Cosmetic surgery

Key Features: Lasers that are founded on the theory of selective thermolysis, as well as nonlaser light and energy devices, are available to treat vascular lesions, pigmented lesions, textural abnormalities, hirsutism, and skin sagging. Prepackaged injectable soft-tissue augmentation materials are associated with minimal immunogenicity, low risk of implant migration, and clinical efficacy. Short-term, medium-term, and permanent fillers can provide volume replacement for the aging face. Nonablative lifting and tightening procedures are in their infancy. Though lasers and lights, radiofrequency, and ultrasound offer the potential for significant tightening without skin excision, parameters remain to be optimized and currently their efficacy is not consistently comparable with that of surgical procedures such as rhytidectomy, or abdominoplasty. Ablative resurfacing, whether with lasers, moderate to deep chemical peels, or dermabrasion, remains the gold standard for the correction of severely aged facial skin. Associated with reduced risk of scarring and briefer healing time, partially ablative procedures such as fractional resurfacing and plasma resurfacing now offer many of the benefits of ablative resurfacing without the associated patient inconvenience. Tumescent liposuction is a procedure for body contouring via subcutaneous fat removal. A dilute solution of lidocaine with epinephrine minimizes intraoperative blood loss. Fat melting or dissolving procedures such as meso-therapy, laser lipolysis, and externally directed ultrasound remain less effective than liposuc-tion used for fat removal. There is an increasing interest in cosmetic procedures off the face. Facial procedures must be adapted to the diminished blood supply, thicker skin, and slower wound healing on the trunk and extremities. Superficial leg veins can be treated with a variety of minimally invasive procedures. Measurement of esthetic improvements after cosmetic procedures is challenging. The gold standard may be the blinded rater assessment, since the use of so-called objective measures may not correlate with clinically significant improvements, and may also detect differences below the threshold of human recognition.