Ethics Considerations In Plastic Surgery

History that plastic surgery has an ancient origin, nevertheless, it was not only until First World War when it was defined and recognized.

Nowadays, scientific advances on this specialty allows plastic surgeons to get better results compared to those obtained 10 years ago.

It is as important as to state that this specialty demands a high level of academic quality so the professionals can restore its position. It is also important to say that this specialty requires an acute way of proceeding but firstly and most indispensable is to remember that this activity is centered on the patient's interest. Moreover, surgeons are always looking for the best technique quality always supported by the higher ethicalconcepts. Plastic surgeons must acknowledge themselves that this is the only way to be more human professionals.

As any surgical procedure, it is a medical activity that carries out its risks and complications, so the doctor must have a previous interview with the patient where the fist one clearly explains to the latter the surgical objectives making a sketch on the surgical procedure having in mind the risks and the benefits, so finally the decisions not only can be shared but must shared by both.

It is in this context that we want to present some relevant ethical aspects concerning plastic surgery practice.

Nowadays, society must learn how to see life from a different point of view, not only focusing on the epidermis and external body look, but having present the important matters that identify ourselves and give sense to us.

Mathilde – Facial Surgery

Mathilde returned to her home with a light bandage on Wednesday morning, after spending a night at the clinic.

On Tuesday evening, when I visited, she was in no pain. Cool compresses covered her eyes to prevent bruising. On Wednesday morning, when the bandage was removed, I showed him the result in a mirror. She was amazed at the absence of bruises or marks. His face was just a little swollen and the neck was no longer hanging down.

The oval and the cervico-mental angle perfectly drawn. The scars are camouflaged. The perfectly fine and invisible seams. No pain just a feeling of tightness and the skin a little hard. I give him his prescriptions, and his appointments for the following Monday at the Academia Aesthetica office in all discretion.

She will no longer return to the aesthetic clinic.

In the meantime, she will do her own care, apart from a few medicines not to swell too much and prevent edema, advice to rest, and drops in the eyes to prevent them from being dry and fight the tearing.

She doesn’t wear contact lenses , but if she had, she should have worn prescription glasses .

Some vitamin A- based creams are to be put under the eyelids. She therefore returns on Monday afternoon to the office (I am in the operating room in the morning). Received by the secretaries and my assistant , we proceed to the final removal of the dressing.

The benefits of light therapy

There are no threads to remove except on the eyelids. When she returns home, she will shampoo gently. After post-operative care advice, she began a first light therapy session . This will speed up the recovery process, reduce edema quickly. Mathilde must return to work in a week, the following Wednesday, or 15 days after the operation. In the meantime she can go about her business and work from home on her computer. She can go out shopping, take a leisurely walk. Driving is possible.

Light therapy is of great benefit for well-being and healing.

5 sessions are prescribed at the rate of one per week. They will take place on Monday afternoon. The following Monday, what a change! Mathilde is rested, the edema has disappeared, everything is healed. She is made up, she is a different person, rejuvenated, embellished, she made an appointment with her hairdresser the next day before resuming her work. She keeps drops of mild eye drops (based on hyaluronic acid ) in her eyes, this is her only treatment. She is happy with the result, which is not final. She is in absolutely no pain. Second long-awaited light therapy session, because it does him a lot of good, soothes him enormously. We will see each other 3 more times. She is in total confidence. His family circle, who was of course worried, is totally reassured. An appointment for a post-operative consultation has been set in 3 months. No massage is advised.

In the meantime, she corresponds from time to time with my secretary Céline, who takes her news.

During the follow-up consultation, Mathilde is smiling, comfortable in her skin, in total confidence. At work, her colleagues found her looking good, convinced that she was coming back from vacation.

A successful facelift leaves no visible scars at 3 months. Before, they can be camouflaged in the hair and by makeup. That day, I gave a Botox injection , advised him to consider a peel at the office every year. She will return to her beautician for her skin care as she wishes, but if she prefers, she can come to the office where my assistant does it.

Already, she seems to have gained 10 years.

Appointment is made in 6 months, I remain at her disposal when she wishes.

This story is typical of that of the other patients. I am delighted to rejuvenate, embellish, care for my patients who make me feel good. Besides, Mathilde offered flowers to my assistants. Teamwork is fundamental. I will take photographs 6 months after the operation, then 1 year after. They of course remain confidential.

Second Part Of The History Of Pierre’s Blepharoplasty

The Blepharoplasty is cosmetic surgery most requested with rhinoplasty and liposuction . The facelift in men is more taboo, but the double chin is a frequent request. A cervical liposuction alone is sometimes possible, if the skin has sufficient retraction capacity (the tensor threads have a very ephemeral action). The Asian blepharoplasty is in growing demand.

In general, consultations in cosmetic surgery of the face are probably increasing because the techniques of aesthetic medicine find their limits, if we want to keep a natural face.

A cosmetic surgeon is, it should be noted, a doctor. But a cosmetic doctor is never a cosmetic surgeon .

Moreover, blepharoplasty without surgery gives very insufficient results, even if certain techniques are undoubtedly interesting avenues of research.

Pierre’s blepharoplasty operation in detail

At the end of July, Pierre entered the clinic . He is directed to the outpatient department and I made sure to make him wait as little as possible. He finds himself in the operating room 30 minutes after his arrival (the administrative formalities were done during the pre-anesthetic consultation).

Before entering the operating room, we did a final check-up. Installed and entrusted to the team, Pierre is asleep. Begin the operation by removing fat from the flanks (20 cc). This is centrifuged to keep only the pure part but I always keep some blood which contains platelets rich in stem cells.

Then an infiltration with xylocaine and naropein serum is carried out. The lower eyelid is everted by my assistant. I then cut the conjunctiva on 1 cm with a very fine point scalpel. By this way I access with the help of a blunt forceps the orbicularis muscle which lines the turn of the orbit. The fatty pockets are under the orbital rim. Either they came out of the orbit like fatty hernias, and reintegration in their place may be sufficient, or they are too large and fill the eyelid. In this case, it is better to remove the exteriorized part, this with great caution so as not to create an unsightly depression in place of fatty pockets.

For Pierre a resection of 3 pockets (internal, median and external) is necessary. There is no cutaneous resection in this technique. The conjunctival wound heals very quickly in 48 hours without stitches, there is no bleeding if you are meticulous, skilful and precise.

Secondly, using the prepared fat, I create a lipostructure of the valley of tears and the top of the cheekbones (about 4cc on each side). It is done in contact with the orbicularis muscle, above and below. You should be very moderate in the amount injected and avoid areas rich in lymphatic vessels to avoid roll edema. This is done with cannulas so fine that there is no point to put.

The 3rd step concerns the upper eyelids. Landmarks were marked before the operation in a seated position, then the drawing is made. The incision is masked in the eyelid crease. For Pierre, the ptosis is more marked externally. After the incision according to the drawing, I remove the skin, but also a small muscle band externally. Then I put a point in suspension of this outer part under the eyebrow, inside of course.

The effect will be a lifting of the eyelid externally, and the fatty mass (Charpy pad). Internally we do not resect the skin to avoid a bridle that would be troublesome.

Sometimes some fat (rolled and white) is removed internally, under the orbicularis muscle, if needed. This will not be the case here. Very careful hemostasis is performed. There will be no bleeding. The closure is done with a very fine thread which will be removed 8 days later.

At the end of the operation, an eye ointment is placed on the conjunctiva in order to protect it from any infection, and to protect the cornea. Finally, ice-cold serum compresses are placed on the eyes to prevent bruising and limit postoperative edema. In one hour the intervention is finished. Pierre is then taken to the recovery room where he will stay around 1 hour. Following this, Pierre will return to his room, where his wife is waiting for him, whom I completely reassure and explain to him the work carried out.