Nosejob without Surgery

We all know that nose is the centerpiece of the face and a defining feature. Plastic surgery has been the best and the only option so far to change one’s nose from ugly to beautiful. Those of you who have been scared about surgery and its cost or unsure of how you will look after surgery have perhaps resigned to live with your unattractive noses.  Fortunately a solution is now available which is painless, quick, scarless, safe and also reversible if you do not like it!

We are talking about the “filler injections”. Fillers are usually made of hyaluronic acid. Hyaluronic acid is natural body substance and is proven to be safe. Hyaluronic acid fillers can be injected into the nose to change the shape of the nose. Filler can be injected over the nose bridge to increase the height of the nose, to hide small humps and irregularities and to balance a slightly crooked nose. Advantages of this kind of nonsurgical nosejob are many. It is a virtually painless procedure, takes just 10 minutes and you can see the result immediately. In fact you can actively participate in your nose job and give your suggestions during injection to fine tune the results to your liking. What you see at the end is what you get. There is very little downtime if any. Most people can do it in course of their routine day.

But surgical nosejob is not out yet! That is because fillers only work for noses where relatively smaller improvement is required. Fillers will not suffice if the nose is too flat or too crooked. Obviously filler injections can not make a big nose smaller or a wide nose narrow. These can be done only by nose surgery. Nose surgery is permanent –whereas hyaluronic acid  filler injections are temporary with result lasting upto 6 -12 months only. This can of course be a plus point if you want your old nose back, because the nose will be back to original after this time. In fact “hyaluronidase” injections are also available which can dissolve the filler and bring it back to original.

So, what is the best option for you to fix your nose – surgery or filler? Your plastic surgeon will be the best to decide if fillers will work for you. Your plastic surgeon can offer you a trial normal saline injection which simulates filler result to help you decide. Of course you can have the surgery done anytime in future once filler effect is gone after an year or you can have the filler injection repeated as often as you need.

Cosmetic Surgery for Scars

” Doctor, I have tried everything for the scars on my face but nothing worked. can it be removed by cosmetic surgery?” This is a common question I am asked. This situation can sometimes be helped and sometimes not much can be done. Answer depends on scar, its location and patient’s expectation.

» Scar can be treated in many ways
• Scar revision surgery: This is the commonest and best method. Scar is removed under local anaesthesia and it is stitched back using fine techniques and materials. This works well for old operation scars and injuries that were stitched badly earlier. So your old bad scar is replaced by a fine line like scar which if taken proper care in next few months, fades to a very faint like which is visible at only close look, but not otherwise.

• Dermabrasion: This surgery is useful if there are many scars in a small area, like pitted acne scars. This is done under local anaesthesia. The skin is dermabraded (rubbed) with a special machine till the superficial layers are gone and pits are leveled. The raw area of skin is dressed. Healing time is one week and colour matching takes 1-2 months. Sometimes 2 sittings may be required and overall50- 70 percent improvement occurs.

• Filler: This can work for depressed scars. A filler substance can be injected with a fine needle under the scar to elevate it. This is a quick procedure but works for only few types of scars.

Injections: Red, elevated scars keloid can be removed by surgery and then injected with steroids for next 3 months to get the best result.

» Important things to remember are
• Final result takes 6 months to an year: Therefore make sure to do any plastic surgery well ahead of any    important event like marriage.
• If scar is too wide or too deep the surgery may need to be done in two stages with a gap of 3 months.
• Scar can be improved but can not be made to vanish without a trace. Scar revision surgery is like darning    an expensive dress or sticking a broken cup with fevi quick. A fine line will always be there.
• Results vary from surgeon to surgeon but more importantly from person to person- on their healing    quality.
• Scars on body do not body do not usually improve as much as face scars.
• Aftercare for 6 months is very important.

All scars can not be improved. Some scars and some patients are not ideal candidates for surgery, like

• Very small superficial scar that can not be further improved.
• When person’s expectations are unrealistic – he/she expects a 100 percent result without slightest mark,    wants instant results or wants guarantees.
• When scar is minimal and person is disproportionately concerned about it. In other words if he/she is    psychologically fixated with the scar.

Scars on face can be very traumatic experience. Plastic surgery can Improve most of these scars and enhance the self esteem and quality of life of the patient.

Skin Grafting – Myths and Reality

Once I asked a group of first year medical students “what is plastic surgery”. Not surprisingly many answered that it was removing skin from a part of body and putting it elsewhere. This is what a lot of patients believe- that their face can be improved by putting new skin from their thighs.

Skin grafting is often considered synonymous with plastic surgery. This is a misconception which is slightly more educated than the older version when plastic surgery was thought to involve putting plastic in the body. Skin grafting and using synthetic materials like silicon (not plastic) to enhance the body are certainly the techniques used by plastic surgeon, but only occasionally. That is not what plastic surgery is all about.

Let me first explain how the skin grafting is done and why. Skin grafting is done when there is a large area where the skin is lost- because of burns or accidents. Skin from another part of body( like thighs) can be used to cover the raw area to allow it to heal. The donor area is usually a hidden part like thighs, hips . Only a thin superficial layer of skin is removed from donor area. The remaining skin of thigh grows back from its roots (sweat and oil glands) and heals in less than 2 weeks time. Its like taking cuttings from plants to grow more plants. This is called partial thickness skin grafting or simply skin grafting. Skin grafting is also done when a tumor or large mole is removed and there is a large gap. This can be covered with skin graft.

Skin grafting is used extensively by plastic surgeons when dealing with burns, trauma and cancers. Skin grafting is a lifesaving surgery in major burns. After accidents it allows the wound to heal fast and person can go back to work. But skin grafting to improve person’s skin or for removing scars is another story- with not so happy ending!

Skin grafting is not a good tool for cosmetic plastic surgery because skin from another part of body will never match. After grafting the grafted skin tends to become darker than surrounding skin and has a different texture. This mismatch improves with time and care but never completely goes. So there is a good chance of a patchwork look. To overcome this full thickness skin graft from certain areas of body is used. Matching with full thickness graft is better than partial thickness graft- but still it is never a total match.

Whenever a mole , scar or a tattoo is removed from any part of body stitching the cut ends together with a line like scar, gives the best cosmetic result. Skin grafting can never match this and therefore it is done only as a last resort. True skills of the plastic surgeon lies in ability to close the gap without using graft. Common situations where patient comes asking for grafting are:

• Burn scars on face or body: Sometimes these patients have already had partial thickness grafting and they are unhappy with the look. If the scar is very bad and limited, full thickness grafting can Improve the scar by fifty percent. Still makeup will be required to look completely normal.

• Acne scars on face: Patients who are very distressed about their acne scars request to replace the face skin with grafting. Face may look worse after skin grafting. These patients improve a lot with skin resurfacing procedures like dermabrasion and skin grafting is not required.

• Tattoo marks: Cutting out the tattoo mark and stitching, or Q switched NdYAG laser is the best option. Skin grafting can be done if nothing else is possible.

• White patches (vitiligo): Cutting and stitching is best for small patches. For larger patches thin partial thickness skin graft is used and patients are usually happy to get rid of white patch even if there is now a darker patch instead.

• Pigmented patches: Here again skin grafting is not of much use because graft itself becomes darker. Only in few instances of dark birthmarks grafting is used.

Skin grafting has limited usage in cosmetic surgery and it is certainly not done by choice but only as a last resort when nothing else is possible.

Maintaining Lipo Results

So, you are happy to be in good shape after liposuction !You have got a new wardrobe and you are ready to flaunt your figure. But do you sometimes wonder if its going to last? Is fat going to come back?

Its common to hear things like – so and so eats a lot but does not put on weight, whereas I am forever on diet but do not lose weight. Whenever I have studied the lifestyle of slim people who do not diet, I found that they eat mostly at home and do not have taste for high calorie food like sweets, fried stuff , hotel food. They also tend to eat smaller quantities at a time. These people also tend to be active, even though they may not be actually setting aside time for exercise.

On the other hand overweight people, even though conscious about their weight and food intake, tend to overeat in terms of calories. They may diet for half a day but will take something extra high in calories towards evening . Or they will eat outside and the calorie count jumps. Overall they tend to consume more calories and fat/ sugar rich food. Since these habits are usually formed early in life these people have no idea how little the body actually needs. Its like how a rich man who spends Rs.5000/- for a dinner with family can not imagine how working class people can survive the whole month on that money and still be healthy. The whole mindset needs modification, and a good starting point is to actually begin counting the calories and stay within limits.

One hour of vigorous – say on treadmill or brisk walking is bare minimum need for people who hold desk jobs and for housewives who use servants. This is enough to maintain weight if your calorie count is right. Exercise alone without diet control will not help.

Its time to revise the basics and use the common sense. If you were within healthy weight range before liposuction and had the liposuction done just to improve your shape by removing some odd bulges- you don’t need to do anything special. Your food intake and energy expenditure was balanced to begin with. So just continue as usual and enjoy your good figure.

If you were 4-5 kgs overweight ,but maintaining at the same level 1 year prior to liposuction, you are likely to maintain the results if you continue with same diet and activity.

If you were say, 10 kilos overweight before liposuction, and your weight was not stable before surgery. Also you find it hard to count calories and you are too busy to exercise- then common sense dictates that you are at risk of putting on the weight again, unless you change your lifestyle. If you opted for liposuction because you did not have enough time to lose weight on your own, say before your engagement then at least change your lifestyle after liposuction.

So all of you who are worried about putting on weight after liposuction, here are some practical tips:
• Buy a book containing calorie count of common foods and count your calories everyday- till its imprinted    on your mind.
• At least half the quantity of food you consume should be fresh/boiled vegetables and fruit. You can   substitute one whole meal with these if you like.
• Buy low fat cookbook or gift that book to your mother/wife.
• Pack home cooked food.
• Limit eating outside to once a week.
• Find time for exercise. Join a gym if you have the starting trouble then you can do it on your own once   the habit has set in.

Remember, developing obesity is a result of longstanding lifestyle defects. By making exercise and healthy eating an essential part of your daily living you can not only maintain but also improve on the results you got from liposuction.

Making New Breasts with Plastic Surgery

Breast cancer is one of the most common cancer affecting women. Early detection of cancer and intensive treatment with surgery, radiotherapy and chemotherapy has increased the survival rate and a lot of patients are living long life even after breast cancer. That raises the question of quality of life of cancer survivors. Breasts are an integral part of woman’s body and her self image. Without breasts women feel incomplete and studies have demonstrated that they suffer from lack of self confidence and depression. Relationships also may suffer. Lack of breast is a constant reminder of the disease that they have left behind. Plastic surgery reconstruction of new breasts after mastectomy can help women overcome the sense of loss and give them a normal body.

When the cancer is detected very early by mammography or during routine breast self examination, and its size is smaller than 2 cms and it has not spread outside the breasts, total breast need not be removed. That is why early detection is very important. Unfortunately many times cancer lump is larger or has spread to lymph nodes by the time it is detected. In this scenario complete removal of breast becomes mandatory. New breast can be made immediately at the same time of mastectomy (breast removal) or can be made at any later date. Immediate reconstruction is popular in western world, and it is also covered by insurance there (but not in India) as breast reconstruction is considered an integral part of breast cancer treatment in west. There is hardly any woman who does not get her breasts reconstructed after breast cancer. At times in advanced cases reconstruction is done as a delayed procedure, after completing chemo and radiotherapy, to make sure that the cancer will not come back.

There are many ways a new breast can be made. The most popular procedure worldwide is TRAM flap. In this procedure new breast is made by taking skin and fatty tissue from the lower abdomen below the belly button. Areola and nipple is made in second stage and a very natural looking and soft breast can be created.

Breast can also be made by taking skin and muscle from the back. This tissue is called LD( latissimus dorsi) flap. Usually a breast implant is placed under the flap to give it good size.

Breast can also be made by first stretching the skin on the flat chest with a balloon like tissue expander and then placing an implant in the stretched skin envelope after removal of tissue expander. This surgery requires two stages. Breast implants are made of high quality silicone gel and they are available in different sizes and shapes to match the normal breast.

Sometimes the normal breast is sagging or too big. In that case to achieve perfect symmetry, normal breast also can be lifted or modified in size to match the reconstructed breasts. The end result is usually pleasing and natural looking.

Breast reconstruction is a major surgical procedure. Ideally even before the cancer surgery is undertaken a plastic surgeon should be consulted to plan immediate reconstruction if possible. Close coordination between cancer surgeon and reconstructive surgeon is a must. Reconstruction surgery takes 3-4 hours to perform under general anaesthesia and 3-5 days of hospital stay is required. Complete recovery may take more than a month’s time. Areola and nipple are made usually under local anaesthesia in another stage after 3-6 months. Chemotherapy if needed can be given after or before breast reconstruction. The reconstructed breast does not interfere with follow up of cancer for recurrence.

Breast reconstruction is a popular procedure worldwide. In our country due to lack of awareness it was not so common until recently. But now more and more women are seeking this procedure to improve their quality of life for years to come.

Stunning Figure- Secret of “ Yummy Mommies”

Motherhood is a beautiful experience. Unfortunately it brings with it permanent changes in body, which some women are able to hide effectively in clothes and some others are not. The fear of childbirth at younger age and living lifelong with sagging body makes some women postpone the childbirth and avoid breastfeeding while some others sigh at the sight of shapely women like Malaika, Madhuri and Hemamalini who look gorgeous even after having babies.

In past women bore children at younger age and were working hard performing their household work and raising children. They did not put on excessive weight during pregnancy and lost it quite soon after childbirth. Whatever loose skin on tummy remained or if their breasts sagged they accepted it as a part of life and tried their best to hide the flaws in suitable clothes. Scenario has changed with time in more than one ways:

Women are gaining more weight during pregnancy: This is due to better availability of food, excessive indulgence by family and overall sedentary lifestyle. Some women develop problems like hypertension during pregnancy which makes them still heavier. In a high risk pregnancy often women are prescribed rest which again contributes to their weight gain.

Women are not working as hard at home as in past: Due to the availability of household help and maids who look after kids.

Women are going back to the deskjob sooner after childbirth: This is inevitable due to their demanding professional lives and financial considerations.

Women do not breastfeed for long: Breastfeeding is not only good for child but also helps mother lose a lot of weight. Breastfeeding for upto an year or more is a thing of past. Due to their work or social lives women prefer to wean the child completely in a couple of months. Generally they tend to mix breastfeed with bottle feed which in turn leads to faster drying up of milk. Even though they are feeding the baby infrequently they tend to take rich food during breastfeeding. All this contributes to weight gain.

Women do not get time to exercise after childbirth: They are usually overwhelmed with the child and work. By the time they are pregnant with the second child they are still overweight and the cycle continues.

Society, jobs and women themselves today are more demanding. The need to be fit and look young is on everyone’s mind. The factors responsible are:

Exposure to media: One sees middle aged “yummy mommies” coming back so shape and flaunting their flat abs even before the baby is out of the cradle. So an average woman is perceived as careless and uninterested if she continues to be fat after having children. Very often husbands are not happy with fat wife.

Jobs are demanding: Not just air hostesses and actresses, women in variety of jobs like hospitality, fashion designing, marketing and sales need to look trim always. Even other professions like software engineers need to look fit to be perceived as efficient and competitive. Doctors need it too to be able to set an example for their patients.

Desire to wear fashionable clothes: Like jeans and T- shirts which do nor hide the flaws too well.

Lifestyle sports like swimming: Require slim figure to be able to get into swimsuits.

So what is the secret of getting back enviable shape after childbirth? Are some women plain lucky to have good figure even after having kids.? No, their shapely body is a result of their motivation, balanced diet and exercise and often plastic surgery. Diet and exercise helps them shed fat and tone up their muscles. Most times diet and exercise alone are not sufficient. What women want is:

Flat stomach: Loose tummy is not due to fat alone but due to stretched muscles and skin which loses its elasticity and does not go back completely. This part though well hidden in sarees, tends to show up in other clothes. Tightening the muscles and removing the excess skin with a scar that is well hidden in panties is the secret of flat abs.

Firm breasts: Breasts tend to enlarge during pregnancy and breastfeeding. This stretches the elastic ligaments in the breast and also stretches the shin. The result is sagging, soft breasts with nipple pointing downwards. Unless special support bras are worn the breasts look saggy even in clothes. Breast lift surgery with a cleverly Hidden scar on the undersurface of the breast enables women to wear all kinds of clothes with ease even without a bra.

Trim figure: Often the fat deposits on certain places like hips and thighs refuse to go even after healthy weight is achieved. These resistant bulges can be easily and permanently removed with liposuction through small holes.

If healthy lifestyle in form of balanced diet and regular light exercise like walking and yoga can be fitted into the schedule one can expect stunning figure and long lasting results with plastic surgery.

Cosmetic Surgery for Fitness Freaks

“Cosmetic surgery for fitness freaks” does that sound incongruous? The fact is a lot of plastic surgery patients are regular gym goers.

• Gym enthusiasts have high expectations from their bodies- they often want chiseled bodies which seems    elusive at times even with the toughest workout.

• Some fat deposits are genetically resistant to diet and exercise: Like fat on lower abdomen, love    handles, outer thigh bulges or hips. Even after idea weight and muscle toning is achieved these bulges    stay on.

• People who have shed a lot of weight with exercising are left with loose hanging skin that bothers them.    Due to accumulation of sweat underneath these folds tend to become irritated and infected.

• Chest bulges in men (gynaecomastia) stand out in gym wear against their flat abs.

• Some people who avoided gym earlier become motivated to maintain and improve the results of their    body contouring by plastic surgery. Plastic surgeons advise people to maintain healthy lifestyle.

• Breast size and shape can not be modified significantly by exercising and disproportionately smaller or    larger breasts distract from the rest of the body.

• Some people lose facial fat before the other parts of body and end up looking old and haggard.

And how does plastic surgery improve these nearly perfect bodies? Gym goers are plastic surgeons delight because they provide good base to work on. Some of the most spectacular results of plastic surgery are seen in fitness enthusiasts. Similarly some of the perfect figures seen in gym and on screen have taken plastic surgeon’s help. Plastic surgery comes handy in:

• Liposuction can help remove localized bulges from anywhere in body to balance the figure.

• High definition liposculpturing and body etching can outline and define sixpack abdomen.

• Abdominoplasty (tummy tuck), thigh lift, buttock lift arm lift and lower body lift procedures can handle    problem of hanging skin.

• Gynaecomastia surgery is often the only way to flatten male chest and show the pectorals.

• Some bodybuilders who are unable to develop their pectoral muscles take help of Pectoral silicone     implants to mimic bulging pectorals. Similarly calf implants can be used for enhancing underdeveloped     calves.

• Breasts can be balanced by breast reduction, breast augmentation and breast lift surgeries.

• Sunken cheeks can be filled up with fat from ones own body or face can be lifted.

Healthy diet, exercising and plastic surgery work in tandem to achieve the perfect bodies. They are complimentary and not mutually exclusive.

Why are My Breasts Sagging

It’s disheartening to see once perfect breasts lose shape. Unfortunately sagging is an inevitable process related to gravity and aging.

Young natural breasts are conical with nipples pointing towards front or slightly sideways. The part above the nipples has a gentle sloping profile from collarbone to the nipple. Lower breast is full and rounded. There is a natural cleavage. Nipple is above the breast crease. Outer part of breast is rounded. The breasts do not go beyond the imaginary line dropped from the anterior axillary fold which is the front part of armpit.

Not all young women have perfect breasts though. Frequently Obesity and weight fluctuations are the reason behind early breast sagging. Sometimes breasts can grow very large and sag in otherwise slim young women, due to hormonal hypersensitivity of breasts. In another condition called snoopy breast deformity, breasts are small and sagging with large areola and nipple.

Gravity and aging is the main cause of breast sagging. Due to the law of gravity breasts with size D and above start sagging quite early, even though they look good in the supportive bra.

Skin envelope of the breast is attached to the underlying Pectoralis muscle with supportive cooper’s ligaments. They are the delicate pillars. In between are breast glands, ducts and fat. Breasts sag whenever there is relative skin excess associated with loss of breast substance and laxity of ligament pillars. This is observed in women who have lost a lot of weight. Obesity has become a major culprit of breast sagging. Fatty breasts are softer due to relative excess of soft fat over firm glandular breast. Yo-yo diet and major weight fluctuations also lead to breast sagging.

Pregnancy is another important cause of sagging breasts. During pregnancy the breast glands enlarge to prepare themselves for breastfeeding. Breasts are further stimulated to grow by breastfeeding. After stopping breastfeeding these glands shrink leading to sagging breasts. Sagging occurs even when the woman has not breastfed. Women who gained a lot of excess fat during pregnancy and lose the weight later experience more sagging.

In india, a lot of young unmarried women queue up at beauty shops for firming and lifting up their breast, with so called breast lifting machines and massages. Nothing works on breasts, neither machines nor massages or exercises. Wearing good bra does not significantly prevent sagging. Sagging can either be accepted as it is, or can be simply corrected by breast lift surgery.

Preparing Yourself for Smooth Recovery After Breast Implant Surgery

Cosmetic surgery is a very private decision. Most cosmetic surgery patients do not inform their office or friends about their surgery want to join work and social activities at the earliest. Even people living with their parents or in joint families do not want to involve others in their decision and therefore end up looking after themselves. Following tips will help you plan a smooth recovery from surgery: Those of you who live alone or in hostel, or do not want to involve too many people in your care can prepare yourself for surgery in advance. Here are some suggestions for you to have a problem free surgical experience during first couple of weeks after plastic surgery. Support: If you are having day care breast surgery, its mandatory that you have some friend or family whom you have taken into confidence stay with you for 24 hours after surgery. That person should accompany to back to home from hospital and he/she should have Dr. Priti’s number to reach in case of any need. In the absence of such a person it may be required for you to stay in hospital for longer time (2-3 days). If you live in a joint family you may not wish for others to know but it is strongly recommended to have your husband’s support. If he has any apprehensions about your decision he can meet Dr. Priti. She would be happy to clarify his doubts. This surgery is not an emergency surgery. You can take time to convince him. Bed: keep a lot of pillows (3-4) for back support. you will find it difficult to get up from bed for first few days. Also keep extra pillows to use as arm rest. Bathroom: Keep your toiletries at lower level. Reaching up above the level of shoulders will be difficult during first week. Keep your flush working. Keep a plastic chair and stool for easy bathing/ sponge bathing. Shower is allowed after 4 days only. Kitchen: Keep things within reach and keep your fridge stock full for a week. Have some help for cooking food for a week, or eat light easy to cook food like – pasta, rice, vegetables and fruits, juices. Avoid ordering food from outside. Avoid washing utencils for a week- use paper plates instead. Wardrobe: It is strongly recommended to wear front open loose clothing (shirts). Raising the arms up for dressing will be difficult. Keep bigger size bras (3-4 nos) for after surgery. Bra should have the appropriate cup size (C or D) and it should not be underwired. Try marks and spencers. Back hooks are preferred. Hair: Wash your hair before surgery. If you have long hair you may find it difficult to comb or wash it during first week. Take someone’s help or visit a parlour for wash. Periods: It is not uncommon to miss periods or have heavy periods following surgery. It settles down by itself in a month or two. If not, consult your doctor. Climbing stairs: You can do it slowly. Moving outside home: Get as much rest as possible in first few days. If you need to go out to see doctor its preferable to travel in the backseat of car, with pillows for back support. Autos are not advisable, due to excessive jerks. Driving with seatbelt is possible after 2 weeks and 2 wheeler after 3-4 weeks. Looking after children: If you have little kids,you will need help. Avoid taking them on your lap for 2 weeks. Lifting the baby up is not advisable for 3 weeks. You can dress them up, feed them and comb their hair after a couple of days once you feel comfortable.

Choosing the Right Size Breast Implant

You have the most important role to play in choosing the right implant size, because its your body and no one knows more than you, what you want. Leaving the decision entirely to your plastic surgeon is may lead to possible future disappointment. So how do you know what implant size would look best on you?

Female breasts come in a variety of sizes and shapes. Breasts should be generally in proportion with your body and equal to or slightly less than your hip size. Personal preference, culture, trends, lifestyle, dressing style, hobbies and profession are some other variables that will determine the size chosen by you. Women usually have a good idea about how they want to look like but they are not able to effectively convey it to plastic surgeon. They are commonly referring to their bra size as 30, 33 inches etc without knowing their cup size which is more important because only cup size changes after breast augmentation. So basically there is communication gap leading to confusion.

Knowing your present breast size is the first step. You should know both your band size and cup size. Roughly A cup is 236 cc, B cup 384cc, C cup 621cc and D cup 798 cc. Average woman seeking breast augmentation is A or B cup and wants to be enhanced to C or D . Breast implants are available from less than 100 cc to more than 1000 cc size. Most commonly used implants are 250-450 cc. A 150-200 cc implant will enhance the breast by one cup size. This can be further confirmed by trying sizer implants inside the bra that you would like to wear after surgery.
You can show also the doctor some pictures of women (from magazine/net) whose breasts you like. You can request the doctor for seeing pictures of patients with implants of various sizes

Plastic surgeon will then assess your tissue elasticity and chest wall measurements to determine whether the tissues will allow the size you have chosen to be inserted. The placement of implant whether below or above the muscle also will affect the choice of size. The pocket under the muscle being tight usually does not allow very large implants. While inserting the implants through areola, if areola is small then very large silicon implant can not be inserted. Larger implant can be inserted through inframammary incision in the breast crease.

Implants are available in round and teardrop shape, low, medium and high profiles. Your surgeon can help you choose the best one for you based on your tissue characteristics, measurements and breast shape.

Choosing the right implant is important. Studies have shown that most common cause of second surgery after breast augmentation is woman seeking to change her implant size. This can be avoided by choosing the right size carefully. Its advised to try the sizer implants and check yourself in full length mirror from all angles with and without clothes. Some women are apprehensive about looking too big and therefore choose smaller implants. Not uncommonly, after surgery they get used to the new breast size they find it small and want bigger implants. Hardly any woman complains about being too big after surgery I therefore suggest my patients to err on the side of bigger size. Choosing the right implant carefully is the best way of avoiding disappointment and secondary surgery.

Breast Aging

Female breasts change throughout life. Desmond Morris in his book ” The Naked Woman” describes 7 ages of female breast:

• Nipple breast of childhood.
• Breast bud of puberty.
• Pointed breast of adolescent.
• Firm breast of young adulthood.
• Full breast of motherhood.
• Sagging breast middle age.
• Pendulous breasts of old age.

Breasts are glands with important function of nourishing the newborn. Apart from this they have a strong association with female gender identity and sexuality. Anatomically the breasts are composed of milk glands, ducts that carry the milk to the nipples, supporting fibrous tissue and fat. Throughout the lifecycle the quantity and proportion of these individual elements keeps changing.

At birth the breasts are virtually nonexistent. At times both in male and female newborns the breasts are swollen and even ooze milk when pressed. This is because of circulating female hormones of mother in baby’s body. In a couple of weeks the hormones disappear and breasts spontaneously flatten. In India grandmothers try to squeeze the milk out everyday. This only makes the baby cry and possibly damages the breast. This practice is best avoided.

Breast development is the first sign of puberty. Breast buds develop much before the menstruation starts. Small breast bud is visible. Throughout the teenage years breasts develop at a steady pace. This growth is affected by the general health of the girl. Its not uncommon to see flat chest in undernourished girls and excessively large breasts in obese girls. The difference is usually in fat content of the breasts.

Breasts look their best in late teens- the so called photographic super breasts .At the age of about 25 human breasts are at the peak of their growth. They are hemispherical but not usually sagging. With pregnancy come the major changes in the breasts. Breasts start enlarging in early pregnancy and sometimes become tender. Ducts and glands are growing at this time under influence of female hormones. By 6^th month drops of milk are being produced. Once the baby suckles, breasts grow further, especially the glands part, to produce milk. Milk production is not related to the size of the breast . Women with very small breasts can feed effectively and sometimes huge breasts do not produce any milk. The reason is usually hormonal.

Once breastfeeding is stopped the hormones become inactive and the breast glands and ducts shrivel. Fat and larger skin envelope remains as it is. At times women loose the extra weight they gained during pregnancy and breast fat also goes down. All this results is saggy breasts of adult life. Breasts are flatter on top and heavy and round at bottom.

Nipples are low and point downwards. There may be stretch marks and areolas are larger. Due to relative excess of fat in comparison with gland and fibrous tissue breasts feel softer. Wearing an under wire support bra becomes necessary to give shape to the breasts. With advancing age, in older life breasts become more and more softer, empty and saggy in sixties and seventies.

All breasts do not age similarly. Aging is worst when woman has had major fluctuations in weight and has nursed several babies. Some women lose the breast volume completely after nursing whereas in others breasts stay larger. Bra does not help much except it can make saggy breasts look good in clothes. Plastic surgery of breasts can reverse the signs of aging and make the breasts look their best at any age.

What is The Ideal Breast Size

Beauty is in the eyes of the beholder. The parameters of beauty also differ from one culture to another and also change with time and fashion. Ancient Indian sculptures and art depict women with full hemispherical breasts. Such breasts are still in vogue in India especially with women who prefer traditional saris or other ethnic dresses. The West, in contrast, has seen a lot of change in fashion -as related to breast size. In last hundred years fashion changed from full breasts to small flat look to artificially enhanced look.

Breasts should be proportionate to woman’s body frame and build. The concept of 36-24-36 inches, though quite exaggerated, basically refers to breast size being equal to hips, with a significant narrower waist in between.

Breast size is commonly referred to in terms of cup size, B C and D cup sizes being most common. The C cup is a moderate and pleasant size for a woman of an average build. The B cup may look adequate on a petite athletic woman. A lot of western models are a cup size B. D cup size breasts are full and look good on women of larger a frame. A lot of Indian women seeking breast augmentation like cup size D, especially married women who have had children. Younger, unmarried women tend to prefer smaller breasts.

A Woman’s body build is important in determining the most suitable breast size because if one’s arms or tummy is bulky then the breasts will have to be bigger to give the right profile. In thinner women relatively smaller size breasts will give the same look of fullness in the breasts.

Ideal breast size is also determined by one’s lifestyle. Active sporty women like moderate sized breasts. Women who wear heavier clothing like sarees want larger breasts. In contrast women who wear flimsy or western clothes may prefer moderate size breasts. Women in the entertainment industry prefer larger breast sizes.

A lot of women with breasts smaller or larger than average are perfectly satisfied with their size. Some women, on the other hand, are uncomfortable or embarrassed about their breast size. Sometimes their partners are dissatisfied. In such circumstances plastic surgical augmentation or reduction of breast can help women achieve a size they are more comfortable with or desire.

What is Your Bra Size

According to a latest UK survey more than 70 percent of women wear incorrect bra size. The result is improperly fitting bra which looks odd and provides improper support. Many Indian women are not aware of the concept of cup size and they commonly buy bra only by size in inches (32, 34). Most Indian manufacturers offer only limited range of sizes. Commonly in the plastic surgeon’s clinic woman with small breasts says that she wears 32 inches bra and wants to be 36 inches after breast augmentation. Or a woman with larger breast may be wearing a size 40 bra which she says does not fit her properly but she wears it because of non availability of her size.

These numbers do not represent the correct bra size. Bra size is a combination of Band size and Cup size. Leading bra manufacturers of the world make bras with cup sizes like A, B, C, D, E, F, G. To determine your correct bra band size you should measure your chest in inches with a soft measuring tape, first below your breasts where the bra band usually lies (measurement 1). To this measurement add 5 or 6 to get an even number and that is your band size. For example if the measurement is 30 inches below breasts then your band size is 30+6=36 inches and if the measurement is 31 inches its 31+5=36 inches. Next you measure the breasts at the most prominent part (measurement 2), while wearing a comfortable non padded bra. The difference between this second and the first measurement (in inches) gives the cup size.

Difference between measurement 2 and 1 Cup Size

1 inches	AA
1 inch	A
2 inches	B
3 inches	C
4 inches	D
5 inches	E/DD
6 inches	F/DDD
7 inches	G/DDDD

Since fit can vary somewhat with bra design material and brand, it is advised to try the bra before purchasing it.

It is quite obvious to you now that doing a surgery on breast, whether it is breast augmentation or reduction surgery, will not change the band size. Only the cup size changes. Only when you know your breast size, you can convey to your plastic surgeon what you would like to be after breast surgery. If you are seeking breast implant, you can buy a new bra of your desired size and then try sizer implants in the doctor’s clinic inside the bra to get an idea about how you will look after implants.

Why do Men Seek Cosmetic Surgery

Cosmetic surgery is one area where women are leading. Men traditionally were not interested in self adornment. With time and changed social realities men have not only opened up to the idea of cosmetic surgery but have taken it up in a big way. Men seek cosmetic surgery for the same reasons as women- to look and feel good. This is a simple yet profound reason with many conscious and subconscious motivations. Common motivations are:

• To lead a normal social life: Men with enlarged chest never take their shirts off. They avoid gym or swimming pools and wear only loose thick clothes to hide their deformity. After gynaecomastia surgery they experience freedom and become more social, active and confident. Obese men who have lost a lot of weight, have hanging folds of skin on their body. They experience the similar self imposed isolation and plastic surgery helps the situation.

• Better career opportunities: Some professions demand perfect flawless looks like air stewards, models, actors. But in today’s market oriented scenario people with good looks have an edge everywhere especially if they are talented. Job insecurity and increasing retirement age makes one try to look young and energetic every time he is attending a new job interview. Obese people are discriminated against and perceived as lazy. Liposuction and facelift surgeries then become a professional expense with rewarding returns.

• To succeed in relationships: Some men are convinced that changing some facial feature will make them more successful with women. Some older men get the facelift done to marry younger woman. Fat men look more attractive after they become slim. Sometimes the effect of surgery is on person’s own mind than on others. If after correcting the physical flaw he becomes more happy, confident, and outgoing automatically he becomes more attractive to the opposite sex.

• Peer influence: Sometimes when the wife or a friend has got cosmetic surgeries done and is looking young and fabulous, husbands also get motivated. Some young balding men are pestered into having hair transplant surgery by their parents and relatives to improve their marital prospects.

• To avoid ridicule: Some kids are ridiculed by friends for prominent ears, larger chest or flat nose etcetra. This leads to inferiority complex and frustration which affects their interest in studies, sports and social life. Simple plastic surgery procedures make a world of difference to their well being.

• Due to some psychological reasons: Its not uncommon to find young men who are severely distressed by some minor physical flaw. They may blame all that lacks in their life to that one problem. They have unrealistically high expectations from plastic surgery and usually they do not feel happy even after a successful surgery.

A good plastic surgeon is always interested in ascertaining the true motive why the patient is seeking cosmetic surgery. People with stable confident personality who are seeking cosmetic surgery to make them look and feel better – the way they do after owning a new car or watch- are the best candidates for cosmetic surgery. Those who have deep seated inferiority and insecurity do not get cured by cosmetic surgery alone. Sometimes they are unhappier after surgery and cause distress for the surgeon too. Experienced plastic surgeons avoid to operate on such people.

Preventing Breast Cancer

Breast cancer is the commonest cancer of women in the world. It can happen to anybody, young or old, married or single. One in 5 women is at the risk of developing breast cancer in her lifetime in USA. In India the incidence is slightly lower but it is increasing. A lot of research is being done to find the cause and cure of breast cancer. Cause of breast cancer is still unknown. Certain cancer genes have been identified that run in families or can occur newly by mutation in women without any family gene. Tests are available to detect such a gene so that extra precautions can be taken to detect cancer early in women with such genes. Since the advances in plastic surgery have made it possible to create attractive new breasts, women who are genetically at high risk can go for removal of breasts and reconstruction. Prevention gives the best chance of cure. You can beat the cancer by being cautious and detecting it early. Remember cancer starts as a painless lump in the breast and you have the best chance of detecting it yourself. By Breast self examination ( BSE). This is how you can do It: • Stand in front of a mirror with top exposed. • Place hands on hips. • Look for signs of dimpling, swelling, soreness, or redness in all parts of your breasts in the mirror. • Repeat with arms raised above your head. • While still standing, palpate your breasts with your fingers, feeling for lumps. Try to use a larger area of your fingers rather than prodding. Feel both for the area just beneath the skin and for the tissue deeper within. • Go over the entire breast while examining. One method is to divide the breast into quadrants and palpate each quadrant carefully. Also examine the “axillary tail” of each breast that extends toward the armpit. • Repeat palpation while lying down. • Check the nipples and the area just beneath them. Gently squeeze each nipple to check for any discharge. Breasts tend to feel different in different parts of menstrual cycle. Therefore BSE should be done 7-10 days after the first day of periods, every month. Once you get the feel of your breasts it will be easy for you to detect any change and you will be able to differentiate normal breast feel from that of a lump. If you have detected a lump or nodule do not panic, because 8 out of ten times these are harmless. You should go to an expert surgeon for examination. She/he may advise further testing if needed like mammography( breast X ray) and sonography of breast -both of which are painless .Fine needle biopsy may also be needed to get the diagnosis. If the lump is benign (harmless) it can be left alone or can be removed through small incision. If it is malignant (cancer) and detected early (less than 2 cm size lump) then it is possible to have breast preserving surgery wherein only the lump with surrounding rim of normal breast is removed leaving behind rest of the breast and radiation to the breast. For bigger cancers treatment usually involves total removal of breast and chemotherapy, with or without radiotherapy. Plastic surgical breast reconstruction is commonly done after total removal of breast. If the cancer is detected in early stage, very long survival 20 years or more is known after complete treatment. After the age of 40 yearly mammography can be done to detect any minute cancer. It is like an X ray and is painless. Early detection not only allows for breast preservation but also increases the chances of cure.

Plastic Surgery Without Scar – Fact or Fiction

The word scar brings to mind the irregular long hatched marks one remembers seeing on the tummy of some relative who had surgery, or ugly marks left after an accident or some cut which was stitched in haste by a doctor/ nurse in emergency. The word “scar” in medical language means any mark after any injury or surgery, however faint it may be. Plastic surgery is widely believed to be a scar less surgery. But do you really think any surgery can be performed without a cut- or without a scar? So what is the fact?

Plastic surgery scars differ from all other surgical scars because if well healed and matured, they look like fine line with no cross hatching. They are neither elevated, nor depressed and are skin coloured. The truth is that even plastic surgery involves cutting the tissues and thus a scar. Only difference is that plastic surgeons use special tricks to minimize the scar:

Concealed location: Plastic surgeons choose deep creases or hidden areas to operate so that scar is not obvious even if it is there.

• In nose surgery cuts are made inside the nose. Sometimes cuts are made outside the nose but in places    like where nostril meets the cheek. Being in the crease, the scars are not visible.
• Facelift scars are mostly hidden inside hair and behind the ear in the crease. A small portion of scar is on    face at the place where cheek meets the ear. The scar is fine and thus inconspicuous.
• Eyelid surgery scars are in the eyelid crease and thus not visible.
• Chin surgery scars are under the chin.
• Lip reduction surgery scars are inside the lips.
• Breast augmentation scars are on undersurface of breast.
• Male breast surgery scars are cleverly placed in a semicircular manner at the junction of dark areola skin    and normal chest skin.

Smaller scars: Liposuction surgery can remove a lot of fat through 4mm cuts. Similarly gynaecomastia surgery can remove enlarged male breast through a very small cut.

Finer materials and techniques: Plastic surgeons use delicate instruments and fine suture material (threads), and fine needles. They also put a lot of absorbable stitches under the level of skin and sometimes avoid skin stitches altogether. Instead of using few coarse stitches on skin they use tens and hundreds of fine stitches, both under and on the skin. They use magnification to stitch exactly. These finer techniques are time consuming. Plastic surgery work can be equated to darning versus ordinary stitching.

Early stitch removal: Plastic surgery stitches are at multiple levels, therefore the outer skin stitches can be removed early, so there are no stitch marks. Sometimes there are no skin stitches at all, only stitches under the skin which need not be removed.

Good care after surgery: Plastic surgeons look after the scars till they are fully matured in 6 -12 months.

All scars are not alike nor are all scars ugly- especially not the plastic surgery scars. Only in exceptional circumstances depending on individual’s scarring tendency, can the scars be prominent. Usually scars fade with each passing year.

Will I have Scar After My Surgery

Every surgery involves cutting the skin, including cosmetic plastic surgery. People opting for cosmetic surgery understandably want as little marks of their surgery as possible. Fine scar is always a part of a good cosmetic surgery result.

Cosmetic surgery scars are fine to begin with. They are like a line without any cross hatching. Gentle techniques and fine stitching materials are used to close the incision (cut). Under ideal circumstances these incisions heal within a week and gradually mature over a period of an year or two and have the potential of becoming virtually invisible except at a close look.

All scars on body undergo a process of change with time, that is called maturation of scar. Even though externally skin is healed the internal healing of scar goes on for months.In first few weeks or months scars tend to be pink or red. They blanch momentarily when pressed with finger. This indicates that scar is still healing. With passing time scars become paler and gradually come close to skin colour and texture. This process is called maturation. This maturation can take anywhere between 6 months to 2 years.

Scars behave differently and sometimes unpredictably in different people. Therefore result can be vastly different even if the same technique is used for stitching. Following factors determine the final appearance of scar, in the order of importance;

• Individual skin type: There are 6 types of skins . Fairest and delicate Scandinavian skin is type one and thickest dark African skin is type 6. In between these are other skin types from fairer to darker. Tendency of scarring is least in fair, type one skin and maximum in dark type 6 skin. Indian skin is type 4-5. Therefore a surgery done on a fair European may heal with invisible scar but the same surgery may leave a scar on Indian skin. There are 6 types of skins. Fairest and delicate Scandinavian skin is type one and thickest dark African skin is type 6. In between these are other skin types from fairer to darker. Tendency of scarring is least in fair, type one skin and maximum in dark type 6 skin. Indian skin is type 4-5. Therefore a surgery done on a fair European may heal with invisible scar but the same surgery may leave a scar on Indian skin.

• A surgical technique: Gentle techniques, finer suture materials and use of magnification lead to better scars.

• Part of body: In the same individual, scars may be of different quality on different parts of body. Face and neck fair better than chest, back, arms and legs.

• Care after surgery: Sun protection, massage with certain creams, pressure follow up with your plastic surgeon and timely care in case of first sign of any problem are important for best results.

Day Care Cosmetic Surgery

Those of you who have had any surgery or have looked after someone having surgery in the family, know that it involves a lot of preparation and recovery time. For a routine surgery patient usually gets admitted the day before surgery, is examined by junior doctors and blood and other tests are done. For a lot of major surgeries blood is reserved in the blood bank for which usually a family member or known donor is needed. On the night before, shaving of the part to be operated like abdomen, groin, armpits chest, legs or head is done by hospital staff- and one only prays that they would be gentle and not cause any cuts. Then comes the worst part- rectal enema which is considered mandatory before anaesthesia. After overnight fasting or fasting thru the day (at least 8 hours) one is taken into the operation theatre. After surgery patients averagely stay in hospital for 2-5 days and sometimes longer, during which time fluids and antibiotics are commonly given intravenously apart from intramuscular painkillers. These wholes exercise though necessary at times has very powerful negative psychological impact on the patient and the family and even though surgeries have become safer people still fear them.

There are several disadvantages associated with this prolonged process:
• Lot of time way from work and family.
• Lot of manpower (family or friends) is needed.
• Loss of privacy due to shaving and enema.
• Hospital acquired infections are associated with long hospital stay.
• Prolonged iv fluids cause additional pain and sometimes swelling.
• Increased cost associated towards room rent, duty doctor and nurses visits etc. Attendents also have to   spend additionally on food and travel everyday.
• Psychological feeling of being sick while in hospital.

Day care cosmetic surgery is a relatively new concept in our country but its gaining popularity rapidly. Going for day care surgery involved following steps:

• Visit to doctor in her clinic with the blood test reports. You are examined by doctor personally and related measurements and clinical photography are done in privacy. Consent forms are filled now rather than in the morning of surgery, so that you have enough time to go over them and ask any questions. Then you are handed simple instructions to be followed before surgery which are usually nothing more than fasting for 6-8 hours. You may be asked to remove hair from armpits or groin at home if necessary. A lot of cosmetic surgeries are done under local anesthesia for which you don’t even have to fast .

• Report at the hospital at the designated time usually in the forenoon, one hour before surgery. There is no more examination by duty doctors, beyond recording your pulse, BP and temperature.

• If surgery was under local anaesthesia patient goes back home 1 hour after surgery. If surgery was under general anaesthsia then patient is shifted to postoperative unit for 4-5 hours. When he is fully conscious , has eaten food, is walking and comfortable, he is sent home, usually 6 hours after surgery.

• Patients are instructed to have someone with them at home who can reach the doctor in case of any emergency. All medications are given orally and stitches are removed in doctor’s clinic.

A lot of cosmetic surgeries like nose jobs, facial surgeries, breast surgeries and liposuction can be done as daycare surgery. Patient has to be perfectly healthy to have daycare surgery. Only procedures that take shorter than 2 hours to operate and which are not associated with significant blood loss are selected for daycare surgery. Special anaesthesia is given for quick recovery. If the abovementioned criteria are followed the daycare surgery is safe.

Most cosmetic surgery procedures are superficial and not very painful. Usually patients do not want to involve too many people in their care and do not want their surgery to be a common knowledge. Day care surgery involves less cost and less risk of hospital acquired infection. Therefore demand for daycare surgery is increasing.

How to Minimize Scarring After Cosmetic Surgery

People believe cosmetic plastic surgery to be totally scar free. Cuts are made during all surgeries including cosmetic surgery. Cosmetic surgery cuts are originally sutured very finely and after healing they look like a fine line which fades gradually over a period of one year or more. Extra care is taken during surgery by using fine instruments, suture materials and special techniques to make the finest scar possible. But just having a cosmetic surgery done does not guarantee good fine scar. There are many other factors that can make difference in the final result, like individual skin type and care after the surgery. Whatever may be the skin type good care after surgery always improves the results. Care is essential with Indian skin which is not very favorable from scar point of view and also tends to have excess pigmentation. General tips are: • Timely stitch removal: If removed too late marks can form. • Sun protection: Regular usage of sunscreen cream of SPF 20 or more every 3 hourly when outdoors is essential during first 6 months • Massage with certain creams: Massage is more important than cream itself. Gently massaging the scar twice daily for 5 minutes with a simple cream like Nivea for 3-6 months on a fresh scar can work wonders. At times some other creams like silicone may be prescribed if the scar is not favorable. • Pressure: Wherever it is possible to apply, pressure helps. Like wearing a headband for a forehead scar and elastic band on arm or leg scar. Elastic compression garments can be specially made to fit any body part for this purpose. Proper pressure band/garment should be worn more than 12 hours a day for 3-6 months. • Taping: Paper tape application on the fresh scar helps in early maturation and fading. Regular monthly followup of scar especially during first 6 months after surgery is important. Early detection of problem and timely action prevents bad scar. Signs of problem are: • Elevated, red and itchy scar: It requires immediate attention. Injections of steroids into the scar, silicon sheet or gel and pressure may be needed to suppress this kind of scar. • Hyperpigmented (dark) scar: This type of scar responds to special creams and sun protection. First 6 months after surgery is the golden period during which scar is fresh and can be improved by timely action. Once scar is old repeat surgery to improve the scar will be needed. Good care and regular follow up visits during this period can help you get the best and the finest possible scar.

Can Plastic Surgery Change One’s Identity

You see it all the time in soaps and cinema. There you see someone who is changed completely, so much so that they live with their friends without being identified. You also hear of international criminals taking another identity reportedly ith the help of plastic surgery in some unknown faraway countries. And do you believe this is possible?

Let us examine the facts one by one. Face is the most identifiable part of a person. What can plastic surgery do for the face? Plastic surgery is commonly performed to improve one’s features. Take the case of nose. Plastic surgery can turn a flat nose into a prominent one, a thick nose into a slender and shapely one, a very big nose into smaller one. This is done through concealed scars and no one can make it out. Some people have excessively large or small chin. With plastic surgery bone can be shaped and new bone or an implant can be added to give a pleasing look. People who have flat cheeks can get cheek implants done for better definition of face. Sunken cheeks can be made chubby by injecting fat into them which is sucked out from another part of persons body with a syringe. If the cheeks are too chubby they can be reduced in size by removing a little fat through a cut inside the mouth. If the lips are too thick they can be reduced in size by cutting out a thin strip and if the lips are too thin they can be made thicker with certain filler injections or by filling them with one’s own tissue by surgery. In older individuals facelift surgery can remove loose skin and make one look 10 years younger. In middle aged people filler and fat injections can smoothen the face and Botox^TM injections can remove the wrinkles, making one look younger. The acne or pock marks on the face can be smoothened by dermabrasion surgery. Scars on the face can be removed or improved by plastic surgery. If the ears are shapeless or too big they can be fixed. Double chin can be corrected by sucking out fat. Bald head can grow hair with plastic surgery.

The shape of body can be changed markedly with plastic surgery. Liposuction surgery can remove fat from any part of body and can give an enviable figure. Shape and size of breasts can be changed by plastic surgery. A woman can have a Pamela Anderson look with breast implants . Silicone implants can be placed in buttocks to give them J Lo curves. Implants can be inserted in male chest and calves to give the appearance of bulging muscles. If there is a tattoo or scar anywhere, it can be removed.

People opting for sex change often go for plastic surgery to change from a feminine to musculine look or vice versa. Since they also change their clothing, hair and makeup they can be virtually unidentifiable.

Coming back to the million dollar question, can plastic surgery change one’s identity to the extent that even family and friends do not know? Plastic surgery is commonly done to improve the looks, correct deformities and reverse the signs of aging. After such a surgery person gets compliments that he looks better, or younger and most of the times people do not guess that this is because of plastic surgery. But what if person is already young and he or she has no significant deformity or imbalanced features which require plastic surgery. Theoretically it can still be done by abovementioned procedures but result is usually ugly. For example a beautiful nose can be made crooked.

Even if some of those changes are made person can still be identified by his friends and family due to his body language, voice, expressions, height etc. In other words it is possible in movies but not in real life. Also in real life no plastic surgeon will be willing to do such a job. It is completely unrealistic, unsustainable and sometimes downrightly illegal. It’s a great savior for some of the screen scripts though.

Combined Plastic Surgery

Patients often need and request cosmetic surgery of more than one body part. They want to look with minimum number of surgeries and in the shortest span of time. Improvements in surgical techniques and anesthesia safety have made these combined procedures routine. Patients enjoy the benefits of having only one recovery period and sooner gratification. Combination surgical procedures, like all cosmetic operations are individualized for the particular patient. Commonly combined procedures are: • Liposuction of abdomen with another body part like thighs, to give figure improvement. • Tummy tuck with liposuction of hips or thighs. • Tummy tuck with breast lift/ breast implants; for figure correction after pregnancies. • Breast reduction with liposuction of abdomen/arms. • Male breast reduction with liposuction of abdomen. • Nose surgery with chin implants. • Liposuction with fat injection into face. • Facelift with eyelid surgery. Many factors are to be considered before deciding to combine cosmetic surgeries. Person should be in perfect health to be able to safely withstand longer surgery. One should also be prepared for possibility of blood transfusion, hospitalization and longer recovery time. Only when the person is deemed fit combined surgery is undertaken. There are several reasons why combined cosmetic surgery is popular. One can have a more balanced look in just one surgery and one recovery time. People traveling from long distance avoid multiple visits. Cost wise it is more economical. The flip side is that some patients are unrealistic and push the doctor for combined surgeries even when they are not fit for longer surgery. Operating on large areas of body like multiple part liposuction can make recovery period very painful. Safety can never be compromised for convenience, family reasons or cost.

How to Choose Your Cosmetic Surgeon

Cosmetic surgery is increasingly becoming popular. A lot of people gather information a from various sources like magazines, internet and sometimes from others who have had the similar surgery done. But often they are ignorant about the surgeon, and who exactly will be the best to perform the surgery. This is the critical factor in the success of surgery.

The tag of “Cosmetic surgeon” is what people look for generally. Cosmetic surgery is not a well defined term and a lot of doctors (and sometimes quacks) from various specialties use this tag to enhance their practice. Their training and capabilities may be vastly different and it is important to realize that all cosmetic surgeons are not same. It is advisable that you specifically find out the qualification your surgeon has . Cosmetic surgeons come from many backgrounds:

• Cosmetic plastic surgeon (MBBS, MS, MCh Plastic surgery): After 51/2 years of MBBS one takes 3 years degree of MS (master of surgery) during which the surgeon learns to do all kinds of major surgeries like liver, intestines, thyroid etc. Also they learn to handle major trauma and critical patients. Then 2-3 years MCh plastic surgery training makes them plastic surgeons, making it 11-12 years of training. Plastic surgery is a broad specialization and one learns to treat burns, facial injuries, hand surgeries and reimplantation, microvascular surgery and also cosmetic surgery. Depending on their interest and aptitude plastic surgeon at times choose to focus on a certain aspect of plastic surgery and call themselves cosmetic surgeons, hand surgeons or microvascular surgeons. There is no formal degree/course like cosmetic surgery. Most plastic surgeons acquire the skills of cosmetic surgery by informal training in western countries by working with a plastic surgeon who is doing a lot of cosmetic surgery. Cosmetic surgery is a rapidly evolving subject commonly continuing medical education in form of conferences and workshop is required. Cosmetic plastic surgeons perform the widest variety of cosmetic surgery to any part of the body.

• Cosmetic dermatologist (MBBS, MD): Dermatologists do MBBS followed by 3 years skin specialization. Most dermatologists do biopsy of skin, removal of moles and warts etc. They also use lasers for hair removal and other indications.

• ENT surgeons/ Eye surgeons: They do MBBS and 3 years MS in ENT or Ophthalmology. ENT surgeons can perform nose and ear surgeries and ophthalmologists can perform eyelid surgeries.

• Cosmetic dentistry: They are BDS (dental surgeons) with usually some further MDS specialization in dentistry. They deal with surgeries to beautify teeth, jaws and sometimes lips.

Apart from this sometimes one finds MBBS or MS (general surgeons) practicing cosmetic surgery. Some people confuse cosmetic surgeon with cosmetologist. Cosmetologists are not medical doctors- they are like beauticians.

When performing any job qualification acts as quality control. Basic surgical training ensures one’s capacity of handling major surgeries, blood loss and emergency situations. Plastic surgery training emphasizes on gentle and artistic surgery with a lot of imagination and creativity in minimizing the scars. Experience further adds to the skills. Always make sure that the surgeon has the adequate qualifications, training and experience in performing the surgery you are seeking.

Smokers and Plastic Surgery

Smoking is associated with higher risk of complications after any surgery, including plastic surgery:

• Chemical substances in tobacco cause constriction of blood vessels. Good blood supply to tissues is    essential for healing. Surgery in smokers is associated with delayed healing and sometimes necrosis
(death) of wound margins- which may take 6-8 weeks to heal.

• Certain surgeries like facelift, large breast reductions etc need to be modified to suit smokers- too    extensive procedures are avoided for the fear of complications.

• Smokers are at higher risk from point of view of anaesthesia in view of their compromised lung function    and their higher cardiac risk.

Plastic surgeons routinely advise the patients to stop smoking before surgery. Sooner its done better are the benefits. Nicotine patches and gum are available in the market to cut craving. Plastic surgery is a planned procedure. This can be a good chance for person to quit smoking for ever.

Anti Scar Creams – Do They Work

There are creams in the market that claim to remove all types of scars. They are expensive and their advertisements are attractive. But the truth is that by using these creams without consulting a specialist you may be wasting your time and money and possibly inviting trouble.

Most important thing before treatment is the diagnosis. All scars are not alike, basically there are some scar which will never improve by anything except surgery. So you are wasting time using any medicines on them. Among the rest of the scars that can be improved without surgery there are many kinds and each one requires a different treatment. A dark pigmented scar needs a different kind of cream rather than an elevated red scar. Some scars need stronger treatment like injections and lasers or chemical peeling. If you are doing self treatment with these creams you are likely to lose the golden period when the scar is fresh and can be treated without surgery. After the scar is old, nothing else works. The best treatment of your scar, which may be:

• Creams/gels: Different cream for different problem.
• Injections into the scar: Like steroid injection for elevated scar, dermal fillers for depressed scars.
• Silicon gel/sheets: For red elevated scars.
• Laser for pigmented or red scars.
• Chemical peels: For pigmented scars.
• Surgery for depressed scars, birthmarks, old scars, acne scars.

A consultation with a specialist plastic surgeon or dermatologist can save you months of wasted efforts and money.