can be affected by how
and where the cut is made, how it is sewn together and how it is cared for
after the operation (see p. 229). The idea that scars can be removed with
lasers is also false. A scar will always exist, although its appearance
can be modified.
During the consultation it is very important to review the risks associated
with the surgical procedure (see p. 60). It is also important to review
the healing process and how it is expected to progress.
The results of a plastic surgery operation depend not only on the skill
of the surgeon but also on his clinical judgment and ability to choose the
best method for each patient. In this context the surgeon must consider
a multitude of different factors. Diversity is a characteristic of plastic
surgery, not only in the problems one meets but also in the ways they can
be solved. All roads lead to Rome, as we know, but some of them can be better,
easier or faster. The same is true of plastic surgery operations.
A plastic
surgeon assesses the following at the consultation, before proposing a method
of treatment:
1. The patient's
age and sex
We know that
old skin heals scars better than young skin, and therefore that a procedure
which may be appropriate for an older person can be totally wrong for a
young person. Another example is beard growth, which makes some procedures
appropriate for women totally inappropriate for men.
2. Is the
surgery to restore the normal, original anatomical conditions, or is a defect
to be simply camouflaged?
If the cheekbone
(below the eye) is damaged, it may have been pushed down and then healed
in the wrong position. One alternative in such cases is to saw the bone
loose and raise it back to its original place. This is a complicated procedure,
however, and an easier way to achieve an equally satisfactory result may
be to camouflage the irregularity by building up the bone with some form
of implant.
3. The color and quality of the skin that is
to be operated on.
In a skin transplant, for example, skin should
be taken from a part of the body that closely matches the color of the area
it is to be transplanted to.
4. What kind
of tissue causes the deformity?
A projecting
or depressed area on the body may be due not only to the amount of skin and
fat, but also to the form of the underlying muscles and bones. Bone structure
is extremely important in determining the shape of the face, for example.
5. Is there
too much or too little tissue, and if so where and how much?
A patient with
a protruding stomach, for example, can sometimes be treated with liposuction
alone, but if there is too much surplus skin it will have to be stretched
in order to achieve a good result.
Another example is a
cancer operation in which large amounts of tissue are removed. The plastic
surgeon must decide whether there is enough remaining tissue to allow the
wound to be sewn together or if additional tissue must be borrowed from elsewhere
on the body.
