GENERALE ANESTHESIA

Executed by a board certified anesthetist.

PRINCIPLE

Analgesia and sleep are drug induced, breathing and oxygen supply are assured by a tracheal air way. Vital functions are monitored.

INDICATIONS

Extensive or multi location surgery.
Fear of local anesthesia.

ADVANTAGES

Comfort for patient and surgeon.

DISADVANTAGES

Will be explained by anesthetist.
Patient has to fast 6 hours prior to the anesthesia.

LOCAL ANESTHESIA

Executed by the surgeon.

PRINCIPLE

After suitable premedication, the to be treated areas are locally anesthetized through injection of the agent.

INDICATIONS

Most superficial surgery.

ADVANTAGES

Out patient procedure.
No sequels.
Less bleeding.
No need to have an empty stomach.

DISADVANTAGES

Allergic reactionspossible.
Heart beat acceleration from adrenalin containing agents.

REGIONAL ANESTHESIA

Executed by a board certified anesthetist.

PRINCIPLE

A main neural branch innervating a larger anatomic region is locally anesthetized.

INDICATIONS

Surgery of the extremities or in the lower trunk.

ADVANTAGES

Absence of post general anesthesia discomfort.

DISADVANTAGES

Intolerance of the applied drugs possible.

FACE LIFT

THE OPERATION

Reshaping facial and neck skin by repositioning and tightening the soft tissues including the muscles and by resecting the redundant skin.

INDICATIONS

Sunken cheeks, drooping jowls, sagging neck.

COUNTER INDICATIONS

Heavy smoking.
Important adiposity.

SURGERY

(as out-patient possible)

Through an incision that goes from the temple along the anterior ear creases upwards behind the ear into the scalp, the slack skin and the soft tissues are undermined and repositioned. Occasionally, a short incision under the chin allows a better re-draping of a slack neck.
  Operation time   3-4 hours.
  Anesthesia          general or local anesthesia with twilight premedication.
  Scars                   inconspicuous, see above.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Hematoma.
Hypertrophic scarring.
Hair loss in the scalp region.
Temporary muscle palsy.

POSTOPERATIVE CARE

Head bandage for 24 hours.
Suture removal after 10–14 days.
Resume work after 2-3 weeks.

FOREHEAD LIFT

THE OPERATION

Raising and smoothening the forehead skin including the eyebrows.

INDICATIONS

Forehead skin folds and descended eyebrows.

COUNTER INDICATION

High forehead.

SURGERY

(as out-patient possible)

Several approaches are possible: Continuous scalp incision from ear to ear or continuous incision along the hair line from temple to temple.
Also endoscopic through several button hole incisions in the scalp or two temporal incisions in the hair bearing skin.
  Operation time   1-2 hours.
  Anesthesia          general or local anesthesia with twilight premedication.
  Scars                   inconspicuous, see above.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Hematoma.
Hair loss in the scalp region.
Temporary muscle palsy.

POSTOPERATIVE CARE

Head bandage for 24 hours.
Suture removal after 1 week to 10 days.
Resume work after 2-3 weeks.

UPPER LID PLASTY

THE OPERATION

Removal of tissue redundancy in the upper eye lids.

INDICATIONS

Heavy upper eye lids, creating a tired, sad expression. Make-up problems.

COUNTER INDICATIONS

Vision problems, dry eye syndrome.

SURGERY

(usually as out-patient)

Removal of redundant skin, muscle and fat. Sometimes redistribution of the latter.
  Operation time   1 hour.
  Anesthesia          usually local anesthesia .
  Scars                   inconspicuous in the upper lid fold.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Hemorrhage.
Lid deformation.
Vision troubles (very rare).

LOWER LID PLASTY

THE OPERATION

Removal of the redundant and tensioning of the remaining skin to smoothen the wrinkles. Redistribution and leveling of the fat deposits. Fill tear troughs.

INDICATIONS

Eye bags.
Tear troughs.

COUNTER INDICATION

Weak lid tone.

SURGERY

(usually as out-patient)

Incision just below the ciliary line or directly on the bag in a skin fold.
Also possible in the conjunctiva, if no skin removal is planned. Any of these approaches will allow the manipulations mentioned above.
  Operation time   1 hour.
  Anesthesia          usually local anesthesia.
  Scars                   see above, very inconspicuous.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Hemorrhage.
Deformed lid aperture.
Ectropion.

POSTOPERATIVE CARE

Paper tapes until stitch removal after 3–5 days.
Resume work after 3 days or 2 weeks (bruises).

RHINOPLASTY

THE OPERATION

Reshaping of an unpleasant or deformed nose.

INDICATION

Nose deformities.

COUNTER INDICATIONS

Cocaine addiction.
Psychological problems (Dysmorphophobia).

SURGERY

(as out-patient possible)

Reshaping of the cartilaginous and bony structures, either with a closed procedure through the nostrils or with an open approach.
  Operation time   1-2 hours.
  Anesthesia          usually general anesthesia, local anesthesia possible.
  Scars                   inside the nostrils and, in the open procedure across the
                              columella.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Hemorrhage.
Secondary deformation through internal hypertrophic scarring (polly tip) or bone callus.

POSTOPERATIVE CARE

Nasal packing for 24 hours.
Light cast during up to 10 days.
Resume work after 1 week.

In some 15% of the cases, touch ups will be necessary. In our Center they will be performed as a warranty service within the first 18 months.

FAT TRANSFER

THE OPERATION

Recreation of youthful facial roundness through multiple micro grafting of the patients own fat.

INDICATIONS

Natural fat loss in the aging patient or disease caused fat loss.

COUNTER INDICATION

None.

SURGERY

(as out-patient)

Fat harvesting with syringe in suitable donor site. The decanted fat cells are then injected into the designed zones.
  Operation time   1-2 hours.
  Anesthesia          local anesthesia .
  Scars                   small stab mark at the donor site.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Total absorption of the fat grafts irregularities.

POSTOPERATIVE CARE

Taping to reduce bruising.
Resume work after 1 week.

OTOPLASTY

THE OPERATION

Ear reshaping, correction of protruding ears.

INDICATION

Ear deformities.

COUNTER INDICATIONS

Non consent of the patient if under age.

SURGERY

(as out-patient possible)

Incision at the back of the ear. From there the ear cartilage is weakened through scouring and modeled in the desired shape which is maintained with sutures.
  Operation time   1-2 hours.
  Anesthesia          usually local anesthesia .
  Scars                   behind the ear.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Hematoma.
Hypertrophic scarring.
Infection.
recurrence.

POSTOPERATIVE CARE

Head bandage.
Suture removal after 1 - 2 weeks.
Resume work after 1 week.

FACIAL IMPLANTS

THE OPERATION

BREAST AUGMENTATION

THE OPERATION

Augmentation of the breast volume with synthetic implants.

INDICATION

Small or emptied breasts.

COUNTER INDICATIONS

Puberty and development not yet terminated.
Short time plans for pregnancy.
Anorexia.

SURGERY

(as out-patient possible)

Introduction of soft synthetic implants behind the breast glands or the pectoral muscle.
  Operation time   1-2 hours.
  Anesthesia          general or local anesthesia with twilight premedication.
  Scars                   3 possibilities: In the arm pit, in the lower breast fold or
                              at the areolar border.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Hematoma.
Hypertrophic scarring.
Changed sensitivity in the nipple for several weeks.
The organism can react to the foreign body (implant) in forming fibrous tissue around it. In extreme cases this will result in a hard, deformed breast.

POSTOPERATIVE CARE

Drain removal after 24 to 48 hours.
Suture removal after some 2 weeks.
Resume work after 2 weeks.
Wear of a special bra.

BREAST REDUCTION

THE OPERATION

Diminishing of the breast volume, removing glandular and fat tissue as well as the redundant skin.

INDICATION

Voluminous, heavy breasts.

COUNTER INDICATIONS

Short time plans for pregnancy.

SURGERY

(rarely as out-patient)

Access is gained through a wide key-hole incision in the lower half of the breast and around the nipple. The redundant soft tissue and skin is then resected and the breast cone remodeled. The skin is trimmed to fit the new breast shape.
  Operation time   2-3 hours.
  Anesthesia          general anesthesia.
  Scars                   around the areola and down to the infra mammary fold.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Hematoma.
Hypertrophic scarring.
Diminished sensitivity in the nipple for several weeks.

POSTOPERATIVE CARE

Drain removal after 24 to 48 hours.
Suture removal after some 2 weeks.
Resume work after 2 - 3 weeks.

BREASTLIFT

THE OPERATION

Repositioning and remodeling of a slack descended breast, occasionally with the addition of a breast implant.

INDICATION

Slack, drooping breasts.

COUNTER INDICATIONS

Short time plans for pregnancy.
Anorexia.

SURGERY

(as out-patient possible)

The slack soft tissues are accessed and remodeled through a key- hole incision around the areola and across the lower pole of the breast. The nipple is raised and the redundant skin is removed and the remaining draped snug around the new breast cone.
  Operation time   2-3 hours.
  Anesthesia          general or local anesthesia with twilight premedication.
  Scars                   around the areola and vertically down to the infra mammary
                              fold.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Hematoma.
Hypertrophic scarring.
Diminished sensitivity in the nipple for several weeks.
Recurrence if skin quality is bad.

POSTOPERATIVE CARE

Drain removal after 24 to 48 hours.
Suture removal after some 2 weeks.
Resume work after 2 weeks.

ABDOMINOPLASTY (Tummy Tuck)

THE OPERATION

Removal of redundant, slack and adipose abdominal skin.

INDICATION

Abdominal skin redundancy after weight loss or pregnancy.

COUNTER INDICATIONS

Short time plans for further pregnancy.
Heavy smoking.

SURGERY

(rarely as out-patient)

Low transverse incision from one hip bone to the other, along the pubic hair border in a lazy W pattern. Through this approach, the entire abdominal skin including its fat is undermined towards the thoracic cage and liberated from the navel that remains in place. All this tissue is then pulled taught and its redundancy resected. Through a buttonhole incision, the navel is brought to the surface and sutured in place. The skin border is sutured in several layers to the skin margins of the transverse incision. If necessary, the abdominal muscles are tightened and the waist fat is suctioned. In minor skin redundancies, a limited abdominoplasty without navel repositioning can be performed.
  Operation time   2-3 hours.
  Anesthesia          general or local anesthesia with twilight premedication.
  Scars                   transverse in the lower abdomen.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Hematoma, Skin slough.
Seroma accumulation under the skin that has to be evacuated.
Diminished skin sensitivity for several weeks is normal.

POSTOPERATIVE CARE

Drain removal after 24 to 48 hours.
Elastic girdle for several weeks.
Suture removal after some 2 weeks.
Resume work after 2–3 weeks.

LIPOSUCTION

THE OPERATION

Suction assisted removal of undesirable localized fat deposits.

INDICATION

Diet resistant, unsightly redundant fat tissue in the average weight patient.

COUNTER INDICATIONS

Pathologic adiposity, slack skin that would not adapt to a new contour.

SURGERY

(usually as out-patient)

With specially designed suction cannulas of various calibers, the redundant subcutaneous fat is vacuumed.
  Operation time   1-2 hours.
  Anesthesia          4–6 mm long in remote areas close to the region to be
  Scars                   suctioned.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Hematoma.
Irregular surface.

POSTOPERATIVE CARE

Pressure garment has to be worn during some weeks.
Suture removal after approx. 1 week.
Professional activity resumed after 2–7 days.

ARM LIFT

THE OPERATION

Removal of the redundant skin with its adjacent soft tissues along the upper arm.

INDICATION

Skin slackness in the upper arm region.

COUNTER INDICATIONS

History of bad scarring.
Lymphoedema.
Pathologic adiposity.

SURGERY

(usually as out-patient)

Elimination of the circumferential cutaneous redundancy through a longitudinal, full thickness skin resection between armpit and elbow.
  Operation time   1-2 hours.
  Anesthesia          general or local anesthesia with twilight premedication.
  Scars                   longitudinally between armpit and elbow.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Hypertrophic scarring.

POSTOPERATIVE CARE

Suture removal after some 2 weeks.
Resume professional activities after 1–2 weeks.

THIGH LIFT

THE OPERATION

Removal of the redundant skin with its adjacent soft tissues of the upper medial thigh region. Repositioning and tightening of the remaining tissues.

INDICATION

Skin slackness in the thigh region.

COUNTER INDICATIONS

Vascular problems in the lower extremities.

SURGERY

(rarely as out-patient)

The skin and sub cutis is removed with a crescent shaped resection from the inguinal fold to the infragluteal fold.
The remaining skin will be pulled taught and anchored in the inguinal ligaments. If the circumferential skin redundancy is important, an additional vertical resection may be necessary.
  Operation time   2-3 hours.
  Anesthesia          general or local anesthesia with twilight premedication.
  Scars                   from the infragluteal fold to the inguinal fold, sometimes
                              longitudinally at inner thigh.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Hypertrophic scarring.
Scar migration.
Skin slough.

POSTOPERATIVE CARE

Suture removal after some 2 weeks.
Resume professional activities after 2–3 weeks.

BOTOX – VISTABEL

PRINCIPLE

Botox or Vistabel is the trade name for the injectable medication, Botulinum toxin. Used in minute quantities it has for many years successfully treated facial spasms.
For now more than ten years it has been used in aesthetic surgery to diminish “dynamic” wrinkles in the face.

INDICATIONS

Dynamic, mimic dependent facial wrinkles.

COUNTER INDICATIONS

Neural diseases, skin infections, pregnancy.

PROCEDURE

The agent is injected into the specific muscles that are to be weakened.
  Operation time   several minutes.
  Anesthesia          with anesthetic cream.
  Scars                   none.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Asymmetry of facial expression may occur as well as drooping of an eye lid, both are reversible.

POSTOPERATIVE CARE

Temporary bruising and swelling may occur. It may take up to one week before the Botox takes full effect. It usually lasts between 3 and 6 months. To maintain the effect requires repeated injections. It has been found that over time, the effects of Botox last longer.

FILLERS

PRINCIPLE

A biocompatible, absorbable filler is used to replace vanished facial soft tissue or to fill facial creases.
There is a vast array of fillers. We currently use a cross linked hyaluronic acid product. (Hyaluronic acid is a natural building block in the skin and does not require allergy testing).

INDICATIONS

Facial skin wrinkles.
Thin lips.

COUNTER INDICATIONS

Infected skin.
Prior treatments with non absorbable fillers.
Pregnancy.

PROCEDURE

Local injection of the viscous product.
  Operation time   several minutes.
  Anesthesia          local.
  Scars                   none.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Temporary superficial irregularities.
Bruises.
infection.

POSTOPERATIVE CARE

No intense sun exposure during the first 48 hours.

CO2 LASER RESURFACING

PRINCIPLE

Smoothening of the skin through computer controlled superficial burning.

INDICATION

Weathered facial wrinkles.

COUNTER INDICATIONS

Pigmented skin.
Herpes prone patients need prophylactic treatment.

PROCEDURE

(usually as out patient)

Removal of damaged skin layers with a laser beam.
  Operation time   30-60 minutes.
  Anesthesia          local or general.
  Scars                   usually none.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Too deep sanding may cause hypertrophic scarring.
Deep dermabrasion leaves depigmented zone.
Temporary hyperpigmentation in certain skin types.

POSTOPERATIVE CARE

During the first week, the oozing wound needs frequent changing of the medication. Creams are applied.
The initial redness turns into pink and disappears slowly after 3 months. During this recovery period, Total sun block is compulsory.

PEELING

PRINCIPLE

There are various peeling agents on the market, including phenol combinations as well as glycolic and other fruit and trichloric acids.

INDICATIONS

Sun damaged skin with fine wrinkles, shallow acne scars and mild hyperpigmentation.

COUNTER INDICATIONS

Pigmented skin.
Herpes prone patients need prophylactic treatment.

PROCEDURE

The agent is applied with a brush, swab or cotton tips.
  Operation time   several minutes.
  Anesthesia          rarely necessary.
  Scars                   none.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

If deep action is required, depigmentation of the treated zones cannot be avoided.
In many types of skin a reversible hyperpigmentation occurs.

POSTOPERATIVE CARE

During the first week, the oozing wound needs frequent changing of the medication. Creams are applied.
The initial redness turns into pink and disappears slowly after 3 months. During this recovery period, Total sun block is compulsory.

DERMABRASION

PRINCIPLE

Smoothening of the skin through superficial sanding.

INDICATIONS

Sun damaged, wrinkly skin, acne and other scars.

COUNTER INDICATIONS

Certain skin types.
Known bad scarring.
Herpes prone patients need prophylactic treatment.

PROCEDURE

(usually as out patient)

Motor driven diamond heads are used to mechanically remove the damaged skin layers.
  Operation time   30-60 minutes.
  Anesthesia          local or general.
  Scars                   usually none.

POSSIBLE COMPLICATIONS, UNDESIRABLE RESULTS

Too deep sanding may cause hypertrophic scarring.
Deep dermabrasion leaves depigmented zone.
Temporary hyperpigmentation in certain skin types.

POSTOPERATIVE CARE

During the first week, the oozing wound needs frequent changing of the medication. Creams are applied.