Plastic Surgery

Department Features

Some of you may not be familiar with what kind of department plastic surgery is.
Plastic surgery is a department that addresses complaints related to a wide range of conditions (diseases, injuries, congenital conditions) affecting all parts of the body from head to toe. Our department also handles a broad spectrum of conditions. If you are unsure which department to visit, please feel free to consult us.

1. Skin lesions

There are many types of skin lesions. These range from benign conditions such as warts, epidermal cysts, lipomas, and moles to malignant ones. Even if something appears to be just a mole or a scar, it may be diagnosed as a malignant tumor (such as skin cancer) after removal. Therefore, it is important to seek medical evaluation if you are concerned. In particular, areas related to appearance such as the face, or removal of malignant tumors, require specialized treatment. In addition to excision, our department actively uses CO2 lasers and other treatments. In cases of simple excision or laser procedures, treatment may be performed on the same day depending on outpatient availability (not always possible), so please consult us.

Epidermal cyst: Removed with a portion of the overlying skin attached.

Lipoma: Usually located in the subcutaneous fat layer called the superficial fascia, but can also occur within muscles as shown in the figure.

Basal cell carcinoma: A patient visited with what appeared to be a wound on a neck wart. Malignancy was suspected, and after excision it was diagnosed as basal cell carcinoma, a type of skin cancer.

2. Scars and keloids

Even scars that remain (called scars) can be made less noticeable with proper care if treated early after healing (they cannot be completely erased). Scars that have matured over time may be difficult to improve with care alone. In such cases, surgical revision may be indicated.
If the concern is cosmetic, procedures such as re-suturing neatly or W-plasty (a method of suturing in a zigzag pattern to conceal scars within fine wrinkles) may be performed. For contractures, procedures such as Z-plasty (inserting triangular flaps into a straight scar to release tension), skin grafting (transplanting skin from another area), or flap surgery (moving nearby skin and fat) may improve the condition.
Additionally, keloids may form, which are raised scars that extend beyond the original wound. These are thought to be related to individual predisposition rather than a disease, and simple excision alone often results in recurrence. Standard treatments include:

1. Compression (taping, sponges, silicone sheets, etc.)
2. Steroids (topical, patches, injections)
3. Excision plus steroids or electron beam therapy (electron beam therapy is not available at our hospital)
   It may be difficult to distinguish from hypertrophic scars, but since itching or pain may occur, please consult us if concerned.

3. Ptosis, entropion (inward eyelashes), ectropion

Ptosis is a condition in which the eyelids droop due to contact lens use or aging. It may cause headaches or shoulder stiffness, and even without symptoms, patients may unconsciously raise their eyebrows to compensate (latent ptosis).
Causes of ptosis are broadly divided into:

1. Excess eyelid skin
2. Loosening of the muscles and fascia that lift the eyelid

If excess skin droops over the eye, removal of the excess skin may improve the condition (excess skin excision). This is often performed below the eyebrow.
If the lifting muscle is loose, the muscle is advanced and reattached to the eyelid cartilage (levator advancement).

① Excess skin excision

A design is created focusing on the areas with excess skin. Since eyelid skin is thin and flexible, removing too much along the double eyelid line can lead to an unnatural appearance. Therefore, we mainly remove skin below the eyebrow.

Actual case

② Levator advancement

The levator muscle lifts the eyelid. It connects via the levator aponeurosis to the tarsal plate. Many cases of ptosis are due to loosening of this aponeurosis caused by aging or contact lens use (aponeurotic ptosis).
In this procedure, the loosened aponeurosis is detached, advanced forward, and reattached to the tarsal plate, improving eyelid opening. The incision is made along the double eyelid line, making scars less visible.

Actual case

Both conditions may coexist. Typically, one procedure is performed first, and both may be done if desired. Ptosis can be treated under insurance. Surgery is usually performed under local anesthesia as a day procedure, but hospitalization is available if needed.

We also perform surgery for entropion and ectropion. Entropion may be managed temporarily by eyelash removal in ophthalmology, but most adult cases do not achieve permanent resolution. Surgery may be indicated.

We use the Amco high-frequency electrosurgical device (ERBE VIO50C) for eyelid surgery to minimize bleeding and tissue damage.

4. Burns and burn scars

If a burn occurs, cool it under running water for at least 30 minutes before visiting.
Burns are classified into three levels, and treatment varies accordingly. Some may require surgery. Even burns that appear superficial may deepen over time. Infection can worsen the condition rapidly.
If blisters form or the affected area is large, consultation is recommended. Severe burns may not show blisters but may appear white or black.
After healing, scars or contractures may remain. Treatment is available for cosmetic concerns or contracture improvement.

5. Facial fractures and injuries

Facial fractures and injuries are treated in plastic surgery due to their impact on appearance. Symptoms may include double vision, difficulty opening the mouth, or numbness. Surgery may improve these.

※Absorbable plates are also used in addition to titanium plates.

Initial treatment greatly affects scarring. Early consultation is recommended if cosmetic outcomes are a concern.

6. Breast reconstruction

Breast cancer is a malignant tumor that is said to be the most common among Japanese women, and it is currently estimated that 1 in 9 Japanese women will develop it. Since it is cancer treatment, achieving a cure is naturally required; however, some patients may also wish for surgery that takes cosmetic outcomes into consideration. By performing breast reconstruction surgery, we aim to support patients so that they can maintain a positive outlook during treatment and in their daily lives.
Our hospital is a certified facility for breast reconstruction using expanders/implants, and we are able to perform breast reconstruction surgery for patients after breast cancer surgery, known as secondary reconstruction. There are two methods of reconstruction: using artificial materials or autologous tissue. The surgery is performed under general anesthesia with hospitalization.

① Artificial materials

In principle, two surgeries are required.
First surgery (Expander): Especially in secondary reconstruction, the skin is often contracted, so a tissue expander is first inserted, and saline is injected during outpatient visits to gradually stretch the skin. Replacement surgery is performed after approximately 3 to 6 months.
Second surgery (Implant): After the skin has been expanded with the expander, a space called a capsule forms in the breast. A breast implant is inserted into this space.
For both surgeries, a drainage tube (called a drain) is inserted, and discharge is possible once it is removed. Hospitalization is often slightly less than one week.

② Autologous tissue

Common donor sites are the back or abdomen.
Latissimus dorsi flap: The latissimus dorsi muscle from the back is harvested together with surrounding fat and skin, and a tunnel is created under the armpit to move it to the chest. It is shaped to form a breast and sutured in place. Although harvesting the latissimus dorsi does not affect daily life, some patients may experience tightness in the back or symptoms similar to shoulder stiffness. Depending on body type and breast size, it is not suitable for reconstructing very large breasts.
Abdominal flap: The shape of the breast is created using subcutaneous fat from the abdomen. One method involves transplanting the rectus abdominis muscle together (called a rectus abdominis flap), but harvesting this muscle is considered to have a significant impact on the body. Another method preserves the muscle and uses only skin and subcutaneous fat (called a deep inferior epigastric perforator flap); however, this requires temporarily disconnecting the blood vessels and reconnecting them to chest vessels (vascular anastomosis), resulting in the longest operation time. There is also a risk of flap necrosis due to vascular blockage. Except in very thin patients, it is possible to create large, soft breasts.

In autologous tissue surgery as well, a drain is inserted, and discharge is possible once it is removed. Hospitalization is often a little over one week.

For those who would like to learn more, the Japanese Society of Plastic and Reconstructive Surgery has published a book titled “Breast Reconstruction Guidebook for Patients and Their Families.” Dr. Kitaguchi from our department also participated as a member of the editorial team, and we created this book to be as easy to understand as possible. A sample copy is available in the outpatient clinic, so please feel free to ask if you are interested.

7. Axillary Osmidrosis

It is said that odor is caused by apocrine sweat glands in the armpits. In Western countries, it is sometimes accepted as a physiological phenomenon, but in East Asia, including Japan, where it is less common, it can be a source of concern. Recently, the effectiveness of treatment devices using ultrasound or microwaves (not performed in our department) has been reported. Other treatments include topical agents, Botox injections, and surgical removal of apocrine glands under direct visualization (flap method: covered by insurance). Surgery can be performed under local anesthesia, but hospitalization is generally recommended to prevent complications such as hematoma formation due to bleeding.

Sebaceous glands and sweat glands of the skin — apocrine sweat glands that cause odor

Flap method: An incision is made in the center of the axilla, the skin is flipped over, and the apocrine glands, which appear darker in color, are selectively removed.

8. Others

We also treat animal bites, puncture wounds, pressure ulcers, lower limb ulcers, and ingrown nails.

9. Private (self-paid) medical care

Spots (Hyperpigmentation)

Brown pigmented spots on the face are often collectively referred to as “spots,” but in fact, their causes and conditions vary, including senile lentigo, seborrheic keratosis, moles, post-inflammatory hyperpigmentation, freckles, melasma, acquired dermal melanocytosis, nevus of Ota, and café-au-lait spots. Treatment methods differ accordingly. In our department, we examine each case and propose the most suitable treatment, proceeding in consultation with the patient.
We offer treatment for spots using a Q-switched alexandrite laser, which is effective in lightening black and brown pigmentation. We also provide treatments such as medical-grade cosmetics (e.g., ZO Skin Health), topical hydroquinone, and oral vitamin C and tranexamic acid. If you are concerned about spots, please feel free to consult us.

Hair Removal

We provide medical laser hair removal using the GentleMax Pro laser. Many people undergo hair removal at salons or use home devices due to the inconvenience of self-care and razor irritation. Medical laser hair removal can achieve results in fewer sessions compared to salon or home treatments. In recent years, there has been an increase in beard hair removal for men and hair removal among younger individuals after puberty. In our department, laser treatment is performed after examination by a physician. Some patients with less hair may complete treatment in about 5–6 sessions, but due to individual differences, some may require more than 10 sessions. Payments are made per session, allowing patients to receive treatment as needed.

Wrinkles

Wrinkles on the forehead, between the eyebrows, and at the corners of the eyes are caused by facial muscles. By using botulinum toxin injections to reduce muscle movement, expression lines can be improved, and regular treatment can help prevent wrinkles from becoming deeply etched over time. In our department, we use Botox® manufactured by Allergan. In addition, we offer lifting laser treatments using long-pulse Nd:YAG lasers to improve fine wrinkles, skin texture, firmness, and enlarged pores.

Axillary Hyperhidrosis (Underarm Sweating)

Unpleasant underarm sweating in summer can be reduced with botulinum toxin injections (Botox® by Allergan). A single injection can provide effects for 3–6 months. Patients with persistent symptoms even in winter may receive injections twice a year, in summer and winter.
For private treatments, physicians provide consultations and detailed explanations. We ensure thorough informed consent before starting treatment. Please feel free to consult us.
Initial/revisit consultation fees and medication costs are charged separately.
Costs are not covered by health insurance and must be paid out-of-pocket.

Column 1: Subcutaneous Foreign Body

A patient visited us with a slight scar on the right first toe and persistent pain. An X-ray revealed a foreign body near the joint.

Upon extending the incision from the scar and exploring subcutaneous tissue in the operating room, we found that although the original scar was about 1 mm, there was a 1 cm glass fragment embedded at a slightly distant location. The patient had stepped on broken aquarium glass at home and initially thought it had been removed, but due to persistent pain, they visited us suspecting a retained foreign body. Sharp objects like glass can penetrate deeply and are transparent, making them difficult to detect. If they break during removal, extraction can become even more difficult. If you have such an episode or any discomfort, please do not hesitate to consult us.

Column 2: Phenol Method

What is the phenol method? It is one of the treatments for ingrown nails (a condition where the nail digs into the skin, causing pain). Conservative treatments include taping, packing with cotton or silicone tubes, and correction using plates or wires. One surgical treatment is the phenol method, explained briefly below.

① First, anesthesia is injected at the base of the finger or toe to numb the entire digit (direct injection into the fingertip is very painful, so this method is used).

② The ingrown portion of the nail is partially removed, ensuring that the root is adequately treated (if insufficient, the phenol applied later will not reach the target area).

③ Phenol is applied to the nail matrix (the part that produces the nail) from the removal site. By chemically treating the matrix, the ingrown portion will no longer regrow. Phenol is tissue-damaging, so it is neutralized with absolute ethanol afterward to prevent residue. Phenol is also said to reduce pain, resulting in milder postoperative pain compared to conventional surgery.

④ If there is no bleeding, showering is allowed from the next day. Although individual differences exist, a small amount of exudate may persist for about two weeks, which can be managed with standard bandages.
Since a small wound is created, patients with poor peripheral circulation or conditions such as severe diabetes or immunodeficiency may not be suitable candidates.
In principle, recurrence at the same site should not occur, but in rare cases, nail regrowth or deformation of residual nail leading to recurrence may happen.

Doctor Introduction

Chief Physician / Yohei Kitaguchi

PhD
Board-certified specialist and instructor, Japan Society of Plastic and Reconstructive Surgery
Board-certified specialist, Japanese Society for Wound Healing
Instructor in reconstruction and microsurgery, Japan Society of Plastic and Reconstructive Surgery
Responsible physician for breast reconstruction expander/implant
Part-time physician, Department of Plastic Surgery, Okayama University Hospital
Part-time physician, Department of Plastic Surgery, Wakayama Medical University
Member, Breast Reconstruction Guidebook Committee
Editorial board member, JPRS

Awards

September 2021: Graduate Student Presentation Award, Japanese Society for Tissue Culture
April 2023: Excellent Oral Presentation Award, 66th Annual Meeting of the Japan Society of Plastic and Reconstructive Surgery

Physician / Ryoko Okuno

Plastic Surgery Outpatient Physician Schedule