Indications for surgical treatment in aesthetic dermatology

Here are some typical indications for surgical treatment in aesthetic dermatology and surgical procedures commonly used in given situations.

1. Filling out wrinkles and skin depressions, lip augmentation: semi-liquid injectable fillers or permanent implants inserted through the skin incision. Most commonly used materials include various marketed formulations and implants derived from the patient's own tissue (adipose tissue, plasma).

2. Skin resurfacing (reduction of elastosis, hyperpigmentation, fine lines): various ablative skin procedures (chemical peels, dermabrasion, microdermabrasion, CO2 lasers, Erbium:YAG) and non-ablative procedures (laser of 585nm and 1450nm wavelength accompanied by intensive cooling of the skin surface, and intense pulsed light-IPL)

3. Correction of expression wrinkles: induction of temporary facial muscles paresis by botulinum toxin.

4. Correction of scars (post-acne, post-traumatic): dermabrasion, reshaping (Z-, W-, M-plasty), CO2 laser resurfacing, laser reduction of the number of blood vessels in a vascularised scar, with e.g. a dye laser.

5. Tattoos removal: dermabrasion, salabrasion, lasers: puncture CO2 laser vaporization, selective pigment targeting with Q-switched lasers (Nd:YAG, 755nm, Ruby), surgical excision and closure of the defect.

6. Treatment of facial telangiectasia: needle electrocoagulation, vascular lasers.

7. Treatment of lower limb telangiectasia: obliteration - sclerotherapy, lasers, phlebectomy.

8. Removal of the unsightly birthmarks and other skin lesions: full-thickness excision (spindle-shaped or circular) with suturing, tangential excision, CO2 laser vaporization, cryosurgery, electroresection.

9. Excess hair removal – epilation: electrocoagulation, lasers - usually alexandrite, Nd:YAG, diode lasers and intense pulsed light.

10. Surgical hair restoration: hair transplants and scalp reduction procedures.

11. Treatment of keloids: preliminary injections of triamcinolone, tangential laser vaporization or shave, cryosurgery, postoperative injections of triamcinolone, pressotherapy, flavonoids (onion extracts), massage.

12. Vitiligo: surgical treatment consists of two components, i.e. creating a recipient site within a vitiliginous lesion and grafting tissue or its component containing melanocytes into that site. Recipient site is prepared by mechanical abrasion of the skin (dermabrasion), laserabrasion or by blister grafting technique, which involves raising a blisterby means of cryosurgery or vacuum. Subsequently, full-sized or fragmented (mechanically or enzymatically) split thickness skin grafts (optimum epidermal grafts) are placed on the recipient site. Graft fragments containing keratinocytes and melanocytes may be suspended in a variety of fluids, including tissue culture medium. The most biotechnologically advanced and specific for vitiligo treatment are epidermal cell cultures containing all epidermal cell components or cultures with the predominance of melanocytes. The latest advance in the treatment of vitiligo is laser treatment with the 308nm excimer laser.