Posted: Saturday 29 September 2018 | 10:15:43 pm.
Author: Ana María Domínguez Cruz
A CubaNews translation.
Edited by Walter Lippmann.
Aesthetics and health. The debate is still endless because the search for beauty, beyond the superficial, can also be a guarantee of emotional health, psychological stability, high self-esteem and general well-being.
Plastic surgery professionals also work in the field of reconstructive surgery and caumatology, and say that in the first place the safety of the procedure and the training of the professionals who put it into practice should be paramount.
According to data released at the 2nd Congress of the Cuban Society of Plastic Surgery and Caumatology, held from September 5 to 7 on the Island, from 2001 to 2016, 309,469 plastic surgeries were performed in Cuba The majority (200,508) were aesthetic and the rest reconstructive.
They added that there is a considerable increase every year starting in 2011, which places us in line with the rest of the world, where each time the number of people who come or need this specialty grows.
Dr. Ariel C. Prada, a third-year resident in Plastic Surgery and Caumatology at the Hermanos Ameijeiras Clinical Surgical Hospital, recently arrived at the Multimedia Editorial Office of Juventud Rebelde to answer questions related to the discipline in the country, its potentialities and perspectives, as well as its risks and complications.
The professor instructor and editor of the magazine Cirugía Estética y Reparadora [Esthetic and Reparative Surgery] clarified not a few doubts of our readers -some teenagers and young people-, from whom we offer a selection.
Lissa: What are all the plastic surgery services that we can access for free?
Ariel C. Prada (ACP): You can access all plastic surgery services (including cosmetic surgery and reconstructive surgery) free of charge, after a medical assessment to determine whether or not you qualify for that intervention. There are procedures in which alloplastic materials are used (breast implants, buttocks, etc.) that in the case of cosmetic surgery must be acquired by the patient, having first the indication of its model and volume by the plastic surgeon.
Susel: Is it necessary to be of legal age to access an operation or is it only possible with the authorization of the legal guardian?
ACP: Like any medical-surgical procedure it has a legal background and risks. If you are a minor must have the approval of parents or legal guardians. We do not know the nature of the procedure you wish to be performed, but we always recommend that, if it is not strictly necessary, you wait until the age of majority, either to seek better aesthetic results or because they are purely elective surgical interventions (cosmetic surgery), not essential for your life. Remember that undergoing surgery, in this case, is a very personal decision that requires full awareness and maturity.
Hope: I want to remove the “crows feet”, a little fat from my belly, my neck wrinkles … How many cosmetic surgeries can a person do, and how long should you wait between one and another?
ACP: There is no specific number of cosmetic or reconstructive surgeries that can be performed on a person. Above all, it must be evaluated by a specialist, who will determine, according to his opinions, which is the best aesthetic option, according to factors as varied as the type of patient, age, basic diseases and magnitude of the procedure, among others.
“Our specialty is a complement to improve the quality of life of people. Thus, it in no way replaces healthy habits such as a good diet, avoiding toxic habits or frequent physical exercise. In fact, many times our intervention is not necessary or its magnitude decreases, with much better results. The patient must be aware and responsible for their own health, to have lifestyles that maintain the results of the procedure performed.
Yaima: I have black skin, am 52 years old… Does race influence this type of surgery?
ACP: In medicine, and particularly in plastic surgery and caumatology, one of the elements taken into account is the racial biotype. Age is also a factor that is considered depending on the patient’s desire.
Iris: How is the procedure so that a woman who was operated on a radical breast can have access to the reconstruction of this part of her body? Where should she go?
ACP: Surely you were seen in a center with oncology service. Your oncologist, after considering that you are free of the disease (at least for a year) can refer you to a reconstructive surgery service, either in an oncology hospital or clinical-surgical, to begin the process of breast reconstruction which can be done in several stages.
“The National Breast Cancer Program contemplates the free reconstruction of all women affected by this pathology, with quality and first-class breast implants in centers such as the National Institute of Oncology and Radiobiology (Havana), Hermanos Ameijeiras Clinical-Surgical Hospital (Havana) and Conrado Benítez Oncological Hospital (Santiago de Cuba). You should consult with your oncologist in which center, according to the regionalization of health services, you should be treated.
Carmen: Those of us in our third age can opt for simple procedures, such as, for example, one that allows us to lift our drooping eyelids?
ACP: Although there are “simple procedures”, all require the expertise, experience and “aesthetic vision” of a plastic surgeon. We mean that there are sick people, not diseases (an old medical adage). Therefore, each treatment must be individualized, because what a patient requests is not always the best aesthetic or technically possible option.
“In the elderly, we must take into account the compensation of their basic illnesses, because we are talking about purely elective procedures, in which the risk must be minimal and the benefit, the highest possible.
Yeny: What practices should a patient follow after having a lipectomy*? How long should she wait to perform physical exercises and which are the most recommended? Is it normal to feel punctures in the abdominal region two years after this type of surgery has been performed?
ACP: First of all, you must have followed the indications of the plastic surgeon who operated on you, because s/he knows the characteristics of the patient, the details of his procedure and therefore the limitations and possible evolution, among others.
“Generally, three months after the operation, as long as they have not been complex dermolipectomies, patients can gradually resume themselves into their lives fully, without excesses. Physical exercises should be dosed and increased progressively. Aerobes and any activity that tones the muscles improve the results of the procedure. Consult your surgeon about the symptomatology presented, because s/he will surely offer you a more exact explanation and a solution.
Surgeries do not replace healthy lifestyle habits, but they are a choice many make.
When we speak of plastic surgery, the term also includes reconstructive surgery, which guarantees not only an aesthetic result, but also the return of function to the affected area.
In this sense, Dr. Yamilé León Rodríguez, who works at Hermanos Ameijeiras Hospital, tells Juventud Rebelde that oncological, traumatic or congenital deformities in the face, in the breast due to cancer and ulcers in dissimilar parts of the body, among others, are treated in this way.
“We have a multi-disciplinary breast cancer care group that includes oncologists, mastólogos, radio-oncologists, imageologists, psychologists, psychiatrists and specialists in reconstructive plastic surgery, who enter the process after it has been decided how the ablative surgery of the patient will be conducted.
“The defect to be corrected may be in the breast, when a partial or total removal of an organ or body tissue is performed in a radical mastectomy, or to correct a defect that remains in the chest wall, as a result of an ablation of a large tumor.
“We have developed several techniques, including reconstruction with the local tissues of the breast, with muscles, especially the abdominal rectum and the broad dorsal, as well as through flaps obtained from the abdomen, or the novel technique applied in the country of the sentinel ganglion, which determines the degree of spread of cancer.
León Rodríguez points out that patients of different ages, from 18 to 85 years old, have been treated with this type of aesthetic reconstruction. “The results show that it is not mandatory to perform total exeresis and that the subsequent reconstruction, with or without the use of prostheses, gives the woman back one of the classic attributes of femininity”.
Rhinoplasty is a complex but generally not life-threatening procedure.
Dr. Julio Cesar Galvez Chavez recognizes that in the desire to look younger, more and more patients come to his office. They should know that there are also selection criteria for cervicofacial rejuvenation surgeries.
“If there are signs of aging, then we can consider this type of surgery. We can find these elements in young people, perhaps because they have very white skin. In general, however, we perform them in patients over 40 years and up to 60, although the age limit is not as determinant as physical conditions and health.
“Many people believe that this is a magical intervention that will return them to the freshness they had at 15 years. This isn’t so, because, although it is guaranteed to make you look younger, you can’t turn back the clock.
The fundamental motivations for performing a surgery in the environment of cervicofacial rejuvenation are related to the fall of the eyebrows, the appearance of horizontal or transverse wrinkles in the eyebrows, the excess of skin on the eyelids and the appearance of fat pockets in that area, the loss of the contour of the jaw and the presence of the so-called marionette lines, the fall of the chin and the loss of angularity in the neck, among others.
Gálvez Chávez is also an expert in rhinoplasty, an aesthetic procedure indicated for those who wish to modify the size and shape of their nose as well as to improve their respiratory function in case of deformities in their septum.
“We perform reductive rhinoplasty in those noses of large dimensions and augmentative for flat or underdeveloped. In addition, we can make other procedures to model or perfect the features according to aesthetic patterns worldwide, either in the tip of the nose, the wings, the back, the nostrils and in general in all regions of the nose.
“Rhinoplasties are not recommended for people over 40 years of age because the skin’s ability to adapt to structural changes is important. This is most noticeable before the age of 30,” says the specialist, who notes that, although vital rules of care must be respected after rhinoplasty, it is not a life-threatening surgery.
How many people yearn for an aesthetic surgery after which they will look slim and slender? Dr. Heizel Escobar Vega, a specialist at the Hospital Clínico-Quirúrgico Hermanos Ameijeiras, states that this is the main reason why patients come to her practice. They ignore the fact that liposculpture is not a method for treating obesity.
“Liposculpture is the surgical treatment we perform to treat the areas of the body where fat deposits are found, such as the abdomen, the trochanteric regions and the arms, among others. Not only is it a question of removing those fat accumulations, but also of performing the lipo-injection in other areas in which they are desired.
“With this procedure, we obtain a corporal mold, as much in men as in women. Lately, they want to lose fat, in the abdomen and lumbar regions. They also request high definition surgery to obtain the well-known “squares”, an increased request also in recent times in the female population”.
Escobar Vega insists that not everyone can be a candidate for this surgical intervention. “We are rigorous in the selection of patients. Although people generally think that it is a simple surgery, due to the fact that it is among the most performed globally, it is certainly one of the riskiest and has the highest mortality associated with it, depending on the time and volume of fat extracted. Moreover, its realization leads to the modification of the metabolic, biochemical and hepatic mechanisms of the organism.
“Follow-up after surgery is essential, and the patient must respect the measures indicated by his attending physician.
Dr. María del Carmen Franco Mora is a specialist at the Juan Bruno Zayas General Hospital in Santiago de Cuba. She explains that the demand for gluteal lipo-injection has grown, a procedure that requires prior liposuction or liposculpture, from which the fat extracted is injected into that area of the body.
“The most frequent general complications are associated with the most feared, ranging from fatty and pulmonary thromboembolism, septic shock and severe anemias, to local infection and hematomas, among others.
“The criteria established for the classification of the patient must be very respected. We do not operate on people with a body mass index above 30 until they lose weight before, nor on those with a history of thrombotic diseases in lthe ower limbs or with the presence of varicose veins, nor on those who take oral contraceptives, among other exceptions”.
Falling is a geriatric syndrome, a disease; when it becomes recurrent it is clearly giving alarm signals that must be paid attent to.
Author: Lisandra Fariñas Acosta | firstname.lastname@example.org
October 28, 2018 20:10:34
A CubaNews translation.
Edited by Walter Lippmann.
“It took human beings about five million years to learn to walk and only 70 years to fall. This, which humorously may be interesting, should not really be allowed, because falling is not a habitual state. Falling is a geriatric syndrome, a disease. In other words, not everyone falls, because there are people who reach the age of 90 without having suffered any event of this type.
This was explained to Granma by the doctor of the Argentine Association of Orthopedics and Traumatology and member of AO Trauma, Emilio Fantin. He emphasized the need to prevent falls in the elderly, an aspect that is not often thought of. For the expert, it is important not only to know what a fall is, but also to understand why we fall and to evaluate the old person who falls.
Participating in the Seminar AO Trauma “Traumatology in the Elderly”, which was held in recent days in the teaching Fructuoso Rodriguez orthopedic hospital, and included recognized experts from this organization, Dr. Fantin commented that if we take into account that 1 to 5% of falls end in fracture and almost all hip fractures are secondary to them, it is vital to talk about this issue.
After a hip fracture, between 20 and 50% of older people fall again within two to six months of the first fall, so that prevention is once again the key. It happens that of those who fall for the second time, approximately 12% have a new fracture and 5% a hip fracture.
According to the World Health Organization (WHO), there are a thousand hip fractures per million inhabitants. If this figure is taken to the aging population, it is considered that a thousand fractures occur for every 100,000 people over 60 years of age, which would correspond to 10% of this age group.
It is estimated that around 12,000 of these fractures occur annually in Cuba, with resulting costs that they imply for the patients, the family, the health system and society in general.
20.1% of the Cuban population is 60 years of age or older, as shown by data from the Center for Population and Development Studies of the National Office of Statistics and Information. According to the latest Population and Housing Census (2012), 40% of Cuban households are inhabited by older adults. In 32% of them reside up to two or three persons of 60 years or more, so it is very likely that an older adult is caring for the other, and 13% of older adults live alone.
The fall causes worries from the first moment, but when it becomes something recurrent (two or more falls in the space of a year) is clearly giving alarm signs that should be addressed, warned the specialist.
At the same time,” said the interviewee, “we must pay more attention when patients tell us “I have no strength, I fall, what can I do?
In Dr. Fantin’s opinion, the first thing is to think that falls are not normal events, because the fact of being old does not necessarily imply falling. Why does it happen? It has to do with physiology and physical structure, loss of bone and muscle mass, and functions such as hearing and sight.
But these aren’t the only causes, he explained. As we age, we must adapt to the environment, which is often aggressive in carrying out the activities of daily living. The streets, the transport, the footwear that is used, derive in reason of fractures in numerous occasions.
With respect to the profile of the older adult who falls and fractures, the professor pointed out that generally they are over 80 years old, there is a poor self-perception of their state of health, cognitive deterioration, that is, of the state of consciousness, and many have depression. To this is added the presence of visual and motor deficits, because a large part of this age group needs help to walk, using walkers, canes or someone who accompanies them.
“Even if we investigate, we can find stories of falls that deny us, or do not tell because they are ashamed. It is very rare for an older person to confess to a child who has fallen. They come to the bathroom with the fracture, but they usually fall for longer: in the early morning when they go to the bathroom, for example. Falls can also be related to the consumption of certain medications and polypharmacy, which can cause fragility and gait disturbances due to unbalance,” he said.
When evaluating a patient at risk of falling, the expert commented that intrinsic and external factors must be taken into account, in addition to others that may precipitate this fact, such as alcohol consumption.
Among the intrinsic causes, diabetes is one of the most frequent, followed by the state of consciousness, that is, dementia, delirium, or depression. A third place is given to diseases where muscle mass decreases, and the fourth element is the female sex, since a greater number of falls occur in women than in men.
Regarding external factors, the interviewee mentioned domestic animals, sidewalks, stairs, public transportation and medication.
“More than four drugs a day are considered polypharmacy, and this is a cause of falls, so making adjustments to prescribed drugs is essential. The older adult is given a medication and it is never taken away, they leave it forever,” explained Dr. Fantin.
In addition, the interviewee pointed to osteoporosis, tobacco use (mainly in women) and vitamin D deficiency, as other elements not to be lost sight of. “Older adults don’t sunbathe regularly, and it’s important to get them out in the sun. The amount of ultraviolet light needed to convert vitamin D, either from the diet or as a medicine, is 10 minutes, you don’t have to go to the beach, and you just have to discover your hands and face.
The ideal,” he said, “is to treat these fractures within 48 hours of their occurrence, which has allowed mortality in the world from this cause to decrease from 30 to 10%.
Particular emphasis was made by the expert in post-cause syndrome. “Whoever falls and fractures is afraid of falling again and the great majority does not return to their previous state. Anxiety disorder is very serious, and there is a tendency to the syndrome called immobility, which can even lead to death. For each day of rest, 1% of body mass is lost,” explained Dr. Fantin, who placed great importance on family support.
It is fundamental that prevention also begins at an earlier age, stimulating, for example, exercises such as the use of bicycles, which are less expensive, ideal for recovering muscles, stimulating the semi-circular ducts of the ears and making it easier for people to have balance, concluded the interviewee.
– AO Trauma is one of the four clinical subdivisions of the AO Foundation (Working Group to Study Fracture Problems) created in Switzerland in 1958. Its purpose was the integrating and aligning of efforts in research, community development, and education in Traumatology and Orthopedics at the global and regional levels.
– According to Dr. Roberto Balmaseda Manent, secretary of the Cuban Society of Orthopedics and Traumatology, it has been particularly useful for the training and improvement of specialists in this branch.
– About 600 professionals from all regions of the country have had the opportunity to be trained step by step in the courses, workshops and seminars that the Society has organized.