Plastic & Reconstructive Surgery
Chemical Peels (non-invasive)
Skin texture is the foundation for a youthful complexion. Grenada Plastic Surgery offers a variety of chemical peels which rejuvenate the skin by increasing its collagen and elastin proteins. Chemical peels also treat pigmentation problems which cause irregularities in the colouring of the skin, as well as wrinkles and acne. Talk to us to find out which chemical peel is right for your skin type.
Injectables (non-invasive): Dysport®, Botox®, & Fillers
Injectable Botulinum toxin (Botox®) helps reduce fine lines and wrinkles. Injectables help restore a youthful appearance and a smooth contour as a non-invasive surgery option. Common applications include the forehead, glabella (between the eyebrows), and crow’s feet (fine lines outside the eyes).
Fillers are incredibly popular to rejuvenate the face by adding lost volume that occurs with the aging process. We offer a variety of filler options depending on the results you want or problem area you’d like to address.
Common applications include lip fillers for added volume and mid-face fillers to reduce the skin crease between the nose and cheek (nasolabial fold).
Rhytidectomy, commonly known as a face lift, literally means to cut away wrinkles. The procedure is most effective by tightening or repositioning the SMAS (deep strength layer below skin) which restores a youthful look. Repositioning the SMAS is recommended for a successful and natural looking face lift, to avoid an over-tightened “plastic” result which may occur with a skin only tightening. By placing the incision in the hairline an inconspicuous scar remains, while the face appears more youthful with less visible signs of aging.
Fat Grafting for Facial Rejuvenation
A youthful look is defined by facial convexity (curving outwards) rather than concavity (curving or sagging inwards) which is determined by tissue volume. As the aging process occurs tissue volume initially deflates and eventually becomes ptotic (having a sagged appearance). Fillers are temporary solutions and repeat treatments are necessary to restore facial volume. Over time this is cost prohibitive.
We can offer facial fat grafting as a long-term solution. Facial fat grafting involves taking fat from the abdomen or thighs by liposuction. The fat is washed and placed into the face for volume restoration, resulting in boosted volume and a more youthful appearance.
Rhinoplasty (Nose Reshaping)
Rhinoplasty, often referred to as a nose job, is a common procedure to improve the appearance or proportion of the nose. It involves specific surgical techniques to expose and reshape the anatomical elements of the nose. This may involve removing a dorsal hump or augmenting the nasal dorsum depending on your present nasal structure. The nasal ala may be reduced, the nasal tip refined, and the nose may be straightened if crooked.
Meticulous technique is necessary to achieve superior and natural results as rhinoplasty is one of the most challenging operations - millimeters matter. Preoperatively, it’s important to discuss not only what results you want from a nose job but also any nasal airway breathing problems.
Facial Implants (Facial Augmentation)
Facial augmentation using implants is a permanent augmentation (amplification) of the bony foundation of the face. For men and women with a deficient chin the addition of a chin implant can remarkably change the overall facial balance and bring other facial features into harmony.
Other common areas of augmentation of the face that we can offer include jaw angle implants, total jaw line implant (customized implant for a refined jaw line), paranasal implants (augmentation of the bony foundation beside and below the nose), malar implants (cheek bone implants), and temporal implants. Implants can be provided as stock or custom designed for an exact anatomic fit.
Blepharoplasty (Eye-Lid Skin Removal)
We communicate with our eyes and drooping, wrinkled eyelids (periorbital aging) contributes to a tired and aged facial appearance. This is why blepharoplasty (removal of excess eye-lid skin) is the most common facial plastic surgery procedure. We can offer upper and/or lower eye-lid blepharoplasty which involves removing excess eye-lid skin and repositioning periorbital fat, resulting in a more youthful look.
The eyebrow in women should be above the orbital rim and in men at the orbital rim. Brow ptosis (sagging) gives the impression of an angry and tired appearance even when you are not angry and tired.
A brow lift involves raising the brow by creating an inconspicuous hair-line incision to restore a youthful rejuvenated appearance.
Otoplasty (Ear Reshaping)
Prominent ears affect approximately 5% of the population and can have a profound psychological impact at a young age. There are 3 basic components to the prominent ear which include conchal bowel excess, lack of an antihelical fold, and an increased auriculocephalic angle. At Grenada Plastic Surgery, we can offer surgical correction techniques to address all three of these abnormalities.
Aesthetic Skull Reshaping
Abnormal shapes of the skull are common and commonly tolerated. However, plastic surgery techniques can be applied in order to reshape the skull extracranially (not violating the skull bone).
Implant augmentation of the skull can be performed or bony prominences can be reduced such as brow bone reduction, resulting in a more uniform skull shape.
Luke Gutwein, MD
Plastic & Reconstructive Surgeon
St. Augustine's Medical Services
American Board of Surgery Certified
Professor of Anatomy
St. George's University
Grenada, West Indies
Breast Augmentation (Implant & Lipoaugmentation)
Breast augmentation using breast implants is the single most common plastic surgery operation. At Grenada Plastic Surgery, we work with the patient to select an implant volume that is the right choice for their body frame. Be aware that in choosing your breast implant volume you want to consult with your plastic surgeon to ensure your tissue is able to adequately support the volume, otherwise you are at increased risk of needing breast revision surgery down the road.
Breast lipoaugmentation (fat grafting) is a natural alternative to an implant which utilizes your own fat tissue from other areas of your body. The fat is harvested by liposuction, washed, and then placed into your breasts. Your body habitus determines how much fat is available to augment your breasts.
Mastopexy (Breast Lift)
The common process affecting the aging face and body is gravity. With time, the nipple areolar complex settles below inframammary fold known as breast ptosis or breast sagging. The grade of ptosis (I, II, or III) determines the extent of surgery to lift the breast and nipple areolar complex to or above the inframammary fold.
Multiparous breasts (having breast-fed more than one child) especially have a deflated appearance and may benefit not only from mastopexy but also augmentation. Combining the two procedures does slightly increase the risk of a complication, however, this is commonly performed with excellent outcomes.
Postoperative mastopexy result with contour and nipple position restoration
History of massive weight loss resulting in deflated breasts and severe ptosis (sagging).
Breast Reconstruction (Implant & Autologous)
Breast cancer affects 1 in 8 women and removing the normal breast along with the cancer-diseased breast is more common than ever before in order to nearly eliminate any return of breast cancer. Additionally, reconstructive surgery options have increased in the last 20 years to make breast reconstruction after mastectomy commonplace.
Grenada Plastic Surgery can offer implant based reconstruction using a breast implant to recreate a breast or autologous reconstruction, using your own tissue (usually abdomen, back, or thigh) to recreate a breast.
Preoperative bilateral breast defects Postoperative Breast Reduction result
Also referred to as reduction mammaplasty, breast reduction is the 5th most common plastic surgery procedure performed. It also has one of the highest patient satisfaction scores. Bra strap grooving, neck pain, back pain, rashes, and excoriations are all common in patients seeking breast reduction.
An extensive understanding of breast anatomy is required in order to reduce tissue volume while preserving the blood supply to the nipple areolar complex.
Postoperative breast reduction result. The breast size is reduced while restoring an appropriate contour. The nipple areolar complex size is decreased and lifted for a youthful & aesthetic result.
Breast revision surgery refers to an operation that revises a previous breast procedure such as a mastopexy, augmentation, or reconstruction. If implants were placed months or years prior without the tissue support, implants may “bottom out” and need revision. Implants are not guaranteed for life and may rupture. Should this occur an operation to remove and replace the implant is performed.
Correction of Inverted Nipples & Nipple Reduction
An abnormal nipple appearance may have psychosexual implications and correction with plastic surgery is possible. The nipple may enlarge after breast-feeding or when the nipple lies below the plane of the areola it has retracted or inverted. If this is the only component of the procedure, then we can offer the procedure under local anesthesia.
Nipple reduction for a natural and aesthetic appearance
Treatment of Gynecomastia
Gynecomastia (enlargement of male breasts) in a young male can have a devastating impact on their emotional and social development. Hormonally induced changes in the breast bud leading to a transient enlargement affects 65% of adolescent boys. When this fails to regress or occurs in excess, gynecomastia results. Treatment depends on the extent of the deformity and may be as simple as liposuction.
Abdominoplasty (Tummy Tuck)
Multiparous women (having given birth to and breast-fed more than one child) or weight loss patients can radically change their body contour by removing excess skin. Additionally, pregnancy stretches the rectus abdominus muscles laterally resulting in diastasis recti (separation of the rectus muscles). An abdominoplasty or tummy tuck realigns the rectus muscles restoring proper biomechanics of the abdominal wall while also removing excess skin and fat for contour restoration with the scar hidden beneath the undergarment.
Brachioplasty (Arm Reshaping)
Contouring of the arm can be achieved by removal and redistribution of tissues in the arm with the goal of leaving as inconspicuous a scar as possible. Depending on your age, body habitus and skin elasticity, your potential options include liposuction, surgical excision of redundant tissue or both.
With weight gain, fat is distributed throughout our bodies in a proportional manner. However, with weight loss the same is not true! This translates to stubborn areas in the body that persist, no matter what we do in the gym. Liposuction is the 4th most common plastic surgery procedure for this reason. Although liposuction may appear simple, contour deformity is the number one complication of the procedure and an important understanding of the different fat layers throughout the body is essential to avoid this. For instance, too much liposuction in one area or liposuction too close to the skin will lead to a contour deformity. Additionally, there are classically 5 areas to avoid in liposuction to minimize contour deformities known as “zones of adherence”: lateral gluteal depression, gluteal crease, distal posterior thigh, mid medial thigh, and the inferolateral iliotibial tract.
As in other areas of the body (i.e. face & breast) gravity can also produce a ptotic (sagging) deflated buttock. Gluteal reshaping can be achieved by one or all three of the following depending on your body habitus:
1. Brazilian butt lift (fat grafting to increase volume)
2. Excess skin excision (to correct ptosis) providing a buttock lift
3. Implant augmentation – using buttock implants to increase volume when fat supply for fat grafting is limited).
Thighplasty (Thigh Reshaping)
Weight loss and aging result in skin laxity of the inner and outer thighs which can be corrected with skin excision with or without liposuction. The scar is hidden on the inner thigh and inguinal crease below the undergarment. Restoring contour to a deflated and ptotic (sagging) thigh is a rejuvenating experience.
If you are seeking to augment certain areas of your body to either obtain symmetry or simply a more defined look, body implants can help you attain this. Common body implants include pectoral implants (chest implants) and calf implants. It is important that the implant is placed under the muscular fascia which is more technically challenging than placing them in the fat layer directly below the skin which is a common error in judgement. Placement below the muscular fascia helps prevent implant migration and extrusion for optimal long-term results. Incisions are kept as small as possible away from the resting site of the implant for an inconspicuous scar.
Whether your scar is from accidental trauma that healed with or without stitches or a scar from a previous surgery, they can be revised for an improved appearance. The wound healing phase of collagen remodeling extends beyond 6 months therefore it is important that the scar is not revised too soon. Specific principles of plastic surgery instruct closure of the dermal layer of the skin for a multi-layered closure. This translates to less tension on the healing wound resulting in a less visible scar.
Skin Lesion/Cancer Biopsy, Excision, & Reconstruction
Basal Cell & Squamous Cell Carcinoma
There is more skin cancer than all other cancers combined. It is important to have a skin lesion that crusts or fails to go away inspected by your doctor. A biopsy could be recommended. Nonmelanoma (basal cell & squamous cell) skin cancers can be aggressive in nature and invade nearby structures and squamous cell carcinoma can spread to nearby lymph nodes and eventually other organ systems. If you need a skin cancer removed, consider closely who is doing it. Closure of these wounds is an expertise of plastic surgery. Many other surgeons can simply remove a skin lesion from your back with acceptable results but you want your plastic surgeon to remove it from your ear, lip, hand, or eyelid—or any area of the body that has high aesthetic and/or functional value.
Defect of skin after resection of skin cancer
Malignant melanoma is the most lethal skin cancer. If you notice a new mole or a changing mole have it checked immediately. We often associate melanoma with people over 50 years of age, however, it can afflict people much younger and be a devastating disease for them and their family. The most crucial understanding of a melanoma is the depth of invasion reported on biopsy. The surgical plan is formulated around this invasion depth because it tells the surgeon how much margin of normal skin to remove with the melanoma. Additionally, the invasion depth tells if a lymph node in the area should be sampled at the time of melanoma excision.
Great toe melanoma
Tracking of lymph node in groin for biopsy (to see if melanoma is in groin lymph node). Blue dye was injected at the site of the melanoma tumor and the dye collects in lymph nodes so that they can be identified during surgery.
Location of groin lymph node; note preservation of adjacent anatomical structures such as blood vessels and nerves
Tissue is temporarily stained blue because that is where blue dye was injected for groin lymph node identification
Carpal & Cubital Tunnel Release
Our hands are how we interact with the world. Having a deficit of your hand can impact your quality of life and your efficiency/ability to work. Carpal tunnel syndrome is a common diagnosis and is caused by compression of the median nerve in the carpal tunnel. After attempting conservative measures such as wrist splints and possibly a steroid injection, the definitive treatment is releasing the transverse carpal ligament at the wrist which allows the median nerve to receive the blood supply needed to function appropriately. Patients experience relief of symptoms quickly. Talk to your doctor if you have difficulty picking up coins, dropping items, or experience tingling in your thumb, index, and middle fingers. If not corrected, the condition may become irreversible and you will have a permanent hand disability despite carpal tunnel release.
Cubital tunnel syndrome is a similar disease process as carpal tunnel syndrome with the symptoms experienced in the small (pinky) finger and with time muscles within the hand can atrophy (waste away). The cubital tunnel is located at the elbow and instead of the median nerve being compressed it is the ulnar nerve (funny bone) being compressed. Treatment is similar in that anatomical structures surrounding the ulnar nerve are released at the elbow. You might have symptoms exacerbated awakening you from sleep or while talking on the phone with your elbow bent holding the phone to your ear. If these symptoms are worsening or affecting your quality of life, talk to your doctor as you might find relief with a cubital tunnel release.
Trigger Finger Release
A trigger finger is present when you attempt to straighten your finger and it locks or catches before straightening. Although conservative measures are attempted first, the definitive treatment is to release the A1 pulley. The A1 pulley is a covering of the tendon that keeps the tendon close to the bone which increases the biomechanical advantage of tendon excursion allowing you to bring your fingertip into your palm for pinch or grip strength. The trigger is caused by a nodule of inflammation located on the tendon that “catches” on the A1 pulley covering as the nodule is trying to pass underneath the A1 pulley. By releasing the A1 pulley, the tendon can now glide freely. Other pulleys exist (A2, A3, A4) to keep the tendon close to the bone, therefore, there is no negative consequence by releasing the the A1 pulley.
This disease is rare and commonly afflicts men of Northern European decent. Symptoms start with pits developing in the palm and progressively the small (pinky) and ring fingers contract into the palm disabling hand function. No cure exists for the disease however surgery may improve hand function.
Thumb Basal Joint Arthritis
Basal joint arthritis is a common arthritis in the hand and impacts function of the thumb. The thumb accounts for 50% of hand function! Thus, when the base of your thumb hurts it’s hard to do work and everyday activities. The severity of basal joint arthritis is graded by an x-ray which guides surgical planning. Conservative treatment with splinting and steroid injection is usually attempted first. Definitive treatment involves removal of the trapezium (bone in the wrist which the thumb rests on) and stabilizing the thumb. By removing the trapezium, symptoms are relieved because of the loss of bone on bone contact.
Tendonitis & Ganglion Cysts
Tendonitis in the wrist is common and includes conditions such as DeQuervain’s tenosynovitis and intersection syndrome. Both conditions involve inflammatory conditions of tendons that are treated by release from their synovial sheaths in which they travel. Surgical management is considered when conservative measures fail. Symptoms are present on the thumb side of your wrist and are primarily pain and soreness when attempting to do everyday activities.
A ganglion cyst is a very common fluid-filled sac at the wrist (other locations do also exist). They often grow and fluctuate in size and occur around joints and tendons. Aspiration or removal of fluid by needle will only be effective temporarily and delay the definitive treatment which is cyst excision.
Cleft Lip & Palate
The most common facial birth defect in the world is the cleft lip with or without a cleft palate. Cleft repair requires the surgeon to have a keen aesthetic sense armed with the knowledge of extensive oral & facial anatomy to restore both form and function.
Immediately before cleft lip repair. Cleft palate repair will take place approximately a year later (must be performed before speech development).
1 week postoperatively. Scar will continue to mature (redness and size will decrease). Rhinoplasty is an option when the child is a teenager.
Congenital Nevus Excision & Reconstruction
Congenital nevi are present at birth and grow proportionately as your child grows. It results from the benign (noncancerous) collection of melanocytes (the pigmented skin cells). Not all congenital nevi need to be removed, however, if of sufficient size there is a real risk of transformation into melanoma, albeit extremely low. Consult with your doctor to see if a congenital nevus needs to be removed. If of substantial size, reconstructive principles can be utilized such as tissue expansion (balloon expansion) to recruit enough nearby tissue for wound closure after excision.
Vascular Malformation (Evaluation & Treatment)
Childhood tumors (or growths) are commonly benign (noncancerous) and the most common childhood tumor is the infantile hemangioma (or strawberry mark). An infantile hemangioma is a collection of blood vessels that will go away with the passage of time. The vast majority need no intervention, however, when these growths compromise vision (location around the eye), breathing (location around the airway), hand function, ulcerate, or bleed a medical or surgical intervention may be needed.
2017 © Grenada Plastic Surgery, All rights reserved.