The hidden  wish of everyone-wants to look young & attractive as for as possible . Many researchers proved that physical appearance is significant and can influence the self esteem and behaviour of a person. Analyses by various organisations reveal that one likes to spend more on methods that make one look better,after fullfilling their basics needs (In some cases they even take priority over the basic needs). like any physcal problem the minor deformities created while formation by mother nature are correctible by Plastic & Cosmetic Surgery. Some are bold euogh to express and get rid of the problem, while others are not. Earliear cosmetic surgery use to be a fad and confined to rich and the affluent. Thanks to the media and other means of communication.beauty may be skin deep, but it does have significant impact over the self confidence. Temporary improvement in external appearence can be brought about to some extent by makeup but lasting results can be achieved by plastic& cosmetic surgery. With advances in surgical methods and increased safety in anesthesia, the cosmetic surgery has become relatively a safe procedure. cosmetic surgery is one of the rapidly advancing medical specialties. Our aim is to provide a over view of this fascinating branch of medicine, make you aware of the various procedures that are being performed  & the pros and cons of each procedure. you will apreciate our sincerity and frankness of our team in explaining about various aspects of cosmetic surgery that we perform. we try to reach perfection in all but may not be able to reach in some cases. we offer you suggetions to reach the ultimate goal. you may come with high expectations, but we make you understand the reality and practicabality of each procedure. An ideal candidate for cosmetic surgery is the one who is looking for improvement, if not perfection in the way they look. 
                                                                                                                                                                                   
Hair Transplantation :

            It is a surgical procedure being performed on men & women who have signicant hair loss. It corrects alopecia (hair Loss)- from various causes eg- male or female  pettern baldness, scarring etc... Hair transplation invovles transplanting hairs (skin with its hair) from the back of the head  (donor area) to the bald areas. A typcal hair transplantation procedure involves consultation, blood test, local anesthesia, harvesting of the donor hairs with the skin (strip method), implantation of the donor hairs in the bald areas, adressing and postoperative care.

Rhinoplasty :

            Rhinoplasty (reashaping of the nose) is one of the most common plastic surgery procedures. Rhinoplastiy can reduce or increase the size of the nose, alter the width of the nose, the shape of the tip or the bridge of nose. The ideal time to operate on any nose is after 15 years, as the the facial growth is complete by then. Indications- large nose, small nose, depressed nose, crooked nose, bulkitip, wide nostrils, asymmetry of the nose, hump nose (parrot beak). Some general principles followed for some common problems in the nose are-

A. Short nose-the length and height can be increased to the possible extent by various materials.
    Natural (own tissue)- cartilage or bone-taken from rib cage (or) forearm bone, hip bone etc
    -Synthetic (artifical)- silicone material, which is a safe bio-compatible alternative
B. Long nose- The length and height can be decreased by trimming parts of bone (or) cartilage of the nose.
C. Hump nose- can be corrected by removing the overprojecting part of front of nose.
D. Deviated (or) crooked nose- corrected by surgery on the midline septum -either bony or cartilagenous or both..
E. Wide nose- can be made narrow by reducing the width of nostrils.The scars are hidden under the nostrils and hardly noticeable.
        
     Most of the procedures are performed through cuts made with in the nose- that means no scars are visible outside, except in some cases, where in the a small scar will be present under the nostrils, which is hardly visible in many cases. the operation can be done under local or general anesthesia. usually the surgery lasts for 1 to 3 hours. Aftet the operation a small dressing is placed over the nose which may be removed 2 to 7 days later, depending on the type of operation. There will be some swelling for 2-3 days, which subsides by one week time in most of the cases. When osteotomies are done  (operation on
bone) the swelling reduces very slowly. Some can go on same day, for others 1-2  days of hospital stay is necessary.

Surgery  for Aging face (Face lift) :

Many a time we assess the age of a person by looking at the face. So 'Face' is the window of our age. Many creams are being used to decrease or reverse the changes of aging of the face. But after certain time, operation may be needed to give the face a youthful appearance. As we grow older certain changes do occur in our face,due to prolonged  exposure to the environment like - sun, wind, gravitational effect, decreased elasticity of the skin. All these affects lead to sagging of skin & excessive skin folds over fore head, cheeks, jaw, chin neck or entire face. The basic principle in surgery for aging face is simple-meticulous lifting up of the sagging of not only skin, but also muscles in some cases upwards, so that youthful appearance results and wrinkles disappear. The excess skin is removed and sutures applied. Depending on the area of involvement the operation can be on
            - Fore head lift- if only the fore head winkles are to be improved.
            - Brow lift - to lift the sagging "eye brow ".
            - Blepharo plasty- To improve the baggy eyelids and deposits around the eyes.
            - Full face lift - if entire face & neck wrinkles are to be improved.
Time: 2-4 hours depending on the procedure, requires 1-3 days hospital stay. Swelling & bluish discoloration may persist for up to 1-2 weeks depending on the area. skin tightening will be noticed for up to 3-4 weeks time.

Surgery for ears :

•  Many deformities are noted even in normal persons.
• Prominents ears (bat ears)- This can be corrected by simple surgery of creating folds in the cartilage of the ear.
• Small or under developed ears- These require elaborate procedures with meticulous planning  (A piece of cartilage from chest is taken along with skin to mould the missing parts of ear).
• In addition to the above -ear holes can  be made, and the large holes in the ear created due to heavy ear rings - can be made small or closed.

Scars over the face and body :

When there is cut to any part of the body- be it injury or following operation there will be scar. Scar depends on many factors like-
        - Age
        - Area of injury
        - Hereditary
        - Race
        - Type of injury

One has to understand the fact that a scar can never be removed totally from the body. It can only be revised and made least visible with poper precautions.  Scar revision is the name given to correct a scar.  This procedure should not be done till the original scar matures (6 months or more from the time of injury). Most scar revisions are done under local anesthesia and patients can go home on the same day.

Small pox scars :

 In many cases there is no actual scar but, because of depressions over skin caused by the healing of infected acne (pimples), it mimics scars. In some there may be true scars. The principle in treating these scars is to peel off the upper layers of the surrounding skin over the prominent portions, or the pigmented portion, so that the entire skin surface looks even with out scars. The following methods are routinely followed.

For minor pitting / scars- Lasers :  by certain type pf lasers one can reduce the severity of this pronblem.  It may take more sittings and helpful only in some.
 Not all the types of lasers available in the market are suitable for this purpose . A qualified dermatologist or plastic and cosmetic surgeon can assess the type of skin, amout of scarring and decide if laser would benefit or aggravate the problem

Dermabrasion - is a popular & conventional method to treat the severe types of pitting / scarring and is still the choice in some cases. It aggressively treats the scars in one sitting, but with some post operative sequelae-like- pigmentation, prolonged time of recovery...

Jaw and teeth problems :

The jaws and teeth can be prominent or retruded. The problem may lie in teeth or skeleton (bone). After deciding the nature of problem (whether it is in the teeth or bone) it can be corrected either by teeth correction or by skeletal (bone) surgery or both. An experienced plastic and cosmetic surgeon alonng with an orthodontist can assess the magnitude of the problem and correct it by placing the jaw bone (forwards or backwards) either in toto or only the front teeth bearing segment. the common problems with chin are-

Retruded chin - Can be various tupes - Some are born with this defect. If dental occlusion is normal it can be improved by simple procedure of placing an implant under the skin and the patient can go home on the same day This can also be done by cutting bone and bringing it forwards.

Prominent chin - This problem can be corrected by cutting excess part of jaw bone and placing it backwards. It requires 1-2 days
of hospitalization.

Lips : One does not have to worry from having either thick lips or thin lips. Both can be connected with ease. Thin lip can be made thick- by Hyaluronic acid / fat injections .The large lip can be thinned by minor surgery which is done from inside the mouth with out any visible scars.

White / dark spots on skin:

It is a common notion in the public to think that all white patches may be related to leprosy. Some white spots are harmless and are only a cosmetic problem. This can occur following Burns, Injury or without any reason. Many methods are available for treating these patches. Initially medicines should be tried by a dermatologist if no improvement occurs, surgery is advised. Abrasion of superficial layers of the white patch and skin grafting is one of the options. puch grafting where in areas of normal skin in form of punches are introduced into areas of white skin, so that the pigment spreads to the areas of white skin.

Cosmetic surgery for breasts :

May women do have minor or major problems with breasts, but unwilling to discuss about them for various reasons. They silently suffer from the problem till a stage comes when they find it difficult to manage. As in other areas of the body, the problems with breast can be .
      -  Small breasts
      -  Large breast
      -  Sagging breasts
      -  Enlarged male breasts

A- Breast augmentation (for small breasts) : Is the term used to enhance the size of breasts.  It is a very common surgery and is probably the commonest cosmetic operation in some parts of the west.  This operation is a more satisfying procedure, as the results are instantaneous. This is carried out by placing a silocone implant behind the breast tissue. Scars are less noticeable with time.

Myth - placing silicone implants to enlarge breast increases the chance of cancer. Though some western countries have banned the use of silicone gel filled implants, it is proved by many studies that silicon does not have any added risk of cancer. With improvement in science, better materials & techniques, chance of gettijng problems is less.

B- Breast rediction: Some women are embarrassed by having very large breasts, so much so that they do suffer from psychological problems. They may not like to move in the society . Some suffer from health problems like- back pain due to excessive weight of the breast, fungal infection in the skin folds etc. In this operation the size of breast is reduced by  removing a part of breast tissue and skin. The nipple is relocated at a new position. The scars produced are hidden under the breast fold.

C.  Sagging of breasts: It is noted mostly in aging women & after delivery & lactation, due to lack of support. Treatment involves lifting up of breast tissue and reshaping them.The operation may take 2-3 hours and one may have to stay for 1-2 days in the hospital . in some there may be uneven breasts. Depending on the desire of the patient the large can be made small or small can by made large.

D.  Correction of enlarged breast in male (Gynecomazia)
In some boys and early adult life breasts enlarge to noticeable size leading to embarrassing situations. But many of the times these breasts return to normal size in 2 years time and on rare occasions they persist or increase in size and may be associated with hormonal problems. Depending on the size of enlargement either liposuction or removal of the excessive breast tissue or a combination of these two procedures is done.

10.   Tummy tuck (Abdomino plasty) :

The following categories of persons do suffer from sagging of abdomen.
1. Women after their child birth do suffer from excess sagging of skin and fat deposits over the abdomen.
2. Some have weak abdominal muscles leading to separation of muscles of abdomen and hernia of the intestines also.
3. Those who were on 'diet' regulating measures (especially those over 30 yrs) to loose excessive weight develop these.
          
During pregnancy, obesity& in hernias- the skin stretches to a greater extent to accommodate the increased contents of abdomen. After the delivery of the child or reduction of weight etc. the skin may not retract back to the original status in all the persons  to the same extent. in some especially those under 30 years of age the skin retraction is better, where as in others it may not. "Abdominoplasty or tummy tuck" is beneficial in this category of persons where skin retraction is less and skin hangs over abdomen in loose folds.

             In this procedure the excess skin and fat are removed. If excess fat is the problem it can be removed by liposuction at the same sitting.
During this process the abdominal muscles can be tightened in those with weak muscles, because of pregnancy and other reasons. The judgment
of doing tummytuck alone or in combination with liposuction depends on the experience of the surgeon . In this procedure a cut is made very lower abdomen and excess fat and skin
are removed and skin closed. The scar obtained is hidden by under garments. The operation may take 3-5 hrs and is done under GA. One may have to stay for 2 - 4 days in the hospital.

11.  Liposuction (Fat removal) :

 Various terminologies are in use about fat removal. Liposuction,Lipoaspiration,Liposculpture….But all boil down to only –removal of excess fat from the body, with or without fat refilling in areas of depressed regions over the the skin-ultimately giving a uniform, smooth cotour to the body parts, along with reduction in the size of the girth of the body parts. Weight is in relation to height of the individual. If the weight is more than 20% of ideal weight for the height of the individual - It is called obesity. In cities 50% of women and 30% men suffer from obesity.The common causes are:
         -  Increased intake of food
         -  Decrease physical activity
         -  Metabolic disordrs
         -  Hormonal disorders

If we take more than what is required- most of it is stored in the form of fat. In the majority the number of fat cells is constant and only the size of the fat cell increases in obesity. In a minority (20%), fat cells many increase in number. This second category have more problems. Liposuction has come into vogue since 1960, but is more popular from 1970 on wards. Dr. Illouz popularized this procedure with certain modifications. The basic principle in this technique is sucking out fat by introducing metal tubes with holes at the tip and connected to a suction machine at the other end. The tubes are safe, as their tips are blunt and fat is taken from the walls of abdomen and not inside the abdomen.

Liposuction is not the first choice for management of obesity. In fact it should be done as a last resort. Initially one has to follow weight reduction measures- such as
          -  Decreased intake of food
          -  Increased physical exercises
          -  Other measures

Even when the above measures are followed strictly, fat may not melt in some areas of the body (abdomen, loins, inner sides of arms, thighs etc).Liposuction is more useful in limited areas like these, rather than in diffusely obese patient.

One can not take out more fat at a time, as it may have adverse affects as the body. But the safe limit is increasing with increased understanding of the metabolic changes in the body after liposuction.Previously we were not taking more than 5 lts of fat at a time. But now we are able to take out fat up to 10-15 lts depending on the situation. But in general the safe limit is 8-10 % of the body weight in liters. If necessary, it can be done again with a time gap of 3-6 months. Immediately after liposuction one may feel the skin hard and numb but in course of time they do settle giving youthful appearance to the body. The operation takes 1-4 hours time  and one may have to stay for 1-2 days in the hospital.

Doctors Name:

Dr. Deepu Chundru

MS (General Surgery), Fellow Surgical GE (NIMS),
MCh (Plastic & Reconstructive Surgery)