Cosmetic Plastic Surgery Spain Trends

The demand for certain procedures in cosmetic surgery changes from year to year, and techniques develop.
To keep up with new trends, the American Society for Aesthetic Plastic Surgery (ASAPS), the leading national organization of board-certified plastic surgeons who specialize in cosmetic surgery, publishes its predictions for cosmetic surgery for the coming year, publish their predicition of trends yearly, and of course also for 2011.

These predictions are based on patient questionnaires as well as interviews with surgeons who are chairing the countries leading academic Plastic surgery departments.
They are also influenced by publications in relevant scientific literature.
This expose is a very valuable predictor both for patients and surgeons working in the field of aesthetic surgery.

These forecasts have shown to be very reliable in recent years.

For me the most interesting trends for cosmetic surgery in Spain trends are the following:

1. The society foresees that demand for facelifts and other facial rejuvenation surgery will increase.
This is a relativeley easy prediction since growing age in the overall population will always fuel facelift surgery numbers.
Recent techniques with less invasive procedures have made the procedure regain popularity.
Non-surgical facial rejuvenation procedures will also see some growth, and I believe they will continue to do so in the coming years.

2. Our population is more and more aware of the dangers and health consequences of obesity, and the number of patients seeking plastic surgery procedures for body contouring after dramatic weight loss (abdominoplasty, lower body lift, upper arm lift, etc.) will rise in 2011.

We have seen a steady increase in such surgeries in the last years, with specific demand for combined body contouring procedures (so called „mummy makeover“).

In this kind of surgery, an abdminoplasty(tummy tuck) is usually combined with a breast surgery procedure, usually breast augmentation with or without breast uplift.
Other combinations are possible and frequent.

Recent publications have clearly shown this to be a safe procedure for a skilled surgcial team and patient satisfaction rates tend to be signifcantly higher as compared to single stage procedures.

In our own publication of 132 cases,the second largest series published worldwide so far, we have seen the difference in patient satisfaction to be nearly 15 % in favour of the combined group.
With weight loss procedures on the rise, this trend will likely continue both in Europe as well as in the U.S.

3.Breast implants, the second most popular cosmetic surgery in Spain (and worldwide), will continue to grow.
This year many baby boomer women who have aging implants and/or breast ptosis will replace their implants and have breast lifts.
In my department, we have also seen a marked increase in demand for non-implant breast augmentation, mainly Macrolane and fat transfer.
Our Macrolane (non surgical injectable breast augmentation) numbers have doubled in the last six months and we believe this trend will continue.

4. To my assessment buttock augmentation with fat transfer (“Brazilian butt lift”) will be one of the most popular procedures in coming years.
In our department , we currently see a dramatic increase in demand for this kind of surgery, which relies on transplanting fat , usually from flanks and thighs, to augment the buttocks.
The procedure has seen great advances enhancing the survival of fat grafts in recent years, and will continue to do so in the future.
Recent advances in fat transplant technique have made the procedure more predictable and reliable.
It requires a lot of experience in tissue transfer to do the procedure correctly, but I think that the rates of patient satisfaction are really worth it.
I think that the secret of success in this procedure that patients somehow have the feeling to “kill two birds with one stone, since harvesting of the fat, which is done by liposuction with special cannulas, results in some good toning of abdominal and hip areas.

5. As the popularity of non surgical and minimally invasive procedures continues to grow, surgeons and manufacturers will develop new techniques and products that advance the science, produce even better results and lessen recovery time.
This will of course continue in 2011.
In our department laser liposuction is currently an innovative technique which we develop with great enthusiasm.

The quality for Plastic surgery research has steadily increased in recent years and will continue to do so in 2011.

Reproducible data and quality documentation will increase consumer safety and satisfaction.
Patients will be able to rely on reproducible data and less on self declared „artists“.

Following the trend in increased consumer sophistication patients will increasingly want to know if the latest procedure and device being touted on the internet and TV talk show really works and if it is safe.
By incorporating evidence-based medicine into the core specialties of plastic surgery, we will make it easier for both doctors and patients to determine fact from fiction.
This will raise quality in cosmetic surgery in this and coming years.

Mommy makeovers

Currently, we observe an impressive increase in demand for so called “mommy-makeover” surgery. Mommy makeover is the usual terminology for the combination of two body contouring procedures, most popular are the combination of breast augmentation/uplift surgery and tummy tuck (Abdominoplasty).

Choosing the right implant in breast augmentation

In my opinion, individuality is the key to success in any kind of aesthetic surgery, and also for breast augmentation.
There is no one-size-fits-all implant. There are different types of implants for breast enlargement that come in different sizes.
Preferences vary amongst patients one patient may like what the other one may not.

In the South of Spain, I work in an environment where patients will spend half of the year on the beach, and good implant size correction is of utmost importance.
Most of our patients are eager to have scar free minimally invasive breast augmentation surgery, and natural fat transfer breats augmentation has become one of our most frequently performed operations.

Fat transfer breast augmentation is our procedure of choice for all patients who are suitable, this means who have at least one problem zone fat tp spare.
Removing this problem zone together with the breats augmentation does significanlty increase patient satisfaction.

However, not all patients wanting breast augmentation have such extra fat.

When using implants, I generally use cohesive silicone gel implants. Cohesive means that the gel is stable, and no evacuation of fluid can occur.

I do not regard saline implants as indicated for any breast , at least not in my practice.

There is no substitute for accurate measurements. The size of an implant is just one aspect, but form and projection are equally important for a perfect result.

Another important factor is skin laxity or looseness. To achieve successful augmentation, you must have enough tissue to cover the breast implant. It is also important to make sure your breasts are even.

My experience, and other surgeons seem to share this, is that patients tend to rather err on the conservative side, meaning that it is very common that patients go for bigger implants later rather than for smaller ones.

Volumetric facelift: modern facelift surgery with less scars

There are many types of facelifts.
Every surgeon may have different preferences, but more importantly not every facelift is the same.

The vast majority of facelifts in my department are done with the so called scar sparing (MACS) technique (although not every facelift candidate is advisable for this).

Not only my, but I think the ideas of the majority of Plastic surgeons have changed in recent years , and the trend is going to less invasive procedures and most importantly, have changed from mere stretching to an understanding of volume loss.

When patients come to my Marbella practice for a facelift consultation, I normally ask them to bring me a photo showing themselves at closer range 10-20 years ago.
One nearly always sees that over the years they have lost volume in the midface (a normal effect of aging). There are some exceptions of this rule, but really not that many.

Every aging face does also show frequent areas of skin sagginess (mostly skin and jowls).

We do therefore work a lot with volume restoration in the face together or instead of a facelift.
All patients seeking facelift surgery benefit from that, sometimes together with a facelift, but sometimes even instead of facelift.

In cases of marked nasolabial folds I prefer to restore facial volume with fat grafts (the Bod Jet hydrosurgery technique has made this a very quick and reliable procedure) instead of surgical facelift.

Patient satisfaction with that is very high, and togheter with endolaser (Smartlipo) treatment this combination can make surgical facelift indeed unnecessary.

If an additional surgical facelift is required, volume restoration with fat grafts makes the result significantly better, and helps to keep scars shorter.

Should you require some more extensive information on this procedure, either in the Department of Plastic Aesthetic and Reconstructive Surgery at Hospital Quiron Malaga or in Cirumed Clinic Marbella please contact us.
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Scar free facelift: Voluma

The working mode of the Voluma facelift is reshaping of ptotic facial soft tissues.
In short terms, the technique works in the following way:

Usually I take a fat graft , usually from the abdomen. Fat grafts have historically been a very troublesome and lengthy procedure, requiring extensive centrifugation of grafts.

The Body Jet technique, which uses a waterbeam irrigation suction system to harvest such fat grafts, has changed this dramatically, and has converted fat grafting into a very swift and straightforward procedure. With the Body jet technique graft take rates are excellent.

In areas of saggy skin, mostly the nasolabial folds and the neck, we add the Smartlipo technique, which is able to add some significant skin retraction of about 25%.

The whole voluma facelift procedure takes about one hour and is done under local anesthetic.
Pateints can go home immediately afterwards. There are no scars.

In my current practice, about 50-60 % of patients wanting a facelift are suitable for this technique, and , in fact, I find that satisfaction rates of these patients are somewhat higher than with „conventional“ facelift techniques with scars.

Should you require some more extensive information on this procedure, either in the Department of Plastic Aesthetic and Reconstructive Surgery at Hospital Quiron Malaga or in Cirumed Clinic Marbella please contact us.

Modern, minimally invasive liposuction

Modern liposuction techniques are mainly the Body Jet liposuction technique (water jetstream assisted liposuction) and laser liposuction (also known as Smartlipo).

Other alternatives exist…………we have extensively road tested all of them, but these two techniques are by far the best.

We mostly combine these two liposuction techniques , especially in cases where patients want removal of larger quantities of fat, the Smartlipo with Body Jet body sculpting is ideal.

The combination gives the best possible result: Body Jet is a very precise water jetstream device with simultaneous irrigation and suction.

For the surgeon it is great to work with because it is very precise.
With jetstream liposuction it is no longer necesssary to inject large volumes of fluid such as in “conventional ” tumescent liposuction.
Body contouring with Body Jet is very precise and the rates of postoperative irregularities are about 20 times less than conventional liposuction.

The Body Jet liposuction procedure is virtually bloodless and large volumes of fat can be removed in a comparably short time.

Body Jet liposuction does also offer the massive advantage that it can be combined with a lipocollector filter system to harvest a top quality fat graft, which in our Marbella practice is mainly used as a facial filler and for breast augmentation.

Breast augmentation: Implants versus fat

Different patients request different options, and a solution which is desired by one patient may not be so good for another patient.

This does not only apply to breast augmentation, but also to all other types of cosmetic surgery.

There is no precut recipe which applies to all patients, therefore we suggest to take sufficient time to discuss in depth all options between surgeon and patient.

In my practice, we have seen a major change in breast augmentation with introduction of the Body Jet fat transfer system.
This technqiue has solved most or the problems that we have seen with fat transfer breast augmentation in the past.

Less volume is lost during harvest, the „take“ rates of the fat exceed 70-80%, there is no interference with mamograms and the procedure is safe and easy to perform under local anesthetic.

I regard it as ideal for all patients who have fat to spare elsewhere, and in fact the treatment of such „problem zones“ seems to add significnalty to patient happiness.

However, there is alsways a certain number of patients who have no fat to spare, and for those silicone gel implants remain the best option.

I have developed a certain faible for microtextured impalnts, which give a more natural feel especially in very thin patients.

Breast enlargement without implants

Autologous fat transplantation

The one of the dreams of Plastic surgery, and like most surgeons (at least the ones that I talk to) is the future of Plastic surgery.

Take the patient´s own (autologous) fat from somewhere else and inject it for breast enlargement (or buttocks or face.
In the past, this has been a very troublesome procedure since it was very time consuming suctioned fat for transfer, and the survival rates where somewhat unpredictable.

This technique has experienced a major boost lately with the introduction of the Body Jet transfer system, which is a special,water assisted liposuction system.
This enables atraumatic harvest of fat without destroying single fat cells,and is currently the only fat transfer breast augmentation technique with guaranteed success rates.

In our practice, Body Jet assisted breast augmentation with the patient´s own fat is currently our procedure of choice for the greater part of patients seeking breast augmentation already.

In comparison to the classical centrifugation techniques (like the Coleman technique), the Body Jet is significantly superior both in handling as well as success rate.

They main difference between the two philosophies is that the Body jet technique puts emphasis not to damage the fat during harvest and manipulate it as little as possible afterwards, since every manipulation of the fat will decrease survival.
Our data suggests that about 90% of fat cells survive the harvest process and are therefore excellent for survival.

In contrast the centrifugation techniques are more traumatic and leave only aboput 5-10% of fat cells alive, which do then undergo lengthy preparation processes.

In our experience take rates of fat with the Body Jet technique are somewhat 10 fold higher.

Most importantly, the Body jet procedure has made the procedure quicker and more cost effective for patients, since it is no longer necessary to waste hours of theatre time with the harvest and preparation process.

That does also make the Body jet natural breast augmentation techniquemuch more cost-effective for patients.

Gynecomastia

Whilst it is difficult to verify exact statistics, it seems that gynecomastia (male breast reduction) is the most frequent request for cosmetic surgery among males, competing with liposuction and rhinoplasty.

There is a multitude of reasons for the condition, we have clearly identified a few drugs causing it, I personally see increasing numbers of steroid abusers.

Other common culprits causing gynecomastia are a couple of antihypertensive drugs, hormonal problems, and often, simply genetic predisposition to gynecomastia (in other words bad luck).

What is the ideal age for operating a gynecomastia?

There is none because the problem can occur at very different ages. Depending on the cause, the ideal age is when the condition becomes unbearable for patients. The most difficult question is normally what to do with young patient. Whilst cosmetic operations on miors are obsolete, gynecomastia is not strictly cosmetic and psychological distress can be unbearable.

Under these circumstances psychological distress for patients may well be unbearable and needs relief.

Does social insurance pay for gynecomastia ?

That depends. Some insurers, at least in Spain, accept grade II+ grades as medical indications. This reflects my opinion as well, certain degress of gynecomastia are rather resonstructive by nature than cosmetic. Not all insurers share my opinion though.

In Spain the majority of cases are treated outside the social insucrance system,

Can gynecomastia be solved by liposuction alone?

In selected cases yes.

In most cases resection of breast gland will be necessary.However, this depends always of the individual case.

As a rule of thumb, being deliberately vague, one can say that the older you are the more fatty tissue you will find and the more likely liposuction alone will be successful. However, we do not use “classical” liposuction” anyway. Both myself and all other surgeons of my team seem to find this a rather traumatic and outdated technique.

In gynecomastia, we prefer the endolaser technique (has become very popular as “Smartlio”) in the US. We have found that increasing the energy level of the laser to a higher level and changing into “cutting” mode enables us to destroy the glandular tissue with laser alone and no incision are necessary.

What scars are involved ?

None. The endolaser technique, which is the technique that we prefer, does not leave any scars. The endolaser does lead to significant skin retraction, so there are no problems with lax skin.

92% of our gynecomastia cases are now done with the scar-free endolaser technique.

What is the biggest problem around gynecomastia ?

Recurrence. The gland behind the nipple needs to be resected in true gynecomastia cases, some part of it will usually remain and possibly lead to recurrence. There is no difference regarding recurrence whether classical surgical incision or endolaser is used, and the percentage is about 2-3% (higher in steroid abusers).

What is recovery time after a gynecomastia operation ?

Usually very short, defintely depending on the extent of resection. The scar free endolaser technique for male breast reduction is an ambulatory day case procedure, and there is no physical recoevry.

I like to use a compression garment of a minimum of two weeks post surgery, possibly longer.

For more information visit our Homepage:
www.beautymedicine.es/gynecomastia

Combine cesarean section with abdominoplasty ?

This is an interesting idea that, to my knowledge, still enjoys certain pouplarity in the United States.

The idea sound appealing, because the concept is to use the cesarean incision to perform the abdominoplasty in one go. Nevertheless, our experience with combining a ceasarean with abdominoplasty in the same session is slightly controversial.
It may be done, but the rates of certain complications are , although not uniformly confirmed in scientific literature, slightly raised.

We do routinely use laser scalpel dissection technique in abdominoplasty surgery which improves scar quality and makes the procedure less traumatic.
Laser dissection does also reduce blood loss during the procedure and therewith makes abdominoplasty surgery safer.

For certain patients with very large birth weightsthe combionation is still be an option, because their muscle distension seems to be quite extensive.

On the other hand, scientific literature clearly opines that there is no higher incidence of grave complication such as deep-vein thrombosis when perfoming an abdominoplasty together with a cesarean section.

Whether to the tummy tuck together with the cesarean section or not is something that I indivisually discuss with my cooperating gyneoclogist depending on each individual case. It is, and will remain a controversial topic in the future, and best restricted to patients who have finished their family planning.
Classical abdominoplasty complications, especially seroma, are definitely raised in comparison to sole abdominoplasty.

We do noy have a clear protocol neitehr approving or disregarding this procedure, but decide case dependent together with our cooperating gynecologists.

For more information visit our Homepage:
www.beautymedicine.es/abdominoplasty

Dr. Ramin Pakzad, Clinica Ginecologica Banus