Aesthetic and Dermatologic Surgery

Aesthetic and Dermatologic Surgery

Aesthetic medicine is a broad area covering disciplines that focus on improving cosmetic appearance through the treatment of disorders such as scars, skin laxity, wrinkles, moles, liver spots, excess fat, cellulite, undesired hair, skin discoloration, and spider veins. 

Aesthetic medicine is defined by The British College of Aesthetic Medicine as a subspecialty of medical and surgical practice that consists of a comprehensive group of health interventions, including preventative, minimally invasive, and operative procedures involving human tissues, performed by duly qualified and registered medical, dental, and advanced nurse practitioners in order to maintain, improve, or restore patients' physical, psychological, and/or social wellbeing, using techniques that combine both medical and aesthetic techniques.

Traditionally, it includes dermatology, oral and maxillofacial surgery, reconstructive surgery, and plastic surgery, surgical procedures (liposuction, facelifts, breast implants, radio frequency ablation), non-surgical procedures (radio frequency skin tightening, non-surgical liposuction, chemical peel, high-intensity focused electromagnetic field, radio frequency fat removal), and a combination of both. Aesthetic medicine operations are often optional.

Each year, the number of cosmetic dermatological operations performed in the United States grows. More than 11 million surgical and nonsurgical cosmetic operations were performed in the United States in 2013, with a total cost of more than $12 billion, $5 billion of which was spent on nonsurgical procedures.

Nonsurgical cosmetic dermatology includes a wide range of techniques that are both safe and effective. These treatments, which include energy-based device therapy, neurotoxins, and dermal fillers, are increasingly being used in conjunction to improve results. 

Although there is no national registry of procedures or efforts to promote data collection on aesthetic procedures, a recent prospective cohort study (n=20,339 cosmetic procedures) evaluated the total incidence of procedure-related adverse events and discovered that such adverse events occurred in less than 1% of all cosmetic patients, with the majority of these being minor and transient.

 

Statistics of aesthetic and dermatological surgery

Statistics of aesthetic and dermatological surgery

Between 2014 and 2015, 20 million cosmetic operations were done worldwide. Cosmetic surgery is a primary driving force behind medical tourism. In February 2018, the president of the British Association of Aesthetic Plastic Surgeons stated that operations were performed on people who were not surgical candidates, that unscrupulous practitioners jeopardized their health for profit, and that the cost of rectification for more than 1000 patients per year fell on the British National Health Service.

In the US, there were more than 11 million aesthetic procedures performed from 2012-2013, and 83.5% of the procedures were nonsurgical.

In the UK, there were 50,000 cosmetic surgery procedures performed in 2013-2014.Surgical aesthetic procedures account for 10% of the cosmetic procedures in the UK, and non-surgical techniques constitute the remaining 90%.

In the US, the top 5 surgical aesthetic procedures were Liposuction, Breast augmentation, Blepharoplasty, Abdominoplasty and Rhinoplasty.

In the US, the top 5 nonsurgical aesthetic procedures were Botulinum Toxin, Hyaluronic acid, Laser hair removal, Microdermabrasion and Photorejuvenation.

In South Korea, there were more than 980,000 aesthetic procedures performed from 2014-2015.In South Korea, the top 5 surgical aesthetic procedures were Blepharoplasty, Rhinoplasty, Fat Grafting, Rhytidectomy and Hair Transplantation.

 

Indications of aesthetic surgery

Indications of aesthetic surgery

Aesthetic medicine focuses on improving one's aesthetic attractiveness. It is useful for a variety of dermatological and surgical problems. It contains recommendations for reducing age indicators such as skin laxity, wrinkles, and liver spots. Aesthetic medicine is also used to treat excess fat, cellulite, and obesity. Scars, unwanted hair, skin discolouration, and spider veins can all be treated with laser therapy.

A physician evaluates the patient's overall health to verify that the symptom being treated (for example, weight gain and abundant hair) is not a symptom of an underlying medical issue (such as hypothyroidism) that should be stabilized with medical therapy. It is also critical for the medical aesthetician to use a team approach while doing minimally invasive face aesthetic procedures.

 

What does cosmetic dermatology treat?

A cosmetic dermatological procedure can be used to improve the appearance of:

Wrinkles:

They're a normal part of aging. Wrinkles mainly happen on the parts of the body that get the most sun exposure, including the face, neck, the backs of the hands, and the tops of the forearms.With age, skin cells divide more slowly, and the skin's inner layer, called the dermis, begins to thin. That starts to undo skin's stretchiness and structure.

Aging skin also starts to lose its ability to hold on to moisture. It makes less oil and is slower to heal. That all contributes to the wrinkling process. Other things that cause wrinkles are smoking, skin type (people with light-coloured skin and blue eyes are more susceptible to sun damage), heredity (some families wrinkle more), sun exposure and repeated facial expressions.

A variety of procedures are used to smooth out wrinkles. Some studies indicate that a combination of treatments may yield the most satisfying results. The following are the most common aesthetic surgeries performed to treat wrinkles:

  • Laser resurfacing: In ablative (wounding) laser resurfacing, a laser beam will damage the outer layer of skin and heats the underlying skin (dermis). This promotes the formation of new collagen fibers. Smoother, tighter skin grows when the wound heals. Laser resurfacing cannot remove extra or sagging skin.

Laser resurfacing may be done as an outpatient procedure, usually with a local anesthetic. The patient may be fully sedated for extensive resurfacing. It can take several months for the lesion to fully heal from ablative laser resurfacing. A novel approach that employs fractional lasers provides a faster recovery time. Scarring and skin lightening or darkening are both risks.

Nonablative laser fractional resurfacing provides a quicker healing period and fewer dangers than ablative laser resurfacing. Because the results are modest, nonablative lasers are better suited to persons with moderate wrinkles. This treatment must be repeated more frequently than ablative treatment. A fractional laser can also be used for this procedure.

 

  • Photodynamic rejuvenation: Fine wrinkles induced by sun exposure can be treated with photodynamic therapy. The patient may require repeated treatments, although recovery time is less than with laser resurfacing.

 

  • Chemical peel: the doctor applies a chemical solution to the skin to remove the top layers. The skin that grows back after a chemical peel is smother. Depending on the depth of the peel, the patients may need several treatments sessions before they can see a difference. Possible side effects include scarring, infection, and lightening or skin discoloration.

 

  • Dermabrasion: Dermabrasion sands down the surface layer of skin with a rapidly rotating brush. New skin grows in its place. The patients may need several treatments sessions before they can see a difference. Possible side effects include temporary redness, scabbing and swelling. 

 

  • Microdermabrasion: This method, like dermabrasion, removes only a thin layer of skin. A series of treatments over several months may be required for the patient to achieve modest, transient benefits. If you have rosacea or small red veins on the face, this procedure may aggravate this problem.

 

  • Botulinum toxin type A (Botox): Botox, when administered in small dosages into certain muscles, prevents them from contracting. When the muscles are unable to contract, the skin appears smoother and less wrinkled.

Botox is effective for frown lines between the brows and across the forehead, as well as crow's feet in the eye corners. The findings take one to three days to appear. Typically, the impact lasts a few months. Repeat injections are required to keep the results.

 

  • Soft tissue fillers: Soft tissue fillers, such as fat, collagen, and hyaluronic acid (Restylane, Juvederm, and others), can be injected into facial creases. They fill the skin and smooth out wrinkles and furrows. In the treated region, you may notice transient edema, redness, and bruising. Most products have a short-term impact.

 

  • Face-lift: The underlying muscle and tissues are tightened during the face-lift surgery. It can be performed in a hospital or an outpatient surgical center under local, sedation, or general anesthesia. Healing durations following a facelift might be extensive. Bruising and swelling are common for many weeks following surgery.

 

Skin pigmentation and discoloration

Skin color or pigmentation is determined by the amount of melanin generated in the skin. However, particular parts of the skin may have more or less melanin than surrounding areas. This causes discoloration of the afflicted skin, which appears as patches or spots that are brighter or darker than the surrounding areas.

Pigmentation and discoloration of the skin can occur anywhere on the body, including the face, arms, and legs. Birthmarks, freckles, age spots, and other skin pigmentation and discoloration are examples of skin pigmentation and discolouration.

 Laser therapy, a non-invasive treatment option that utilizes light to treat a variety of conditions, including skin pigmentation and discoloration, is generally used to treat skin pigmentation and discoloration. Laser therapy is precise and enables for the treatment of particular regions of skin while leaving surrounding skin and tissue completely untouched while treating skin disorders.

 

Skin Scars

Scars occur as a result of the healing process of the body. The body creates tissue to heal damaged skin and fill gaps caused by an injury. Scars occur in a variety of forms and sizes. Accidents, burns, surgeries, acne, and disease can all cause them. Most scars disappear with time. Scars can be made less visible using a variety of surgical therapies such as:

  • Dermabrasion: Dermabrasion is a frequent acne scar therapy that removes the top layer of skin by gently "sanding" the skin. The process softens and smoothes the skin and can help scars seem better.
  • Laser treatments: Several types of laser and light treatments can make scars (including acne scars) less noticeable. Laser treatments use a particular wavelength of light to cause a particular action in the skin.
  • Scar revision surgery: A variety of surgical methods can be used to eliminate a scar, improve its look, or transplant skin from another part of the body (skin graft). This is an exchange of one scar with a different, more desirable scar.
  • Pressure therapy: During the healing process, an elastic bandage, dressing, or stocking applies pressure to a wound. The pressure either prevents the formation of a scar or reduces its size. Massage treatment can also aid in the breakdown of scar tissue and its remodeling.
  • Drug injections: the healthcare provider injects medication directly into the scar, making it smaller and flatter. Corticosteroid injections can reduce the size of keloid scars. 

 

Hairy skin:

Most women have thin, light, hardly noticeable hair on their faces and bodies, although this hair can be thicker and more prominent at times. Laser therapy is one of the most long-lasting procedures, however it usually takes four or more sessions spaced 4-6 weeks apart. It will only work on dark hair.

To destroy the hair bulb, a laser beam or a light pulse is used. The therapy is costly and sometimes uncomfortable, but it may be used on many different regions of the body where unwanted hair grows. Choose a doctor or technician that is well-trained and competent.

A expert performs electrolysis by inserting a small needle containing an electric current into the hair follicle. Electrolysis has two basic hair removal methods: Hair removal with galvanic and thermolytic currents 

 

Complications of aesthetic dermatological procedure

Dermal granuloma: 

Granulomas show a type IV hypersensitivity reaction to introduced foreign material. They may appear months or years after filler injection as a delayed consequence and constitute a major adverse event due to their tenacity and resistance to therapy. In the case of a HA filler granuloma, they are followed by an intralesional hyaluronidase injection, and in the case of all other filling materials, by an intralesional corticosteroid injection.

Malar edema:

Malar oedema is a significant consequence that manifests as persistent swelling in the periorbital area following the use of dermal fillers, most often hyaluronic acid gel to the infraorbital hollows. In general, the tear-trough area is regarded as a high-risk area, with adverse events after tear-trough augmentations with HA fillers including bruising (10–75%), contour abnormalities (11%), discoloration (4–7%), and swelling, effusion, or edema (15 to 26%). 

However, the development of eyelid edema, also known as malar bags, malar oedema, or malar mounds, is not just the result of cosmetic operations, but rather an unspecific indication that may presage a range of systemic or periorbital disorders.

Non-inflammatory nodules:

Non-inflammatory nodules are typically caused by material buildup or inappropriate filler application (e. g. overcorrection, too superficial placement of filler or an incorrect indication such as intramuscular placement in a sphincteric muscle). They often emerge soon after the surgery and must be distinguished from biofilms or foreign body granulomas. Nodules caused by HA filler are best treated by hyaluronidase. Early nodules that appear following non-HA filler therapy may react to strong massage; alternatively, the material may be ejected.

Neural complications:

Neural problems, such as sensory and/or motor impairments, can result from either nerve laceration by the needle tip or nerve compression by the implanted substance. A compression of this degree may also disrupt the vascular supply. This type of vascular compromise, as well as an intravasal filler injection, may both result in tissue necrosis. The glabella and nasolabial folds are two high-risk locations.

In cases with significant blanching, violet discoloration, acute pain, and the development of an erosion and ulceration, first aid in the form of an intralesional injection of hyaluronidase and application of a 2 percent nitroglycerin paste is advised. Intravascular fat or filler injections might cause temporary blindness. 

A review of the current literature indicated around 45 and more than 60 cases of blindness caused by filler or fat injections, respectively. In compared to fillers, intravasal fat injections appear to have a higher prevalence of this severe consequence, as well as an inferior visual effect.

Biofilms:

Biofilms might appear as recurring painful nodules that appear weeks to months after the filler injection. These delayed responses following dermal filler treatments were formerly attributed to hypersensitivity reactions, however it has recently become clear that some of them may be caused by bacterial aggregations.

The precise mechanisms behind their development are yet unknown. Biofilms, according to current knowledge, are collections of microbes adhered to surfaces that are not recognized by the immune system and are extremely resistant to medicines. Bacterial diversity is minimal in chronic biofilm infections.

 

How much does Aesthetic procedures cost?

How much does Aesthetic procedures cost?

The following list provides some price ranges for some of our most popular cosmetic treatments. 

Botox: $550 – $1,550

Fillers: $800 – $1,300

Platelet Rich Plasma (PRP): $600 – $1500

Laser Tattoo Removal: $625 – $1,500

Fraxel: $1,500 – $1,750

Ultherapy: $ 2,500 – $5,500

Microneedling with Radio Frequency: $800 – $1,500

Laser Hair Removal: $225 – $2,500

Coolsculpting: $750 – $1,500

 

Conclusion

In recent years, a wealth of unique treatment techniques to combating symptoms of aging and influencing external body appearance have been accessible in aesthetic dermatology. Extensive study in this topic has resulted in a better knowledge of the anatomy and physiology of the aging face. To properly address the various age-related changes, anti-aging treatment today requires a multifaceted strategy. 

Botulinum toxin, a variety of filler substances, microneedling (collagen induction treatment), chemical peeling, lasers, radiofrequency, thread facelift, and injectional lipolysis with phosphatidylcholine/deoxycholate are among the most often used cosmetic procedures. Unfortunately, many practitioners still lack a thorough awareness of the possible problems, risk factors, and adverse effects associated with minimally invasive treatments.