Plastic surgery - How it's performed

Skin grafts used to be the main type of plastic surgery, but newer techniques, such as tissue expansion and flap surgery, are now often used.

They'll explain in detail what will happen before, during and after surgery. You may also be given a psychological assessment.

Before having plastic surgery, you should have a consultation with a plastic surgeon.

Plastic surgery can involve a number of different techniques to move and manipulate body tissue.

Skin grafts

A skin graft is where healthy skin is removed from an unaffected area of the body and used to cover lost or damaged skin.

They can be used for bone fractures that break the skin (open fractures), large wounds, or where an area of the skin is surgically removed – for example, due to cancer or burns.

There are 2 main types of skin graft.

Partial or split thickness skin graft

This is where a thin layer of skin (as thin as tissue paper) is shaved from an area that usually heals well, such as the thigh, buttocks or calf.

The donor area may look pink or lighter than your surrounding skin for a few months, depending on your skin tone, then leave a faint (hardly noticeable) scar.

Full thickness skin graft

This is where the full thickness of skin (the top layer and layers underneath) are removed and the area is stitched closed.

Sites often used include the neck, behind the ear, the upper arm and groin.

Because this type of skin graft is thicker, picking up a new blood supply can be more difficult, so any dressing will be left in place for 5 to 7 days before being removed by the surgical team.

What happens

Before the procedure, you'll be given a general anaesthetic or a local anaesthetic, depending on the size and location of the affected area.

The skin graft will usually be held in place using stitches, staples, clips or special glue.

The area will be covered with a sterile dressing until it has connected with the surrounding blood supply, which usually takes around 5 to 7 days.

A dressing will also be placed over the area where the skin has been taken from (the donor site) to help protect it from infection.

The donor area of partial thickness skin grafts usually takes about 2 weeks to heal.

For full thickness skin grafts, the donor area only takes about 5 to 10 days to heal, because it's usually quite small and closed with stitches.

At first, the colour of the grafted skin may appear red or purple, but it should begin to look more like your surrounding skin over time. It can take a year or two for the appearance of the skin to settle down completely.

The final colour may be slightly different from the surrounding skin, and the area may be slightly indented.

There are many different techniques used to perform cosmetic and reconstructive plastic surgery procedures, including the following:

Endoscopic surgery

Endoscopic surgery is performed with an endoscope, a tubular probe that has a tiny camera and a bright light, which is inserted into a small incision (a small cut in the skin). Images from the camera are transmitted back to a screen, which the surgeon watches while manipulating the endoscope inside the body. The endoscope is a device to assist the surgeon during surgical procedures. Instruments to actually perform the surgery are inserted through a different incision(s). Large procedures can then be done with minimal scars.

Flap surgery

Flap surgery involves moving healthy, live tissue from one location of the body to another--often to areas that have lost skin, fat, muscle movement, and/or skeletal support. There are several different types of flap surgery methods that may be used, depending on the location of the flap and the structures that need to be repaired. The types include the following:

• Local flap. This is located next to the wound; the skin remains attached at one end so that the blood supply is left intact.
• Regional flap. This uses a section of tissue that is attached by a specific blood vessel.
• Bone/soft tissue flap. This type of flap is often used when bone and the overlying skin are moved to a new location.
• Musculocutaneous flap (muscle and skin flap). This type of flap is often used when the area to be covered needs more bulk and an increased blood supply. This type of flap is often used to rebuild a breast following a mastectomy.
• Microvascular free flap. This involves detaching and reattaching skin and blood vessels from one site of the body to another site. Microsurgery is used to attach the blood vessels.

Laser technology

Lasers used in plastic surgery often provide for minimal bleeding, bruising, and scarring. There are many different types of lasers that may be used, depending on the purpose and location of the surgery to be performed. Consult your doctor or surgeon to determine if laser surgery, and which type, is most appropriate for you.

Skin grafts

A skin graft may be used to cover skin that has been damaged and/or is missing. This surgical procedure involves removing healthy portions of skin from one part of the body to restore normal appearance and/or function to another part of the same body. The place where the skin is removed is called the donor site. There are several different types of skin grafts that may be used, depending on the size and location of needed skin. These include, but are not limited to, the following:

Split-thickness skin graft

• Commonly used to treat burn wounds or nonweight-bearing parts of the body
• Uses only the layers of skin closest to the surface
• Donor location site will be chosen based on size, type, and pigment of skin needed

Full-thickness skin graft

• Used to treat deep, large wounds and scars or weight-bearing parts of the body
• Used when maximum skin elasticity is needed
• Uses all layers (not only the surface layer) of skin from the donor site, including the blood vessels

Tissue expansion

A tissue expansion is a surgical procedure that involves inserting a balloon-like device (called an expander) under the skin. The expander is then slowly filled with liquid to actually stretch and expand the skin over time. This serves the function of "growing" extra skin to repair nearby lost or damaged skin.