Cosmetic Surgery 101
-Win Pound, M.D.
In its most basic form, cosmetic procedures deal with volume versus loose skin. The volume may be too much, as in fat deposits of the stomach, hips, or thighs or breasts that are too large. In this case, the volume needs to be reduced. If there is too little volume, such as depressions in the face or loss of volume in the breasts following weight loss or pregnancy, volume must be replaced.
In some cases, age or weight loss may contribute to so much loose skin or skin that is of poor quality (such as with stretch marks) that the problem cannot be corrected with the simple addition of more volume. In this case, tightening of the skin may be the best option, with or without the addition of more volume.
Removing volume works best when there is good skin elasticity over the involved area. Skin does not spring right back but requires a period of time to tighten. In the case of liposuction, I tell patients that they may not see their final results for as long as three to six months, even longer if SlimLipo or SmartLipo are used.
Adding volume can be done with commercial fillers or the patient’s own tissue. Commercial fillers tend to have a limited life span, usually ranging from six months to slightly over a year before they need to be replenished. While the patient’s own tissue may be more long-lasting, it is also less predictable as far as how well and how much of it will survive transplantation.
Back in my dad’s era, fat was considered bad stuff that we wanted to get rid of. Now it is one of the best resources for adding volume, whether to the face or the breasts and buttocks. The good news is that the fat that survives should last a lifetime. The bad news is that fat is living tissue and grows like living tissue. If, for example, you take fat cells from the abdomen, transfer them to the lower eyelid area, and later gain a significant amount of weight, the transferred fat cells will grow just as they would if they were still located in the abdominal area. This could lead to fullness in the lower eyelid area as well.
Sometimes a combination of skin removal and volume replacement is in order. A breast lift with breast implants is an example. A facelift with fat transfer is another. While there are exceptions (for example, nose surgery or pinning back the ears), at the end of the day, most cosmetic surgery procedures revolve around volume (too much or too little) versus excess skin.