Endoscopy is a surgical technique that uses the endoscope as a surgical tool, a special instrument that allows the surgeon to visualize internal elements of the body through small incisions. Endoscopic surgery has been performed for decades in operations such as gallbladder resections, gynecological disorders and knee surgery.
The endoscope consists of a hollow tube which holds a small television camera in its end; a TV monitor will show the surgeon images of the structures to be treated with the appropriate instruments.
In plastic surgery, its most important use is in the treatment of facial aging and especially in forehead lifting. The endoscope guides the surgeon, who resects the muscles which cause the wrinkles and repositions drooping eyebrows due to aging, thus avoiding the need for large incisions.
It is a great complement of blepharoplasty, which is the operation performed to correct eyelid wrinkles. It is also helpful for treating neck’s wrinkles. Endoscopy is also applied in nose surgeries that require correction of the nasal septum, to release the obstructions which are difficult to access under direct visual control.
Objective: To treat nasal deformities.
The intervention: The surgeon’s role is not to change the face but rather to correct the defects of that patient so that the nose is in harmony with the rest of the face; for example to remove the hump, refine the tip of the nose, shorten and make the nose smaller, treat large nostrils and resolve cases with respiratory obstructive disorders.
Type of procedure: outpatient.
Anesthesia: local and sedation
Duration of the procedure: ranges from 1 to 2 hours.
Initial recovery: between one and two weeks.
Final appearance: attained in 6 to 9 months.
Result: permanent.
Complement: occasionally, it is necessary to add a chin augmentation in order to improve the patient’s profile.
Objective: To correct flaccidity, eyelid wrinkles and remove fatty bags under the eyes.
Fatty bags are small herniations of the fat which surrounds the eye, which, since there is no septum containing them, become visible and bulky under the skin.
The intervention: consists in removing the excess of skin and fat and repairing the septa, to prevent recurrences.
Type of procedure: outpatient.
Anesthesia: local and sedation.
Duration of the procedure: ranges from 1 to 2 hours.
Recovery: variable, usually from 3 to 5 days to begin activities and 2 to 3 weeks until complete recovery.
Results: last 5 to 10 years.
Complement: occasionally the procedure is combined with a limited facial lifting or an endoscopic forehead lifting in order to obtain better results.
Objective: to rejuvenate those facial traits that have lost their position and eliminate/attenuate most facial wrinkles. To diminish the signs of facial aging, while preserving the expression of the face.
The intervention: consists in repositioning the skin, muscles of the face and neck, remove the excess fat (when necessary) while achieving an overall natural result.
Type of procedure: outpatient.
Anesthesia: local with sedation, occasionally general anesthesia is used.
Duration of the procedure: from 2 to 4 hours.
Recovery: between 7 days and 3 weeks.
Results: last 5 to 10 years.
Complement: occasionally, it is necessary to perform a forehead lifting (endoscopically), or to place a malar prosthesis to better define a flat face, as well as fat fillings recycled from the same patient or eyelid surgery.
Each patient will require a different solution according to the surgeon’s advice and the final joint decision of the patient and surgeon.
Post-operative recovery: to make it faster, the use of anti-inflammatory masks is recommended, which enhance and improve the results of surgery.
Objective: Destined for women who wish to reduce the volume of their breasts, and elevate them in order to make them more harmonic and young-looking.
In cases of large-volume breasts (gigantomastia), this surgery also alleviates the back pain caused by their excessive weight.
The intervention: The technical rationale consists of removing a wedge of skin and gland in a vertical and horizontal direction.
Type of procedure: outpatient or one-day admission.
Anesthesia: local with sedation, or general.
Duration of the procedure: from 2 to 3 hours.
Recovery: between 7 days and 3 weeks.
Approximately 7 days, one month to completely resume all physical activity and 6-12 months for scars to become unnoticeable.
Results: are permanent, only modified by weight gain, pregnancy or aging.
Objective: increase in breast volume.
The intervention: consists of placing silicone implants (gel or saline filled) through small incisions, in the space between the mammary gland and the pectoralis major muscle. Occasionally, it may be necessary to implant them behind the muscle.
The size of the implants will be decided by the patient and surgeon jointly.
Type of procedure: outpatient or one-day admission.
Anesthesia: local with sedation or general.
Duration of the procedure: from 1-2 hours.
Recovery: initial recovery takes 7-15 days, and one month is necessary to fully resume all physical activity.
Results: are long-lasting, although they may be modified by weight gain or pregnancy/breastfeeding.
Until present, no relation between silicone implants and auto-immune diseases or breast cancer has been proven.
Objective: Patients with normal-sized breasts, but with flaccidity or sagging breasts may benefit from some type of surgery.
The intervention: may entail placing implants or true breast "liftings" in which the surgeon removes skin and remodels the tissues: occasionally, the combination of both procedures is necessary.
Type of procedure: outpatient.
Anesthesia: local with sedation or general
Duration of the procedure: 2 to 3 hours.
Recovery: initial recovery takes 7 to 15 days and a after one month the patient may resume her usual physical activity.
Results: are long-lasting, although they may be modified by weight gain and pregnancy or breastfeeding.
Until present, no relation between the use of silicones and auto-immune diseases or breast cancer has been proven.
Objective: Breast reconstruction of a gland that has been partially or totally resected due to cancer or other diseases is one of the most gratifying procedures that the surgeon can currently perform. It is a true challenge for the plastic surgeon, who has to make use of all his/her experience, since each case requires special consideration. Reconstruction can be immediate (performed simultaneously with the resection) or delayed (performed at a later time).
The intervention: There are several procedures and materials used in the reconstruction: placement of tissue expanders, prostheses, transfer of autologous tissues (such as the patient’s own abdominal fat or skin), etc. The reconstruction may require more than one surgical stage.
The patient must openly explain her wishes and concerns, so that the surgeon can decide which technique is best adapted to her particular case.
Objective: this operation is performed to correct protruding ears and may be undertaken as early as in school-age children.
The intervention: the technique consists in removing skin, while at the same time treating the auricular cartilage in order to bring it closer to the head, and in some cases removing cartilage.
Type of procedure: outpatient.
Anesthesia: local or general (in young children)
Duration of the procedure: approximately 1 to 1 1/2 hours.
Recovery: is quick; in 3 days the patient may resume activities partially, and fully in 15 days.
Results: Results obtained are definitive.
Objective: Patients with a prominent or flaccid abdomen require the resection of the excess of skin and fat, as well as muscle remodeling in order to improve their appearance.
The intervention: consists of removing the redundant tissues and is sometimes complemented by a lipoaspiration of the flanks. In the internal aspect of the thighs, when lipoaspiration is not enough, the excess of skin has to be removed.
Type of procedure: may be done as outpatient or inpatient.
Anesthesia: local with sedation or general anesthesia.
Duration of the procedure: ranges from 2 to 3 hours.
Recovery: ranges from 7 to 15 days and about a month to fully resume physical activity.
Results: are long-lasting when body weight is maintained.
Objective: filling of wrinkles, highlighting facial traits.
The intervention: there are several options: material implanted through local injections may be utilized, or the patient’s fat may be used as filling. Each procedure has its precise indication.
There are numerous filling materials in the market and others that are being introduced:
· collagen
· collagen + acrylic microspheres (arte-coll® ), radiesse®
· hyaluronic acid used alone or in combination
· bioplastique, etc.
Another option used to temporarily remove some wrinkles is the application of botulinum toxin type "A" (Botox®).
In cases of marked nasolabial folds, depressed commissures or the need for lip or cheek filling, fat may be obtained from some area of the patient’s body (abdomen, knees, gluteii, etc.), then processed, recycled and injected.
Although fat undergoes a process of resorbtion, it allows to obtain very good mid-term results. A second fat injection becomes necessary in some cases, since it complements the first one, and allows to obtain longer lasting results.
Type of procedure: outpatient.
Anesthesia: The injection of filling materials or fat is performed using local or topical anesthesia (EMLA).
Results: each type of material provides variable duration of results.
Objective: is the care, improvement and maintenance of the skin damaged by aging, photosensitivity, seborrhea and different environmental factors.
Most frequent indications are: facial aging (skin dryness, fine wrinkles), pigmentation (spots), facial eritrosis (reddened skin), acne, sequelae of acne, facial seborrhea, damage due to excessive exposure to sunlight, etc.
The intervention: Several products are used : alfahydroxyacids (glycolic acid), retinoic acid, hydroquinone, vitamin C, derivatives of these products, etc. They cause almost no side effects. The procedure is also useful in the preparation of facial surgery (lifting) or as a complement to it, but does no t replace it.
Procedure:
1- At home, with creams, gels, lotions, etc. According to the need of each patient and the characteristics of the lesions to be treated.
2- In the office, with topical applications performed and controlled by the physician.
Duration of the procedure: The frequency of topical applications ranges between 7 and 14 days, with a number of 6 to 12 sessions. During maintenance, it is convenient to have one application monthly. Results: After 1 to 14 months, a marked improvement in the quality of the skin is noticeable.
El procedimiento se utiliza para quitar el exceso de depósitos grasos localizados en zonas del cuerpo que no responden a dietas y ejercicio, y que generalmente tienen una fuerte carga genética. Las zonas más frecuentes son papada, brazos, abdomen, espalda, caderas, nalgas, muslos y piernas. Se realiza utilizando una cánula que emite ultrasonido y aspira simultáneamente. Hay dos métodos para realizar lipoaspiración: aspiración directa con cánulas de distinto espesor; o la aplicación de ultrasonido para transformar la grasa en un aceite primero, para luego aspirarlo (lipoescultura). Realizamos ambos métodos, pero habitualmente y de acuerdo a las zonas a tratar preferimos este último. Este tipo de lipoaspiración ultrasónica destruye selectivamente el contenido de la célula grasa, respetando el soporte de tejido conectivo, colágeno, nervios, arterias y venas, provocando escaso traumatismo a los tejidos. De esta manera lo que se aspira es la grasa derretida, lo que permite obtener un resultado homogéneo con un efecto de retracción de piel significativa. Puede ser usado como complemento de otras cirugías. La duración del procedimiento es de 1 a 2 horas, dependiendo de la extensión de la cirugía. La anestesia es local con apoyo anestésico y no requiere internación. La recuperación inicial es rápida, dura en unos pocos días a 1 o 2 semanas, y para una actividad intensa re requiere esperar entre 2 y 4 semanas. El resultado final se podrá apreciar luego de 1 a 3 meses. Para mantener el resultado es importante no aumentar de peso y realizar actividades físicas.
Sobre la base de nuestra experiencia, se aconseja como tratamiento complementario altamente efectivo, el drenaje linfático aspirativo (endermología) en un numero variable de sesiones (de 6 a 10), lo que produce una importante aceleración en la recuperación postoperatoria de las zonas lipoaspiradas.
El objetivo de este programa es el cuidado, mejoramiento y mantenimiento de la piel dañada por el envejecimiento, la fotosensibilidad, la seborrea y distintos factores ambientales. Las indicaciones más frecuentes son envejecimiento facial (sequedad de piel, arrugas finas), pigmentaciones (manchas), eritrosis facial (piel enrojecida), acné, secuelas de acné, seborrea facial, daño producido por la excesiva exposición solar, etc. También es de utilidad en la preparación de la cirugía facial (lifting) o como complemento de ella, pero no la reemplaza. Se utilizan diversos productos: alfahidroxiácidos (ácido glicólico), ácido retinoico, hidroquinona, vitamina C, derivados de estos productos, etc. Éstos no poseen mayormente efectos colaterales. En un plazo mediano de entre 1 y 4 meses producen notoria mejoría en la calidad de la piel.
El tratamiento se puede realizar, de acuerdo a la necesidad de cada paciente y las características de las lesiones a tratar, en el domicilio con cremas, geles, lociones, etc.; o en el consultorio con aplicaciones tópicas que hace y controla el médico tratante. La frecuencia de las topicaciones oscila entre 7-14 días, y el número de sesiones entre 6 y 12. Luego es conveniente realizar una topicación mensual durante el período de mantenimiento.
Existen diversas opciones para el relleno de arrugas, aumento y demarcación de rasgos faciales. Se pueden utilizar materiales implantables por medio de inyecciones locales o rellenos con grasa del mismo paciente. Cada caso tiene una indicación precisa. Hay numerosos materiales de relleno en el mercado y siguen apareciendo nuevos: colágeno, colágeno + micro esferas de acrílico (arte-coll), ácido hialurónico solo o combinado, bioplastique, polimetil-metacrilato (PMMA), hidroxiapatita (Radiesse), poliacrilamida (Outline). Éstos tienen una duración variable. Muchos materiales se presentan en distintas densidades para ser inyectados en la superficie -arrugas finas- (estos tienen menor duración); o más profundos. Por otro lado, en casos de surcos naso genianos marcados, comisuras deprimidas, aumento de labios, mejillas, se puede tomar grasa de alguna parte del cuerpo (abdomen, rodillas, glúteos, etc.) procesarla, reciclarla e inyectarla. Si bien es cierto que la grasa sufre un proceso de reabsorción, permite obtener muy buenos resultados a mediano plazo. En algunos casos es necesaria una segunda inyección de grasa, que complementa la primera produciendo resultados más duraderos. La inyección de materiales de relleno o grasa se hace con anestesia local o tópica (EMLA) y es un procedimiento ambulatorio.
Cuando la piel de los labios presenta muchas arrugas finas conviene evaluar la abrasión mecánica (ver pulido).
Las arrugas de expresión faciales se pueden disminuir o eliminar con la toxina botulínica tipo “A” (Botox®, Disport ®, Xeomin®). Esta sustancia tiene la propiedad de disminuir temporalmente la respuesta muscular de los músculos tratados. Habitualmente los efectos duran de 4 a 6 meses. Para mantener el efecto de relajación de los músculos faciales y por consiguiente el resultado deseado, deberá repetirse idealmente dos veces por año.
Objective: The procedure utilizes a cannula which emits ultrasound and aspirates simultaneously.
It is used to remove the excess of fatty deposits located in areas of the body which do not respond to diet and exercise and are generally under a strong genetic influence.
The intervention: The most frequent are double chin, arms, abdomen, back, hips, buttocks, thighs and legs. This type of ultrasonic lipoaspiration selectively destroys the contents of fat cells, while preserving the support of connective tissue, collagen, nerves, arteries and veins, causing limited trauma to the tissues. Hence, what is aspirated is the melted fat, with a homogeneous result and a significant effect of skin retraction. It may be used as a complement to other surgical procedures.
Procedure: no admission is required.
Anesthesia: local, with anesthetic support.
Duration of the procedure: ranges from 1 to 2 hours, according to the extent of the surgery.
Results: initial recovery is quick, from a few days to 2-4 weeks; for strenuous activities 2 to 4 weeks are required and the final result can be appreciated after 1 to 3 months.
For results to be durable, it is important to avoid weight gain and exercise regularly.
Complement: based on the experience of our center, where we have found it to be highly effective, we prescribe aspiration lymphatic drainage (endodermology, cellu-vac), for a variable number of sessions (6 to 10), which leads to a marked improvement in the postoperative recovery of the treated areas.
- ENDOSCOPIC PLASTIC SURGERY
- NOSE SURGERY: "RHINOPLASTY"
- EYELID SURGERY: "BLEPHAROPLASTY"
- FACIAL REJUVENATION: "LIFTING"
- BREAST SURGERY. REDUCTION MASTOPLASTY
- BREAST SURGERY. AUGMENTATION MASTOPLASTY
- BREAST SURGERY FOR FLACCIDITY OR PTOSIS. MASTOPEXY
- BREAST RECONSTRUCTION
- PROMINENT EARS: "AURICULOPLASTY"
- ABDOMEN AND THIGHS: FLACCIDITY AND ADIPOSIS."DERMOLIPECTOMY"
- WRINKLE FILLING/REMOVING
- CHEMICAL PEELING
- LOCALIZED ADIPOSIS "LIPOASPIRATION / LIPOSCULPTURE"