Plastic Surgery - Nose and Boob Jobs

Okay, so today, I participated in my first 2 plastic surgeries. I mainly just held the suction device to suck up any blood, or smoke from the cautery machine, nothing to exciting, but very interesting to watch.

*Warning, I do go into some detail on these procedures and mention the word breast, so if you find that offensive, you may want to stop reading. :)

The first surgery was a Rhinoplasty (aka: nose job). This pt had 2 bumps on the bridge of her nose that she didn't like. Dr. Williams is very old school, and uses techniques that they apparently don't teach much anymore. For his nose jobs, he makes his incisions inside the nose, not outside, that way you don't have to deal with visible scaring, makes sense to me. The tools they use are pretty cool, they look primitive, but have very specific uses. I was informed that a lot of them were developed by a German Jewish physician, he was a pioneer in rhinoplasty and many of the tools were created and named after him, Jacques Joseph (look up "History of Rhinoplasty" in Wiki if you are interested). Anyway, after making the incisions, he separated the skin from the cartilage and bone, then ground the bumps down, broke the nose, and reshaped it. Very interesting. I was also able to see a pt come in 1 week post op this afternoon. His nose was still swollen, but the differences were remarkable in the before pictures. In spite of the swelling your could see the change. It will be interesting to see the pt we operated on today in a week or two.

The second operation was a breast augmentation. He makes 2 small one inch incisions, one below each breast. He then separates the muscle from the rib cage and creates a space in which to place the implant. A spacer is then inserted and saline is injected to see what size implant to use. It is also used to make sure that everything is balanced. The pt, who is laying with their arms out, as if on a cross, is brought into the sitting position (while asleep) to make sure that the implants will be balanced and symmetrical. If every thing looks good, the pt is laid back down and the spacers are removed. The space is rinsed with saline and antibiotic to prevent infection. The Dr. makes sure there is no bleeding, and then the implants are inserted. They only contain about 100 cc (100 mL) of saline when inserted. They are then filled to the level that was indicated by the spacers. Today's patient was going to receive 350 cc on the right, and 330 on the left, but when that was done and the pt was placed in sitting position again, they just didn't look balanced. I was able to use the skills I have developed as an osteopath to detect the asymmetry (all of those OMM labs on asymmetry payed off). The Dr. made some adjustments, and some saline was removed from the right and added to the left. In the end, the pt ended up with 340 cc on the right and 350 on the left. This pt went from being a very small A, to a full C cup.

So for any of you women out there contemplating breast augmentation, that is how it works. Hope you found that informative and educational. :) If any of you have questions, don't be afraid to ask. I am obtaining a wealth of knowledge, which now extends from gallbladder and thyroid removals to nose and boob jobs. Tomorrow will be hand surgery, adding to my repertoire.