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Plastic & Reconstructive Frequently asked Questions
1. What is Liposuction or Liposculpturing?
Liposuction or Liopsculpturing is a common, popular procedure performed for permanent removal of fatty tissue (cellulite). It removes undesirable fat from beneath the skin in isolated areas where diet modifications and exercise has failed to remove unsightly bumps. These areas include the hips, thighs, abdomen, knees, face and neck. This helps you look prettier, younger & thinner! Liposuction gives best results in people with good skin tone who have fatty deposits.

Please note that It is not a treatment for obesity! Neither is it a treatment for weight reduction ... This is essentially a BODY CONTOURING surgery. If weight gain occurs following liposuction, the fat will be deposited in areas that have not been treated previously. The procedure can be repeated, if necessary. Earlier there was a limit to how much fat can be removed at one time but now with advent of anaesthesia techniques (Tumuscent Anaesthesia) and with proper monitoring, larger amounts of fat can be removed in a single surgery (even upto 15 to 20 litres!).

Procedure: After assessing general health, Liposuction is done under general anesthesia on an outpatient basis in a hospital or surgical center. Pre-operative images are taken to compare with the results. The surgeon makes small (less than 1/2 inch) discreet incisions in the areas to be treated. Mixture of fluids is instilled in the areas to be treated (this allows the fat to liquefy so that it is easier to be removed & moreover it contributes to relief of your pain after surgery). A cannula is inserted in the small incision and attached to a suction machine. The procedure may take an hour or more, depending on how many areas are involved. Fat can be removed using either suction alone or assisted with ultrasound. Stubborn fat is best removed by using PAL (Pressure assisted) or UAL (Ultrasound Assisted Lipoplasty)

Recovery: Recovery from liposuction is relatively easy & smooth. Some amount of swelling and bruising in the following two weeks is common in treated areas which subside eventually. Specialized compression garments worn during recovery will minimize swelling and provide support while healing. These garments also assist in retraction of the skin. Stitches will be removed in a week to 10 days. Results are recognizable almost immediately and will continue to improve as swelling subsides. You can resume your office work in 3-5 days and more active employment at 10-14 days. The results of liposuction are permanent. If you were to gain a large amount of weight you might note rippling in the treated areas, depending on your skin elasticity.

Possible Complications: As with any surgical procedure, Common complications include contour irregularities, skin discoloration, asymmetry, scar, collection of blood or fluid under the skin. Uncommon complications include loss of sensation, skin breakdown and very rarely fat embolism.
2. About Breast Enlargement
Natural looking, Fuller breasts are an important symbol of femininity and adds to the confidence of the women. Breast enlargement or augmentation mammoplasty, enhances the body contour of a woman who is unhappy with small breast size. When compared to the norm, inadequate breast volume may lead to a negative body image, feelings of inadequacy and low self-esteem. These disturbances may adversely affect a patient's interpersonal relationships, sexual fulfillment and quality of life. Breast Augmentation is one of the most common cosmetic procedures performed for following indications:
    •  Breast aplasia, defined as an absence of breasts and inframammary fold
    •  Breast hypoplasia, which is primarily according to the patient's subjective opinion
    •  Breast asymmetry, a difference in breast size or chest wall projection that can be corrected by differently shaped or sized implants
    •  Correction in volume or sagging following pregnancy
    •  Tubular breasts (tuberous breast deformity)
    •  As a reconstructive technique following breast cancer surgery.

Women who are concerned about the size of their breasts will seek an improved appearance with augmentation to conform to their own body image.

Procedure: Augmentation mammoplasty is done as an outpatient procedure usually under general anesthesia. An implant (prosthesis) is placed through an inframammary incision (other options include: periareolar, transaxillary & transumbilical. Last 2 are done under endoscopic guidance & require typically saline filled implants), under the breast tissue (subglandular) or under the muscle (submuscular). A breast implant is composed of an outer silicone shell & is filled with saline orsilicone gel. The outer surface may be smooth or textured, and implants come in various shapes to meet the individual woman's needs. Doctors can help you decide access, placement and type of implant that will work best for you. Immediately after the procedure, a supportive dressing is applied which will be removed in a couple of days. Use of sports bra in postoperative period stabilizes the implant & avoids discomfort.

Determining Implant Size: The shape of your augmented breasts depends on the implant. Implants may be round or teardrop-shaped (anatomical). The choice depends on the look you want to achieve: Anatomical implants produce a gentle slope, resulting in a fuller upper area, whereas round implants create a round curve in the upper part of the breast. Another factor to consider prior to surgery is breast width which determines the amount of cleavage between your breasts and the outer curves, which you may want to balance with your hips. However, realistic expectations out of this procedure are important. With advent of new cohesive gel implants achieving fullness and cleavage at desired place has become more simplified.

Post-Operative Care & Result: Minimal pain & discomfort for couple of days after surgery will be easily controlled with analgesics. Some tightness in the breast area is also normal as your body adjusts to the implants. You can move about freely after surgery. You will most likely be able to return to work within a few days but you will need to avoid any strenuous activity for at least a couple of weeks. Scar will fade up over couple of months. You will be pleased with your improved breast size and hence body image in early postoperative period itself. Gentle messaging of the breasts with circular motion prevents likelihood of developing capsular contracture.
Possible Complications: Wound healing is delayed in few numbers of patients who are either diabetic or having other autoimmune diseases. Other complications include capsular contracture, bleeding, infection or irregularity of the skin. Augmentation mammoplasty is a safe procedure that has produced pleasing and satisfying results for many women. Those who set realistic expectations benefit the most. A preliminary consultation can help you determine whether breast augmentation is right for you.

About implants: Silicone gel implants are absolutely safe. They
    •  Are not associated with increased risk of breast cancer
    •  Do not interfere with diagnosis of breast cancer
    •  Do not increase chances of developing collagen disorders
    •  Do not interfere with any other screening procedures like routine X rays, CT Scan, Ultrasonography or MRI.
3. About Breast Lift or Mastopexy
Breast lift surgery or mastopexy restores a youthful appearance to a womans breasts. Over the years breasts can lose their shape and firmness due to pregnancy, lactation and loss of skin elasticity (as a part of normal ageing process) causing them to sag. These effects of ageing and pregnancy can be reversed by mastopexy which helps regain the firmness and projection to the breasts. Necessary alterations in the areola (Darker skin around nipples) can be done in the same sitting. Mastopexy is commonly performed in conjunction with breast augmentation (with implants) to increase breast firmness and size. Women who feel their breasts are of unequal size will benefit with mastopexy as the lift can be done differentially on both sides to achieve desired symmetry. As with all cosmetic surgery procedures, realistic expectations are important.
4. About Tummy Tuck
Protruding belly is no longer considered a sign of wealthiness! Rather it is considered a social stigma! Abdominoplasty or a ‘tummy tuck’ is a surgical procedure to correct a protruding abdomen resulting from weak abdominal muscles, weight gain or pregnancy. Obesity causes the skin to lose its elasticity. These conditions may not respond well to diet or exercise as the skin and underlying muscles are already stretched. Loose skin folds following either heavy weight loss or following bariatric surgeries seldom settle on their own. These folds also need to be tackled by abdominoplasty. With abdominoplasty, the abdominal wall muscles are tightened and excess fatty tissue along with skin are removed to improve the body contour. The goal is a narrower, flatter abdomen. Realistic expectations are important. Abdominoplasty is not a weight loss surgery rather it is BODY CONTOURING SURGERY. Doctors consider age, obesity and smoking habits when evaluating a candidate for this procedure.

Ideal candidate: A complete medical history and thorough clinical examination is conducted to evaluate your general, overall health. Ideally, the abdominoplasty patient has no health problems and wishes only to remove an excess deposit of fat or loose abdominal skin. Patients on a weight-loss plan should be close to their target weight (or have achieved it and are left with loose folds) before having the operation. Women planning future pregnancies should delay abdominoplasty as pregnancy may promote further abdominal stretching. Photographs will be taken before and after surgery. Antibiotics will be prescribed prior to surgery to prevent infection. To minimize the possibility of excess bleeding you will need to avoid taking drugs that thin your blood. You will also be advised to bathe with an antiseptic soap for several days prior to surgery.

The Procedure: Abdominoplasty is performed using general anesthesia. You may be given medication beforehand so that you feel relaxed. The surgery may take 2-3 hours, depending on your overall condition. You will require a few days of hospitalization. The procedure is most commonly performed by making a lazy U-shaped incision below one hipbone across the pubic area and under the other hipbone. A second incision is made around the belly button. The skin is then separated from the abdominal wall and lifted up to the hipbone, exposing loose tissue covering the abdominal muscle. Loose, stretched out muscles are tightened with sutures and excess skin and fat is removed. The skin is lowered over the abdomen and the belly button is reconstructed at its new position. The incisions are then sutured together in layers. Drains are often inserted to eliminate fluid collection and firm elastic bandages are applied to the area.

Recovery-What to Expect: Before starting the procedure a tube will be inserted in the lower back to provide adequate pain relief and post-operative comfort. There may be some discomfort following the surgery that can be controlled with medications also some swelling is normal. You will be given special instructions for showering and changing your dressings until the surface stitches are removed in 5-7 days. You may also be required to wear a support garment. The speed of recovery depends on your physical condition prior to surgery. Allow at least 2-4 weeks to recuperate before returning to work. Some scarring is also normal. The scar is well hidden and often takes 3-4 months for to fade. Though the recovery period is longer than that of other cosmetic procedures, the rewards are great for a patient previously distressed by a protruding abdomen. Those who follow a proper exercise routine and healthy diet postoperatively will benefit from tummy-tuck the most.
5. What is Rhinoplasty or Re-contouring Or Reshaping Of Nose?
Rhinoplasty is one of the most common operations performed by cosmetic surgeons today. This operation is designed to improve general appearance of the nose by doing any one or more of the following procedures
    •  Reducing the forward projection of the nose
    •  Removal of the hump
    •  Correction of depressed nose
    •  Correction of deviation of the nose
    •  Narrowing of upper nose
    •  Narrowing of the tip of the nose
    •  Narrowing of lower nose
    •  Reducing the nostril size
    •  Lifting the tip higher
It can also correct a birth defect or injury, or help relieve some breathing problems.

Many patients fear that after Rhinoplasty the nasal change will be so great that it will become a subject of discussion amongst their family and friends. In reality, neither the patient nor the patient's relatives or friends really remember the original shape of the nose few weeks after the surgery.

The Best Candidates for Rhinoplasty: It is better not to operate on teenagers until after they've completed their growth spurt i.e. around 14/15 years for girls and a bit later for boys.
6. Excision Of Lesion & Scar Revision
Various small benign lesions or scars particularly on the face give an unsightly appearance and may warrant removal or revision. The aim of scar revision is to make the old scar look better or less noticeable. This operation leaves behind another scar at the site of excision or revised scar. The amount of the scar could vary due to various factors like the person's age, heredity, race, skin characteristics and the type, direction, depth, size and location of the wound.
7. What is Skin Grafting?
Skin graft means removing skin from one area and placing it in another area. Only on rare occasions, after removing a large lesion or scar, a skin graft is applied. Skin grafts look like patch even after 1 to 2 years. Some scars (like small pox scar or pimple scars) are improved upon by dermabrasion. Dermabrasion means sanding of the skin and it is almost like sanding the wood. Patients with darker complexion are not good candidates for Dermabrasion surgery. Alternatively chemical peel or lasers are also used in some cases to improve appearance of scars cosmetically.