Breast Implant Surgery. How We Do It?

Minimally invasive procedures to tighten and lift skin give natural results with minimal risk and recovery time. Monopolar radiofrequency delivers a high-frequency electric current—tissue resistance to electrical current results in volumetric heating to the deep dermis and underlying tissue. The resulting heat leads to immediate collagen contraction and a delayed wound healing response, with new collagen formation up to 4 to 6-month post-treatment. INITIALLY, the FDA approved monopolar radiofrequency (RF) devices to treat periorbital wrinkles. Since then, they have been used to treat laxity of the forehead, cheeks, nasolabial folds, marionette, lines, jawline, and neck. Although the results of RF are not as dramatic as a facelift, over 90% of patients obtain noticeable tightening of the treated areas, and it never looks “pulled.” Another benefit of radiofrequency is reducing fat and tightening the skin by directing energy to target collagen. For example, a patient with flabby upper arms may have more loose skin than fat in this area. In this instance, Prof Moawad might use radiofrequency to tighten the skin first and then remove excess fat. However, if he determines that there is fat mainly in an area, he will remove the fat first and then tighten the skin afterward. “Radiofrequency is a versatile procedure that can be used on any area of the body – from large areas like the abdomen to minimal areas such as the chin – with the same degree of success.

Breast augmentation or enlargement is typically done through silicone breast implants or fat injection Breast implant surgery is tailored to meet a woman's individual needs. The filling type, shape, profile, and size of the implants are discussed thoroughly in the pre-operative consultation. A breast implant will be inserted into a pocket either under or directly over the muscle. Modern breast augmentation is about volume distribution, not just volume addition. The excellent shape should prevail over volume. The technique of autologous fat-graft injection to the breast is applied for the correction of breast asymmetry; breast deformities; congenital disability correction" micromastia, and tuberous breast deformity, breast reconstruction: for post-mastectomy breast reconstruction (as a primary and as an adjunct technique; trauma-damaged tissues (blunt, penetrating), disease (breast cancer), explanation deformity (empty breast-implant socket).); for the improvement of soft-tissue coverage of breast implants and the aesthetic enhancement of the bust.

Skin scars treatment or revision surgery results in the improvement of scars, either cosmetic or functional. Skin scars are results of earlier surgery trauma, or inflammatory processes, e.g., acne. The injury may be cosmetically distressing or may distort functional anatomy. Thus, the aim of scar revision is the achievement of an aesthetically pleasing or less visible scar. Scars can be categorized by various descriptive characteristics, including contour, shape, length, width, color, and function. Recognition and analysis of these unique characteristics, along with the scars’ location and place, will aid in determining the proper technique or combination of procedures in revising a given scar. Numerous revision procedures are available to correct the various types of injuries. No one treatment or procedure is effective in correcting all types of scars. Therefore, knowledge, understanding, and experience using various techniques are vital to achieving acceptable results.

Hair restoration involves moving hair from one body area to another for cosmetic improvement. The latest advances in the field, such as smaller grafts, follicular unit extraction or FUE, and novel pain reduction methods, make hair restoration treatment successful, safer, and more comfortable. Hair transplantation is most used for male pattern baldness. The second most common use is to treat female pattern baldness. Many women do not experience recession but wish to advance their hairline because of the congenital high hairline, traction alopecia, or previous facial cosmetic surgery. There are several key differences to note in the appearance of the male verse female hairline. It has been previously reported that the male hairline is typically 7 to 8 cm above the glabella and 5 to 7 cm in women. Besides, a variety of conditions can be successfully treated with hair transplantation, such as scalp scarring, facial scars due to trauma or surgery, and hair loss due to traction can be repaired with hair transplantation. Finally, hair transplantation can be successfully used to restore hair to the eyebrows, eyelashes, beard, mustache, or goatee area; and even in areas of the body, such as the pubis or chest. The PRP and growth factors are used pre-operatively, intra-operatively, or post-operatively. The scalp where hairs are transplanted decreases bleeding, and bruising accelerates healing and reduces shock hair loss. The injection of nano fat or enriched micro fat is performed subcutaneously above the galea and in proximity to the hair bulb, which is the region where stem cells exist.

Arms in shape surgery results requires understanding the aesthetic arm deformity and its causes. Brachioplasty, liposuc­tion, and non-invasive body shaping may be used for arm shaping or contouring. Women interested in shaping the arm who would like to improve along the deltoid region and over the triceps are good candidates for liposuction of the arm. Upper extremity liposuction is appropriate for younger patients with fatty collections and good skin quality. Skin is relatively thin in the arm, so skin retraction is less likely in the standard patient than abdomen or back. Skin laxity is possible after liposuction, and if this is anticipated, it is best to discuss the potential need for second-stage skin removal. Liposuction treatment is often weighed against arm lift with the possibility of a visible scar. Weight loss leads to variable degrees of skin redundancy. Some patients receive help from a minimal incision arm lift. In contrast, others receive help from traditional arm lifts, and others have so much laxity that the arm lift needs to be extended beyond the axilla along the lateral chest wall. There is an increasing number of transcutaneous energy delivery devices currently available. They are classified according to the energy they deliver to their target—mechanical (e.g., suction, massage), radiofrequency, ultrasound, cryolipolysis, and laser.

Abdomen in shape surgery results depends on abdominal imperfections. Abdominal alterations may be summarized as: cutaneous (redundancies, stretch marks, scars, flaccidity, and retractions); accumulation of subcutaneous tissue (lipodystrophy); and those affecting the muscular-aponeurotic system (diastasis, hernia, eventration, and convexity. The abdomen is essential to define the younger and more vital physique. The stomach contour is set by the bones, fat, skin, muscles, and the protrusion of the intra-abdominal organs. Surgical treatment will remove excess skin and fat and tighten the muscle to push back internal organs. Surgical treatment will give a contour that approximates the person's ideal self-image. The goal of surgery is to make an aesthetic contour with acceptable scars and the return of full function of the abdominal girdle. There is an increasing number of transcutaneous energy delivery devices currently available. They are classified according to the energy they deliver to their target—mechanical (e.g., suction, massage), radiofrequency, ultrasound, cryolipolysis, and laser. Radiofrequency devices are the most popular for non-surgical skin tightening and fat reduction.

Fractional radiofrequency (FRF) is the newest in the nonabrasive approach. FRF uses an array of microneedles arranged in pairs between which bipolar RF energy is delivered. The fractionally delivered energy creates zones of thermally damaged skin adjacent to unaffected areas. The damaged skin stimulates wound healing and deposits new collagen, elastin, and hyaluronic acid formation. The unaffected areas serve as a reservoir of stem cells that accelerate wound healing.  FRF improves acne scars, large facial pores, and skin quality. FRF devices are safe, tolerable, and effective modalities for wrinkles and facial laxity reduction. I may use a topical anesthetic cream before the treatment to minimize pain. Fractional radiofrequency is combined with PRP with significant amounts of growth factor and heal promoting factors to fasten healing. Recently, Nanofat has been combined with fractional radiofrequency to enhance skin quality and stimulate hair follicles. Fractional radiofrequency gives a wake-up call to your skin to remove injured collagen and elastic fibers, encouraging your fibroblast to synthesize new collagen and stimulate hair follicles to stem cells.

Skin rejuvenation laser peel involves the removal of the outer layer of damaged skin. Many ablative skin resurfacing techniques are available at MSI, broadly grouped as mechanical, chemical, and laser abrasion. All ablative techniques result in upper to the mid-dermal wound. Dermabrasion relies on mechanical 'cold steel' injury, acid peels result in a 'caustic' injury, and lasers result in a thermal injury. All ablative resurfacing treatments work the same way. First, the outer layers of damaged skin are stripped away. Then, as new cells form during the healing process, a smoother, tighter, younger-looking skin surface appears. Superficial or medium resurfacing is limited to the epidermis and papillary dermis. For deeper resurfacing, I can also remove the upper levels of the reticular dermis. Unlike chemical peels and dermabrasion, laser skin resurfacing (LSR) with the CO2 laser generates heat, which results in immediate tightening because of the shrinkage of collagen, which forcefully shortens the collagen fibers by 30%. This translates clinically into the smoothing out of superficial irregularities, including wrinkles, acne scars, nevi, epidermal growths, and even tumors, and a tightening effect that improves the skin's overall appearance. The laser stimulates the growth of healthy new collagen and elastic fibers in the skin continuously for six months after resurfacing. Therefore, any wrinkles or scars will continue to improve for up to one year. Nonablative or minimal ablative fractional CO2 holds great promise in both treatments of skin textural abnormalities (acne scarring, wrinkles, and skin mottling associated with photoaging) and pigmentary variation (melasma, hyperpigmented scars, lentigines, and dyschromia

Acne inversa or hidradenitis suppurativa (HS) is a disease that usually begins as pimple-like bumps on the skin. The pimple-like bumps tend to develop in places where everyday pimples do not appear. HS is most common on the underarms and groin. Getting treatment for HS is important. Early diagnosis and treatment can prevent HS from worsening. If HS worsens, the pimple-like bumps can grow deep into the skin and become painful. They can rupture, leaking bloodstained pus onto clothing. This fluid often has a foul odor. As the deep bumps heal, scars can form. Some people develop tunnel-like tracts under their skin. As the skin continues to improve and scar, the scars thicken. When thick scars form in the underarm, moving the arm can be difficult. Thick scars in the groin area can make walking difficult. Because HS can look a lot like acne, folliculitis, or boils, it is best to see a dermatologist for a diagnosis.

A dermatologic surgeon usually does plantar warts removal. Plantar warts are small growths that usually appear on your feet' heels or other weight-bearing areas. This pressure may also cause plantar warts to grow inward beneath a hard, thick layer of skin (callus). Plantar warts are caused by HPV. The virus enters your body through tiny cuts, breaks, or other weak spots on the bottom of your feet. Dermatologists have many treatments for warts. The procedure used depends on the patient's age and health. I prefer to cut the callus by scalpel. Then I use a curette to remove the viral material. Then I use a vascular laser to burn or cauterize tiny blood vessels that feed the virus. Then it cauterizes the base using an ablative laser or chemical TCA. A topical antibiotic is applied, and a special dressing is applied. The patient can walk without any pain immediately