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Each year the number of individuals who undergo cosmetic surgery increases at an incredible rate. The social and economic influences which place emphasis upon "appearances" are quite evident at both ends of the age spectrum. Younger people seek peer acceptance; older people face their own challenge in maintaining positive attitudes for an extended time.

Cosmetic surgery can truly satisfy many needs and often will provide that extra measure of inner confidence which may otherwise be difficult to achieve. It requires no apologies and is understandably well accepted in all circles. It is however, not the answer to all of life's problems. The purpose is to "improve" one's appearance as much as may be possible. It can do no more, and if you are expecting a transforming miracle, you will undoubtedly be disappointed.

Most patients understand these limitations and view the potential benefits realistically. Under these circumstances, the true objectives can be accomplished and yield final results that are predictably accurate. The surgical procedures have been repeated successfully thousands of times and are dependable when executed by experienced surgeons.

The decision to undergo any surgical procedure is one which must be made by the patient alone and should not be undertaken solely at the suggestion or encouragement of others. On the other hand, well-meaning friends or relatives sometimes misinterpret the patient's desire for assistance and express negative attitudes without basis. An understanding that improved self-confidence is the essential need will, however, lead to a supportive position by those whose interest is truly in the patient's behalf.

My role will include functions of technical adviser and counselor. Appraisal of the patient's motivation and his or her sense of realism toward anticipated results will at times lead me to conclude that the benefits of any surgical procedure may be questionable. This might be true regardless of anatomical improvement. Under these circumstances, solution to the patient's difficulty must be sought elsewhere.

In the discussion of each subject the significant surgical risks or potential hazards have been included. While these vary to some extent, the underlying mechanisms of bleeding, infection, compromised soft tissue circulation, and poor scar formation are quite similar. No attempt has been made to review every remote possibility since this would be quite confusing and provide no real basis for intelligent conclusions. The overall risk of any surgical procedure including anaesthesia (e.g. clots in the leg veins that can rarely travel to the lungs) must, however, be considered by every patient. Omission of these details does not suggest that they are of lesser significance; quite to the contrary, these are always present even with minimal procedures, but are beyond the scope of this brochure. Essentially, these hazards are the same for all surgical operations.

In contemplating any corrective surgery, the patient need not be apprehensive or approach any procedure with fear. With present methods of anaesthesia, there will be no pain during any operation and usually only moderate discomfort for a short time afterward. These details are described as they relate to the various subjects discussed in the brochure. My personal attention will be directed to all of the important details, and every effort will be made to obtain the best possible result.

Surgical considerations

In the performance of all surgical operations, there are fundamental principles which are observed before, during, and after each procedure. These are all directed towards the achievement of optimum healing by correcting or controlling co-existing medical problems in any given situation.

In the case of cosmetic surgery , a significant advantage is the good physical health with which most patients begin. They do not require many of the preoperative studies necessary in other fields where elimination of a disease condition is the primary objective. At the same time, however, the need to improve upon natural conditions demands attention to every known detail of the healing process. Scar tissue, the normal end point of all healing must therefore be carefully cultivated and at the same time controlled or minimised - a difficult task indeed to be accomplished at all times.

Complete removal of scars is impossible since it is the body's natural response in the healing process. At best, one can minimize unfavorable scar development by eliminating all of the known obstacles to primary healing. Planning surgical incisions within normal tension lines and natural skin folds will be advantageous, as will meticulous careful surgical wound closure techniques. It is not possible, however, to predict the character of final healing with complete accuracy. It should also be noted that complete healing for most scars will require a minimum of six to eight months. Under some circumstances, final healing may require twelve months and possibly longer.

Every patient must play a part in his or her own treatment program by adhering strictly to post-operative instructions. This is equally as important for the achievement of the best results as is excellent performance on my part. The demands of reparative surgery require attention to all details when improvement of nature's own healing process is required. Simple wound healing alone may not be sufficient to accomplish superior results. Although a patient's general condition may not be physically compromising after a surgical procedure, protective dressings and voluntary restriction of activity during the early healing process may be desirable to promote optimum results. The pursuit of perfection, therefore, demands cooperation on the patient's part in adhering carefully to postoperative instructions.

The use of antibiotics and the development of various non-reactive materials has widened the scope of living tissue substitutes in corrective surgery. While use of bone, cartilage and muscle tissue for repair of structural and contour defects can be considered first choice; practical considerations may permit use of non-reactive substitutes in selected situations. Antibiotics and the observance of careful technical details permit a wide range of such procedures in cosmetic and reconstructive surgery (chin, cheek, orbit and breast implants) with a high degree of safety - however, some potential for failure still exists.