Correction of Surger

Correction of Prior Liposuction Surgery

The majority of the unwanted results or sequels of prior liposuctions are due to the NON compliance to the basic principles of the technique. Regardless of the Technology used (Ultrasound, Laser, Vaser, Vibroliposuction, Traditional) or the tactic used (Tumescent, Dry or Wet) one must always respect the skin and the subcutaneous cellular tissue adjacent to it. This means that during the procedure the depth of the cane tube is the key to the procedure.

The human body has two types of body fat. The Superficial or Areolar fat layer which is located just below the skin and gives the skin its tone, color and lushness and cannot be liposuctioned because it would cause fibrosis, adhesions, fatty depressions and furthermore cause circulation damage which can be easily noticed due to the violaceous or purple skin color giving it a marmoreal aspect. The second type is the Deep or Profound type and is the one the Plastic Surgeon should reach and remove in order to avoid the complications described above.

Another common complication with patients that were superficially liposuctioned is that they cannot slim down or put on weight in a harmonious or proportioned way. Since the first layer of fat just below the skin has been removed those fatty cells cannot produce fat and Lipogenisis occurs which consists of Hipertrophy or a Hiperplasia of the deep fatty cells not allowing the patient to slim down or put on weight in a harmonious and proportioned way. That’s why the Plastic Surgeon usually hears the Patient saying “I had Liposuction done but now I put on weight only on my legs” or vice versa.

The correction of errors or sequels of prior liposuctions is one of the most challenging procedures in our profession and not all the cases can be corrected to our liking. These challenges arise because of the Superficial Liposuction and the solution is to Superficially Lipoinject. Furthermore when the Plastic Surgeon does not have a clear understanding of the different fat layers on the human body and thus superficially liposuctions the procedure is very painful which would not happen with a profound or deep Liposuction. The superficial fatty layer is separated from the profound or deep layer by a fascia called FASCIA SUPERFICIALIS which must be traversed in order to reach the correct location of the fat layer that has a very different consistency and thus can be easily removed. That’s the secret.

Secondary Rhinoplasty

When a procedure is done on a nose that has been operated on once, twice or more it is called Secondary Rhinoplasty. This is the result of the patient not being comfortable with the results and thus is full of distrust and must be heard very carefully to be able to determine if the patient’s objectives and expectations can be reached. The doctor’s visit, which normally is done with a new Plastic Surgeon, must be very realistic for the patient and the Plastic Surgeon so that another undesired result is not achieved. The Plastic Surgeon HAS TO BE very confident in being able to achieve the patient’s expectations so that the patient/doctor relationship does not deteriorate.

A nose that has been operated on will have internal scaring, diminished blood irrigation, fibrosis and a different anatomical structure, so the diagnosis must be very precise to avoid unnecessary scaring or lesions and very complete to obtain the desired final result.

1)It is recommended to postpone the surgery at least a year since the last one so that the tissues can relax and there will be no residual edemas.
2)To know with accuracy what was missing or what was superfluous.
3)The Plastic Surgeon must identify if the patients expectations are real and attainable and has to be capable of delivering the required results.
4)The Plastic Surgeon must undo what was done wrong but keep what the prior Plastic Surgeon did well in order to avoid further scarring and lesions.
5)If needed only use fillings or implants from the patient such as bone or cartilage.

The most common tactic used for a Secondary Rhinoplasty is an Open Rhinoplasty so that the Plastic Surgeon can have a full view of the deformities and abnormalities and thus achieve a more accurate result. It is also recommended to start with undoing what was done in excess during the prior intervention in order to properly identify the actual anatomical structure of the nose. The next step is to start correcting from top to bottom (from the dorsum to the tip) which will aide and facilitate the proper execution of the corrective motions.It would be more complex to do it in reverse since we would have to pass above of the tip to improve the dorsum. If there are going to be implants on the dorsum, these implants must be sustained by transcutaneous sutures so that they will not move during the post-opt. Once the dorsum is finished we direct our attention to the tip and apply the proper planned correctives. We cannot forget to carefully observe the lateral walls of the nose since they might be affected by the work done in the dorsum and the tip.

Normally a Secondary Rhinoplasty is a very laborious procedure since the exact diagnosis will only be determined during the procedure and thus the Plastic Surgeon must be able to adapt to the actual conditions.

During the post-opt, the immobilization and the proper intake of antibiotics are extremely important to protect the implants from a possible infection and thus reabsorption. The patient must keep in mind that the reabsorption of the edema will take longer compared to a Primary Rhinoplasty.A successful Secondary Rhinoplasty will open the doors to new challenges and the benefited patients will be our best spokesmen so that other people can believe in our specialty and dare to improve.

Correction of Prior Mammoplasty

A patient that has gone through an Augmentation Mammoplasty procedure and did not attain the results she expected will ponder a lot before once again going back to a Plastic Surgeon for a consultation. This is why these patients must be carefully analyzed and studied in order to finally attain those desired results.
Augmentation Mammoplasty can have these types of undesired results:

Improper placement of the implants: The most common is when they are place above their ideal location.

Enlargement of the nipple-areolar diameter complex: This is usually due to a bad technique during surgery.

Hypertrofic or enlarged scar: Normaly due to tension on the sutures. The implants were too large or there was too much skin removed.

Capsular Contracture (of the implant): The most common of the complications and there is still no definitive reason for its occurrence. It is thought that it is produced by multiple factors:

a.By a large hematoma in the immediate post-opt.
b.By a Seroma post-opt immediately or not immediately.
c.By creating a very large pocket for a small implant.
d.By creating a very small pocket for a very large implant.
e.By infection.

f.By patients that have the implants for more than 10 years.

Another complication is due to the breasts that fall after a pregnancy and breastfeeding, leaving the implants above and the breasts below, especially when the implant was places underneath the muscle.

Another sequel is the visualization or palpation of the implant on very thin patients. This usually occurs when the implant is placed above the muscle.

As you can see there are many types of complications, sequels or errors and each one has to be attended in an individual manner, starting with the correct diagnosis.