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Thursday, 16 November 2017

Rhinoplasty – For All Who Expect More…!


“My nose is long and flabby at the end…” “Whenever I smile, my nose looks wide and ugly…” “I’ve got my nose distorted in an injury, and now I suffer from breathing problems everyday…” – these complaints are common. It’s a fact that half a million people are unhappy with the nose with which they were born, and are living with such worries… Rhinoplasty is the best solution for all such people – it is not just a procedure with complex series of steps, and it is not as bad as you may think! Here we are gonna review various aspects and possibilities of Rhinoplasty, which may help people who wish to, enhance the appearance of their nose.
Understanding Rhinoplasty…
    Rhinoplasty is one of the most popular cosmetic procedures available today to reshape the nose. It involves making the nose larger or smaller, changing the symmetry or angle of the nose with respect to the upper lip, altering the nose tip, correcting the bumps, indentations, or other defects in the nose, to bring it into better proportion with the rest of your face. Rhinoplasty may also restore structural problems with the nose that cause chronic congestion and breathing problems.
    Rhinoplasty are generally carried out by surgeons who are trained either in plastic surgery, otolaryngology (ear, nose, and throat specialty), or both.

The Procedures Involved…
During rhinoplasty, your surgeon will first access the bone and the cartilage support of the nose through smaller external incision made at the base of your nose, between your nostrils. Followed by this, the underlying bone and cartilage is readjusted to create a newly framed structure. For example, if you are dejected with the tip of the nose which is too large, your surgeon will sculpt the cartilage in this particular area, as a means to reduce its size. In case, if you feel that some portion of your nose is disproportionately small, cartilage or soft tissue grafts can be placed in order to create a more pleasing profile. Now, if the issue is that the bridge of the nose has a prominence, your surgeon will reduce this to yield better harmony. The angles of the nose in regard to the upper lip or the forehead can also be remolded by further sculpting the nasal support structure.
Next, the tissues are re-draped over the new frame and the incisions are closed. A small splint is then placed outside the nose to help maintain the new shape of the nose, as it heals.

Life after Rhinoplasty…
    All rhinoplasty techniques are different – so, recovering time varies from patient to patient, somewhat depending on how much your nose is altered during surgery. However, here are few things, which you can expect during your recovery stage.
  • In the first week of rhinoplasty, it’s very common to have swelling and bruising around eyes and nose, sore throat, headaches, and nausea. Cold compresses and over-the-counter pain relievers will be recommended to help you abate these symptoms. Keeping your head elevated can also help to minimize swelling.
  • While it’s crucial that you follow your surgeon’s post operative instructions, ensure that you take your antibiotics religiously.
  • It’s still important that you should watch for any signs of infection, including worsening pain, redness, swelling, fever, red streaks or pus. If any such concerns occur, report immediately to your surgeon.
  • Avoid any activities that would increase the risk of injury (For example, heavy lifting, excessive exertion, sun exposure etc.).
  • It is indispensable to make sure that you don’t blow your nose and avoid any impact to the nose while the structures are healing.
  • If you are a person who wears glasses, you must be very careful not to exert excess pressure on the nose bridge.
  • Majority of the patients can return to work during the second week of recovery, as long as you do not work on any strenuous activities. At this time, gentle washing of the face can be resumed and a little makeup can be applied, as well (of course, that’s your choice!).
  • By week three, you can recognize the new changes and start appreciating the brand new shape of your nose!

Even though rhinoplasty surgery is a minor surgery, there are complications, risks and recovery time to consider, as with any surgery. However, with proper analysis, combined with the skills of a qualified surgeon, rhinoplasty will become a very rewarding procedure for all.

Monday, 11 September 2017

Facial rejuvenation - Restoring the triangle of Youth




Many of us are happy with the wisdom and composure we attain with age , But few are happy with the wrinkles, folds, jowls and deflation of the face. The pursuit for a youthful facial appearance may involve everything from healthy diet, exercise, facials, anti-ageing creams,  to lasers , skin tightening procedures, botox and injectable fillers. However with time the traingle of youth turns to the pyramid of age. Traingle of youth refers to the widest part of the face between the two cheek bones in young person with  the narrow point at the chin. With ageing, it reverses and the widest part becomes the jawline , with the narrow tip at the bridge of nose. This is because of the midface deflation, fat pad loss, bone resorption, skin wrinkles and jowls. Skin becomes thinner, collagen and elastin breaks down and hyaluronic acid is lost resulting in  crow’s feet, nasolabialfolds, tear trough and  marionette lines .Usually this starts around the age of 35 ,with further deflation and midface bone resorption at 45-50 years. Many of the non surgical procedures like botox, fillers , lasers help in defying the age, but are effective only upto a point.

Restoring the triangle of Youth


A modern face lift procedure is customized or individualized to patients needs because not every face  is the same. It not only lifts the deeper tissue and removes extra skin but also fills the midface volume loss with fat grafting. The windswept unnatural look  with lift-alone procedures has given way to the more pleasing and rejuvenated fuller facial profile with the current facelift surgery.

Mini facelift- Patients who exhibit a mild degree of jowling and sagging skin are often good candidates for a mini-facelift.This is a less invasive technique that allows to tighten deep facial tissues through shorter incisions, typically located along the natural creases surrounding the ear. It can be done under local anesthesia with sedation or under general anesthesia. Structural tissue around the cheeks are lifted and plicated to refine the jawline and restore the midface. Advantages include shorter scar, quicker recovery and lesser complications.

Standard face lift- This procedure will more fully address moderate to advance aging of the midface and neck .It involves incisions starting in the temple region extending  to ear running in front, around and then behind the ear and back into the scalp. Facial skin on the cheeks and neck is dissected free and underlying muscle and fascia of the face and neck is dissected and tightened. Excess skin is trimmed and the incisions are closed. It take around 4-6 hours for the surgery, recovery is longer but the outcomes can be rewarding.

Blepharoplasty or the Eye rejuvenation surgery-  Many a times the telltale signs of aging can first appear in  and around the eyes. This can be droopy upper eyelids and brows , puffy bags under the lower lids, or  sunken eyes and  tear trough. This can make you look old and tired and sometimes interfere with the vision too. Blepharoplasty is a surgery that removes excess skin ,plicates the muscle in upper lid to lift it up , and redistributes the fat in lower lid to attain a smooth lid-cheek junction. The incisions follow the natural creases of upper lid and just below the lashline in lower lid. A lateral canthopexy is also incorporated to tighten the outer part of eye.This can be combined with a brow lifting procedure for a sagging lateral brow.

Autologous fat grafting for facial rejuvenation- Fat transfer techniques using fat from the other parts of body and transferring it to elsewhere has become more widespread and established technique. It has been used for breast augmentation, buttocks augmentation( Brazilian Butt lift) , hand rejuvenation and also for facial aesthetics. Micro and nano fat harvested from abdomen or inner thighs are  injected in the planes of facial tissue with blunt cannulas. Clinical applications include  filling of the malar prominence, tear troughs, nasolabial folds and  fine lines along the lips. The  adipose derived stem cells in fat tissue are critical in tissue regeneration and repair. The effect lasts for 3-5 years unlike fillers which has to be injected every 6-9 months.

Adjuvant procedures for face

Thread lift- Bioabsorbablethreads with barbs or cones are inserted  underneath the skin in specific areas of face to lift the eyebrows, lift the sagging skin over cheek , reduce nasolabial folds, define jawline and reduce the neck folds. The procedure can be done with patient being fully conscious and they can approve the look of their thread lift while the surgeon works . This innovative technique assures a subtle yet a noticeable change .

Double chin Injectables- Submental fullness or  fat under the chin can be treated with injectable deoxycholic acid in 4-6 sessions spaced at 1 month interval. This treatment has been approved by FDA. Deoxycholic acid is a naturally occurring molecule in the body that aids in the breakdown of the fat cells resulting in a noticeable reduction in fullness of the chin.

Friday, 5 August 2016

Top 5 Myths about Plastic surgery








There are plenty of myths and misconceptions surrounding the field of Plastic surgery. But plastic surgery is very much like any other field of medicine with highly trained and specialised surgeons performing all kinds of reconstructive and cosmetic work. In this article I would try my best to clear some of the myths about Plastic surgery.

Myth #5-  Plastic surgery is all about glamour and beauty
Not necessarily. Though there are number of cosmetic procedures like breast augmentation, botox, rhinoplasty, liposuction to name a few, the field actually encompasses everything from correcting birth defects like cleft lip and palate to complex reconstruction following accidents to breast reconstruction after mastectomy. Plastic surgeons are trained to focus on restoring the function and form , and not just aesthetics.
Most often cosmetic surgery is resorted to if the correction is near impossible with nonsurgical methods.

Myth# 4- Plastic surgery is a scarless surgery and lasts for ever.
Very often patients ask me  if the scars are totally invisible after plastic surgery.  Yes best plastic surgeons are trained to deliver scars that are minimal /small and refined, but it does leave a scar after any type of plastic surgery. The scar formation is a long run process that can continue for an year. We can recommend scar treatments in the form of creams, nonsurgical methods and precautions to be taken after surgery.
Many of the cosmetic procedures lasts long if taken proper care after surgery. Plastic surgeons do decelerate the hands of clock, but the clock keeps ticking. Hence procedures like facelift, liposuction, tummy tuck can give you years with good skin care, surgical touch ups and nonsurgical interventions.

Myth #3 – All cosmetic surgeons are Plastic surgeons.
Unfortunately it is not so. Any person with a medical degree and license can practice cosmetic surgery in India. There are many clinics without a certified Plastic surgeon treating patients with liposuction, hair transplantation  and what not. So it has become a ‘buyer beware’ speciality.
Patients choosing a plastic surgeon should inquire about the training and certification , whether surgeries are done in accredited centers with safe anesthesia practice .

Myth #2 - Plastic surgery is only for women
It is not so now. A good number of  men are now opting for procedures to enhance their looks and  self esteem. While there a procedures like botox and fillers for a rejuvenated youthful face there are also more invasive surgeries like liposuction for gynecomastia ; rhinoplasty and facelift for a chiseled facial profile  or a abdominal etching for toned abdominal wall. Other common cosmetic surgeries that men opt to are chin implant for a firm jawline, liposuction for a double chin and body contouring after massive weight loss.

Myth #1- Plastic surgery is only for the rich and famous.
This is #1 myth about Plastic surgery. Most of the aesthetic patients are normal patients who want to look as good as they feel. This can restore confidence, overrall appearance and  improve their lives. Cosmetic surgeries opted for correction of deformities not amenable to nonsurgical methods is not going to burn a hole in your pockets. It is tremendously going to improve your self esteem -to name a few, correction of gynecomastia in a young man who is extremely embarrassed to wear any T-shirts, or a mommy makeover for a otherwise healthy lady with lax breasts and abdomen, or a breast implant in a young girl who is depressed about her body image.  Any of these above mentioned procedure is going to cost an affordable amount .

Yes it shouldn’t become an obsession to look good  and undergo repeated surgeries when it is called body dysmorphism.

Columbia Asia hospital,Whitefield
Varthur Kodi, Varthur Hobli,
Ramagundanahalli Village, Bangalore East - 560057
  (+91) 7259605940/ 080-6165666
Email: drsandhyabala@gmail.com
Web: www.drsandhyabala.com




Thursday, 4 August 2016

An overview of liposuction- what you need to know about it






And so the battle against the bulge still continues. Hence I decided to write this post. 

There are umpteen number of options for weight loss, body toning , sculpted body and like wise. From hot water with honey and lemon to green tea , weight loss capsules, protein shakes -skip your meal types , or just simple veggies everything is on a roll now. Your neighbourhood is teaming with stores which stock them . There are slimming centers, gyms, Zumba and aerobic classes which can complement these stores. But still you are  unsatisfied with your body. You are unable to  get rid of the back rolls, bulge on your lower tummy, love handles on your flanks or the banana rolls on your buttocks with all your efforts . That is when you should consult a Plastic surgeon.

Safe Liposuction practice started by Dr Ilouz and Dr Fournier in the 1980’s in France has now become the most common cosmetic procedure worldwide. Though it initially started with simple manual liposuction , now there are power assisted liposuction, ultrasound liposuction and laser lipolysis. Your Plastic surgeon can guide you into which method is suitable for you depending upon the amount of fat, skin quality and preferred areas of liposuction. Ideally liposuction is targeted for inch loss and body contouring though you can lose your weight anywhere between 3-6 kgs postprocedure. Though the American guidelines for safe liposuction practice is removal of 5 liters of fat in a sitting, megaliposuction can be done in selected cases with utmost caution in which 8-10 % of your body weight can be sucked out in a sitting. Hence patients with BMI > 35 kg/m2  would benefit from a bariatric weight loss surgery rather than a liposuction.

This surgery is done through small 3 mm incisions placed along the concealed areas. A fluid is injected into the fat cells to break down the cells and liquefied fat is aspirated out. It is done under general anesthesia though local anesthesia can be given for small areas of liposuction. On an average 2-5 lts of fat is taken out from the body. Your surgeon may advise you to wear a compression garment postoperatively which helps reduce the swelling. Recovery after liposuction is smooth. You may have bruising, swelling which can last for 10-15 days. You can get back to work  2-3 days after surgery. The body starts shaping after 6 weeks, however the final result can take as long as 3 months.

Liposuction is combined with tummy tuck if there is excess lax skin in the lower abdomen. In a tummy tuck , a long incision is done spanning your hip bones on either side to remove all the extra skin. Umbilicus is also re-positioned in the waist. Similarly Liposuction surgery is also an ancillary procedure  undertaken in a person who had a massive weight loss surgery done. Here the folds of skin on the abdomen and thighs /arms are excised with liposuction of the remaining fat. Sometimes  a breast reduction surgery can be accomplished by liposuction alone in young girls where preserving the breast architecture and lactation is vital. This can be a stop gap solution to heavy breasts until child bearing and lactation is completed. 

The fat that is sucked out from the body has stem cells( ADSC- adipose derived stem cells) which has the potential to regenerate and multiply. This same fat, is filtered and centrifuged and can be injected in fat deficient areas of the face like the cheeks, laugh lines, wrinkles for a rejuvenated look.  This has also been used for a subtle augmentation of  the breasts in a natural “no implants” way. However the flipside of this procedure is the atrophy of 30% of fat cells and need for redo fat grafting sometimes.

The results of liposuction are technically permanent since the fat cells are removed from body. However your body shape and contour can change according to weight gain, lifestyle changes,aging, pregnancy etc. So the basic message is to keep your weight stable for a long lasting result.


Columbia Asia hospital,Whitefield
Varthur Kodi, Varthur Hobli,
Ramagundanahalli Village, Bangalore East - 560057
  (+91) 7259605940/ 080-6165666
Email: drsandhyabala@gmail.com
Web: www.drsandhyabala.com