First, scar plastic scar is the inevitable result of the human body to repair trauma, is a natural product of the tissue repair process, no scar is no repair. The mechanism of scar formation is not fully understood and may involve a wide range of biological factors and molecular biological mechanisms. Scarring is the result of excessive collagen secretion by fibroblasts in the body, part of which are myofibroblasts that contract resulting in contracture deformities. According to its etiology, the morphology of keloid scars can be divided into superficial keloid scars, hyperplastic keloid scars, depressed keloid scars, contracture keloid scars, atrophic keloid scars, keloid scars, etc., and the treatment options are not nearly the same. Treatment options for keloid scars: 1.Surgical excision: including direct excision and suture, scar release, Z and W reshaping, skin grafting, flap transfer and other methods. 2.Drug injection: intra-scar injection of drugs such as Depo-Provera, Coningkatone, etc., usually once every 3-4 weeks, 4-8 times as a course of treatment. 3.Oral medications: oral skin health tablets (cumecoside) and other scar softening and anti-itch medications. 4.Topical medication: such as skin health cream, Conrad, scar paste, scar enemy (silicone film), etc. 5.Compression therapy: elastic bandage, elastic sleeve, shaping tights, moldable brace, etc. 6.Grinding treatment: microdermabrasion, laser grinding, etc. There are more methods to choose for scar treatment, and multiple methods are usually used in combination to improve the efficacy. Note: Incorrect choice of treatment may be counterproductive, such as hyperplastic scarring and keloid scarring on the chest, surgery or grinding will make the scar even larger, and injection plus other treatments must be used. III. Cleft lip and palate surgery Early in embryonic development, well before the baby is born, the left and right sides of the lip and palate are generally fused together. However, in about one out of 800 newborns, they do not fully fuse, and those born with a cleft upper lip are called cleft lip and those with a cleft palate are called cleft palate. Because the lip or palate is separated at development, a baby may be born with a cleft lip, a cleft palate, or both. Timing of surgery: 3-6 months of age for unilateral cleft lip, 6-12 months of age for bilateral cleft lip, and 18 months of age for cleft palate. Precautions before and after surgery: 1. The child should be free of upper respiratory tract infections such as fever, cough and runny nose two weeks before surgery; 2. Train the child to eat by spoon or dropper before surgery, and not to let the child suck on a nipple or bottle or use a straw for liquid food after surgery; 3. Encourage the child to eat liquid food, drink more water and ensure adequate nutrition after surgery. Early after cleft palate surgery into the whole liquid food, forbidden to eat hot, hard or crumb food, 1-2 weeks after surgery can begin to enter the thin semi-liquid food, according to the recovery situation gradually increased, 6-8 weeks can begin to enter the ordinary food, but should still pay attention to avoid too hard food; 4, after surgery need to strengthen wound care, keep clean, cleft palate surgery need to maintain oral hygiene, avoid crying, avoid colds, fever and other adverse effects on wound healing. 5, children with cleft palate should not shout in the early postoperative period, do not use fingers to pick the nose and mouth, 2-3 months later you can start voice training; 6, in order to prevent scar growth, cleft lip repair after the application of medical advice to prevent scar growth measures. Fourth, abdominoplasty and fat aspiration abdominoplasty is a surgical method to remove excess skin and fat from the abdomen and tighten the loose muscles of the abdominal wall. The surgery can significantly improve the shape of the abdominal bulge, but at the same time will leave a scar in the lower abdomen. Abdominoplasty is suitable for those who have loose abdominal muscles and sagging skin and want to have a proportionate body shape. For people with excess abdominal fat but good skin elasticity, fat aspiration can achieve good results. If the sagging skin is mainly in the lower abdomen, while there is more fat in the upper abdomen and side waist, then fat aspiration can be performed at the same time as abdominoplasty. In addition to fat aspiration for the treatment of local fat accumulation, such as waist, abdomen, buttocks, thighs, upper arms and other parts of the body to improve the shape, fat aspiration can be used to treat male breast enlargement, early limb lymphedema, large subcutaneous lipomas and other diseases. Suitable for surgery: Healthy people who are generally under 50 years old, have no history of hypertension, diabetes, or heart disease, no coagulation disorders, and no long-term or ongoing use of anticoagulants, vasodilators, corticosteroids, and other drugs. For morbidly obese people, it is necessary to decide whether surgery can be performed after the original disease is cured or controlled. Postoperative precautions: 1, after surgery need to wear tight elastic shapewear; 2, abdominoplasty patients after surgery abdomen will remain more obvious scar, early scar will be congested, hyperplasia, generally need 9-12 months later, scar congestion will subside and gradually become flat; 3, fat suction surgery after the surgical site swelling, bruising is a normal phenomenon, generally within 3 months after surgery can subside. Some areas may have numbness, and it takes several weeks to recover the feeling; 4. Pay attention to the active and passive activities of the lower limbs to avoid the formation of deep vein thrombosis in the lower limbs. V. Facial wrinkle surgery Facial wrinkle surgery can make a big change in facial aging appearance, making your face and eyes more vibrant and youthful, the effect of surgery can generally be maintained for 5-10 years. Indications for surgery: There is no optimal age for wrinkle reduction surgery, but the age group of 40-69 is more suitable. Today, there are three generations of surgical techniques, namely the first generation of subcutaneous separation, the second generation of subcutaneous separation + superficial muscle and tendon system separation, and the third generation of subperiosteal wrinkle removal. There are also non-surgical wrinkle removal methods, including photorejuvenation wrinkle removal and drug injection wrinkle removal. Pre-operative preparation: The patient is prohibited from smoking for two weeks prior to surgery, and is prohibited from taking estrogen, aspirin, salvia and other drugs. Wash your hair with disinfectant before surgery and avoid using any cosmetics on the day of surgery. Cut the hair on both sides of the incision in the operation area before surgery, the width is about 2cm, and the hair on both sides of the hair cutting area is braided into pigtails. Wrinkle removal surgery subtype: (according to the part of surgery and separation depth) 1.Forehead wrinkle removal surgery: mainly used to treat forehead transverse lines, inter-brow wrinkles, nasal root transverse lines, sagging eyebrows, upper lid laxity. 2.Temporal wrinkle removal surgery: mainly used for the treatment of sagging eyebrows and crow’s feet. 3.Mid-facial wrinkle removal surgery: mainly used for the treatment of mid-facial soft tissue sagging, including nasolabial fold deepening, cheek and suborbital area pouch sagging, etc. 4.Facial and neck wrinkle removal surgery: mainly used to treat sagging and wrinkles of cheek and cheek, lower eyelid and neck, and to correct crow’s feet and deep nasolabial folds. 5.Full neck wrinkle removal surgery: It is a combined application of the forehead, temporal and facial wrinkle removal surgery mentioned above and completed in one time. Seven, skin expansion surgery The human skin is very limited. When a certain part of the skin is damaged to a certain extent, it cannot heal by itself, and even if it heals after treatment, it will leave a large scar or even deformity. In this case, only normal skin from other areas can be used for repair, and new scars will be left in the area where the skin was removed. In contrast, skin expansion provides “extra” tissue for repairing tissue defects, reconstructing organs, or prepping space for tissue filling or prosthesis placement by implanting expanders deep in the skin and gradually expanding the skin’s surface soft tissue. Since skin expansion makes full use of the limited skin resources, no donor area is destroyed, no new scar is added, and the color, texture, sensation and function of the repaired skin are identical to those of normal skin tissue, its therapeutic effect is far better than that of traditional skin implantation. Therefore, skin expansion has become one of the main techniques in plastic surgery at present. The application of skin dilation to treat skin scars or other deformities generally requires two surgeries and a 1-3 month dilation process. After the incision is healed, a certain amount of saline is injected into the expander periodically, so that the expander will gradually expand and the skin area on its surface will increase accordingly. The scar tissue is excised and the expanded skin is transferred in the form of a flap to the desired area to repair the skin defect. For large scars, multiple skin expansions can be performed to achieve the desired treatment effect if one expansion cannot remove the entire scar. At present, skin expansion has been widely used in the treatment of keloid scars on the head, neck, face, chest, trunk, and extremities, etc. It is also increasingly used in breast reconstruction, external ear reconstruction, and nose reconstruction, and has shown superior results. Eight, microsurgery microsurgery is a new milestone in the development of modern surgical techniques, it makes surgical techniques from the macroscopic field to expand the microscopic field, to surgery belongs to many professions have brought a leap, such as severed limbs (fingers) replantation and transplantation success, free skin flap transplantation, free muscle transplantation and anastomosis of blood vessels free bone grafting in the clinical are widely used. For plastic surgery, microsurgery has created a new era of plastic surgery tissue grafting defect repair, such as the use of thoracic and abdominal flaps to repair calf skin and subcutaneous tissue defects through a phase. Microsurgery techniques have greatly expanded the content and scope of plastic surgery tipped tissue grafts, such as the use of giant island latissimus dorsi muscle flap plus pectoralis major muscle flap or rectus abdominis muscle flap, external oblique abdominal muscle flap, internal oblique abdominal muscle flap and other tipped grafts to repair thoracoabdominal wall defects. Microsurgery extends the theory and practice of one-stage organ reconstruction in plastic surgery. Mainly including: repair and reconstruction of motor organ defects, currently more clinically applied is broken limb (finger) replantation and transplantation, toe transplantation for thumb reconstruction; repair and reconstruction of genitourinary organ defects, the application of forearm flap free transplantation for penile reconstruction, not only can complete the operation at once, and good shape and function. In addition, we can also use the inferior abdominal wall artery and paramedian flap with tip graft, the inferior abdominal flap with tip graft of the superficial abdominal wall and superficial iliac artery, and the anterolateral thigh flap with tip graft for penile reconstruction, all of which can be completed in one operation with good results. In women with vaginal defects or congenital absence of vagina or vaginal atresia, microsurgical flap transfer can be used to repair and reconstruct the vagina with good shape and function and no postoperative contracture sequelae. In the emergency immediate reconstruction of tissue and organ defects, the intervention of microsurgery will increasingly play a great role in achieving early defect repair and reconstruction, and successful vascular anastomosis is the key to successful microsurgical tissue transplantation and replantation. Nine, breast augmentation The normal breast shape is hemispherical, conical or disc-shaped, of which hemispherical breasts are the most aesthetic, full and elastic breasts are the charm of female health and beauty, physical beauty. How to have a smooth, round and beautiful three-dimensional curve? With the continuous development of technology and medical technology, breast augmentation is a safe and effective way to change the shape and size of breasts. It can make women have moving curves and restore their self-confidence. 1.The indications for breast augmentation: breast dysplasia or breast atrophy after pregnancy, mild sagging of breast. Pre-pubertal breast tissue lesions resulting in breast dysplasia. After mastectomy alone. Patients with thin body shape, flat chest, small breasts. Those with bilateral breast asymmetry. At present, breast augmentation mostly uses sealed silicone capsule implants, which feel realistic, are not easy to exude and can be removed intact. The size of the implant is generally determined by the patient’s height, body type and subjective requirements of the patient combined with the surgeon’s judgment. The breast needs to be fixed and shaped after breast augmentation, and breast massage should be started 10 days after surgery under the guidance of the surgeon. Avoid strenuous movement of the upper limbs as much as possible. Generally, the breast augmentation method adopts the axillary crease incision, the postoperative scar is small and the site is hidden, or the areola incision or the inframammary crease incision can be used. 2.Breast reconstruction Breast reconstruction timing selection: traumatic breast loss, congenital breast dysplasia breast loss should wait for the girl to be reconstructed at the developmental age; the timing of breast reconstruction after sex reassignment surgery depends on the physical and psychological preparation of the patient. Breast reconstruction after breast cancer surgery can be performed immediately, or second-stage breast reconstruction can be performed 3-6 months after the first surgery, i.e. after the completion of chemotherapy or radiotherapy. Currently, more patients are undergoing breast reconstruction after surgery for breast cancer. Due to environmental pollution and increasing social pressure, the trend of breast cancer becoming younger is becoming more and more obvious. Early detection and early surgery are the only options to eradicate breast cancer. The scar on the chest wall, flat chest wall, and clearly countable ribs through the skin after mastectomy have a great impact on the patients’ psychology, and most of them are reluctant to go out. Postoperative dressing is inconvenient, and the bra is not easily fixed and often moves on the chest wall. For such patients, breast reconstruction is undoubtedly an effective way to relieve patients’ psychological barriers. We have been carrying out this work for more than 10 years, and we found from the psychological changes of patients before and after reconstructive surgery that breast reconstruction is really beneficial for them to restore their self-confidence and reinvent themselves, and many patients even forget their experience of breast cancer. At present, most of the reconstructed breasts are made of latissimus dorsi flap, abdominal flap with tip or free flap, and implantation of prosthesis. This can greatly improve the quality of life of postoperative breast cancer patients. Body surface tumors and cosmetic surgery Body surface tumors refer to tumors originating from superficial soft tissues such as skin, skin adnexa and subcutaneous tissues. Common body surface tumors include: melanocytic nevus, benign melanocytic proliferation disease, hemangioma, neurofibroma and neurofibromatosis, lymphangioleioma, lipoma, skin cyst, and also malignant body surface tumors: basal cell carcinoma, squamous cell carcinoma, augmentation fibrosarcoma, malignant melanoma and so on. Pigmented nevi less than 2mm in diameter can be removed by laser treatment. Generally, body surface tumors are treated by surgical excision, and the excised tissues are routinely examined for pathology. For malignant tumors on the body surface, enlarged excision is required and then further coverage of the wound is considered. The treatment of benign body surface tumors in plastic surgery will be considered from both therapeutic effect and aesthetics, which will lead to good results for patients. The common facial cosmetic surgery includes blepharoplasty, eyebag revision, rhinoplasty, chin augmentation, lip reshaping, dimple surgery, etc. The aim is to make the patient’s appearance more compounded with the aesthetic standards of the human body’s three stops and five eyes, and the surgeon will design the eyelid line, nasal bridge height, nasal tip shape, jaw shape, etc. suitable for the candidate according to the aesthetic principles, the patient’s basic conditions and the candidate’s wishes. Eleven, rhinoplasty The nose is an important respiratory organ, is the most three-dimensional facial organs, has an important impact on appearance, the nose is located in the center of the face, according to our ancient painters outline the face of the “horizontal three, vertical five” principle, the ideal length of the external nose is 1/3 of the length of the face, the width should be 1/5 of the width of the face, that is, equal to the width of a glance. With a straight and beautiful nose, you can make your facial contour more full and vivid, so that you are full of confidence in life. 1, common rhinoplasty: (1) cosmetic rhinoplasty: the application of autologous or artificial materials implanted between the soft tissue of the nose and the nasal scaffolding tissue, the low dorsum or tip of the nose augmentation surgery, is one of the more oriental application of cosmetic surgery. (2) Correction of nasal deformity: saddle nose (the bony and cartilaginous part of the nasal bridge is sunken inward, shaped like a saddle, the tip of the nose is upturned and the nostrils are facing the sky), hump nose (the bridge of the nose is spine-like, if it is accompanied by the nasal septum cartilage and lateral nasal cartilage development is too long, the tip of the nose is sagging, it is also called “hawk’s hook nose”), nasal tip and nasal wing deformity correction (2) nasal deformity correction, nostril deformity correction, nasal column deformity correction. (3) partial nasal defect plastic surgery: small skin defect of nasal dorsum, area within 1cm2, direct pulling together suture, need to pay attention to the cosmetic unit of nasal area and the direction of local skin pattern. For repair of nasal wing defects, auricular composite tissue flap graft or nasolabial flap transfer is applied to repair nasal wing defects. For nasal hemifacial or large defects, the frontal zone island flap needs to be used for repair. (4) Total nasal reconstruction: there are more methods of total nasal reconstruction, and the surgery mainly includes the preparation of nasal lining, the repair of nasal outer being skin and the formation of nasal scaffold. 2, indications: age after adolescence, no psychological barriers, no nasal diseases, mild to moderate saddle nose deformity with rhinoplasty requirements, and various reasons for external nasal defect deformity. Twelve, auriculoplasty The auricle is located on both sides of the skull, the height is equivalent to the position between the arch of the eyebrow and the nose, the long axis is parallel to the bridge of the nose, symmetrical. The common auricular deformities are: small ear deformity, beckoning ear deformity, cup-shaped ear deformity, hidden ear deformity, earlobe deformity, auricular deficiency, auricular burn deformity, the following is a detailed introduction to small ear deformity. Congenital microtia generally has severe auricular hypoplasia, often accompanied by atresia of the external ear canal, middle ear deformity and maxillofacial deformity, while the inner ear development is mostly normal and has some hearing through bone conduction. The incidence is 1:7000 and is more common in males, with the majority of deformities on the right side and less common in bilateral cases. According to the development of the auricle, microtia can be divided into 3 degrees: degree I, where all parts of the auricle are still recognizable but the outline is small. In degree II, most of the structures of the auricle are not recognizable, and the residual ear is irregular, peanut-shaped, boat-shaped and salami-shaped, and the external auditory canal is atretic. In degree III, the ear is only a small dermatome or mound-like bulge, or there is only an ectopic earlobe. If the auricle does not develop at all, it is called aural agenesis, which is extremely rare. Currently, the ear scaffolding material is usually autologous rib cartilage or artificial material, and the surgery can be completed in one stage or in stages. The steps of auricular reconstruction in one stage: cut rib cartilage from the chest wall, sculpt and splice the ear stent according to the healthy ear mold, and implant the ear stent under the skin, the stent should be wrapped with skin flap or fascial flap, and the local skin piece is transplanted behind the ear defect; or wrap the Medpor ear stent with superficial temporal fascia, and then implant skin on the fascia Staged surgery steps: Method 1: The implantation of the ear stent is the same as the first stage surgery, and the ear stent is implanted 3 to 4 months later on the The auricular stent and flap are lifted from the deep surface of the fascia and fixed in the corresponding position to form a new auricle, and the traumatic surface of the postauricular and mastoid area is free of skin grafting. This method can effectively solve the problem of insufficient amount of skin in the postauricular mastoid area when reconstructing the auricle, and can avoid scarring of the new donor area caused by skin implantation. XIII. Burn treatment Burns are tissue injuries caused by heat, such as flame, hot liquid, hot steam, etc. They also include injuries caused by electricity and chemical substances. Burns mostly occur on exposed parts of the body, and about half of the patients have injuries to the face, neck and hands. Scarring and scar contracture in these areas will lead to dysfunction, disfigurement, and disfigurement, causing great pain to the patient and a significant decrease in quality of life. Burn wounds should be treated promptly to prevent infection, and patients with large burns also require surgical reconstruction and repair. Emergency treatment after burns: quickly detach from the heat source, simple bandage or cover the trauma to reduce pollution, sedation and pain relief, keep the trauma clean, the area is larger when the available cold wet compress (such as flushing with cold water). More than II degree burns require trauma treatment. 1.Burn depth estimation: (1)Ⅰ degree burns: damage superficial epidermis, epidermis erythematous, dry, burning sensation, 3-7 days of desquamation without scarring. (2)Ⅱ degree burns: superficial Ⅱ degree burns: large and full blisters are seen on the surface, swelling, redness, more exudate and severe pain on the traumatic surface after blister rupture, which can be healed in 2 weeks without infection, without scarring, and may have pigmentation. Deep Ⅱ degree burns: surface see blisters small and flat thin, slightly dull sensation, epidermal peeling trauma fishy red or red-white, less exudate, swelling obvious, if there is no infection, 3-4 weeks to heal, leaving a scar. (3) Ⅲ degree burns: trauma without blisters, waxy white or burnt yellow, touching like leather, or even carbonized, sensation disappears, trauma slightly larger often difficult to self-heal, need to cover the trauma through surgery. After the burn wound is healed, some drugs that inhibit scar proliferation should be used, either topically or orally or simultaneously; prevent pigmentation, no direct sunlight within six months after healing, prohibit smoking and alcohol, reduce stimulation, and avoid friction on the wound surface as much as possible; strengthen functional exercise to prevent scar contracture.