Cosmetic Surgery plus Thalassotherapy in France

BREAST

BREAST AUGMENTATION

Breasts can be made larger by placing an implant behind the muscle on which the breast lies. Implants are inserted through incisions around the areola. This incision permits to lift the breast during the same procedure if necessary.
The prostheses currently most used are the pre filled prostheses with silicone gel. The inflatable or pre filled prostheses with salt water give a less natural result and present a risk of deflation. The implants are round and give a natural aspect of the breast. The manufacturers life expectancy of breast implants is about 10 years, although implants can stay in without problems for a much longer time.

Course of the intervention : Under general anaesthesia, the breast implant is inserted by an inferior periareolar incision(scar located at the limit between the areola and the surrounding skin). One places the implant behind the pectoralis major muscle. Drainage tubes are systematically used. A compression bandage is set up. The intervention lasts on average l hour 30.

Post operative care : The hospitalization lasts usually 24 hours. Before the exit, the compression bandage and the drains are removed. A specific bra is immediately installed. The operational continuations can be relatively painful during 3 or 4 days requiring analgesics. After the exit of the hospital, the patient can take showers. The bra must be worn day and night during 1 month and in the day time for the next month, and any physical activity stopped for about the same time. The stitches are removed about the 10th day. The prostheses must be also massaged beginning from the 1th month to prevent a capsular contracture. One can expect a week’s discomfort.

Expectations and complications :

The body normally forms a capsule around the implant, but this capsule can become thickened and contracted. The sub muscular placement of implants have features to reduce the likelihood of this happening. This occurs to some extent in around 5% of patients and usually starts six or more months after surgery. This can lead to pain, and/or an abnormally hard feel of the implant in the breast. Treatment may be needed and occasionally removal of the implant.
Many studies have been conducted to establish whether silicone breast implants cause certain diseases. As a result of these studies we can say that at present there is no evidence to suggest that silicone breast implants are associated with an increased incidence of breast cancer. There is also no evidence to suggest that these implants cause autoimmune diseases such as rheumatoid arthritis.

BREAST REDUCTION AND MASTOPEXY

This operation corrects the excess of volume and/or ptosis (drooping breasts).

Course of the intervention : the intervention proceeds under general anaesthesia and lasts 2 hours. The scars are in general in a reversed anchor with a peri-areolar scar, a vertical scar and a horizontal scar in the inframammary fold. ln some cases, the scars can be limited to vertical and peri-areolar portions.

Post operative cares : in the days following the operation, pain is usually minimal.
not very painful. The hospitalization lasts 2 days. Just after leaving the clinic, a specific bra is immediately installed. At the exit, the patient can take showers. The stitches are removed around the 10th day.

The bra must be worn day and night during the 1st month and in the day time for the next month. Sports activities can be taken again after the 2nd month. The scars are massaged from the 3rd week to attenuate them and soften them as soon as possible. Their evolution will be final at the end of one year.
It requires at least one week off work.

Expectations and complications :

ln the event of realization of breast surgery with peri-areolar scar and pure vertical scar, initially, the lower part of the vertical scar can take on a wrinkled aspect. This aspect disappears during the months which follow the intervention. If the aspect is not fully satisfactory at the end of 6 months, a surgical recovery under local anaesthesia can be considered, with creation of a short horizontal scar in the inframammary fold.

LIPOSUCTION

Liposuction, also known as liposculpture or suction assisted lipectomy, is a technique to remove unwanted fat deposits. The unsightly distribution of body fat is usually due to an inborn tendency to deposit fat in one particular area of the body, most commonly the hips. Other areas include the neck, arms, tummy, thighs, inner side of the knees and the ankles. It is important to understand that liposuction is not a treatment for obesity. The amount of fat that can be removed from a localised area is limited by what is safe (maximum of 3 litres). Dimples and wrinkles of the skin, sometimes called cellulite will not be improved by liposuction.
The stability of the result is directly related to ponderal stability. A putting on of weight can involve a reappearance of fat in the same zone.

Course of the intervention : Generally carried out under general anaesthesia, the fat excess is aspired using a narrow metal tube of small diameter introduced by small incisions. It is attached to a strong vacuum pump which is drawn back and forth within the area of excess fat. The skin will then retract.
Some localizations are particularly favorable: the anterior abdominal area, the hips, the external face of the thighs, the internal face of the knees and thighs, the cervical area. Some areas are more difficult to correct: the anterior face of the thighs,the ankles. The intervention can last from l to 2 hours depending on the number of the zones to treat.
After the intervention, a pressure garment is set up in order to decrease the oedemas and to permit the skin to retract. You will only need to take a few days off work if a small area is treated, but larger areas may necessitate 7 to 10 days off work.

Post operative care : the patient spends one night in the Hospital and can take showers. Compressive clothing must be worn day and night for 3 weeks. The stitches are withdrawn towards the 7th day. The next few days are painful requiring analgesics.
You can expect considerable bruising which will be uncomfortable and at times painful. The larger thearea treated the greater it will be. The discoloration of this bruising will usually last for about 2 weeks, but the lumpiness and swelling can take 2 or 3 three months to disappear. As swelling can take a long time to settle you may not see the full benefit of the operation for up to three months.

FACE REJUVENATION

EYELID REDUCTION

The skin loses its elasticity and the muscles slacken with age. For the eyelids this results in an accumulation of loose skin which collects as folds in the upper lids and forms deepening creases in the lower lids. Bags are caused by an accumulation of fat and with age the skin stretches and the muscles around the eye weaken.
An eyelid reduction (blepharoplasty) removes the surplus skin and protruding fat to produce a more dynamic appearance and reduces the swelling. Sometimes it is only necessary to reduce the skin, sometimes the skin and the fat and sometimes just the fat. If only the fat is being removed from the lower eyelids, then this can be removed from the inside of the lower eyelid avoiding an external scar(transconjunctival blepharoplasty).
Sometimes wrinkles are suitable for treatment by laser resurfacing.

The Operation : Both upper and lower eyelid surgery can be carried out under local anaesthesia or under general anaesthesia in a hospital.
In a typical procedure the surgeon makes incisions following the natural lines of your eyelids; in the creases of upper lids and just below the lashes in the lower lids (see illustration). These incisions are extended a little way into the crows feet or laughter lines at the corner of the eyes. Through this incision surplus fat is removed and excess skin and sagging muscle removed.
If there is a pocket of fat beneath your lower eyelids without surplus skin then the fat may be removed through the inside of the lower eyelid.
The resurfacing laser can be used at the same time as a transconjunctival blepharoplasty to tighten the external skin and reduce wrinkles, although there is no external scar but there is residual redness in the skin which will last 3 months.
The patients must be checked by an ophthalmologist to eliminate a glaucoma.

FACE LIFT

The face lift is performed to correct the after-effects of ageing on the level of the face and the neck. With the aging process, the skin progressively loses its elasticity and our muscles tend to slacken. The folds and smile lines deepen, the corners of the mouth droop, the jaw line sags and the skin of the neck becomes slack. Around the eyes, the eyebrows
droop and the skin of the eyelids gathers in loose folds. In the skin the first sign is fine wrinkles developing around the lips, at the outer corners of the eye and lines of expression.
Who will benefit from a facelift?
The best candidate is one whose face and neck has begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well defined. Most patients are in their 40’s to 60’s, but facelifts can be done successfully on people in their 70’s or 80’s.
It should not be obvious that a patient has had a facelift, but instead they look younger, more vital and cheerful.
A facelift works better for the lower half of the face and particularly the jaw line and neck.
Loose skin with fine wrinkles, freckles and rough areas will benefit more by laser resurfacing.

Course of the intervention :

The intervention proceeds under general anaesthesia and lasts between 2 and 3 hours.

1) The cervico-facial face lift: Incision lines follow the natural creases. They are made above the hair line at the temples and extend in a natural line at the front of the ear, and continue around behind the earlobe and up in the crease behind the ear and off in front of the lower scalp.

The intervention proceeds simultaneously on the excess of skin, and on the subjacent muscular level of the neck and the face to redefine anatomical outlines: the cervical angle, the oval of the face,jaw lines.
The platysma muscle and its fibrous attachments are dissected free and sutured tightly to the solid structures in front and behind the ear. Fat along the jaw line and under the chin may be removed by liposuction.
The skin is sutured so that it is lifted upwards and backwards.
Drains are inserted. The face will be bandaged to minimise bruising and swelling. These bandages will stay for one day and the sutures are removed in 7 to 10 days.

2) Upper and lower eyelid reductions are almost systematically carried out during a face lift. A laser abrasion of the lower eyelid can be simultaneously performed to reduce the wrinkles.

3) Associated procedures
A laser abrasion of the upper lip or contour of the mouth can be carried out in the same operational time to attenuate the superficial wrinkles.

Post operative care :
At the beginning the face will look a little puffy.
It is normal for there to be some numbness of the skin of the cheeks and ears.This will usually disappear in a few weeks.
The next few days are not very painful but uncomfortable.
The bandage and the drainage tubes are removed a day after surgery. There is often bruising of the eyelids. The scars are cleaned and the hair is washed allowing an exit generally after 24 hours. The stitches are removed by the 4th day on the eyelids, the 7th day in front of the ears, and by the 10th day in front of the hairlines and behind the ears.
Most of the oedema will decrease during the first 2 weeks. It will have completely disappeared after 3 months. During several weeks, some unpleasant phenomena may occur: feeling of tension of the neck, modification of the sensitivity of the face. These sensations will regress completely at the end of 3 to 6 months.

FULL FACE RESURFACING WITH C02 LASER

Objective : The use of the C02 laser aims to attenuate or make disappear the superficial wrinkles on the face. The use of the C02 laser causes the equivalent of a 2nd degree burn, which while healing will have an effect of retraction and of resurfacing. This technique can obtain a clear attenuation or disappearance of the wrinkles and the effect of retraction permits to redefine contours of the face (face lift effect). We can be treat localised areas(upper lip, contour of the mouth, lower eyelids) or the full face. According to the importance of the zones to treat, the intervention could be realized under local anaesthesia or general anaesthesia.

Post operative care : With this technic, the next days are relatively important and require a monitoring to follow the healing. It is necessary to envisage a stop work for the period of healing for 10 to 15 days. Immediately after the treatment, the skin is red and oozing. Sometimes an important oedema can settle in a few hours and will last 24 to 72 hours. This one will be limited by the corticoid treatment for 5 days. Feeling of Pain can range from a sunburn effect to a feeling of more intense burn. It can be avoided by the systematic adapted analgesics. The oedema is maximum towards the 4th day and decreases then very quickly. Healing is obtained from 8 to 10 days. During this period, the skin will be cleaned with sterile water (thermal spring in pulverization) several times per day and of the greasy substances (petroleum jelly) will be applied. An antiherpetic prophylactic treatment is systematically prescribed. After healing, the skin presents an inflammatory rosy aspect which can be easily dissimulated by make-up. The skin finds a normal aspect at the end of 3 to 6 months. The patient will have to respect in an extremely rigorous way the application of a solar shield in the event of exposure for the period of 1 year.