CANDIDATES:

• Women who feel that her breasts are too small, when clothes fit well around the hips but are too large around the bust line. This can be due to the fact that,the breasts have not developed properly, or evenly, leaving one breast smaller than the other or that the original shape and volume may have been lost due to weight loss, childbirth or aging.

OBJECTIVE:

• To enhance the size of the breasts using either silicone gel or salineimplants.

INCISIONS AND TECHNIQUE:

• There are several choices either an incision of one to two inches underneath the breast along the fold, a half moon following the lower edge of the areola,or an incision within the armpit. Whether the implant will be placed on top of or underneath the chest muscle will depend on each case and on the type of implant chosen. After the incision a pocket is made into which the implant willbe inserted, either behind the breast or under the pectoral muscle. If the breasts are flaccid a breast lift may be recommended in conjunction with theaugmentation.

DURATION OF THE RESULTS:

• Results are variable but usually long-lasting, however implants may requireremoval or replacement. Mammograms are routinely prescribed annually after the age of 40. Significant weight loss can affect the result. Pregnancy and breast-feeding can alter breast size in an unpredictable way, although breastimplants do not affect pregnancy or the ability to breast-feed. If, with aging,the appearance of the breasts change, it is possible to undergo a breast liftto improve contour.

RECOVERY TIME:

• A return to work, if not physically strenuous, is possible in a few days. Thescar will fade after several months but can be up to a year or more in somecases. Dressings will be changed over several days immediately postoperatively. Showering is permitted between three and seven days following surgery, and stitches are removed after 7 days. A support bra is worn for amonth, driving is permitted after two weeks and exercise after two to threeweeks.

RECOVERY PERIOD:

• There will be temporary soreness and sensitivity, swelling, a change in nipple sensation and possibly bruising for two to three weeks.

RISKS:

• Nipple or breast sensation may change, usually temporarily. Surgical removal and replacement of the implants may be required to treat capsular contracture,which can provoke breast hardness.

OPERATING TIME:

• 1 to 2 hours.

ANESTHESIA:

• General anesthesia

IN/OUTPATIENT:

• Usually performed on an outpatient basis.

CANDIDATES:

• Women who are generally satisfied with their breast size but unhappy with thebreasts lack of firmness, or the fact that the nipples point to the floor. Thisis due to a loss of the skins' elasticity, caused by weight loss, pregnancy,breast-feeding or just the passage of time.

OBJECTIVE:

• To elevate and reshape sagging breasts by removing excess skin andrepositioning the nipples. The breast lift will restore a more youthful appearance.There are cases where the breasts develop into different sizes, sometimes quitemarkedly different and in these instances an implant, often on one side only,is inserted in conjunction with a breast lift to increase the size and helprestore the breast to its normal position.

INCISIONS AND TECHNIQUE:

• The incisions for a breast lift vary according to three different techniques;the "inverted T," is one incision around the nipple, one in the foldbelow the breast and a third vertical incision joining them. The second is the"vertical" technique with two incisions, one around the nipple and avertical one. The third is called "periareolar" and uses only anincision around the nipple. The choice of the appropriate technique variesaccording the type of breast and the desired shape. More incisions usually meana better shape can be achieved and this should be discussed during theconsultation.

RECOVERY PERIOD:

• Temporary pain is treated with analgesics. Swelling, tenderness, numbness ofabdominal skin, bruising, and tiredness, some, or all of these can last up toseveral weeks. Small drains, removed after a few days, are used to help avoidthe accumulation of fluids in the abdominal wall. Dressings are applied andwill be changed every other day for the first two weeks. You may be required towear a girdle for 20 to 30 days. Stitches will be removed in stages over aperiod of one or two weeks.

OPERATING TIME:

• 3 to 4 hours.

ANESTHESIA:

• General anesthesia

IN/OUTPATIENT:

• Usually scheduled as an outpatient procedure but can include an overnight staydepending on the patient.

RECOVERY TIME:

• Back to work: in 1 to 2 weeks. Strenuous activities can usually be resumedafter 1 month, and the fading of scars can take from several months to a year.

SIDE EFFECTS:

• Temporary bruising, swelling, discomfort, numbness, dry breast skin, badscaring.

RISKS:

• Can include a collection of liquid (seroma) in the operated area that will haveto be drained. Blood clots. Infection. Bleeding under the skin flap. Delayedhealing or poor healing resulting in visible scarring or skin loss and thepossibility of wide scars (keloids) in patients with a tendency. Unevenlypositioned nipples. Temporary or permanent loss of feeling in nipples orbreast. The need for a second procedure.

DETAILS:

• During the computer consultation, the desired breast shape and size will bedecided with the surgeon. The nipples and areolas will be virtuallyrepositioned and the necessary incisions will be informed. There is no agelimit to perform a breast lift once development has stopped.

DURATION OF THE RESULTS:

• Pregnancy and breast-feeding may affect and change the size and shape of thebreast. Some women will undergo breast lift surgery before having children,having decided that they will enjoy their adult lives with the new breasts andaddress any changes later. Gravity, pregnancy, aging, and weight changes willcause the breast to change shape. Breast lift surgery will not interfere withthe ability to breast-feed if the milk ducts are left intact.

CANDIDATES:

• Women who demonstrate physical pain, usually in the back or shoulders, causedby the excessive weight of large breasts. Often this excess volume can alsocause skin irritation underneath the breast and leave indentations in theshoulders from the bra straps. Women who have difficulty finding clothes thatfit, because their breasts are too large in proportion to their body frame; whohave one breast that is much larger than the other, or who have difficultyexercising due to the breasts size and weight and dissatisfaction of theirself-image because of large breasts.

OBJECTIVE:

• To reduce, raise and reshape big breasts by removing excess tissue and skin andrepositioning the nipples.

INCISIONS AND TECHNIQUE:

• As in the breast lift procedure, breast reduction incisions vary according tothree different techniques; the "inverted T," where there is oneincision around the nipple, one in the fold below the breast and a thirdvertical incision joining them. The second is the "vertical" techniquewith the incision around the nipple and extending vertically to the mammaryfold, and the third is the "periareolar" incision only around thenipple. The choice of the appropriate technique varies according to the breastand the desired new shape and size. This should be discussed during theconsultation.

RECOVERY PERIOD:

• Temporary pain is treated with analgesics. Swelling, tenderness, numbness ofabdominal skin, bruising, and tiredness, some, or all of these can last up toseveral weeks. Small drains, removed after a few days, are used to help avoidthe accumulation of fluids in the abdominal wall. Dressings are applied andwill be changed every other day for the first two weeks. You may be required towear a girdle for 20 to 30 days. Stitches will be removed in stages over aperiod of one or two weeks.

OPERATING TIME:

• 1 to 3 hours.

ANESTHESIA:

• Local with sedation, or general.

IN/OUTPATIENT:

• Usually performed as an outpatient procedure. But can be an inpatient procedureif desired.

RECOVERY TIME:

• It will be more comfortable to sleep on the back for the first 2 weeks; returnto work is between 1 to 2 weeks. Strenuous activities may be resumed in 1month, and it will take from several months to a year for the scars to fade.

SIDE EFFECTS:

• Pain that can be treated with painkillers. Swelling, redness, numbness in thefirst week after surgery. Results start getting better after the second week.

DETAILS:

• During the computer consultation, you will decide with the surgeon the desiredbreast shape and size. The nipples and areolas will be repositioned and youwill be informed of the incisions needed for each case. There is no age limitto perform a breast reduction once breast development is completed.

DURATION OF THE RESULTS:

• Pregnancy and breast-feeding may affect and change the size and shape of thebreasts. Some women undergo breast reduction surgery before having children,preferring to address any changes in shape and size at a later date. Gravity,pregnancy, aging, and weight changes may have significant and unpredictableeffects on the size and shape of the new breast. Breast lift surgery will notinterfere with the ability to breast-feed if the milk ducts are left intact,and if you plan to breast feed in the future you should discuss this with yourplastic surgeon

CANDIDATES:

• Usually children between the ages of 4 and 14 years, but also adults.

OBJECTIVE:

• Reduce the size of large ears and place prominent ears back closer to the head.Congenitally absent ear is reconstructed with costal cartilage graft

INCISIONS AND TECHNIQUE:

• The incisions are generally in the fold behind the ear. The cartilages aretreated; the excess is removed, reestablishing the desired shape and positionof the ear.

OPERATING TIME:

• One to two hours. For microti-5 to 6 hours

ANESTHESIA:

• Children: usually general. Adults: local, with sedation.

IN/OUTPATIENT:

• Usually outpatient. Microtia- in patient

RECOVERY TIME:

• Back to work or school: 5 to 7 days. Strenuous activity, contact sports: 1 to 2months.

SIDE EFFECTS:

• Temporary bruising, swelling, discomfort, numbness, dry breast skin, badscaring.

RISKS:

• Infection. Blood clot (hematoma) that may need to be drained. Recurrence of theprotrusion, requiring second surgery.

DURATION OF THE RESULTS:

• Permanent

CANDIDATES:

• Adults of all ages can benefit from blepharoplasty. Patients in their 20s or30s might improve their inherited traits that can make them look older ortired. Patients with excess skin or puffy appearance on the upper eyelids,excess skin, bags and dark circles on the lower eyelids.

OBJECTIVE:

• The eyelid procedure can be designed according to the problem. If only theupper eyelids are affected there is no need to operate on the lower eyelids,and vice versa. If the problem is only caused by excess fat, with no skinexcess, there is no need to remove skin. If excess skin is the problem, theremight not be necessary to remove fat. Usually, however, with a patient in theirforties of fifties, there is usually the need to correct the drooping uppereyelids and puffy bags below the eyes by removing excess fat, skin, and muscle.Sometimes a forehead lift is recommended if the upper eyelid condition isaccompanied by sagging of the eyebrows. A chemical peel can be necessary ifthere is dark pigmentation forming circles around the eyes. Crow's feet can betreated simultaneously through laser resurfacing.

INCISIONS AND TECHNIQUE:

• I prefer to do blepharoplasty using a CO2 laser. The technique will depend onthe problem, the excess fat and skin in the eyelid areas, and the position ofthe eyebrows. In the upper eyelid the incision is hidden within the naturalfold and extends to the outside corner of the eye. Excess skin and fat areremoved. The incision is performed with the laser and there is no bleeding. Thelower eyelid fat pockets are removed through an incision placed inside thelower eyelid. There is no need for stitches. If there is a need to removeexcess skin and muscle another incision is hidden just below the lower lashes,easily camouflaged by natural creases. The laser may be used to tighten thelower eyelid skin.

OPERATING TIME:

• 1 to 3 hours. Anesthesia:Usually locally with sedation or general.

IN/OUTPATIENT:

• Usually outpatient.

RECOVERY PERIOD:

• There is usually no pain, just temporary discomfort, swelling, bruising,itching of eyes, tearing and sensitivity to light for a few days.

RECOVERY:

• Reading: 2 or 3 days. Back to work: 7 to 10 days. Contact lenses: two weeks.Exercising about 3 weeks. Bruising and swelling may take several weeks todisappear, but usually with makeup or dark glasses the aspect is almost normal.

RISKS:

• Hematoma (accumulation of blood under the skin that may require removal),infection and reactions to anesthesia. Temporary blurred or double vision.Bleeding, dry eyes, slight asymmetry in healing or scarring. There might be atemporary difficulty in closing eyes completely (rarely permanent). If there isa pulling down of the lower lids it may require further surgery. Blindness isextremely rare.

DETAILS:

• Besides the normal pre-operative exams you will be asked to do an eye test. Thefirst evening after surgery, you should rest quietly with your head elevated.You should apply cold compresses to your eyelids to increase comfort. Stitchesare usually removed after five to seven days.

DURATION OF THE RESULTS:

• Several years. Sometimes permanent.

CANDIDATES:

• Usually men and women over 40, although some patients in their thirties maybenefit from this procedure.

OBJECTIVE:

• To improve the deep fold from the nose to the corner mouth, the jowls, jaw lineand cheekbones. It can also help the loose skin, and “turkey gobbler” aspect ofthe neck by removing excess fat, tightening muscles, redraping skin. It can bedone in conjunction with the forehead lift and blepharoplasty to correct theeyebrows and eyelids.

INCISIONS AND TECHNIQUE:

• There are different variations of facelift procedure. The incision is usuallyplaced in front and behind the ear, and is hidden in the natural folds. Fromthe back of the ear the incision goes into the scalp and is hidden by the hair.The ear lobe has to be free and natural, avoiding a stretched appearance.Sometimes a small incision underneath the chin can be used to help with thetightening of the neck muscles. If necessary the deeper tissues of the face andneck may also need to be repositioned. The skin is pulled up and back and theexcess is removed. The aspect should look normal and not stretched. The fixingof the neck might involve liposuction or liposculpture to improve contour. Oneof the most important aspects of the facelift is the reposition of the lostvolume. This can be achieved either by folding and suturing the deeperstructures or by injection of fat, which is aspirated from another area.

DETAILS:

• A facelift does not correct wrinkles around the mouth. The choice of procedurewill depend on the thickness, texture and elasticity of the skin, the degree ofthe wrinkles and folds. Usually excessive sun exposure produces more wrinklesand the facelift might have to be combined with a skin resurfacing procedure toeliminate them. The placement of the incisions will depend on the hairlineAnother procedure commonly associated with the facelift is the rejuvenation ofthe nose (See Rhinoplasty.) Smokers should stop smoking before surgery. Aspirinshould be avoided to avoid increased bleeding. A bandage may be used to avoidbleeding and minimize swelling. Drains will be applied to avoid theaccumulation of fluids. Recovery varies greatly. Sleeping with the headelevated helps minimize swelling and bruising. Bandages and drains should beremoved in one or two days. Temporary asymmetry can be caused by the swellingand bruising and it is normal. Bruising should disappear in two or three weeks.Makeup can be applied after a few days. Numbness can last for several weeks.Sun exposure should be avoided for the first month. wait several weeks toevaluate the "new look." As the aging process continues, somepatients want to make additional improvements in their looks. Some men mighthave to shave behind ears, where beard-growing skin is replaced.

OPERATING TIME:

• 1 to 4 hours.

ANESTHESIA:

• Local with sedation, or general.

IN/OUTPATIENT:

• Usually outpatient. Some patients may require a 24 hour stay.

RECOVERY:

• Back to work: 10 to 14 days. More strenuous activity: 2 weeks or more.Bruising: 2 to 3 weeks. Must limit exposure to sun for several months.

RISKS:

• Complications from facelifts are not frequent. Hematoma (the accumulation ofblood under the skin), infection, bleeding and reactions to anesthesia. Someincisions can be visible due to individual variations in healing and might haveto be revised. Temporary injury to the nerves that control facial muscles orfeeling are rarely permanent. Asymmetry or change in hairline.

DURATION OF THE RESULTS:

• Usually 5 to 10 years.

CANDIDATES:

• We have been performing "refreshing" techniques over the past tenyears, offering our patients an alternative to the classical facelift forfacial rejuvenation. We start treating our patients at an earlier age say 35,and can also improve the face that has been "over-stretched" by thetraditional facelift techniques With these techniques we can improve the facialappearance of patients of all ages. Our technique of Superficial SyringeLiposculpture. For facial deformities facial implants are used to correct bony deformities. In indicated cases facial soft tissue defects arecorrected with autologous fat injection.
• For facial deformities facial implants are used to correct bony deformities.
• In indicated cases facial soft tissue defects arecorrected with autologous fat injection.

WHAT IS HAIR TRANSPLANTATION?:

• Hair transplantation is a procedure to replace the lost hair permanently. Micro and mini grafting is the latest and accepted method.Generally hairs of the back and side of the scalp-occipital hair are resistant to androgenic baldness. So the hair bearing skin from the back is taken in the strip form. This defect is stitched primarily and so no hairless scar is seen.From these strips of hair bearing scalp skin, follicles are dissected. These follicles may be 2-6 hair bearing. Such 500-1200 follicles are dissected under magnification, depending upon the density of hair growth and size of the donor strip. After defining the anterior hair line, the follicles are implanted 2 mm.apart. 1500-4000 hairs can be implanted.

HOW IS IT DONE?

• This procedure is done under local anesthesia. Patient can go home on the same day. In very anxions patient sedition or a sleeping dose is given. Glucose drip is given occasionally. In rare case, patient may need overnight stay. Hair bearing skin strip is taken from back in prone position.After acquiring this hair bearing scalp skin is stitched together. This procedure is for Operation takes 6-8 hours.

WHEN IT SHOULD NOT BE DONE?

• There is no absolute contraindication but it should not bedone in rapid hair-fall phase, telogen effluvium, with chemo-therapy & in severe medical contraindication. It should not be done in immature person with unrealistic expectation.

WHAT AREAS OF THE BODY CAN BE TREATED?

• Male & female bald scalp, post burn-traumatic scars,cleft lip scars, eyebrow, moustache, hair-less flap to cover lip, eyebrow.

HOW IT IS BENEFICIAL COMPARED TO ALTERNATIVE TREATMENT?

• No alternative treatment is as permanent, as promising & as natural. Other all alternative treatment require repeated sittings.

WHAT ARE THE RISKS OF HAIR TRANSPLANTATION?

• After proper pre-operative medical check up, surgery is safe.

ARE TRANSPLANTED HAIRS PERMANENT?

• Yes & hairs can be given in direction of your desire.

HOW CAN I GET THE BEST RESULTS?

To get the best results, hairs & scalp should under go pre-Operative treatment of:

• Any infection if present.
• Dandruff if present.
• Of nutritional deficits of various vitamins & minerals if present.
• SOS hormonal & minoxidil treatment.

Post operatively same treatment should be continued.

WHY THERE IS A NEED FOR MULTIPLE TREATMENTS?

• Multiple treatment are necessary in progressive baldness-if hair - fall still present, to replace the newly developed bald area. If fuller hair growth is expected.

IS THE TREATMENT SAFE?

• Yes, treatment is safe.

IS THE TREATMENT ECONOMICAL?

Yes, because:

• It is permanent treatment.
• No repeated weaving or wigs.
• Big psychological effect.
• No uncertainty.

WHAT ARE OTHER ASSOCIATE SURGERIES?

The other associate surgeries are:

• Tissue expansion.
• Scalp reduction.
• Occasionally hair bearing skin flaps.

CARE & PREPARATION BEFORE SURGERY?

• Adequate Hb gm%.
• Evaluation of patient & medical check up.
• Balanced personality & realistic expectations are must.
• Shampoo the hair daily for prior 3 days.
• Treatment of dandruff, psoriasis.
• Medication preferably for 1 to 3 months.
• To stop tobacco/smoking/aspirin.
• Adequate breakfast before surgery.

WHAT IS CARE AFTER SURGERY?

• Preferably indoor stay to avoid sweating, dust, smoke, rain, pollution, etc.
• To apply ointment as prescribed
• Balanced personality & realistic expectations are must.
• Shower bath next day- non touch technique.
• Anti-biotic,analgesic as prescribed.
• Some times edema in upper eyelids, resolves spontaneously.
• No combing for 1 month.
• No smoking/tobacco/aspirin.

WHEN DO WE SEE HAIR GROWTH?

• We can see hair growth after 3 to 4 months. Hair starts growing which can reach maximum to 10 to 12 months. These transplanted hairs also under go Proportionate Growth cycle.

WHEN 2ND NEXT STAGECAN BE DONE?

• 2nd next stage is required sometimes. It can be done after 4 to 6 months.

WHAT IS FUE?

• Follicular Unit Extraction is technique where hair follicles may be one or two or four hair bearing are extracted individually from donor occipital area.here procedure of surgical removal of stripe with incision is not done.Thus linear scar is avoided.But multiple punctate punch scar are developing.This surgery has less downtime.

WHEN FUE IS NOT ADVISABLE?

• This is not advisable in type four and beyond baldness and in developing baldness where further hair transplantation stages will be needed.Reason is entire donor occipital area is exhausted and future possibility of obtaining hair follicles no longer remain.

WHERE STRIPE AND FUE METHOD IS INDICATED?

• stripe method where possible multiple sittings are anticipated as in progressive baldness and in type four stage and beyond.
• FUE in bitempoal or localised or static baldness.

CAN HAIR CAN BE TAKEN FROM OTHER AREAS OF BODY?

• Yes, from dark area of beard,chest,pubic area,extermities.

DO THEY GROW NORMALLY?

• Yes, with passage of time it adopts recepient area characteristic and growth.

WHEN IT IS DONE?

• It is done where occipital donor area is exhausted and lot bald area remain to be grafted.

CANDIDATES:

• Liposuction is a procedure for women and men who are of relatively normalweight but have deposits of localized fat in certain areas of the body that donot respond to dieting or exercise. Liposuction is the way to eliminate them.Liposuction is not a treatment for obesity. Candidates of almost any age canbenefit from this procedure, providing their skin is elastic enough to retractto the normal position. Patients with loose flaccid skin might have to undergoa combined procedure, which involves skin resection. Patients who also havedepressions in their bodies can benefit from liposculpture. Fat can be injectedto improve contour.

OBJECTIVE:

• To improve cheeks, jowls, neck, arms, breast, back, abdomen, waist, hips andbuttocks, inner and outer thighs, knees, calves and ankles. It can also be usedto treat the male breast enlargement, or gynecomastia. It can be performed onseveral areas of the body at the same time, or together with other aestheticplastic surgery.

IN/OUTPATIENT:

• Fat is removed through a small hollow tube, called cannula, inserted throughone or more small incisions near the area to be suctioned. Incisions areusually 4 to 8-mm long and are often hidden in skin folds or lines. Forliposculpture the aspirator was substituted by disposable syringes connected tothe cannula to aspirate the excess fat. With syringe liposculpture and we canmeasure precisely how much fat is aspirated and there is the possibility ofre-injecting fat. Fat can be injected in the face to smooth folds and wrinklesand in the body to improve contour of areas such as buttocks, thighs, hips, legs,ankles and hands. Superficial liposculpture allows us to remove more fat andimprove body contour of patients with a more flaccid skin tone. For fibrousbody areas an external ultrasound machine may be used to "melt" thefat before aspiration.

OPERATING TIME:

• 1 to 3 hours.

ANESTHESIA:

• Local with sedation. Tumescent anesthesia made the procedure safer.

IN/OUTPATIENT:

• Usually outpatient. Extensive procedures may require short inpatient stay.

RECOVERY PERIOD:

• Walking a mile: two days. Temporary mild pain, especially in the first 48 hourscan be treated with analgesics. Swelling, soreness, numbness, bruising usuallylast a few weeks. Dressings are applied on the small incisions. There will be aleak of the anesthetic fluid through the incisions in the first 24 hours.Dressings will be changed daily. Shower is allowed after 24 hours. You may haveto wear a girdle for a few weeks. Stitches will be removed between the 5th and7th day. Back to work: 2 to 3 weeks. Exercise and sunbathing: 4 to 6 weeks ormore. Fading and flattening of the little scars: 3 months to 2 years.

RISKS:

• Significant complications from liposuction are infrequent. Potentialcomplications are asymmetry, rippling, and pigmentation of the skin, bleeding,infection and problems with anesthesia. Temporary numbness of the skin andhematomas (blood accumulations) are possible mild complications. Irregularitiesof the skin can happen in some patients, but can be treated if necessary. Moreserious complications involve loss of fluid or blood that can provoke shock,although this is now very rare with the tumescent anesthesia. Infection is veryrare.

DETAILS:

• Liposuction improves body contour and increases self-confidence. The resultsmay take a few months to show because there is the possibility of fluidretention following surgery with prolonged swelling. Occasionally, a secondaryprocedure, or "touchup" may be indicated to improve certain areas,most times under local anesthesia. A special massage, called manual lymphaticdrainage helps with the swelling and bruising in the post-operative period,increasing comfort.

DURATION OF RESULTS:

• If the weight remains the same results should be permanent, especially whencombined with diet and exercise.

CANDIDATES:

• Liposuction is a procedure for women and men who are of relatively normalweight but have deposits of localized fat in certain areas of the body that donot respond to dieting or exercise. Liposuction is the way to eliminate them.Liposuction is not a treatment for obesity. Candidates of almost any age canbenefit from this procedure, providing their skin is elastic enough to retractto the normal position. Patients with loose flaccid skin might have to undergoa combined procedure, which involves skin resection. Patients who also havedepressions in their bodies can benefit from liposculpture. Fat can be injectedto improve contour.

OBJECTIVE:

• To improve cheeks, jowls, neck, arms, breast, back, abdomen, waist, hips andbuttocks, inner and outer thighs, knees, calves and ankles. It can also be usedto treat the male breast enlargement, or gynecomastia. It can be performed onseveral areas of the body at the same time, or together with other aestheticplastic surgery.

INCISIONS AND TECHNIQUE:

• Fat is removed through a small hollow tube, called cannula, inserted throughone or more small incisions near the area to be suctioned. Incisions areusually 4 to 8-mm long and are often hidden in skin folds or lines. Forliposculpture the aspirator was substituted by disposable syringes connected tothe cannula to aspirate the excess fat. With syringe liposculpture and we canmeasure precisely how much fat is aspirated and there is the possibility ofre-injecting fat. Fat can be injected in the face to smooth folds and wrinklesand in the body to improve contour of areas such as buttocks, thighs, hips, legs,ankles and hands. Superficial liposculpture allows us to remove more fat andimprove body contour of patients with a more flaccid skin tone. For fibrousbody areas an external ultrasound machine may be used to "melt" thefat before aspiration.

OPERATING TIME:

• 1 to 3 hours.

ANESTHESIA:

• Local with sedation. Tumescent anesthesia made the procedure safer.

IN/OUTPATIENT:

• Usually outpatient. Extensive procedures may require short inpatient stay.

RECOVERY PERIOD:

• Walking a mile: two days. Temporary mild pain, especially in the first 48 hourscan be treated with analgesics. Swelling, soreness, numbness, bruising usuallylast a few weeks. Dressings are applied on the small incisions. There will be aleak of the anesthetic fluid through the incisions in the first 24 hours.Dressings will be changed daily. Shower is allowed after 24 hours. You may haveto wear a girdle for a few weeks. Stitches will be removed between the 5th and7th day. Back to work: 2 to 3 weeks. Exercise and sunbathing: 4 to 6 weeks ormore. Fading and flattening of the little scars: 3 months to 2 years.

RISKS:

• Significant complications from liposuction are infrequent. Potentialcomplications are asymmetry, rippling, and pigmentation of the skin, bleeding,infection and problems with anesthesia. Temporary numbness of the skin andhematomas (blood accumulations) are possible mild complications. Irregularitiesof the skin can happen in some patients, but can be treated if necessary. Moreserious complications involve loss of fluid or blood that can provoke shock,although this is now very rare with the tumescent anesthesia. Infection is veryrare.

DETAILS:

• Liposuction improves body contour and increases self-confidence. The resultsmay take a few months to show because there is the possibility of fluidretention following surgery with prolonged swelling. Occasionally, a secondaryprocedure, or "touchup" may be indicated to improve certain areas,most times under local anesthesia. A special massage, called manual lymphaticdrainage helps with the swelling and bruising in the post-operative period,increasing comfort.

DURATION OF RESULTS:

• If the weight remains the same results should be permanent, especially whencombined with diet and exercise.

IN/OUTPATIENT:

• Usually outpatient.

CANDIDATES:

• Girls should be at least 14 or 15, boys 16 to 17 before they can have nose surgery, because the structures of the face change with growing and it is better to wait until full development of the face is achieved to perform the surgery.Younger patients should be advised carefully, to understand the reasons that motivate to want to change their noses. It is important to realize the change should satisfy the patient, avoiding influences from relatives and friends. The upper age limit for rhinoplasty depends on health conditions and psychological motivations that provoke the need for the change. A classical reason for nose surgery in older patients is the rejuvenating effect that can be produced to correct a drooping tip, when performed together with a facelift. Breathing problems can be corrected at the same time. A computer consultation is the bestway to evaluate the change that can be obtained through plastic surgery of thenose. If the nose has a "ball" at the tip, if it is too large for theface, if there is a hump in profile, or if it is too wide, crooked orasymmetrical.

OBJECTIVE:

• Reshape the nose by reducing or increasing size, removing a hump, changingshape of tip or bridge, narrowing the nostrils, or changing the angle betweennose and upper lip. It may also relieve some breathing problems. The skinquality and the size and shape of the nose in relationship to the face arestudied. Sometimes correction of the chin can be done together with nosesurgery to balance the face.

INCISIONS AND TECHNIQUE:

• Results from rhinoplasty will vary according to several factors, type of skin,shape of the nose, etc. Results are individual and should not be compared withothers. The nose can be increased or decreased, nostrils can be narrowed, thetip reshaped and elevated. Usually all of the incisions will be placed insidethe nose. To reduce the base of the nose or the nostrils small incisions areplaced at base of the nostrils, hidden in the natural crease. Sometimes a smallincision is made in the columella, the tissue that separates the nostrils. Thiscan be used in more difficult cases or in re-operations. Though the smallincisions cartilage and bone are treated to narrow and straight the nose. Toaugment the nose cartilage from the septum or the ear can be used.

OPERATING TIME:

• 1 to 2 hours or more.

ANESTHESIA:

• Local with sedation, or general.

IN/OUTPATIENT:

• Usually outpatient.

SIDE EFFECTS:

• Temporary swelling, bruising around eyes and nose. Somebleeding.

RECOVERY PERIOD:

• Bruising around the eyes and cheeks can appear three days after surgery andshould disappear around the second week. Cover-up makeup can be used to concealthe discolored skin. Most of the swelling disappears on the first month, butthere can be residual swelling up to the sixth month. Usually the final resultof rhinoplasty is obtained around the eighteenth month. Packing can be used inthe first 24 hours to avoid bleeding although it is not absolutely necessary inevery case. A nasal splint, when used is usually removed between the 5th and7th day after surgery. Back to work: 1 to 2 weeks. Strenuous activities: 2 to 3weeks. Sun exposure: one to two months.

RISKS:

• Serious complications from rhinoplasty are not common. Potential complicationsinclude hematoma (an accumulation of blood under the skin which may requireremoval), infection and reactions to anesthesia. Numbness of the skin followingrhinoplasty may occur but is usually temporary. Occasionally, furtherimprovement can be obtained through a second procedure.

DETAILS:

• There should be no pain after rhinoplasty. Dressings usually stay for sevendays. Stitches usually reabsorb and do not have to be removed. During the firsttwo days after surgery it is necessary to sleep with the head elevated toreduce swelling and the possibility of minor bleeding. A small amount ofbleeding on the dressing is not uncommon on the first two days.

DURATION OF THE RESULTS:

• Permanent.

CANDIDATES:

• Women who find that their vaginal muscles may be looser, stretched and weakerafter natural childbirth, or due to an episiotomy (an incision made in theperineum to enlarge the space during child birth.). Women who intend to havesusequent children through vaginal delivery should be aware of the possibilityof a second procedure after the baby is born.
• Congenitally absent vagina.

OBJECTIVE:

• After childbirth, a woman’s vaginal muscles may loosen and become weaker dueto vaginal stretching that occurs during delivery. This procedure corrects theloose tissues and tightens the muscles of the perineum.

INCISIONS AND TECHNIQUE:

• Vaginoplasty surgery is done as an in-patient procedure. The hospital stay isusually 24 hours. The surgeon joins the stretched muscles at the back of thevagina and removes the unwanted tissue. This reduces excess vaginal lining andtightens vaginal muscles. The scarring is inside the vagina. This procedure canbe done together with labiaplasty. Vaginal tightening may also be performedusing a laser.

OPERATING TIME:

• Approximately 1 hour.

ANESTHESIA:

• This procedure can be performed under general or spinal anesthesia or underlocal anesthesia with sedation.

IN/OUTPATIENT:

• A minimum 24-hour stay is advised.

RECOVERY PERIOD:

• The patient can usually return to work 6 to 7 days after surgery. Temporarypain is treated with analgesics. Swelling, tenderness, numbness of the vaginalwall may be experienced. Some stitches will be reabsorbed. Others will beremoved in stages over a period of one or two weeks. Patients should avoidintercourse for between four and six weeks.

POSSIBLE COMPLICATIONS:

• Infection, bleeding and delayed healing. Although this rarely happens, scartissue can develop in patients with a tendency to thick scarring, causingtenderness, pain or tightness. This "scar hypertrophy" may requirefurther surgery or other treatment to soften the scars. Overtightening can leadto urine retention.

RISKS:

• Blood clots, infection, bleeding ,delayed healing or poor healing, the need fora second procedure.

RECOVERY TIME:

• Back to work: about one week. The area may be tender and swollen after surgery,but walking and sitting should be no problem. Sexual intercourse, strenuousexercising, riding and bicycling are recommended only after 4 to 6 weeks ormore. There can be some discharge (reddish-yellow) for 4-6 weeks.

DURATION OF RESULTS:

• The vagina should remain firm and tight for many years. This might change ifthe patient undergoes vaginal childbirth after the procedure.

CANDIDATES:

• Adolescents and men with enlarged breasts. The degree of augmentation variesaccording to the problem and can be formed by glandular and fatty tissue.

OBJECTIVE:

• Reduce enlarged, female-like breasts in men cutting out the excess glandulartissue through a small areolar incision and aspirating the excess fat throughliposuction.

OPERATING TIME:

• 1 hour to one and half hour.

ANESTHESIA:

• Local with sedation.

IN/OUTPATIENT:

• Usually outpatient.

SIDE EFFECTS:

• Bruising, swelling, numbness, soreness, temporary pain.

RECOVERY:

• Back to work: 3 to 7 days. Strenuous activity: 2 to 3 weeks. Exercising: onemonth. Swelling and bruising: 3 to 6 months.

RISKS:

• Fluid accumulation, infection, asymmetry. Pigmentation changes (may becomepermanent if exposed to sun). In cases where there is too much excess tissuethere might be the need for a second procedure to remove more tissue after theskin has retracted.

DURATION OF THE RESULTS:

• Permanent

VITILIGO OR WHITE PATCH:

• Vitiligo (white patch or SAFED DAAG) is a skin condition in which there is a loss of brown color (pigment) from areas of skin, resulting in irregular white patches that feel like normal skin. Vitiligo appears to occur when immune cells destroy the cells that produce brown pigment (melanocytes). This destruction is thought to be due to an autoimmune problem, but the actual cause is unknown. Though vitiligo does not cause any problem to health, but its appearance is a taboo or stigma for our society. Vitiligo may appear at any age. There is an increased rate of the condition in some families. Vitiligo most often affects the face, elbows and knees, hands and feet, and genitals. It affects both sides of the body equally. Vitiligo is more noticeable in darker-skinned people because of the contrast of white patches against dark skin. No other skin changes occur.

TREATMENT :

VITILIGO IS OFTENDIFFICULT TO TREAT. EARLY TREATMENT OPTIONS INCLUDE THE FOLLOWING:

• Phototherapy, amedical procedure in which your skin is carefully exposed to controlledultraviolet light. Phototherapy may be given alone, or after you take a drugthat makes your skin sensitive to light. A dermatologist performs thistreatment.
• Skin may be grafted from normally pigmented areasand placed onto areas where there is pigment loss. The white portion of skin isrubbed off or peeled off very superficially and a very thin skin graftcontacting only the top most layer of skin with melanin pigment is applied overthat. This is the most satisfactory method of treatment of vitiligo andconsidered as GOLD STANDARD treatment for vitiligo. But vitiligo must bestabled for at least 1-years for any surgical treatment to be useful oreffective. Small vitiligo can be directly excised and closed using very finestitches to make it almost invisible. Remember, after skin grafting or excisionof the vitiligo, the final result may take 6-12 months, so plan your surgerywell in advance to any social event or ceremony.
• Several cover-up makeups(waterproof skin colors) can mask vitiligo.
• In extreme cases when most of the body is affected, theremaining skin that still has pigment may be de-pigmented to provide a uniformcolor to the skin. This is a permanent change that is used as a last resort.
• It is important to remember that skin without pigment is atgreater risk for sun damage. Be sure to apply a broad-spectrum (UVA and UVB),high-SPF sunscreen or sunblock and use appropriate safeguards against sunexposure.