WHAT IS RHYTIDECTOMY?

a. Surgery of the ear that “pins back” protruding or deformed ears by reshaping the cartilage

b. Facelift surgery that removes excess skin and tightens muscles

c. Surgery to reduce the size of the bald area on the scalp

d. Surgery of the eyelids that removes fat and excess skin, bags, pouches, and wrinkles in the eye area.

FOR THE CORRECT ANSWER PLEASE SCROLL TO THE END

Advances in Plastic and Reconstructive Surgery

The UCLA Division of Plastic Surgery started as a busy plastic surgery service at Wadsworth Veterans Hospital shortly after World War II.

The word “plastic” in plastic surgery comes from the Greek word plastikos, that means “to mold or shape.”

Reconstructive plastic surgery is intended to correct a physical abnormality caused by a physical trauma, birth defect, disease or tumor.

Cosmetic plastic surgery’s goal is to enhance or change a healthy, normal, part of the body.

According to the American Society of Plastic Surgeons, the most common plastic surgery procedure is tumor removal (for skin lesions such as skin cancers) and the most common cosmetic surgery procedure is liposuction.

In this quarter’s newsletter, we highlight advances in Plastic and Reconstructive Surgery available at UCLA Healthcare. The scope of expertise provided by UCLA’s board-certified specialists includes skin cancer removal and reconstruction, breast reconstruction, microvascular surgical reconstruction, hand injury repairs and replantation, and repair of abnormalities caused by maxillofacial trauma and congenital deformity. The Division of Plastic Surgery is also home to the state-of-the-art UCLA Cosmetic Surgery Center that offers aesthetic surgery, body contouring, scar revisions and tattoo removal. (read more)

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Young War Victim Receives Chance for a New Life

Imagine being a 12-year-old girl in a war-torn country, whose world is suddenly shattered when a bomb strikes her family home. When UCLA plastic surgeons heard about Marwa Naim from Northern Iraq, whose injuries from that explosion left her without a nose, they wanted to help her. (read more)

Several humanitarian organizations joined forces to make this miracle possible. In a series of four outpatient surgeries between February and May 2006, UCLA doctors transferred a flap of skin from her forehead and folded it down to create a new nose. The shape of the tip was achieved by using grafts of cartilage taken from Naim’s ear. In the last two procedures, scar revisions and aesthetic refinements were made. (read more)

The Challenge of Cleft Lip/Palate

Clefts of the lip and/or palate result from incomplete development of the face or mouth, and occur in approximately one in 600 births. Feeding is the most immediate challenge faced by parents of a newborn with a cleft.

The most significant reason for repairing the palate is to preserve speech. “A child can have a hole in the roof of his mouth and still be able to eat OK ― they adapt,” says UCLA surgeon Henry K. Kawamoto Jr., M.D., D.D.S. “But with a cleft palate, they will never be able to communicate in terms of speech. Repairing the palate is, for that reason, very important.” (read more)

Children with a cleft lip and palate need the expertise of an interdisciplinary medical team. In addition to requiring plastic surgery to repair the opening, interventions to correct issues with teeth, hearing and speech are necessary, as well as addressing children’s psychological development as they mature.

The UCLA Craniofacial Clinic is one of the largest centers in the United States and provides consultative and surgical treatment for patients on a weekly basis. The UCLA team is comprised of internationally recognized experts who provide state-of-the-art treatment for all children with birth defects. (read more)

Myth-Busting - The Truth about Breast Reconstruction

When a woman is faced with a decision about breast reconstruction following a mastectomy, nothing is more important than having all the information on which to base that decision. Breast reconstruction may not be the right choice for every woman, but it’s a tragedy if she bases her decision on frightening or confusing misinformation.

Here are some common misconceptions about breast reconstruction as identified by UCLA surgeon, James Watson, M.D.

Myth # 1: Breast reconstruction reduces survival.

Fact: Five scientific studies have compared mastectomy patients with and without reconstruction, and each has concluded that reconstruction does not affect survival.

Myth # 2: Immediate reconstruction is not safe.

Fact: The belief behind this myth is two-fold: 1) immediate breast reconstruction will delay chemotherapy and 2) the cosmetic result will be ruined by postoperative radiation.

The reality is that if the incisions do not heal well, postoperative chemotherapy can result in problematic infections because the chemotherapy suppresses the immune system. There are certain types of breast reconstructions that can be performed with reliable wound healing. One of these options is usually recommended for patients who need post-operative chemotherapy.

Post-operative radiation can cause capsular contracture or hardening of breast implants. This can be avoided by choosing a reconstruction option that does not use implants. Most options that use your body's own tissue (autologous reconstruction) hold up well to post-operative radiation and do not result in cosmetic problems.

Myth # 3: There is only one breast reconstruction option.

Fact: Sometimes a woman is presented with only one option possibly because her physician only knows how to do one kind of surgery. There are actually eight to 10 reconstruction options so any patient who is presented with only one should get a second opinion. It is very likely that there is an option that will meet her specific needs. (read more)

The Right Time for Breast Reconstruction

Primary care physicians should refer their breast cancer patients to a plastic surgeon at the same time that they are referring to an oncologist so that the two can coordinate their treatment plans and, preferably, perform the surgeries at the same time. According to UCLA plastic surgeon, Jaco Festekijian, M.D., “It’s very rare now that we would recommend delaying reconstruction. Too often, women unnecessarily have to live without a breast for a period of time before the reconstruction.” Immediate reconstruction not only prevents the negative psychological consequences many women experience through their changed body image; it also provides the plastic surgeon with tissue that is softer and easier to work with, making a better result more likely. (read more)

Microsurgery Used in Breast Reconstruction

Surgeons, specially trained in new microsurgical techniques, are able to transfer the patient’s own tissues at the time of mastectomy with minimal or no muscle loss.

Microsurgery involves disconnecting a tissue and its blood supply from the body and reattaching it, transferring the vessels, and sewing them under the magnification of a microscope. The “free-flap” ― in which the tissue is completely disconnected and reattached ― has become the predominant technique in breast reconstruction at the Revlon-UCLA Breast Center, and has made possible the transfer of patient’s tissue from the lower abdomen or buttocks at the time of the mastectomy, with minimal risk. (read more)

Microsurgical breast reconstruction requires special training. At high-volume centers such as UCLA, which is performing 200-250 of the procedures per year, there is a growing demand. At institutions where breast microsurgery is performed in high volume, success rates are as high as 99 percent.

The following free flap procedures are performed at UCLA:
· Breast
· Trunk
· Head and neck
· Lower extremity
· Facial re-animation
· Hand

(read more)

A Difficult Decision - Prophylactic Mastectomies

Women living with a high risk of developing breast cancer because of a strong family history of the disease or positive genetic testing are faced with a difficult decision - that is, whether or not to undergo removal of both breasts before cancer develops. “For women who do elect to go through with prophylactic mastectomies, this no longer has to be looked at as a mutilating type of experience,” cautions UCLA plastic surgeon Andrew Da Lio, M.D. “Certainly, it’s an individual decision, but in some cases, if patients and their physicians could see the results of current breast reconstruction techniques, they would probably be more accepting of the idea.” (read more)

Reconstructive Surgeries - Restoring Normal Function and Appearance

Not to be confused with cosmetic surgery, reconstructive surgery is performed to correct abnormal structures of the face or body caused by congenital problems, disease or injury. The goal is different from cosmetic surgery in that it seeks to improve function as well as to achieve normal appearance.

Orthognathic (Jaw) Surgery aims to improve both functionally (greater ability to chew with an improved occlusion or ‘bite’) and cosmetically (a more balanced facial appearance). (read more)

Ear Reconstruction
Microtia is a congenital condition in which the ear is not completely formed. In total reconstruction of the external ear, the plastic surgeon sculpts a delicate convoluted framework from rib cartilage and covers it with a fine skin envelope. The goal of the surgeon is to create an acceptable representation of the external ear with proper size, position and orientation to other facial structure. (read more)

Orbital Reconstruction
Correction of the deformities of the bony orbit and soft tissues surrounding the eye requires proper diagnosis and preoperative planning with the help of computerized tomography (CT) scans. Though several different techniques exist to correct these deformities, surgeons at the UCLA Craniofacial Clinic decide which procedure will be most effective on a case-by-case basis. (read more)

For additional reconstructive procedures, click here.

Is Cosmetic Surgery Right for You?

Nearly 11.5 million surgical and non-surgical cosmetic procedures were performed in the United States in 2005.

“The best motivation for cosmetic surgery is a healthy sense of vanity ― emphasis on the word healthy,” says Timothy A. Miller, M.D., chief of the Division of Plastic and Reconstructive Surgery at UCLA. “There is nothing wrong with vanity, but when it becomes obsessive or the patient sees it as an avenue to changing the direction of his or her life, it can be a problem.”

Is cosmetic surgery the right chose for you? If so, then it’s important to understand that cosmetic surgery is not a recognized specialty of the American Board of Medical Specialties (ABMS). Just because a physician claims to be “board certified” doesn’t mean he or she has had sufficient training in cosmetic surgery. Certification could come from an unrecognized, self-designated board that requires little more than an application fee.

Cosmetic surgery is, however, an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles both to improve overall appearance and optimize the outcome of reconstructive procedures. (read more)

Cosmetic Surgery - So Much More than a Facelift

The UCLA Cosmetic Surgery Center offers a wide array of the most current surgical and minimally invasive techniques to enhance the appearance and reflect the inner vitality of each patient. Surgery may not be an option for everyone, but at the UCLA Cosmetic Surgery Center, a surgeon works one-on-one with a patient to recommend a customized plan.

Rhytidectomy (Facelift)
A facelift rejuvenates the aging face and neck by removing excess skin and tightening the deeper facial tissues. This is an effective procedure for sagging necklines and jowls, and deep wrinkling of the face. In order to obtain the best results, a facelift is often combined with other procedures such as browlift, eyelid surgery or liposuction under the chin, but this varies from patient to patient. (read more)

Blepharoplasty (Eyelid Surgery)
The goal of blepharoplasty is to rejuvenate the eyelids by treating drooping eyelid skin, and puffiness below the eyes. This is typically accomplished by removing fat, skin and muscle in varying combinations from the upper and/or lower eyelids. The surgery is usually performed on an outpatient basis and most patients are able to return to work within one week to 10 days. (read more)

Rhinoplasty (Nasal Reshaping)
Nasal reshaping, or rhinoplasty, is often used to improve the appearance of the nose, but can also be effective in correcting breathing difficulty (especially during exercise or sleep). The surgery can be performed under local or general anesthesia, and usually lasts for one or two hours. According to the American Society of Plastic Surgeons, nasal reshaping is the second most common cosmetic procedure for men. (read more)

Mentoplasty (Chin Surgery)
A facelift may not improve a double chin with excess skin, fat or ropey muscle cording beneath the chin. A procedure involving liposuction and suturing can be performed in conjunction with a standard neck or cheek lift. Or if the chin requires augmentation to improve the appearance of the lower face by changing the position of the chin point, a chin implant can be used to change the basic shape and balance the face. (read more)

Non-Surgical Facial Rejuvenation

If a surgical facelift, browlift, or eyelid surgery is not for you, there are other options available to rejuvenate your appearance.

Chemical Peels are a chemical solution, usually trichloroacetic acid (TCA), that is applied to the skin, causing the skin to blister and peel off over a period of five to 10 days. As the treated skin peels off, new more fresh skin replaces it. Chemical peels are a suitable procedure for facial rejuvenation and diminishing the effects of sun damage. This technique works best on fair, thin skin with superficial wrinkles.

Dermabrasion is a scraping of the top layers of the skin. This procedure softens edges of surface irregularities, including fine wrinkles and acne scars, especially around the mouth. The results are permanent, however, new wrinkles may form as skin ages.

Restylane and Captique are injectable gels used as soft tissue fillers to treat wrinkles and fill lips. Both are composed of hyaluronic acid, a substance found in all living organisms. No allergy skin tests are required. These dermal fillers are often used in conjunction with Botox for optimum results, especially for rejuvenation of the upper face, and diminishing the appearance of frown lines. Both products last between four to six months.

Radiesse fills acne scars and wrinkles, including frown lines and smile lines. Composed of a synthetic compound, radiesse does not require allergy testing and can be injected in a simple office procedure.

Sculptra is a long-lasting filler used to fill sunken areas of the face, as well stimulate new collagen growth. It is made from Poly-L-lactic acid.

Laser Skin Resurfacing with the Erbium Laser uses the most advanced techniques to “resurface” the skin, correcting damage caused by time and sun.

Collagen/Cosmoderm/Cosmoplast Injectable Wrinkle Fillers can smooth out, fill in, and decrease wrinkles. It will also plump lips and define the edges of the lips. Collagen can effectively fill in and reduce the depth of the nasolabial fold. It will also fill depressed acne scars quite well.

Skin Cancer on the Rise

Each year more than a million new cases of skin cancer are reported, making it the fastest growing form of cancer in the United States. Although a potentially fatal condition, even the most dangerous skin cancer can, if detected early enough, be treated and cured.

Reconstructive plastic surgery has played an important role in helping patients who have been treated for skin cancer. Most instances of skin cancer occur in the upper extremities, and it is the goal of the reconstructive plastic surgeon to return the patient's physical appearance back to what it was, to the greatest extent possible, prior to the skin cancer. Some skin cancer reconstruction can be simply performed once the cancer has been removed. But larger skin cancers, as well as skin cancers in visually critical areas of the face, can require more extensive reconstructive surgery involving techniques such as skin grafting and complex facial flaps.

In Skin Cancer, Less is Mohs - Achieving Excellent Results Using Precise Surgical Removal of Skin

Mohs micrographic surgery is an innovative skin cancer treatment that removes all skin cancer cells while preserving the surrounding healthy skin. Named after Dr. Frederic Mohs, the surgeon who pioneered the procedure, Mohs surgery is most commonly used to treat large tumors, recurrent tumors, and those occurring in cosmetically sensitive areas, such as the face.

In Mohs micrographic surgery, the dermatologist usually serves as the surgeon, pathologist and reconstructive surgeon. At UCLA, the Mohs surgeon works closely with other specialists when more extensive reconstruction is needed. "We have an ocular plastic specialist for eyelid tumors, and head and neck or plastic surgeons for tumors on the nose and ears," Dr. Soriano explains. “Through this collaboration, we are able to provide our patients with the best possible cosmetic outcome." (read more)

Why Do Teens Get Plastic Surgery?

Most teens don't, of course - but some do. The number of teens who choose to get plastic surgery is on the rise. According to the American Society of Plastic Surgeons (ASPS), 335,000 people 18 years and younger had plastic surgery in 2003, up from about 306,000 in 2000.

Interestingly, the ASPS reports a difference in the reasons teens give for having plastic surgery and the reasons adults do: Teens view plastic surgery as a way to fit in and look acceptable to friends and peers. Adults, on the other hand, frequently see plastic surgery as a way to stand out from the crowd. (read more)

SURGERY QUIZ Test yourself! Match the surgery to the targeted body area:

1) Blepharoplasty	a) Nasal passage
2) Dermabrasion	b) Jaw
3) Mentoplasty	c) Scalp
4) Orthognathic surgery	d) Ear
5) Septorhinoplasty	e) Chin
6) Mini or micro-grafting	f) Eyelid
7) Otoplasty	g) Skin
Please scroll to bottom of newsletter for answers.

ASK OUR EXPERTS

Many of our readers sent us their questions on a variety of topics. Following are a few of the questions and their answers provided by UCLA Medical Center specialists.

What should I look for in a plastic surgeon?

Choosing a qualified physician is the most important decision that you, as the patient, make when selecting a plastic surgery procedure. A plastic surgeon should be board certified by The American Board of Plastic Surgery. You should also ask how frequently that surgeon performs the procedure you are considering and outcomes of those surgeries. (read more).

I am not a candidate for autologous breast reconstruction because I do not have sufficient autologous tissue in my lower abdomen. Are my only other options saline or silicone implants?

UCLA surgeons can offer numerous alternative autologous breast reconstruction options. Autologous tissue can also be harvested from the buttock, thigh or hip areas to create a new breast mound by using similar methods. (read more)

What are the effects of radiation therapy on breast implants?

Problems and complications with breast implants are significantly increased with radiation therapy. In general, if one requires or has had radiation therapy, the use of breast implants should be discouraged unless there are no other options and both surgeon and patient understand the higher complication rates.

I am too heavy in my hips and thighs and I’d like to slim down quickly. Am I a good candidate for liposuction?

Liposuction is not a substitute for weight reduction, but rather a way to remove localized deposits of fat and thus “contour” the body. The best candidates for liposuction are of a relatively normal weight, and have elastic skin. To determine if a little body contouring is what you need, you should consult personally with a qualified plastic surgeon. (read more)

Rather than have a surgical facelift or surgery to correct baggy eyes, couldn’t I get the same results with a laser procedure?

No. Lasers do firm up the skin and increase skin tone by heating and contracting collagen in the skin. However, lasers cannot eliminate skin that has lost its elasticity. Once the skin begins to sag, surgery is typically required to correct the undesirable cosmetic appearance.

Puzzler Answer:

What is rhytidectomy?

Answer: b) Facelift surgery that removes excess skin and tightens muscles (read more)

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Answers to Surgery Quiz

1. Blepharoplasty           (f) eyelid
2. Dermabrasion            (g) skin
3. Mentoplasty               (e) chin
4. Orthognathic surgery (b) jaw
5. Septorhinoplasty        (a) nasal passage
6. Mini or micro grafting (c) scalp
7. Otoplasty                   (d) ear