Cosmetic surgery 1985

Rhinoplasty is the most popular ofall cosmetic surgical procedures. The nose may be considered to require an overall reduction in size, or surgery may be sought to correct the shape ofa normal sized nose-for example, if there is a large dorsal hump or the nose may have been damaged and either be crooked or have a depressed dorsal profile, possibly also with nasal airway obstruction. The surgeon must understand exactly what the patient is requesting before undertaking surgery, and preoperative photography may well help in this instance. The other important point to explain to the patient is that, although the surgeon's skill is important in the final outcome, so also is the way in which the patient's tissues heal. This is particularly important in the way a nose tip finally takes up its shape.

Reduction of the abdmen
It is not known why some women who have multiple pregnancies can retain almost the same contour to their abdomen as they had in their younger days when others after a single pregnancy develop excess folds of skin that becomes thin and deeply marked with striae. At the same time excess adipose tissue may accumulate and the recti muscles become divarificated. Once such patients have undertaken to lose weight the incsion situation can be greatly improved by excising the excess abdominal skin.

Body contouring operations
Obese patients are best served by initial weight reduction followed by surgical excision of the excess skin. Skin and fat are sometimes in excess in the upper arms and the thighs. After weight reduction excess skin may drape off the upper arms and in some patients may present a distressing deformity when the patient abducts the arm to show two empty bags of skin. This excess skin can be excised, but the resulting scars are extremely unattractive and usually require the patient to keep this area permanently covered. The procedure, however, allows closer fitting clothes to be worn.

Reassignment of gender
There are an estimated 10 000 transsexuals in the United Kingdom, of whom about 1000 have received surgery ofone form or another. Team management is required for this and is usually based around the psychiatrist to whom the patients are referred in the first instance. Initially, the patient has to live in the role of the new gender for at least two years, totally for the final year. This period may be reinforced with hormone treatment. At the same time, patients, particularly men becoming women, are instructed in the attitudes and mannerisms ofthe new sex so that they can fill the role more successfully.

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