτίδες που θα σχηματίζονταν ως αποτέλεσμα της σύσπασης μειώνονται αισθητά. Χρησιμοποιείται κυρίως για τις ρυτίδες στο μέτωπο, στο μεσόφρυδο ,στην εξωτερική γωνία του ματιού και τις χορδές στο λαιμό. Εφαρμογές  γύρω από το στόμα και κάτω από τα μάτια είναι λιγότερο συχνές  καθώς μπορούν  να προκαλέσουν πτώση του κάτω βλεφάρου και παραμόρφωση του στόματος.

Το BTA μπορεί να χρησιμοποιηθεί με επιτυχία σε ασθενείς με υπερίδρωση (υπερβολικός ιδρώτας) στην περιοχή της μασχάλης και στις παλάμες. Μπορεί επίσης να είναι χρήσιμο σε μερικούς ασθενείς που πάσχουν απόημικρανίες. Άλλες ιατρικές ειδικότητες χρησιμοποιούν το BTA για την θεραπεία ορισμένων διαταραχών της κίνησης (δυστονίες), της σπαστικότητας και άλλων διαταραχών των μυών.

Πόσο ασφαλές είναι;
Σε υψηλές δοσολογίες μπορεί να είναι θανατηφόρο, κυρίως λόγω της  παράλυσης των μυών της αναπνοής,  αλλά οι ποσότητες που χρησιμοποιούνται για ιατρικούς λόγους, είναι πολύ χαμηλές, καθιστώντας το ΒΤΑ μια πολύ ασφαλής ουσία.

Υπάρχουν παρενέργειες;
Στις λιγότερο σοβαρές παρενέργειες περιλαμβάνονται αλλεργικές αντιδράσεις, εξανθήματα, κνησμός, πονοκέφαλος και στο σημείο της ένεσης πόνος, ερυθρότητα, πρήξιμο ή ευαισθησία. Σοβαρές αλλεργικές αντιδράσεις που  απαιτούν ιατρική περίθαλψη είναι πολύ σπάνιες.
Οι ενέσεις BTA μπορούν να προκαλέσουν ανεπιθύμητες παρενέργειες σε λειτουργικά σημαντικούς μύες, είτε από λάθος τεχνική, από τοπική διάχυση του φαρμάκου ή υπερβολική δόση. Βλεφαρόπτωση, αδυναμία στα χείλη, πτώση του φρυδιού  και δυσκολίες στην κατάποση είναι μερικές από τις σπάνιες ανεπιθύμητες επιπλοκές. Η κανονική λειτουργία επανέρχεται  σε 2-6 μήνες, όταν θα επιτευχθεί η επανανεύρωση των μυών.

Πού γίνεται το BTA και από ποιούς;
Όλες οι ενέσιμες ιατρικές θεραπείες είναι διαδικασίες που απαιτούν την κατάλληλη εκπαίδευση με στόχο την προστασία και ασφάλεια των ασθενών. Βεβαιωθείτε ότι ο ιατρός (συνήθως πλαστικός χειρούργος ή δερματολόγος)  είναι κατάλληλα εκπαιδευμένος. Μην επιλέξετε μόνο με βάση  την τιμή και αποφεύγεται εκπτώσεις που φαίνονται ακραίες. Είναι πιθανό ότι θα πάρετε  μια πολύ αραιωμένη μορφή του BTA ή ακόμη κάτι που δεν είναι καν πραγματικό BTA. Ρωτάτε πάντοτε για την προέλευση του υλικού.

Ένας εξειδικευμένος ιατρός θα πρέπει να έχει το χρόνο να σας εξηγήσει όλα τα οφέλη και τους κινδύνους κατά τη διάρκεια της ιατρικής εξέτασης, αφού κάθε ιατρική διαδικασία εμπεριέχει κινδύνους.  Θα πρέπει να πάρει ένα πλήρες ιατρικό ιστορικό, να μπορεί να απαντήσει σε όλες τις ερωτήσεις σας και να καταγράψει στον ιατρικό σας φάκελο όλα τα στάδια της θεραπείας.
Όλες οι ιατρικές εταιρίες συνιστούν όπως τέτοιες  ιατρικές διαδικασίες γίνονται σε μέρη που διαθέτουν  τον κατάλληλο ιατρικό εξοπλισμό  και όχι σε εμπορικά κέντρα, ιδιωτικές κατοικίες, σε  γραφεία, σε διάφορες  κοινωνικές εκδηλώσεις σε κομμωτήρια και spa.

Σε γενικές γραμμές όταν το BTA χρησιμοποιείτε από εκπαιδευμένους ιατρούς και κάτω από τις κατάλληλες συνθήκες  είναι πολύ ασφαλές,  μειώνει της ρυτίδες και αναζωογονεί το πρόσωπο.

Botox, how safe is it?



What is Botulinum Toxin (Botox)?
Botulinum toxin type A (BTA) is a toxin produced by Clostridium botulinum, a gram-positive anaerobic bacterium. It acts by binding specific nerve- endings responsible for muscle movements, thus causing a blocking effect on the muscles. Recovery occurs through the growth of new nerve-endings, thus re-innervate the muscles. The new growth will take between 2 to 6 months.

What are the indications?
In plastic surgery it is used mainly for cosmetic reasons. Treatment with BTA can relax the muscles that cause expression lines, thereby preventing wrinkles from forming and improving the appearance of existing wrinkles caused by facial expressions. It can be used mainly for the frown lines, crow’s feet, forehead wrinkles and skin bands on the neck. Injecting around the mouth and under the eyes is less common, as it can cause dropping of the lower eyelid and deform the mouth.

BTA can be used successfully in patients with hyperhidrosis(excessive sweating) in the underarm and palms. It can also be helpful in some patients suffering from migraine. Other medical specialties use it for the treatment of some movement disorders (dystonias), spasticity and other disorders of the muscles. 

How safe is it?
In high dosages it can be lethal mainly due to paralysation of the breathing muscles but the quantities used for medical reasons are very low, making BTA a very safe substance.

What are the risks and site effects?
Minor side effects include allergic reactions, rash, itching, headache and at the injection site pain, redness, swelling, or tenderness. Severe allergic reactions requiring medical treatment are very rare.

Botox injections can cause unintended side effects to functionally-important muscle fibers, either from improper placement of injections, from localized distribution, or overdose. Eyelid drooping, lip weakness, eyebrow malposition and difficulties in swallowing are some of the rare site effects. Normal function will return in 2-3 months when the new nerve-endings will re-innervated the affected muscles.

Where can you get BTA?
Injectable treatments are medical procedures that require appropriate training and sound judgment in order to help protect patient safety. Make sure that the doctor is credentialed. Don't choose a provider based only on the price and avoid discounts that seem extreme. It’s possible that you are receiving a very diluted form of BTA or perhaps something that is not even real BTA at all. Ask always of what you are being injected with.

A credentialed doctor should have the time to explain you all the benefits and risks during the consultation as every medical procedure has inherent risks and benefits. He should take a medical history, answer all your questions and document in your file all the steps of the procedure. It is recommended by medical societies that all medical procedures should be performed in an appropriate medical facility and not in shopping malls, private homes, office parties, group social gatherings or hair salons and spa.

Overall BTA injected by professionals and well educated physicians in appropriate medical facilities is a very safe treatment to remove wrinkles and rejuvenate the face.  


Παρασκευή, 4 Ιανουαρίου 2013

Neck Rejuvenation

Neck liposuction is performed on patients who have persistent fat deposits below the chin and in the neck area. When fat accumulates around the neck, the youthful shape of the jaw is lost. With this kind of neck plastic surgery, your plastic surgeon sculpts this area and removes fat, to restore the angular qualities of the chin and jaw removing stubborn areas of neck fat that don't respond to traditional weight-loss methods achieving a Neck lift.

Liposuction may be performed in a surgeon's office-based facility, in an outpatient surgery center, or in a hospital. Smaller-volume liposuction is usually done on an outpatient basis for reasons of cost and convenience. However, if a large volume of fat will be removed, or if the liposuction is being performed in conjunction with other procedures, a stay in a hospital or overnight nursing facility may be required.

Although many techniques can be used, the tumescent technique seems to be the safest and the most effective technique. The tumescent technique for local anesthesia involves the injection of large volumes of very dilute lidocaine (local anesthetic) and epinephrine (drug that shrinks capillaries) into subcutaneous fat. The local anesthetic lidocaine in the tumescent solution provides such complete local anesthesia, that it eliminates the need for general anesthesia, or IV sedation.

Then a thin hollow tube, or cannula, is inserted through 3 small incisions (under the chin and under each ear) to loosen excess fat using a controlled back and forth motion. The dislodged fat is then suctioned out of the body using a syringe. As this fat is removed, the layer of fat left behind is sculpted into aesthetically pleasing curves.

Once your procedure is completed, a compression garment will cover the Neck for 24-48 hours. These help to control swelling after liposuction and compress the skin to your new Neck contour.You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about four to six months, any persistent mild swelling usually disappears and as the skin contracts the final contour and the neck lift will be visible.




Dr Ioannis Georgiou
Plastic Surgeon Cyprus