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Scar prevention, treatment, and revision

Synopsis ■ Mammalian skin healing is a complex orchestrated process that results in scar formation. Scars are problems that arise in all areas of aesthetic and reconstructive surgery. As scars can cause a huge psychological and physical burden for patients, they pose a significant challenge for even the most experienced surgeon. Thus, the prevention and treatment of scar formation is vital to achieving acceptable patient satisfaction…

Wound healing

Access video content for this chapter online at Elsevier eBooks+ Introduction Wound healing is a dynamic, complex process that is essential for survival. Derangements in wound healing, either due to incomplete healing or excessive healing, are a source of significant patient morbidity and possible mortality. Millions of people worldwide suffer from severe, non-healing wounds, and billions of dollars are spent annually on wound treatment. Improving our…

Principles of cancer management

Synopsis ■ There has been a gradual progression from radical to more conservative resections of many cancers. ■ While surgery remains the most successful single modality treatment for solid tumors, recent advances in multimodal therapy have improved outcomes. ■ Neoadjuvant therapies have facilitated tumor extirpation and can downstage some tumors. ■ Targeted therapies represent a new paradigm in the treatment of cancer combining efficacy and decreased…

Health services research in plastic surgery

Synopsis Health services research (HSR) in plastic surgery takes a broader view of outcomes and delivery of care than traditional clinical research. As attention turns to equitable access and health, the role of insurance coverage, out-of-pocket cost, quality of care and patient-reported outcomes will be central to future research. In this chapter, methodologies that investigate these domains will be introduced with examples and key considerations for…

Patient-reported outcomes in plastic surgery

SYNOPSIS Patient satisfaction and health-related quality of life are essential outcomes to consider in addition to traditional clinical outcomes (e.g., flap survival, postoperative infection, length of hospital stay) for many plastic and reconstructive surgery procedures. Patient-reported outcome measures (PROMs) are valuable tools for evaluating the benefits of treatments and newly developed surgical techniques. PROMs developed using modern psychometric methods, such as Rasch Measurement Theory, represent highly…

Evidence-based medicine and health services research in plastic surgery

Synopsis The key take-home messages from this chapter are how to: Gather existing evidence on outcomes Interpret evidence on outcomes Design new studies to add evidence on outcomes Synthesize existing evidence, as in systematic reviews and meta-analysis Recognize the importance of an essential dimension of evidence: the patient’s and the third-party payer’s perspective Consider the cost dimension in achieving outcomes Understand the challenges and approaches in…

Anesthesia and pain management in plastic surgery

Introduction Pain management before, during, and after any procedure is a key component to successful outcomes in plastic surgery. Consistent patient satisfaction hinges largely upon favorable impressions and recollections of the surgical experience. As such, patient satisfaction and pain management protocols must be effective, dynamic, multimodal, and customizable. Pain is a self-reported, complex, and subjective experience commonly defined as an unpleasant sensory and emotional experience due…

Patient safety in plastic surgery

Introduction “Patient safety” refers to the healthcare discipline that strives to reduce the risk of medical errors and harm to patients receiving medical care. The World Health Organization (WHO) estimates that adverse events due to unsafe medical care is one of the top ten causes of death and disability in the world. Adverse events in healthcare affects patients in low- and high-income countries alike, as a…

Pre- and intra-operative imaging for plastic surgery

Access video and video lecture content for this chapter online at Elsevier eBooks+ Introduction Healthcare costs in the United States have steadily been rising, and medical imaging has been no exception to that trend. From 2000 to 2006, Medicare spending on medical imaging more than doubled, with an average annual increase of 13%, as opposed to 8.2% for all other Medicare services during the same time…

Digital photography in plastic surgery

SYNOPSIS Photography is not only useful, documentary, collaborative, didactic, medicolegal, a research tool and even promotional – it is standard of care and a sine qua non for proper practice in plastic surgery. Our specialty is highly visual and relies on accurate representation of form, as well as function, to diagnose, plan, treat, evaluate, and track patient surgical outcomes. The photographic record contains much more information…

Value-based healthcare

Introduction Over the past few decades, healthcare costs in the United States (US) have risen considerably faster than gross domestic product (GDP), wage growth, and inflation. In 2017, the United States spent nearly 18% of GDP on healthcare, nearly double that of any other industrialized country. The causes of this trend are undoubtedly multifactorial and encompass high unit prices, an aging population, administrative complexity and costs,…

Business principles for plastic surgeons

Synopsis ■ This chapter provides a broad overview of the essential principles that characterize what a business does and how a business does its work. ■ The ability to apply business concepts is of paramount importance if plastic surgeons are to become and remain leaders in healthcare. ■ Plastic surgeons should understand and use strategy, accounting, finance, economics, marketing, and operations to help guide decisions about…

The role of ethics in plastic surgery and medico-legal issues in plastic surgery

Introduction Consideration of topics pertaining to ethics in the field of plastic and reconstructive surgery is frequently provocative. With ongoing clinical, technological, and interpersonal evolution, and the emphasis on innovation that drives this specialty, one may assume that new decision-making quagmires will constantly arise. This situation is only compounded by the novel ethical issues created by a specialty that is, for better or worse, often driven…

Applying psychology to routine plastic surgery practice

Introduction Until now, research on the psychology of plastic surgery has coalesced around two main themes; firstly, the motivation to undergo appearance-altering surgery, and secondly, the prevalence of psychopathology in the population of prospective patients. Findings have been contradictory and difficult to apply in routine practice. Progress in improving understanding has been hampered by the lack of data in this sector, however, recent studies of the…

History of reconstructive and aesthetic surgery

Synopsis ■ Closure of wounds represents one of the first gestures of reparative surgery. ■ History shows that almost every possible local flap has been described in the past and that the ingenuity of plastic surgeons was unlimited. ■ The lesson drawn from history reveals that the so-called new flaps are variations of what has already been published. ■ We have to be humble and recognize…

Plastic surgery and innovation in medicine

Access video lecture content for this chapter online at Elsevier eBooks+ Introduction What is different about plastic surgery compared to other areas of specialty practice? I pointed out in the last edition of this textbook that plastic surgeons do not own a disease like oncologists do, or a body part like heart surgeons do. We do not concentrate on a system like orthopedists or urologists do,…

Board and Fellowships Exams

Introduction The fellowship or boards of plastic surgery equivalent exams are the final trial by ordeal for most trainees, who will have faced exams over a large portion of their adult lives. Their respective examining boards put together the general structure of all four exams with the aim of presenting a safe surgeon who has adequately covered the entire plastic surgery curriculum. This is perhaps the…

Abdominoplasty and Body Contouring

Anatomy An excellent knowledge of the entire anatomy of the lower trunk and extremities is essential for esthetic and reconstructive skin-tightening procedures. In addition to knowledge of the main perforating vessels, the course of important nerves is mandatory to avoid postoperative complications. Furthermore, the knowledge of Langer’s lines (relaxed skin tension lines) is crucial for the best possible scar development. Skin Abdominal skin and fat tend…

Liposuction and Liposculpture

Introduction Liposuction and liposculpture represent the evolution of minimally invasive plastic surgery techniques developed in an attempt at restoring shape and form. Liposuction was first described in the 1920s but it was not until the 1970s that the technique was popularized in Europe by Illouz, Fournier, and Otteni whereby fat was harvested using a blunt cannula and aspirated using negative pressure. Prior to liposuction, fat was…

Blepharoptosis

Definition Blepharoptosis is defined as a lower than normal position of the upper eyelid in relation to the globe and pupil. The term is often abbreviated to ptosis. The upper eyelid normally covers the upper 1–2 mm of the cornea, but this tends to increase slightly in old age. As the cornea has a diameter of 11 mm, the distance from the upper eyelid margin to…