AEsthetic Surgery
1. Cervicofacial lift with vertical suspension
T. Bratu, D. Grujic, Z. Crainiceanu, G. Nwachukwu
2. Our protocol in face rejuvenation
T. T. Mugea
3. The open rhinoplasty for bifid nose
T. Stamate
4. Halfopen rhinoplasty in nasal lobul malformations
T. Stamate
5. Some indications for open rhinoplasty
Al. V. Georgescu, C. Moraru, Ileana Matei
6. A sequential graduated anatomic nose surgery from transcartilaginous to
external (open) approaches"
C. Stan, S.Popescu
7. Breast augmentation – our experience
T. Bratu, D. Grujic, D. Olariu, D. Mihajlovic
8. The breast reduction using the superomedial technique and fixation of the
dermal inferior pedicle
T. Bratu, D. Grujic, D. Olariu, D. Mihajlovic
9. Mammopexy and breast augmentation with implants placed completely in
the retromuculoaponevrotic pocket.
T. Bratu, S. Olariu, P. Matusz, D. Grujic
10. Diminishing of the clinical appearance of capsular contraction in
augmentation mammoplasty
Al. V. Georgescu, C. Moraru, Ileana Matei
11. Breast augmentation combined with mastopexy
N.Antohi, V.Stan, C.Stingu
12. Surgical management of gigantomastia
N.Antohi, C.Stingu, V.Stan, G.Hodarnescu, S.Nae
13. Vertical scar mastopexy with dermoglandular flap transposition.
N.Antohi, V.Stan, C.Stingu, Carmen Orban.
14. Cosmetic augmentation mammoplasty – anatomic mamar implants
versus round implants
Ileana.Boiangiu, D.Calota, L.Banacu, C.Brezeanu,T. Panazan
15. Rehabilitation after surgical breast . It is a need?
Sandra Dan, L. Galosi, T. Bratu, P. Matusz, Gh. Noditi, Z. Crainiceanu, Daciana
Grujic, Mihaela Mastacaneanu.
16. "Sparring" soft tissue mono RF rejuvenation in the brow-upper and
lower eyelid region
C.Stan, S.Popescu
17. Liposuction. Removal of fat with the tumescence technique (Maag's
solution)
C. Chertif, M. C. Chertif
18. Limitations, approach, adjuvants and expectations in body contour
aesthetic surgery
Noela Elena Ionescu, I.P. Florescu S. Marinescu, Carmen Giuglea
19. Aesthetic Surgery – publicity deontology and postoperative results
management
Toma T. Mugea
20. Surgical treatment of axillary hyperhydrosis
D. Totir, M. Leventer
1. Cervicofacial lift with vertical suspension
T. Bratu, D. Grujic, Z. Crainiceanu, G. Nwachukwu
Brol Medical Center Timisoara, Romania
In the past years we have been trying to find a face-lift technique that will bring
about a good and stable result for a period of time and, on the other hand, to reduce the
surgical risk of the patient as well as stress.
Thus, after the elevation of the necessary skin from the SMAS , a plicaturation
and vertical traction of the SMAS is done using a 2-0 Vicryl suture. The first suture is
placed between the posterior edge of the platysma muscle and the pretragal ligament.
Then, additional 3-4 sutures are placed on a horizontal line parallel to the zygomatic arch.
The skin is closed in horizontal and posterior orientation, avoiding suture tension that
may lead to vicious scars.
2. Our protocol in face rejuvenation
T. T. Mugea
The visible morphologic changes associated with the ageing process are:
- reduction of bony structure
- diminution of skin thickness and elasticity
- lessening of subcutaneous fat tissue volume
- gravitational fall of soft tissues
- appearance of skin wrinkles in the adherence areas with deep structures and also
in the areas of muscles insertion
Therapeutical principles:
As a matter of fact there are seven available elements in the process of face
rejuvenation:
- stimulation of muscular tonus and of lymphatic drainage through:
• microdermabrasion combined with vaccumatic massage, phototherapy and
electrostimulation
- improvement of local metabolism and revitalization of skin structures through:
• mesotherapy
- correction of dynamic wrinkles through supervised and temporal paralysis of the
involved muscles through:
• injection of botulinic toxin
- microscopic abrasion proceeding of the skin and improvement of the skin
features through:
• chemical peeling or
• laserpeeling
- repositioning of ptosed structures with mini invasional threads
- removal of skin excess and repositioning deep structures through:
• surgical lifting, and
- restoration of needful volumes of the cheeks or lips through:
• resorptive materials
• non resorptive materials
3. The open rhinoplasty for bifid nose
T. Stamate
U.M. „Gr.T. Popa" Iasi
Plastic Surgery and Reconstructive Microsurgery Clinic
Clinical Emergency Hospital Iasi
Contact e-mail: tstamate@mail.dntis.ro
The "bifid nose" is a rare congenital anomaly, part of the median clefts –
deformities that goes from the simple enlargement of the vermillon up to major skeletic
malformations, frequently associated with hypertelorism. Of the 14 cranio-facial clefts
described by Tessier, the pairs 0-14, 1-16, 2-12, 3-11 and 4-10 include nose lobule
malformations.
For the bifid nose, pathognomonic is the central sulcus in the center of the lobule,
which can be associated with a partial or complete separation of the osteo-cartilagineous
skeleton in the axis of the nose, resulting either a bifid nose with a central depression
with variable depth or even two completely separated half-nose.
Miller (1999) deals efficiently with the bifid nose by skin excision, exploring de
viso all possible ways to bring closer the distant structures, with skin suturing in the axis
of the dorsum. The widest excision is in the lobule area, where the nose has its largest
segment.
The personal; technique proposed by the author and applied in two patients has
the advantage of avoiding any scar in the midline of the lobule, using only a columellar
incision as in the open rhinoplasty.
4. Halfopen rhinoplasty in nasal lobul malformations
T. Stamate
U.M. „Gr.T. Popa" Iasi
Plastic Surgery and Reconstructive Microsurgery Clinic
Contact e-mail: tstamate@mail.dntis.ro
Rinoplastia semideschis` în malformatiile lobulului nazal
T. Stamate
U.M. „Gr.T. Popa" Iasi, Disciplina de Chirurgie Plastica si Reconstructiva
5. Some indications for open rhinoplasty
Al. V. Georgescu, C.Moraru, Ileana Matei
Clinical Rehabilitation Hospital, Cluj-Napoca
Contact e-mail: geordv@hotmail.com
Despite of the fear of the close approach rhinoplasty, there are some special
categories of patients in which open rhinoplasty is mandatory.
We will refer to the patients coming for congenital or posttraumatic nasal
displasya, with deformations of the nasal pyramid and cartilaginous modifications
especially on the septum level. In this situation, septorhinoplasty and open approach are
followed by a better reshape, especially of the tip of the nose and, in the same time, by
the excision of some components which eventually can be reused for obtaining the best
aesthetic and functional result.
Cateva indicatii ale rinoplastiei deschise
Al. V. Georgescu, C.Moraru, Ileana Matei
Spitalul clinic de recuperare, Cluj-Napoca
6. A sequential graduated anatomic nose surgery from transcartilaginous to
external (open) approaches"
C.Stan*, S.Popescu**
*Medical Service Clinic, Bacau, Romania
*, ** Clinical Emergency Hospital Bucharest
To get a satisfactory surgical result in the eyes of both patient and surgeon, the
last one needs a large technical knowledge in the surgery of the nose.
In this communication, on a study made between January 1999 and December
2004, on 728 cases, the author tries to find the most characteristic difficult nose (primary
and secondary) and to identify between closed and open approach the different surgical
ways to get a good result.
The surgeon must have a graduated, sequential incremental anatomic approach
and the procedure selected is that dictated by the anatomy encountered where minimal
deformities needs less invasive techniques and major deformities are approached more
aggressively.
In the surgery of the tip of the nose, one of the most difficult parts of aesthetic
surgery, the definition and analysis of a deformity is the first step o a good final outcome.
After a thorough case study and previous other authors and own experience the
most common deformities are:
1. wide tip
2. tip with low definition
3. overprojected tip
4. under-projected tip
5. downward rotated tip
6. upward rotated tip
7. asymmetric tip
8. abnormal tip shapes (boxy, ball tip, parenthesis tip)
Each factor gets a "value" between ideal, minor, moderate and major deformity.
Deeply connected with preoperative analysis is the selection of the operative
planning.
According to the previous tip analysis, the surgical technique is a sequential
selection approach.
1. minor deformities are treated by closed incision with or without sutures.
2. moderate deformities are treated by open approach and tip excision with
sutures
3. major deformities are treated by open approach and tip excision with sutures
and grafts for so called tip complex structures.
The study was made in the last 6 consecutive years on 728 cases; 156 patients
were treated through open approaches and 572 by closed tip surgery.
Having clear ideas on deformities and appropriated surgical techniques, the
accuracy and quality of the results was improved in one of the most difficult and most
challenging part of aesthetic surgery.
7. Breast augmentation – our experience
T. Bratu, D. Grujic, D. Olariu, D. Mihajlovic
Brol Medical Center, Timisoara, Romania
Augmentation mammaplasty remains one of the most common operation in the
field of aesthetic surgery.
Material and method
This presentation is based on a 10 years study ( 1995-2005) and makes
references to the evolution of tendencies in surgical techniques ( incision, placement of
the implant ) , types of implants, patients follow-up and long-term satisfaction degree .
Conclusions
In the last three years we used only anatomic coesive gel implants , by
inframammary approach. the abord was through the lateral edge of pectoralis muscle,
Followed by the section of the inferior costal and sternal insertions.
Also we try to persuade the patients that a smaller implant gives in time a better
result, avoiding the thinning of the tissues and visualisation of the implant. We consider
that a good and long term result depends on the surgeon experience, the quality of the
implant and the postop follow-up.
8. The breast reduction using the superomedial technique and fixation of the
dermal inferior pedicle
T. Bratu, D. Grujic, D. Olariu, D. Mihajlovic
Brol Medical Center, Timisoara, Romania
Although it has been described more than 100 techniques and variations of breast
reduction, based on the principal vascular pedicles, we prefer the superomedial pedicle
technique because it is safer, doesn’t give us emotions concerning the vascularization of
the mammary gland and nipple areola complex.
We prefer to combine the superior pedicle technique with the superomedial
pedicle technique based on anatomist’s studies that confirmed that the internal thoracic
artery with his branches have a relativelly constant distribution ( 74%). For obtaining a
long time stabile result we anchored the inferior dermal pedicle at the fourth intercostal
space level, creating an anatomic glandular bra.
This technique has proved to be safe and doesn’t put at risk the gland and areola
vascularization, even in wide excisions ( over 2000 g ) in gigantomasties.
9. Mammopexy and breast augmentation with implants placed completely in
the retromuculoaponevrotic pocket.
T. Bratu, S. Olariu, P. Matusz, D. Grujic
Brol Medical Center Timisoara
With references to the combinations of both techniques for the achievements of a
good and stable result , there is always been a controversy.
Some surgeons prefer to perform at first mammopexy and after about 6-9 months
augmentation, while others perform augmentation and after 3- 6 months mamopexy. The
controversy related to the first approach is that there is a wide sacr because of the
pressure exerted by the implants. In literature, we describe a technique for the correction
of ptotic and hipoplastic breasts. This technique combines mamopexy with superomedial
pedicle technique with mammary augmentation placing the implant completely in a
musculoaponevrotic pocket.
It is known that in cases with a small and moderate grade of ptosis, periareolar
mamopexy has been used to lift the NAC, but in most cases after operation the areola
remains in inferior orientation making it necessary for mastopexy or reintervention.
In case of moderate and severe ptosis, we underline the necessity of correction at
the same time of the voilume and the projection using the combination of the two
techniques with a good aesthetic and dureble result.
Thus, the implant is placed in a vasculoaponevrotic pocket created by the
dilaceration of the pectoral muscle and after the introduction of the implant the muscle is
sutured.
The pressure exerted on the scars is smaller and the implant being sustained by
the newly created bra.
10. Diminishing of the clinical appearance of capsular contraction in
augmentation mammoplasty
Al. V. Georgescu, C. Moraru, Ileana Matei
Clinical Rehabilitation Hospital, Cluj-Napoca
Contact e-mail: geordv@hotmail.com
One of the most frequent belated complications after the augmentation
mammoplasty is capsular contraction. Unfortunately it isn’t still found any kind of
prosthesis of which presence in human body can cause a minimal capsular retraction.
We are convinced, as statistics show; that the capsular contraction appears in the
majority of the cases, but it is clinically evident only in few.
We will try to present one of the multiples modalities which can enhance the
tolerability of the capsular contracture secondary changes and to reduce negative
implications concerning aesthetic result.
11. Breast augmentation combined with mastopexy
N.Antohi, V.Stan, C.Stingu
U.M.Ph. "Carol Davila"
Hospital for Plastic Surgery and Burns, Bucharest
Contact e-mail: nantohi@rol.ro
In many clinical situations, breast augmentation is difficult because of initial
severe breast ptosis. Correction of ptosis cannot be achieved by implants only. In this
paper we present 32 patients with breast augmentation combined with mastopexy (roundblock, vertical scar, inverted T, L). Indications, results, complications are overviewed.
12. Surgical management of gigantomastia
N.Antohi, C.Stingu, V.Stan, G.Hodarnescu, S.Nae
U.M.Ph. "Carol Davila"
Hospital for Plastic Surgery and Burns, Bucharest
Contact e-mail: nantohi@rol.ro
Surgical management of gigantomastia is always a challenge for plastic surgeons.
Besides the aesthetic considerations, gigantomastia always affects the patient in many
physical and psychological ways. There are some surgical techniques proffered which are
outlined in this paper. In 10 patients results, complications and aesthetic outcomes are
discussed.
13. Vertical scar mastopexy with dermoglandular flap transposition.
N.Antohi, V.Stan, C.Stingu, Carmen Orban.
U.M.Ph. "Carol Davila"
Hospital for Plastic Surgery and Burns, Bucharest
Contact e-mail: nantohi@rol.ro
Mastopexy should result in a short and less visible scar assuring a good shape and
nice appearance of the breast.
The purpose of this paper is to present our experience in short scar mastopexy
with vertical infraareolar dermoglandular flap, analysing the results and establishing
indications and possible contraindications.
We have used this technique in 41 cases. In all cases nipple-areolar complex was
transposed on the superior pedicle. The infraareolar dermoglandular flap was folded
behind the nipple-areolar complex and anchored at the level of 3rd rib to the prepectoral
fascia serving as a biological breast implant.
The inferior pole of the breast was created by suturing of the lateral and medial
pillars. The new iframammary fold was usually placed 2-3cm above the old one. It
converted the lower pole breast skin to chest skin. Vertical scar never exceed the new
inframammary fold.
The results were appreciated as good in 37 cases and satisfactory in 4 cases. There
were no unsatisfactory results. Complications included one haematoma and one local skin
slough along the vertical scar. Revision of the vertical scar was performed in two cases.
In conclusion, vertical scar mastopexy using infraareolar dermoglandular flap
significantly improves the shape and projection of the breast not leaving a horizontal scar.
It proved to be a safe and reliable method and good addition to the mastopexy methods.
Better results were achieved in grade one and two of breast ptosis. In severe ptosis with
skin laxity we prefer to convert the vertical scar in J-fashion to obtain a better shape of
the breast.
14. Cosmetic augmentation mammoplasty – anatomic mamar implants
versus round implants
Ileana Boiangiu, D. Calota, L. Banacu, C. Brezeanu, T. Panazan
Clinical Hospital for Plastic Surgery and Burns, Bucharest
Contact e-mail: www.chirurgieplastica@webline.ro
This paper is presenting a comparative analysis (without statistic involvement)
between anatomical and round mammary implants in cosmetically mammary
augmentation.
Comparing criteria are: augmented upper pole breast aspect, lower pole
augmented breast projection, implant dynamic, harmonious and adequate balance
adjusted to thorax dimension, correction/lessening preoperatory asymmetry, ptosis
correction, implant shell borders palpability or visibility, patient satisfaction, neutral
surgeon evaluation.
The aim is not a pleading for one or other implant, but the underlining of initial
and perspective criteria that has to be considered in choosing the mammary implant
form.
15. Rehabilitation after surgical breast . It is a need?
Sandra Dan, L. Galosi, T. Bratu, P. Matusz, Gh. Noditi, Z. Crainiceanu, Daciana
Grujic, Mihaela Mastacaneanu.
Breast cancer is the most common neoplasm ¨in this century’s women¨, yet very
little information is available about the reabilitation needs of these patients. Mastectomy
will remain a way of treatment for breast cancer, in spite of efforts to perform more
breast-conserving treatment.
Although mortality rates from breast cancer are declining, many breast cancer
survivors will experience physical and psychological sequela that affect their every day
life (significant diferences were observed in the scales ¨self acceptance of the body
image¨).
The place of the physical therapist is inquestionable in the interdisciplinary team.
It is important both for the doctor and for the patient to know WHEN, WHAT,
HOW, the physical therapist could help a patient to regain functional use of her upper
limb on the affected side, and to adapt functionally, psychologically, and emotionally to
the loss of her breast and to the diagnosis of cancer, in the shortest time possible.
16. "Sparring" soft tissue mono RF rejuvenation in the brow-upper and lower
eyelid region
C.Stan*, S.Popescu**
*Medical Service Clinic, Bacau, Romania
*, ** Clinical Emergency Hospital Bucharest
Objective:
To review and appreciate our results and the surgical technique benefits in
aesthetic surgery of the upper eyelid-brow interface region, doing mobile tissue incision
and dissection with 4.0 Mhz RF generator and a special surgical tool called Micro Mono
Bleph RF Forceps.
Methods:
The of 4.0 Mhz radio wave surgical technology is discussed in a multimedia
presentation with a review of histological studies and a comparison with the cold scalpel,
0.6 Mhz classical electro-surgical unit and other RF Low frequency devices (
1.7Mhz).
Based on our experience and clinical observation during the last 10 years, using
the scalpel and the classical electrosurgery unit for surgery of upper and lower eyelid
and our 7 years experience using high radiofrequency, we had noticed clear differences
and advantages of radio surgery technique as less bleeding with simultaneous hemo
stasis, pressure less incision in a special area with very lax skin, minimal safety
precautions needed compared with lasers, les post surgical pain and faster healing.
An important element of RF technology is the active electrode. A special
innovative device designed as a modification of a small bipolar forceps is called Micro
Mono Bleph RF forceps for cutting, dissecting and simultaneously prospective hemo
stasis who gives more.
17. Liposuction. Removal of fat with the tumescence technique(Maag's
solution)
C. Chertif, M. C. Chertif
COSMEDICA Plastic Surgery Center, Baia Mare
Liposuction is one the most frequently performed operations in aesthetic surgery.
In men liposuction is primarily requested for the abdominal area. In women it is for the
lateral and medial thigh, buttocks and hips ("saddle area").The tumescence technique was
first published at the beginning of the 1990 by Jeff Klein. Lidocaine was used as local
anesthesia. In view of the toxicity, we carried out a large study that showed that the
aesthetic plastic surgical tumescence technique with lower doses of Pritocaine solution
(maag's solution) produces the same results with lower incidence of complications.
18. Limitations, approach, adjuvants and expectations in body contour
aesthetic surgery
Noela Elena Ionescu, I.P. Florescu S. Marinescu, Carmen Giuglea
Plastic, Reconstructive and Aesthetic Surgery Department,
Clinical Emergency Hospital “Bagdasar-Arseni” Bucharest
Contact e-mail: inoela @yahoo.com
Fat tissue deposits means an actual problem, induced by two factors: heredity and
diet. In our experience we tried various methods of body contour improvement:
liposuction, mini-abdominoplasty, abdominopalsty, redistribution of fat tissue, breast
augmentation, breast reduction, mastopexy, penis enlargement. Doesn’t matter the
method of choice, we performed our best to avoid risks and complications like skin
irregularities, prolonged edema, hematoma, seroma, scars, pain, asymmetry, patient
dissatisfaction etc.
Our paper presents few cases, adjuvants methods for this type of surgery and our
conclusions after an obvious improvement in body self-image in all the situations.
19. Aesthetic Surgery – publicity deontology and postoperative results
management
Toma T. Mugea
20. Surgical treatment of axillary hyperhydrosis
D. Totir, M. Leventer
Dermastyle Clinic Bucharest
Treatment of axillary’s hyperhydrosis can be accomplished with the botulinic
toxin or using surgical procedures. A simple liposuction in the axillary’s area does not
provide satisfactory results and the recurrence risk and the degree of unsatisfaction of the
patient is relative high, so attention must be paid to use special canullae and a specific
technique.
This study is made on a group of 34 patients operated in the clinic in the last two
years and demonstrates the method efficiency. The procedure is not risks or incidents free
which are also evident in this study.