Interview with the chief plastic surgeon of Russia

A series of materials about transgender people - people who decided to change the external signs of gender - encouraged Wonderzine to talk with the chief plastic surgeon of Russia Nikolai Milanov, Head of the Department of Plastic and Maxillofacial Surgery of the Russian Scientific Center of Surgery them. Acad. BV Petrovsky, who first began to do these operations. In the process of conversation, among other things, taxied on breast augmentation, hyaluronic acid and Botox injections.

If we compare plastic surgery in Russia and in other countries of the world, we are at what level now?

The quality of the development of plastic surgery can be compared, but the level of development is not. For example, in 2012, 402,000 mammoplasty were performed in the United States (breast augmentation with implants. - Note ed.), in Brazil - 436 thousand, in Russia - 22 thousand. Rhinoplasty in the United States made 106 thousand, we have - 6 thousand. Of course, our Russian statistics, in general, is unreliable, because many private clinics hide the number of operations, not all patients go through the cashier. Plastic surgery consists of two sections: reconstruction and aesthetics. Reconstruction is the correction of post-traumatic, oncological defects, congenital abnormalities. And aesthetics is the correction of age-related changes and those features that patients themselves want to correct. Aesthetics is a commercial branch, reconstruction is a budget one.

The reconstruction also includes floor adjustment operations. Are they free too?

Some operations with transsexuals were quotaable (funded by the state as part of the treatment of patients with high technology. - Note ed.), some - no. I will explain. If an operation to remove the uterus is quotaed, no one is trying to find out who it was done with - whether it is transgender or not. Urethroplasty (restoration of patency of the urethra. - Note ed.) Quoted if the transsexual changed the passport floor and goes for an operation. She will be licensed for urology. Mastectomy (breast removal. - Note ed.) when a man is made of a woman and his documents are not changed, this is, of course, a paid operation. And then, when the most visible organ of the floor (chest) is removed, they decide: either they go further or not. A certain contingent stops at this. A passport changes when an organ is removed that does not allow it to return to its former state: if you have removed the uterus, that's all, you can already change the passport.

In all countries of the world, the ratio of men and women who want to make an adjustment of external signs of gender is approximately the same: four men per woman.

Yes, more men want to become women than vice versa. Only the ratio changes: it was 1 to 9, now it is 1 to 4. Previously, there were more women in Russia who wanted to change their sex than men. Everybody was joking then that it was easier for a man to survive here than a woman. It is hard for me to say what statistics are now: when we started doing this in the 90s (at the All-Russian Research Center for Surgery of the Russian Academy of Medical Sciences. - Note ed.), no one except us did this, and all the statistics depended on us. Then these operations began to engage in commercial clinics. Considering their dullness, such operations were not always carried out according to indications. They do not care who to operate, so lately there is a fairly large contingent of patients with schizophrenia who have begun to change their sex. A man comes and says: "I want to change the floor, remove my chest", or: "I want to change the floor, increase my chest." And go ahead. Although in normal clinics that are engaged in transsexuals, the breast increases in the very last turn: first the bottom is done, and then the top.

What do you think about transsexualism?

When it comes to the so-called "nuclear type", pronounced real transsexualism, this is a mistake of nature. They do not live, they are trying to commit suicide. We had a lot of suicides in the Soviet era, 30% of them tried to commit suicide, 18% brought it to the end. For nuclear transsexuals, sex life does not come in the first place, their first place is the appearance in the field in which they want to see themselves, and life in the field in which they want. This (admission to operations for the adjustment of external signs of the floor. - Note ed.) There are commissions for several people, they have their own methods, how to identify it. Transsexuals are absolutely normal people. There are a lot of talented and capable people among them - maybe even more than among the ordinary population. They hold on to each other, help each other. This is a certain group of people who used to be outcasts, and now you will not know that they are transsexuals.

And what are the most popular plastic surgeries in Europe and in Russia?

If we talk about statistics all over the world, then mammoplasty is in the first place, bleforoplasty is on the second place (surgery on the eyelids. - Note ed.) liposuction (reduction of adipose tissue. - Note ed.), and then rhinoplasty (surgery to change the shape of the nose. - Note Ed.) and abdominoplasty (abdominal reduction. - Note ed.). Bleforoplasty is on the first place, liposuction is on the second, mammaplasty is on the third, and then rhinoplasty and abdominoplasty, but this is not very accurate statistics.

If I understand correctly on this hit parade, do elderly people turn to plastic surgeons? Bleforoplastika because there will not be a young man to do?

All plastic patients can be divided into three groups: the first group is women under 30 years old. Girls want to change the nose, increase the mammary glands, make liposuction (create contours) and postpartum abdominoplasty if the abdomen is stretched. The second group consists of patients over 60 years old, who mostly make eyelids and face lift. And patients from 30 to 60 years old are the most mysterious group: everything is there.

How do you yourself feel about women who come with an obsessive desire to increase their breasts?

Fine. What do you think: is it normal that a woman spends an hour in front of a mirror, applying make-up?

But where is the line between correction and interference with one's nature? On the one hand, I also wore braces, and if you follow the philosophy of naturalness, the teeth could not be corrected, but to increase the chest?

There is a medical relationship to this: no one will operate a girl under 18 without the permission of their parents. I will never say that I believe that it is necessary to enlarge the breasts, put dentures before the girl gave birth. This is a difficult question, because not everyone has a very smooth life, especially in his youth. “I don’t have a young man, everyone throws me away, I have small breasts.” And it is impossible to convince her, she has a fad: she does not meet young people, she no longer goes to the beach, pushes napkins for herself and wears push-ups. Without an operation, this point cannot be removed.

You can not send it to a psychologist first?

I can not, I have no right even to send anyone to a psychologist. I can advise. A clinical psychologist should treat, find out the reasons, and he can say: "Well, guys, you have to do it!"

But how much is a person in 20 years ready and mature for such a decision? Here today the girl wants her fourth size breast, and in five years will she take over?

This is another question. I have the right to refuse anyone and somehow. If I see that this person will be ugly, I will not do. What makes me different from private clinics - I work for the state, my well-being does not depend on these operations. I will never allow myself to do what I do not like.

This is a feature of mentality - turning on the exterior?

This lack of self-sufficiency. They will make artificial limbs, they come and say: "I want like hers!" They gather in the tops and feel each other: "Why is it softer for me, and harder for her?" This is already a group of people who do not imagine that it is possible to differ from the rest in this group. This is trouble, but I think it will all pass.

There are a lot of talented and capable people among transsexuals - maybe even more than among the ordinary population.

Are there any developed regional centers for plastic surgery?

Of course. These are Nizhny Novgorod, Rostov-on-Don, Chelyabinsk, Yekaterinburg, St. Petersburg. Good, serious people work. In Tomsk, in Perm. There are a lot of them.

What is happening now with lawsuits against plastic surgeons or clinics in case of unsuccessful surgery? How much can a patient in Russia sue something?

It is necessary to clearly understand: what the horseman did, and what - the result of surgical complications that may be. If you make two-fifths of your body, no surgeon will give you a guarantee that you will be completely symmetrical. The asymmetry detected after the operation (one gland is more, the other is less) is not a complication, but the cost of the method. Another thing is when a woman comes to the surgeon and says that it is necessary to correct, and his superiors (the owners of private plastic surgery clinics. - Note ed.) says: "Please pay the money. What are the problems?" Do not treat surgeons like that, as if they were all grabs. It is very important for them that they talk about them well and have a good job.

Women make implants for themselves, and how do they breastfeed later?

When the implant is placed, the mammary gland is not affected, the prosthesis is placed under the muscle or under the fascia of the gland. It is affected if an implant is inserted through an areola, so you cannot do this if the patient is going to give birth and feed. Everything can be normal, but maybe a segment of some kind of clogged, and there will be mastitis.

When I was breastfeeding, it increased by three sizes. And what would happen if I had implants? Would there be huge stretch marks?

Yes, then something shrinks, and sometimes pyxia occurs (tightening. - Note ed.) do.

A woman puts implants, breastfeeds, and then comes back to have surgery?

If the skin is not reduced, then yes. All the same in different ways. For 13 years I have been leading a patient who bore three with artificial limbs and breastfed. And she had everything standing as well. It depends on the elasticity of the skin.

There is such a common misconception that one should choose: either I protect the breast and do not feed the child, or I feed the child - and God is with her, with the breast.

There is such a thing - the involution of the breast. Iron consists of glandular tissue and fat. You get fat - you have increased form due to fat. When you are pregnant, your iron increases due to glandular tissue, because it takes lactation. You can have a small gland and feed for a year and a half, and you can have a big one and not have milk, because there is only fat there. With age, the involution of the gland occurs, the malnutrition of the glandular tissue, it is gradually replaced by fatty and connective tissue. Both breastfeeding and age influence this involution. If you don’t feed, you’ll still have the top edge (breast. - Note ed.) with age, and iron will fall due to age involution. It will be three to four years later, but it will still be. Therefore, it is wrong to say that lactation spoils the breast. In some, the breast after lactation becomes better, because not all glandular tissue returns to its former size, for someone it remains (enlarged. - Note ed.). A woman after childbirth begins to recover, her breasts become more beautiful. Then the woman decides to lose weight, and the skin is already stretched, and so the chest falls.

And what is this new technology to transplant their own fat, with which they increase the breast?

This is lipofilling, which was talked about 20-25 years ago, and then it was discredited. Now they are returning to it again, because new technologies of taking and processing adipose tissue have appeared. Breast so you can increase, but you need a lot of fat. The volume of the mammary gland of size C is 500-600 cubes. So, we need somewhere to take a half liter of fat.

Cosmetology is a drug addiction. She does not treat, she substitutes

But the fat is absorbed?

Not all, but in part, and all different. Therefore, it must be added.

Is it then all life must go add?

No, it is one or two times, and then it will take root. But while lipofilling does not replace dentures.

And after how many years do you need to replace implants?

For all implants manufacturers give a lifetime warranty. In fact, nothing should happen to them. But a person grows older, glandular tissue leaves. If the implants are placed with the same volume of the breast - one look, if the breast is reduced, and the prosthesis is already standing, it is encapsulated, the iron flows down over it, and it hangs. Then the chest must be tightened. But there is a rule in normal plastic clinics: once you touch the prosthesis, it is better to change it. Anything can happen. It happens, the prosthesis and after a year breaks, it happens, and after 15 years breaks. Prostheses are of two types: gel and saline. Gel - standard saline filled with saline. They were rarely used before, because there is a valve through which fluid is pumped into the prosthesis. And when this valve is pulled out, the liquid slowly leaves, and it begins to squish. You walk and squish. Here are Hollywood beauties who are used to introduce artificial limbs through the navel, put these saline ones (a thin, thin, empty shell, rolls up into a tube, is driven in, swells there, and it goes for a year). A year later, the squishing person is pulled out and put on a new one.

What about the face?

It is necessary to teach Russian girls from 13-14 years old to care for their faces, process them before you go out into the street, before you go to bed. It is not necessary in the 15-16 years to apply scrubs to face was rosy. Then the results of aging will be later. When mimic and age wrinkles appear, it is too late to care for your face. After all, what does cosmetology give? Cosmetology is a drug addiction. She does not treat, she substitutes. So you smeared your face, and after that you have been fine for two or three hours. And then everything returns to the original positions. You again smear and sit down on this makeup. You gave Botox once, the second, but each time its effect is shorter and shorter.

I have a prejudice against Botox, it's poison. How can you poison your skin?

And how do people do vaccinations? This is a live vaccine, the same poison, only in small doses.

And how quickly does Botox end?

For some, the first effect lasts a year, for someone - eight months. It’s the same with all these fillers, such as Restyline: for some, they dissolve faster, for someone - more slowly. That is why I say that it is a drug addiction. You have introduced a hyaluronic acid based filler to smooth out wrinkles. It will take some time, the acid will resolve, you need to enter more. The next time they entered - it resolves even faster.

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