Migraine Surgery

Migraine Surgery

18% of the women and 6% of the men have migraine. The coincidental detection about Botox injections are helping the treatments of some patients for headache, has been opened the way of migraine headache’s surgery.

The surgical intervention of eliminating the frowning eyebrows (corrugator release) during the endoscopic brow and eyebrow lifting operation, is releasing and relaxing the nerves between this muscles like Botox. Therefore it has been come to the conclusion that the eliminating the pressure on the sense nerves is preventing the triggering or starting of the headache.

The studies have been focused on eliminating (deactivating) the trigger points of migraine headache by surgical methods and applications. For determining the trigger points first a Botox injection will be applied to the patients.

After four weeks, if the patient have decreased migraine headache and if some improvisations have been determined, the surgery will be performed. After a one year follow-up period, the scientific studies have been proved that the frequency, period and intensity of the migraine headaches have 50% reduced for the patients who undergone the surgical operations. These studies have been reflected to the annual productive power loss and treatment costs, and after the calculations it will be discussed today in the United States of America if the migraine surgery treatment will be covered by the health insurances.

Four main triggering points have been determined;

Eye surrounding, brow area (the area in which the supraorbitale and trochlear nerves are raising and passing through the corrugator supercilii, depressor supercilii and procerus muscle fibers)

Temporal region (the area in which the zigomaticotemporal branch of the trigeminal nerves is raising from the temporal muscle)

Nape area (the area in which the small and large 3rd occipital nerves are raisin between the nape muscles)

Nose origin (reflecting into the eye)

Let us make a short overview to these triggering points;

1st area is the place where Botox applications will be made against the frowning eyebrows ans it is easy to access endoscopically from the hairy skin. Botox will give a result in 5-7 days, but having a permanent result with endoscopic surgery the muscles which are making the pressure on nerves must be determined and they should be expurgated (one of the factors that prevents the full-success is continuing pressure of the muscle tissue over the nerve)

Complete endoscopic removal of the zigomaticotemporal branch of the trigeminal nerve. This nerve branch can be seen during the endoscopic subperiosteal mid-face lifting surgery and its ablation is very easy.

The large occipital nerve which gives the nape sense and small occipital and 3rd occipital nerves can have pressure when they are raising from the muscles in the area (occipital, trapezius, splenius, semispinalis capitis, sternocleidomastoid muscles). This is the non-endoscopic part of the surgery. Its anatomy is pretty standart. The nerve is large enough to see with naked eyes

As the 4th area is triggering the inner nose irritation which is familiar for ENT (ear, nose and throat) specialists, these are the migraine headaches that the patients are describing as it is coming from the inside of the eye (with the relations of concha pathologies, concha bullosa, septum-concha). Can be corrected with conchaplasty and septoplasty.

Breast Reconstruction

Breast Reconstruction

For the women who has lost a breast due to cancer; shunning from the society, worthlessness feeling and depression caused by the defection of body image may be seen very often. These women are applying to the breast construction surgeries.

After this operation the women can go back to their normal lives and activities, can wear all kinds of dresses and swimming suits, and van do all kinds of sports including swimming.

The breast reconstruction has several phases and will be affected from various factors;

First of all, the operation’s size is very important. The reconstructive procedures of partial breast tissue removal (Lumpectomy – breast protective surgery) and total breast tissue removal (total mastectomy) are totally different.

It is necessary to protect the veins during the removal of lymph glands on the armpit (axillary abortion). If the veins have been protected, the reconstruction options will be highly increased and it allows to transplanting tissues from back muscle-skin (latissimus dorsi muscle-skin phleb) or tissue transplantation by microsurgery from the other parts of the body.

In case the tummy muscle (rectus abdominis) used for the reconstruction, extra additions will be made to the veins and the success chance will be increased.

Previous chemotherapy (CT) or radiotherapy (RT) applications during the treatments are also affecting the results. In case of radiotherapy, the reconstruction with silicone breast implant will not be preferred. Because the tissues which should cover the implant have been weakened by the radiotherapy and become low-nourished tissues, in this case the silicone breast implant can come out. For the patients who have radiotherapy, the tissues far from the radiotherapy area will be used for the reconstruction.

The healthy breast’s situation is also important. The other breast, in other words the healthy and in comparison with the new one, the sagged breast will be reduced, lifted or augmented on the second session for equalizing.

-The situations of the tissues which will be used for reconstructions are also important in accordance with the reconstructive options; Silicone implant is the fastest option. However in case of RT (radiotherapy) the tissues which should cover the implant have been weakened and become low-nourished tissues. Because of that, preferably it will not be used for the patients who had radiotherapy.

Back muscle (latissimus dorsi): If the volume need is not much, the armpit veins have not been damaged and patient accepts the scar on the back, this method will be used.

Tummy muscle (rectus abdominis): If the patient has donor area on her tummy (if the sagged or meaty tummy form exists), fairly full breast tissue can be supplied. At the same time, the tummy lifting will also be performed. It can not be used for tummies with hernia problem or for the tight tummies.

Another option is to move the partial hip muscle to the breast area through microsurgery. The scar on the donor area/deformity and microsurgery need is its disadvantage.

Before the reconstruction:

The detailed notes about amputation surgery and the information about breast cancer’s phases,

The post-surgical treatments: Axillary abortion, chemotherapy (detailed), radiotherapy (if available details and doses),

Photos from the front, side and back till the border of genital area (for evaluating the opposite breast’s situation and donor tummy option)

will be given to the plastic and reconstructive surgeon who will perform the operation. Besides these, it is necessary to have a good general health conditions (internal examination) and possibility to go under anesthesia should be checked.

The Surgery

The operation will have generally two sessions. During the first session the tissues will be moved, and on the second session forming, creating the breast nipple and procedures for the opposite breast (for supplying the symmetry) will be performed. Can be additional session needs (retouches).

Aesthetic After The Weight Loss

Aesthetic After The Weight Loss

Major weight loss has multiple benefits either you make the success with a well balanced diet and exercises, or with bariatric surgery or other medical treatments. But, when you reach your weight loosing target you may see that you still don’t have the fit and healthy body appearance. Your skim may be sagged and loosely and your body contours may seem dissonant and formless.

If you had a major weight loss with excessive sagging, the surgical body contouring can be the best solution for you. Generally the body contouring after the major weight loss will removes the fat and skin that have been built on the various areas of your body. The result of this surgical procedure is more soften and attractive body contours. The body contouring after the major weight loss is an important and rewarding phase of your contest for having a healthy and attractive body shape and it can help to improve your body’s appearance and to increase your self-confidence.

This information form has been prepared to investigate the body contouring procedures after the major weight loss. The best method to learn how body contouring may help you to reach your targets after a major weight loss is making a consultation with a plastic surgeon.

What Is Body Contouring After a Major Weight Loss

The excessive fatness can create various stresses with different ways on your health. If your physical activities have been limited because of your weight, your muscle and skin tonus can be weak and your skin can be excessively stretched.

The bariatric surgery also known as gastric by-pass surgery, will create a major loss especially for the people who defined as clinic obese. After the weight loosing surgery or any major weight loss the skin and tissues will lost their elasticity and can not conform to the reduced body size. As a result of this, the excessively stretched skin stays without support and starts to sag generally on the below mentioned areas:

On the face, neck and lower chin; it causes to a sagged and sad appearance.

On upper arms; it causes to a bat-like view.

On the breasts; it causes to flattening and the breasts are sagging with the downward nipples.

Abdominal region; it widens on the sides and under the belly and ends with an apron-like bulge.

Buttocks, groin and hips; they became like sagged skin pockets.

The weak and macerative (wet of infected) sagged skin is not only unattractive; it can also create a serious threat for your health which should be treated.

The plastic surgery which follows the major weight loss is forming the body, improves the shape and tone of your underlying tissue that supports fat and skin and removes excess sagging fat and skin. The result is softened contours and a normal appearance of the body. This is actually the last step of your weight loosing experience.

However, after a major weight loss you should be sure that your weight has been stabilized before you decide to have a body contouring surgery. If you continue to loose weight, the sagged pockets will be re-generated. If you take the kilograms back in a short period, this will stretch your weak and thinned skin in a traumatic way, and will cause to an excessive stretching and you will have visible stretching scars and another wide scars on your skin.

If you had a previous weight decrementing surgery, your plastic surgeon will contact with your doctor for determining the most acceptable time to start your body contouring surgery.

Generally the best candidates for the body contouring surgery are the following ones:

The adolescences in any age with stabilized weight loss

The persons who have no medical illness which can be lessen the wound healing or increase the operation’s risks

Non-smokers

The persons who are aiming to have a positive appearance and realistic expectations which the body contouring can realize

The persons who utterly devoted themselves to live a healthy life style including regular nutrition and fitness

From Where Should I Start

A consultation with your plastic surgeon is the first step to understand how body contouring after a major weight loss can help you to improve your health and have a better physical appearance. This consultation has been prepared to inform you fully about the body contouring and it includes the followings:

Discussing your targets and evaluation of your personal state

The options of body contouring surgery

The possible results of the body contouring procedures, the surgical risks or potential complications

The procedural steps of the treatment suggested by your plastic surgeon

Answering your questions

Evaluation

The general health and your personal appearance may largely affect the result of your surgical operation. These will be carefully evaluated during the consultation with your plastic surgeon. You have to do the followings for the success of your procedure, safety and total satisfaction:

Share your expectations honestly and fairly

Explain your medical records, and the medicaments, vitamins, herbal supplements, alcohol and drugs that you are currently using

Definitely follow all the instructions of your plastic surgeon

Safety

You are taking an important step for helping to guarantee your safety by asking the advices of your plastic surgeon and following all the given instructions carefully.

Your plastic surgeon must be a member of Turkish Plastic and Reconstructive Surgery Association. This confirmation defines the educated surgeons especially for the face and complete body’s plastic surgery.

Body Contouring

After a major weight loss the body contouring will be planned according to your situation and the body areas which will be operated. The necessary procedures for reaching your targets will be explained, and a plan will be made for the timings of these procedures. The recommendable specific plastic surgical procedures for contouring the body are including the followings:

Face lifting: improving and lessen the sagging of mid-face, lower chin and neck.

Breast lifting: correction of the flattened and sagged breasts

Tummy Tuck: removing the excessive fat skin sagged over your tummy

Lifting upper parts of the body: removing the sagging on contours of the tummy, hip, thigh and buttocks.

Inner sideward hip lifting: removing the sagging on the inner, outer and medium parts of the hip

Arm lifting surgery: removing the sagging on upper arms

You may accept the reality that is necessary to cut the excessive skin for contouring the body. In common cases these cuts may be too wide. The length of the cuts is depending on the amount and location of excess skin to be removed as well as personal preference and your doctor’s surgical judgment. Generally the advanced techniques allow incisions to be placed in strategic locations where they can be hidden by most types of clothing and bath suites, but this is not always the case.

The body contouring after a major weight loss is often performed in stages. Your particular condition and goals, health, safety and comfort, as well as your plastic surgeon’s best judgment will all influence how your surgeon defines a surgical plan. While it may have taken you two years or more to lose all the excess weight, it may take equally as long for the results of your body contouring to be complete.

Additionally to prepare yourself for the steps of contouring and healing period after the procedures, you have to accept that you can not have your aimed results on a specific area with only one operation. Some asymmetrical contours may develop after your body contouring operation and in some cases the elasticity of the skin might be so bad to cause repeated sagging.

After the major weight loss, a complete lower body lift treats sagging buttocks, tummy, waist, hips and outer tights in one procedure or in staged procedures. Incision patterns vary, and may include a circumferential incision around the body to remove the “belt” of excess skin and fit like the lower part of a bikini. The incision patterns for lifting a woman’s sagging breasts will be determined based on the amount of excess skin to be removed. These may include one or a combination of incisions in a circular pattern around the areola, in a line extending from the areola to the breast crease, and horizontally along the breast crease. A silicone breast implant also may be recommended to enhance breast shape and size. Sagging skin in the upper arms is treated with an incision from the underarm area extending along the inside or back of the upper arm. Additional incisions on the arms may be necessary anywhere excess skin has formed sagging pockets. The smoother, tighter contours that result from upper arm contouring are apparent almost immediately, although initially obscured by swelling and bruising. In addition, skin quality is dramatically improved in both appearance and texture.

Preparing for Surgery

Prior to surgery, your body contouring plan will be explained carefully. Before any surgery, you will receive the specific instructions which may include the followings:

Pre-operative points, diagnostic tests and medications

Fay of surgery’s instructions and medications

The specific information about using the anesthesia

Post-operative care and follow-up

Besides that, you will be asked to sign consent forms to ensure that you fully understood all the information about the procedure or procedures you will undergo, possible risks or potential complications which have been explained by your plastic surgeon.

Possible risks of body contouring following major weight loss include bleeding, infection, fluid accumulation, delayed or poor wound healing, skin loss, blood clots, excessive or expanded scars, numbness or other changes in skin sensation, irregular or asymmetrical contours and scars. Any surgery has also anesthesia risks. These risks will be completely discussed with you before taking your written consent.

It’s very important to ask directly your plastic surgeon questions about your body contouring procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Share your feelings with your plastic surgeon.

Your body contouring procedures will be performed by your plastic surgeon in a contracted hospital possibly one night stay. As it is possible to perform the operation under local anesthesia together with the sedation, generally the procedures will be realized under general anesthesia. These decisions will be taken in accordance with your specific procedures, apprehensions and your doctor’s surgical preference.

After the surgery

After your body contouring procedure(s) is completed, dressings or bandages will be applied to the incisions. For lessen the swellings on the treated areas, and supporting the new contours parallel to your healing, an elastic bandage can be used. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid that may collect. Before you leave the hospital, you and your companion will receive specific instructions that may include:

How to care for your surgical site(s) and drains

Medications to apply or take orally to aid healing and reduce the risk of infection

Specific concerns to look for at the surgical site or in your general health

What you have to talk about with your plastic surgeon.

Improvement and Healing

At the beginning the healing will include the swelling on incision areas. The discomfort is expansive and can be controlled with medicaments. For preventing the clots and other complications it will be requested to make some walking exercises as soon as possible.

In common cases it will be recommended to avoid bending, stretching and bearing something for a few days till couple of weeks period. If tummy and hips have been lifted, your plastic surgeon may also tell you not to straighten up exactly and avoid stretching your inner stitches during the healing period and to put a pillow under your kneed when you sleeping. It is very important to follow all the instructions for the success of your result.

The wound healing may take 7-14 days at the beginning, then, if necessary the stitches can be removed. You can go back to your work and make your normal activities in a few weeks if you don’t lift or bear heavy things and make active exercises.

The healing period will last a couple of weeks as the swellings and incision scars are continuing to heal. The numbness and induration feeling on the surface of your skin will be healed with the time. When you completely healed after these procedure series, it might be the time to start for preparations about other additional procedures on the face and other areas of the body. You must be protected from the sun until the healing period is complete. The complete healing and disappearing of the incision scars might be last one year or more. Continue to follow your plastic surgeon’s instructions and visit him/her for the follow-up cares.

Results and Appearance

The results of a body contouring after a major weight loss are visible almost immediately. However, it may take as much as one to two years, or more, for the final results of the body lift procedures to fully develop. Scars will remain, but the overall results of the body contouring are long-lasting, provided that you maintain a stable weight and general fitness. As your body ages, it is natural to lose some firmness. However, most of your initial improvement should be relatively permanent.