By: Dr. Yehuda Ullmann, Director, Plastic Surgery Department and Esthetic Medicine Services, Rambam Medical Center


“By means of beauty all beautiful things become beautiful” (Socrates)

There is no definite answer yet to the question of how the ideal of beauty is determined. The sociological approach states that the model of beauty changes in accordance with time, the ruling culture, and the economic and political situation. This is the approach that claims that the ideal of beauty that we see through the media and the world of advertising is dictated by men.

In contrast, the biological approach states that evolution, and not ideology, is what dictates our ideal of beauty. The model of beauty is dictated by an ancient genetic code imprinted in every one of us. The principles of natural selection are responsible for causing the good genetic qualities to be perceived as beautiful and attractive by the opposite sex.

According to the evolutionary model, smooth, light-colored skin, flowing hair, well developed breasts and rounded hips convey beauty, but all these features actually indicate fertility, good health and the ability to give birth.

There is also an issue of symmetry. Those supporting the Darwinist principle of beauty claim that symmetry indicates health, and that it only underwent transformation, from a sign of genetic quality into a sign of beauty. According to them, the right and left sides of our bodies are never completely identical, and the balance between them, which is established during pregnancy, can change due to the penetration of certain parasites into the uterus. Therefore, a symmetric build indicates a good and clean mixture of genes.

Reinforcing their statements, the Darwinist psychologists found that women are sexually attracted more to men whose features are symmetric.

According to this theory, the higher the degree of similarity between the right and the left sides, the more attractive is the person considered to be. The faces of Bill Clinton and Paul Newman, for example, were found to be almost perfectly symmetrical, much more so than the average.

One phenomenon is undisputed: most people, especially women, are not satisfied with their physical appearance. Into this breach - between the mirror and the body, the existing and the desired - steps esthetic medicine, with a variety of operations and treatments, which enable us to get closer than ever to the desired model of beauty, and to maintain it over time, even if it is still elusive.

Breast augmentation

The most common esthetic surgery for women. During this operation, implants are inserted in order to enlarge the breasts. Nowadays, using silicon implants is common practice throughout the world, after FDA approval of their safety.
The implants vary in shape and size. The implant is chosen by agreement between the patient and the surgeon, according to the structure of the body and the breasts, and the patient’s aspirations.
The operation is usually performed under deep sedation. The implant is inserted via an incision in the sub-mammary fold, or around the inferior pole of the nipple.
The recovery process entails pain which can be relieved by regular pain killers. The results are maintained for years.

Mastopexy and Breast reduction

Designing the appearance of the breast for women suffering from drooping and/or enlarged breasts, by breast lifting, with or without reduction and nipple relocation, as required.
There are several techniques for performing these operations, and the choice of the suitable method depends on the size and the form of the breast.
The operation is usually performed under general anesthesia.
In most cases, the patient may be discharged on the day after the surgery; some patients require a short hospitalization of a few days. The recovery period is about two weeks (depending on the type of surgery).
The major disadvantage is scarring of the breast, around the nipple and along the middle lower pole of the breast.

Abdominoplasty (Tummy tuck)

Shaping the appearance of the abdomen by removing excess skin and fat, and strengthening the abdominal wall with stitches. It is possible to remove “stretch marks” where the skin is excised.
Sometimes, a combination of abdominoplasty with liposuction is required to achieve optimal results. This surgery is not performed for purposes of weight reduction or slimming. In most cases, the surgical scar is at the bikini line and around the umbilicus.
The surgery is usually performed under general anesthesia. In most cases, the patient can be discharged on the day after the surgery; some patients require a short hospitalization of a few days. The recovery period is a little longer, and may last about two weeks. Drains which are left after surgery are removed, usually 3-7 days after the surgery.

Liposuction

Body shaping by suction-assisted fat removal from various areas of the body: abdomen, waist, thighs, buttocks, knees, breasts, neck, and more.
It is important to understand that this surgery is not intended for weight reduction or slimming, and the amount of fat which can be removed during a single operation is limited.
The surgery is performed under general or regional (epidural) anesthesia. Liposuction is performed through a number of small skin incisions, usually in hidden areas. No new fat cells will be formed at sites of fat suction.
Hospitalization is short, and the patient is discharged on the day after the surgery.
Special clothing is required after the surgery. The swelling and local hemorrhages resolve within 2 weeks.

Rhinoplasty (Nose surgery)

Rhinoplasty (Nose surgery), designed to improve the appearance of the nose, is one of the most popular esthetic surgical procedures. This surgery is based on the principle of improving the general shape of the nose by altering its internal structure.
Different parts of the nose can be shaped during the surgical procedure: the hump, tip of the nose, nostrils, nasal septum, etc. Sometimes it is also necessary to perform a surgical procedure to improve nasal air passage.
In most cases, the surgery can be performed through internal incisions which are concealed by the mucous tissue of the nose, with no external skin scars. However, for nostril shaping, scars are inevitable.
The surgery can be performed mostly under local anesthesia. The patient is released following a short recovery time after completion of the surgery.

Otoplasty (Ear surgery)

The most popular esthetic ear surgery is designed to correct protruding ears.
There is a variety of surgical methods for bringing the ears closer to the head. The method is chosen according to the problem causing the distorted appearance and the surgeon’s experience. In some cases, several subcutaneous stitches are sufficient to achieve the desired result. In more problematic cases, more extensive surgery is required that involves skin and/or cartilage excision, and reshaping the remaining cartilage. The procedure is done under local anesthesia with sedation.
Recovery takes from one to two weeks, and the results are long lasting.

Blepharoplasty (Eyelid surgery)

The process of aging leads to changes in the eyelid appearance, characterized by excess skin and fat, folds, wrinkles and accumulation of “fat bags” in the upper and lower eyelids.
The purpose of this surgery is to make the eyelid appear younger, resulting in the entire eye appearing younger. The surgery is performed under local anesthesia, and involves removal of the excess skin and fat.
This surgery does not lift the eyebrows, and does not remove the wrinkles from the corners of the eyes. The scars remaining are almost invisible.
Significant swelling around the eyes is expected to occur during the first days following surgery. This swelling will gradually resolve.
The recovery period is short, and the results are long lasting.

Mentoplasty (Chin surgery)

Esthetic medicine currently enables both augmentation (more common) and reduction of the chin.
Chin augmentation is now most frequently performed using silicon implants. The implant is inserted through an incision made in the mucous tissue inside the mouth (no external scar), or through an incision made under the chin (an external scar remains).
The surgery is performed under local anesthesia.
New materials such as “Bio-Alcamid” can be injected, thus enabling the reshaping of the chin with no need for surgery.
The recovery is short and quick, and the results are long lasting.

Face lifting

The purpose of this surgery is to remove the excess facial and neck skin formed over the years, due to the force of gravity and the loss of skin elasticity.
[In a single operation, tightening of loose facial muscles is performed, and excess skin is removed.] / [During the same operation, tightening of loose facial muscles is also performed.]
The surgery is performed under deep sedation or under general anesthesia.
The major disadvantage of this surgery is the scars left at the hair line, in front of the ears and behind them. This procedure is not intended for [fine wrinkle removal] / [the removal of fine wrinkles].
This surgery usually requires overnight hospitalization.
Recovery takes about two weeks, and the results are maintained over several years.

Forehead lift

This surgery is designed to return the eyebrows to their natural position after having sagged over the years, to eliminate some of the creases across the forehead, as well as the “worry lines” at the root of the nose. This surgery can be done either as part of the face lifting procedure, or as a separate surgery.

The procedure is performed under deep sedation. A scar is left within or near the hairline. Excess skin is removed, and muscle activity is partially eliminated. In some cases, the lift may be performed through more limited incisions.

Facial Resurfacing (Peeling)

This procedure is designed to “smooth out” the superficial and moderate facial wrinkles around the eyes and the mouth, and to reverse the skin damages caused by the sun.
The procedure can be performed by mechanical skin abrasion, by application of various acids (chemical peeling) or by CO2 laser, which is our preferred method.
The procedure is performed under deep sedation. Actually, a controlled second degree burn is induced, whose healing process leads to the formation of new skin tissue which is healthier and tight.
This procedure is not an alternative to face and neck lifting surgery, and is limited to the facial area only.
The recovery process lasts about two weeks. The new skin is red, and requires concealment with make-up for a few months.

Photorejuvenation (Rejuvenation of facial skin)

The purpose of this treatment is to lighten facial blotches (brown and red), as well as tiny blood vessels in facial skin.
The treatment uses filtered light energy, activated in pulses, and is performed after a local anesthetic ointment has been applied for an hour to the areas to be treated.
This treatment is relatively simple, and most patients can return to full normal activity after two or three days, with light make-up.
In contrast to peeling, this treatment can also be performed on the neck, in the cleavage, and on the backs of the hands. Sometimes, supplementary treatment is required. Some people claim that this procedure is appropriate for elimination of small wrinkles as well. According to our department’s experience, there is no foundation for that.

Treatment of facial wrinkles

In recent years, these treatments have become more popular due to the introduction of substances that are more efficient and safer to use. Treatment of wrinkles is mainly a treatment of first aid, and does not replace, but rather postpones part of the “heavier” treatments. Since these treatments do not involve surgical procedures, there is almost no need for medical leave of absence from work, the recovery period is short, and there is no need for incisions and an operating room.

Botulinum toxin

This treatment has been in use for many years for syndromes related to contracted muscles. Intramuscular injection of the substance leads to muscle relaxation.
The esthetic use is a recent application, after it was discovered that injection of the substance, especially into the muscles at the sides of the eyes and in the forehead, eliminates wrinkles at these sites.
The procedure is short, and the action of the substance begins a few days after the injection. The major disadvantage of this treatment is its short-lasting effect: about three months. After this period, the treatment has to be repeated.

Autologous fat injection
 
The use of autologous fat (the patient’s own fat) is based on extracting fat from sites containing sufficient amounts of fat, such as the abdomen and buttocks, and injecting this fat into sites where augmentation is desired, usually in the face: wrinkles, cheeks, lips.
The major disadvantage of using this fat is the need for fat suction, which is performed under local anesthesia. In addition, partial fat absorption occurring during the first two weeks requires injection of excess fat in order to achieve the desired result. The recovery process is longer than with other substances.

Injection of hyaluronic acid

Agents based on this substance, which is a natural component of the skin and other tissues, are injected into the wrinkles.
The procedure is simple and does not require local anesthesia. Actually, patients can return to their daily routine almost immediately, as except for redness which disappears within a short time, and in rare cases local bruises, no signs are left on the skin.
The major disadvantage is the need to repeat the procedure every 8-12 months, since the substance is degraded in the body. These substances do not provoke allergic reactions, in contrast to collagen based agents that were used in the past.