[The therapeutic purpose of plastic surgery]. / La finalité thérapeutique en chirurgie plastique.

The acts of plastic surgery consist in providing care to patients and pursue a therapeutic purpose. They benefit from VAT exemption in accordance with European legislation. They appear in the Common Classification of Medical Acts as therapeutic acts, whether or not they are covered by health insurance. To assist the plastic surgeon during the consultation in his role as a medico-surgical expert, we propose a global assessment scale for physical disgraces. This scale specifies the importance of disharmony, its etiology, and considers the patient in his entirety, both biologically and psychosocially. All repercussions are analyzed: physiopathological impact, pain, functional impact on daily life activities, pleasure and sexual activities, psychological, social, and professional impact. Each item is independently rated. Depending on the overall score obtained, the therapeutic nature of the act can be confirmed. The proposed scale is a simple tool that easily and seriously supports the therapeutic nature of our acts. It ensures argued expertise, a reliable and indisputable synthesis. We are, above all, doctors, caregivers, contributing to health as defined by the WHO: "a state of complete physical, mental, and social well-being." We alone are able to judge the therapeutic nature of a service, in agreement with our patients.

[Facial aesthetic lipostructure]. / La lipostructure faciale esthétique.

Coleman's lipostructrure, based on the use of specific material and on a strict methodology has reconciled the surgeons with adipocyte transfer. The quality of the lipostructure results depends significantly on: The topography of the graft locations (the best results being obtained in the malar, chin and cheek units), the candidates (better results in young women, less than 60 years). The quality of the lipostructure results has influenced our surgical strategy: Lipostructure can be used alone, or frequently associated with a face lift. We adopted a regional operatoring strategy: A more limited zone of face lift undermining enabling us to target lower cheeks and neck, adjunction of lipostructure in adjacent anterior locations. In our experience the association face lift-lipostructure gives good and natural results. Lipostructure is currently the best way to restore facial volumes.