Plastic Surgery

Department Features

Some patients may not be familiar with what plastic surgery treats. Plastic surgery is a specialty that addresses a wide range of concerns related to diseases, injuries, and congenital conditions affecting any part of the body, from head to toe. Our department treats a broad spectrum of conditions. If you are unsure which department to visit, please feel free to consult us first.

On This Page

• 1. Skin Tumors and Lesions
• 2. Scars and Keloids
• 3. Blepharoptosis, Entropion, and Ectropion
• 4. Burns and Burn Scars
• 5. Facial Fractures and Facial Injuries
• 6. Breast Reconstruction
• 7. Axillary Osmidrosis
• 8. Other Conditions
• 9. Self-Pay Treatments
• Column 1: Subcutaneous Foreign Bodies
• Column 2: Phenol Method
• Column 3: Diabetic Foot Gangrene
• Doctor Introduction

1. Skin Tumors and Lesions

There are many types of skin tumors and lesions. They range from benign conditions such as warts, epidermal cysts, lipomas, and moles to malignant tumors. Even if a lesion appears to be only a mole or a small wound, it may be diagnosed as a malignant tumor, such as skin cancer, after excision. For this reason, it is important to seek medical evaluation if you have any concerns. Lesions involving cosmetically important areas such as the face, and excision of malignant tumors, require specialized treatment. In addition to surgical excision, our department actively uses treatments such as CO2 laser therapy. For simple excisions or laser procedures, treatment may be performed on the same day depending on outpatient availability, although this is not always possible. Please consult us.

Nevus: Even when removing a simple mole, placing the incision line along natural skin creases can make the postoperative scar much less noticeable.

Epidermal cyst: The cyst is removed together with a small portion of the overlying skin.

Lipoma: Lipomas are usually located in the subcutaneous fat layer at the level of the superficial fascia, but they may also occur within muscle, as shown in the illustration.

Basal cell carcinoma: A patient visited us because a wound had developed on what appeared to be a wart on the neck. Malignancy was suspected, and the lesion was excised. It was diagnosed as basal cell carcinoma, a type of skin cancer.

2. Scars and Keloids

Even scars that remain after healing can often be made less noticeable with appropriate care if they are treated early after the wound has healed. However, scars cannot be completely erased. Mature scars that have been present for a long time may be difficult to improve with care alone. In such cases, surgical scar revision may be indicated.

When the main concern is appearance, treatment may include careful re-suturing or W-plasty, a technique in which the scar is revised in a zigzag pattern so that parts of the scar are hidden within fine natural wrinkles. For contracture or tightness, Z-plasty, skin grafting, or flap surgery may be used. Z-plasty releases contracture by inserting triangular flaps into a straight scar. Skin grafting transplants skin from another area of the body, while flap surgery moves nearby skin and fat to improve the contracture.

Keloids are raised scars that extend beyond the boundaries of the original wound. They are thought to be related more to individual predisposition than to a simple disease process, and recurrence is common if they are treated only by excision. Main treatment options include compression therapy such as taping, sponges, and silicone sheets; steroid therapy such as topical medication, steroid tape, and injections; and excision combined with steroid treatment or electron beam therapy. Electron beam therapy is not provided at our hospital. It may be difficult to distinguish keloids from hypertrophic scars, but itching or pain may occur. Please consult us if you are concerned.

3. Blepharoptosis, Entropion, and Ectropion

Blepharoptosis is a condition in which the upper eyelid droops due to factors such as contact lens use or aging. It may cause headaches or shoulder stiffness. Even when patients have no clear symptoms, they may unconsciously raise their eyebrows to lift the eyelid skin and compensate for drooping eyelids. This can be considered latent blepharoptosis. The causes of blepharoptosis can be broadly divided into excess eyelid skin and looseness of the muscle and fascia that lift the eyelid. When excess eyelid skin droops over the eye, removing the excess skin may improve the condition. This procedure is called excess skin excision and is often performed below the eyebrow. When the eyelid-lifting muscle is loose, the loosened tissue is advanced and reattached to the cartilage at the eyelid margin. This procedure is called levator advancement.

1) Excess Skin Excision

A surgical design is made with particular attention to the area where excess skin is most prominent. Eyelid skin is thin and flexible, and removing too much skin along the double-eyelid crease may pull thicker skin from the upper side down toward the eyelid, creating an unnatural appearance. For this reason, we mainly remove skin below the eyebrow.

Actual Case

2) Levator Advancement

The levator palpebrae superioris is the muscle that lifts the eyelid. In practice, the eyelid opens because a thin tissue called the levator aponeurosis connects this muscle to the tarsal plate, which is a cartilaginous structure in the eyelid. Blepharoptosis has various causes, but many cases are caused by loosening of the levator aponeurosis due to aging or repeated contact lens use. This is called aponeurotic blepharoptosis. In levator advancement, the loosened aponeurosis is first separated from the surrounding tissue and advanced forward. It is then re-fixed to the tarsal plate with sutures in a slightly advanced position, allowing the eye to open more effectively. The incision is used as the double-eyelid crease so that the scar is less visible; as a general rule, this surgery creates a double eyelid.

Actual Case

Many patients have both excess eyelid skin and levator aponeurosis looseness. We usually perform one of the procedures first. If further surgery is desired, both procedures may be performed. When blepharoptosis is diagnosed, treatment can be covered by health insurance. Surgery is performed as a day procedure under local anesthesia, but hospitalization is also available for patients who find it difficult to rest at home or who feel anxious about the night after surgery. Some patients remain hospitalized until suture removal.

We also perform surgery for entropion, including inward-turning eyelashes, and ectropion. Entropion may sometimes be followed by an ophthalmologist through repeated eyelash removal, but regular visits are required, and most adult cases do not achieve a definitive cure this way. In contrast, entropion in children often improves with observation. Surgery may be indicated, so please consult us if you are concerned.

For eyelid surgery, our department uses the ERBE VIO 50C high-frequency electrosurgical device manufactured by AMCO. Swelling is common after eyelid surgery, and bleeding is considered one of the main causes of swelling. We therefore use a high-frequency electrosurgical device to minimize bleeding. Compared with ordinary electrocautery devices, it causes less damage to surrounding tissue, allowing us to perform less invasive surgery.

4. Burns and Burn Scars

If you suffer a burn, cool the affected area under running water for at least 30 minutes and then visit our department.

Burns are broadly classified into three degrees of severity, and treatment differs significantly depending on the degree. Surgery may be required in some cases. Even burns that look superficial immediately after injury may deepen during the course of treatment and require a long time to heal. In particular, if bacteria enter the wound and infection develops, the condition can worsen rapidly, so caution is necessary. If blisters form or if the burn seems to cover a wide area, we recommend that you visit the outpatient clinic. In severe burns, blisters may rupture immediately and appear absent. In such cases, part of the underlying skin may look white, and flame burns may appear black.

After a burn heals, it may leave a cosmetically concerning scar or cause contracture. If you wish to improve the appearance of a burn scar or reduce contracture, please visit our department, as treatment may be indicated.

5. Facial Fractures and Facial Injuries

Facial fractures and injuries are treated by plastic surgery because they are directly related to appearance. When a fracture is present, symptoms may include double vision, difficulty opening the mouth, numbness of the skin, and other problems. These symptoms may improve with surgery.

In addition to titanium plates, our department also uses absorbable plates.

For facial injuries, the initial treatment greatly affects the final appearance of the scar. If you wish to heal as cleanly as possible or if you are concerned after receiving sutures at an emergency hospital, please visit our department as soon as possible after the injury.

6. Breast Reconstruction

Breast cancer is said to be the most common malignant tumor among Japanese women, and it is currently estimated that one in nine Japanese women will develop breast cancer. Because cancer treatment is involved, curative treatment is naturally the priority. However, some patients also wish to consider cosmetic outcomes in surgery. Through breast reconstruction surgery, we aim to support patients so that they can face treatment and daily life with a more positive outlook.

Our hospital is an accredited facility for breast reconstruction using tissue expanders and implants. We can perform breast reconstruction surgery for patients after breast cancer surgery, known as secondary reconstruction. Reconstruction methods are broadly divided into two types: artificial materials and autologous tissue. These procedures are performed under general anesthesia with hospitalization.

1) Artificial Materials

In principle, two surgeries are required.

First surgery: Tissue expander placement
Especially in secondary reconstruction, the skin is often contracted. A tissue expander is therefore inserted first, and saline is injected during outpatient visits to gradually stretch the skin. Replacement surgery is performed after approximately three to six months.

Second surgery: Implant placement
After the skin has been expanded with the tissue expander, a space called a capsule forms in the breast. A breast reconstruction implant is inserted into this space. In both surgeries, a drainage tube, called a drain, is inserted. Patients can usually be discharged once the drain can be 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 in the back is harvested together with surrounding fat and skin. A tunnel is created under the skin of the axilla, and the tissue is moved to the chest. The transferred tissue is shaped into a breast and sutured in place. Harvesting the latissimus dorsi muscle does not usually interfere with daily life, but some patients may feel tightness in the back or symptoms similar to shoulder stiffness. Depending on body build and breast size, this method is not suitable for reconstructing very large breasts.

Abdominal flap
Subcutaneous fat from the abdomen is used to create the shape of the breast. One method, called a rectus abdominis myocutaneous flap, transfers the rectus abdominis muscle together with the tissue; however, harvesting the rectus abdominis muscle is considered to place a greater burden on the body. Another method preserves the muscle and uses only skin and subcutaneous fat. This is called a deep inferior epigastric perforator flap. In this procedure, the blood vessels are once divided and then reconnected to blood vessels in the chest, a process called vascular anastomosis. This requires the longest operating time. There is also a risk of flap necrosis if the blood vessels become blocked. Except in very thin patients, it is possible to reconstruct a large, soft breast. In autologous tissue reconstruction as well, a drain is inserted, and patients can usually be discharged once the drain can be removed. Hospitalization is often a little over one week.

For patients 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 the book was created to make the information 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

Axillary odor is said to be caused by apocrine sweat glands in the armpits. In Western countries, it may be accepted as a physiological phenomenon, but in Japan and other parts of East Asia, where it is less common, it can become a source of distress. Recent reports have described the effectiveness of treatment devices using ultrasound or microwaves, although these treatments are not provided in our department. Other treatment options include topical medication, botulinum toxin injections, and surgery to remove apocrine glands under direct visualization. This surgical procedure is called the flap method and is covered by health insurance. Surgery can be performed under local anesthesia, but hospitalization is generally recommended to help prevent complications such as hematoma formation due to bleeding.

Sebaceous glands and sweat glands of the skin, including apocrine sweat glands that cause odor.

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

8. Other Conditions

We also treat animal bites, puncture wounds caused by objects such as branches or nails, pressure ulcers, lower limb ulcers, and ingrown nails.

9. Self-Pay Treatments

Pigmented Spots

Brown pigmented lesions on the face are often collectively called “spots,” but their causes and conditions vary widely. They include solar lentigines, seborrheic keratoses, moles, post-inflammatory hyperpigmentation, freckles, melasma, acquired dermal melanocytosis, nevus of Ota, and flat pigmented birthmarks such as café-au-lait macules. Treatment differs depending on the condition. In our department, we examine each lesion, propose the treatment best suited to the individual type of pigmentation, and proceed with treatment in consultation with the patient.

Our department provides treatment for pigmented spots using a Q-switched alexandrite laser. This laser is effective for lightening black and brown pigmented lesions. We also provide treatment with physician-dispensed medical cosmetics such as ZO Skin Health, topical hydroquinone, and oral vitamin C and tranexamic acid. If you are concerned about pigmented spots, please feel free to consult us.

Laser Hair Removal

Our department provides medical laser hair removal using the GentleMax Pro laser. Many people use salon hair removal or home-use hair removal devices because shaving and other self-care methods can be time-consuming or cause razor irritation. Medical laser hair removal can achieve results in fewer sessions than salon treatments or home-use devices. In recent years, beard hair removal for men and hair removal for younger people after puberty have become increasingly common. In our department, laser treatment is performed after examination by a physician. Patients with a smaller amount of hair may complete treatment in about five to six sessions, but because results vary by individual, some patients require more than ten sessions. Payment is made for each session, so patients can receive laser treatment only when needed and only for the number of sessions required.

Wrinkles

Wrinkles on the forehead, between the eyebrows, and at the corners of the eyes are caused by facial expression muscles. Botulinum toxin injections reduce the movement of these muscles, improving expression lines. Regular treatment may also help prevent wrinkles from becoming deeply etched in the future. Our department uses Botox® manufactured by Allergan. We also provide lifting laser treatment using a long-pulse Nd:YAG laser to improve fine wrinkles, skin texture, firmness, and enlarged pores caused by skin laxity.

Axillary Hyperhidrosis

Uncomfortable underarm sweating during the summer can be reduced with botulinum toxin injections using Botox® manufactured by Allergan. A single injection can provide effects for three to six months. Patients who experience troublesome hyperhidrosis even in winter may receive injections twice a year, in summer and winter.

For self-pay treatments, a physician provides counseling and explains the treatment in detail. We ensure sufficient informed consent and begin treatment only after the patient fully understands and agrees to the plan. Please feel free to consult us.

Initial and follow-up consultation fees, medication fees, and other related fees are charged separately. These treatments are not covered by health insurance and must be paid out of pocket.

Column 1: Subcutaneous Foreign Bodies

A patient visited us with a small scar on the right great toe and persistent pain. An X-ray showed a foreign body near the joint.

In the operating room, we extended the incision from the scar and explored the subcutaneous tissue. Although the original scar was only about 1 mm, a 1 cm glass fragment was found embedded a short distance away from the scar. The patient had stepped on broken aquarium glass at home and initially thought the glass had come out, but persistent pain led to concern about a retained foreign body, and the patient visited our department. Sharp objects such as glass can penetrate deeply, and because glass is transparent, it is usually very difficult to find by oneself. If the object breaks during attempted removal, extraction may become even more difficult. If you have experienced such an incident or have a persistent sensation of discomfort, please do not hesitate to consult us.

Column 2: Phenol Method

What is the phenol method? It is one of the treatment methods for ingrown nails. An ingrown nail is a condition in which the nail digs into the skin, causing pain. Treatments for ingrown nails include various conservative methods such as taping, packing with cotton or silicone tubing, and correction using plates or wires. The phenol method is one surgical treatment option, and it is outlined below.

Column 3: Diabetic Foot Gangrene

The patient had been receiving treatment for diabetes at a nearby clinic, but blood glucose control worsened. Probably starting from a small wound, infection spread and ultimately required amputation of the second toe and skin grafting. Fortunately, the condition stabilized, the patient became able to walk, and the patient has been actively working on blood glucose control and wound care.

Diabetic foot gangrene is a condition in which infection spreads from a small wound on the foot against a background of poor blood flow and nerve damage caused by diabetes, leading to tissue necrosis. It may be triggered by seemingly minor problems such as small cuts, shoe sores, or nail trouble. Because diabetic neuropathy may also be present, treatment is often delayed, making early detection extremely important. If you notice any abnormality in your feet, early medical consultation is important.

Doctor Introduction

Chief Physician / Yohei Kitaguchi

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