Plastic surgery treats abnormalities of the face and body and covers two types of complementary interventions; though it is often difficult to establish its limits, they differ in purpose:

Reconstructive Plastic Surgery handles congenital deformities and those caused by burns, trauma, infections, tumors and mutilating surgeries. The objective is to try to restore the original appearance of patients who have suffered disfiguring accidents, to rebuild body parts that have been destroyed in operations (like the one caused by the treatment of breast cancer) or facial accidents (covering people with burn injuries with skin), closed paraplegics bedsores, treat scars that prevent extending in the arm or hand, open the eyelids, treat any abnormality of the face caused by paralysis, among others.

Aesthetic Plastic Surgery treats ailments that are caused by alterations or physical deformity, ensuring satisfaction and restoring balance to the individual to their own body. That is, interventions in the natural form of the body in order to improve, beautify and rejuvenate it.


If on the one hand we believe Cosmetic Surgery responds to specific demands of the population, we cannot consider extending its use indiscriminately. Only when the control of the balance between benefits and risks is tilted by early surgical intervention, plastic surgery will be justified.

Minimizing risks through rigorous preoperative examinations, well prepared surgical equipment and adequate facilities are the responsibilities of the surgeon. However, the plastic surgeon is not the only one to select the surgical techniques used, but the patients themselves! It’s not uncommon to find patients who have unrealistic expectations and who will not benefit from the results - no matter how good they are. As you would imagine, it is better to avoid the frustration of both patient and surgeon by preventing the surgery.

Moreover, and ultimately, we can ask what is the purpose of Cosmetic Surgery, then, if you understand perfectly the role of reconstructive surgery, aimed at correcting obvious defects, so cruel to those who suffer them, it may be more difficult to accept a surgery that aims to wellness, beauty, perfection or youth.

When our external image does not match our inner image, the desired onewhich we believe corresponds to ourselves, when a defect means unhappiness, shame, discomfort, dissatisfaction, ... why not help it, why do we have to suffer like an inescapable stigma? Every human being, even all beings, are inclined to equilibrium. Plastic Surgery can help, in certain cases, to restore that balance.

Currently considered assets of the Specialty Surgical treatment of burns, ulcers, scars and skin tumors, congenital or acquired craniofacial deformities, genitals and some of the limbs and reconstructive surgery and facial mutilation are purely aesthetic surgery.

The increasing complexity of the specialty has led it to branch into several subspecialties, which are incorporated into or are in collaboration with other specialists working in multidisciplinary teams, essential for the treatment of certain diseases. The sum and combination of the knowledge of each specialty and specific technical training are the keys to better outcomes.

Cosmetic Surgery treats facial and bodily features that start to reveal over time and can cause discomfort and insecurity, especially when we do not identify with the image we see of ourselves . Often this leads to serious problems of insecurity, difficulties at work and emotional and social limitations.

Cosmetic surgery is often attributed with offering the possibility of eternal youth. But, time passes inescapably, leaving its mark and thus the quest for eternal youth remains just a myth or a dream. However, it is possible to maintain and lenghten a youthful and rejuvenated look.

Facial rejuvenation surgery includes not only the forehead and neck (rhytidectomy or facelift), but all processes whose common purpose is to smooth, reduce, or eliminate the traces and stigma accumulated with time.

Try, therefore, facial features that reveal the passage of time, especially when they cause discomfort and insecurity, lack of identification or rejection of the image itself, or labor difficulties, emotional and social.

It is based on four concepts: Stretches (for sagging), Remodelling (for the drooping /hanging of excess fat tissue), Fill (to compensate for atrophy) and Regeneration (to stimulate the tissues).

Stretching aims to restore the original position of skin and muscle tissue, through removing excess skin and restoring lost muscle tension. Remodeling refers to the treatment of structure accusing age-appropriate alterations, as with the malar fat ptosis, eyelids, nose, chin, ear lobe and orbit. Filling compensates for suffering tissue atrophy in senile involution and / or diminishes wrinkles and folds. Regeneration or cutaneous stimulation is an important complement to this type of procedure and its purpose is to remove the epidermis and superficial dermis in order to acquire a new, younger and better quality skin.

The most important part in any operation is to have a correct diagnosis in order to select the correct form of treatment. Each patient needs a type of procedure depending on the alterations that presents and expectations. The main difference between one type of face-lift and another lies in the extent of skin detachment and the treated parts.

We suggest therefore to treat disorders as they appear -rather than waiting for further deterioration- for several reasons : firstly, it maintains a longer, youthful appearance , procedures are less intense ; with faster recovery and are cheaper.

We often associate facial rejuvenation surgeries with other operations - primarily eyelid surgery, which refers to the excess skin and pockets that form around the eyes, giving them a tired and sickly look.

This treatment is specific to each patient, does not always correspond with ageing, and will depend on the affected areas, the degree of sagging and the type of wrinkle. In the picture on the left we can see the intensity of peeling in the skin of the face and neck, as well as the location of the incisions.

The face-lift is the term given to the procedure for the treatment of stigmas of time in the face. Its meaning is selfexplanatory: it involves stretching of the skin; to treat wrinkles (rhytids) and raise the structures that have fallen (Lifting).

To facilitate the understanding of the facelift, and following the proverb 'a picture is worth a thousand words'; imagine a brown paper to crumple and the folds predominate do parallel lines, something like an accordion. We stuck to the bottom line in contact with a table. Once dry, when attempting to stretch will note the failure and the risk of the paper breaking. Now peel off the paper part, stretch, and see how the paper is smooth.

There is only one small detail, the skin is elastic. It is not enough to remove wrinkles stretch. What is needed is the underlying tissue: fat and muscles to retain its forms, and this requires tensioning a very fine structure, something like a mesh, which is called the SMAS (superficial muscular-aponeurotic system).

Another feature of importance is that the skin is peeled off and lifted together with a layer of fat by going vessels that feed the flap. This procedure is very delicate and compromised circulation caused by smoking, diabetes, atherosclerosis or others could make it necessary to have a number of special precautions and limitations in these patients.

Eyelid surgery is called blepharoplasty and treats bags, wrinkles, sagging or excess of skin.

Just like any other surgery, cosmetic surgery is indicated when the alteration is a problem for the sufferer.

There is, as noted, a certain age, but it is most common after the age of forty, and is one of the surgeries that men undergo the most. The desire to rejuvenate and get rid of that aspect of fatigue and illness are the main reasons which prompt the patient to seek a solution. Sometimes it can be both the excess skin and fat in the upper eyelids that can cause fatigue in the weak eyelid-levator (eyelid muscles), causing the fall or ptosis of the eyelid.

It is ideal to perform blepharoplasty when the first signs of aging appear. If there are signs of sagging and bags added with eyebrow falling, it may be more appropriate to complement the blepharoplasty performing a brow lift (temporal region, or temples). Moreover eyelid surgery is normally conducted with a facial cervical lifting.

To get the balance of proportions many devices and methods have been tried, such as the rhinometer or using the dimensions of the nose at the beginning of the 20th century. However it is only through artistic sensitivity that the nose can reach natural harmony in its results.

Under these principles we address one of the most interesting facets of cosmetic surgery: the possibility of modifying the human face. In the face configuration there are straight lines, curves, angles, outgoing and incoming depresions involved. The face depends on the shape and size of the nose, chin volume, the curvature and angle of the front, and the projection dimensions of the mouth and the angle, as well as the neckline.

The nose is the central and most striking feature of the face that is balanced between the ends of the chin and forehead. Although its size has a relative value with respect to the other parts and the whole face, at the same time, it has absolute or objective values, demonstrable by special studies comprising photography, and cephalometric radiography. However, the sensitivity remains determined, in most cases, by the type of alteration that presents a face which is confirmed by tests above. Rhinoplasty modifies nose shape, size and position.

Chin: When the chin is underdeveloped it is called retrognathism, and if its overly prominent it is called prognathism. The chin can be increased or decreased by implants or osteotomy (bone cuts).

Lips: There are several changes that affect the lips: macroquelia (oversized) , microquelia (small), fissures (cleft palate), atrophy (senile lip), and thin lips, among others.

The lips surgical treatment is called chieloplasty, although frequently used, there are lip implants when the desire is to increase the volume, shape or balance the proportions between the top and bottom lips. In these cases it is very important the arrangement and size of the teeth to maintain face harmony.

Jaws: Face surgery includes the remodelation of the jaws, both the upper jaw (maxilla) and the lower jaw(mandible).

The cervico-mandibular angle, the angle formed by the jaw and the neck itself, depends on both bone structure and muscle and fat. In this area the muscles are attached to a bone called the hyoid. The level of implementation modifies the angle: a low bone will make the angle, which under ideal conditions is close to 90 degrees, more open, becoming a line or even in cases of large obesity, is transformed into a convex curvature .

Cosmetic Surgery treats disorders of the face shapes: large or misshapen noses, prominent ears and other facial deformities are mocked in childhood and youth, potentially resulting in personality disorders and difficulties relating to the also treats other alterations of nasal breathing difficult and incapacitate for physical effort. Plastic surgery also treats deviated septum, nasal tip crash, broken noses, among others.

It is important in facial surgery the frequently changing structures involving in some alterations in self-image that can become important and affect personality. That's why the patient undergoing this type of surgery has to be especially knowledgeable and be prepared to accept changes notwithstanding their mental balance. That is, a person must be mentally and physically healthy.

Often, however, anatomical imbalances do not correspond to the intensity of the psychological impact involved. Understanding the patient's psychical structure is of paramount importance to avoid operating on someone who has expectations that are inconsistent with the expected results: small deformities can have an indication for surgery in patients with normal psyche while even important surgeries may be discouraged in emotionally disturbed individuals. Moreover, do not forget that the nose has a clear hereditary influence, family and racial traits whose face beauty about arbitrary attributes and in turn dependent on multiple social factors.

There is no doubt that above all that the individual’s own satisfaction with their physiognomy must prevail: make your ‘flaws’ your greatest strength. Finally, a nose is normal when certain proportions are kept in harmony with the other structures of the face. Sometimes a patient comes to the plastic surgeon dissatisfied with the nose they were born with, carrying a clipping from a magazine with a picture of a famous person, placing it on the table and carefully saying, "Doctor , I'd like to have a nose like that! "

Unfortunately, and in fact, it is not easy to reproduce certain types of noses. Moreover, many times this is impossible due to the limitations imposed by the characteristics of the nose in question, for example, a thick skin and a strong cartilage prevents getting a fine and delicate nose. The most important thing remains the understanding between patient and surgeon, between them, choosing the most suitable type of nose to the particular face. This may require more than one visit. It is essential to examine each case carefully and answer any questions before the intervention .

Depending on the alterations and features present, rhinoplasty (nose surgery) can treat the stand (back) and the tip; it may be decreased (this is the most frequent type of surgery),or increased. Often performed in the same operation, the correction of the septum (septoplasty) and, if necessary, of the turbinates (nasal concha). In the patient in the picture we see the outcome of tip treatment (it was fall and it was wide) and the back (presents a moderate hump).

Cosmetic surgery in the nose can try the stand (back), the tip and the septum, depending on the alterations present, the nose can be decreased (as the patient shown in the picture) or it can be increased.

Rhinoplasty is one of the most frequent surgeries performed in Ecuador, and its main objective is to get a harmonic effect, not only of the nose as a separate structure, but from the nose to the rest of the facial physiognomy. The surgery actually seeks to “make the nose” that corresponds to the features presented in each patient and, furthermore, the nose must have a natural effect, which means most patients don’t like a nose that shows evidence of surgery. Therefore, surgery of the nose is one of the biggest challenges for the plastic surgeon: is the combination of science, art, technique and sensitivity.

Traditionally, rhinoplasty has been used for the treatment of very large noses (rhyinomegaly) that usually present a dorsum elevation with a hump in it (rihnocifosis).

Prominent or protruding ears cause important alterations in a person's self esteem, specially in children and teenagers but also in adults. Operations are usually performed at the age of 8 or 9, when the ears have acquired their final shape, although operations at older ages are not infrequent. They are easy to correct by achieving the curvature they lack through a small incision in the back of the ear.

For the child, this type of flaw is frequently ridiculed and mocked by other children. Even among adults can we often find people who still hide, are ashamed of themselves or feel limited because of their ears.

This type of deformity is an alteration either in the ear's anatomic proportions or in the harmonic development of the curves that mould the outer ear.

Sometimes the possibility of prominent ear genetic transmission from parents to children exits. These ears are easy to correct with swift, safe and ingenious surgery. The diagnosis is carried out early in the child's life by pediatrician and parents, who observe that the child's ears are excessively prominent. This first diagnosis is temporary, because the possibility exists that the ears regain the correct shape in the first years the child's life.

The ideal thing is to operate when the ears have finished developing at the age of 7 to 9, but it is not always convenient to wait so long. The consequences and repercussions can have a more negative impact than operating sooner (at the age of 3, ear development is around 85%). This decision must be made by child, parents and surgeon.

One of the most frequently used procedures in a cervicofacial lifting is placing grafts of the patient's own tissue (aponeurotic-muscle tissue or SMAS) to increase the volume of those face areas that require it; to achieve an enhancement of the lip, as in this case. Fine wrinkles on the upper lip can be treated with fillings, but deep upper lip wrinkles require regeneration of the skin (Dermoabrasion).

The upper lip is made up by the following: vermilion or red portion itself and the area formed between the upper vermilion, nose base and nasogenian grooves. The lower lip is also built up by vermilion and the skin area going from the continuation of the nasogenian grooves to the beginning of the chin.

Lips can suffer a series of aesthetic alterations which can be corrected: size disparity, depressions and wrinkles.
The current facial image model gives great importance to lip shape and size that denotes certain exotic tendency. Not all faces allow this kind of aesthetics, it is facial harmony what determines lips in balance with other facial features. We are, so as to say, conditioned by the other facial measures, that is, the vertical length of the upper lip (skin not mucous) is related to the projection of the nose base. The upper lip must overhang the lower lip and be slightly thinner, etc.

For this reason, we include these operations in "Facial modeling". We just have to remember the good taste aberrations of deformed lips the yellow press shows us and which some of our famous personalities have.

Use the following to increase lip volume:

Plasty: own lip tissue is taken from one area to another: VY plasty is the most frequently used method; muscle and mucous are turned outward. Vermilion is increased in volume and height: good results.

Grafts: only used when operating simultaneously on other areas that serve as donors, mainly in face lifts. Tissue called "smas" (Superficial Musculoaponeurotic System) or temporalis muscle aponeurosis is used: it's absorbed slightly, but can cause other irregularities due to scar contracture. Other tissues can be used, although we currently advise against fat grafts, because the edema in this region is too large and there is practically total reabsorption.

Gore-tex: permanent and useful to outline vermilion, some strands might extrude although this is usually not the problem.

Bovine-derived collagen is one of the most frequently used organic compositions. It has short-term effects and can cause allergic reactions that require the patient to undergo an allergy test. A negative result does not exempt from possible allergic reaction during insertion procedure.

Hyaluric acid: non-animal origin, lasts 6-12 months.

If, aside from having a thin upper lip, the distance from upper vermilion to base of the nose is very long, tissue resection might be necessary near vermilion or nose base, so as to recover natural proportions and diminish wrinkles caused by sagging skin. Superficial wrinkles respond very well to dermabrasion.

Aesthetic procedures are those that aim to correct the angle made up by mandible and neck or cervico mandibular angle.

Alterations or angle loss can be due to different causes and the corresponding treatments would be the following:

Excess fat in neck or double chin: Liposculpture (Cervical liposculpture) is useful when treating young patients. Besides undergoing liposculpture, it is necessary for older patients, who suffer from sagging skin or from skin excess, to undergo cervical lifting in order to compensate skin excess.

Receding chin or underdeveloped chin bone: corrected by solid silicone implant (Augmentation mentoplasty) or by bringing the chin bone forward.

Hypertrophy and fibrous chin tissue fall or double chin: double chin resection of excess tissue, flaps and tissue plasties.

Muscle alterations: can be due to low muscle insertion to mouth floor or hypertrophy (size augmentation) and sagging of the platysma muscle or platysma bands. Both cases require muscle manipulation. This is usually done during cervical lifting and it consists of a tightening of the neck's platysma muscles to establish a better angle between the neck and jaw line or a resection and tightening of the muscle bands.

The procedure, if confined to this body area, can be performed under local anesthesia and on an outpatient basis, that is, the patient is not required to stay in the hospital overnight.

The resulting scar is hidden either under the chin or, sometimes, inside the mouth, where lower lip mucous and gum meet.

Scar tissue can be removed by excision, covered by regenerating the skin around or substituted by other tissues. If the scar is not large or deep enough, it can be treatead from the surface with dermabrasion or CO2 laser peel or Fotona® Neodymium Laser sessions, that actually are one of the best treatments for scars.

When the scars are larger, the best treatment consist of resection, ie: removing the scar tissue and suturing or joining the edges again so it can aesthetically improve.

Acne has two phases: active and inactive. In the first phase, the treatment consist of a specialized diet, antibiotics and vitamin A. In the second phase, when the problem is the aesthetic effects or scars, the treatments can be either surgical: excision of significant scarring, dermabrasion or can be laser peeling.

In Clinica Borja we use the most advance technology for Acne treatment, the Fotona® Nd:YAG Laser

Fotona Laser: Fotona offers a laser acne treatment protocol that provides a truly comprehensive solution to the problem of acne. Fotona’s precisely controlled Nd:YAG laser light safely penetrates into skin to effectively target overactive sebaceous glands and to reduce the risk of developing new acne inflammation.

For improving the appearance of acne scars, Fotona offers a complementary laser treatment based on a precise and gentle skin resurfacing procedure in which an Er:YAG laser beam is absorbed by the top micro-layers of the skin to vaporize scarred tissue and stimulate the production of new collagen in the dermis.

Fast results, Without Side-Effects

For active acne, Fotona’s laser treatment reduces acne inflammation through photoselective absorption and controlled heating effects. Fotona’s high powered Nd:YAG laser safely penetrates the skin to an optimal treatment depth to thermally and selectively destroy overactive sebaceous glands.

In addition to its thermal penetration effects, the Nd:YAG acne laser treatment also accelerates the healing process and stimulates collagen remodeling, an important step in the long-term treatment of acne.

Gentle & Effective Acne Scar Revision

For treating problematic acne scars, Fotona's Er:YAG laser wavelength is ideal for gentle ablative scar revision. The Er:YAG laser safely and effectively provides the minimal penetration depth required for light resurfacing of acne-scarred skin, helping to improve skin texture and tone. Unlike chemical peels and dermabrasion, laser skin resurfacing allows the penetration depth to be precisely controlled. The laser gently vaporizes micron-thin layers of the acne-scarred surface to reveal healthy, undamaged skin below. Laser resurfacing is a fast, safe and simple procedure.

Taken from:

http://www.fotona.com/en/treatments/1087/acne-acne-scar-revision/

accessed on: February 23th 2014

Body contouring surgery covers different procedures that have the purpose to modify all body morphological features but the face.

It covers:
Breast procedures for aesthetic results:
• Breast augmentation or reduction.
• Breast reshaping.
• Breast lifting.
Liposculpture.
Abdominoplasty.
Dermolipectomies or skin and fat resection in thighs, buttocks, arms and hands.
Prosthesis placement in buttocks, calf or, in the case of men, pectoral muscle.

Alterations in the abdomen can be due to excess of fat, skin or abdominal wall weakness. In cases of skin sagging, it will be necessary to undergo abdominal dermolipectomy or abdominoplasty which consists of eliminating abdominal excess skin and fat and tightening the muscles in the abdominal wall. The patient in the photograph presents Grade 1 Lipodystrophy with important skin flaccidity in the infraumbilical region.

Abdominoplasty or abdominal dermolipectomy consists of resection of skin segment and abdominal fat as well as restoration of normal muscle wall tension.

Abdominoplasty is one of the aesthetic procedures that cause most unease to the surgeon due to the scar's great dimensions. At the same time, it is one of the procedures that satisfies patients most, due to the important change in their body contour. It is frequently combined with liposculpture of fat deposits that don't respond to diet or weight loss.

Complete exploration is required, like before any other procedure, in order to discard any type of pathology that could contraindicate surgery. Among these pathologies, cardiovascular, lung and coagulation problems are to be highlighted.

Obese patients, whenever possible, should lose weight under endocrine control. In patients, who cannot manage to lose weight and have a large abdomen, abdominoplasty may be the answer. In said cases, some days prior to the procedure some breathing exercises will have to be done.

Due to the great extension of skin separated from the abdominal wall and the flaps dimensions, which is usually performed in this procedure, it is important for smokers to stop for around 2 weeks before surgery. The reason is that smoking can cause alteration in microcirculation, which can seriously compromise the final result.

Liposculpture is a modern surgical procedure designed to eliminate fat through small incisions in the skin using a blunt cannula with holes at the tip, which is connected to a syringe that produces the vacuum needed to absorb or suck the adipose tissue.

Although liposculpture seems easy, it is a difficult procedure that requires very specific morphology and body anatomy knowledge besides certain artistic sense. Technical refinement has led, in the last years, to conceive liposuction as liposculture, which in some way defines the technique's characteristics. Liposculture can be compared to a sculptur pushing away splinters of wood with a gauge, making 3-dimensional shapes of surfaces, that, to make things more difficult, he/she cannot see, since they are covered by the skin.

Although this procedure was not indicated for obese people at the beginning, it is currently used quite frequently. It has been proved that it has very good results in this type of patients, not only due to the fat extraction, but also because of the stimulus provided by the improvement and the metabolic change that follows the drop in fat ratio.

Liposculpture is not the solution in cases of skin sagging or excess. These cases require another type of procedure. In any way it also does not eliminate the tendency to gain weight, reason why it is necessary to keep a healthy and balanced diet.

Liposuction can be performed in nearly all body parts, going from face to legs and arms, as an isolated procedure or complementary to other procedures, especially cervico-facial lifting and abdominoplasty.

Gluteal lifts (Buttock lift) are achieved through prosthesis placement, fat grafts, dermofat flaps or, like in the image, through skin and fat resection, only leaving a scar underneath the inferior gluteal fold.

Procedure aimed at highlighting the gluteal fold and removing skin and fat excess from this place. It can be done as an isolated procedure or complementary to inner thigh lifting, liposculpture or prosthesis placement in said region.

Silicone prosthesis implants are used when the patient's wish is to increase gluteal volume. Depending on implant size, the procedure can be performed under local or epidural anesthesia. Patient needs 24h hospitalization and must use a soft elastic compression garment for 15 days.

Male breast augmentation is due to abnormal development of male mammary gland. This growth can take place during puberty due to the hormonal changes that take place during this period. It can also be due to hormonal disorders, drugs or other substances.

Breast volume increases, usually below areola, due to mammary glandular tissue hypertrophy. In some cases, galactorrhea or whitish fluid nipple discharge is observed. Pseudogynecomastia takes place when breast augmentation is only due to subcutaneous fat deposit.

In those cases, in which ginecomastia persists, especially in young people, it determines an aesthetic alteration with very important (complex) emotional repercussions.

Gynecomastia diagnosis is clear in male mammary volume increase although, it is often the person himself/herself who recognizes the alteration that in some cases can be painful.

It's a relatively frequent syndrome that appears spontaneously in puberty, or is provoked by intake of certain legal drugs such as estrogens, corticoids, spironolactone, sulpiride, digoxin, cimetidine, neuroleptics, amphetamines, etc., or certain illegal drugs like cannabis.

Endocrinic causes, which are less frequent, are testicle tumors, genetic illnesses such as the Klinefelter syndrome, hyperthyroidism (10%). It also appears with hypophysary adenoma and sometimes, during acromegaly.

Idiopathic gynecomastias (without apparent cause) are detected in 75% of the cases in puberty. Spontaneous regression gynecomastias are not serious. It appears in 35% of new borns and goes together with placentary hormones. In older people, it is usually due to estrogen/testosterone imbalances following testosterone decrease.

It can also appear in hepatic cirrhosis, Parkinson's disease, Wilson's disease (excessive deposition of copper in the body), and following cranial traumatism or brain tumors.

As we have seen, the diagnosis is based, on the patient's clinical history and surgeon's exploration. Hormone determinations and lung radiography are vital to determine cause of gynecomastia. A mammography confirms the diagnosis and excludes presence of malignant tumor.

This operation repositions the protruding clitoris and reduces the length and projection of the clitoral hood. It is also indicated in the woman with mild clitoral enlargement who does not want to undergo a formal clitoris reduction.

Some women are bothered by the size of the clitoral hood and the clitoris shaft or head (glans). The hood may protrude too much causing the woman to be self-conscious or irritated. She may feel that the protruding hood and clitoris cause a bulge in her clothing or the appearance of a small penis, or finding it difficult to have orgasms because the clitoris is not stimulated well enough due to the excess of skin in the clitoris.

If desired by the woman, I routinely reduce the sides of the clitoral hood while performing labiaplasty. However, that does not change the length or projection of the clitoral hood. In order to resolve this situation, I make a horizontal incision on the lower clitoral hood and setback the clitoris slightly higher with a few sutures (clitoropexy).

The pulling up and moving in of the head of the clitoris eliminates the protrusion and now allows me to remove some of the longitudinal hood skin. The hood becomes shorter, and the hood and clitoris no longer protrude, so there will be more pleasure during the intercourse. There is no risk of nerve injury or sensation change.

Male clientele can also take advantage of all the services we offer at our clinic, including Botox and dermal fillers. With men becoming ever more conscious of their appearances, our beauty treatments are both suitable for, and of great benefit to, male patients seeking to improve the way they look. Two especially popular procedures for men are liposculpture and antiage treatments.

Liposculpture is gaining favour amongst men who have problem fat deposits in the following areas: breasts, love handles, abdomens and chins. Whilst these regions are the most requested areas for improvement in men, liposculpture is appropriate for almost any area of the body where fat deposits have built up.

Breasts (”man boobs”) respond particularly well to liposculpture. No surgery or general anaesthetics are necessary, and scars are almost invisible as no stitches are required. It is possible to have the procedure performed on a Friday and be back at work on Monday. The skin will not sag in the majority of cases.

Abdomens in men do not always respond well to liposculpture as there are some patients in which abdominal fat is actually situated inside the abdomen and around the organs; there is also another group of men where the appearance of the bulge is due to overstretched abdominal muscles. However, in the remaining cases where a large volume of subcutaneous fat exists, liposculpture is an excellent way to reduce the bulge and reshape the body. This is where a face-to-face consultation is necessary.

Chins respond very well to liposculpture and can take years off your face, making you look younger within a matter of days. Bruising generally lasts only five to six days and scarring is hardly visible.

The breast is biologically a gland that secretes sweat, it is a defining structure in mammals and its main function is to feed offspring. In humans, breasts have an added sexual component: female human breasts, in opposition to female primate breasts, maintain a considerable volume through out puberty, which can increase by one third during lactancy.

The mammary gland originates in the breast. Female breasts do not begin growing until puberty, moment in which breast skin also stretches to adapt to new shapes and sizes. Inside the breast, changes take place that prepare the mammary gland for lactancy: acinar cells, clustered in the lobules and which communicate to the outside through the galactophorous canals, suffer hypertrophy and activate, producing a typical secretion, which is milk. Hormone stimulation during menstruation, pregnancy and lactancy, as well as, hormone treatments and obesity, lead to a breast size increase.

The breast is formed early in fetal life from an invagination of the ectoderm (superficial layer) of the embryo's ventral region. During this stage, some mammals develop two parallel rows (dogs, cats…), others such as humans, horses and bovine mammals only have two functioning mammary glands, the rest suffer atrophy. Nonetheless, some women present vestiges of these atrophied structures and more or less complete breasts are visible going from axilla to groin (supernumerary breasts or nipples).

Other possible anomalies are: complete absence of one or both breasts, important asymmetries (certain level of asymmetry is normal), alterations in nipple-areola complex (inverted nipples, hypertrophy, etc.), or breast growth in males (gynecomasty).

The aforementioned alternatives are mainly of morphological character.

We will not cover hispathological alterations, since they are not of special interest to our subject, but we can superficially highlight the most common pathologies: swelling (mastitis, abscesses and fat necrosis), hormones (benign mammary dysplasia, cysts and adenosis) and benign (fibroadenoma) or malign (carcinoma) tumors. Due to the frequency of alterations, an early diagnosis is vital. This implies periodic medical examinations and a well-informed patient, including breast self-examination and a periodic gynecological control.

In plastic surgery, breast augmentation is one of the most gratifying types of surgery. Its greatest achievement is obtaining a natural breast in its consistency, movement and shape. The patient in the photograph had mammary hypertrophy and underwent breast augmentation surgery by placing silicone prosthesis.

Female patients mainly recur to breast surgery because they wish to increase their breast size due to aesthetic reasons. But there are other reasons: amastia, or lack of breast development; atrophy, or involution usually related to ptosis or breast sagging; post surgery mammary tissue loss, burns,
traumatisms, etc.

Augmentation mammoplasty is applied in patients who have psychic disorders and emotional alterations due to lack or alteration of one or both breasts. It is also used to treat thorax deformities or for reimplantations due to patient's dissatisfaction with previous implants.

Breast implants should not be used or used taking special precautions in the following cases: recent clinical history of mammary abscesses, important diffuse mammary pain, mastitis or breast tumors, persistent or recurring breast cancer, active infection in a certain body area, history of hemorrhage, immune system alterations, hypersensitivity to strange materials, tissue alterations due to thorax irradiation, excessive resection of the upper pectoral muscle. We strongly advise against its use in patients with psychological imbalance or reluctant to undergo possible further revision operations.

This is a new technique which manages to increase breast volume with the patient's own fat tissue. This technique is called lipotransference. One of its benefits is that belly or waist fat is removed, so we can also achieve a body shaping. The other major benefit of this technique is that by using the same, autologous tissue to reposition the breasts it will avoid any types of rejection, as it’s the patient’s own tissue. Breasts can be increased as desired. If the patient wants to continue to enhance their breasts, the intervantion can be repeated as many times the treatment requires.

Breasts can also be reduced using this technique. Always with minimal scarring and rapid postoperative recovery.

Aside from their aesthetic aspect, very big breasts can entail important physical repercussions. So with, breast reductions are not only an aesthetic matter, but they also avoid that the weight excess affects the spinal column causing pain and important alterations. The photograph shows a patient with breast hypertrophy who underwent breast reduction surgery. We can see the beneficial effects of the procedure which favored her weight loss.

Breast hypertrophy is exceedingly large breast volume. Breast volume augmentation can be due to a single, isolated symptom, especially in young patients (juvenile breast hypertrophy) or together with breast sagging (mammary hypertrophy with ptosis). It is usually due to an exaggerated development of the mammary glands or adipose tissue and is frequently followed by tissue alteration (mammary dysplasia) and an inability to breastfeed. There are different types of hypertrophy. Type 1 corresponds to subjective augmentations. Type 2 includes physical symptoms such as backaches or spinal column alterations. In type 3, the symptoms are more severe and breast volume can reach disproportionate sizes, going over 1000gr (Gigantomasty).

These are relative classifications, since what in some countries might not be considered normal, in others it might be the beauty ideal. For example, in Western Europe correct breast volume would range from 200cc-300cc, whereas in the USA it goes from 400cc-500cc and in central European countries sizes from 500cc-700cc are considered to be normal.

Finally, in order to define breast hypertrophy it is necessary to take the social characteristics into account along with and above all, the woman's biotype: weight, height, width of the thorax and bone-muscle structure.

Breasts that are too large can cause both physical problems and psychological alterations of different levels. A negative body self-image can even cause the person's denial of said body part, causing disorders in the field of relationships, and, above all, in the psychosexual field.