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This is the personal website of dr. Teddy, a surgeon specializing in the field of plastic surgery who resides in Indonesia. Please feel free to browse, leave a comment, or get in touch through the provided contact information here.

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Smart Tips for Smart You

As you know now, aesthetic plastic surgery is a series of surgical procedure aimed at improving physical image, be it facial shape or even whole body shape. It is a medical procedure done by a board-certified plastic surgeon.

To help you make a decision on getting an aesthetic plastic surgery procedure, there are 7 essential tips you can follow:

1.  You know what you want

The first and foremost is that you understand yourself.

  • It is not uncommon to find a beautiful and charming woman who views a fine part of her body as unattractive and needs to be refined. In this case, such person possesses a barrier that prevents her to accept her image as it is. Hence, the issue that needs modifying is her own mindset. As an old proverb said, get rid of those old wineskins!
  • In a different circumstance, a fine-looking person can experience a flaw in understanding him/herself due to others’ judgment. In this case, one needs to sift others’ opinions on one’s physical appearance, as they may not always be objective. They might be telling lies about you.
  • As being said above, inability to accept one’s conditions can originate from oneself and others around him/her. Others’ opinions can be a booster to loathe oneself even further. Therefore, break out of your self-imposed prison, and build a positive image in and around you!
  • If you are certain that you do not have any problem as mentioned above, you should ensure that your choice to undergo the plastic surgery procedure is aimed for your own benefit and happiness; not for others including your spouse. As you know, in most surgeries there is no way to go back. It is you who will have to endure any discomfort, make time for the procedure and the recovery period that follows, and prepare yourself for any consequences regarding the procedure. If you can make yourself happy with the change, you can ultimately affect your spouse and others around you to be happy for you.

 2.  Do your own research

The increasing need for a gorgeous and stunning look in the era of globalization has tempted the growth of many medical service providers who are not competent, even those not from medical society. They often advertise so-called “aesthetic procedures” or “cosmetic procedures” which they claim can transform a person to be more beautiful in just a short period. They often mention cosmetic products and “state-of-the-art” equipments. They also include an appealing price and money-back guarantee. It is no wonder that many have fallen victim to those unprofessional service providers.

One thing that you should bear in mind is that layman people generally have a more limited knowledge compared to medical service providers. A dilemma which may occur is that you often don’t know whether or not a “doctor” whom you face is truly a competent plastic surgeon who has been formally trained and has the legal authority to practice medical procedures. Dr. Calvin's Medical Clinic provides regenerative medicine and stem cell therapy. Sometimes it is difficult to differentiate a plastic surgeon from “aesthetic specialist/practitioner”, “aesthetic medicine doctor”, “anti-aging specialist”, “laser specialist doctor”, etc. Make sure that you choose the right doctor for you!

If you are wondering how such predicament can occur, in fact similar situations also occur in many other fields of profession. The main problem is the matter of regulation. The similar predicament happens in advanced countries such as United States of America, Japan, European, and especially Asian countries.

To avoid error in choosing a provider, you should carry out a careful research on plastic surgery service providers. There are a number of sources that can help you note board certified plastic surgeons, such as magazines, hospital information, internet search engine, and official websites of local and international plastic surgeon associations. Theses websites are, for example, www.perapisurgeon.org for information on Indonesian plastic surgeons, www.surgery.org, www.isaps.org, www.osaps.org, or www.plasticsurgery.org for international associations for plastic surgeons, and many more.

 3.  Get support from your close relatives

The need to undergo an elective surgery is a decision that a grown up person can make for him/herself. However, this is not an instant procedure without its own consequences. You will go through some degree of pain or discomfort, temporary hospitalization and a break from your daily occupation, and the process of recovery. A surgery procedure may be accompanied by complications, of which you should be aware before. All those issues will be easier to deal with when you have support from your spouse, parents, children, or friends.

4.  Visit your best plastic surgeon

Before making up your mind on your choice of plastic surgeon, you should confirm his/her certification and license. This way, you will be under the care of an eligible and board-certified surgeon. For those of you who choose to undergo the procedure in Indonesia, make sure that your surgeon is a member of InaPRAS (Indonesian Association of Plastic, Reconstructive, and Aesthetic Surgery), which is the only official association of plastic surgeons in the country.

Another factor you should take into account is the accessibility of your surgeon. Your surgeon should be easily accessible through clinics, hospitals, or websites. This is also important to accommodate easier postoperative consultations.

Another matter you may want to consider is whether to get a second opinion. A rushed planning from only a single consultation may lead to an immature decision. To achieve a firm decision, you should make time to get a second consultation, or make a visit to another equally qualified surgeon should you need one.

5.  Do your meticulous consultation

Consultation session is the moment to ensure yourself that you are in a good hand. You have the right to ask questions and receive a thorough explanation from your doctor. Before you decide to undergo the surgery, you should understand every aspect regarding necessary physical evaluation and additional lab workups, steps of the procedure, type of anesthesia utilized, postoperative care, and possible complications.

Language should not be a setback for you to understand the procedure that you will go through. Explanation can be done with the help of sketches, animation, or pre and postoperative photos.

6.  Organize your budget

A scrupulous financial planning is needed to avoid the temptation of “special offers” presented by beauty centers. If needed, have a discussion with your family before deciding to have the surgery.

Aesthetic plastic surgery is still considered a luxurious choice for most people, a tertiary necessity compared to more pressing matters such as health and education. Most medical insurance companies won’t fund this procedure in their service. Delaying the procedure is a wise decision should you have more pressing financial matters.

7.  No hurry!

Planning for the surgery should be done carefully, and not in a rush. You will be asked to provide some time for an optimal postoperative recovery period. If you insist to have the surgery in a limited period, you will make it difficult for yourself. Your postoperative care may be inadequate. Furthermore, complications that might occur may not receive a proper treatment. Therefore, it is essential to provide enough time so that the whole procedure can be done optimally.

(© Teddy O.H. Prasetyono, 2012)

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Microvascular Reconstruction in Fingertip Injuries

Although it is seldomly fatal, fingertip injury has the potential of causing long term disability. In performing fingertip reconstruction, several priorities should be bear in mind: restoration of skin cover to protect underlying bone, tendon, and nerve structure; maximize sensibility and nullify pain; preserve the length of the affected digit; and minimize cosmetic defect. In the effort to give a “normal” shape of the digit, microvascular surgery holds an important role. As you may be aware, microvascular surgery is a surgical technique where the surgeon performs the techniques under magnification aided with a surgical microscope to connect small vessels and nerves.

The level of fingertip injury determines whether a replantation can be performed. An amputation injury at the level of proximal nail plate can be managed by replantation. However, replantation is more difficult when the injury is located more distally or only involves volar skin loss. Despite the difficulty in microsurgical reconnection of distal vessels due to their size, the functional results are often superior to more proximal level of replantations.

Replantation by microsurgery is considered an important technique compared to classic alternative techniques. This is due to more displeasing aesthetic results on both the site of injury and the donor area, paresthesia, joint contracture, and the risk of necrosis associated with classic treatments. Replantation means that the surgical procedure is aimed to reconnect the totally amputated body part, including finger tip amputation.

In the event where the pulp of a finger is lost and gives a technically difficult situation, the patient may have an option to get a reconstructive surgery to get the contoured finger pulp back. A small area of the great toe side pulp can be a good donor site to reconstruct finger pulp, leaving minor scar and no functional impairment in the toe. That small pulp tissue is then transferred to the finger by microsurgical technique where the vessels (artery and vein) and the nerve are connected to their counterparts in the finger. The finger gets its normal and natural look and function.

Top left: A 34 year-old male with the skin and soft tissue on the palmar side of the ring finger crushed. Top rigt: A free pulp tissue flap is taken from the great toe. Bottom left: 1 week after the pulp tissue is transferred to the injured ring finger. Bottom right: 4 month after surgery. (with permission from the Journal of Medical Sciences)

Top left: A 34 year-old male with the skin and soft tissue on the palmar side of the ring finger crushed. Top rigt: A free pulp tissue flap is taken from the great toe. Bottom left: 1 week after the pulp tissue is transferred to the injured ring finger. Bottom right: 4 month after surgery. (with permission from the Journal of Medical Sciences)

More information on fingertip injury is available on this article.

 

Reference:
Seswandhana R, Prasetyono TOH, Sukasah C.  Microvascular reconstruction for finger tip injuries: case series. J Med Sci Volume 43, No. 2, June 2011:145-149.

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Wound Healing

One would consider his/her skin to be flawless when it is smooth without any unsightly scar. A scar not only impairs the aesthetic appearance of the skin, but also has the potential to hinder functional movement. The formation of a scar, be it a fine inconspicuous scar or an abnormal scar, depends on the process of wound healing.

Wound healing is one the most complex processes of human physiology. A wound is generally defined as a raw surface on the body surface due to loss of skin. When a disruption happens on the epidermis (outer) layer of the skin, adjacent cells will migrate and proliferate, and the wound will heal naturally without the need of any special treatment. This results in a relatively inconspicuous scar. The more superficial the wound, the more inconspicuous the resulting scar.

A wound that goes deeper to the dermis (inner) layer, on the other hand, will need more effort and time to heal, depending on the depth and extent of injury. Epithelialization comes from the skin appendages i.e. hair follicles, sweat glands, and sebaceous glands.

Wound healing happens in 3 phases, all of which are overlapping rather than separate to each other:

  • Inflammatory phase, which aims to stop any bleeding, remove dead tissue, and prevent infection. This phase starts immediately at the onset of injury and lasts until 4-6 days.
  • Proliferative phase, where the formation of new vascular and skin tissue starts. This phase occurs during the second-third week. Most people consider a wound is “healed” when the open skin is closed by new epidermis. This is not true. What you see covering the previously “naked” wound is actually an immature wound. It is generally accompanied by several symptoms, such as redness, itch, pain, and rigid skin.
  • A wound is considered healed after it has gone through the maturation phase, which is the final and longest phase. It can last for as long as 6 months-2 years from the onset of injury. A mature scar is characterized by pale color, lack of pain and itch, soft, and flexible. In this final phase, balancing between collagen deposition and degradation takes place. A deficient collagen deposition or synthesis will result in a scar which lacks tensile strength or an atrophic scar, while an impaired collagen degradation may result in an abnormal or pathological scar in the form of hypertrophic scar or keloid.

The process of wound healing depends on several local and systemic factors.  The risk of abnormal scar formation can be minimized by creating an ideal local condition for a healing wound. The first is that all tissue involved must be viable. Dead tissue must be removed extensively and thoroughly during debridement (the effort to remove dead/damaged/infected tissue). Foreign bodies cause the wound to be unable to contract, grow new blood vessels, and epithelialize completely. Therefore they must be removed during wound cleansing. Contamination/infection also impairs wound healing, so it must be prevented, or managed adequately if it has already occured. Systemic factors that may affect wound healing are diabetes, smoking, hypothyroidism, aging, nutrition, medication (including chemotherapy), specific organ failure, and radiation.

The final appearance of a scar depends on numerous factors: the adequacy of wound care, sufficiency of skin moisture, wound site, age of the patient, the surgeon’s skill (should the patient need a surgeon’s expertise), the duration of wound healing, and genetic factor. In the case where an abnormal scar occurs, a variety of treatment options can be undertaken, such as surgery, silicone gel sheeting or covering, corticosteroid injection, radiation, compression garments, or a combination among them.

As the proverb says, to prevent is better than to treat. To prevent the formation of an abnormal scar, it is suggested that a wound is taken care of by a doctor – preferably a plastic surgeon – earlier since the onset of the wound so that it can be evaluated and managed adequately. For example, after the usual 1 week follow-up to your obstetrician following a caesarian section, ideally you should visit a plastic surgeon for follow-up, in order to achieve the optimal appearance of your scar. This way, the wound can be observed and managed adequately and an appropriate care can be undertaken should an abnormal scar appears. The timing of follow-up is usually at 2-3 weeks, 1 month, 3 months, 6 months, and 1 year post surgery.

References:

  1. Prasetyono TOH. General concept of wound healing, revisited. Med J Indones 2009; 18: 206-14
  2. Anna LK. Agar luka tak meninggalkan bekas. Kompas 2012 Sept 21 [cited 2013 Jan 24]. Available from http://health.kompas.com/read/2012/09/21/18052051/Agar.Luka.Tak.Meninggalkan.Bekas
  3. Prasetyono TOH. Take care of your scar.
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