GENERAL ISSUES

A head and neck plastic surgeon specializes in otorhinolaryngology and head and neck surgery or maxillofacial surgery. Most elective plastic surgeries on the head and neck are performed by specialists in this field. The specialization lasts 5 years, and the subspecialization (fellowship) of plastic surgery of the head and neck an additional two. During the training, special emphasis is placed on learning about the complex anatomy, physiology, pathology, biochemistry and bacteriology of organs and structures of the head and neck.

The reasons for undergoing head and neck plastic surgery are numerous. Some patients have an inherited problem such as deformities, hereditary tumors and the like. Other patients are victims of trauma, burns, consequences of various diseases, as well as defects caused by their treatment. Many want to improve the signs of premature aging, or change the size or shape of some facial features.

SPECTRUM OF PROCEDURES IN PLASTIC HEAD AND NECK SURGERY:
  • Rhinoplasty – nose surgery
  • Blepharoplasty – eyelid surgery
  • Facelift – removal of excess skin on the face and neck, tightening of the subcutaneous layers and muscles. Forehead and eyebrow lifting – removing rough lines and wrinkles on the forehead, as well as raising the eyebrows, has an indirect effect on the upper eyelids
  • Submental lipectomy – improvement of the chin contures, ie. removing excess fat
  • Autologous fat transfer/liposculpture/facial fat grafting)
  • Genioplast/mentoplasty – chin surgery where the projection is changed by affecting the length of the bone and/or the placement of the implant
  • Otoplasty – surgery of outstanding ears. The outer ear is moved in a position closer to the head, and its configuration is changed as needed
  • Non-invasive facial rejuvenation
  • Laser rejuvenation – removal of superficial layers of skin with the use of lasers in order to obtain smooth and less wrinkled skin
  • Chemical peeling – controlled removal of the outer layers of the skin with the help of various chemical agents
  • Dermabrasion – abrasion (peeling) of the superficial parts of the skin with the help of a diamond drill to get smooth and less wrinkled skin
  • Facial reconstruction – an operation to repair or reconstruct facial or neck defects. It includes scar revision, treatment of facial bone fractures, surgical treatment of wounds, cuts, or the consequences of injury. Furthermore, treatment of hereditary vascular tumors, reconstruction of cleft lip and palate, craniofacial deformities, orthognathic surgery, free microvascular flaps and other types of reconstructions in head and neck oncology
  • Uvulo-palato-pharyngoplasty (UPPP) – correction of snoring/sleep apnea

The safety of surgical procedures in the Polyclinic is based on the correct selection of patients for surgical procedures. This selection was made on the basis of careful preoperative planning: consultation and examination of the patient by a doctor, i. e. operator and, if necessary, an anesthesiologist

Comorbidity

An integral part of such an examination is the identification of the patient’s health conditions (comorbidity) essential for surgery. Different conditions can be a predisposition for intraoperative or postoperative complication. These factors are most commonly age, body weight, some past illnesses, diabetes, heart disease, predisposition to venous thrombosis, and some airway diseases (e.g., sleep apnea). In case of necessity, consultation and opinion of specialists of the appropriate profession regarding the patient’s ability for surgery is mandatory.

Environment

There are researches done on the topic of patient satisfaction with surgical procedures performed outside the classic hospital environment. The results show that this experience is less stressful, with a greater degree of discretion, and generally more enjoyable. This result is in line with the set goals so called. outpatient surgical institutions (policlinics). A high degree of efficiency, safety and satisfaction, with minimal disruption of the pace of life and a quick return to daily activities. Over the last twenty years or so, we have witnessed great advances in medical practice. A significant part of this improvement relates to the shift towards outpatient treatments, including increased safety of surgeries.

Precautions

However, from time to time, unwanted outcomes or side effects occur in such outpatient facilities, which draws the attention of the public and the media. When such situations arise, the questions that are asked are mainly reduced to two main ones:

  • Was it a patient who could have had more adequate treatment in a hospital setting?
  • Did the institution and its staff act as safely as possible during the medical treatment, in accordance with the rules of the profession?

Of course, no one expects an adverse outcome in an outpatient setting (policlinic or similar) in advance. If this does happen, it is usually never a simple mistake or a one-time wrong decision in a treatment or surgery procedure. Such incidents are mainly the result of several factors. Therefore, their avoidance requires complex planning, staff training, and postoperative follow-up.

Smoking affects the blood supply to the skin, and consequently slows down the healing time and increases the risk of bleeding and other complications. Although smoking does not necessarily prevent your procedure, it is imperative to have information about this factor before surgery. If you are planning surgery (especially aesthetically on the head and neck), motivate an open conversation with the operator about your smoking habits.

In some cases, the operation may/must be modified (eg the location and length of the incision may change). However, you are more likely to be advised to quit smoking a few weeks before and after surgery. Sometimes this factor is crucial for the quality success of the operation and the speed of healing.

It is definitely advisable to consider reducing or quitting smoking. There is ample evidence that smoking contributes to the formation of wrinkles on the face, especially around the mouth. Cigarette abstinence is one of the most effective steps in slowing down the aging process and maintaining skin quality.

AESTHETIC AND PLASTIC SURGERY

Question : Hello, I am interested in whether nose correction for aesthetic reasons is possible with local anesthesia instead of general, in case the patient is afraid of falling asleep during general anesthesia? Thank you very much.
Answer : Nowadays, rhinosurgery operations, aesthetic or otherwise, are performed regularly under general endotracheal anesthesia. It is the development of anesthesia that has made it possible to raise the quality of the procedure to a higher level and thus be more precise, detailed, safer and more comfortable for the operator, but also for the patient. Today’s anesthesia that we have in practice and perform in the Polyclinic in our experience is a better option with which there have been no problems so far in> 20 years of practice.

In the times before these standards were reached, operations performed under local anesthesia or variations were fast, with a lot of inaccuracy and nonexact, with excessive bleeding, but also linked with limitations such as the restlessness and non-cooperation of the patient. All this resulted in unpredictable results with non-acceptable frequency . Today, local anesthesia with sedation can be performed in some minor interventions, minor revisions, but not in primary rhinoplasty with osteotomies and other components of the operation.

The problem of fear that you often have in the background hides some fears related to the operation and outcome, so this should be borne in mind and certainly discussed in detail at the consultation because only in this way we can ensure the prerequisites for a successful procedure and mutual satisfaction.

  • Claim: The use of Botox is not safe at all.
  • Fact: Botox has been in clinical use for over 20 years. Of these, it has been approved for cosmetic/aesthetic indications (wrinkles) for over 10 years.
  • Claim: There are creams that have a better effect than Botox.
  • Fact: Topical creams act only on the surface of the skin. Botox cosmetic acts on strong muscles that are located under the skin and that affect the formation of wrinkles. By relaxing the muscles, the skin relaxes as a result, which therefore becomes smooth.
  • Claim: After the Botox injection, the “frozen” face remains.
  • Fact: Although the results of Botox injection are very quickly visible (5-7 days), your face does not look “frozen”. The activity of the muscles affected by Botox is simply significantly reduced. Ideally, there is still the possibility of frowning and other facial expressions, but without wrinkles and furrows.
  • Claim: After the Botox effect stops, the face looks different than before.
  • Fact: the effect of Botox lasts for about 4-6 months, after which the substance is gradually and completely removed from the body. The appearance of the face then returns to its initial state (as before treatment). Patients often choose regular treatment after the first application (typically 2-3 times a year).
  • Claim: Botox leaves visible changes on the skin, like some other treatments (lighter skin).
  • Fact: Botox only works on the muscles that are located under the skin. There is no barrier to application on all skin types (lighter or darker complexion) without the danger of pigment change.
ABOUT STEM CELLS

They have the potential to transform into more than 200 different cell types, normally present in our body. Fat stores in the body have been shown to be an excellent source of stem cells. They are a common topic in medicine, from cardiology, neurology, sports medicine to cosmetic surgery.

There is a lack of better quality studies or methods that would be more successful than existing ones in plastic surgery or have longer-lasting results. Despite the lack of efficiency, interest is on the rise. Such a growing trend is a combination of strong marketing and unfounded promises. Possibilities equal to or even better than traditional techniques are presented, but with the avoidance of operative incisions and shortening of the inevitable healing process.

All this leads to the need to clarify facts, half-information and unfounded views.

IN PRACTICE THERE ARE SEVERAL DIFFERENT APPROACHES:
  • Minimally invasive procedures, such as liposuction, collect fat and process it under the assumption of isolating, concentrating, and/or stimulating stem cells. Adipose tissue, “enriched” with stem cells, is injected into “strategic” locations on the face or body, with the claim that there is rejuvenation and remodeling of the skin, but also the replacement of defective or damaged tissue.
  • Another group of experts conducts such therapy as part of traditional aesthetic procedures. The results are reported within a few weeks.
  • The third goes even further claiming that stem cells are stimulated by the application of some external influence (chemical, thermal or optical tissue stimulation).

Some processes and devices that are considered to be fully automated for stem cell isolation are also in practical use. Some doctors, advertising this or similar procedures, often (erroneously) state that centrifugation and processing of fat obtained by liposuction also increases the number of stem cells, despite the lack of evidence.

INSTEAD OF CONCLUSION

Nevertheless, there are a sufficient number of experts who emphasize the need for further research into the potential of stem cells (which certainly exists) and the expected application in the practice of aesthetic and plastic-reconstructive surgery and medicine.

On the ethical side, last but not least, it is necessary to avoid unfounded marketing of “stem cell medicine” until critical knowledge and experience is gathered, so that the public can be offered useful and usable facts.

  • Question:

I am 45 years old and I have dark circles that I would like to get rid of. I successfully cover them with cosmetics, but as these products are quickly absorbed into the skin, after a couple of hours my eyelids come to the surface again. I don’t have bags under my eyes but light blue eyeshadows. :)) Since I have a light complexion and very sensitive skin prone to couperosis, I kindly ask you how to remove dark circles? How long does the treatment last, as well as the post-treatment, that is, when I am ready to go public, without perhaps seeing some bruising but a fresh and rested face. I note that I do not have a problem with eyesight, nor poor sleep and staring at the computer, but these dark circles have been with me since childhood. Greetings and thank you in advance for your reply.

  • Answer:

From your question I can assume you are talking about the problem of bluish pigmented skin. True “dark circles” are acquired during life through the process of normal aging, ie. changes in the tissues of the eyelids (skin, muscle, fat) or pathological processes and the effects of excessive exposure to UV radiation. If my assumption is correct, you most likely have a hereditary complex of thin light skin – a pronounced capillary/venous drawing. It shows through such skin and gives it a bluish pigment. Unfortunately, surgery (blepharoplasty) can affect the skin with different techniques, but it is not possible to change the quality or elasticity only surgically. This fact represents a major limitation in eyelid surgery. However, today there is a wide range of other auxiliary methods, such as chemical peels, lasers, dermabrasion and medical cosmetology, which can work in some cases like yours, with or without blepharoplasty. Each of these methods has its indications, advantages, but also potential dangers. In conclusion, careful selection of candidates for treatment is required.

OTORHINOLARYNGOLOGY AND MAXILLOFACIAL SURGERY

  • Question :

Dear doctor, I am the mother of a 9-year-old girl and I report one small problem: it is about the appearance of my daughter’s ears. It has rather deformed cartilage on both ears, and not entirely in it but more in the upper parts which are very pronounced and somehow soft and flat in comparison with the lower parts. I’ve read that this can be improved with surgery, but I’m a little scared given my child’s age, and also if the ears return to their starting position after surgery.

  • Answer :

Ear surgery in a child can be considered aesthetically functional due to the improvement of the appearance of standing or malformed ears, as well as for psychological reasons because the child is at the most sensitive age when frustration with appearance can have long-term consequences for psychological and social development. For these reasons, childhood is most ideal, when cartilage is softest. The operation aims to place the ears in the correct position and angle to the head and to get an aesthetically pleasing appearance. This is achieved by surgery that can be done under local or general anesthesia. The surgical technique consists of combining cartilage incision and placement of surgical sutures at the target sites. The rule is to operate on both ears in the same act. The sutures are removed 7. day after surgery. The child has a bandage over the ears for the first few days and then for one month just overnight. After the operation, there is a small inconspicuous scar behind the ear itself. With this combined technique, the chances of the ears returning to the starting position are reduced to a minimum.

  • Question:

I have difficulty breathing but also snoring. I was found to have a deviation of the nasal septum. Since I am not happy with the look of my nose due to the size and shape I would like to correct this. Is it possible to do this in the same surgery?

  • Answer

Very often the problem of snoring is caused by the difficult flow of air through the nose, ie. in nasal septum deviation or nasal mucosal problems. Nasal septum surgery can be done in one act together with aesthetic correction of the external appearance of the nose. However, other possible causes of snoring must be ruled out before deciding on surgery. These include e.g. long palate, enlarged tonsils (tonsils) or loose palate (uvula). These problems can also be solved with relatively simple surgical procedures.