Aesthetic Plastic Surgery and Various aspects of it.

In the world of modern aesthetic surgery, there is really no part of the body that cannot be revised. Aesthetic surgery, a discipline within plastic surgery that seeks to improve the appearance of the face and body, actually covers a wide array of surgical and nonsurgical procedures. Common areas that people seek to improve with aesthetic surgery are the face, body, breasts, and the skin itself; however, there are procedures to correct, enhance, or improve virtually any spot on the body, even less common sites like the elbows, calves, and feet.

While cosmetic plastic surgeons may attempt to perform aesthetic surgery on any place on the body, it is important to have realistic expectations regarding the procedure’s outcome. For certain regions of the body, it is reasonable to have rather high expectations. For example, liposuction of the abdomen or neck is technically feasible for virtually all aesthetic surgeons. If you would like a certain amount of fat removed from an area, a cosmetic surgeon should be able to closely estimate the amount of fat removal to expect from the body region and give you an accurate prediction of the outcome.

For some aesthetic surgeries, even the best plastic surgeons face certain limitations. Consider what is involved in aesthetic surgery of the face, for example. First a patient must have a clear, unwavering goal in mind for her what she wishes to be changed on her face. Second, this information has to be accurately conveyed to the surgeon. While the patient can usually visualize what they desire in their mind’s eye, explaining that mental picture to the aesthetic surgeon can be difficult. Third, assuming the surgeon understands the patient’s desire for aesthetic surgery, the plastic surgeon must then attempt to create that ideal with the structures available to her on the face. For instance, taking away tissue is much easier than adding it, and, each structure must have an adequate blood supply. Therefore there are intrinsic limitations to what can be performed in a given aesthetic surgery.

Despite these challenges, plastic surgeons can accomplish some amazing feats of aesthetic surgery. When you look at the “Before and After” photos in the surgeon’s office, you will see an example of what she can accomplish. Also, plastic surgeons know their own limitations and comfort level with a given aesthetic surgery. The personal experience of a surgeon also comes into play—a surgeon is likely to be very comfortable with breast augmentation versus calve muscle augmentation, for example, since many more procedures of the former are performed than the latter. Your plastic surgeon will be happy to discuss realistic outcomes with you. They want you to be perfectly satisfied with the results of the aesthetic surgery.

Feel free to ask about complication rates and long term outcomes in the doctor’s previous patients. As with anything in life, practice makes perfect and aesthetic surgery is no different. The more procedures that one has performed, the better at the procedure the surgeon will be. Fortunately, in order to perform aesthetic surgery, a doctor must have completed countless procedures during training. Thus for the most common procedures like breast augmentation and liposuction, virtually any aesthetic plastic surgeon that you choose will be able to provide excellent results.

Disk removal

Disk removal is one of the most common types of back surgery. Diskectomy (also called discectomy) is the removal of an intervertebral disk, the flexible plate that connects any two adjacent vertebrae in the spine. Intervertebral disks act as shock absorbers, protecting the brain and spinal cord from the impact produced by the body's movements.

Purpose

Removing the invertebral disk is performed after completion of unsuccessful conservative treatment for back pain that has been present for at least six weeks. Surgery is also performed if there is pressure on the lumbosacral nerve roots that causes weakness, bowel dysfunction, or bladder dysfunction.

As a person ages, the disks between vertebrae degenerate and dry out, and tears form in the fibers holding them in place. Eventually, the disk can develop a blister-like bulge, compressing nerves in the spine and causing pain. This is called a "prolapsed" (or herniated) disk. If such a disk presses on a nerve root and causes muscle weakness, or problems with the bladder or bowel, immediate disk removal surgery may be needed.

The goal of the surgery is to relieve all pressure on nerve roots by removing the pulpy material from the disk, or the entire disk. If it is necessary to remove material from several nearby vertebrae, the spine may become unsteady. In this case, the surgeon will perform a spinal fusion, removing all disks between two or more vertebrae, and roughening the bones so that the vertebrae heal together. Bone strips taken from the patient's leg or hip may be used to help hold the vertebrae together. Spinal fusion decreases pain, but decreases spinal mobility.

Description

The surgery is performed under general anesthesia. The surgeon cuts an opening into the vertebral canal, and moves the dura and the bundle of nerves called the "cauda equina" (horse's tail) aside, which exposes the disk. If a portion of the disk has moved out from between the vertebrae and into the nerve canal, it is simply removed. If the disk itself has become fragmented and partially displaced, or is not fragmented but bulges extensively, the surgeon removes the damaged part of the disk and the part that lies in the space between the vertebrae.

There are minimally invasive surgical techniques for disk removal, including microdiskectomy. In this procedure, the surgeon uses a magnifying instrument or special microscope to view the disk. Magnification makes it possible to remove a herniated disk with a smaller incision, causing less damage to nearby tissue. Video-assisted arthroscopic microdiskectomy has exhibited good results with less use of narcotics and a shortened period of disability. Newer forms of diskectomy are still in the research stage, and are not yet widely available. These include laser diskectomy and automated percutaneous diskectomy.

Total disk replacement research in the United States is underway. Products under investigation include the ProDisc (made by Spine Solutions, Inc.), and the SB Charite III (made by Link Spine Group, Inc.). In these clinical studies, a significant number of patients who received artificial disk implants report a reduction in back and leg pain; 92.7% state they are satisfied or extremely satisfied with the procedure.

Risks

All surgery carries some risk due to heart and lung problems or the anesthesia itself, but this risk is generally very small. (The risk of death from general anesthesia for all types of surgery, for example, is only approximately one in 1,600 surgeries.)

The most common risk of the surgery is infection, which occurs in 1–2% of cases. Rarely, the surgery damages nerves in the lower back or major blood vessels in front of the disk. Occasionally, there may be some residual paralysis of a leg or bladder muscle after surgery, but this is the result of the disk problem that necessitated the surgery, not the operation itself.

orthopetics history

Jean-Andre Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities. He is considered by some to be the father of orthopedics or the first true orthopedist in consideration of the establishment of his hospital and for his published methods.

Antonius Mathysen, a Dutch military surgeon, invented the plaster of Paris cast in 1851. Many developments in orthopedic surgery resulted from experiences during wartime. On the battlefields of the Middle Ages the injured were treated with bandages soaked in horses' blood which dried to form a stiff, but unsanitary, splint. Traction and splinting developed during World War I. The use of intramedullary rods to treat fractures of the femur and tibia was pioneered by Gerhard Küntscher of Germany. This made a noticeable difference to the speed of recovery of injured German soldiers during World War II and led to more widespread adoption of intramedullary fixation of fractures in the rest of the world. However, traction was the standard method of treating thigh bone fractures until the late 1970s when the Harborview Medical Center in Seattle group popularized intramedullary fixation without opening up the fracture. External fixation of fractures was refined by American surgeons during the Vietnam War but a major contribution was made by Gavril Abramovich Ilizarov in the USSR. He was sent, without much orthopedic training, to look after injured Russian soldiers in Siberia in the 1950s. With no equipment he was confronted with crippling conditions of unhealed, infected, and malaligned fractures. With the help of the local bicycle shop he devised ring external fixators tensioned like the spokes of a bicycle. With this equipment he achieved healing, realignment and lengthening to a degree unheard of elsewhere. His Ilizarov apparatus is still used today as one of the distraction osteogenesis methods.

David L. MacIntosh pioneered the first successful surgery for the management of the torn anterior cruciate ligament of the knee. This common and serious injury in skiers, field athletes, and dancers invariably brought an end to their athletics due to permanent joint instability. Working with injured football players, Dr. MacIntosh devised a way to re-route viable ligament from adjacent structures to preserve the strong and complex mechanics of the knee joint and restore stability. The subsequent development of ACL reconstruction surgery has allowed numerous athletes to return to the demands of sports at all levels.

Modern orthopaedic surgery and musculoskeletal research has sought to make surgery less invasive and to make implanted components better and more durable.

Top 4 Preventable Orthopedic Injuries

1. ACL Tears

The anterior cruciate ligament, also called the ACL, is one of four major ligaments of the knee. Injuries to the ACL can be devastating, and may require surgery and a prolonged rehabilitation. Rates of ACL tears are especially high in women; about 8 times as frequent when compared to men. Why do women injure their ACL more frequently? Can these ACL tears be prevented?
ACL prevention has been the focus of many researchers in the past decade. Understanding how to prevent ACL tears requires an understanding of why some groups of people are more prone to sustaining ACL tears than others. Women have been shown to have a much higher risk of developing an ACL tear, and research has focused on answering the question as to why they have a high risk.

Why do women have a higher risk of ACL injury?

• Anatomic Differences
  There are many anatomic differences between men and women, including pelvis width, Q-angle, size of the ACL, and size of the intercondylar notch (where the ACL crosses the knee joint). Limited studies have shown a difference in these factors, but not an ability to predict individuals who will sustain an ACL tear.

• Hormonal Differences
  It is known that the ACL has hormone receptors for estrogen and progesterone, and it has been thought that hormone concentration could play a role in ACL injuries. Studies have shown some differences in rates of ACL injury during different phases of the menstrual cycle. However, there has been some conflicting data, and the effect of hormone concentration on ACL injury risk has yet to be defined.

• Biomechanic Differences
  Stability of the knee is dependent on different factors. The two most important are the static and the dynamic stabilizers of the knee. The static stabilizers are the major ligaments of the knee, including the ACL. The dynamic stabilizers of the knee are the muscles and tendons that surround the joint. Women have been found to have differences in biomechanic movements of the knee seen when pivoting, jumping, and landing -- activities that often lead to an ACL injury.

What can be done to prevent ACL injuries?

The best way found to reduce the risk of ACL injury is with the use of neuromuscular training programs. As stated above, the dynamic stabilizers of the knee are important in helping to control knee stability. Neuromuscular training is the process of teaching your body better biomechanic movements and improved control of these dynamic stabilizers. This is an unconscious process -- not something you can choose to do. However, there are ways to teach your body to have better unconscious neuromuscular control.

Neuromuscular programs have been designed to address deficits in dynamic stabilization of the knee. There are several neuromuscular programs that have been designed, most of which involve stretching, plyometrics, and strengthening. These programs "teach" the athlete how to land from a jumping position, pivot side-to-side, and move the knee without placing as much force on the ACL.

2. Back strains

1. Plan ahead before lifting.
   Knowing what you're doing and where you're going will prevent you from making awkward movements while holding something heavy. Clear a path, and if lifting something with another person, make sure both of you agree on the plan.
2. Lift close to your body.
   You will be a stronger, and more stable lifter if the object is held close to your body rather than at the end of your reach. Make sure you have a firm hold on the object you are lifting, and keep it balanced close to your body.
3. Feet shoulder width apart.
   A solid base of support is important while lifting. Holding your feet too close together will be unstable, too far apart will hinder movement. Keep the feet about shoulder width apart and take short steps.
4. Bend your knees and keep your back straight.
   Practice the lifting motion before you lift the object, and think about your motion before you lift. Focus on keeping you spine straight--raise and lower to the ground by bending your knees.
5. Tighten your stomach muscles.
   Tightening your abdominal muscles will hold your back in a good lifting position and will help prevent excessive force on the spine.
6. Lift with your legs.
   Your legs are many times stronger than your back muscles--let your strength work in your favor. Again, lower to the ground by bending your knees, not your back. Keeping your eyes focused upwards helps to keep your back straight.
7. If you're straining, get help.
   If an object is too heavy, or awkward in shape, make sure you have someone around who can help you lift.
8. Wear a belt or back support.
   If you are lifting in your job or often at home a back belt can help you maintain a better lifting posture. For ideas on inexpensive back supports that can help support the low back while lifting.

2. Hip fractures

1. Stay Active

Not keeping active is the biggest mistake I see older patients making. Many people believe that they should become less active as they age. They feel as though they cannot safely exercise, and become more sedentary.

Unfortunately, this is precisely the opposite of what needs to be done. Weight-bearing exercise has been shown to have beneficial effects on maintaining healthy bone. Furthermore, fit people have better balance and are less likely to fall or fracture a bone.

While maintaining fitness is crucial, it is important to exercise safely. Contact your local senior center or physical therapist to see if any classes are offered specifically for older adults.

2. Check Your Bone Density

A bone density test is a quick, painless way to measure your bone density and determine if you have osteoporosis. People who have osteoporosis, also called bone thinning, are at much higher risk for fracture.

Knowing your bone density can help you and your doctor determine what steps are necessary to help improve your bone health and prevent fracture. Patients with lower bone density may be placed on medications to limit bone loss and improve bone density.

3. Perform a Home Safety Check

Simple steps can be taken to ensure the home is a safe environment. Over 60% of falls causing a fracture in the elderly population occur at home. By taking a few simple steps, people can make the home a much safer environment.

A 1999 survey of homes by Yale University researchers found safety problems in the vast majority of houses. Almost 80% of houses of elderly people had loose objects on living room floors. including rugs, piles of books, or loose cords. Other areas of concern were stairways, kitchens, and bathrooms.

4. Stay on Top of Medications

Do you know what medications you are taking? Do you know what they are for? Everyone should be able to answer these two simple questions. Many medications have side effects that can include dizziness and lightheadedness.

By knowing your medications, and the signs of problems with these medications, you can take control of your health. Let your doctor know if you think a medication could be causing a side effect that may lead to unsteady walking, loss of balance, or a fall.

5. Check Your Vision

As we get older, we may face problems such as failing vision, cataracts, and glaucoma. These problems can be easily screened by an eye doctor, and all people should have their vision regularly checked.

Many older patients have poor vision and may wear corrective lenses. But unless they check regularly with their eye doctor, they may not know if their vision has been worsening. Treating poor vision is a crucial step to avoiding falls.

4. Wear & tear arthritis

1. Weight Control
   Obesity is one of the most significant factors contributing to the development and progression of arthritis. By losing even a small amount of weight, patients ofte n find dramatic relief of their arthritis. Unfortunately, exercising with painful joints can be difficult, but there are ways to lose weight while protecting joints.
2. Activity Modification
   Impact sports can accelerate the progression of arthritis. Patients with arthritis should perform low-impact exercise activities. The best low-impact exercise options include cycling, swimming, pilates, and yoga. Stair machines and walking can all be low-impact, but are not as good.
3. Physical Therapy
   Physical therapy can be used to strengthen the muscles around the knee joint. By strengthening the muscles, the damaged joint is better supported. Physical therapists can be very helpful at teaching patients ways to stay fit despite their joint problems.
4. Ambulatory Aids
   The most common ambulatory aids are a cane or walker. Another option for patients with knee arthritis is a special brace that can relieve pressure on the most damaged side of the joint. While not every patient can use this type of brace, it is worthwhile to ask your doctor if a so-called 'offloading brace' may be appropriate.
5. Joint Supplements
   Glucosamine and chondroitin are often sold as 'joint supplements.' The benefit of these medications has been the subject of controversy, but they are thought to be most effective in patients with early arthritis.
6. Anti-Inflammatory Medications
   Medications an be used to help control inflammation in the arthritic joint. These medications can help ease the symptoms of mild to moderate arthritis. Always use anti-inflammatory medications under the direction of your physician.

Can I Be Allergic to a Metal Implant?

Metals Implanted in the Body

The most commonly implanted metals used in orthopedic implants are cobalt/chrome, stainless steel, and titanium. All orthopedic implants are alloys, meaning they have several different metals in the implant. The base metal(s) are found in the highest quantities, but smaller amounts of other metals are also found in the implant. Metals often included in orthopedic implant alloys include nickel, aluminum, and others.

Many people have known skin sensitivities to various metals. The most frequent sensitivity encountered is to inexpensive jewelry that may contain nickel. Some orthopedic implants contain small amounts of nickel, and there has been concern that this may be an issue for those individuals receiving implants who also have skin irritation from this metal.

Should I Be Concerned About Metal Allergy When Getting an Implant?

Metal sensitivities and allergies have been implicated in some situations of painful or problematic orthopedic implants. It is likely that metal sensitivities are the cause of implant problems in some situations, but this is also thought to be extremely rare. Pain around the site of orthopedic implants has many causes, and before blame can be assigned to metal sensitivity or allergy, a thorough investigation must occur.

Unfortunately, the symptoms of metal implant sensitivity and allergy are not well defined. Having a skin sensitivity to a particular metal is not thought to correlate well to

having sensitivities to implanted metals. Therefore, making the diagnosis of a sensitivity or allergy to metal implants usually requires the removal of the implant. Patients who have pain around metal implants and associated skin changes (eczema) should be evaluated for possible metal sensitivity.

What if I Have a Skin Sensitivity to Nickel?

As many as 10% to 15% of the general population has a sensitivity or allergy to nickel. Patients who are sensitive to nicke l should inform their doctors of this allergy. Your doctor may want to consider the use of an implant made without nickel in the alloy (usually a titanium implant). This may not always be possible, and an implant made with nickel may be the most appropriate implant available for your condition. Fortunately, the chance of developing problems with metal implants, even in people with known skin sensitivities, is extremely low.

Should I Have My Metal Implant Removed?

Removal of metal implants for treatment of an allergy to metal is rarely performed. While it is nice to know that metal implants rarely cause allergic reactions that require implant removal, it has been reported, and some individuals have found resolution of their symptoms after removal or replacement of their implants. Your doctor can help you determine the cause of your problems and the appropriate treatment to consider. Fortunately, for those patients who truly have metal sensitivity causing their implant problems, removal of the implant will often provide immediate relief of symptoms.