LIPOSUCTION

1) Definition:

Liposuction, also known as lipoplasty ("fat modeling"), liposculpture, suction lipectomy, or simply lipo ("suction-assisted fat removal"), is the surgical removal of localized or regional excess fatty tissue.

2) Indications

Despite good health and a reasonable level of fitness, some individuals may still have a body with disproportionate contours due to localized fat deposits. These areas may be due to hereditary or family traits rather than a lack of weight control or fitness. Liposuction must not be considered as a treatment for obesity or a substitute for proper diet and exercise. In Brazil, the surgeon can remove up to 7% of the patient’s body weight, e.g. 10 pounds of fat from a 150-pound person, and so on.

3) Techniques

The procedure lasts an average of 2 to 3 hours, depending on the areas to be treated and on how much fat each area contains. Liposuction can be accomplished either with the use of general anesthesia, with local anesthesia plus IV sedation, or totally by local anesthesia. The incisions are small and can be either sutured or left open for drainage of fluid.

The techniques available are described below, as follows:

a) Areas of the body where liposuction is performed;

b) Amount of fluid injection;

c) Mechanism of liposuction;

d) Superficial x Deep.

a) Areas of the body where liposuction is performed:

• Cheeks, chin, and neck
• Upper arms
• Breast or chest area
• Abdomen
• Flanks (love handles)
• Hips and Buttocks
• Outer thighs (saddlebags)
• Inner thighs
• Inner knees, anterior knees
• Calves and ankles
• Submental (chin/neck)
• Gynecomastia (male breast tissue)

b) Amount of fluid injection:

b.1) Dry liposuction

The dry method does not use any fluid injection at all. This method is seldom used today because of the increased amount of blood loss when compared to the other methods available. Some patients may need blood transfusion depending on the how many areas are treated.

b.2) Wet liposuction

A small amount of fluid, less in volume than the amount of fat to be removed, is injected into the area. It contains lidocaine as a local anesthetic, adrenaline to contract the blood vessels and thus minimize bleeding, and a salt solution (saline). This fluid helps to loosen the fat cells and reduce bruising. The fat cells are then suctioned out as in the dry method.

b.3) Super-wet liposuction

In this method, the infused volume is in about the same amount as the volume of fat expected to be removed (1 cc of infiltrate to 1 cc of aspirate). This is the preferred technique for high-volume liposuction by many plastic surgeons as it better balances homeostasis and potential fluid overload (as with the tumescent technique). 

b.4) Tumescent liposuction

The surgeon injects high volumes of the saline solution (plus lidocaine and epinephrine) directly into the subcutaneous fat to be removed (2-3 cc of infiltrate to 1 cc of aspirate). Due to a potentially large total volume of local anesthetic injected into the tissue, systemic toxicity from lidocaine is a potentially complication, which must be considered with larger volume cases. The blood loss with both the super-wet and the tumescent technique are significantly lower than with the dry method.

c) Mechanism of liposuction:

c.1) Suction-assisted liposuction (SAL)

Suction-assisted liposuction is the standard method of liposuction and the first one developed. In this approach, a small cannula (a hollow stainless steel tube) is inserted through a small incision and attached to a vacuum device (usually a machine, but syringes can also be used to create vacuum). The surgeon pushes and pulls it in a forwards and backwards motion, carefully through the fat layer, breaking up the fat cells and drawing them out of the body by suction. There are numerous types of cannulas that can be used and different ways of performing the procedure, but all of them end up leading to similar results. 

 Examples of Cannulas

c.2) Power-assisted liposuction (PAL)

PAL devices use power supplied by an electric motor or compressed air to produce either a rapid in-and-out movement or a spinning rotation of an attached liposuction cannula. This mechanized movement makes the procedure easier since the surgeon does not need to make as many manual movements. Otherwise it is similar to traditional liposuction (SAL). Some surgeons and the company that sells the instruments (Microaire ®) advocate better results with this method, although there is not enough scientific evidence to support their claim.

 Microaire ®

c.3) Ultrasound-assisted liposuction (UAL)

In ultrasound-assisted or ultrasonic liposuction, a specialized metal probe or metal paddle is used which transmits ultrasound vibrations into the subcutaneous fat. This vibration bursts the walls of the fat cells, emulsifying the fat (i.e. liquefying it) and making it easier to suction out. UAL is a good choice for working on more fibrous areas, like the upper back or male breast area. It takes longer than traditional liposuction (SAL) because after ultrasonic liposuction, it is still necessary to perform suction-assisted liposuction (SAL) to remove the liquified fat. There is slightly less blood loss. There appears to be slightly more risk of seromas (pockets of fluid) which may have to be drained with a needle and skin necrosis (tissue damage leading to localized skin loss). Vaser ®, also known as liposelection ®, is one of the most popular ultrasonic devices used. 

 Vaser probe

c.4) Laser-assisted liposuction (LAL)

Laser assisted liposuction uses thermal and photomechanical energy to affect the lipolysis. The addition of a laser to traditional liposuction possibly increases skin tightening effects through tissue coagulation. It is believed that this procedure offers certain benefits, such as smaller incision with less scarring, less pain, faster healing, less bruising, and increased tightening of the skin. However, the efficacy of this technique as opposed to traditional SAL is still being debated, due to a lack of scientific studies proving its effectiveness and results. There are a number of companies who have developed different liposuction lasers, as follows: SmartLipo ®, CoolLipo ®, ProLipo Plus ®, LipoLite ®, LipoTherme ®, LipoControl ®, SlimLipo ®. 

 Laser Probe

c.5) Twin-cannula (assisted) liposuction (TCAL or TCL)

Twin cannula (assisted) liposuction uses a tube-within-a-tube specialized cannula pair, so that the cannula which aspirates fat, the mechanically reciprocated inner cannula, does not impact the patient's tissue or the surgeon's joints with each and every forward stroke. The aspirating inner cannula reciprocates within the slotted outer cannula to simulate a surgeon's stroke of up to 5 cm (2 in) rather than merely vibrating 1–2 mm (1/4 in) as other power assisted devices, removing most of the labor from the procedure. There's a video on youtbue that better illustrates this method of liposuction (Airbrush Liposculptor ®) - CLICK the link below. A good advantage would be to prevent fatigue in the surgeon, even though the results should be similar to traditional liposuction.

c.6) Water-assisted liposuction (also waterjet-assited liposuction) (WAL)

Waterjet-assisted Liposuction (WAL) was developed by the German company Humanmed in conjunction with German Plastic Surgeons with the aim of improving the results, safety and recovery of liposuction surgery. The Body Jet (R) device has been in use since 2004 but only recently achieved FDA approval. WAL uses a thin fan-shaped water beam, which loosens the structure of the fat tissue, so that it can be removed by a special cannula. During the liposuction the water is continually added and almost immediately aspirated via the same cannula. It is believed that the blood vessels are kept intact, hence less bruising and swelling should be expected after WAL than any other liposuction technique. The utility of this technology is under study and is currently not widely used.

When I was still a resident in 2008, we had a German plastic surgeon come to Brazil and performed a demonstrative procedure in a patient and I had the privilege to participate as his first assistant. The procedure was a little messy due to the high infiltrate volume. The results were similar to any kind of liposuction described previously in this article. 

c.7) External ultrasound-assisted liposuction (XUAL or EUAL)

XUAL is a type of ultrasound-assisted liposuction (UAL) where the ultrasonic energy is applied from outside the body, through the skin. Then, the surgeon needs to suction the fat out through the traditional method (SAL). At this time however, it is not widely used and studies are not conclusive as to its effectiveness. It has also been used as a non-operative and non-invasive technique for emulsifying fat deposits.

d) Superficial x Deep Liposuction:

Most areas of our body have two distinct fat layers:  superficial and deep.  Liposuction is mainly based on the removal of fat tissue from the deep layers. Superficial liposuction is mostly used to obtain a thinner flap with good retraction of the skin as well as to improve cosmetic results in specific areas, for example the abdomen and neck. Note that superficial liposuction should be avoided in some other areas, such as outer thighs (saddle bags), due to increased risk of indentations and worsening of pre-existing cellulite. If overdone, superficial liposuction may lead to conspicuous contour irregularities and excessive skin retraction.

 Contour irregularities (due to superficial liposuction)

4) Innovations

Abdominal Etching: or Ab etching, is a plastic surgery procedure that uses a special cannula to contour and shape abdominal fat pad to provide patients with a flatter stomach. The procedure selectively removes a small amount of fat around the patient's natural muscular contours and shapes or sculpts the abdomen to create a more athletic contour (the famous 6-pack).

5) Combined with other procedures

Liposuction can work as useful adjunts to other procedures, such as rhytidectomy( facelift), mastopexy (breast lift), abdominoplasty (tummy tuck), lower body lift, thigh lift, or buttock lift. In addition, fat can also be used as a natural filler. This is sometimes referred to as "autologous fat transfer (or fat grafting)" and in general, for these procedures, fat is removed from one area of the patient's body, cleaned, and then re-injected into an area of the body where contouring is desired, for example, to reduce or eliminate wrinkles.

Sharp cannulas without suction can be used as a treatment for cellulite, the dimpled skin that typically appears on the thighs, hips, and buttocks.

6) Recovery (briefly discussed here)

Depending on the extent of the liposuction, patients are generally able to return to work between two and ten days. A compression garment and bandages are worn during weeks to months. It is common to happen temporarily after surgery: bruising, swelling, pain (controlled by prescribed medications), numbness, and apparent scars. These will fade after some time.

Most common complications: small contour irregularities and insufficient fat removal.

NEXT ARTICLE WILL BE ON NON-SURGICAL ALTERNATIVES TO LIPOSUCTION

References

1. Mark Laurence Jewell. Lipoplasty. In: M. Eisenmann-Klein, Constance Neuhann-Lorenz, eds. Innovations in Plastic and Aesthetic Surgery. Springer, Berlin Germany; 2006:439-444
2. De Souza Pinto et al. Liposuction and VASER. Ibid, 108-110
3. Information from the US Food and Drug Administration
4. http://seattletimes.nwsource.com/html/living/2008109157_undergarment13.html. 
5. www.liposuction.com
6. http://en.wikipedia.org/wiki/Liposuction
7. Lee Y, Hong JJ, Bang C. Dual-Plane Lipoplasty for the Superficial and Deep Layers. Plastic and Reconstructive Surgery. Volume 104(6), pp 1877-1884, 1999. 
8. Johnson D, Cormack GC, Abrahams P, Dixon A. Computed Tomographic Observations on Subcutaneous Fat: Implications for Liposuction. Plastic and Reconstructive Surgery. Volume 97(2), pp 387-396, 1996. 
9. De Souza Pinto EB, Erazo I, Prado Filho FS, et al. Superficial liposuction. Aesthetic Plastic Surgery. Volume 20: p 111, 1996.
10. Gasparotti M, Lewis CM, Toledo LS. Superficial Liposculpture: Manual of Technique. New York: Springer-Verlag, 1993.

Long and Fuller Eyelashes: Truth or myth?

 

LATISSE^® (bimatoprost ophthalmic solution) 0.03%

Latisse^® (produced by Allergan) is an ophthalmic solution recently approved by the FDA (in December 2008) for growing eyelashes longer, fuller, and darker, and when indicated, it can also be used on the eyebrows (even though I didn’t find this information in the full prescribing information of the product). Back in 2001, Latisse^® was initially developed and indicated for the treatment of ocular hypertension/glaucoma (see Lumigan^®.) Ever since its approval, Allergan has sold over 1.5 million bottles of Latisse^® solution.   

Latisse’s results are noticeable after 16 weeks of treatment, if applied correctly on the upper eyelid skin, at the base of the eyelashes (exactly where the eyelashes start growing). It’s not intended to be applied to the lower eyelid, because the constant contact with the eye increases the risk of developing undesired side effects.

The most common side effects after using Latisse^® are an itching sensation in the eyes and/or eye redness, which were reported in approximately 4% of clinical trial patients. Other less common side effects occur close to where Latisse^® is applied. These include skin darkening, eye irritation, dryness of the eyes and redness of the eyelids. 

Although iridal pigmentation was not reported in clinical studies with Latisse^® patients should be advised about the potential for increased brown iris pigmentation of the colored part of the eye, which is likely to be PERMANENT (since the clinical study published by the company treated the patients for only 4 months, beware of this complication, which is IRREVERSIBLE). The lid and eyelashes can become darker as well, but this reaction seems to be reversible upon discontinuation of the product (but it will take weeks or months to go away).

Note that Latisse^® stimulates hair growth in any area where it has repeated contact, so avoid applying the product to your mustache area or letting it run down through your cheeks, unless you want to be cast as the bearded woman in the next Cirque du Solei show or on the next Saturday night live episode.

If you have any kind of eye problems, such as intraocular inflammation, macular disease, etc., discuss the benefits and risks of using Latisse^® with your physician. Latisse® contains benzalkonium chloride, which may be absorbed by soft contact lenses. Contact lenses should be removed prior to application of solution and may be reinserted 15 minutes following its administration.

Unfortunately, after the 16-week treatment period, if you stop using Latisse^®, lashes will gradually return to their previous appearance.

Final note: there’s only one 4-month clinical trial done by the company that sells Latisse^®. 278 individuals (Latisse group = 137, control group = 141) were included in the study, and they were subject to a 4-month period treatment with either Latisse^® (Latisse group) or an inert vehicle (control group). Treatment was discontinued after 4 months in both groups.  Therefore, the long-term results and side effects of Latisse^® are not known yet. 

References:

http://www.latisse.com/

http://www.allergan.com/assets/pdf/latisse_pi.pdf

http://www.thefrisky.com/post/246-latisse-side-effects-even-scarier-than-we-thought/

BREAST AUGMENTATION

Definition: 

Breast augmentation, also known as breast enlargement, mammoplasty enlargement, augmentation mammoplasty, and popularly known as boob job, is a surgery performed to increase the size of the breasts in women that are dissatisfied with the size of their breasts for either cosmetic or reconstructive reasons (e.g. after treatment for breast cancer or to correct congenital deformities and asymmetries). According to the American Society of Plastic Surgeons, breast augmentation is the most commonly performed cosmetic surgical procedure in the United States.

Indications:

Primary augmentation (for cosmetic reasons)

Primary reconstruction (in cases of congenital deformities (presents at birth), trauma, or after treatment for breast cancer)

Secondary augmentation (revision surgery to correct or improve the aspect of the breasts)

Procedure:

The surgical procedure for breast augmentation takes approximately one to two hours. Variations in the procedure include the incision type, implant material, and implant pocket placement, as follows:

A)     Incision types:

• Inframammary: an incision is placed below the breast in the infra-mammary fold (the place where the breast and the chest meet). This approach provides maximum access for pocket dissection and placement of an implant. However, this method can leave more visible or thicker scars. 

•  Periareolar: an incision is placed along the areolar border (usually the lower half). This technique allows the surgeon to make adjustments to the infra-mammary fold position or even to combine a mastopexy (breast lift) with it (e.g. Benelli mastopexy). Silicone gel implants require a minimal incision length of about 4 -5 cm, which could be contraindicated in patients with small areolas. This method can also leave visible or thicker scars, especially if the surgeon fails to accurately follow the border of the areola. The quality of the scars is better in patients with lighter areolar pigment. This technique is more associated with breastfeeding problems, due to cutting milk ducts, and problems with areolar sensitivity.

• Transaxillary: an incision is placed in the armpit and the dissection tunnels medially. This approach allows implants to be placed with no visible scars on the breast, but is more likely to produce asymmetry of infra-mammary fold (the bottom of the breasts). Subsequent revisions of transaxillary-placed implants usually require inframammary or periareolar incisions. Transaxillary procedures can be performed with or without an endoscope, which is small video camera that allows the surgeons to perform the surgery under direct vision, increasing the precision of the procedure.

• Transumbilical Breast Augmentation (TUBA): a small incision (~ 2 cm) is placed in the navel and dissection tunnels superiorly. This approach enables implants to be placed with no visible scars on the breast, but makes appropriate dissection and implant placement more difficult. Transumbilical procedures can also be endoscope-assisted or not. This technique is not appropriate for placing silicone gel implants because those implants are pre-filled and cannot be passed through the small 2-cm incision.
• Transabdominoplasty Breast Augmentation (TABA): surgery similar to TUBA, where the implants are tunneled up from the abdomen into bluntly dissected pockets while a patient is simultaneously undergoing an abdominoplasty (tummy tuck) procedure.

A)     Implant Pocket Placement:

The placement of implants is described in relation to the pectoralis major muscle (main muscle situated at the chest, behind the mammary gland/breast):

• Subglandular: the implant is placed between the breast tissue and the pectoralis major muscle. The subglandular position in patients with thin soft-tissue coverage and small mammary gland is more likely to show ripples or wrinkles of the underlying implant. Also, the borders of the implant may be more noticeable to the eye due to insufficient soft-tissue coverage. Capsular contracture rates (see complications) are slightly higher with this approach. A rough estimate to determine if you are a candidate for this procedure is to pinch the breast tissue between your thumb and the forefinger and measure its thickness. If your breast tissue is equal to or greater than 2 cm thick, you are a good candidate for the subglandular approach. 

• 

• Subfascial: the implant is placed in the subglandular position, but underneath the fascia of the pectoralis muscle (which is a thin tissue layer that surrounds the muscle). The benefits of this technique are controversial, but proponents believe the fascial layer of tissue may help with coverage and sustaining positioning of the implant.
• Submuscular/Subpectoral: the implant is placed below the pectoralis without release of the inferior origin of the muscle. This technique is most commonly used for maximal coverage of implants used in breast reconstruction. The implants tend to migrate upwardly due to the contraction of the muscle.
• Submuscular/Subpectoral with Dual Plane Technique: the implant is placed underneath the pectoralis major muscle after releasing the inferior muscular attachments. It’s a combination of the subglandular technique and the submuscular technique, where the implant will be partially beneath the pectoralis major muscle in the upper pole, while the lower half of the implant is in the subglandular plane. Animation or movement of the implants in the sub pectoral plane can be excessive to some patients. The implants can also migrate upwardly if the inferior muscular attachments are not completely released.
•  

B)      Types of Implants (filling):

• Saline-filled Breast Implants: are made of a silicone elastomer (rubber) shell. They are inserted empty and then filled with salt water (saline) after the implant is placed in the body. Therefore, they can be surgically placed via smaller incisions (when compared to the pre-filled silicone gel implants). The saline implants may be placed through all 4 incisions available, including the transumbilical (through the belly button) approach (TUBA). Saline-filled implants are rarely used in other countries due to the increased risk of cosmetic problems when compared to silicone gel implants, such as rippling, wrinkling, and to be more noticeable.

• Silicone gel-filled Breast Implants: also made of a silicone elastomer (rubber) shell, but they are pre-filled with silicone gel. The high cohesive gel filler (that reduces the risk of leakage) associated with the high quality shell produced nowadays improved durability of the implants to the point that surgeons cannot predict a timeframe for the implants to be replaced. Capsular contracture is the most common cause of removal and replacement of both silicone and saline implants.

C)      Types of Implants (Coating):

• Smooth: the silicone rubber shell is made with a shiny polished surface.

• Textured Surface: the silicone rubber shell is made with a finely rough surface. It’s not an extra layer attached to the surface, but the surface itself is made textured rather than smooth. There are different textures depending on the manufacturer and type of implant. Overall, the purpose of texturing an implant is to prevent the rotation of the implant (in anatomical shaped implants) and to decrease the capsular contracture rates (which have been controversial). When there is rippling or wrinkling, it is more pronounced with textured than smooth.

• Polyurethane: These implants are similar to textured implants but they have an extra layer of polyurethane coating on the implant shell, which is believed to diminish capsular contracture rates. They were briefly discontinued due to concern of potential carcinogenic (related to cancer) breakdown products from the polyurethane. Polyurethane implants are still used in Europe and South America, especially in Brazil. They are surgically harder to be placed as they require more precision in its positioning and a pocket dissection. They are also more likely to present rippling and wrinkling than smooth implants.

D)     Types of Implants (Shape)

• Round: they are shaped as their name suggests. Some people think that round implants take the natural shape of the breast when held vertically into position in the body. Round implants are more popular than anatomical ones among plastic surgeons, especially in the United States and Brazil.
•  

• Anatomical (tear-shaped, teardrop, contour implants):  they are tear-shaped, designed to look more natural by resembling the shape of a normal breast (more volume on the bottom and less volume on the upper pole). There is risk of malpositioning or rotation, rendering the implant upside down or sideways in the body, leading to an unnatural look and a poor result. To prevent this complication, the surgeon usually uses a textured and more adherent implant. The anatomical implants were originally developed for breast reconstructive patients. There are some surgeons that prefer anatomical shaped implants to round ones (e.g. Dr Perin, Sao Paulo, Brazil, Dr. Parsa, Honolulu, Hawaii).
•  

E)      Types of Implants (Profile/Projection)

The profile is the relation between the projection (height) and the base diameter of an implant. The profile will depend on the patient’s frame (wide, narrow), size of the implant, and the amount of projection and cleavage desired. By comparing the patient’s frame and desires with the implants’ specifications, the surgeon is able to choose the right profile for each patient.  
 
            Low                       Moderate                       High

• Low Profile: for wide framed patients;

• Moderate Profile: Low and moderate profile implants are better used in wide framed patients

• Moderate Plus Profile: Mentor's breast implant line (both saline and silicone breast implants) also includes this profile which is between moderate and high profile breast implants.

• High Profile: if a woman has a small chest diameter, the increased breast implant width is transmitted laterally toward the arm and vertically toward the neck. This may not look and feel proportional to her body. Therefore, A high profile implant would look more natural in narrowed frame patients.

• Extra High Profile: High and extra high profile implants are used in patients with narrow and very narrow frame, respectively.

Risks: (not common but possible)

1.      Capsular contraction:  Scar tissue forms around the implant to form a hard
shell.  There are several steps to prevent it, such as, size and location of the implant, as well as medications like Singular and Acculent.
2.      Infection or rejection from non-sterile techniques.
3.      Shifting (moving) of the implant.  The pocket for the implant should be adjusted for the patient (this will usually, prevent shifting).
4.      Scars:  Less conspicuous in the periareola compared to sub-mammary incision.
5.      Sensation:  May be initially decreased.  Usually 90% of sensation will return within 1-2 years of surgery.
6.      Violation of breast tissue.
7.      Breast Feeding:  About 50% of women won’t be able to successfully breast feed, particularly those with periareola incision.
8.      Synechia:  Adhesions (also known as "kissing Breast"), sometimes related to techniques.

References:
1. Young VL, et al. (1994). "The efficacy of breast augmentation: breast size increase, patient satisfaction, and psychological effects". Plast Reconstr Surg. 94 (Dec): 958–69. 
2. National Plastic Surgery Procedural Statistics, 2006. Arlington Heights, III, American Society of Plastic Surgeons, 2007
3. Johnson GW, Christ JE. (1993). "The endoscopic breast augmentation: the transumbilical insertion of saline-filled breast implants". Plast Reconstr Surg. 92 (5): 801–8.
4. Hester TR Jr, Tebbetts JB, Maxwell GP (2001). "The polyurethane-covered mammary prosthesis: facts and fiction (II): a look back and a "peek" ahead". Clin Plast Surg 28 (3): 579–86. 
5. Heden P, Jernbeck J, Hober M (2001). "Breast augmentation with anatomical cohesive gel implants: the world's largest current experience". Clin Plast Surg 28 (3): 531–52. 
6. Tebbetts T (2002). "A system for breast implant selection based on patient tissue characteristics and implant-soft tissue dynamics". Plast Recon Surg 109 (4): 1396–409. 
7. Brown MH, Shenker R, Silver SA (2005). "Cohesive silicone gel breast implants in aesthetic and reconstructive breast surgery". Plast Reconstr Surg 116 (3): 768–79; discussion 780–1. 
8. http://en.wikipedia.org/wiki/Breast_implant
9. Tebbetts JB (2004). "Does fascia provide additional, meaningful coverage over a breast implant?". Plast Recon Surg 113 (2): 777–9.  

10. http://en.wikipedia.org/wiki/Endoscope

11. http://www.plasticsurgery.org/ 

12. Plastic surgeon's opinions around the US and Brazil 
13. http://www.locateadoc.com/articles/plastic-surgery-breast-implants-1311.html

Let's build this Blog together

I expect that you, readers, to send me feedback. What do you want to learn?
Soon I'll post an article on transaxillary breast augmentation with implants. 
I have been working with and assisting Dr. Schlesinger@www.breastimplantcenterofhawaii.com in a number of breast augmentation surgeries, mostly through the axillary approach. In Brazil, there are some surgeons who perform this procedure routinely, for example: Dr. Antonio Graziosi @www.graziosi.com.br, Dr. Alexandre Munhoz (University of Sao Paulo School of Medicine - USP @www.usp.br/internacional/home.php?idioma=en), Dr. Ricardo Marujo@www.drmarujo.com.br among others.  
Soon I'll post an article about this particular technique.

Welcome to my blog

Today is my first day writing on my blog. I hope many people will benefit from the information available here. I would like you to add me on twitter and facebook and help me spread the knowledge in plastic surgery worldwide.
In this initial phase, I will begin to post articles about the basic procedures in aesthetic plastic surgery. I am open to suggestions, questions and requests.
At the same time that I am building a log with basic plastic surgery procedures and techniques used nationally and internationally, I will post articles written by renowned surgeons in the field; innovations and latest developed techniques included.



Come back soon and don't forget to add me on Twitter and Facebook (links on the right side of your screen