How do you treat a cyst on your jaw?

 

 
 
 
 
 
View this post on Instagram
 
 
 
 
 
 
 
 
 
 
 

 

A post shared by Effie Politis, MD, FACS (@dreffiepolitis)

This young lady presented with a 5-year history of a mobile subcutaneous mass along her mid-right mandible.⁣⁣⁣⁣

She opted to have her cyst removed because it was enlarging and more noticeable. She also found good timing given most are wearing masks during the current pandemic.⁣⁣⁣⁣

When evaluating the subcutaneous masses, we do a careful head and neck examination of the patient to rule out a possible cutaneous malignancy. This includes a careful history as well as a lymph node evaluation and intra-oral evaluation. She denied any trauma to this area or any drainage.⁣⁣⁣⁣

 

 
 
 
 
 
View this post on Instagram
 
 
 
 
 
 
 
 
 
 
 

 

A post shared by Effie Politis, MD, FACS (@dreffiepolitis)

After careful evaluation, the area is numbed with local anesthesia, and then the cyst removed with sharp dissection followed by a layered closure to ensure a fine, hidden scar.

Sebaceous cysts may develop as a result of trauma or blocked glands in the skin and rarely cause pain or other symptoms. They’re most commonly found on the face, neck, and trunk. ⁣

Many patient prefer the removal of any lesions or cysts on the face to be performed by a plastic surgeon to ensure optimal scar healing and placement along with aesthetic units.⁣

 

 
 
 
 
 
View this post on Instagram
 
 
 
 
 
 
 
 
 
 
 

 

A post shared by Effie Politis, MD, FACS (@dreffiepolitis)

This is the defect after the entire cyst including sack and contents are removed.

Important structures in this area are the facial artery and vein and marginal mandibular nerve. ⁣

These structures were abutting the cyst but knowledge of anatomy helps us dissect them away without damaging them. ⁣

The defect was cleaned with betadine and peroxide and saline prior to layered closure for a nice fine scar.⁣⁣

What is Revanesse Versa Used For?

 
 
 
 
 
View this post on Instagram
 
 
 
 
 
 
 
 
 
 
 

A post shared by Effie Politis, MD, FACS (@dreffiepolitis)

This patient was treated with Jeaveau to her upper forehead rhytids, brow lift, crow’s feet, and a midface volumization with 1 vial of Revanesse Versa, 1 cc on each side of her cheeks (deep medial fat pads), using the cannula technique. ⁣

⁣”Revanesse Versa is a hyaluronic acid dermal filler. Hyaluronic acid is a naturally occurring substance that is found within the body. It may be produced by bacteria and purified for use as injectable soft tissue filler in order to correct the appearance of facial wrinkles and creases, (nasolabial folds). The product is approved for use in the U.S. by the Food and Drug Administration for the cosmetic treatment of facial wrinkles and creases.” ⁣
⁣Would you like to know more about this procedure and the products used? You can reach out to us by calling (813) 542-2587 or using our online contact form. ⁣

What are breast implants?

A breast implant is a medical device (prosthesis) inserted under breast tissue or chest muscle to change the size, contour or shape of the breast. In plastic surgery, breast implants are used to increase breast size, replace breast tissue removed due to trauma or cancer surgery, or to correct severe birth defects and deformities of the breast and the chest wall.

There are three main types of breast implants used in plastic surgery: saline implants, silicone implants and structured implants.

Saline breast implants

Saline breast implants are filled with saline solution. They are placed by means of a less invasive surgery through smaller incisions. During the surgery, empty saline implants are inserted into implant pockets and then filled with saline solution. The incisions made for this insertion are smaller and shorter compared to the relatively longer incisions required to place pre-filled implants.

Saline breast implants offer an increased breast size with a realistic texture and smooth contour. However, they are associated with cosmetic problems such as the wrinkling of breast skin and the implant being more noticeable to the eye and touch, particularly in women with less breast tissue. For women with enough breast tissue, saline implants produce aesthetically better results.

Silicone gel breast implants

The current models of silicone gel breast implants are filled with a high-strength, highly cohesive silicone gel which reduces the likelihood of filler leakage to the body. These form-stable implants can retain their shape even when their shells are broken. They are also less likely to wrinkle and tend to feel a bit more like natural breasts. However, they require slightly longer incisions for placement and they can spread into the breasts, causing lumps. Breasts augmented using silicone gel implants require regular ultrasound or MRI images for assessing the condition of the implants.

Structured breast implants

Structured implants incorporate both saline and silicone gel implant technologies. They use the saline solution as the filler while having the natural feel of silicone. Their internal structure consists of a series of nested shells that support the upper pole and two lumens (cavities) where the filler material is added.

During surgery, a structured implant is inserted while empty and then filled with saline once placed, requiring a smaller incision than a pre-filled implant. And if one of the lumens ruptures after the procedure, it just leaks and empties, leaving the other lumen intact and the implant only partially deflated. This feature allows for ease of removal and replacement.

How are breast implants placed?

When choosing a plastic surgeon for breast implant surgery, finding someone experienced reduces the risk of complications after the procedure. Before the surgery, you will have an appointment with the surgeon for a medical evaluation. Your consultation will allow you to share your goals and expectations with the surgeon, and learn how to prepare for the procedure.

Breast implant surgery is usually carried out under general anesthesia. The plastic surgeon makes a cut in the skin below or next to the breast. The implant is positioned either behind your chest muscle or between your breast tissue and chest muscle. The doctor then closes the incision and covers it with a dressing.

The procedure usually takes 60 to 90 minutes. You may be able to return home the same day, or you may need to remain in the hospital overnight if the operation is scheduled late in the day. You will be given pain medication to help manage the discomfort after the anesthesia wears off. Your breasts will be covered with compression garments, and drainage tubes will be applied in order to drain the surgical area. Expect to need rest for a few days after the surgery and avoid heavy lifting for at least 6 weeks.

Are breast implants safe?

Breast implants are quite safe and rarely cause issues. Though it is possible for the implants to rupture and leak, they rarely cause medical problems. When saline implants rupture, the salt solution is safely absorbed by the body. For silicone gel implants, the gel either remains in the shell or leaks out following a rupture that results in no obvious symptoms.

How are breast implants maintained?

Breast implants are, by design, not intended to last a lifetime. They may have to be replaced if there are complications or if the breasts change in size and shape over time. If you have silicone gel-filled implants, you will need an MRI scan three years after your implant surgery, and then MRI scans every two years to check for silent ruptures. Ruptured implants should be removed or replaced.

At Politis Plastic Surgery, we offer breast implant surgery to enhance the natural appearance of your breasts, create fuller curves, and give you a more aesthetically pleasing shape. We understand that your breasts are a defining feature of your body and enhance your femininity, sexuality and beauty. Through breast augmentation, you can change the size and shape of your breasts and, in turn, your self-confidence.

Are you considering breast augmentation?

Schedule a private consultation today with Dr. Effie Politis and have your questions answered and concerns addressed. For more information on breast implants and breast augmentation, visit the Politis Plastic Surgery website.

“Breast in a Day” Surgical Technique

 
 
 
 
 
View this post on Instagram
 
 
 
 
 
 
 
 
 
 
 

A post shared by Effie Politis, MD, FACS (@dreffiepolitis)

Another ‘Breast in a Day’ case, but executed differently since she has much larger ptotic breasts (sagging breasts). ⁣

She basically had a mastectomy performed through a Wise pattern skin mastopexy and I kept the nipples on an inferiorly based adipodermal flap. ⁣

I reduced her mastectomy envelope, reduced and repositioned her nipple areolar complexed, and placed a cohesive Natrelle Inspira SCF 520cc implant in the prepectoral position with anterior Galaflex sheet. ⁣

“Wise pattern or inverted-T mastopexy has traditionally been used in patients with severe excess of skin relative to breast parenchyma (tissues of the breast essential for functioning) in a patient with severe ptosis. Incisions are made around the areola with extensions for the vertical limbs as in a vertical mastopexy.” (Qureshi, Myckatyn, & Tenenbaum, 2018)⁣

“The Wise-pattern incision addresses any redundant mastectomy skin envelope and avoids excessive and unsightly scarring on the “social” aspect of the breast mound.” (Newman, 2016)⁣

“The pattern allows removal of skin in both vertical and horizontal dimensions allowing for lifting and coning of the breast into a less ptotic shape.” (Todd, 2016)⁣

What is Bruxism?

Bruxism is a condition in which you grind, gnash or clench your teeth. If you have bruxism, you may unconsciously clench your teeth when you’re awake (awake bruxism) or clench or grind them during sleep (sleep bruxism). Mild bruxism may not require treatment. However, in some people, bruxism can be frequent and severe enough to lead to jaw disorders, headaches, damaged teeth and other problems.

What is Breast Augmentation?

 

Sagging breasts can be disappointing and conspicuously small breasts can feel inadequate. Clothes that fit neatly at the shoulders and waist but appear too large at the bust line can be awkward. But you don’t have to be self-conscious when you wear swimsuits or form-fitting tops. You can achieve your desired breast size through the medical procedure known as breast augmentation

Read more about Breast Augmentation

GalaFLEX Surgical Scaffold for Plastic or Reconstructive Surgery

 
 
 
 
 
View this post on Instagram
 
 
 
 
 
 
 
 
 
 
 

A post shared by Effie Politis, MD, FACS (@dreffiepolitis)

Another important technique to point out from the case that we’ve recently posted about(please see our grid @dreffiepolitis ), is the use of Galaflex Ravioli construct⁣⁣⁣⁣⁣.⁣⁣

The GalaFLEX Scaffold (Galatea Surgical, Inc., Lexington, MA) for plastic and reconstructive surgery belongs to a new generation of products for soft tissue reinforcement made from poly-4-hydroxybutyrate (P4HB)⁣. ⁣

It is comprised of high-strength, resorbable P4HB monofilament fibers. It is a knitted macroporous scaffold intended to elevate, reinforce, and repair soft tissue. The scaffold acts as a lattice for new tissue growth, which is rapidly vascularized and becomes fully integrated with adjacent tissue as the fibers resorb.⁣

The “ravioli” technique involves using 2 pieces of extra thick ADM to completely wrap the TE/implant. The 2 pieces of ADM are cut to the size of the TE/implant with 1 piece covering the anterior and the other covering the posterior surface of the TE/implant.⁣⁣

Acellular dermal matrix (ADM) is a soft connective tissue graft generated by a decellularization process that preserves the intact extracellular skin matrix. Upon implantation, this structure serves as a scaffold for donor-side cells to facilitate subsequent incorporation and revascularization. In breast reconstruction, ADM is used mainly for lower pole coverage and the shaping of a new breast. It helps control the positioning of the implant in the inframammary fold, and prevents the formation of contractile pseudocapsule around the breast implant.⁣⁣

The “ravioli” construct is something Dr. Stephen Sigalov came up with which involves performing a 360 degree wrap of the implant with Galaflex to stabilize the implant in the breast pocket given the normal landmarks are obliterated with the mastectomy. The Galaflex or P4HB totally resorbs (turns in CO2 and H20) in 18-24 months and is replaced by the patients own Type 1 collagen to provide long lasting implant support. Type 1 collagen is the strongest collagen in the body. This prevents issues such as stretch, bottoming out, malposition, implant flipping etc. ⁣⁣

Tummy Tuck: All You Should Know

Do you have loose skin, stubborn fat deposits and stretch marks in your abdomen? Are you feeling embarrassed and self-conscious because of your protruding belly? Have you tried to achieve a flat tummy through diet and exercise without success?

If so, a tummy tuck is ideal for you.

Abdominoplasty, better known as a “tummy tuck,” is a surgical procedure to reshape and flatten the abdominal area. The surgeon removes excess sagging skin, gets rid of stubborn fat, tightens abdominal muscles, and corrects a protruding belly. The surgeon also removes some, if not all, stretch marks.

More detailed information about Tummy Tuck here.

What is SPY Elite Imaging?

SPY Elite imaging uses an injectable fluorescing agent to intraoperatively assess the perfusion and viability of tissue, including skin flaps, during post-mastectomy reconstruction for breast cancer patients.⁣⁣
⁣⁣
We evaluated the patient preoperatively and also used intraoperative SPY imaging (intraoperative laser angiography) to ensure adequate perfusion of the mastectomy flaps prior to engaging in single stage reconstruction. ⁣⁣
⁣⁣
Intraoperative laser angiography using indocyanine green (ICG) is a vascular imaging methodology that can be used in the intraoperative or postoperative setting to visually assess superficial blood flow. ⁣⁣
⁣⁣
Characteristics of ICG angiography make it a desirable option for tissue evaluation. The technique provides real-time assessment of tissue perfusion that has been correlated with clinical outcomes and guides surgical decision making, such as flap design or intraoperative tissue resection. ICG has an excellent safety profile and short plasma half-life, allowing for repeat evaluations during the same operative procedure. ⁣⁣
⁣⁣
_______________⁣⁣
⁣⁣
Please note: These are my individual patients who have provided written photo consent. These photos and posts do not constitute medical advice. Results may vary. See a board certified plastic surgeon for evaluation.⁣⁣⁣⁣⁣⁣

“Breast in a day” direct-to-implant breast reconstruction

 
 
 
 
 
View this post on Instagram
 
 
 
 
 
 
 
 
 
 
 

A post shared by Effie Politis, MD, FACS (@dreffiepolitis) on

Surgical Technique

⁣⁣⁣⁣⁣

Type of Recon: Single Stage Direct to Implant Breast Reconstruction after Mastectomy⁣⁣⁣, Galaflex Ravioli construct⁣⁣⁣⁣⁣
Type of Mastectomy: Nipple Sparing or Nipple Preserving⁣⁣⁣ through inframammary approach⁣⁣⁣⁣⁣
Implants: Natrelle Inspiration Cohesive SCF 295⁣⁣⁣⁣⁣
SPY Elite Imaging⁣⁣⁣⁣
⁣⁣⁣⁣⁣
Breast in a day” direct-to-implant breast reconstruction represents an emerging technique in the field of postmastectomy reconstruction and holds appeal, as it shortens the reconstructive process, eliminates the expansion period, and avoids a second operation.
⁣⁣⁣⁣⁣
This case was performed with bilateral nipple sparing mastectomy and single stage reconstruction with cohesive implant and Galaflex ravioli construct placed in prepectoral position.⁣⁣⁣⁣⁣
⁣⁣⁣⁣⁣
The advantage of this technique is that it is performed at time of mastectomy whereas traditionally, we place tissue expanders partially under the muscle and expand the patient and then perform a second procedure in 3-6 months where we exchange the expanders for permanent implants. ⁣⁣⁣⁣⁣
⁣⁣⁣⁣⁣
Therefore, instead of a staged process, we can achieve stable and long term results with a single stage or direct to implant reconstruction. This requires collaboration with the surgical oncologist, meticulous dissection, scaffold material (Galaflex to stabilize and secure implant in mastectomy pocket ), and cohesive implants, we are able to perform implant based reconstruction in a single stage. ⁣⁣⁣⁣⁣
⁣⁣⁣⁣⁣
Also, the implants are typically placed over the muscle, which decreases pain, animation deformity, preserves shoulder/arm strength, and creates a more natural result. ⁣⁣⁣⁣⁣
_____⁣⁣⁣⁣⁣
⁣⁣⁣⁣
Please note: These are my individual patients who have provided written photo consent. These photos and posts do not constitute medical advice. Results may vary. See a board certified plastic surgeon for evaluation.⁣⁣⁣⁣
⁣⁣⁣⁣