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Blepharoplasty (Surgery
of the Eyelids)
Also
called eyelid lift, blepharoplasty is a procedure in which the physician
surgically removes excess fat, muscle, and skin from both the upper
and lower eyelids to redefine the shape of the eye. Transconjunctival
blepharoplasty (eyelid surgery) is performed by making an incision
from inside the lower eyelid. It avoids any scarring on the lower
lid. It is a useful technique when only fat, and not skin or muscle,
needs to be removed from the eyelid area.
Aesthetic eyelid surgery is performed on adults of all ages. Some
people have eyelid surgery to correct problems that are a result of
aging, while others have inherited traits that cause them to seek
treatment as young as their 20s or 30s. Because of individual factors,
not everyone will achieve the same results from eyelid surgery. A
plastic surgeon will select the surgical technique that they feel
will obtain the best outcome, and improve the appearance of upper
eyelids. For upper eyelid surgery, usually an incision is hidden within
the natural fold of the upper eyelid extending slightly beyond the
outside corner into the laugh lines or other existing creases. Through
this incision, excess skin and fatty tissue are removed. Because the
incision follows the natural contour of the upper eyelid, it will
be well camouflaged when healed. For lower eyelid surgery, often an
incision is hidden just below the lower lashes. Through this incision,
excess skin, muscle and fat are removed, or fat may be redistributed
to eliminate puffiness or bulges. Other adjustments to correct special
problems such as muscle laxity may be performed. As in upper eyelid
surgery, the incision is well camouflaged by natural creases.
In some cases,
the plastic surgeon may decide that the best approach for removing
excess fat is through an incision placed inside the lower eyelid,
a technique requiring no external incision. Since it cannot be used
to remove excess skin, a laser may sometimes be used in conjunction
with this method to tighten the lower eyelid skin.
Breast Enlargement (Breast
Augmentation)
Also called
augmentation mammaplasty, breast enlargement or augmentation is a
procedure to reshape the breast in order to make it larger. The procedure
can also be performed to reconstruct the breast following breast surgery.
Many women choose to have their breasts enlarged in order achieve
a fuller bustline, because their breasts may not have developed to
a size that meets expectations. One breast may be significantly smaller
than the other, or after weight loss, childbirth or as a result of
aging, the breasts lose volume and their shape changes. Breast augmentation
can enhance breast size and shape, and provide a more proportional
figure.
Individual factors and personal preferences will help the patient
and their plastic surgeon to determine appropriate breast size, the
location of incisions, and whether the implants will be placed on
top of or underneath the chest muscle. Incisions can be made underneath
the breast, just above the crease, around the lower edge of the areola
or within the armpit. Implants are placed in a pocket either directly
behind the breast tissue or underneath the pectoral muscle which is
located between the breast tissue and chest wall.
Breast Implant (Silicone)
A breast
implant is a silicone shell filled with either silicone gel or a salt-water
solution known as saline. On April 10, 1991, the Food & Drug Administration
(FDA) asked the manufacturers to submit evidence in a pre-market approval
(PMA) application that silicone gel-filled breast implants were safe
and effective. However, they were unable to provide the FDA with this
information. Without enough data on safety and effectiveness, the
FDA determined that silicone gel-filled breast implants could not
be approved. Therefore, silicone gel-filled breast implants were removed
from the open market. Because of concerns that there was insufficient
information demonstrating the safety of silicone gel-filled breast
implants, the FDA determined that new gel-filled implants, should
be available only to women participating in approved studies. Silicone
gel-filled implants are available to women through the following FDA-approved
studies: an adjunct study or an investigational device exemptions
(IDE) study. Some women requiring replacement of the implants are
also eligible to participate in the study. To date, both Mentor Corporation
and McGhan Medical have adjunct and IDE studies approved by FDA. For
further information on enrolling into one of these studies, or the
latest on FDA approval contact your doctor or the manufacturer. (The
above guidelines were current as of August 29, 2000.)
Breast Implant (Saline)
Saline-filled
breast implants continue to be available to breast augmentation patients
on an unrestricted basis, pending further Food & Drug Administration
(FDA) review. The manufacturers of saline-filled breast implants were
notified by the FDA in January 1993 that the agency would require
data on their products' safety and effectiveness. While the manufacturers
were conducting the required studies, saline-filled breast implants
remained on the market. On August 19, 1999, the FDA asked the manufacturers
to submit evidence in a PMA that saline-filled breast implants were
safe and effective. On March 1-3, 2000, the FDA's General and Plastic
Surgery Devices Panel met to review PMAs for saline-filled breast
implants manufactured by Mentor Corporation, McGhan Medical, and Poly
Implant Protheses (PIP). The Panel voted to recommend approval of
Mentor Corporation and McGhan Medical's saline-filled breast implants
and to recommend disapproval of PIP's implants. On May 10, 2000, FDA
granted approval of Mentor's and McGhan's PMAs. To date, all other
manufacturers' saline-filled breast implants are considered investigational.
You should ask your doctor more about the specifics of the FDA decisions.
(The above guidelines were current as of August 29, 2000.)
New scientific data on the safety of breast implants is rapidly being
researched and collected. In the future, it is possible that additional
types of implants or filler materials will become available.
Breast Lift (Mastopexy)
Mastopexy
is a procedure performed to lift a sagging breast. It can be performed
with various incisions of different lengths and complexity depending
on the severity of the problem. Loss of skin elasticity, gravity and
other factors (such as weight loss, pregnancy and breast-feeding)
ultimately affect the shape and firmness of the female breasts. Patients
who are generally satisfied with the size of their breasts can have
a breast lift to raise and firm them, resulting in a more youthful
breast contour. Some patients are unhappy because they have lost a
significant amount of breast volume over time. In such cases, implants
inserted in conjunction with a breast lift can increase breast size
at the same time as the shape and position of the breasts are enhanced.
See Breast Enlargement (Breast Augmentation).
A common method
of lifting the breasts involves three incisions. One incision is made
around the areola, while another runs vertically from the bottom edge
of the areola to the crease underneath the breast. The third incision
is horizontal beneath the breast and follows the natural curve of
the breast crease. After the plastic surgeon has removed excess breast
skin, the nipple and areola are shifted to a higher position. The
areola (which in a sagging breast may have been stretched) can be
reduced in size. Skin that was formerly located above the areola is
brought down and together beneath it to reshape the breast. The nipples
and areolas remain attached to underlying mounds of tissue, usually
allowing for the preservation of sensation and the ability to breast-feed.
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