plastic comes from the Greek word plastikos, meaning
to mold or shape. Many of the first plastic surgeries were developed to close a difficult wound
or replace tissue lost due to injury or cancer.
These procedures often involved the formation of a skin flap to reshape or mold the defect so as to approximate the original shape.
Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient's appearance and self-esteem. Cosmetic surgery is usually not covered by health insurance because it is elective.
Reconstructive surgery is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance.
Reconstructive surgery is generally covered by most health insurance policies although coverage for specific procedures and levels of coverage may vary greatly.
There are a number of
gray areas in coverage for plastic surgery that sometimes require
special consideration by an insurance carrier. These areas usually involved surgical operations which
may be reconstructive or cosmetic, depending on each patient's situation. For example, eyelid surgery
(blepharoplasty) – a procedure normally performed to achieve cosmetic improvement may be covered
if the eyelids are drooping severely and obscuring a patient's vision.
Each patient will tolerate pain post-operatively in a different way, and we consider this. While some patients may describe the pain as an ache, others experience greater discomfort. Appropriate pain medications are prescribed for the post-operative patients, and these help minimize discomfort.
Most facial cosmetic operations have minimal discomfort post-operatively. Liposuction is slightly more uncomfortable, and operations that require elevation or tightening of the muscles, such as an abdominoplasty or breast augmentation, have discomfort equal to that of a C-section.
The length of time it takes to recuperate after plastic surgery varies depending on the procedure performed and the person operated on.
Most patients will require assistance for the first two days. Then most patients are able to care for themselves, but may still need assistance if they have small children to care for.
The time a patient resumes regular exercises varies based on the operation performed. All patients are encouraged to start a slow walking routine on the second postoperative day. Regular aerobic and more vigorous activities are not allowed during the first 2 weeks in order to decrease the risks of bleeding, swelling, and bruising. Weight lifting and contact sports are allowed at 1 month in most cases.
There have not been any scientific studies published about better post-op bras. Each of us makes general recommendations based on our experience and feedback from our patients.
I believe that in general all of us want our patients to wear a comfortable bra that does not put
pressure on the area of the sutured tissues. We don't want a bra that will distort the position of the
implants. It also helps to have a bra that will accommodate post-op swelling in the first weeks after
surgery. Frequently a bra that hooks in the front is more convenient. We use an inexpensive
bra with no seam at the inner and outer edges of the cup immediately after surgery. We then
switch to one of several bra choices recommended by our prior patients.
Another recommendation is to wait at least 6 weeks before choosing better or more expensive bras, since the size may be different compared to what you might select at 2 weeks post-op. I also recommend that your get advice of a professional fitter for the first good bras. I learned from one of my patients that used to work at Victoria's Secret that not all of the women working there are properly experienced in fitting customers. Get the right help and get the right fit. It will be worth it to you.
A properly fitted bra with good support beneath and at the side will help prevent the occasional problem of the implants settling too low or too much out to the side. This is also the reason that many experience plastic surgeons want their patients to sleep in a bra for the first 6 weeks.
Please remember that your ultimate choice of a bra and the support that it provides will be your contribution to the best possible result post-operatively.
Manufactures have a number of profiles of implants for any given volume. Usually the optimal size for saline implants will have the same dimensions as silicone filled implants. You should read about the pros and cons of both types of implants.
While there may be subtle differences based on the material filling the implant, the volume of both is the same when the implants compared are the same shape. There may be a small difference if comparing a round saline implant with a contoured gel implant.
Scars change and mature over 6-12 months. Massage in the early months can frequently help. Paper
tape, such as 3M Micropore tape, has also been found to help scars. (a number of years ago this study
was published in our primary journal
Plastic and Reconstructive Surgery as it applied to breast
reduction patient's scars). In some cases it is more effective than silicone sheeting.
There are some silicone gel creams that may help also. I sometimes wonder whether it is the massage or the cream or just time that is most helpful.
If the scar to be treated is beneath clothes, then paper tape is usually my recommendation. If the scar is in an exposed area, then I suggest a silicone gel or other over the counter scar gels or creams.
There are 4 areas that Board Certified Plastic Surgeons evaluate in order to make the best recommendations for the abdomen:
Skin laxity with stretch marks and the fat layer beneath the skin are the 2 most obvious to the patients and the surgeon. Plastic Surgeons also evaluate the contour of the abdominal wall muscle and connective surgery level. The hidden area that we also evaluate is the body's fat stored beneath the abdominal wall.
Skin laxity is removed when the excess skin is surgically removed and the wound closed. Frequently this will diminish the appearance of the stretch marks. Fat beneath the skin flaps may be cut away or suctioned, depending upon where the fat is located. Fat located on the sides may be suctioned if the suctioning will not interfere with the blood supply to the central abdominal skin which will be pulled down when removing the excess.
Muscle (and connective tissue) tightening can repair the stretching that has occurred with pregnancies and weight gain. Most, but not all, of these women will benefit from this part of the repair. The body's store of intra-abdominal fat cannot be removed when we do an abdominoplasty. However, its presence needs to be recognized because it can prevent our tightening of the muscle and connective tissue layer. Weight loss by the patient is really the only way to get rid of this. Persistence of intra-abdominal fat may lead to an abdomen that is not as flat as you and your surgeon hope to achieve.
The ideal patient for an abdominoplasty will have returned as close as possible to their goal weight.
This is a frequent question that we deal with in plastic surgery. Septal deviation is covered by insurance more frequently than the more external rhinoplasty. However, if the nasal bones are deviated enough to one side that they are contributing to the septal deviation then that may be covered as well.
Experienced plastic surgeons have learned what questions to ask about your symptoms, previous injury and various types of treatment that you have tried and found unsuccessful. These are what we use to explain the indications for getting insurance pre-authorization. Insurance companies are more willing to provide insurance benefits when the surgery is performed to correct functional problems such as airway obstruction which does not respond to medications.
I have several guidelines that I discuss with my patients about lifting and straining after cosmetic and reconstructive surgery, including breast augmentation.
The greatest risk of bleeding after cosmetic surgery is within the first 14 days. Lifting more than ten pounds, such as a baby, groceries, and laundry should not be done during this first 14 days after surgery. You can hold your baby while seated, however.
This is also the period that I also recommend not using aspirin or Non-Steroidal Anti-inflammatory pain relievers, such as ibuprofen, Motrin, Advil, or Aleve. Celebrex is one that can be used after surgery.
When you start doing more strenuous things, start slowly because the implant is next to the muscle
and you need to let it heal like a
There are several reasons that surgeons recommend that the patient be as close to their desired weight as possible. First, plastic surgeons can remove more excessive tissue (both loose skin and underlying fat) when your weight is less. That will result in a flatter, improved contour.
Furthermore, it will also help in planning both in incision and where to plan removal of the most problematic tissue. If you are carrying excessive abdominal fat, then some of it is above or external to the muscle layer. That is what can be removed by the abdominoplasty.
Additional fat is also stored inside the abdominal wall which means that it will not be removed at the time of a tummy tuck or abdominal suction lipectomy (liposuction).