Since ancient times the female breast is accepted as a unique sym bol for femininity , seduction and fertility even in very distinct cultures all over the world . Apart of its cultural role the female breast has even gained more importance in our modern society when we have a loo k at fashion , music and media , were the perfect bust nearly sems to be a key element for suces .

>>>Apart from its cultural role, the female breast has gained even greater importance in

our modern society.

Speaking only of the societies based on western ideals of beauty, the image of the “ideal” female breast changed a lot during the last century following the great changes in social life like sexual liberation in the late sixties, upcoming feminism, the new femininity of the eighties and the androgyny of the nineties which substantially influenced the self-confidence of especially the young woman regarding her looks as well as her outer image in society, media and fashion. The new millennium, in spite of its obvious futureorientated acceleration and progression of all aspects of life, actually recreated a female look and style that is reminiscence to the times when a full breast was an important part of any woman’s sensual and seductive femininity.

>>>The breast of the young woman between 18 and 30 years of age has totally different needs from those of a woman of over 30 years who has maybe already had a baby.

This reborn image being transmitted by topmodels at the current fashion shows, by young female stars in the movies and by famous pop stars is reflected in every aspect of fashion and social life and makes more and more younger women to undergo plastic surgery to achieve the bust line that they feel belongs to them but accidentally was not given to them by nature.

From a plastic surgeons view, the female breast is something very delicate to change because in has an evident impact on the patient’s life and contrary to the image created by many so called “Aesthetic surgery businesses” you can not seriously offer a one price-one technique solution to achieve excellent aesthetic results. The very complex composition of the female breast consisting of glandular (milk-producing) tissue, fatty tissue and numerous fibre-like bands which hold the breast in its natural form demands anatomical expertise and individual techniques which take in consideration the age-related changes of the breast tissue. The breast of the young woman between 18 and 30 years of age has totally different needs regarding the type and shape of the implant, the position of the implant and even the position of the scars than a woman over 30 years with children. It is important to know that the tissue composition of the female breast isn’t static, but tends to change regarding the relation between glandular tissue and fatty tissue which subsequently affects firmness, elasticity and shape of the breast.

Therefore, the operating technique must be carefully adapted to the age of the patient taking in consideration the following elements :

Contrary to most women who did give birth, young women with small breasts mostly don’t have any or only minimal sagging of the breast, so the fold under the breast is not very accentuated and may even be absent. This fact diminishes the advantage of placing the implants via an incision in this fold, because the scars are not automatically hidden by the normal form of the breast like in older women. So the alternative access placing the implants via a small incision below the areola can provide excellent results with a scar even less visible and therefore needs to be considered carefully together with the treating surgeon. After a decision for the placement of the future scars has been taken, the position of the implants in the breast needs to be evaluated. Basically, a breast implant can be placed directly underneath the gland overlying the pectoral muscle or it can be placed underneath the muscle. Besides the patient’s expectations regarding the desired shape of the enlarged breast the age and the actual shape of the breasts play a very important role in making that decision. In a young woman presenting no or minimal sagging of the breast, a good elasticity of the skin and a normal breast shape, placing the implant underneath the muscle provides excellent aesthetic outcome, a better protection of the implant through the muscle and more satisfying long term results because the muscle prevents the implant from sagging.

Also if the breast is very small and the desired augmentation is more than one size, the position behind the muscle is advisable, as the glandular tissue would not cover the implant, and the result would not be natural.

>>>Today’s market offers a broad variety of different implant shapes and sizes.

On the other hand, if the patient is older and maybe has already given birth and gone

through a period of breastfeeding, the shape of breast may require the need to put the implant directly underneath the gland to provide enough volume to fill up the skin stretched by sagging.

The last important point to consider together with the treating surgeon is the style or shape of the implant. As in all other areas of life, science and technology provided a steady and remarkable improvement of breast implants during the last 10 years. Modern silicone implants have a highly resistant shell covering a soft, gel-like core, therefore providing a soft, natural feeling never achieved before while offering implant life expectations of 15 years and more. Today’s market offers a broad variety of different implant shapes and sizes which allow for an individual solution for almost every patient. Any responsible plastic surgeon should thoroughly discuss the different types of implants with the patient, and should provide the possibility to touch them, to know how they feel and to try out different shapes and sizes by wearing them inside a bra.

>>>Therefore, the operating technique must be carefully adapted to the age of the patient.

Based on his experience, the surgeon will suggest a certain range of implants that will suit the individual needs of the woman, but in most cases there will be the possibility to choose between a more rounded breast form with a little bit more volume in the upper part or a more natural, tear shaped form; or to decide between different degrees of implantsoftness referring to the patient’s individual taste.

There is no unique breast shape that can be taken to be “the ideal breast” for every woman; the most important thing when it comes to deciding about the size and shape is to give every woman her own very unique shape that suits her body and style. The seduction evoked by a perfect bust line is not only related to volume, but to an individual harmony in the relation between the breast and the chest.

This kind of harmony, that can be achieved at any age, is what we always aim to create in our patients.

Taking care of the individual needs of the woman’s anatomy and taking into consideration the elements mentioned above, the breast augmentation with silicone implants is a safe and reliable procedure with excellent and long lasting aesthetic results, especially when performed on younger women.

The following interview with a 29 year old patient is an example of the results that can be achieved with implants in a patient who has slightly saggy breast but does not want a correction with an additional uplift. The excellent results achieved by breast augmentation in a patient who has small breasts without any sagging are illustrated by photos of another 26 year old patient.

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Editorial: Dr. Pier Albrecht, Dr. Pierre Albrecht, Dr. Pierjean Albrecht,

Dr. Pier Jean Albrecht, Dr. Pierre F. Albrecht, Dr. Pierre Frank Albrecht,

Dr. P. Frank Albrecht, Dr. Pierjean Frank Albrecht, Marbella Clinic

Normally in social life, we greet someone by looking them in the eyes and shaking their hand. Those brief moments already give us an impression of the person standing before us. For this reason, the eyes and the look are so important. The look…is not only the eyes themselves, the colour of the iris, the uniformity of the white and the light in the iris (things that are always touched up by computer in the photos of celebrities and models on the cover pages), but the look has to include the eyebrows, the upper lids, the eyelashes, the lower lids, the bags and shadows under the eyes, the crows feet.

When we meet someone, we always look first at his or her eyes. Our attention then passes to the mouth. These two parts of the face allow us subcon sciously to obtain information will help us to guess the approximate age of that person, and perhaps also some traces of his or her character.

If the mouth and lips are frequently the first question for a woman, the eyes are usually the object of consultation for a man. For some it is the aesthetic aspect, for others, it is a question of practicality or aesthetics, but the motive is really the increasing demand for this type of surgery.

We should try to look at it from a different viewpoint, particularly regarding the correction or increased volume of a woman’s lips. The first thing we should remember is that when we look at ourselves in the mirror, we have a tendency to focus our attention on details, slight imperfections. But other people don’t look at us in the same way, they don’t observe us in so much detail.

When we meet someone, we always look first at his or her eyes. Aesthetic surgery can be of great help to give a fresh and seductive touch. (see pictures before and after)

In our day to day life, most people we meet will greet us by looking us in the eye, to establish whether our look is deep or empty, warm or cold, straight and honest or, on the contrary, evasive, etc….Throughout the ages, the eyes have been considered to be the mirror of the soul. The brain immediately registers the forms and movements of the face, which give us an idea of the vitality and emotional state of that person.

Only the professionals, (and this can include best friends!!!), make a critical analysis of tones, texture, the skin condition, etc, in order to determine more precisely the age and the requirements for face care. Eye contact is therefore by far the most important, followed by the lips. In most cases, the need is to correct, rejuvenate and “sweeten” the look.

Patients generally understand this concept, but they immediately state that they do not wish specifically to change the expression of their look. The role of the professional is then to focus the attention on the fact that our look is not the same at all stages of our life and that maturity is sometimes synonymous with sadness, associated with a drooping of the eyelids and the outer corner of the eye.

The youngest patient on whom I have performed an eye operation was 27, and oldest was 79. Both were motivated for different reasons, but their circumstances were identical. They both had drooping eyelids which gave them a weary look and feeling, the younger patient because of her natural anatomy and the older one due to her age. The younger one, naturally, wanted not only to look younger but also to appear fresher and above all, sexier. The older patient only wanted to continue working without the feeling of tiredness.

Well, now I have used the word “sexy”. It could also be “seductive”. It’s true that drooping eyes, whether the eyelids or the outside corner (called the external canthus) do not look very sexy, but tired and even sad. Eyes that are larger and somewhat drawn out (feline) look more attractive. Throughout the centuries, women have painted their eyes to make them look larger and wider. This reminds us of Cleopatra, but apparently the men of Ancient Egypt also used to paint their eyes.

“the

LOOK”

The truth is that there is an almost magical attraction with large eyes. They are the symbol of an open vision towards others and to the world. Wide eyes are also associated with the natural shape of the eyes when we smile. They send out a message of sweetness, like a smile. In fact, there are people who are cruel and cold but who naturally have this kind of eyes, and they seem to always give a sweet smile, even when they are very angry.

It is very important to point out that the eye is closely joined to the upper and underlying structure. In fact, upper lids that are heavy and wrinkled are possibly, in the majority of cases, the result of sagging forehead skin. Lax lower eyelids, with circular rings, are often due to a loosening of the facial skin. In this way it is understood that the eyes can normally be operated on, independently from the rest of the face, whilst they should really be analysed as an integral part of a harmonious whole. This way it is preferable to create younger eyes, raising the “outer corner”, eliminating the excess skin, with a little of the muscle in the case of the upper lid, but trying to tuck in the skin without tensing the muscle too much at the level of the lower lid.

A final detail, it is possible to give a touch of embellishment to the eyes, creating or recreating at the external part of the upper lid, what Steven Hoefflin, the famous surgeon to the stars in Hollywood, calls a “beauty egg”. The study of thousands of faces has, in fact, demonstrated that the beauty of the features is almost a mathematical equation. It depends on the face having certain areas of fullness, seven for women, that are common to all of the most beautiful faces in the world. If these small areas of fullness do not exist, they can be created by fat injections, synthetic injectable products or implants.

This type of surgery is very satisfying to the surgeon and also to the patient, because the rejuvenating and embellishing effect is immediate in the majority of cases.

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Editorial: Dr. Pier Albrecht, Dr. Pierre Albrecht, Dr. Pierjean Albrecht,

Dr. Pier Jean Albrecht, Dr. Pierre F. Albrecht, Dr. Pierre Frank Albrecht,

Dr. P. Frank Albrecht, Dr. Pierjean Frank Albrecht, Marbella Clinic

Wrinkles and creases in the skin are very significant during the aging process. With the passing of time, the skin loses its elasticity due to changes in its basic components such as collagen, elastin,hyaluronic acid (the filling substance containing collagen and elastin), and in glicosaminoglicans, that lose quantity and quality, etc… but at the same time the percentage of moisture is considerably reduced, meaning dehydration. These changes are both hereditary and genetic – what is known as “constitution” in Chinese medicine – and

the hygiene of life such as exposure to the sun, to the cold, to the wind, and the consumption of products like sugar, fats, cigarettes, alcohol and spices  – known as the “condition” in Chinese medicine.

The dermis becomes thinner, less elastic, it separates slightly from the hypodermis, and when you smile or grimace, instead of moving to follow the movement of the underlying layers, it forms creases. The repetition of these expressions causes the dermis to break up along the creases, forming wrinkles that, at first, are fine and gradually become

more pronounced.

Also, the deepest layer of the skin, the hypodermis, which is mainly composed of fat, undergoes change, and in the majority of cases is reduced, but sometimes increases. In all cases, the fat changes position on the face due to the lack of support from the skin that has lost its elasticity. And of course, this change is a downward movement as in the case of the upper cheek, just below the eyes. Babies have practically no lower eyelid as the cheek only sags after some years have passed, pulling the skin below the eyelashes downward and thus forming the lower eyelid. When it loses its elasti-city, the skin sags, and the underlying fat with it, forming nasogenian grooves and marionette lines.

Aesthetic medicine does remedy this aging process by filling in the wrinkles and creases, restoring part of the skin’s moisture and elasticity. Two different kinds of products are basically used for this purpose :

1) Semi-permanent filling, containing hyaluronic acid in different concentrations, that fills

in the dermis between the collagen and the elastin fibres. The quality and density of this hyaluronic acid can vary according to the make, but are nearly all the same. (RESTYLANE, HYLAFORM, JUVEDERM, HYDRAFILL etc…) There are three different degrees of density, for filling in fine lines up to the deepest lines. With greater density, the hyaluronic acid can be injected into the fine lines but contains more water and dissolves more rapidly. Grade 1 hyaluronic acid, less dense, has a duration of 3 to 5 months, Grade 3, more dense, can last up to a year. RESTYLANE produces a high density hyaluronic acid for correcting volume that can be injected close to the bones and that lasts 18 months.

“ Adverse reactions to hyaluronic acid are very rare. Personally I have never seen any cases, neither amongst my patients or those of any other doctors.”

2) There are also products for permanent filling using polyacrilamide (AQUAMID) that are safe and achieve a very good level of volume correction (lips) and creases (naso-labial furrows, for example). Polyacrilamide is a product that is used in its solid form for manufacturing contact lenses. Consequently we know that it is compatible with the human body. AQUAMID is injected deep into the hypodermis and remains in the area where it is injected. As in the case of any other permanent filler, my attitude towards AQUAMID has been to use it with great care. I started injecting only in the glabellar frown lines (between the eyebrows) for a few years to make sure it would not displace nor creat any adverse side-effects. After two years, I started injecting in the nasogenian grooves two years later

I started using it on the whole face to restore the original volume.

When someone wants to correct their wrinkles and creases, it is important to explain that the best results are achieved by correcting the same aging process.

That is to say, it is possible, but not sufficient, to correct a fine line o a deep wrinkle by filling it in with hyaluronic acid. In reality, this is only the correction of the aging process, the loss of moisture and elasticity from the dermis. To achieve the best and most

durable results, the hyaluronic acid should be injected into the dermis and a polyacrilamide into the hypodermis, to compensate the other aging process which is the loss of fat. In this way we can achieve more natural-looking and longer-lasting results.

The reality about the nasogenian folds :

It is important to mention this subject because an incorrect use of the filler products

can give rise to very unaesthetic results. It is true that aesthetic doctors tend to prescribe injections for their patients because they cannot perform surgery, but the patient should have a good understanding of the aging process in order to be able determine what is the best course for looking younger.

The nasogenian folds are the result of fatty tissue sagging from the upper cheek or malar area, this sagging is halted by the upper lip. Because of this, two grooves appear when you smile and the condition becomes worse if you sleep on your side, because it accentuates the grooves even further, breaking the dermis and creating a wrinkle inside the folds. When a patient asks for these folds to be corrected, he or she should be aware that the doctor is going to inject a product into a place where it is not really needed. That is to say, to fill in a nasogenian fold is to CHANGE the natural appearance of the face. In reality, the physiological correction would be to lift the skin and the fatty tissue upwards and outwards by means of surgery. By doing this, the grooves disappear immediately. What I am saying is that the filling in of nasogenian grooves is a TEMPORARY solution because it is an aesthetically artificial and un-natural solution to the problem of the sagging of the cheeks. This treatment can be carried out successfully, but up to a certain limit. After that we have to resort to surgery, or rather inject the cheeckbone to lift the cheeks out.

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Editorial: Dr. Pier Albrecht, Dr. Pierre Albrecht, Dr. Pierjean Albrecht,

Dr. Pier Jean Albrecht, Dr. Pierre F. Albrecht, Dr. Pierre Frank Albrecht,

Dr. P. Frank Albrecht, Dr. Pierjean Frank Albrecht, Marbella Clinic

A Tummy Tuck is a surgical procedure by means of which we can improve the appearance of the abdomen when there is an excess of fat and skin tissue

In the majority of cases, a tummy tuck is performed on adults over the age of 50 who are feel uncomfortable with an excessive amount of skin and have to wear loose-fitting clothes to conceal it. It can also be related to obesity problems. Generally speaking, it involves skin that has lost its elasticity, whether through several pregnancies or after a weightloss diet, and is no longer smooth and taut over the framework and muscles of the body.

There is an evident aesthetic problem and greater inconvenience with regard to clothes.

For many years, abdominoplasty has been described as a technique to eliminate a large amount of excess skin by means of an incision made from hip to hip, passing across the pubis and the navel. Several types of incisions and scar patterns are described, generally in the form of an inverted “M”. The fact of having to cut a large quantity of skin means the surgeon has to relocate the navel, making an opening higher up and stitching at that level.

During the operation it is possible to take the opportunity to stitch the abdominal muscles in cases of slackening of the stomach wall. In general it is not advisable to have a liposuction followed by an abdominoplasty because the risk of the tissue scarring badly or dying (necrosis) is much higher.

The results of a classic tummy tuck are variable. In the majority of cases patients have been very pleased at being able to dress more easily and with the image of having a new body, when clothed. When the clothes come off, then the results are not quite so satisfactory because the scar is very large and visible, which patients are somewhat embarrassed to show.

“ In the field of abdominoplasty, as in any other procedure of aesthetic plastic surgery, my concerns have always been to reduce the pain, the trauma of the anaesthetic, surgery and recuperation time, as well as the visible aspects of having undergone surgery i.e. the scars…”

My point of view

In the field of abdominoplasty, as in any other procedure of aesthetic plastic surgery, my concerns have always been to reduce the pain, the trauma of the anaesthetic, surgery and recuperation time, as well as the visible aspects of having undergone surgery. i.e. the scars… At the same time to increase the patient’s pre- and post-operatory comfort, the naturalness of the results and the discretion of the surgeon’s intervention to be able to enjoy a new life to the full.

For these reasons, I have never been fully in favour of performing a major tummy tuck, and have always tried to achieve satisfactory results with a minitummy tuck, i.e. by making only one incision at the level of the pubis that goes 2 or 3 centimetres beyond the pubic hair, respecting the original navel, or in other words, removing a crescentshaped section that is 4 or 5 cm wide.

Upper Abdominoplasty

But of course, the technique of a minitummy tuck is not enough in cases of an excess of skin, and we have to think of something additional. For this there is a new surgical option that can complement what is known as a lower abdominoplasty, and is called specifically the upper abdominoplasty. The technique, always with the aim of reducing the “visibility” of the operation and increasing the naturalness of the results, consists of lifting the skin above the navel and cutting the excess at the level of the inframammary folds. With incisions of 10 to 15 cm long, it is possible, as with the lower abdominoplasty, to remove 2 more crescents of skin of 4 and even 5 centimetres width.

NEW Abdominoplasty

(Tummy Tuck )

“…Many men ask questions, interested in this technique, particularly after the age of 55 or 60, because they do not have inframammary folds, to hide the scars”…

Many advantages The advantages of this technique are numerous : it is a far less invasive technique than the major tummy tuck, it is not necessary to touch or reposition the navel, the scars are almost invisible because they are hidden by the weight of the breast that always falls a little and covers the fold. The recuperation period is much less and more comfortable, with far less risk of skin necrosis, infections and split stitches. While it is true that this technique cannot be used in cases of extreme obesity, many patients, both men and women, are able to enjoy having a flat tummy – not only with no fat, as would be after a liposuction – but also with smoother skin. Many men ask questions, interested in this technique, particularly after the age of 55 or 60, because they do not have inframammary folds to hide the scars. It is the same as in the case of younger women with small breasts. For these cases, the solution would be to make use of a tattoo. Nowadays it is widely accepted and not considered at all strange to wear a tatoo, which can even be discreet and simple, such as a leafy branch, for example, although some people prefer the idea of a snake tattooed all along the scar. In any case, I would tell anyone who is definite about not wanting a scar in that place, that it is far more attractive than a lot of hanging skin or a scar running from one side of the abdomen to the other. It is simply a matter of mentalizing yourself and having a tattoo applied when you had never before thought of having one.

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Editorial: Dr. Pier Albrecht, Dr. Pierre Albrecht, Dr. Pierjean Albrecht,

Dr. Pier Jean Albrecht, Dr. Pierre F. Albrecht, Dr. Pierre Frank Albrecht,

Dr. P. Frank Albrecht, Dr. Pierjean Frank Albrecht, Marbella Clinic

Beauty and perfection should go together? This is the most mistaken idea that we come across in our speciality of Plastic Surgery and Aesthetic Treatment.

For that reason there is a risk of people ending up looking like each other. It is sad to see faces with forced curves, noses that are straight but rigid, big lips that look swollen, exaggerated cheekbones, etc. The idea of perfection comes from the fact that many people imagine themselves like a car, with parts that are interchangeable with those from other types of car.

The case frequently arises when someone comes with one or more magazines and tells the doctor “I want this mouth, doctor, I’d like to have this nose, these breasts,” etc. And in the end what do we have? An image that is fabricated out of identical parts that are used by many others, an image that looks unnatural, in which the human being who is hidden behind it has been lost.

What is left of Michael Jackson on the outside? and what is left of Michael Jackson on the inside?

I always feel that the victims of this kind of image have lost their common sense. Don’t they realize that it is obvious to everyone? Even their best friends laugh when they are with other people, otherwise ask their hairdressers, who are experts in camouflaging so many scars produced by the face-lifts of which there are more and more every day.

We have come to the point of thinking that a pretty face can be the sum of a number of pretty features : lips, nose, eyes, chin, cheekbones… But this is not necessarily so. Nowadays I often hear in my surgery that people prefer perfection rather than beauty, in the same way as people prefer respect rather than love. Perfection can be worked on, in the same way as respect, it can be developed starting with standardized and normal things until it responds to defined scientific rules. I think we could even say that perfection is something that is measured by the immobility of statues. Perfection is rigid and boring, it is not in favour of contrasts.

Beauty, like love, is something that cannot be easily controlled, it is something mysterious that is perceived and is related to the world of art, a world whose rules are unknown to us and that has to be understood with the intellect of the heart rather than with the intellect of the brain. It is also related to intuition. It is possible to be handsome with a long or short nose, with large or small eyes, with irregularly shaped lips. Latin beauty is not the same as Scandinavian beauty, for example. Beauty and perfection should go together. This is the most mistaken idea that we come across in our speciality of Plastic Surgery and Aesthetic Treatment.

Beauty, like love, is something that cannot be easily controlled, it is something mysterious that is perceived and is related to the world of art, a world whose rules are unknown to us and that has to be understood with the intellect of the heart rather than with the intellect of the brain. It is also related to intuition. It is possible to be handsome with a long or short nose, with large or small eyes, with irregularly shaped lips. Latin beauty is not the same as Scandinavian beauty, for example. Beauty is something that is measured by the movement of real life. An expression, a smile, even certain movements that are almost imperceptible in the muscles of the face and body, can give an impression of beauty and seduction…..or the complete opposite. Yes, natural beauty is movement and life, it does not allow room for boredom because it changes with the circumstances.

Not long ago I saw a photo of a wellknown English singer from the 80’s on the cover of a magazine. She must have been around 50. I could see she had undergone a deep phenol skin peel. The truth is that her face had no wrinkles, nor marks nor flabby skin, but I could see that this woman must have been over 45 by looking at her eyes. The upper part of her eyes, just below the eyebrows, was very hollow, you could see perfectly what we call the skeletonization of a face…this is when the bones start to protrude…a sign of aging. Her face looked as if it were made of porcelain. It certainly did not look very inviting to kiss it. This is a typical example of a face that is perfect, but not beautiful, nor young.

In natural beauty a face can be slightly assymetrical, with imperceptible movements of the curves that are a result of human nature. Many people have an idea of ideal beauty as in a sculpture. But a live human face has greater value than a sculpted face.

Beauty, youth and maturity In this aspect there is a difference between men and women. As in the animal kingdom, men want their women to be beautiful because in this way, through a strong sexual attraction, they can reproduce and improve the species. And in most cases, a woman’s beauty in linked to her youth, which is the ideal moment for reproduction. Age, with its wrinkles and flabby skin, relates women to the ravages of time and tiredness, and men do not want the object of their desire to be ravaged and tired.

The woman turns into a mother, and men are not keen to make love to a mother. These statements are generalities, obviously, but it becomes a global tendency, a more animal and instinctive way of seeing others. The problem is that today’s society is more in favour of this more superficial and physical way of seeing other people than through deeper and more sentimental values. This situation has always existed, but nowadays even more so.

With men it’s a different matter. Women find men to be more attractive when they are older, with wrinkles, showing signs of experience, strength and maturity. This is because women are subconsciously searching for the best father for their children and the maximum security. As in the animal kingdom, men with more experience, wisdom and strength are considered to be the most appropriate. So whilst men consider age to be detrimental with regard to women, women take it as a sign of improvement in the case of men.

In conclusion, for women we associate beauty with youth, while for men, beauty is associated with maturity.

Dr. P. Albrecht M.D. Ph. D. – 952 816 981

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Editorial: Dr. Pier Albrecht, Dr. Pierre Albrecht, Dr. Pierjean Albrecht,

Dr. Pier Jean Albrecht, Dr. Pierre F. Albrecht, Dr. Pierre Frank Albrecht,

Dr. P. Frank Albrecht, Dr. Pierjean Frank Albrecht, Marbella Clinic

Aesthetic surgery legal requisites h a n d s o m e When you decide to have any treatment carried out on the face or body, you must make sure that you are dealing with an adequately qualified professional. The ONLY legal requisite for being a doctor of aesthetic medicine – surgery was to be a general practitioner (from 6 to 8 years of study in Europe) with a non-official training imparted by colleagues or through conventions or workshops. Things are changing.

Spanish legislation has recently introduced changes to the effect that a Doctor who practices aesthetic medicine or “Cosmetic” surgery, may only handle skin and fat down to the level of the muscles. This means he can carry out all kind of injections, exfoliation treatments, laser treatments, diets, anti-aging programmes and limited liposuctions.

The surgical training of these doctors is probably incomplete, to ensure safer conditions for anything that goes beyond those treatments. Generally speaking, “cosmetic” basically means superficial. For this reason we gradually come to an international standardization of vocabulary, using the term Aesthetic Plastic Surgery, instead of Cosmetic Surgery, only for real specialists. A surgeon is entitled to the qualification of Specialist in Plastic, Aesthetic and Reconstructive Surgery if he has received training for techniques in plastic surgery for a minimum of three years, or more, and with an average of between five and seven years of hospital practice (if he has studied the reconstruction of the face or hands after burning), and he must also have received training in plastic surgery, carried out in a hospital.

The fact of a surgeon belonging, or not, to a Scientific Association, is not a legal requisite. He MUST be registered in a Professional Doctors’ Association (for Malaga, El Ilustre Colegio de Medicos de Malaga).

The security provided by this aspect means that patients are guaranteed that the treatment is going to be carried out by a real specialist in a clinic that is registered. The European Community has set out a series of safety regulations and requisites that must be complied with for clinics to be able to obtain the licence required for aesthetic surgery to be performed within their facilities.

Aesthetic Plastic Surgery in this new millenium is undoubtedly based on technological progress. Photos are taken with a digital camera of full face, profile, etc, then these photos are stored on a computer using ultrapotent software that will evaluate the best strategic options for rejuvenation or the changes necessary for obtaining the face or body that is closest to the established standards of beauty.

Then orders pass from the computer to mechanical “arms” to perform the operation under the supervision of the surgeon, but in a way that is more mechanized. This is not a dream, it is reality. It already exists in some fields of surgery, where operations are performed long-distance. Nevertheless, nowadays, surgery is still carried out for the most part completely manually (with two hands and ten fingers). The surgeon is the key element of the operation. He measures, draws, cuts and stitches. In short, he decides which is the most appropriate option and technique for his patient, according to his training, his experience and his own technical and artistic preferences.

Dr. P. Albrecht M.D. Ph. D. – 952 816 981

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Editorial: Dr. Pier Albrecht, Dr. Pierre Albrecht, Dr. Pierjean Albrecht,

Dr. Pier Jean Albrecht, Dr. Pierre F. Albrecht, Dr. Pierre Frank Albrecht,

Dr. P. Frank Albrecht, Dr. Pierjean Frank Albrecht, Marbella Clinic

By Dr. Pier Albrecht

The art of skin rejuvenation

Our facial skin is a magnificent organ being thick enough to protect our face from a lifetime of sun, wind and rain while in the meanwhile being flexible and delicate enough to express emotions and mimics in the unique way only a human being is able to do. After having undergone the changes of many seasons and the sum of emotions of a full life our skin starts to show the inevitable signs of ageing: Wrinkles, age spots, a thinning of the skin and an overall loss of elasticity.

Not long ago, any correction of these ageing effects was only accessible by more or less invasive plastic surgery procedures. But since a couple of years new treatments called Peelings are available which consist of a chemical or mechanical removal of the upper layers of the skin (Epidermis) followed by an assisted healing phase which allows for a regeneration of a new, immaculate skin.

It is very important to know that the exfoliative effect of a chemical peeling only is responsible for a part of its results, while the other part is the effects in the deeper layer of the skin (Dermis), where a deep chemical peel induces a hypertrophy and a retraction of the elastic fibres which results in the remarkable lifting effect of such a deep chemical peeling. Furthermore this lifting effect can be as well achieved in zones which are difficult to treat with classical surgical face lifting procedures (e.g. the area around the mouth and the lower eye lid area).

There are other peelings available which are targeted only on the exfoliative effect, that means they provide only the removal of old skin cells to enhance the appearance of the skin but have no lifting effect which can remove deeper creases and wrinkles. These superficial or medial depth peelings are for example the Fruit Acids peelings or the glycolic acid peelings which can not be considered as an alternative for surgical lifting procedures.

An alternative to deep chemical peeling is the EXOmask which is only available at a few selected centres in Europe. Based on a special chemical formula which has been developed over 30 years through extensive testing on human tissue samples in the laboratory, EXOmask provides a deep lifting effect on the dermis without any destruction of the underlying pigment cells (Melanocytes), which are responsible for the skin colour and the natural sun protection through the tanning effect. Most of the other deep peelings currently available have an immanent risk of permanent depigmentation of the treated area, which results in an unsatisfying skin colour and the mandatory use of permanent sun protection.

The EXOmask treatment is carried out in only one session, mostly as an out-patient procedure, under local anaesthesia and in some case including a light sedation. After the peeling lotion has been applied, an elastic silicone mask seals the face for 24 hours allowing the solution to penetrate into the deeper part of the skin. This process is painless, the patient can in most cases go home with the mask and sleep normally. After 24 h the mask is removed and a special powder is applied on the skin. This powder enhances the regeneration process and serves as a dressing for 7 days until the new skin has grown completely.

After 7 days the results are instantaneous, the patient has a smooth and spotless skin and the lifting effect through the skin retraction is completed. Due to the ongoing regeneration process of the deep elastic fibres the new skin is widely vascularized and therefore shows a redness which will slowly fade during the next 8-10 weeks but can be covered up completely with make up.

In conclusion the EXOmask peeling is an attractive alternative for patients who have an overall ageing of the facial skin and want effective facial rejuvenation without undergoing classical surgery procedures.

The EXOmask treatment is carried out in only one session, mostly as an out-patient procedure, under local anaesthesia and in some case including a light sedation.

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Editorial: Dr. Pier Albrecht, Dr. Pierre Albrecht, Dr. Pierjean Albrecht,

Dr. Pier Jean Albrecht, Dr. Pierre F. Albrecht, Dr. Pierre Frank Albrecht,

Dr. P. Frank Albrecht, Dr. Pierjean Frank Albrecht, Marbella Clinic

Having been since ancient times an outstanding symbol for femininity and fertility the female breast has always been a central part of the visual image of any woman, and despite the many historical changes that image underwent during the last centuries, there was at any given cultural period a quite well defined image of the ideal breast which inspired artists, fashion and society.When we take in consideration western society’s actual idea of an ideal breast, we experience the recreation of a more female look and style. A full breast is considered as sensual and beautiful and fashion and media are competing to visualize this image day by day.

Therefore, breast augmentation is more and more sought after, especially by young women, to approach their individual image of the perfect breast. But something which is not covered in most features covering aesthetic surgery of the breast is the fact that there are even more women suffering from very big or very saggy breasts who are searching for the possibility to get a smaller and beautiful shaped breast.

This misinformation about the possibilities of modern plastic surgery combined sometimes with the perception of the unfavourable results of some ancient techniques still keeps many women suffering their whole life from their big breasts; with this article we want to provide this missing information by explaining modern techniques of breast lifting and breast reduction and to offer you solutions to this common problem.

From a plastic surgeons view, there are distinctive measurements which define a perfect breast, but aside from those more academic definitions a woman’s feeling regarding her breast size and shape should always be our individual guideline. A breast which may be perfect for a woman looking for a more female and seductive appearance can be much too large for a small-framed woman who loves to do sports and has a more girl-like image of herself.

So the surgeon will consider your personal feeling regarding the size and the form before talking with you about any reduction or lift. After this has been thoroughly discussed the surgeon can evaluate if the adequate technique is a lift which removes only excess skin to achieve a firm and uplifted breast or if a removal of glandular tissue is necessary to meet the patient’s expectations.

A breast lift, sometimes also called a mastopexy, is a procedure which consists of removing excess skin without any removal of glandular tissue to lift up a sagged breast while keeping its original volume. If the sagging and the loose skin are less important the so called Benelli Lifting Technique can be performed removing skin only around the areola. In this case the resulting scar will be only around the areola and is barely perceptible after one year because it is placed exactly on the border of the pigmented areola. If the sagging and consequently the excess of skin are more important, a skin resection of the lower breast pole combined with a resection around the areola is necessary to achieve the desired lift. The result is the circular scar described above and a vertical scar descending to the fold under the breast.

If a patient is suffering not only from an excess of skin but from an excess of glandular breast tissue (Macromastia) the patient’s expectations can mostly only be met by a so called breast reduction procedure. There are multiple factors which can be responsible for Macromastia, in most cases it is a combination of a genetic predisposition together with hormonal changes which can be induced by onset of puberty, pregnancy or menopause. Even without considering the aesthetical aspect, very large breasts are often the origin of serious functional problems like chronic back and neck pain, arthritis of the neck, chronic eczema of the breast fold and others.

Therefore already 2 centuries ago very large breasts represented a serious problem for many women, so the plastic surgeon’s quest for aesthetically and functionally satisfying procedures started in 1882, with the first described breast reduction by the English surgeon Thomas. In the attempt to develop techniques which provide minimal scarring combined with a safe surgical procedure at least 15 different procedures where described during the last century.

Some of those ancient techniques are still frequently used and widely accepted, others have been replaced by more modern procedures, but the basic principle of all breast reduction techniques still remains the same: a circular incision around the areola which allows for skin removal and uplifting of the nipple-areola-complex combined with a vertical incision descending toward the lower breast fold which allows for breast tissue removal in the lower quadrants of the breast. This vertical incision is necessary because any removal of glandular tissue requires a reduction of the skin envelope as well, so by tugging the remaining skin into this vertical oriented scar for suturing the surgeon can rearrange the remaining breast tissue to recreate the natural round breast mound.

Depending on the technique used the scar descending from the areola can have the form of an L, of an inverted T or just be a vertical line. The L or the inverted T shaped vertical scar techniques are the more ancient procedures, but they still have their justification in very large reductions where the single vertical scar technique can not cope with the associated excess of skin.

The more recent technique based on a single vertical scar in combination with the circular scar around the areola was described 1998 by the Belgian surgeon Madeleine Lejour. This surgical approach is based on the ability of the skin to shrink once it has been freed from the glandular breast tissue, so that large amounts of excess skin which would normally need an L or inverted T shaped skin excision can be rearranged in just one vertical scar by using a special purstring suture technique.

Offering the big advantage of minimal scarring, this technique can be used in almost all reductions except for breasts which are extremely big and sagged. Because of the reduced incisions, healing is fast and most patients can get back to normal life activities after 2 weeks. Due to the fact that this technique is based on the postoperative shrinking of the skin, the reduced breasts require 3-6 months after the operation to achieve their final position and the desired aesthetic result; during this early stage the lower half of the breasts will show some small skin folds which will smooth out gradually.

By using all the techniques available after more than hundred years of modern plastic surgery research, the modern breast lift and breast reduction procedures provide excellent aesthetic results combined with an invaluable effect on the functional problems mentioned above resulting in an important improvement of life quality.

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Editorial: Dr. Pier Albrecht, Dr. Pierre Albrecht, Dr. Pierjean Albrecht,

Dr. Pier Jean Albrecht, Dr. Pierre F. Albrecht, Dr. Pierre Frank Albrecht,

Dr. P. Frank Albrecht, Dr. Pierjean Frank Albrecht, Marbella Clinic