Plastic, reconstructive, and aesthetic surgery is a medical service that deals with both the improvement of a person’s appearance and the reconstruction of facial and body tissue defects caused by disease, trauma, or birth defects.

This department restores and improves the appearance of the treatment area as well as the function. Surgery can be performed anywhere in the anatomy except the central nervous system.
There are various surgeries performed in Reyap Hospital Istanbul plastic, reconstructive, and aesthetic surgery department.

Hand surgery
Hand surgery can improve your health if your hand is damaged in any way. Thus, diseases that cause pain and impair the strength, function, and flexibility of your wrist and fingers can be treated. Surgery aims to restore the function of fingers and hands injured by trauma near-normal or correct abnormalities present at birth.

Some of the diseases and conditions treated by hand surgery in Reyap Hospital are;
Soft tissue infection of the hand
Nerve compression and injuries (ulnar, median, and radial nerves)
Flexor and extensor tendon injuries
Late periods of nerve cuts that require tendon transfer
Amputations
Thumb repairs
Dupuytren’s contracture
Congenital hand anomalies such as syndactyly polydactyly
Sequelae (often contracture) due to burns
Breast reconstruction
Breast reconstruction performed in our hospital can serve 2 different purposes.

Breast reconstruction
Women who have had surgery as part of their breast cancer treatment may have had a mastectomy or lumpectomy. Breast reconstruction surgery may be preferred to recreate the shape and appearance of the breast. Different types of breast reconstruction are available for this. These options include implant, TRAM flap, free flap options, or a combination of these.

Tubular breast repair
A congenital abnormality that restricts the normal development of the breasts during puberty can lead to the misshapen development of the breasts. The common problems are not enough skin or fullness under the areola, a large, prominent, or protruding areola, downward-facing or drooping nipples, upward or downward-facing nipples, narrow breasts, and lower-facing breasts. The condition can affect one or both breasts and can be found in both men and women.

A treatment plan is created according to the problems that the person wants to fix.

Treatment of skin burn
Plastic surgery may be an option if you have a severe wound that restricts mobility, causes loss of sensation, or is a cosmetically unattractive burn. Burn treatment can be applied for all kinds of (scalding, flame, electrical, chemical) acute burns and sequelae.
If your wound is severe, an operation to remove dead tissue may be required before reconstructive surgery. Skin grafts, microsurgery, free flap procedure, and tissue expansion are among the most preferred operations in burn treatment.

Maxillofacial tumor, or trauma surgery
Maxillofacial trauma is any injury that affects the face or jaws. Facial trauma can occur with skin tears, burns, obstruction in the nasal cavity or sinuses, damage to the orbital sockets, broken jawbone, and missing or broken teeth.
The most common causes are sports injuries, accidents, penetrating injuries, and violence. Symptoms can include pain, swelling, bleeding, bruising, and numbness, while fractures in the facial bones can also cause difficulty breathing, speaking, or vision. Maxillofacial trauma can also include severe or life-threatening symptoms such as brain damage, airway obstruction, excessive bleeding, or shock.
Treatment of maxillofacial trauma varies depending on the type and severity of the injury. Treatment will include a careful and systematic evaluation of structures and systems, including a comprehensive physical examination and x-ray. In some cases, diagnosis and treatment should be delayed until the swelling has subsided or more severe injuries have resolved.

Maxillofacial trauma repair
Soft tissue repair
Repair with primary suture or flaps
Frontal sinus, orbit, zygoma, maxilla, nasal bone, and mandible fracture fixations

Tumor
Reconstruction of scalp, nose, lip, cheek, eyelid, and chin (mandible and maxilla), especially after basal and squamous cell cancer excision or due to trauma
Facial paralysis
Nerve repair, eyebrow, eyelid, cheek, and lip treatments after facial paralysis
Cleft lip and palate surgery
Cleft lip and palate are conditions that can be treated.
It is a disease that is caused by the inability of the lips and/or palate to join in the midline for various reasons in the first weeks of pregnancy, in which the family and cleft practitioners act together for many years. Therefore, successful results can be observed with an appropriate approach.

Tumor surgery
It is the process of removing benign or malignant tumors that occur on the skin and closing the defect with primary repair, skin grafts, or flaps. The most common benign tumors treated with tumor surgery are nevi and cysts, while the most common malignant tumors are basal cell, squamous cancer cells, and malignant melanoma.

Lymphedema surgery
Lymphedema is a condition characterized by painful swelling in the extremities (arms and/or legs). Swelling occurs when lymph nodes no longer facilitate proper drainage of lymph fluid from one area of ​​the body.
Surgical treatment options for lymphedema include lymphatic bypass procedures, where lymphatic vessels are connected and drained to the body’s venous system, and vascularized lymph node transfer, where lymph nodes are collected from part of the body and surgically implanted into the affected area.
After diagnosing lymphedema, nonsurgical treatment is initiated as soon as possible, including limb lifting, skincare, elastic stockings, physical therapy, and pneumatic compression devices. These treatments, while beneficial, can be burdensome for patients and require a lifelong commitment. When nonsurgical treatment is insufficient to manage symptoms, lymphedema surgery may be appropriate.

Acute or chronic wound healing
Closure of newly formed wounds or chronic wounds (secondary healing, skin graft, tissue) caused by various factors (aging, diabetes, venous or arterial insufficiency, obesity, radiodermatitis, etc.) on the whole body surface (from the scalp to the toenail expansion – expander or flap – microsurgical method or pedicle) is possible. There are many methods to treat this.

Chest wall repair
After bypass, the thoracotomy line becomes chronic, radiotherapy wounds caused by a tumor, trauma, and breast cancer, and repair of meningomyelocele can be performed.

Abdominal wall repair
Trauma, infection or incisional hernia, and secondary open wound repair in the anterior abdominal wall, post-VAC skin graft, or regional flaps repair can be performed.

Lower extremity and foot wound closure
Especially, post-diabetes, non-atonic or post-traumatic wounds are covered with VAC + graft or flap (with microsurgery or regional flaps).

Perineal repair
Vaginal defect repair that develops after tumor surgery, and other skin defect repairs of the perineum area, especially after infection, are possible.

Treatment for pressure sore
Atonic wounds that occur in sacral, trochanteric, and ischial regions due to compression are repaired with dressings or local flaps.

Plastic surgery
The main purpose of plastic surgery is to make the patient satisfied. During the evaluation of the patient, the surgeon can often look at the potential treatment plan as a plan that leads to the patient’s rejuvenation, younger and refreshment, or gives the patient something they did not have before. A minority of any plastic surgery practice will also deal with the correction of acquired facial deformities such as trauma-related or post-pathology treatment. Plastic surgery can cover many procedures and these respond to different problems.

The procedures we apply in the plastic surgery department of our hospital are;

Rhinoplasty
Facelift
Lower-upper blepharoplasty
Mid facelift
Breast enlargement – implant and/or fat injection
Breast reduction
Breast lift (mastopexy)
Prominent ear repair
Liposuction
Tummy Tuck (with liposuction or alone)
Gynecomastia (with liposuction, rarely surgical excision)
Brachioplasty (Arm stretching)
Thigh Lift
Gluteal and leg prosthesis
Botox – Filler
Penis surgery
Penis surgery may be preferred for cosmetic purposes such as enlargement and curvature correction or the treatment of diseases such as hypospadias. Many procedures can fulfill these goals.

Peyronie’s disease
Peyronie’s disease is a disease caused by the connective tissue of the plaque under the skin of the penis. As the plaque develops, it pulls on surrounding tissues and often causes the penis to curl or bend during an erection. The curvature of the penis can make erections painful and make sexual intercourse unpleasant, difficult, or impossible.
There are several types of surgery to treat Peyronie’s disease. The doctor examines the plaque on the penis and decides the best type of surgery. The exact location and size of the plaque are learned through ultrasound. Graf, plication, and implantation can be performed for treatment.

Hypospadias
Hypospadias is a congenital disease in which the opening of the urethra is on the lower part of the penis rather than at the tip. The urethra is the tube that takes urine from the bladder and throws it out of the body.
Hypospadias is a common condition and surgery usually restores the normal appearance of the child’s penis. With successful treatment of hypospadias, most men can have normal urination and reproduction.
Most types of hypospadias can be corrected with a single surgery performed on an outpatient basis. Some types require more than one surgery to correct the defect. When the urethral opening is close to the base of the penis, the surgeon may need to use tissue grafts from the foreskin to reconstruct the urinary tract in the proper position and correct hypospadias.

Penis enlargement
Penis enlargement surgery is a procedure that aims to increase the length or circumference of the penis. Surgery may involve placing silicone implants, transferring fat cells, or using skin grafts to increase the size of the penis. Other approaches can take the form of cosmetic surgery to give a longer penis appearance.
In the case of the disease called micropenis (the penis is shorter than 7.5 centimeters), surgery is optional. A penis that works well enough for both sexual intercourse and urination does not require surgery. However, this process can be performed optionally.
Approximately 1- 1.5 cm length is obtained with liposuction, suspension ligament release, and Z-plasty.

Hair and beard transplantation
Hair and beard transplantation is a very popular procedure in recent years. It is more likely to meet someone who has just been transplanted during the day. Our country has become one of the important health tourism bases in this field.

Hair transplant
The forehead hairline forms the upper part of the frame. As the forehead line goes back, the upper part of the frame disappears and a relatively aged appearance emerges.

The most important factor determining hair loss is genetic predisposition. Although environmental factors contribute, the main reason for hair loss is the sensitivity of androgen receptors to this hormone. Sensitivity to androgen or testosterone is especially in the front and top of the scalp. Although there is no tendency to shedding, decreasing the hair volume in some areas can be considered normal because of aging. The decrease in volume considered normal varies according to age, for example, 30% shedding is normal in the 30s. If the decrease is above this rate, it is considered abnormal. It is also normal to shed 100 hairs a day. However, new ones come out instead of spilled ones. The hair cycle in the scalp takes an average of 2 years and consists of anagen, telogen, and catagen phases. Each hair is at a different time of the cycle. 85% of the hairs on the scalp are anagen, that is, in the active growth phase. 15% is in the resting or telogen phase, while a very small part is in the catagen or spill phase. The regeneration of hair follicles is thanks to the abundant stem cells in this area.
It is the structure of the hair that determines the hairstyle. That determines whether the hair is curly or straight, black or light, thin or thick. The features that increase the quality of hair transplantation are that the hair is black, thick, and straight.
Hair volume means follicular unit per square centimeter and the number in the occipital area, where the grafts are provided, varies between 50 and 160. The ideal rate for planting is 25-35 follicles per square centimeter. It is technically difficult to obtain a volume above 25 and the success of graft retention may be reduced.
The most commonly used transplant methods are:

FUT (follicular unit transplantation)
FUE (follicular unit extraction)
In FUT, the occipital region, that is, the strip above the neck is removed and divided into grafts on the table. Transverse leaves a scar extending between two ears and is rarely preferred in our country.

In the FUE method, grafts are taken as units with a punch. In this method, although the scar is wider, it is easily hidden with the remaining hairs as it is distributed over the area. This method is mainly used in our country, and we prefer this method in our clinic.
The transplantation method is the same in both methods.
It is possible to use an average of 3000 micrografts (skin part with an average of 1-3 hairs) at a time. Although this number can be increased to higher numbers, the total procedure time is prolonged and patient tolerance may decrease. If there are enough resources, it will be more appropriate to apply for a second session the next day.

FUE procedure can also be performed on graying hair. First of all, the hair is dyed with black paint just before the procedure and waited for a while. Turning the hair black prevents the intake and loss during this time.
In the FUE method, a pen-shaped punch tool that is manipulated by hand or low-speed micromotors with a punch (0.7-1 mm diameter) can be used. Both tools have advantages and disadvantages. We prefer to get grafts with micromotor.
Before transplantation, the composition of the scalp is extracted by a hair examination. Answers to these questions determine the hair volume level;

What is the level of hair loss according to the Hamilton-Norwood classification?

What is the hair condition in the treatment area?
How are the hair volume, thickness, and color of the donor area (the occipital region between the two ears)?
Ludwig classification is used for women and the shedding pattern is different than that of men. Blood thinners such as aspirin and vitamin E are stopped one week before the operation and it is recommended not to drink alcohol during this period. Otherwise, the bleeding that occurs during the procedure makes it difficult to get grafts.

The procedure begins with gentle sedation, lying face down on a specially designed table for hair transplantation, and applying local anesthesia to the recipient area. Graft removal is an average of 2 hours for 3000 grafts. This period may increase or decrease depending on the structure of the skin. The grafts taken are prepared for planting in Petri dishes and on ice batteries. When the intake is finished, the treated area is wrapped with gauze and the patient is rested for a while.

Local anesthesia is applied to the previously planned area in the head of the patient who is brought to the sitting position. Holes are drilled to place the graft with the slit or splitting technique, and micrografts are placed in these holes with special tools in a single, double triple as you go backward.
After the planting is completed, this area is not closed. Only the donor site is closed. After recommending painkillers, the patient is called for control and washed 3 days later. Plenty of creams are applied to the planting area and the crusts are expected to soften for half an hour and the cream is removed only with the pressure of the shower jet. This procedure is taught to the patient and asked to do it until the 10th day.
On the 10th day, the crusts around the grafts are completely poured. Following the early growth of 2-3 mm, that is, approximately 1 month after the procedure, the phases of the hair return to the resting (telogen) phase and begin to fall out. This shedding is normal. They start to grow again around the 3rd or 4th week and the hair takes its final shape around the 9th month. A new session is appropriate after this stage.

The donor site is left open after the 3rd day. As the hair grows, the hairs are covered and appear as if they were not removed. The hairs removed do not grow again. The process here is dilution and up to 60% dilution can be taken depending on the hair structure. Since the direction of the hair is downward, the effects of the intake disappear in a short time.
In severe hair loss (such as Hamilton 7), transplantation may not be suitable or may not meet the expectations. In such cases, alternative methods are recommended. Sometimes the recipient area may be insufficient for transplantation in terms of skin or hair features.
If excessive shedding occurs at an early age, it can be prevented by methods such as PRP and hair mesotherapy. However, the disadvantage of these methods is that the effect of the treatment is seen as long as it is applied. A few months after the treatment, the hair loss continues where it left off. Oral finasteride and locally administered minoxidil are the leading drugs used for this purpose. Mesotherapy can be applied to the scalp by making a mixture with B vitamin complexes and dexpanthenol ampoules.

Beard transplant
Satisfactory results can be obtained by applying hair transplantation for camouflage if a scar develops in the beard area for any reason such as burns or infection. Removing and stitching the scarred area leaves long and distinct scars. The beard is planted appropriately and according to the volume of the edge, hair provides excellent camouflage.
The beard transplant procedure is similar to the hair transplant. FUT or FUE is preferred for this treatment method. Both procedures take 2,000 to 5,000 or more hair follicle grafts from the back of the head, usually at the same level as your ears or slightly lower, and these are placed on the face. A graft is a transplanted hair follicle.
Regardless of the type of procedure performed, the hair follicles planted within 3 or 4 months should be set in place and grow. In 8 or 9 months, if you have a full, healthy beard you will know that beard transplantation is successful.
hile both FUE and FUT can produce natural-looking beards, beards transplanted with FUT tend to be fuller. This is because when a skin strip is removed, more follicles are usually collected. So if your goal is a thicker-looking beard, consider FUT.
Beard transplant failure is rare and usually depends on the fault of the person performing the procedure. Therefore, it is important to choose an experienced hair restoration surgeon.