Cosmetic or aesthetic surgery

Surgical jaw corrections

During a surgical jaw correction the jaw and facial bones are moved according to a certain procedure. These operations are performed for functionality reasons: complaints of pain, chewing problems, jaw joint relief, preprosthetic reasons, swallowing problems, logopaedic reasons and occasionally for psychiatric reasons. A surgical jaw correction results in a harmonious face with a correct position of the upper and lower jaw. Often there will also be an externally visible modification of the face which, in most cases, will be a highly appreciated improvement.

Aesthetic facial surgery

Aesthetic surgery is facial surgery from another perspective. In this case, the patient explicitly asks to look “better” or “younger” or “slimmer” or “more feminine”. Generally, this kind of surgery does not relate to the underlying bone. Certain oral and maxillofacial surgeons have also specialized in this domain, which is most commonly practiced by “aesthetic” or plastic surgeons. Usually, this kind of surgery is not covered by health insurance, except in the case of the treatment of burns or severe abnormalities. It is useful to explain some of the terms more in-depth:

Eyelid correction (Blepharoplasty)

Surgery: the surgical modification of the upper and/or lower eyelids can be performed under local anesthesia or combined with a mild sedative; it is usually performed in a daycare setting. The surgeon removes the excess skin as well as the underlying tissue of the upper eyelids. If necessary, he will also tighten the eye muscle. In the lower eyelids, the surgeon usually takes care of the protruding fat deposits. Result: usually, the scars are almost invisible as they disappear in the natural crease of the eyelid. In the lower eyelids, the incision is made just below the lower eyelash line. During the first week after the surgery, the eyelids will be swollen and bruised. After approximately five days, the stitches can be removed.

Nose correction (Rhinoplasty)

Surgery: in most cases, it is possible to make the incisions – and therefore also the scars – at the inside of the nose. This way, the surgeon can modify the skeleton of the nose, which consists of a cartilaginous part. In case of correction of the tip of the nose, surgeons usually prefer the “open” approach which causes a nearly invisible scar between the nostrils. Result: the the surgical correction of the nose is made permanent. Most of the time, it is possible to make the scars at the inside of the nostrils. This kind of surgery results in improvement, but generally not in perfection. The nose is a delicate aspect of the facial aesthetics because, together with the eyes, it constitutes the triangle which draws people’s attention during the first eye contact. Therefore, even small abnormalities of the nose, for example a bulge near the nasal bridge, can be disturbing to the patient. Correction is possible as depicted in the image on the right. Nose corrections of this kind often increase a person’s self-confidence. Within this field of delicate surgery, “aesthetic” is not at all a synonym for luxurious or superfluous. As opposed to superficial skin abnormalities, the nose can hardly be camouflaged by make-up and the surgical result is immediately visible.

Ear correction

Surgery: the surgery can be performed both in an outpatients’ clinic under local anesthesia, as in day care settings under general anesthesia. The incision (and therefore the scar) will be made at the backside of the ear. The cartilaginous skeleton of the ear will be corrected and a piece of skin at the back of the ear will be removed. After the surgery, the patient’s ears will be bandaged in a turban-like fashion for one week and the auricles may be red, swollen and sensitive. Result: the results are generally satisfying. However, the cartilage is a very stubborn kind of tissue which sometimes tends to return to its original shape.

Face or neck lift (Rhytidectomy)

Surgery: a large part of the skin of the neck and cheeks is separated from the substrate and pulled tight towards the hairline above and behind and underneath the auricle. Usually, a deeper tissue layer ialso needs to be pulled tight. Surgery, which is performed under anesthesia or under local anesthesia combined with sedation, takes a couple of hours so a few days in the hospital is recommended. The stitches can be removed approximately one to two weeks after the surgery. Smokers cannot make use of this procedure as smoking increases the frequency of complications. Moreover, it decreases the blood flow to the skin and it obstructs the healing process. Result: the final result will only be visible after a couple of weeks. The aging process of the skin will continue. A patient can choose to undergo a second surgery,  but generally only after 5 to 10 years.

Modern aesthetic facial surgery includes diagnostics of both the bony and of the soft parts. To realize a rejuvenation of the external soft parts (e.g. the skin) efficiently, it is often better to correct the structural underlying disharmony of the bone structures first. During the interview, the surgeon will try to understand the patients’ complaints and assess to what extent they can be met. The picture shows a correction of the basal bony structures together with a local face-lift.

Synthetic collagen

Surgery: this is not an operation but it is nonetheless never completely painless. The doctor uses a very fine needle to inject Artecoll underneath the skin. Synthetic Collagen is a sterile, injectable micro-implant: the treated parts are filled with this ingrowing connective tissue. The existing wrinkle or crease, e.g. the crease of the nose, also called the paranasal gutter, becomes less visible. Result: the process takes a few months and the patient must often be treated a second time. Usually, the result is visible for a long time. A classical example of this treatment is making the lips fuller.

Laser treatment

Surgery: the superficial skin layers are removed by laser treatment under local anesthesia. This way, the skin at the wrinkle or the irregularity is equalized. Result: the wound is usually healed after one week. There is always a risk of pigmentation.

Botox injections

Surgery: this is not an operation, but an injection which paralyses the muscle underneath the wrinkle. Botox affects the transition of the nerve signal to the muscle which is innervated by the respective nerve branch. Multiple injections are needed. Forehead wrinkles are often treated with Botox. Result: the result is usually very satisfying, albeit temporary. Repeated injections are necessary, but the effect will decrease so that higher doses of Botox will be needed.

Dermabrasion

Surgery: this surgery does not take long, depending on the size of the abnormalities, and is performed under local anesthesia or under general anesthesia. The abraded skin is usually bandaged with a grease gauze which can be removed quickly. After a week, the abrasion wound will be healed and the result will already be visible. Result: there is a risk of pigmentation differences. This treatment can be performed several times.

Liposculpture

Surgery: liposculpture is an improvement of the original liposuction technique. The surgeon injects a large amount of serum into the fat that has to be treated. This causes local anesthesia and stops the bleeding. This way, the surgeon is able to use very fine sucking needles and he is able to remove the fat under low pressure. Result: bruises will disappear within two weeks. The risk of irregularities is significantly lower than after the original liposuction and the surgeon can work more efficiently because he can remove a larger amount of fat without taking unnecessary risks.

Lipofilling

Surgery: the surgery is most commonly performed under local anesthesia or narcosis. The surgeon makes small incisions in the skin – preferably in an inconspicuous place – which will be hardly visible afterwards. Then he uses several tubes (cannulas) to suck the fat. Result: an infection or bleeding may occur, but is very rare. Swelling always occurs after surgery. Immediately after the operation, the patient receives an elastic bandage which firmly presses the skin of the treated parts on the substrate. This is necessary to obtain a better contour and to preserve swelling as much as possible.

Silicone implants

Surgery: silicone implants in the face are placed under general anesthesia. Facial surgeons do not use these silicone implants around the chin as this is a very movable area and the implant may sometimes get infected causing complications for the skin. Therefore, correction of the chin is preferably done by moving the bones. Implants at the cheekbones are possible, because in that area there is less pressure on the implant. In case of transgender operations, silicone implants can also be placed at the jaw angle. Results: if the right approach is taken and the implants are firmly fixed on the underlying bone contours, the results are very stable and satisfying. A perfect symmetry between the left and the right is not always possible. The scars appear in the mouth and are not visible.