Chirurgie à visée esthétique de la peau

• Have you ever wanted to get rid of ugly moles, brown spots or scars on your face? If so, you are not alone.
• When it comes to skin cosmetic procedures, a wrong decision on your part can make the difference between aesthetic improvement and chronic embarrassment. Thus, it pays to arm oneself with the requisite basic information to make an informed choice before going for any skin cosmetic procedures.

1. How do I improve the acne scars on my face?

• a) Chemical peeling causes injury to the superficial layers of the skin and believed to induce new collagen to form in deeper layers.

1. Alpha-hydroxy acid (AHA) peels may help improve very superficial scars slightly.
2. Treatment is easily tolerated and cause minimal disruption to the patient’s work schedule. However, multiple treatments are needed.
3. Deep scars do not improve with chemical peeling.

• b) Laser resurfacing of the skin is a new treatment for acne scars.

1. There are several laser systems available to re-surface the skin in a controlled manner.
2. The skin heals and repairs itself with some clearance of the scars. In suitable patients, up to 40% improvement may be expected from a single laser treatment.
3. However, there is risk of complications such as prolonged redness, pigmentation and infections.
4. It takes several weeks to recover from the surgery.
5. It is generally much more effective than chemical peels for the treatment of acne scars.

• c) Dermabrasion is an older technique for skin resurfacing but the principle is similar to that of laser resurfacing using mechanical sanding to re-surface the skin. It involves a certain degree of blood loss and requires greater skill on the part of the surgeon.
• d) Scar Revision Very deep, depressed scars will necessitate excision (cutting) and stitching to correct the defect. Elevated scars (keloids) can be flattened by injecting small doses of steroids into the keloids.

2. I would like to remove my moles (melanocytic nevus). How is it done?

• Moles come in various shapes and sizes.
• Moles should be completely excised and examined under a microscope to exclude cancerous growths.
• Melanocytic neavi can be removed for cosmetic reasons. However, scar formation will be the consequence  of the excision. The size of the scar will depend on the size of the mole.

3. Can anything be done about my wrinkles?

• The deep frown lines over the brow and the horizontal lines on the forehead are due to the persistent hyperactivity of the muscles in the forehead area:

1. These muscles can be paralysed or weakened by injecting a toxin (botulinum toxin) into them.
2. Relaxation of these muscles then result in the disappearance of the frown lines.
3. The procedure is safe but the desired effects wear off after 4 to 6 months.
4. Repeated injections are necessary to maintain the desired effects.

• Finer wrinkles which are not related to muscle activity may improve with chemical peels and/or laser resurfacing.

• Face-lifting involves:

1. loosening the facial skin from its deep attachments
2. stretching it back over the ears
3. trimming off the redundant skin and stitching the tightened skin in place. This procedure has the greatest potential for cosmetic improvement and the highest risk of complications. It is usually carried out by plastic surgeons.

4. How can I get rid of the brown spots on my face?

• There are different skin disorders that appear as brown spots.
• Most seborrhoeic keratoses can be easily destroyed with electrosurgery or carbon dioxide laser.
• Solar lentigines and freckles respond well to pigment lasers with minimal risk of scarring.

5. What are the cosmetic surgical treatments available for baldness?

• Small areas of non-inflammed bald scalp that have remained unchanged for many years can be excised and the hair-bearing sides stitched together.
• Hair transplantation is a treatment option for male pattern baldness: Hair-bearing scalp skin (grafts) are removed from the back of the scalp (donor site) and implanted into the bald areas (recipient site) where hair growth is desired.
• Male pattern baldness worsens with advancing age and the severity of baldness is unpredictable. Thus, hair transplantation must be individualised taking into consideration the person’s family history of baldness, age, severity of baldness and hair texture. It may not be suitable for some persons with male pattern baldness.
• Synthetic hair implants are polyester fibres, which are embedded in the scalpto simulate human hair. The procedure of implanting the artificial “hair” is safe and quick and there is no limit to the number of implants available. However, this expensive procedure necessitates specialised aftercare and the implants fracture after 1 to 2 years. Some people develop inflammation of the scalp after hair implantation.

The decision to undergo cosmetic surgery and the type of procedure to undergo is highly personal. Decision to undergo such procedure should be based on facts and tempered with common sense.

Here are some pointers to help you along:

• DO’S

1. Allow yourself to be treated only by trained medical practitioners. Check that whoever is treating you, has the appropriate training and qualifications.
2. Know the facts. It is important that you understand the nature of the procedure, the consequences and the potential risks and complications so that you can make an informed decision.
3. Know your options. There is usually more than one method of treatment. Get a second opinion if necessary.
4. Know yourself and understand your level of risk tolerance.
5. Have realistic expectations.
6. Nurture a healthy sense of self-esteem. This will help you to put things in perspective and not attach undue importance to the cosmetic procedure and its outcome.

• DONT’S

1. Don’t believe in unsubstantiated claims by establishments and unqualified personnel that are profit-driven.
2. Don’t expect or hope for the same results as someone else who has undergone the same treatment. No two persons respond in an identical manner to the same procedure.
3. Don’t take the passive approach. Saying “I’ll leave it in your hands, doctor”, is like signing a blank cheque. You would have relinquished control of your body to someone who may not understand your deepest concerns.
4. Don’t take the short-term view of things. Understand that things may go wrong. Ensure that your doctor is able to see you through the procedure and handle any complications that may arise.