The desire to do a facelift, or at least remove wrinkles, arises in a woman every time she sees the first features of fading appearance in the reflection in the mirror. However, is facial plastic surgery always justified? And how will it be reflected in 20 or 30 years?
We asked the President of the Ukrainian Association of Cranio-Maxillofacial Surgeons, Vice-President of the All-Ukrainian Association of Plastic, Aesthetic and Reconstructive Surgeons, Corresponding Member of the National Academy of Medical Sciences of Ukraine, Member of the International Association of Implantologists, Professor Vladislav MALANCHUK to answer these and other questions.
"In 99% the result of facial plastic surgery does not match the imaginary image"
Vladislav Aleksandrovich, how do plastic surgeries on the face affect the state of health, in particular, facelifts of varying complexity?
— Facial plastic surgery would be more correctly and correctly called aesthetic surgery. After all, plastic surgery of the intestine, after removing part of it, is also a creation. In addition, there is plasticity with nerve tissues, muscles, bones.
If we talk about aesthetic surgery, then it includes 80 percent of the operations that are performed on the face for aesthetics, and the rest — on the body. If with age, due to the influence of time or due to some kind of damage, a person wants to make changes in his appearance, then this is precisely the scope of aesthetic surgery — one of the branches of maxillofacial surgery.
— How dangerous are such aesthetic interventions for a person?
— It all depends on the general condition of the patient, the technique used during the operation, the hands of the surgeon, the quality of pre- and postoperative management. That is, there should be all the same components as in any planned surgical intervention, the main task of which is to prevent the imbalance of a unique complex called "human biological object", not to disrupt the function of vital organs and systems. Although there are unpredictable situations: allergic reactions to anesthesia, local complications, and more. It all depends on the qualifications of the doctor and on his understanding of what he is doing.
As for the patient himself, during any plastic aesthetic operation, the person will receive a different face, which he virtually imagines. Although we are trying to document the preoperative status: photographs, computer studies of the face. Moreover, with the help of special programs, we can plan the result that a person will receive after such an operation. But — these are all desired things.
— Why?
— Because the hand of a person (surgeon) works, the answer is given by the human body (patient). And what we beautifully drew on the computer before the operation and what we get in real life has some differences.
In 99 percent of cases, the result will not match the imaginary image of the person in the future that a person has before the operation.
The expectations of a person who decides to have such an intervention are of tremendous importance. On the one hand, he is interested in a purely aesthetic result, on the other hand — social. For example, girls after surgery want to get married successfully. Older women — namely, they most often seek the help of aesthetic surgeons — they count on the fact that their husbands will again kindle feelings for them, as in their younger years. But the operation changes only some part of the person. His brains, character, worldview, and qualifications, education — it doesn't change! The woman will still have the same drunken husband, the same wicked boss, the same son of a loser, the same neighbors, who make noise at night and do not let you sleep. The old habits will remain, the old state of health, laid down genetically.
Aesthetic surgery is always, or almost always, relied upon to be disproportionate to what it can actually give. And when, after the operation, patients do not get what they expected, then, of course, they begin to blame everything… surgeon. He is "guilty" in the fact that the guy did not marry the girl after she changed the shape of the nose or that the husband left the woman who had a facelift for another, etc. These are the psychological questions related to aesthetic facial surgery that are unusually complex and are diverse.
In the specialized literature there is even a classification of types of patients who come with a desire to change something in their face. After all, people have very different expectations. Some have an objective attitude to their face, others have an overestimated aesthetic feeling, while others, on the contrary, have an underestimated one. For example, Einstein often went to bed without undressing. He didn't want to waste time getting dressed, he was so engrossed in his life's work. For this type of people, an extra wrinkle or an unironed shirt is not a reason for depression. And there are those who give super-value to the appearance.
Depending on social and personal values, a person manifests his wishes. That is why a surgeon who deals with facial aesthetics must be a psychologist in order to navigate the personal, social issues of any patient. After all, the main — don't hurt him!
I had a friend who was engaged in aesthetic plastic surgery. And somehow a girl came to see him, outwardly attractive, well-built, but who certainly wanted to change the shape of her nose. He sees that she does not need to do this, but understands that none of his arguments against such an operation will work — the girl was too determined. And then he went to the trick: he named such a disproportionately huge figure for the cost of the operation that the young lady flew out of his office like a bullet. That is, he found an accurate, and most importantly effective psychological technique that allowed him not to commit a rash act. As a professional, he did the right thing, clearly understanding that the desired and necessary — things are not always the same.
"Getting rid of wrinkles requires the delicate work of a surgeon"
— Most often, women who seek to get rid of wrinkles turn to aesthetic surgeons. Everything seemed to be tested here. But how is it really?
— There are several types of facial aging, and wrinkles — one of the elements of such changes. According to the method of the famous cosmetologist Kolgunenko, one of these manifestations — "tired face" when its elasticity, freshness seems to dry up. In other cases, the expansion of wrinkles predominates, I would say.
With age, one way or another, sooner or later, facial deformity occurs.
There are 18 types of basic facial wrinkles and folds. Moreover, if wrinkles under the eyes appear at 25 & mdash; 30 years, on the neck — at 30—40, then the nasolabial and buccal skin architectonics changes towards aging often after 50.
The faces of an asthenic and a picnic age differently.
I am not a supporter of surgical correction of these changes. But this — very frequent interventions without a serious guarantee of the return of beauty. All public figures in this circle, say, actresses, businesswomen or women who are overly concerned with appearance, just belong to this kind of patients.
For the surgeon — this is a filigree work. Open and endoscopic techniques are used, skin incisions in inconspicuous places, skillful movement of tissues with the prevention of their tension, aesthetically applied sutures, minimal trauma. All this, while maintaining general surgical safety, must be done flawlessly.
— Probably the so-called "beauty injections" not as radical as surgery? How do you feel about this face correction method?
— Most likely — these are “anti-beauty injections”, the essence of which is — suction of subcutaneous fat mainly in young women, in their opinion, with excessive fullness of the face. The method is quite common, but complications are possible here. For some charm, by tightening the soft tissues of the face, sometimes they even resort to reinforcing the skin with thin gold threads, more often in the cheeks and neck. Chemical or laser peeling — dosed, understandably superficial, destruction of skin areas, which triggers an artificially induced inflammatory reaction, followed by renewal of the “tired face”. In the hands of an experienced cosmetologist who knows the elements of aesthetic surgery, the desired effect is usually achieved. But here, too, complications are not ruled out.
— Obviously, some methods seem to be a more reliable alternative?
— You probably mean the rather popular SMAS plastic surgery, when, in addition to the skin, certain fragments of mimic muscles move. This type of operation reduces the possibility of maintaining a postoperative scar due to the loading of the sutures. But I emphasize again: the face is pierced with branches of the facial and other nerves. Therefore, everything is rather complicated than simple.
This applies, of course, to blepharoplasty to eliminate eyelid wrinkles, as well as raising the eyebrows. When it comes to blepharoplasty, the main thing here is — do not overdo it so that the eyes can close.
Of course, the specialists of our department, including myself, are able to perform any kind of facelift. But life almost every day puts forward more fundamental tasks for cranio-maxillofacial surgery. For example, recently I initially examined a young woman with a congenital retraction of the midface. The operation I intend to undertake will be aesthetic, but the main thing here — functional character. Or eight operations to remove bullets and shrapnel from the facial tissues, carried out by the department for injuries to participants in the confrontations this winter on the Maidan. Of course, such assistance was a priority, but everyone who turned to us on their own or on the recommendation of colleagues was able to help, since the injuries were, relatively fortunately, isolated.
"Infections are transmitted through various grafts, such as bone grafts"
— Chekhov's phrase is known that everything in a person should be beautiful — and face, and clothes, and soul, and thoughts… It turns out that other women care about the beauty of the face for good reason?
— A great writer manifests in these words the general combination of personality charm, if one accepts such a formula. It is, perhaps, deciphered as a psychological harmony that decides a lot, followed by aesthetics.
What does that mean? The eminent medical writer Somerset Maugham seems to have said, "A woman's beauty is transient, but her self-confidence is not." Perhaps this is the secret of unfading beauty.
Returning to the "beauty injections", again, a lot depends on who makes them and how necessary they are. If a person in the body has a deficiency of some vitamins, biologically active substances, then the introduction of such injections is quite acceptable. What can not be said about the excessive enthusiasm for such methods of inducing charm. If, for example, biologically active substances are administered to a patient in the form of an extract from embryonic tissues, this can lead to a high level of complications. And there are many examples of this, some of which we sometimes see in periodicals: photos of people before and after such injections.
Here the question arises: what exactly are we transplanting? After all, there are infections that are transmitted with various transplants — bone, cartilage or iris of the eye. This — serious biological things. Besides, we don't know much yet. But it is known that — these are small molecular weight proteins that can cause infections, neoplasms, or even neurological defects. By the way, their incubation period is 15-20 years. For example, they took biological material, transplanted it to where there is a bone defect, put an implant, made a beautiful smile, and after 15-20 years a person is diagnosed with Alzheimer's disease. And the question arises: where did it come from? And the answer is that 15 & mdash; 20 years ago, the dentist very competently and professionally transplanted biological material,
Therefore, I am categorically against foreign transplant materials. With plastic surgery, you only need to deal with the tissues of the patient himself. And humanity has already gone down this path.In Kyiv, there have been banks of cord or cord blood for 15 years, where there are baby stem cells. Such blood is stored at a low temperature, and when a person is 30, 40, 50 years old and has a serious illness, then cord blood is taken and his own stem cells are injected into him. And this solves a lot of questions.
And those people who sell various transplant materials just want to make good money in such a business. And they absolutely do not care what will happen to the patient after 20 years.
I will tell in this connection both a funny and a sad story. Once, about ten or twelve years ago, an interview appeared in a cosmetic magazine about what plastic surgery is. Not aesthetic, but plastic. This interview was given by two candidates of science — one worked in the center of hand microsurgery, the second had a private clinic, both are quite famous people. So, among other things, they said that all surgeons can do plastic surgery, except for dentists and hygienists. I took note of their point of view.
Six months pass — year. And then one of these doctors calls me: help me consult a patient, the wife of a people's deputy, 35-40 years old, with an incomprehensible anaphylactic reaction after a facelift operation. After examining her, I came to the conclusion to investigate the condition of the facial nerve: damaged — not damaged, clamped — not clamped. Two days later, together with the same patient, a doctor arrived, who actually performed this operation. He examined her again. There was clear damage to the facial nerve — over the past two days, there was no dynamics in the movement of the muscles, the swelling remained. The surgeon who operated, thought, was silent, and then says: «Strange & hellip; And where does the facial nerve pass here? And I began to draw and tell him. He mentioned paralysis and the structure of the facial nerve, types of its structure, types of pain in the face, trigeminal neuralgia, problems of neurostomatology, which were successfully studied by a doctor with front-line experience Elena Stanislavovna Yavorskaya. The issues are complex, requiring complex treatment, sometimes surgical. This — a whole country of great knowledge. And a surgeon or, rather, a pseudo-surgeon (for this area), who encroached on specialization in aesthetic surgery, must possess this range of knowledge, with the presence, in my opinion, of the relevant official certificates. Moreover, the right to issue such a document should belong exclusively to the professional Association. He again: “Yes? It's strange, but here we are doing SMAS-plasty…». SMAS, let me remind you, this is — method of using the superficial muscle layer, which rises and holds on itself all the effort and load of the raised tissues. That is, the person who did the facelift did not even know the complex anatomy of the area in which he worked. It was a glaring case, known to plastic surgeons in Kyiv. What to say…
But the young man has shoes made of crocodile skin. And he was dressed accordingly, as they say, expensively and tastefully. But the trouble is elsewhere. About four or five years ago, the same doctor called me and said: you know, we created the department of combustiology and plastic surgery, scored a course in plastic surgery of five people. Perhaps this was just an adventurous statement by the doctor about joining such an important department. After all, combustiology — burn treatment industry — is based largely on the achievements of plastic surgery of the highest class. But such a collision was…
Today there are quite a lot of companies in Kyiv that are engaged in aesthetic surgery. We also do this when people come to us for such services. After all, the face — this is our area. We also teach these skills to students.
But if a girl comes with a clipping from a glossy magazine and asks to make exactly such a nose or mouth, like the beauty on the cover, and she herself has 150 kilograms of weight, then what can be said here? By the way, this is not a fictional, but a real case. I refused the operation to that girl for her own good, but as a doctor he gave recommendations to get rid of excess weight to begin with. Many say, they say, here, I came to you, you are a doctor, you took the Hippocratic oath, so treat! But the treatment — the process is two-way. Medical efforts alone will not be enough. If the doctor and the patient are together against the disease, they will win! And if the patient is inactive, or even vice versa, smokes, drinks vodka, leads an unhealthy lifestyle and at the same time is looking for a miracle in medicine, then, alas, not a single doctor can cope here…
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