Physiologically speaking, the breast is just a secretory gland and a skin appendage. But in actual fact, a woman's breasts are not just sexual objects but also constitute an important part of her self-image. Their status as an erogeneous zone results from their extreme sensitivity arising from the large network of sensory nerves found all over the breasts and especially in the nipples.
Unfortunately, other physiological aspects of the breast make it, on the one hand, highly vulnerable to undesirable changes and, on the other hand, extremely difficult for creams, exercise and other agents to have more than a minimal effect on its appearance.Unlike other physical appendages like the arm or leg, the proper has no significant mass muscle, nor any system of joints, tendons or ligaments to maintain it in position. It is principally held in place by the holding ability of the skin brassiere that surrounds and covers it. The absence of significant muscle mass explains why exercise cannot increase breast size. And the loss of natural elasticity explains why, with increasing age, the high, firm breast of youth rapidly descends and sags.
Other factors also have a negative impact cosmetically speaking on a woman's breasts. During pregnancy and lactation, the breast increases in size. But in the period after childbearing, there is a great loss in the volume and substance of the breast, as well as a loss of elasticity. Weight reduction is another culprit often responsible for losses and shifts in the breast substance, skin stretching and stretch marks. Unfortunately, the first places in which weight is lost include the face and the breasts. All these factors that affect the size and firmness of breasts cannot be prevented by underwired bras, lotions or drugs.
Today, however, surgery can do much to enhance the youthful appearance of breasts, to give you a fuller bosom, even to restore a breast lost to cancer. In doing so, however, the cosmetic surgeon must take care not to sacrifice too much of those aspects of the breast, in particular its sensitivity, that make it much more than just another functional body organ.
Larger and firmer this has been perhaps the most common quest, down the ages, in the area of breast improvement. A variety of methods, ranging from the useless to the bizarre, have been attempted. Padded bras may have fooled the outside world but not a woman's sexual partner; nor did it do anything for her own sense of inadequacy. "Fillers" of abdominal or buttock fat have resulted in either failure of the filler material to "take" , or have produced irregular or scarred breasts. And liquid silicone injections, now banned, caused breasts that were hard, irregular and infected.
However, all this is now a matter of memory. Today's surgical procedures to enlarge the breasts are known to be safe and effective when correctly carried out.They can be used not only to meet the need of small-breasted women who want fuller, larger breasts but also to help lessen sagging breasts by filling out the upper breast area although, in the case of pronounced sagging, augmentation is best supplemented by another procedure, mastopexy, to tighten loose tissues and to shift up the nipple which has drooped too low.
Basic to the procedure is the insertion of an implant (or prosthesis), a soft envelope made of silicone, and filled with one of a variety of materials. This is surgically inserted within, or more precisely under, the breast. There are variations not only in the filler material, but also in the site of the incision that the surgeon chooses to insert the implant, as well as where he places it in relation to the breast muscles.
Breast implants are so much in the news these days that it's easy to forget that some women, far from having any use for them, actually have the opposite kind of problem: over-large, often pendulous breasts that are not only a cosmetic liability but can also pose other problems. The physical problems include back and/or breast pain and shoulder discomfort - sometimes severe enough to cause breathing difficulties. At the practical level, the over-endowed woman is likely to have problems finding well-fitting undergarments and other items of clothing.
Breast reduction is also an option for the woman with markedly assymetrical breasts - one much larger than the other. This calls for a one-sided breast reduction (though, of course, in some cases, the woman may choose to have the smaller breast made larger with an implant).
Surgery to downsize breasts goes back nearly three-quarters of a century. Since the heaviness is invariably accompanied by sagging to a lesser or greater degree, as well as a displacement of the nipple to a lower position, the procedure is aimed at not only reducing the overall volume of the breast, but also shifting the nipple to a new level that will conform to the newly-created contours of the breast.
Since breasts are reduced to a size that's in proportion with the rest of the body, women who are as close to normal body weight as possible get the best results. If you want to lose weight, do so before having the operation.
There are a few risks associated with breast reduction. It's not for women who want to breastfeed since some of the milk ducts may be severed during the operation. Milk may be produced but not delivered, causing engorged and cystic breasts. If breastfeeding is of critical importance to you, the surgery must be postponed until after the childbearing years.
There may also be extensive scarring around the nipple and under the breast, resulting from the several incisions that require to be made. The scars may fade, but they're permanent. Also, there is a tendency after breast reduction for scars to stretch. Additionally, some women report a loss of sensation in the nipple that can last as long as six months.
Where a large reduction of volume and manipulation has been required, greatly compromising blood supply to the tissues, it can result in destruction of soft tissue and its replacement by scar tissue. But with today's level of technical expertise, it's highly unlikely that there will be a total loss of sensitivity in the nipple area - a major risk of this surgery in decades past.
On the whole, aberrations that can arise with this surgery are dealt with surgically and usually present no permanent problem. Breast reduction is perhaps the most formidable of all breast surgery, and many surgeons feel it is proper to inform a woman seeking it that there is a possibility of touch-up surgery being required a few months later. If you are told about this in advance, you are unlikely to become upset if at all it is found necessary.
Soon after surgery, the shape of the breasts is nearly normal, though approximately a year is needed for them to assume their final appearance.
Post-operative care : Breast reduction is performed under general anaesthesia. For the first week after surgery, painkillers are necessary. During this time, the breasts are firmly bandaged with bulky gauze and elastic dressings. The sutures are gradually removed and tape strips put in their place.
Following the removal of dressings, you are allowed to shower. After a fortnight, routine activities are normally resumed. In about two months you'll probably be back to all activities, including exercise or sports.
Who hasn't heard of the nose bob or the nose job? Cosmetic surgeons, rather more sedately, call it rhinoplasty. It's the most-requested procedure for the face, the one that can make the most dramatic difference on some faces and, unfortunately, also the one with the highest rate of post-op dissatisfaction (either because of over-expectations on the part of the patient or over-correction on the part of an ambitious surgeon, or because tricks by Mother Nature or due to constitutional factors can distort the intended result).
The first nasal surgeries are credited to the great Indian practitioner, Sushruta, in the 6th century B.C. In modern times, the development of nose correction procedures has closely paralleled the advancement of cosmetic surgery itself. In fact it was the nose bob that first made plastic surgery a household word. Until the early part of the 20th century, however, the surgical incisions were mostly placed outside the nose; today, they are placed inside the nose so that scars are not visible.
Additionally, techniques are far more refined today. While the earlier corrected noses had a "surgical look", today's new noses are more natural in appearance. The first rhinoplasty operations in recent times were directed at reducing the size of the nose; today, noses can be made smaller or larger, turned up, pushed back, have their nostrils thinned, their profiles made aquiline and much more.
Nose jobs may be requested for a number of different reasons :
The surgery therefore basically involves altering or restoring nose shape by one or more of three approaches :
The procedure is essentially akin to raising or lowering the central support of a tent, thus altering its external appearance.
"Diets and exercise don't work". True or false? Unfortunately, all too true when it comes to saddle bags, love handles, spare tires and those other well-known trouble spots that resist every lifestyle-change method to whittle them down.
The trail is a familiar one : you follow a scientific, medically-supervised weight-loss regimen, and you do lose weight. Your scales, your measure tape, your waist-to-hip ratio all tell you so. But at the end of it all, you're still left with those bulges that just won't budge : may be that apron of flesh around your abdomen, or the side pouches of flab in your upper thighs, may be even your double chin - suspiciously similar to the one your mother has. The reason is that, these localised areas of resistant fat are genetically pre-determined - which is what makes them hang in there so stubbornly.
Just a decade ago, the only solution that cosmetic surgeons could offer for these fat traps was the old snip-and-trim option : cut away the excess flab (skin and underlying fat) and suture the rest back in place - thus tightening and improving the surface skin contour while getting rid of the pudge below. The procedure, known as lipectomy, found its greatest use in the case of abdominal overhangs, which can sometimes be so gross that they do not merely pose a cosmetic problem but are also a cause of discomfort and unease - the apron being sometimes so extensive that it completely covers the genitals, resulting in constant irritation, weeping and itching in the skin folds. Lipectomy re-shaped the area, giving the procedure its popular name, "the tummy tuck".
Apart from the abdomen, lipectomy was earlier also the only available solution to excise flab in the upper arms ("batwing arms"), thighs ("thunder thighs") and buttocks. To some extent, the surgeon was able to conceal the incision, e.g. in the natural bikini line, or in the inside of the thigh. But this was not always possible; in reducing heavy buttocks,and upper thighs, for instance, the surgeon had to cut away large melon slices of fat and skin, leaving long scars on each side, extending from the buttock crease to the hip bone.
The scarring left behind by lipectomy was its biggest drawback. By its very nature this was also major surgery, requiring several days stay in hospital and posing a long list of potential complications.
In an attempt to bypass these problems, cosmetic surgeons began to look at other ways of removing body fat. One of the earliest of these used a device that looked like a long-handled ladle to literally scoop out fat from the thighs or buttocks; sometimes the surgeon would first thin the fat, using a sterilised whisk to churn up the thick lumps, thus making it easier to remove. Unfortunately, along with the fat, blood vessels and nerves were also often removed. The procedure had to be hastily abandoned.
Then, about ten years ago, American surgeons took a closer, harder look at a method of spot reduction in which fat was first broken up and then suctioned out under negative pressure. In various forms, this approach had been tried out in Germany, Switzerland and France. The French method, developed in Paris by Yves-Gerard Illouz, is the one that the American surgeons studied, employed and, in the process, popularised to its current international status. It was called liposuction (lipos = Greek for "fat"), and since it involves only a small incision through which the fat is aspirated out of the body, it minimises scarring, hospital stay and post-operative complications. Over the last decade, liposuction has been used with such spectacular success that it has become the most in-demand cosmetic surgery procedure in the United States. Refinements in the method have also widened its scope to include more body areas, older patients, smaller incisions.
Not that lipectomy has been totally abandoned. Liposuction can remove fat, but it cannot remove skin that has stretched and become wrinkled and loose in the process of accommodating a great excess of fat. Such skin needs to be trimmed and then sutured into a flatter, tauter look. In other words, lipectomy. But liposuction has transformed the traditional approach to lipectomy as well. In the case of the tummy tuck, for instance, the fat is today first sucked out and the excess skin then trimmed (in contrast to the lipectomy-only method in which both, fat and skin, had to be excised.) The result : surgery that's simpler, safer and virtually scarless compared to the older version.
A combination of liposuction and lipectomy is also used in the case of batwing arms, characterised by a gross overhang of upper-arm flab.
Or, a face-lift might be simplified by first suctioning out redundant fat from a double chin and jowls, and then trimming and tightening the face and neck skin.
And, it seems the possibilities inherent in liposuction can only increase as technical advances (e.g. the use of laser) further minimise blood loss and other complications of surgery.
Under light, general anaesthesia (or, in some cases, under local anaesthesia combined with a sedative), the surgeon makes a small incision in your skin ( between 1/4" to 1/2" ), through which he introduces a thin, blunt-nosed metal tube into the fat layer that lies deep inside, below the skin. Manipulating the tube (called a "cannula") back and forth, he loosens and breaks up the fat into globules. A suction device attached to the tube then "sucks out" the fat globules, which make their exit through an opening in the tube near its outer end.
Essentially, by creating a number of tunnels within the fat layer, the surgeon undermines its integrity, reducing its fullness and compactness; the result is a kind of sponge that, after surgery, shrinks, causing a less fleshy look and an improved surface contour.
Why create tunnels? Why not just remove all that unwanted fat and give you a better slimming effect? Simply because it is necessary to preserve the blood vessels and nerves that lie in the fat tissue but nourish the layer of skin that lies just above it. Getting rid of them along with the fat could result in loss of skin, scarring, infection, deformity - all of these did, in fact, occur when excessive fat removal was carried out in the earliest attempts at liposuction.
Removing all the fat would also cause the skin to adhere to the muscle layer (located immediately below the fat), resulting in unevenness or a depression in the surface contour.
Because no skin is removed, liposuction does not leave conspicuous scars. However, the incision made to allow entry to the cannula will result in a small scar; with time, this will fade to the colour of the surrounding skin, though it will never entirely disappear. Surgeons try to locate the incision in a natural body crease or in a concealed spot to enhance the aesthetics of the final result: just behind the base of the ear for chin liposuction; near the navel for abdominal liposuction, in the buttock crease for the inner thighs.
The surgery can take from 30 minutes to several hours, depending on which areas are being suctioned, and whether the liposuction procedure is being combined with another one, e.g. liposuction of jowls, combined with a face-lift.
Through all your years of youthfulness, your facial skeleton is kept smooth and firm by three layers of tissue: muscle, fat and skin. Aging affects all three muscles lose tone, gravity pulls fat downward and skin becomes less elastic. The result: a craggy, sagging, jowly look as everything seems to go to pieces.
For long decades, the solution to this "all-falls-down" problem has been the face-lift (or rhytidectomy) a fairly aggressive scalpel procedure that involves separating the skin of your face and neck from underlying muscle, pulling it back and up, cutting off the excess skin, re-draping the skin over the face and neck, and then suturing it in front of and behind the earlobes. In the earlier years, this kind of cosmetic surgery often resulted in the waxen, tight look that Hollywood made famous.
Today, facial-contouring procedures are "made-to-order" packages, tailored to each individual's face. What's more, techniques have become more simplified and refined, involve less trauma and pain, and much shorter hospital stays and recuperation periods.
Some persons, such as those whose necks bulge out over their collars or who find themselves with one chin too many, may want to have only a neck lift (or a lower face-lift, as it's also called). That, too, is an option the surgeon will firm up the neck by tightening the cords of muscles, thus eliminating the vertical skin folds that create the turkey gobbler look, and "liposculpting" the chin area to restore firmness and a sharper angle.
Other cosmetic procedures may be super-added to the basic face-lift (although they can also be done separately, as and when they are indicated or desired). These include: a forehead lift, when both brows have gone into a noticeable slouch and when forehead furrows and crow's feet are deeply etched; a chin implant, inserted to correct a receding chin; liposuction to get rid of fat below the chin; blepharoplasty (eyelid surgery) to get rid of the eyebags that often are the first sign of aging. In fact, rather than considering a face-lift alone when it's obvious that you have more to be taken care of than just loose folds and sags, it is far better to discuss with your surgeon an approach that involves a total overhaul of your face. It seems foolish, for instance, to have a face lift to tone and tauten your face while neglecting the tired-looking puffy, eyelids that will compromise the results.
But the classical facelift is still the only option when facial sagging has become pronounced. That is because neither skin creams nor drugs, neither exercise nor chemical peels, can "uplift" skin that has stretched, or tone facial muscles that have gone slack.
Depending upon the surgeon's preference and the type of technique he's going to employ, either general or local anaesthesia or a combination of both may be used.
The head does not need to shaved, If the hair is long enough, it is held back from the forehead with a rubber band; if it is short, as in men, it is trimmed with scissors and plastered upward.
Although the line of incision follows the classical pattern of starting in the hairline above the ear, curving downward to the front of the ear, then skirting around the lobe to the back of the ear and then up again to the scalp, there are infinite variations on this basic pattern. The surgeon will adapt and alter the curve of the incision depending on factors such as a scanty hairline, existing baldness, the amount of facial skin that needs to be excised, whether the hair pattern is high. In men, the incisions are made so as to avoid, as far as possible, interfering with the growth pattern of the beard and side-burns.
In younger patients, who may have no aging of the neck, only the face may be lifted (a procedure known variously as the upper face lift, the temporal face lift, or the mannequin face-lift.) In older patients, the surgeon will also lift and tighten the platysma muscle in the neck.
The technique employed may be either the subcutaneous one where the surgeon dissects just under the skin surface, lifting and stitching lax tissues, or the sub-platysma technique in which the dissection is made under the facial musculature, lifting and tightening this structure too. The first technique is considered the safer one on the whole; in the second, if the facial nerve descends lower than usual into the neck, there is a risk of the surgeon cutting the nerve, resulting in subsequent denervation of the platysma muscle in the neck (if a combined face and neck lift is being performed).
On the other hand, the risks of blood clot formation and of ecchymosis (bruises) are considered to be lower in the sub-platysma approach.
A face-lift normally takes around three hours but may extend to more depending upon the individual case and also upon whether it is being combined with some other facial procedure such as chin liposuction or eyelid surgery.
After the surgery is complete, an antibiotic ointment will be applied over the suture line and a suction-type drain placed below the dissected skin, enabling blood and serum to be aspirated during the first 24 hours. A moderately compressive dressing is also applied and it stays in place for at least the first 48 hours. The dressing keeps the patient more comfortable and prevents undue facial motion (which can aggravate bleeding and swelling, delaying healing and compromising the final 'look').
At least a day's hospital stay is required. Bed rest is recommended for the first 24 to 48 hours, during which visitors are restricted. This is the most crucial period in the development of blood clots, and if the bleeding is severe, immediate corrective treatment will have to be undertaken.
Sedatives or tranquillisers are helpful in the initial post-op period. You'll be allowed to move around a little on the second or third day; by this time, the drains and the dressing will also be removed.
The stitches can be removed in stages during follow-up visits, beginning about a week after the surgery.
You can do a gentle shampoo (no hair dryer) about five days after the surgery; and you can use make-up around the tenth day. Tinting and colouring can be done about three weeks post-op.
Temporary swelling around the eyes often occurs after a face-lift, And, of course, you can expect around 10 to 14 days of bruising and swelling of the skin particularly of the lower face and neck. (The temporary swelling in the immediate post-operative period tends to obliterate all fine wrinkles, but as the swelling diminishes, the lines will generally re-appear).
Because of the tightening of the tissues during the surgery, there will be a feeling of numbness and tension in the areas of the neck, cheeks and around the ears. These will gradually disappear in about 4 to 6 weeks.
Because of this extended period of feeling "battered and bruised", face-lift patients often go through a depression phase, during which they require reassurance; the doctor-patient relationship therefore is very important.
