Issue #6 summary - GO BACK TO ARCHIVE

Robotic surgery makes headway around the world
When a woman in Paris had an operation performed with the assistance of a robot controlled from New York City, robotic surgery had made a giant stride forward. Robotic systems are clearly starting to make their way into operating rooms to help surgeons in endoscopic procedures, and reconstructive surgery is one area that stands to benefit.
   Among the manufacturers trying to secure a toehold in this developing market is California-based Intuitive Surgical, creators of the Da Vinci Surgical System. The Da Vinci is a descendant of a 1980s US department of defense project, which was intended to create a robot that would allow surgeons to operate on critically wounded soldiers from a safe distance, or even perform emergency surgery on astronauts.
   In its 2001 guise, approved by the FDA, Da Vinci is more down to Earth. It consists of a surgeon’s console, a patient side-cart, a vision system and instrumentation. Using Da Vinci, the surgeon operates while seated at a console viewing a 10x-magnified, 3D image of the surgical field. Robotic surgery can, however, make hand movements awkward for the surgeon. But Intuitive’s EndoWrist technology, computer-enhanced mechanical wrists accessed through 1cm incisions, or ‘ports’, gives the surgeon the ability to reach around, beyond, and behind delicate body structures, and is connected to the rest of the system by mechanical cables. The computer translates the surgeon’s open-surgery hand movements into the same movements of the instruments. The wrist can roll, pitch, yaw, and grip, allowing the surgeon a total of seven degrees of freedom for each hand.
   Other robotic devices are being developed by Computer Motion and Integrated Surgical Systems, also based in California. Computer Motion’s surgical robotic systems include Zeus: three interactive robotic arms placed at the operating table, a computer controller, and an ergonomic surgeon console. One robotic arm is used to position the endoscope to provide visualisation of the operative site, while the other two robotic arms manipulate surgical instruments under the surgeon’s control.

Tissue Tisseel glue helps reduce scars
Tisseel Fibrin Sealant, marketed by Baxter International, is rapidly becoming a part of most surgeons’ kit. Tisseel, a tissue that replicates the natural blood clotting process, enables patients to return home from surgery with no bandages, bleeding, bruising, and virtually no pain. European and South American plastic surgeons have been using it successfully in facelift surgery for a decade, but only recently has it been approved in the US.
   When surgeons perform a facelift they lift the skin of the face and neck and expose a raw surface. This can potentially cause post-operative bleeding. Surgeons can spend much time stopping the bleeding, lifting and removing the excess skin and suturing it. If patients are bleeding underneath, a haematoma can result, which occurs in 1% of all cases. But with Tisseel, surgeons spray a few cc’s onto, say, a side of the face, and lift and mold it for about three minutes so that the entire raw surface – from the middle of the Adam’s Apple to the ear – is glued. The skin reverts back to normal, and surgeons trim the excess skin and suture the edges so they line up perfectly.
   As there is no tension on the edges of the face, the scar itself is better. Haematomas would be unusually rare, because there is no open space, as it has been sealed by the tissue glue. Facelift patients return the next day or two following surgery with no bruising or reports of bleeding. Patients 48 hours’ post-op more closely resemble patients three weeks after surgery.

Otoplasty
If you think that your ears are too prominent, you are not alone. The British Association of Aesthetic Plastic Surgeons (BAAPS) estimates around 1–2% of UK residents feel their ears are too protrusive.
   The most prominent ears often lack a normal fold, and sometimes one ear protrudes more. The condition is not physically damaging, but it can cause mental anguish – particularly in childhood, when taunting and name-calling are rife. The impact can cause a loss of confidence that continues into adulthood.
   When a new-born baby’s ear is noted to be very protrusive, it is sometimes reshaped by applying a small splint to the rim. The cartilage or gristle of a new-born’s ear is very floppy and easily remoulded.
   After several weeks of splintage, a permanent correction can be achieved. The older the child, the more stiff the cartilage and the longer the period of splintage must be.
By the age of six months, the cartilage is too hard to be remoulded and a surgical solution is required.
   Otoplasty, also known as pinnaplasty, is an operation that adjusts the shape of the cartilage within the ear to create the missing folds and to allow the ear to lie closer to the side of the head. The operation is carried out from behind the ears, leaving a small scar close to the groove between the ear and the side of the head.
   Where the lobe of the ear is especially large, a small procedure to reduce its size may also be required.

Fighting the resistance
Anand Jon is one of many cutting-edge fashion designers whose models wear micro-minis. As Jon says: “The look is definitely coming back. The mini accentuates the derriere, legs, and stomach. Designers are really taping into these three erogenous zones.”
   As a designer who dresses A-list celebs such as Alanis Morrissette, Mary J Blige and MTV’s Ananda Lewis, Jon is one who is in the know. As he will readily attest, sporting these micro-minis takes more than confidence – it also requires the right physique.
   Micro-liposuction is a technique designed for those happy with their overall physique, except for one or two stubborn spots. People equate liposuction with an involved operation. But with micro-liposuction, surgeons can use tiny cannulas to extricate fat and truly sculpt a desired area.
Patients love it that there is so much less involved with micro-liposuction. The complication rate is less when dealing with smaller areas. As only a small area is involved, patients should see rapid results and can expect to return to work within a few days. This is made possible by fewer incision sites and less swelling, pain, and bruising as would be the case in suturing multiple sites.
   The areas most visible in a micro-mini are also those that benefit the most from micro-liposuction. These are the outer thighs – where the bulges are known as saddlebags – the inner thighs and the buttocks. On the area of the upper inner thigh, I have taken care of patients fanatical about working out and absolutely cannot effectively target fat in stubborn areas. These target areas respond very well to micro-lipo. As well, many patients come to me after they have given birth. Even though they have returned to their previous weight, many have some resistant areas as a result of the pregnancy.
   Where it is common for women to retain fat is the outer hips – often referred to as saddlebags. This is an excellent place to isolate localised fat – so it is not difficult to suction. The surrounding area is sculpted, correspondingly, in order to create the desired contour.

Fuller lips and fewer wrinkles
Launched only last year, Cymetra has some catching up to do in terms of brand recognition in the diverse injectable implant market. But a surge in popularity seems assured. Cymetra’s natural constitution is winning favour, arresting the fear of contamination (which, to be fair, is remote) that shadows its bovine counterparts. The benefit of an injectable is the volume it can give the lips. The ‘poutiness’ is much more defined compared with permanent implants, which give a more subtle, defined lip.
   Like its older stablemate, Alloderm, Cymetra is processed from human tissue donated to US tissue banks. The donation procedure is similar to that of other transplantable organs.
Cymetra is sterilised, but unlike Alloderm, it undergoes an additional procedure to reduce the tissue into a powder. It is rehydrated with lidocaine, which prepares the syringe contents for injection and doubles up as an anaesthetic to reduce pain. The collagens and elastin in Cymetra provide structure for cell repopulation, integrating into the patient’s own tissue. Because it is human tissue, Cymetra is metabolically compatible with the body.
   Cymetra is effective in correcting a variety of skin conditions. It reduces the appearance of depressed scars resulting from injury, disease, surgery and acne. It softens nasolabial folds by diminishing the creases running from the corner of the mouth to the nose, giving the face a smoother overall look. And it fills in deep wrinkles and facial creases, including marionette and laugh lines. Like other injectables, Cymetra may also be used to fatten the lips. At consultation, the medical practitioner will assess the patient’s expectations and determine how much Cymetra to use. As with other injectables, one injection is rarely sufficient because absorption by the body cannot be avoided.
   The method of injection is vital. Injecting too deeply causes the material to spread, and injecting too shallowly can create an unnatural appearance. For nasolabial folds, for example, the thread technique of injection is the best option, says Lifecell, the New Jersey-based manufacturer. Before injection, the skin is treated to minimise discomfort. This may consist of applying ice to the area for a few minutes or a local anaesthetic may be used to numb the area.

Chiselled cheekbones
Faye Dunaway, Bo Derek, Kate Moss, Christy Turlington, Larry Flynn Boyle and a bevy of other beauties represent those genetically blessed with cheekbones. It’s clear that cheekbones which look as if they could cut glass are in, and they have been for quite some time. Years ago, models and actresses would make clandestine visits to the dentist to have their back molars removed with the hope of achieving a contoured look. Thanks to advances in modern cosmetic surgery, women can keep their molars in favour of a far less barbaric procedure – buccal fat removal.
   I see my fair share of models, actresses, and others in the limelight. All are aware that the camera has a tendency to add pounds. Therefore, a desired aesthetic goal is a face with defined planes that will reflect favourably from lights of a flashbulb, yet not look drawn. Fat pads exist in the mouth just beneath the cheekbone, regardless of whether a person is thin or fat. Some people simply have a larger amount of buccal fat. To help sculpt the face and achieve the contoured au courant look, surgeons excise the fat pads by making small incisions inside of the mouth so that there is no external scarring. The ideal candidate is one who has a moon (or full) face and wants a more sculpted look. This procedure is also warranted for those who want a subtle higher cheekbone look as opposed to the more pronounced result with a cheekbone implant.
   Buccal fat is about the size of an olive in most people; although, those with fuller faces have a greater quantity. It is the same type of stubborn fat found on other parts of the body and does not respond to dieting. Essentially, what the buccal fat removal procedure does is to take a convex area and give it a slight concavity. When done properly, a skeletal look or overly hollow look is absolutely avoided. It is true that some plastic surgeons are sceptical about this procedure, because they feel that people should retain the fat in their face for their later years when the face naturally has a tendency to become concave. But it is a question of: is the concern how the patient will look now, or in 20 years, when facial gauntness might become an issue. For those who might deem the change too drastic in the short or long term, the buccal fat procedure is reversible, in that fat can be injected into the face to fill it out.
   

Changing the size and shape of flat bottoms
Buttock augmentation is one of the rarely performed cosmetic surgery procedures in the UK. It is usually done to improve buttock size and shape in women and men who have, by nature, a relatively small buttock or who have experienced a decrease in buttock size following pregnancy or weight loss and desire a fuller buttock appearance. Buttock implants come in oval or round shapes in various sizes, such as 250cc and 300cc. They are, in essence, silicone shells with silicone fillings. There has been no conclusive medical evidence in support of silicone implants causing cancer.
   Each type of implant has advantages and disadvantages. There is no one ideal implant for all individuals.
   During consultation, each type of implant will be discussed and explained, giving due regard to an individual’s age, buttock type and size, familiy history, past medical history, occupation and aesthetic expectations.
   The operation consists of making a 5-7cm incision, usually in the natal cleft crease. A pocket crease is created under the muscle within which the implant is placed. The operation takes about 1.5–2 hours under a combination of local and general anaesthetic. Usually, the operation involves two nights’ stay in a hospital, after which patients are discharged wearing support garments. The dressing must be kept clean and dry for two weeks. Stitches will be removed two weeks after surgery at the outpatient clinic. There may be some initial swelling and pain, which usually settles in four to five days.
   Depending on their occupation, patients will need three to six weeks off work. To help ensure normal healing, pressure should not be exerted on the buttocks for four weeks. Patients should not sleep on their back.

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