Nikolay Milanov plastic surgeon, academician of the Academy of Medical Sciences, Honored Scientist of Russia, Professor, Director of the Plastic Surgery Clinic of the University Hospital of the First MGMU them. Sechenov.
Almost all the plastic surgeries that we do now, have been developed in the early twentieth century. Those new that appeared recently — only slightly more advanced varieties. For instance, the development of technology, surgeons were able to handle loops at comparable power microscopes. It has become easier, but the essence has not changed. Plastic surgery is conservative, and that’s fine, because it insures us against hasty methods. However, some progress is evident. Get at least a hernia of the lower eyelid. Previously, it was believed that it is necessary to excise the subcutaneous fat. And now it turned out that this leads to the formation of dips under the eyes. Tear trough becomes more pronounced, that the old patient. Now, we recommend not to remove and redistribute adipose tissue — instead of bags under the eyes the patient receives high cheekbones.
There is a new concept — the «architecture of face.» The surgeon must not only solve the problem, but also to anticipate the consequences operation will in a few years — to play the lead. We’re not canceling aging — simply change its appearance. For instance, 40-year-old patient concerned upper eyelids: they fell, his face has become tired. You can only operate on them, and it will leave happy. But the doctor must look to the future. Over time, the lower eyelids appear hernias, midface and will fall more evident, contrasting with toned upper eyelids. Given all this, the surgeon may suggest the patient to make such an operation, which would delay such changes. Of course, it is advantageous that it came after two years, then another and another. But the doctor is obliged to think first about the patient, not your wallet. We’ll get me to understand this on a national scale? Tomorrow — no. Hopefully, the day after tomorrow.
«The architecture of the body» — is also a new concept. Imagine appointment comes complete patient with large breasts, asking to put implants to give it shape. An inexperienced doctor attached — is a breast, but now bulging belly: before the operation is not obvious. The woman comes back to reduce the fat on the belly — as a result of the shoulders begin to seem wider. The third step, the third anesthetic … It would not be if the surgeon could feel and think in terms of the proportion of the architecture of the body.
Lipofilling (volume replacement using patient’s own fat) to rehabilitate themselves. Once surgeons have tried to transplant fat from, say, thighs or buttocks in the lower leg. But fat quickly absorbable or solidified. Now, before you enter the fat to a new location, this plot is enriched by platelets and fat survives. In fact, at the disposal of surgeons now have a natural non-absorbable filler. It can be administered in the cheeks, the back of your hands — in areas where not enough volume.
Surgeons must learn to think before surgery solutions to the problem, the pros and cons of each.
And inform the patient: «After this operation, you will recover at least two months, but the effect will last up to 10 years. After this operation a week later you come to work, but after a year will have to have surgery again. » It is necessary that the doctor had all the means, not two or three «favorite», and was not afraid that the patient will take a more sympathetic surgeon.
Patients should stop believing in exclusive. In plastic surgery, exclusive — a synonym for a dangerous, untested. Advertisement «unique implants, created just for you» — is nonsense. The company that manufactures prostheses, is interested to sell them as much as possible. But patients the word «exclusive» is mesmerizing. They agree to the implantation of prostheses neoprobirovannyh. And then they come and ask to remove them.
Computer modeling thing of the past. And it pleases. Very often, the doctor showed the patient a new nose on the screen, and that in the end it does not work — all ended in disappointments courts. No one can predict how the operation will take place, how the wound will heal, how to behave in the bone tissue. Computer model — a help for the doctor means by which to estimate the different options if he lacks experience. The patient should not entertain illusions that it will look as planned computer.
We are working on a draft law under which the treatment of complications after surgery, the clinic will take on, free of charge.
No one can 100% guarantee that the surgery will take place without any problems. The patient should know about it. Meanwhile, treatment of complications sometimes costs a patient more than the surgery itself. This is absurd.
The use of stem cells in plastic surgery will be mass-but certainly not tomorrow. Tomorrow is likely to continue research in this direction — and machinations. Scientists are still arguing about what may well turn into stem cells if they are to plant in a particular organ. Some believe that they will become the cells of the body. Others — this will cause the uncontrolled growth of cells in the body and lead to the development of cancer. While this issue is not resolved fundamental science, practitioners should not experiment on patients. In solving some problems — for example, when filling bone cavities or build bones — the use of stem cells justified. But to grow them from the new skin or a new face of science still can not -and should not this promise.