We summarize some of the frequently asked questions and our answers and explanations.

General

The head and neck plastic surgeon specializes in otorhinolaryngology and head and neck surgery or maxillofacial surgery. Specialists in this field perform most elective plastic surgeries on the head and neck. The specialization (residency) lasts five 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.

Anatomy of the head and neck
Anatomy of the head and neck

The reasons for undergoing head and neck plastic surgery are numerous. Some patients inherit 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.

PROCEDURES IN PLASTIC HEAD AND NECK SURGERY:
  • Rhinoplasty – nose surgery
  • Blepharoplasty – eyelid surgery
  • Facelift – removal of excess skin of 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 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)
  • Genioplasty/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

We base the safety of surgical procedures in the Polyclinic on the correct selection of patients for surgical procedures. This selection includes careful preoperative planning. It is mainly consultation and examination of the patient by a doctor and, if necessary, an anesthesiologist.

Comorbidity – Risk estimation

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 can be predisposition to venous thrombosis. Hereby we also check if there are 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.

The organisation of the facility

There are researches on the topic of patient satisfaction with surgical procedures 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 of 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 witness great advances in medical practice. A significant part of this improvement relates to the shift towards outpatient treatments, including increased safety of surgeries.

Precautions and risk management

However, from time to time, unwanted outcomes or side effects occur in such outpatient facilities. This draws the attention of the public and the media. When such situations arise, the questions that we ask 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? Is it 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. Consequently it 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, surgeon needs to modify the operation may/must. For example, 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

An interested patient asks the question: I wonder if nose correction for aesthetic reasons is possible with local anesthesia instead of general anesthesia. I am asking that in case the patient is afraid of falling asleep during general anesthesia. Thank you very much.

Our response: Today, we regularly perform rhinosurgical operations, aesthetic or otherwise, 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. Thus it is 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. 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. It used to be with a lot of inaccuracy and non-exact, with excessive bleeding. Also it was 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 and/or revisions. It is not typical for 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. We should keep this in mind and certainly discuss in detail at the consultation. Only in this way we can ensure the prerequisites for a successful procedure and mutual satisfaction.

Question: Hello, my 16-year-old daughter has been unhappy with the appearance of her nose for several years. She also has difficulty breathing due to deviation of the nasal septum. Please let me know if she is a suitable candidate for surgery.

Answer: Dear Madam, thank you for your inquiry and the pictures of your daughter’s nose.

If it is a deformity of the nasal septum, then the patient’s complaints in terms of difficulty breathing and other complaints are crucial factor in reaching decision to the surgical treatment.

As for the aesthetic component, we have a slightly different way of thinking.

Although the age of 16 is in theory already suitable enough to consider performing nose surgery in the female gender, in these situations we also have other factors that are just as important as the anatomical anomaly itself. Namely, almost as a rule, it is a psychological immaturity that is still present in puberty or post-puberty age. Minors very often have a relatively difficult time coping with the prolonged postoperative course, and it is especially difficult for them to objectively understand the potential possibility of surgical complications. In your question, you didn’t explain what bothers her the most about her nose, but I assume it’s the large size of the entire nose. If I am right about your daughter’s idea, then you should know that nose reduction surgery is one of the most demanding in nose surgery, which, in addition to reducing the external appearance, also reduces the breathing space (which is already problematic for her due to the septum or some other unusual situation inside).

In any case, I am available for consultation and clinical examination. It is the necessary and the single most important step in the decision to perform the operation.

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. The claim is 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.

autologous fat transfer
Transfer of own fat through nano fat technology in the operating room
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). The expected application in the practice of aesthetic and plastic-reconstructive surgery and medicine is also in view.

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

Otorhinolaryngology and maxillofacijal 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. I see changes 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. I’m a little scared given my child’s age, and also if the ears return to their starting position after surgery.

  • Answer:

Otoplasty 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. 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 wears 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 the difficult flow of air through the nose (in nasal septum deviation or nasal mucosal problems). We can do nasal septum surgery in one act together with aesthetic correction of the external appearance of the nose. However, we must rule out other possible causes of snoring before deciding on surgery. These include e.g. long palate, enlarged tonsils or loose palate (uvula). We can solve these problems with relatively simple surgical interventions.