Cosmetic / Plastic Surgery

The Importance of How We Look.

In the competitive fast paced world that we live in, how we look is extremely important. First impressions make a big difference in making and breaking relations, job prospects and careers. Looking good and attractive, young and youthful brimming with vitality is a desire and dream of many. How you look in the mirror can instill confidence in yourself and improve your self-esteem. Western world has progressed from cosmetics to creams and potions to surgery to improve their looks. It has become one of the most popular specialties in USA and Europe.

Scope of Aesthetic Surgery

Aesthetic Plastic Surgery can be broadly classified into two categories – surgery to make you look younger, more youthful, fresh and to reshape your body to improve your proportions.

Liposuction is the commonest procedure to reshape the body in the West. Other procedures such as Rhinoplasty (Reshaping the nose), Chin and Cheek augmentation, Breast enhancement or reduction, Abdominoplasty, Calf and Gluteal augmentation are few of the other popular reshaping operations. Sometimes, after massive weight loss, skin of the arms, thighs and abdomen have to be tightened and this can be done surgically. Lips can be augmented by injection of Hyluronic acid and depressions can be corrected by Fat injections.

Rejuvenation procedures or operations to make you look younger include, Brow lift, Face-lift, Neck lift and Breast lift. Non-surgical options to get rid of wrinkles and creases on the face include injections of Botox, Restylane and similar hyluronic acid analogues. The finer wrinkles and sun damaged lustreless skin can be improved with Facial peels such as Glycolic acid, and TCA

Liposuction

Liposuction is a procedure in which a suction device is used with a cannula to suck fat cells from under the skin. The fat cells that are sucked and destroyed in this process are lost permanently. This is a quick, easy and definite way to get rid of fat that refuses to disappear even after vigorous exercise and dieting. It works best for localized fat deposits around the lower abdomen, hips, flanks and thighs. Newer techniques such as Power Assisted Liposuction with Super wet infiltration allow sculpturing of the body surface, hence called liposculpture. It can be done under general or local anesthesia. Minor liposuctions can be discharged on the same day, but it is preferable for major liposuctions to stay in the hospital for a day or two. After the operation, it is usual to find swelling and bruising. This subsides by 3 – 6 weeks. This is a reasonably safe procedure in the hands of well-trained Aesthetic Plastic Surgeons. There are risks associated with general anesthesia. Thrombosis of leg veins is a risk associated with age and lying in one position for a long time. Adequate precautions are taken to prevent this. Other risks include contour irregularities, which can be corrected by further liposuction or fat injection.

Abdominoplasty

This is an operation in which the excess fat and skin folds of the abdomen are removed surgically. It is advised when the skin is in excess along with the fat, and is unlikely to contract after liposuction. Many women develop a skin fold in the lower abdominal region and weakness of the abdominal muscles, especially after a caesarian section. This causes protrusion of the abdomen below the umbilicus. It can affect the posture and cause low backache as well. This operation can get rid of the skin fold. At the same time, the muscles of the abdomen can be tightened, a procedure called "correction of divarication of rectii". This whole operation is done through a caesarian type low transverse scar, which heals very well and fades over time.

In a full abdominoplasty, the umbilicus has to be re-sited, in a mini-abdominoplasty- the umbilicus is left in the same place and only the lower abdominal skin is removed. A newer technique that we follow combines liposuction with abdominoplasty, thus providing the benefits of both operations.

Risks and complications are the same as for liposuction. There might be delayed healing of the wound. Drains may have to be placed in this operation to remove accumulated fluid. They are usually removed in 2 – 5 days. Sometimes, after the drains are removed, fluid may re-accumulate and may need aspiration in the clinic.

The results are instantaneous and go on improving for the next 6 – 8 months as the scar softens and fades and the swelling and hardness from the surgery goes.

Rhinoplasty

Rhinoplasty or cosmetic nose operations can change and improve your personality. It is one of the most prominent parts of the face and gives character to the face.

The common cosmetic procedures done to reshape the nose include, removal of nasal humps, correction of depressions of the nose, shortening of the nose, narrowing a wide nose, elevation of drooping nasal tips, correction of boxy nasal tips, and correction of deviation of nose. Cosmetic surgery on the nose is usually done under General but can be done under local as well. Patients usually stay overnight and then are discharged the next day. The nose is usually swollen, there might be bruising around the eyes for a few weeks, and the nose is quite congested for a few days.

Cheek augmentation and chin augmentation/reduction

A balanced proportionate face is an aesthetically beautiful face. The width of the face and the length are governed by exact ratios, which makes the face attractive or handsome. To make the face proportionate, often placement of implants on the cheeks is helpful. These are placed through either an incision in the mouth or through the lower eyelid. These can be done as day procedures.

Many people often do not realize that along with a nasal hump they have an under projecting or an over projecting chin. A simple silicon chin implant or reduction osteotomy can correct the imbalance. It also helps to improve the definition of the jaw line.

Some risks associated with this kind of surgery are infections, which may or may not respond to antibiotics. Some hardness and swelling after surgery should be anticipated and may need 3 months to resolve. Other rare problems are hardness, mobility and extrusion.

Breast Augmentation

Breasts form an important part of the female anatomy. They contribute to augmenting female body proportions. Many women suffer from lack of confidence and self-esteem due to small breasts. This is usually a developmental problem and can be either genetic or hormonal. After excluding any pathological cause, breast volume can be increased by adding volume to the breasts using breast implants.

Breast implants are commonly made of a silicon envelope filled either with saline, silicon gel or cohesive silicon gel. You should discuss the details, pros and cons of various types of implants with the cosmetic surgeon at Ruby Hall Clinic The UK Independent Review Group and the FDA of USA have concluded that Silicon implants are safe for use in the human body.

The appropriate sized silicon implant is placed through a small incision either under the chest muscle or on top of the chest muscle but under the breast tissue. This procedure is usually done under a General anesthetic with a day or overnight stay in the hospital. Enhancement in size is usually instantly visible, although the breast may be swollen, bruised and slightly tender for a few days after the operation. This rapidly improves in 6 – 8 weeks time. Infection, implant extrusion, bleeding, numbness, hardening of the scar around the implant are some of the rare recognized complications.

Reputed implant manufacturing companies give a lifetime warranty with the modern implants, but we advise the patients to have the implants routinely reviewed and screened. They do not need to be changed if they are not causing any problems.

Breast Reduction

Many women with large breasts frequently complain of backache, neck ache, shoulder bra strap pain, poor posture and general diffidence. Reducing the size of the breasts can reduce these symptoms and make the breasts more proportionate to the body.

This is a procedure done under general anesthetic and involves a stay of 2 –5 days in hospital depending upon the amount of reduction. There are three basic types of breast reductions depending upon the type of scars. Standard technique leaves an anchor shaped scar, modern techniques leave a single vertical scar. Scar less technique involves liposuction, a procedure that can be used in selected cases only.

Delayed wound healing, nipple numbness, partial or total nipple loss, bleeding and infection are some of the complications. Post-operative swelling, bruising, firmness and shape may take 12 weeks to improve.

Rejuvenation

It is now possible with latest Aesthetic surgery techniques to make you look more youthful and fresh. These procedures are collectively called as rejuvenation procedures. As you grow older, gravity affects various tissues of your body, which start drooping and become lax. The eyebrows droop, eyelid folds and bags develop, wrinkles appear on the face and the nasolabial folds deepen. Breasts and buttocks sag.

Brow lift is done to lift your eyebrows through either small incisions behind the frontal hairline or through an endoscope . This gets rid of your tired look and makes your forehead look more youthful, as there are no wrinkles and creases.

Blepharoplasty is a procedure that removes the excess skin folds or bags around the eyes. This can be done under Local or General anesthetic as a day case. Usually along with the excess skin, some excess fat is also removed or re-draped. This procedure makes the eyes look youthful and fresh. If not done properly, there can be problems such as inability to close the eye properly, asymmetry in lid margins etc.

Rhytidectomy or Facelift is done to tighten and lift the skin and the superficial muscles of the face. This operation is done through an incision in front and behind the ear and in the temporal hair and hence is not visible after wounds have healed. The face may appear swollen and bruised for a few weeks.

Some recognized complications include collection of blood under the skin (hematoma), delayed wound healing, skin necrosis and weakness of select branches of the nerves of the face. A properly trained aesthetic plastic surgeon will be able to avoid these problems and deal with them if they occur. Cervicoplasty (Neck lift) is advised if there is presence of skin folds or visible bands in the neck. These bands consist of the edges of the muscle called Platysma, and are present just under the skin. To smooth the neck, these muscle bands need to be divided and the muscle lifted up and sutured at the back. A liposuction is also frequently performed to give definition to the jaw line.

These procedures all together have a potential to make you look younger by 10 to 20 years. Mastopexy or breast lift. Sagging of the breasts is a common problem with aging and is also seen after pregnancy and breast-feeding. It occurs because of shrinkage of the breast glandular tissue, while the skin envelope stays the same. This procedure removes the excess skin and moves the nipple and breast gland to a higher and better location on the chest. It is possible to do this operation leaving a single vertical scar, which fades very well. Infection, bleeding, decreased sensation are some of its few complications.

Apart from surgical means to make you look younger, there are non-surgical means as well, such as using injections of Botox, Hyluronic acids (Restylane and Perlane) and fat. Chemical peels using TCA/Phenolic acids and Glycolic acids. Botox is a very mild derivative of botulinum toxin, which when injected under the skin can temporarily paralyse the muscles that cause wrinkles and creases. Its action lasts about 8-12 weeks. Hyluronic acids are similarly injected under the wrinkles. It can also be used to enhance the lips. They last for 3-6 months. Chemical peels remove the superficial layers of the skin and encourage new fresh skin growth.