Humanity’s search for ways to enhance physical beauty is as old as mankind itself. The beginnings of aesthetic surgery go right back to the beginnings of Medicine. Women as well as men from all walks of life regularly have liposuction, breast enlargements or reductions, hair transplants, facelifts, Blepharoplasty, Botox injections, use of fillers and laser treatment.
Data announced by ISAPS, shows that Cosmetic Surgery is popular in emerging economies, such as India and ranks among top five nations for aesthetic surgical and non-surgical procedure. A thriving industry has emerged including its own tourism branch, offering special scalpel safaris to India as part of budget operations to foreigners.
Earlier in India, Rhinoplasty(Nose Job) was he most popular Cosmetic procedure done even from the days of Sushrutha(2000 BC). Recently it as shifted to body contouring procedures like liposuction were fat is removed surgically from body using small cannulas. Different types of liposuction being Suction assisted, Power assisted, Ultrasonic and Laser lipolysis. In a single sitting usually about 5 litres of fat is being removed by placing small incisions less than 1 cm at two or three places. The areas commonly addressed are submental area for double chin appearance, neck, breast, abdomen, arms, buttocks, thigh etc. Following the procedure you need to wear pressure garments inside your clothing for another 6 weeks for skin to get re-draped and newly contoured.
Other popular procedures include Abdominoplasty(Tummy Tuck), Breast Augmentation, Breast lift, Reduction Mammoplasty, Body lift, Fat injection techniques etc. Usual implants used for breasts are either of Saline or Silicone type, now a days fat injections into breast is deferred. The fifth generation Silicone high profile cohesive gel implants cost around 25000 Rs/- per pair.
In younger age group ear deformity correction like bat and cup ear are performed in pre-school ages. Other common procedure in early adolescent period is liposuctioning or excision of gynecomastia(male breast).
There is a quantum leap in number of clients for hair transplant especially with automated machines by follicular unit extraction technique. Its known as lunch time surgery as it can be performed during afternoon break. In US its called Neograft while Europe its known by term Punch Hair Matic or Omnigraft. In a session around 2000 follicles is placed over a period of 3 hours.
A new concept has evolved with anti-aging medicine were 35 to 55 years old individuals are put on hormone replacement therapy, aspirin, statins to reverse the effect of aging. Recently non-surgical procedures have become popular like Botox A injections and Hyaluronic acid preparations as Fillers to treat wrinkles over face. One Botox vial of 100 units will cost around 12000 I.C. When the effects of aging are more marked surgical procedures like endoscopic brow lift, mid face lift, eyelid surgeries, neck lift are performed.
Use of laser in plastic surgery includes- use in hair removal, treatment of hemangiomas, Nd:YAG laser for skin resurfacing, CO2 laser for acne scar treatment, tattoo removal etc. Other facilities available are chemical peeling, dermabrasion, milk peels, facials under one roof. Various genital surgeries done include Phalloplasty, and intimacy surgeries.
Before concluding aesthetic surgery is not a magic, nor a luxury medicine. Its no longer the prerogative of the rich.
Dr Sunoj KS, MS MCH
Consultant Plastic, Reconstructive and Aesthetic Surgeon
NIMS –AESTHETIC TRANSFORMATION CENTRE
Liposuction is a cosmetic surgery operation that removes fat from many different sites on the human body. Liposuction is appropriate for disproportionately large hips, buttocks, thighs, tummies, and "love-handles," as well as fat deposits on arms, calves, knees, ankles, back, and sub mental areas, double chin appearance.
The procedure may be performed under general or local ("tumescent") anesthesia. Liposuction involves the use of a small stainless steel tube, called a cannula. The cannula is connected to a powerful suction pump and inserted into the fat through small incisions in the skin. Fat removal is accomplished as the suction cannula creates tiny tunnels through the fatty layers. After surgery, these tiny tunnels collapse and thus result in an improved body contour.
Depending on the extent of the liposuction, patients are generally able to return to work between two days and two weeks. A compression garment which can easily be removed by the patient is worn for four to six weeks. In case you remove more than 5 litres of fat you might need blood transfusion. In selected persons you can go for mega liposuction sessions.
Arm & Thigh Lift
Weight fluctuations, increasing age and heredity can cause your upper arms and thighs to have a drooping, sagging appearance. An arm lift can reduce excess skin and fat and reshape your arm or thigh, to result in smoother skin and contours leading to a more toned and proportionate appearance.
It is often combined with liposculpturing and the incisions are placed at the inner thigh crease for thigh lift. For arm lift, incisions are generally placed on the inside of the arm or on the back of the arm, and may extend from the underarm (axilla) in a T-shaped manner to just above the elbow. Thigh lift scars are usually located in a relatively inconspicuous location and, are pale in comparison to the benefits provided by the procedure.
Certain anatomical parts of the body can be enhanced if it is disproportionately smaller or ill defined as compared to rest of the body features.
Male Pectoral Implants It is done for enhancing the chest size in males. Surgery is carried out under general anaesthesia and the incision is hidden under the arms. A solid silicone implant is inserted under the muscle or the fascia overlying the muscle. Endoscopic technique helps in precise location of the implants.
Buttock/ Gluteal Enhancement
Buttock implants are usually placed beneath the fascia—or what is termed subfascially—beneath the fibrous lining that encases the buttock muscles. The implants may also be placed in the intra-muscular plane (within the muscle such as the gluteus maximus). The intra-muscular plane of insertion is commonly used when the patient is thin and has little body fat. Both implantation sites are well tolerated by the body. Recovery time is usually longer. Pain medications typically are prescribed to help with the discomfort, but after approximately 5-7 days the patient is able to be up and about; moving, walking, and sitting more comfortably.
Liposculpturing (Fat injections)
As you age, the dermis under your skin thins out. This can leave the face looking too thin and has the effect of making the skin look like it sags. This happens to men and women of all body types. A fat injection adds fat to the area beneath the skin, and has the effect of 'filling out the face' to a more youthful state.
Liposculpturing is a means of autologous fat transfer which refers to the process of taking fat from your lower abdominal area (or another area) and injecting it into your facial area (or other area). The goal of the procedure is to add fullness to the face, lips, buttocks or aging hands. Facial fat injections, by virtue of the fullness, give some lifting to the general facial structure.
Gynecomastia (male breast enlargement) is a very common condition in men. It can result in terrible embarrassment, teasing, and social trauma. Many will try to hide it with thick shirts, avoid bare chest activities, and withdraw from public exposure. Male breast development can occur in many different degrees, anything from a fully developed breast to a bud beneath the nipple. Treatment is considered after all medical conditions that may be responsible are ruled out. Surgery consists of either liposuction, excision of breast tissue, or a combination of the two. Recovery time is about 2 to 6 weeks.
Tummy tuck (Abdominoplasty)
Abdominoplasty, known more commonly as a "tummy tuck," is a surgical procedure to remove excess skin & fat from the middle & lower abdomen & to tighten the muscles of the abdominal wall.
The most common approach of this procedure involves a horizontal incision across the lower abdomen to remove excess skin and fat from the middle & lower abdomen. The incisions are closed with buried sutures that will not require removal.
A firm, elastic-support garment is placed at the end of the procedure.
There will be some post-operative discomfort that can be controlled by medication. You will be up and around in a day or two, but you must avoid strenuous activity for three to four weeks. This procedure is performed in the hospital, under general anesthesia.
You are adviced to have chest physiotherapy, prophylaxis for DVT and avoidance of flight travel for next 3 weeks. Along with the procedure Stretch marks can be addressed, and no additional scar is produced if you already have a caesarean section scar. Every effort is made to minimize the scar, which though permanent, gradually fades over time and will be placed at under the strap of Bikini suit. In case scar gets hypertrophied can be removed with laser therapy.
Recently there is a trend of males preferring tummy tuck over females.
Breast enlargement / Augmentation Mammoplasty
Breast enlargement is done using saline filled bag or upgraded 5th generation Cohesive gel silicone implant that is totally harmless to your body. These soft implants are available in different sizes and contours like round and anatomic, giving a natural feminine outlook. Breast implants do not prohibit you from future breast feeding.
The procedure takes only about an hour and a half to perform. The implants may be placed either above or beneath the chest muscles or Dual Plane (new technique) depending on your build and special needs. Incisions are usually placed at the lower edge of the areola (the darker skin around the nipple), underneath the breasts- inframammary fold( which is the preferred site measuring less than 6 cm.) or in the armpit or trans-umbilical using Endoscope (New Technique) - again depending on your individual needs.
Buried sutures are used for closing the incisions, and there is no need for removal of sutures. They also ensure the best possible wound healing. The procedure can be done as a day care procedure or needs a day or two, usually advised to wear bra depending on cup size for another months time.
Other options for breast enlargement include injection of hyaluronic acid preparation and fat injections. Usually fat injections are not preferred as it interferes with mammogram readings.
Too small or too large breasts, sagging breasts etc. usually lower a woman’s self-esteem. Exercises or medications fail to solve this problem, and the woman usually suffers silently. Small breasts can be enlarged, large breasts can be reduced, sagging and shrinking breasts can be lifted and even breasts that have been removed during mastectomy procedures can be totally reconstructed.
Breast Lift Surgery/ Mastopexy
Gravity, pregnancy, breast feeding, weight gain and loss etc.can cause the breasts to loose their elasticity and youthfulness, and sag. A breast lift can reshape the breasts.In the breast-lift procedure, a circular incision is made around the areola with or without a midline vertical incision to the crease. Excess skin is removed from the lower part of the breast, and the nipple, areola, and underlying breast tissue are elevated to a new, higher position. Incisions are closed with very precise, buried sutures that never need to be removed. The procedure takes about two hours, after which a dressing and surgical bra are applied. Swelling and bruising usually subside within a few days. Most patients are back to work within one week.
Breasts that have been removed during mastectomy procedures can be totally reconstructed. There are many different approaches for breast reconstruction that vary according to the type of mastectomy that was performed, and to the condition of the breast skin.
Reconstruction can be achieved through a simple implant or prosthesis alone, or may involve the insertion of a "flap" of donor tissue. This flap contains skin, muscle, and the blood vessels needed to nourish it and are usually taken from the back or the abdomen to provide adequate skin covering for an implant.
Another technique involves placement of a balloon-like device called a tissue expander, which is placed beneath the chest muscle and gradually filled with saline to stretch the overlying skin until it is able to accommodate an implant. Additional surgery is often needed to reconstruct the nipple and areola. These reconstructive procedures are usually performed in the hospital under general anesthesia and may require a few days of hospitalization. Although some scarring is an inevitable part of this procedure, every effort is made to make scars as inconspicuous as possible.
Large, oversized, sagging breasts can distort the body posture, cause difficulty in breathing, backache, neck ache, cause irritation in the skin crease, and make exercise very difficult. Breast reduction procedure can reduce and reshape large breasts by removing excess skin and underlying tissue. An oversized areola can be made smaller at the same time. The results of this procedure are permanent, although significant weight gain or pregnancy can cause some later enlargement of the breasts.
Women of all ages can benefit from breast reduction, but it is generally only performed after the breasts are fully formed. This procedure may impair your ability to breast feed, and this possibility must be considered in your decision.
Breast reduction is performed under general anesthesia. There are a number of incision options in tune with the individual needs. The one which is preferred in this centre is inferior pedicle method. Most women are able to return to work within one or two weeks after surgery.Prophylactic breast reduction doesn’t give protect from cancer later but surely will bring down the incidence depending on amount of tissue removed.
Botox injections are a diluted form of botulism which is injected into facial muscles to weaken the muscles that form wrinkles. Wrinkles that are caused by muscle contraction, such as frown lines, crow's feet, forehead creases, and neck bands can be safely and successfully treated with Botox. The botox injection is normally injected directly into the muscle with a tiny needle.
The injected Botox attaches itself to nerve endings. During unimpeded muscle function, the neurotransmitter acetylcholine is released from these nerve endings, causing muscle contractions. Botox blocks the release of acetylcholine, causing the muscle to become relaxed.The effect of Botox lasts for approximately three to four months, up to six months.
In usual cases the Botox treatment lasts for about 10 minutes, and no recovery time is needed. The patient can resume normal activity immediately. A marked improvement is seen in the moderate to severe frown lines between the brows within a matter of two to three days. Improvement may continue for as long as a month, and could last up to 6 months. However, results are known to vary from person to person depending on their medical history and lifestyle, dilution and volume injected. Along with botox fillers made of hyaluronic acid preparations are used especially in glabellar,nasolabial folds and marionette lines.
A facelift, technically known as a rhytidectomy (literally, surgical removal of wrinkles), is a type of cosmetic surgery procedure used to give a more youthful appearance. It usually involves the removal of excess facial skin, with or without the tightening of underlying tissues- SMAS, and the redraping of the skin on the patient's face and neck.
The facelift as performed under "twilight" anesthesia or General anesthesia as an outpatient procedure and takes approximately two to three hours. An incision is made in front of the ear extending up into the hairline. The incision curves around the bottom of the ear and then behind it, usually ending near the hairline on the back of the neck. After the skin incision is made, the skin is separated from the deeper tissues with a scalpel or scissors (also called undermining) over the cheeks and neck. After elevating the skin from the underlying tissues, liposculpturing techniques are used to remove excess facial fatty deposits. The deeper tissues can be tightened with sutures, with or without removing some of the excess deeper tissues. The skin is then redraped, and the amount of excess skin to be removed is determined by the surgeon's judgement and experience. The excess skin is then removed, and the skin incisions are closed with sutures and staples.
Facelifts are helpful for eliminating loose skin folds in the neck and laxity of tissues in the cheeks. Together, the tightened muscles and removal of excess skin and fat will diminish and often remove creases, lines, and folds and restore the younger natural contours of your face. Your jaw line, cheekbones, and neck will become more defined and attractive as they regain their youthful, firm appearance.
Recovery is surprisingly quick and usually pain-free. There is some bruising and swelling, and usually needs five days of wearing a bandage. Most patients are back to work and their normal activities within two weeks of the procedure — looking and feeling younger, too.
Filler materials are gel that is injected into the skin in order to add volume to lips and lift up wrinkles and folds. Restylane/ Perlane/ Juvederm consists of hyaluronic acid, which is a natural substance already present in your body that provides volume and fullness to the skin. Fillers can be used for smoothing out folds and wrinkles, lip enhancements and shaping facial contours.
Immediately after the treatment, you can expect slight redness, swelling, tenderness or an itching sensation in the treated area. This is a normal result of the injection. The discomfort is temporary and generally disappears in a few days. After a lip treatment, the lips may become swollen and look somewhat uneven. This can persist for a few days (up to a week). It has been shown in clinical trials that Restylane is effective for up to six months, but individual results may vary.Hydroxy apatite preparations are used to rejuvenate aging hands and one over dorsum of Nose . they can be called more or less as a semi-permanent fillers.
Surgery of the eyelids (blepharoplasty) can remove bags, fat pouches, and excess skin from under and over the eyes. The eyelid surgery usually takes about one hour, is performed under local anesthesia with sedation, and is done as an outpatient procedure.
No bandages are applied after eyelid surgery, and sutures, when they are used, are usually removed within four days. Any swelling and bruising can be minimized by keeping cold compresses on your eyes. Most patients are up and around one or two days after the procedure and usually return to work in a week or even less.
Neck lifting surgery helps a lot in correcting loose neck muscle by removing excess skin and fat from your neck. There are two types of neck lift surgery involved. They are platysmaplasty and cervicoplasty. In the first type, the method alters or removes the muscle from the neck of the patient. In the second type, the procedure helps in removing excess neck skin.
Neck lift surgery is performed with the help of narrow tube known as canulla, fixed with a vacuum kind of device. The surgeon makes a small incision in the skin either just behind your ear lobe or under your chin. With the help of cannula the surgeon breaks or destroys the fat deposits and restructures the area with correct proportion. Without damaging the blood vessels, muscles and nerves the excess neck fat gets removed perfectly. Most people can return to work in 10-14 days.
Browlift (Forehead Lift)
A forehead lift or "browlift" is a procedure that restores a more youthful, refreshed look to the area above the eyes. The procedure corrects drooping brows and improves the horizontal lines and furrows that can make a person appear angry, sad or tired.
A coronal incision is made in a headphone-like pattern, starting at about ear level and running across the top of the forehead and down the other side of the head. The incision is usually made well behind the hairline so that the scar won't be visible. Working through the incision, the skin of the forehead is carefully lifted so that the underlying tissue can be removed and the muscles of the forehead can be altered or released. The eyebrows may also be elevated and excess skin at the incision point will be trimmed away to help create a smoother, more youthful appearance. The incision is then closed with stitches or clips. It may then be covered with gauze padding and an elastic bandage. Most patients are back to work or school in a week to 10 days.
Ear Reshaping (Otoplasty) - cup ear and bat ear
Most people who think their ears are too big have ears that stick out too much. Reshaping and repositioning them closer to the head solves the problem completely. Ears that overly protrude make kids a target for teasing, jokes and derogatory nicknames. This procedure can be done as early as age four or five in children (before school starts) and, of course, at any time for adults.
In adults, this procedure can be performed on an outpatient basis using local anesthesia with sedation. Children need general anesthesia. A well-concealed incision is placed behind the ear. Through this approach, the cartilage is reshaped and sometimes excess cartilage removed.
Reshaping with permanent sutures gives the ears a better contour and realigns them closer to the head in a more pleasing position. These incisions are closed with dissolvable stitches. Then the ears are covered with a dressing that will remain in place for about five days.
Post-operative discomfort is minimal and easily controlled with prescribed medications. Patients who have this procedure are usually up and around the same or next day, and return to work or school within a week. It is necessary to protect the ears during sleep hours with a headband for a few weeks after surgery.
The term microtia indicates a small, abnormally shaped or absent external ear. It can occur on one side only (called “unilateral”) or on both sides (called “bilateral”). The unilateral form is much more common, occurring in approximately 90% of patients. Reconstruction of the microtic ear is usually delayed until the child is 6-10 years old.
This procedure requires cartilage from the ribs that allows a very detailed reconstruction of the new framework that includes all parts of the ear, including the tragus and the lobule. The second stage, six months later, involves the elevation of the cartilage and skin framework to achieve the projection required. Within a six-month period and subsequent healing, the entire ear, framework and projection is complete.
A preauricular sinus or cyst (also known as a "Congenital auricular fistula," is a common congenital malformation characterized by a nodule, dent or dimple located anywhere adjacent to the external ear. They are inherited features and usually appear on one side, but may be bilateral in 25-50% of cases. The sinus opening (pit) is usually located just in front of the upper part of the ear where the cartilage of the ear rim (helix) meets the facial skin. They are asymptomatic unless infected (uncommon), when they become red, sore and may discharge pus.
An ellipse of skin surrounding the preauricular sinus tract is excised and dissected out along with the tract. The tract can simply be identified by its glistening white color, or methylene blue dye can be injected through the opening to faciliate easy identification of the tract. The sinus is opened using sharp scissors. The sinus is opened using sharp scissors. Under magnification the glistening lining which is inside and the outer wall of the tract are dissected free from the surrounding tissue.
The pinna is formed in the embryo by the coalescence of six tiny hillocks, or tubercles, located on the dorsal end of the first and second branchial arches. Accessory auricles represent the remnant of one of the embryologic hillocks. They differ from preauricular tags in that they contain a small island of cartilage. Preauricular tags and accessory auricles are often excised for cosmetic reasons.
Rhinoplasty (Nose job)
Rhinoplasty is a surgical procedure which is usually performed in order to improve the function (reconstructive surgery) or the appearance (cosmetic surgery) of a human nose. Rhinoplasty is also commonly called "nose reshaping" or "nose job". It can reduce the overall size, improve the tip, remove a bump, widen or narrow the width, straighten a crooked nose or even improve the angle between the nose and the upper lip. Generally, any or all of the above changes can be made during one operation, working from inside the nose.
Plastic surgery of the nose begins when the rhinoplasty surgeon makes an incision either inside the nose or across the skin that separates the nostrils (this skin is called the columella). The cartilage and bone that make up the framework of the nose are then exposed and sculpted to create the desired shape and profile. The plastic surgeon then stitches the skin back into place to complete the nose surgery. Rhinoplasty surgery generally lasts two to four hours and is usually needs admission for three to five days.
After surgery, a small plastic splint is placed on the nose to maintain the new shape and to protect it. This splint usually remains on for five days to two weeks depending on augmentation or reduction/ fracture has been performed. The patient will be up and around a day or two after surgery.
Most people return to work within a week after nasal surgery, using makeup if there is any residual bruising. There will be subtle swelling of the nose that subsides over time. Your complete and final result may not be realized for weeks or even months, but you will see improvement within one week.
Hair transplantation is a surgical technique that involves moving skin containing hair follicles from one part of the body (the donor site) to bald or balding parts (the recipient site). It is primarily used to treat male pattern baldness, whereby grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. However, it is also used to restore eyelashes, eyebrows, and beard hair, and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants. Hair transplantation differs from skin grafting in that grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin.
Since hair naturally grows in follicles that contain groupings of 1 to 4 hairs, today’s most advanced techniques transplant these naturally occurring 1–4 hair "follicular units" in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking nature hair for hair. This recent hair transplant procedure is called Follicular Unit Transplantation (FUT).
1.Strip Harvesting - a strip of scalp is removed under local anesthesia, the wound is then sutured back together and this piece of scalp tissue is then cut in to small pieces of tissue called grafts which are then transplanted back in to the thinning area of the patients head. This method will leave a linear scar in the donor area, which should be covered by a patients hair (if long). The recovery period is around 2 weeks and will require the stitches to be removed by medical personnel.
2.FUE Harvesting - (Follicular Unit Extraction) individual follicles of hair are removed under local anesthesia; this micro removal uses tiny punches of between 0.8mm,1mm and 1.25mm in
Transplant techniques, such as punch grafts, mini-grafts, micro-grafts, slit grafts, and strip grafts are generally performed on patients who desire a more modest change in hair fullness. Flaps, tissue-expansion and scalp-reduction are procedures that are usually more appropriate for patients who desire a more dramatic change. Recent additions include use of Automated machines –Punch Hair Matic and Omnigraft.
Hair re-growth for thinning hair is now possible for women and men using mesotherapy. Mesotherapy, a technique of tiny microinjection, places hair stimulating solutions and vitamins into the scalp at the hair follicle - this is superior to topical application of remedies which sit on the scalp and do not reach the hair follicle.
Hair re-growth mesotherapy works for women and men with stress related hair thinning, age related hair loss, post pregnancy hair loss, male pattern hair loss Peri-menopausal and menopausal hair loss.
Hair re-growth mesotherapy is much more effective than topical applications, and is much more convenient: the scalp with thinning hair receives tiny microinjections every week for 1 month, then twice a month for one month & then once a month for 4 months, then on an "as needed" basis.
The medication in mesotherapy treatment causes an increase in blood circulation to the scalp area and stimulates the hair follicles. Small amounts of specially formulated FDA-approved medications are injected under the skin very close to the hair follicles. These medications deliver long-acting neutralizing effects on the DHT (dehydrotestosterone) hormone, which causes hair loss, allowing hair to grow.
Shortly adding Medical Spa and laser Treatment
In addition to above aesthetic procedures all congenital malformations like cleft lip-palate surgeries, Treatment of VPI’s, Congenital hand deformities are corrected. Head and Neck Malignancy resection and reconstruction, treatment of hemangiomas are being performed. Special wound care is given for Diabetic Ulcer patients such as dressings, local flap surgeries, Skin grafting and Microvascular tissue cover. Along with other disciplines of Medicine a total care is given to trauma care, chronic non-healing ulcers and burns patient.