Introduction
My idea of writing an audiovisual work about aesthetic surgery has been crowned by success, for which I am extremely grateful. In Volume 1 of the Manual of Aesthetic Surgery, for the first time treatments were described simply, clearly, and concisely using text, pictures, and videos, so that young doctors who want to learn about this area, either as interested students and doctors or as young specialists in aesthetic plastic surgery, could acquire the basic knowledge and surgical expertise they...
Submammary Incision
a The breast is lifted up by the assistant using his her right hand, and the operating surgeon makes an incision precisely at the position previously 2 marked. It should be ensured here that the incision from the medial to S the lateral level is performed in a slight arch shape that matches the intended inframammary fold, since this makes the subsequent scar as inconspicuous as possible. The incision is made fully into the subcutaneous adipose tissue.
Foreword by S Malakhov
I first became acquainted with Prof. Mang in 2002 when he performed surgery at the St. Petersburg Medical Academy at the invitation of Prof. Zapessotsky. Many plastic surgeons watched him doing this and were fascinated by his atraumatic operation technique. One of my assistants went to Prof. Mang's clinic at Lake Constance for further study and reported back on the friendly and excellent training received in Prof. Mang's clinic. On the occasion of his visit to St. Petersburg, Prof. Mang...
Foreword by M S Mackowski
After training in the field of plastic surgery for more than 20 years and holding the position of Consultant at the Department of Plastic and Reconstructive Surgery at the Ruhr University, Bochum, I have been the Leading Consultant and Deputy Clinical Director at the Bodenseeklinik in Lindau since 2004. It was at this hospital, where aesthetic surgery is carried out and taught to the highest standards, that I first became familiar with Professor Mang's philosophy. He believes that aesthetic...
Preparation Step 1
Using his her right hand, the assistant holds the sharp four-pronged retractor under traction on the upper incision margin in such a way that the operating surgeon can carry out the dissection along the mammary gland in the direction of the pectoralis major fascia cleanly and without bleeding using surgical tweezers and Metzenbaum dissecting scissors. Owing to the tumescence this is largely free from bleeding. The excess tumescence solution flows back out again. If there are small amounts of...
Prospects What Is the Future of Aesthetic Surgery
There has been a boom in aesthetic surgery all over the world and the rate of growth has doubled. The age of patients ranges from 14 to 80 years and every fifth cosmetic operation is now requested by a man. Research into new materials, implants, instruments and equipment, even robot-controlled operation modules, is important for the further development of aesthetic surgery, but these can never replace the skill of the aesthetic surgeon. A first-rate aesthetic surgeon must not only be...
Breast Augmentation
This procedure is requested very frequently. The incision line and access are decisive factors in the success of the operation. In the manual and video, we present the simplest and safest type of access. This involves making a small incision in the inframammary fold and, with supramus-cular insertion, clean dissection between the fascia and the gland. With submuscular access, the implant is inserted below the pectoral muscle, after this has been carefully detached at the medial and caudal...
gMarking the Individual Incision Line
2 Before the operation, the midline from the xiphoid process to the mons pubis and the W-shaped or arched horizontal incision line will be S marked on the patient, who should be standing. The horizontal incision line should be marked in the pubic hair boundary to approximately 3-4 cm caudal to the anterior superior iliac spine on both sides or steeper straighter according to the requirements and the patient's characteristics. Therefore, the most wide-ranging incision variations are possible,...
Brachioplasty
An important factor in brachioplasty, as with all major tightening operations on the torso, is that there may be residual scars if the suturing technique and wound healing are poor. This must be made clear to the patient before the operation. An important preoperative stage in the operation is to mark the surplus skin to be resected precisely on the patient, who should be standing. The size of the resection is also a decisive factor in the successful outcome. If too little is resected, this...
ThreeDimensional Diagram of Fat Injection into Subcutaneous Tissue
The fat droplets lodge themselves in the subcutaneous tissue. If positioned correctly, and because they are not injected in a bolus dose, they become associated with the capillaries and consequently, following appropriate transformation, they help to stabilize the infrastructural connective tissue ICT . Infrastructural connective tissue ICT Infrastructural connective tissue ICT Infrastructural connective tissue ICT Infrastructural connective tissue ICT
Addresses
Professor Dr. med. Dr. habil. Werner L. Mang rztlicher Direktor der Bodenseeklinik Lindau Klinik f r Plastische und sthetische Chirurgie APL-Professor, Klinikum rechts der Isar Technische Universit t M nchen Ismaninger Stra e 22 81675 M nchen Germany Bodenseeklinik Lindau Graf-Lennart-Bernadotte-Stra e 1 88131 Lindau Germany Bodenseeklinik Lindau Graf-Lennart-Bernadotte-Stra e 1 88131 Lindau Germany Bodenseeklinik Lindau Graf-Lennart-Bernadotte-Stra e 1 88131 Lindau Germany Bodenseeklinik...
Nerve Exit Points Supraorbital Nerve Infraorbital Nerve Mental Nerve
If adjuvant therapies are not combined with operations e.g., a facelift , they are performed under local anesthesia and as day-case treatment. Nerve block anesthesia with Ultracain 1 articaine and additional adrenaline have proved to be successful. When treating the entire face by laser or chemical peeling, light sedation also can be induced with Dormicum midazolam with anesthesiology stand-by. No more than 30 ml 1 local anesthesia solution should be injected. Particularly sensitive areas e.g.,...
Cutaneous Sutures Running or Intracutaneous 40 Monocryl
In general, we carry out all cutaneous suturing intracutaneously with 4.0 Monocryl. This suturing method has proved to be the best, as it does not need to be removed and does not cause granulomas. It produces optimum healing of the suture line. Running sutures should also be mentioned in this manual. A study n 25 comparing running sutures with intracutaneous sutures showed that results were similar. Running sutures are removed after 8 days.
Tumescence 1
Tumescence is then performed without blurring the marked borders. Approximately 200 ml of tumescence solution without the addition of triamcinolone acetonide is injected manually per side 0.9 NaCl, 500 ml, 1 prilocaine 250 mg 25 ml, epinephrine 0.5 mg, Tumescence is carried out in the layer where dissection will later be done, i. e., on the fascia of the upper arm, so that the skin fat flap is separated from the fascia by the injection itself. During tumescence the surgeon can feel the...
UpperArm Tightening
Upper-arm tightening is requested increasingly by women over the age of 60. It is often surprising that women of this age do not have a facelift instead they are more bothered by their flabby upper arms when they want to wear a bathing suit or sleeveless clothes. The only way of eliminating the surplus skin and the wrinkles in the long term is cutaneous excision. The art of the surgeon in doing this is to position the incision in such a way that it is on the medial side of the upper arm and to...
Wound Revision and Hemostasis Using the Illuminated Retractor and Bipolar
Hemostasis is carried out by means of electrocoagulation and with the assistance of an endoscope or an illuminated retractor. This hemostasis is carried out twice. One always begins with the right breast. After dissection and hemostasis have been completed, a damp compress is applied. When the left side has been dissected, a second hemostasis is carried out before incorporation of the implant. Until now, we have not seen any postoperative bleeding in patients where this second hemostasis has...
E
Before the operation - semioblique view, left Before the operation - semioblique view, left Before the operation - view from left After the operation - semioblique view, left After the operation - semioblique view, left After the operation - side view, left After the operation - side view, left Patient I Twelve Months After the Implant Normal wound healing, no scar formation, no fibrosis. The breast has an anatomical shape with a round implant. Before the operation - oblique view, left Before...
TwoLayer Skin Closure
The skin edges are closed with concealed subcutaneous interrupted 3.0 Monocryl sutures. Each successive suture bisects the wound length this prevents dog ears at the end of the sutures. It is best if the sutures are started at the distal end and progress to the middle. Suturing can then be started at the proximal end axilla and continued to the middle. Complete wound closure is then carried out with two-layer 4.0 Monocryl interrupted sutures. The wound is closed, therefore, with so little...
Fixation Suture on the Pubic Bone with 20 Monocryl
Following skin resection the inguinal ligament is dissected deeply using dissecting scissors. The same applies to the pubic bone further caudally. The periosteum of the pubic bone can be felt easily. Suturing to connect the subcutaneous fascia and adipose tissue of the cutaneous flap with the periosteum of the pubic bone may be carried out using a 2.0 Monocryl suture. We have the best experience with Monocryl and there has never been any impairment to wound healing. Owing to the long...
Foreword by M P Ceravolo
All plastic surgeons have been waiting for this book. Those who have read Prof. Mang's first volume will be surprised to see how the clarity of the text, the detailed drawings, and the wisdom in the technical advice now proposed by the author are even more impressive than in the first volume. Breast surgery, abdominoplasty, and the technical difficulties of other major operations can easily be tamed through an extremely didactic method and outstanding iconography. The author, like Virgilius in...
TwoLayer Atraumatic Wound Closure Using 40 Monocryl
Following subcutaneous closure with 2.0 Monocryl interrupted sutures there is already good, tension-free wound closure of the skin. Subsequently, the skin is closed continuously, intracutaneously using 4.0 Monocryl. One concealed knot is made at the beginning and the end of the suture so that this thread does not have to be pulled out later. Since we have been using only Monocryl sutures in breast surgery, we have not observed any problems with healing, thread granulomas or poor scar healing....
Foreword by D Millesi
Aesthetic surgery has developed with enormous velocity over the past decade. Owing to the growing number of patients undergoing aesthetic surgery, it is not only more and more accepted in a wider range of our population, but also has to fulfill the growing expectations of very critical patients. Many new techniques are at our disposition and the number is constantly growing. Apart from basic techniques, detailed technical points become more and more important for the successful outcome. It is...
Foreword by I Pitanguy
In his first volume of Manual of Aesthetic Surgery, Professor Mang provided a clearly written and comprehensible book that can be read by all physicians who may have an interest in the field of aesthetic plastic surgery. Prof. Mang shared with us his vast experience in aesthetic surgery and presented the techniques that have proven useful in his hands. Together with his team of collaborators at the clinic at Lake Constance, in Volume 2 Prof. Mang describes operations clearly and explicitly....
Insertion of the Redon Drain size 10
A size 10 Redon drain is used for wound drainage. It empties laterally and is fixed using one suture. One should ensure that the implant is not damaged and that the drain is positioned in such a way that between the implant and muscle fascia it extends from the edge of the incision to the medial dissection margin.
Spacelift
The name spacelift was chosen by Prof. Mang and protected by patent German Patent Office, Patent and Logogram No 303 23891 , as three-dimensional fat droplets of 0.1-0.3 mm are injected via the purified autologous fat cells into the space between the cutaneous and adipose tissue of the face, virtually as if in a honeycomb. As these fat droplets are not injected in a bolus dose but by using microinjections, they do not die but retain a vascular association and are transformed into fibroblasts,...