Medical procedures Overview:

Open-heart surgery:

Open-heart surgery generally means an operation in which the heart-lung machine is used to support the patient’s circulation while the surgeon opens the chest and makes changes to the heart or the arteries on the surface of the heart. This surgery is one of the most commonly performed operations in the United States, with a high overall survival rate. There are a variety of types of open-heart surgeries, depending on the condition being treated and the overall health of the patient. In general, patients undergoing open-heart surgery can expect a hospital stay of at least three to four days after the surgery. The procedure itself takes an average of about five hours. Afterward, the patient will be very carefully monitored, first in the cardiac intensive care unit and then on the general floor. Most open-heart surgeries will not need to be repeated.

After the patient is asleep, a device called the Swan-Ganz catheter is often inserted into the jugular vein (in the neck) and threaded to the pulmonary artery (which goes from the heart to the lungs). The catheter is used to measure heart function and heart and lung pressure. It can also be used to give medication and measure the oxygen levels in the blood. A breathing tube (endotracheal tube) will also be inserted into the mouth and down the windpipe (trachea) to maintain an airway. A urinary catheter is also inserted and connected to a collection bag to measure the patient’s urine output.

 

Heart Lung Machine

An 11- to 12-inch incision is made in the chest and the breastbone is split in two (full median sternotomy). A retractor is then used to pull back the breastbone and ribs in order to open up the chest. The functions of the heart, including blood flow and oxygenation, are rerouted through a heart-lung machine, so that the heart can be safely stopped during the procedure by the injection of a cooled cardioplegia solution.

The cardiac portion of the procedure then begins, according to what the particular condition requires::

  • Coronary artery bypass graft. To treat coronary artery disease. During CABG, a surgeon takes a segment of a healthy blood vessel (either an artery or vein) from another part of the bodyy, and uses it to create a detour or bypass around the blocked portion of the coronary artery. As a result, oxygen-rich blood can flow more freely to nourish the heart muscle. A patient may require one, two, three or more bypasses depending on how many coronary arteries (and their main branches) are blocked. Other procedures may be combined with this surgery (e.g., replacement or repair of the heart valve closure of a heart defect).

     
  • Heart valve valvotomy (also known as valvulotomy, valvuloplasty or commissurotomy), where the surgeon cuts into a valve to repair damage.

     
  • Septal myomectomy. To treat hypertrophic obstructive cardiomyopathy, an inherited heart condition characterized by an abnormal growth of muscle fibers of their heart. During the procedure, a surgeon removes part of an enlarged septum, which is the muscular wall between the left and right ventricles of the heart.

Some open-heart procedures are used to correct or relieve congenital heart defects. Annually, there are about 20,000 open-heart surgeries performed on children in the United States. Infants under one year of age comprise approximately 90 percent of pediatric open-heart surgeries, which include:

  • Norwood procedure. A series of surgeries to treat hypoplastic left heart syndrome, in which the chambers, valves and related blood vessels on the left side of the heart are so malformed that they cannot efficiently pump blood to the rest of the body. Each open-heart surgery is done at a different age, ranging from infancy through the toddler years. The first two surgeries (Stages I and II) are used to temporarily relieve blood flow problems to and from the lungs. The third surgery (Stage III), known as the Fontan procedure, is used to further improve the circulation but cannot cure the underlying heart defects.
 Norwood Procedure

  • Arterial switch operation. To treat transposition of the great arteries (TGA), in which the aorta and the pulmonary artery are in reversed locations, resulting in oxygen-rich blood from the lungs not being able to get to the brain and the rest of the body. During the procedure, the pulmonary artery is disconnected from the pulmonic valve, which arises from the left ventricle. The aorta is disconnected from the aortic valve, which arises from the right ventricle. The aorta is then connected to the pulmonic valve, so that it is exiting from the left ventricle, as it should. The pulmonic valve is connected to the aortic valve, so that it is exiting from the right ventricle, as it should.

  • Rastelli procedure. To treat a number of cyanotic heart defects that restrict the normal flow of blood from the heart to the lungs. The Rastelli procedure is used when a hole in the heart is involved in the defect. The hole is patched to redirect blood flow. Some of these defects include: transposition of the great arteries (TGA) with ventricular septal defect (VSD), pulmonary stenosis, pulmonary atresia (complete closure of the pulmonic valve) with VSD and double outlet right ventricle (DORV) with pulmonary stenosis.

 Cancer Treatment:

What are the different kinds of Cancer Treatment?

The three most common types of cancer treatment are surgery, radiotherapy and chemotherapy. Treatment is aimed at removing the cancer cells or destroying them in the body with medicines or other agents.

Surgery

Surgery can be very successful in treating some kinds of cancer, but it isn't an option for all people. If the cancer is in the form of a malignant tumor and the tumor is in one place (localized), it may be possible to safely "cut out" the tumor and any surrounding affected tissue. Surgery may not be possible if the cancer has spread to other areas of the body or if the tumor cannot be removed without damaging vital organs, such as the liver or brain.

Radiotherapy

Radiotherapy uses radiation — in the form of a special kind of x-ray, gamma rays or electrons — to damage cancer cells so that they can't multiply. There is usually no pain during therapy. Radiotherapy may sometimes be the only treatment needed, or it may be used with other therapies, such as surgery. A combination of surgery and radiotherapy may be used for tumors that grow in one place.

Chemotherapy

Chemotherapy uses medicines to attack the cancer cells. Just the word "chemotherapy" can cause a lot of fear because the side effects can be severe. However, not all people experience severe side effects. The side effects of chemotherapy can often be reduced with other medicines.

Chemotherapy is usually used when the cancer has spread to other areas in the body. Chemotherapy can also be used in combination with surgery and radiation. Sometimes the tumor is surgically removed and then chemotherapy is used to make sure all the cancer cells are killed.

Other Treatments

Another kind of treatment is biological therapy. This treatment uses proteins to trigger the body's immune system to produce more white blood cells (or lymphocytes). Two lymphocytes that can attack and kill cancer cells are the T-cell and the B-cell. The proteins boost the ability of the T-cell and B-cell lymphocytes to kill cancer. Biological therapy can also be used in combination with surgery, radiation therapy or chemotherapy.

Hormone therapy is sometimes used to treat breast or prostate cancer. The hormone estrogen can make breast cancer tumors grow faster. Similarly, the hormone testosterone can make cancerous tumors in the prostate grow faster. Drugs that contain other hormones may be used to block the effects of estrogen and testosterone. In other cases, surgery to remove the ovaries or the testicles may be used. Removing these organs reduces the amount of estrogen or testosterone in the body.

Hormone therapy is often used in addition to chemotherapy or radiotherapy.

Other specialized treatments may be available. Your doctor may talk to you about these treatments if they are an option.

How do I decide what treatment option to use?

Your doctor, or a team of doctors, will help you understand your options and will recommend options for treatment. You may not have a choice in the treatment. Many factors are involved, including the stage that your cancer is in, what organs are affected, and the type of cancer that you have. Some cancers, such as skin cancer, are easier to treat than others. Your age and health, as well as the potential side effects of treatment, may also be factors in how much control you have over your treatment plan.

You and your doctor will want to consider both the advantages and disadvantages of each therapy. In addition, you and your doctor will want to discuss alternative therapies in case your cancer doesn't respond to treatment.

Cosmetic Dentistry Procedures:

The About Cosmetic Dentistry dental procedures area is where you learn about each cosmetic dentistry procedure in detail. In many cases, a cosmetic dentist will implement a combination of several of the following procedures to give you that perfect smile.

Procedures:

  • Teeth Whitening - Learn about the procedures, who it's best for, the costs and options available when having all of your teeth whitened.
          
  • Composite and Porcelain Tooth Veneers - Learn how veneers correct a great many dental problems, the procedures, costs and when they are best used.
     
  • Dental Implants - Learn how dental implants correct missing teeth, the procedures involved, costs and when they are best used.
     
  • Dental Bonding - Is the bonding of a tooth right for you? Learn about the procedures involved, costs and when dental bonding is the way to a perfect smile.
     
  • Dental Bridges - Bridges replace missing teeth. Learn about the procedures involved, costs and when dental bridges will give you a perfect smile.
     
  • Tooth Contouring and Reshaping - A great deal for your smile can be accomplished through small changes. Learn about the procedures involved, costs and when contouring is the way to a perfect smile.
     
  • Dentures - Dentures often solve a host of dental problems. Learn about the procedures involved, costs and when dentures are your way to a fantastic smile.
     
  • Dental Fillings - Today's dental fillings are more than the typical metal fillings of our youth. Dental fillings are now color matched to the rest of your teeth for a great smile.
     
  • Dental Crowns - A great deal for your smile can be accomplished through crowns. Learn about the procedures involved, costs and when crowns are your way to a perfect smile.
     
  • Dental Caps - A great deal for your smile can be accomplished through caps. Learn about the procedures involved, costs and when caps may be your way to a perfect smile.
     
  • Root Canals - Learn about the procedure, costs and when you might be a candidate for a root canal.
     
  • Accelerated Orthodontics - Learn about wearing braces for only a few months compared to a few years with traditional braces.
     
  • Cosmetic Gum Surgery - A "Gummy Smile" or a "Long Tooth Smile" are corrected through gum surgery. Learn about the procedures involved, costs and when gum surgery is the way to a perfect smile.
     

Breast Augmentation:

Depending on the patient and the desired outcome, breast augmentation surgery can be a very simple or very complex procedure. After pre-operative preparation, the surgery starts by cutting one incision into the patient for each implant. The incisions are small and placed so that the scarring is minimal and hard to see. Once the incision is created, the surgeon must cut a path through the tissue to the final destination of the implant. Once that path has been created, the tissue and/or muscle (depending on placement) must be separated to create a pocket for the implant. This is where the surgeon's skill really comes into play: When deciding where to cut the pocket in the breast, the surgeon must predict what the breasts will look like once the implants are filled. In more extreme augmentation surgeries, this involves repositioning the nipple, adjusting for cleavage and creating a new crease under the breast

In some cases, augmentation surgery is accompanied by mastopexy (breast lift) surgery so that everything ends up in the right place. To aid in positioning, the surgeon may decide to use a sizer or disposable implant. Sizers are temporary implants attached to a tube that the surgeon can work inside the pocket and fill up to test placement, implant size and fill levels. Once this has been tested, the sizer is removed and replaced with the permanent implant.

 

Facelifts:

Unlike injectables and fillers, which last for several months, facelifts last for more than 10 years.

Understanding the components of facial aging further emphasizes why injectables are no substitute for traditional facelifts in certain people.

There are five basic components of an aging face:

  • Fine lines and wrinkles
  • Skin pigment changes such as age spots
  • Loss of volume such as hollow cheeks
  • Loss of elasticity
  • Gravity

 Fine lines, wrinkles and age spots may improve with skin resurfacing techniques, such as laser skin resurfacing, chemical peels or microdermabrasion. Wrinkles may further improve with the use of injectables such as collagen or Botox. Loss of volume and folds, including nasolabial folds, may be treated with injectables such as Restylane and Juvederm. Also called laugh lines, nasolabial folds are the deep folds which run from the side of the nose to the corner of the mouth. The loss of elasticity and the sometimes devastating effects of gravity on the face, however, can be improved only with traditional facelifts.

Are you a candidate for a facelift? You may be if your face is loose and sagging. People with a strong jaw line or well-defined bone structure are also good candidates  for a of a facelift. People in their 40s, 50s, and 60s are the most common facelift patients, but others in their 70s and 80s have had successful surgeries as well.

A facelift can correct many things to improve appearance, including:

  • Sagging in the midface
  • Deep creases below the lower eyelids
  • Deep creases along the nose extending to the corner of the mouth
  • Fat that has fallen or is displaced
  • Loss of muscle tone in the lower face that may create jowls
  • Loose skin and excess fatty deposits under the chin and jaw that can make even a person of normal weight appear to have a double chin

Preparing for Facelift Surgery

A consultation is the first step toward your new, improved face. This evaluation will determine if you are a good candidate for a facelift. Your surgeon will take a thorough medical history. He or she will evaluate your skin's elasticity, bone structure, wrinkles and folds, as well as your hairline, to better guide incision placement. Your expectations concerning the facelift will also be discussed, and the surgeon will likely take some “before” photos.Once you have decided to have a facelift, chosen a surgeon and scheduled your procedure, your doctor will give you a list of pre-operative instructions.

In the two weeks before your facelift, your plastic surgeon will likely suggest that you stop taking certain medications, including aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and blood thinners, all of which can increase bleeding risk. Certain herbal remedies may also increase bleeding risk. Just because a product or preparation is “all-natural” does not mean it is safe. For example, vitamin E, omega-3 fatty acids, green tea and gingko biloba all may increase bleeding risk during and after facelift surgery.

Make sure you tell your surgeon about EVERYTHING that you are taking. Never stop taking any medication abruptly without first speaking to your doctor.

Some plastic surgeons may also suggest adding medications to your daily regimen in the weeks leading up to your facelift. The herb arnica and the enzyme bromelain, for example, may help minimize bruising and swelling after a facelift.The pre-op instructions will also include a list of do's and don'ts about eating and drinking before your facelift. Quitting smoking before your facelift is a must. Most surgeons recommend that prospective patients kick the habit for the month before and the month after the facelift. Smoking reduces blood flow to areas of the face. As a result, one in ten smokers will experience skin death (necrosis) at the incision sites if they continue to smoke before and after surgery. Wounds may turn red and black, and the edges may start coming apart. Such wounds may require a skin graft, another surgery in which a patch of skin is surgically removed from one area of the body and transplanted to another area.

The good news is that many tools are available today to help smokers become ex-smokeNicotine replacement products, such as nicotine patches, nicotine gum and nicotine lozenges, are available over-the-counter. A nicotine nasal spray and inhaler are currently available by prescription. These can help relieve nicotine withdrawal symptoms.But keep in mind that nicotine patches and other nicotine replacement systems can't be used as smoking cessation aids immediately before or during surgery. They cause some of the same problems with wound healing as cigarette smoking. Tell your surgeon if you are using any nicotine replacement products.Drugs such as buproprion SR (Zyban) and varenicline tartrate (Chantix) are non-nicotine pills that may help you quit smoking before a facelift. Talk to your doctor about a prescription. Also, hypnotherapy or acupuncture may help some people quit smoking.  Acupuncture involves placing extremely thin needles into the skin along specific acupuncture points to help curb the desire to smoke.

Liposuction:

Liposuction Definedned
Liposuction is defined as the removal of fat from deposits beneath the skin using a hollow stainless steel tube (called a cannula) with the assistance of a powerful vacuum. Liposuction can be accomplished either with the use of general anesthesia, or with heavy IV sedation, or totally by local anesthesia. This web site considers both the benefits and the potential dangers of local anesthesia and of systemic anesthesia.

Tumescent Liposuction
Tumescent liposuction refers to a technique that uses large volumes of very dilute local anesthesia that is injected into the fat causing the targeted areas to be come tumescent, or swollen and firm. Local anesthesia is widely regarded as the safest form of anesthesia. Because local anesthesia persists for many hours there is no need for narcotic pain medications after surgery.

Modified Tumescent Liposuction
Modified tumescent liposuction refers to a combination of tumescent local anesthesia plus some form of systemic anesthesia (general anesthesia or heavy IV sedation). Because general anesthesia or heavy IV sedation can be dangerous, they must be administered by an anesthesiologist.

The Different Liposuction Techniques
There are many ways to do liposuction, for example liposuction can be accomplished painlessly either totally by local anesthesia or with general anesthesia. In the realm of liposuction, maximum speed and maximum volume of aspirate are not criteria for excellence. Ultimately, excellence is measured in terms of patient happiness which is a function of safety, patient comfort, finesse, and quality of results. The important distinction between liposuction surgeons who are board certified is the liposuction technique that they use. The surgeon's specialty is not as important as the surgeon's technique, experience and attitude toward safety.

Liposuction Complications
Liposuction complications are often the direct result of lack of caution, poor judgment, over confidence, ignorance about pharmacology, or adherence to faulty dogma. This web site discusses these traits, and explains how to reduce the risk of liposuction surgical complications.

The "Art of Liposuction"
Liposuction is a medium of artistic expression that displays itself in (1) a practical application of scientific knowledge, (2) the production of what is beautiful, (3) a perfection of workmanship, (4) a perpetual quest for improvement in technique, and (5) a skill attained through clinical experience, and above all (6) making people feel happy about what they see in the mirror.

Artistry and Safety are Related
This web site asserts that artistry and safety depend on each other. The word "art" implies skill and mastery of a technique. In order to master an artistic liposuction technique, the surgeon must have the skill and intelligence to avoid exposing patients to unnecessary dangers. The true artist provides better results, and uses the safest technique and never forgets the duty to "first, do no harm." For example, even if a patient wants to have a large volume of liposuction accomplished in one session, the artist convinces the patient that serial liposuction procedures are safer and ultimately yield better results. It is not artistry to take unnecessary risks or push liposuction to the limits of safety.

Risks of Liposuction
Risks of Liposuction must be well understood by all prospective liposuction patients. This web site emphasizes the need to constantly be aware of safety issues. In order to minimize the risk of liposuction, the patient must be aware of the following facts:

  • Too much liposuction is an excessive volume of aspirated fat, or an excessive number of areas treated. Excessive surgical trauma (excessive liposuction) is dangerous and is an important cause for serious liposuction complications.
  • Unrelated surgical procedures on the same day as liposuction are unnecessary. Prolonged exposure to anesthesia is dangerous and is an important cause for serious liposuction complications.
  • Disfiguring skin irregularities and depressions are frequently the result of the surgeon's inattention to detail. For example, if a liposuction surgeon attempts to do too much on a single day, and becomes fatigued, the result may be an inattention to detail, and undesirable cosmetic results. A liposuction cannula is a stainless steel tube inserted through an incision in the skin that is employed to suction the fat. The size of the liposuction cannula can influence the smoothness of the skin after liposuction. The use of large cannulas tend to create irregularities more commonly than microcannulas (outside diameter less than 3 millimeters). Surgeons who do total-body liposuction tend to use larger cannulas.



Tumescent Technique is Safest
The tumescent technique for liposuction is unquestionably the safest form of liposuction. When tumescent liposuction is done correctly (not excessively), it is a very safe procedure. For example, there have been no reported deaths associated with tumescent liposuction totally by local anesthesia. Even when general anesthesia is combined with the tumescent technique, liposuction is quite safe provided the volume of fat removed and the number of areas treated during a single surgery is not excessive. The dilute epinephrine contained in the tumescent anesthetic solution profoundly shrinks capillaries and thus virtually eliminates surgical blood loss.

Smoother Cosmetic Results
The tumescent technique permits the use of microcannulas which in turn yields smoother cosmetic results. Traditional liposuction cannulas (stainless steel tubes) have a relatively large diameter and remove fat rather quickly. However, with the use of large cannulas (diameter greater than 3 millimeters) there is an increased risk of irregularities and depressions in the skin. Microcannulas with a diameter less than 3 millimeters, allow fat to be removed in a smoother and more uniform fashion. Some surgeons prefer larger cannulas because it allows liposuction to be done more quickly.

Rapid Healing
After tumescent liposuction, there is a certain amount of blood-tinged local anesthetic solution that remains under the skin. This excess fluid is either slowly absorbed over several weeks into the blood stream, or it can be rapidly removed by drainage through skin incisions and absorbed by special absorptive pads (HK Pads).

Rapid Drainage
Rapid drainage of blood-tinged anesthetic solution out of incision sites, accelerates the rate of healing, and reduces post-operative pain swelling, and bruising. Post-liposuction drainage of blood-tinged anesthetic solution can be maximized by 1) leaving incision sites open and not closed with sutures, 2) placing several adits (1.5 mm tiny round holes) in the skin to encourage drainage, 3) placing HK Pads on the skin to absorb the drainage, and 4) wearing spandex compression garments to encourage drainage.