Plastic and Reconstructive Surgery

We can divide this surgery branch into two as “Plastic and Reconstructive” Surgery and “Aesthetic Surgery”.

Plastic and Reconstructive Surgery (Reconstruction and Repair Surgery)

Plastic and Reconstructive Surgery can also be designated as reconstruction and repair surgery. In general, it is a branch that tries to remedy congenital or acquired anomalies, deformities and functional disorders. In summary, Plastic and Reconstructive Surgery tries to repair all kinds of defects (cavities) affecting the skin, underneath the skin and bones in the entire body surface.

Its main areas of interest are:

• Facial disfigurement and asymmetry
• Congenital masses on the face 
• Cleft lip and palate
• Disfigurement  of jaw, face and skull bones
• Jaw closing disorders
• The absence of the pinna , prominent ears and other disfigurement 
• Nasal defects, tumors, ruptures
• Facial bone and soft tissue traumas
• Bone defects-fractures- disfigurement and functional disorders caused by traffic accidents, tumors and for other reasons
• Head and neck tumors and repair of these defects 
• Absence of breast, breast asymmetry or excess breast tissue 
• Breast reconstruction after cancer
• Gynecomastia (large breasts in men) 
• Congenital anomalies of genital organs
• Repair of genital organs, replantation of severed organs, 
• Chest and abdominal wall defects
• Hand surgery (Trauma , tumors , finger transfers, finger repairs- extension, etc.) 
• Hand and foot defects and deformities
• Peripheral nerve problems ( trauma , neuropathies, defects, masses)
• Skin and soft tissue tumors
• Acute burn and post-burn deformities, convulsions, shrinkage, damage to the soft tissues caused by electrical and chemical substances 
• Wounds on the skin and subcutaneous wounds caused by various infections , radiation and other effects
• Chronic wounds ( pressure ulcers , venous ulcers, diabetic foot ulcers , etc.)
• Losses, deformities, pathological events (tumors , cysts , infection, etc.) in bone (especially face, head and hand bones) and cartilage structure (such as ear and nose cartilages) are also within the field of plastic surgery profession. 

Besides conventional surgical methods, it can benefit from microsurgery, laser systems, endoscopy and a variety of chemical agents and drugs for treatment.

Aesthetic Surgery ( Cosmetic Surgery )

It is a sub-branch of plastic surgery. Aesthetic (or cosmetic ) surgery is engaged in operations and interventions performed to ensure that body image acquires a more beautiful and perfect look. It deals with esthetic problems, rather than a medical problem.

These are operations that are conducted to ensure that the patient acquires a more aesthetic and proportionate body. Relevant parts of the body (nose, breast, and abdomen) are made more perfect and aligned with environmental contours environment based on anatomical and aesthetic dimensions. In this surgery, fat injections and a variety of implants can be utilized.

All plastic surgeons are also trained in cosmetic surgery during their training to be a specialist and they are the only surgeons authorized to perform these operations.

Cosmetic surgery requires a long training and experience. This kind of operations require both surgical and artistic talents. 

In cosmetic surgery, not only aesthetic problems but also medical problems are solved. For example, surgical correction of an obese body or breasts grown up to gigantic size (gigantomasty) resolves both medical and aesthetic problems. Besides aesthetic correction, the function of an organ is also extremely important. For example: in aesthetic nose surgery (rhinoplasty) shape and breathing problems should be corrected together. 

Areas of interest of Aesthetic Surgery are:

• Aesthetic and functional nose reshaping (Rhinoplasty, septorhinoplasty)
• Face Renewal (face lift – revisions on the eyelid and around the mouth, treatment of wrinkles)
• Face and forehead lift
• Brow lift
• Aesthetics of eyelid 
• Prominent ear and correction of other aesthetic problems in prominent ear 
• Chin augmentation and reduction operations 
• Removal of skin scarring and irregularities, 
• Hair transplantations
• Laser applications (Face peeling, removal of stains and vascular malformations
• Aesthetic breast operations: Augmentation, reduction and lift
• Operations aiming at reduction of excessive skin-subcutaneous fat tissue (liposuction – lipectomy)
• Tummy tuck (Abdominoplasty)
• Leg contour correction (by fat removal, injections or leg implants)
• Contour adjustments using implants (the pro *** s applied to soft tissue) (hip and thigh implants, male pectoral (chest) implants, leg implants, etc.) 
• Skin care and interventions

Treatment Methods

Botox

Botox is the most commonly used method in non-surgical aesthetic treatments. It is a toxin derived from a type of bacteria, called Clostridium Botulinum. These bacteria have been used in different fields of medicine for many years. 

It is a painless and quick procedure.During Botox procedure, a local anesthetic cream is used and the product is applied directly to the corresponding areas. 

Microsurgery

It is a surgery performed under an operating microscope using special microsurgical instruments. Suturing severed hands, feet and other tissues (replantation) back to their original location can be performed by this surgical technique. The severed organ regains function through suturing small vessels and nerves as well as transfer of tissue from another region to a defect is likely to be done. Today, vessels and nerves as thin as 0.5 mm in diameter can be sutured.

Endoscopic Surgery

The endoscope is a thin tube with a camera on its tip. The image of surgical site is transmitted to a television by this camera. Thus, it is possible to perform the surgery by closed method with the help of the image on the screen by making incisions much smaller than normal ones.

The most commonly used areas in plastic surgery are forehead lift and eyebrow lift. Apart from this, it is commonly used as a method for facelift. Endoscopic methods are also preferred in some breast enlargement techniques.

Basic Operations Performed in Plastic and Reconstructive Surgery

Facial Area Operations

• Face Lift (Cheek, neck lift)

Face lift is a surgical method that recovers facial sagging and facial wrinkles due to aging by stretching and hanging the face. 

By facelift – facial renewal surgeries, sagging and irregularities on facial and neck skin are resolved, extra fatty tissue in the cheek and neck are removed, facial tissues are reinforced, eyelids are corrected.

• Brow Lift

By Botox implementation, the desired results can be achieved by holding up the exterior part of the eyebrows. 

Another preferred method of brow lift is brow lift by using a hanger. It is a method that can be applied very simply and quickly. It can be done under local anesthesia. The forehead is lifted as much as possible by passing threads which do not melt using needles through the hair and above the eyebrow. Its effect lasts up to 2 years.

Forehead lift by surgery is a method revealing permanent results. Brow lift surgery, on its own, can also be done with local anesthesia. The operation can be done by entering through the scalp and freeing the skin region up to the eyebrow from underlying tissues in temple area or by endoscopic method. During endoscopic brow lift, the video called the endoscope is placed into 3-5 small incisions made in the scalp. Thus, the surgeon can work by seeing inside of the forehead using the endoscope. He performs the surgery by inserting surgical instruments through other holes. 

• Aesthetics of Eyelid (Blepharoplasty) 

As we age and with gravity’s influence, skin loosening, excess, sagging occurs in the eyebrows, upper and lower eyelids, and especially on the lower eyelids, bags may occur by forward herniation of fat tissues. This condition not only causes degradation of aesthetic appearance but may also prevent vision of the individual since drooping upper eyelids cover the front of the eye.

Excess skin is eliminated from the eyelid(s) and/or excess fat mass is resected by cosmetic eyelid surgery. In this way, a beautiful appearance is obtained as well as it is ensured that the person can see easily. A scar remains along the upper eyelid. However, this scar can only be seen when it is looked at very closely because it will be matched with the curvature of the eyelid. A scar remains just below the lashes on the lower lid, and the remaining scar looks like normal skin line on the side. Eyelids are regions of the human body which leave least number of scars.

• Rhinoplasty

Cosmetic nose surgery (rhinoplasty) or nose reshaping surgery is the most widely implemented type of aesthetic surgery. Rhinoplasty can shrink or enlarge your nose, change the shape of your nose tip or bridge, reduce the width of your nostrils or change the angle between your upper lip and your nose. At the same time, it can correct a congenital deformity or an injury-related deformity or fix some of your breathing problems.

• Fat Injection (For lips, cheeks and facial contours)

By fat injection, it is possible to correct facial wrinkles and sunken areas and make facial features much more prominent. The fat used in fat injection is taken from the abdomen or legs. The procedure is usually performed under local anesthesia and using thin cannulas and special needles. While there may be minimal swelling and bruising, these are temporary. People return to normal life after the operation.

• Filling Applications

Filling can be made for purposes of removing wrinkles or correcting facial features. 

It is generally performed on lips, different regions of the face for the treatment of fine lines and deep wrinkles, and on the upper side of the neck and chest wall. In addition, it can be applied on hands to remove wrinkles on the back of the hand as well as armpits to stop sweating. 

• Prominent Ear 

It is one of the developmental anomalies of the pinna. It can be in various forms ranging from mild to severe. The cause of prominent ear anomaly is changes in ear cartilage. While planning an aesthetic surgery for prominent ear, the cause should be accurately determined and interventions should be made by aiming at the cause.

Prominent Ear Surgery can be performed from the age of 6.

The surgery is performed behind the ear so no surgical scar is externally visible. Patients are discharged and sent home on the same day.

• Hair Transplant

It is possible to permanently regain lost hair by hair transplant. Hair Transplant is the process of transferring hair follicles from the region between two ears on the nape which has been coded not to suffer hair loss, to the region with hair loss by proper techniques.

Nowadays, it’s often applied by two methods:

Follicular Unit Extraction ( FUE) 

It is transferring hair follicles one by one from the nape or various parts of the body to the region of hair loss with  fine-tipped special needles. No sutures are applied so there are no surgery scars. 

Follicular Unit Transplantation (FUT ) 

It is transferring the scalp taken from intact and healthy area on the nape to the region of hair loss in such a way as to accommodate hair and hair follicles by maintaining their natural structure. 

• Cleft Lip and Palate

A long time before birth of the child, in the first weeks of development, left and right edges of the lips and the palate form together. However, about one in every 1,000 infants, a normal association does not occur. Lips and palate develop separately so cleft lip and palate can be seen in several variations. 

Significant progress has been obtained in the treatment of children born with cleft lip and palate and there is no obstacle preventing most of you from having a normal, healthy and happy life. 

• Maxillofacial Surgery

Gonion may be smaller or larger than normal. Both deformities lead to significant aesthetic worries. Genioplasty surgery aims at changing the appearance of gonion. Size and length of gonion can be increased or reduced by these operations. In other words, gonion can be reshaped in accordance with aesthetic norms.

Body Area Operations

• Breast Operations

  • Breast Reconstruction 

Breast reconstruction surgery performed after removal of breast due to a tumor or another illness is one of the most successful operations of plastic surgery. By the courtesy of new technologies in medicine, surgeons now can create a breast very similar to a natural breast. 

Nowadays, it can be performed simultaneously with breast removal surgery (mastectomy). Thus, when the patient goes out of the operation, she has a new breast and gets rid of psychological distress that can be caused by a breastless period. However, it should be kept in mind that breast reconstruction after mastectomy is not a simple operation. 

• • Breast Reduction

Although aesthetic breast reduction surgery is one of cosmetic surgeries performed to correct women’s outlook, it is a reconstructive surgery, rather than an aesthetic surgery.  A droopy breast because of its size can lead to neck and back pains and may cause hump in women. Numbness of the arm can be experienced because of the pressure caused by a bra on arm nerves. The person may have difficulty in breathing. The skin of the breast rubs against the skin of the chest so there may be rashes or wounds in the groove under the breast. Daily physical activity may be limited.  In addition, large breasts cause challenges in choosing clothes and a woman’s dislike of herself may also cause social and psychological problems. 

A breast reduction surgery brings a natural look to the breasts, the above-listed problems are eliminated and the person’s life is made easier. 

• • Breast Augmentation

Breasts are structures that complete the physical appearance of a woman. Breast volume is important in shoulder width, chest circumference, waist and hip circumference measurements. When breast volume is small in these measurements, body contour appearance remains incomplete. Breasts may be small in structure for various reasons. One can be smaller than the other or they may be asymmetric. One breast can be missing for congenital reasons.

Today, the most applicable method to make both breasts equal or increase size of the breast(s) is silicone prosthesis.  Breasts can be partially augmented by resecting fatty tissue from the person. However, fat filling is not a completely permanent method.

• • Breast Lift

Breasts may sag for various reasons. Bonds holding breast tissue in place may loosen over time. Incompatibility may occur between breast tissue and the surrounding skin envelope because of weight changes, breastfeeding and effect of gravity. The problem can be associated with breast tissue, the skin or both. Ultimately, a droopy breast which looks as if it is hollow inside may emerge.

• • Nipple Surgery

It is possible to surgically correct introverted or sunken nipples. Preventing breastfeeding and an aesthetic appearance, this problem is corrected by bringing nipples back to anatomical position under local anesthesia.

• Liposuction

Liposuction is a surgery in which fat deposits in specific areas of the body are removed by suction using special vacuum or special injectors. It is a surgery aimed at correcting body features and it is definitely not a weight loss surgery. By this surgery, fat tissue with increased volume which is resistant against diet and exercise is removed from the body as well as number of existing fat cells is reduced.

Ultrasound energy has begun to be exploited in recent years.  In this method, the excess fat tissues are crushed by ultrasonic waves, then removed by vacuum in a similar manner.

It has become possible to remove accumulated fat in many areas of the body, including jowls, cheeks, neck, inner side of upper arms, breasts, chest, abdomen, waist, hips, thighs, inner side of knees, behind the legs using vacuum.  

Maximum 4-5 liters of fat can be removed without disturbing balance and body functions of the patient. But some people remove more by giving fluids and blood. This depends on the surgeon’s preference. In patients with large areas, surgery can be performed once every 3-6 months. In the case of obesity called morbid obesity, it has become possible to remove fat up to 28 liters in a single session by taking necessary precautions in patients.

• Tummy tuck (Abdominoplasty)

Abdominoplasty is a surgical procedure in which excess fat in the middle and lower abdomen and sagging skin tissue are removed and abdominal muscles are stretched and strengthened.

• Gynecomastia Correction

Gynecomastia is a condition where amount of male breast tissue is higher than normal.  It is caused by excess estrogen activity and often occurs bilaterally. 

Gynecomastia can be observed physiologically without any pathological cause during neonatal period, the period of transition to adulthood, and in old age. It is often temporary during the age of infancy and the period of transition to adulthood.  Hormone disorders, cirrhosis, malnutrition, thyroid diseases, certain tumors, use of some drugs may also cause pathological gynecomastia.  This condition may improve by discontinuation of these drugs. 

It is attempted to correct any underlying cause, if any. In general, there is no known cause. Some drugs and low doses of radiation in some special cases are known to be effective. 

Permanent, actual treatment of gynecomastia is surgery. In surgical treatment, liposuction and surgical resection can be utilized severally or jointly usually under general anesthesia.