Cosmetic and Plastic Surgery

Cosmetic Surgery

Liposuction

Liposuction is a procedure in which a suction device is used with fine metal tubes to suck fat cells from under the skin. The fat cells which are sucked and destroyed in this process are lost permanently. This is a quick, easy, and definite way to get rid of fat that refuses to disappear even after vigorous exercise and dieting. It works best for localized fat deposits around the lower abdomen, hips, flanks, and thighs. Newer techniques such as Power Assisted Liposuction or Ultrasound Assisted Liposuction allows sculpturing of the body shape, hence are called liposculpture. After a minor liposuction, a patient can be discharged on the same day, but after a major liposuction, it is preferable to stay in the hospital for a day or two. Often patients need to wear pressure garments after the surgery for 4-6 weeks. After the operation, it is usual to find swelling and bruising. This subsides in 3-6 weeks. This is reasonably a safe procedure in the hands of well-trained Aesthetic Plastic Surgeons. Sometimes after the procedure there may be some contour irregularities, which can be corrected by further ‘touch up’ liposuction or fat injection.

Abdominoplasty (Tummy-tuck)

This is an operation in which the extra fat and skin folds of the tummy are removed. Many women develop a skin fold in the lower tummy region and weakness of the muscles, especially after a C-section. This causes tummy to bulge out. It can also affect the posture and cause low backache as well. In this surgery extra loose skin is removed as well as the tummy muscles are tightened to get a nice flat tummy. This whole operation is done through a C-section type low horizontal scar, which hides well in underwear, heals very well and mostly fades over a period of time. Sometimes the belly button has to be repositioned to its natural place. Nowadays both liposuction and tummy tuck can be done together to get the best results. Addition of Epidural Anaesthesia makes this surgery pain free. Tube drains are used to get rid of blood and fluid that collects in the wound after the surgery. They are usually removed in 2-5 days. Dissolvable stitches are used so those don't need removal. Risks and complications of this operation are the same as those for liposuction. There might be delayed healing of the wound. The results are there to be seen immediately and improve next 6-8 months as the scar softens and fades and the swelling and firmness of tissues from the surgery goes down.

Rhinoplasty

Rhinoplasty or Cosmetic Nose operation can change and improve your personality. Nose is one of the most prominent areas of the face and it defines the character of the face. The common cosmetic procedures done to reshape the nose include removal of nasal humps, correction of depressions of the nose, shortening of the nose, narrowing a wide nose, elevation of drooping nasal tips, correction of broad nasal tips, and correction of the slant of nose. Cosmetic surgery on the nose is usually done under general but can be done under local anaesthesia as well. There may be a small plaster on the nose after the surgery which is usually removed after a week. Patients usually stay overnight and then are discharged the next day. The nose may look swollen after the plaster is removed. The bruising of the nose and eyes settles down over a period of 2-3 weeks.

Cheek Augmentation and Chin Augmentation/Reduction

A beautiful face is one in which the width and the height are nicely balanced. This is possible to achieve by reshaping the cheeks and the chin. The cheeks can be made to stand out by putting implants. Done as a day procedure which obviates any need for hospital stay, the implants are placed through small cuts inside the mouth or lower eyelid.

Many times the chin needs correction to balance the look of the face. A small set back chin can easily be corrected with an implant placed through the mouth making it a nice scarless surgery. Similarly, a very prominent chin can be corrected by reshaping the jawbone. Some risks associated with this kind of surgery are infection and occasional rejection of the implant. Some firmness and swelling seen after the surgery takes 2-3 months to resolve.

Breast Augmentation

Breasts form an important part of a woman’s anatomy. Many women suffer from a lack of confidence and low self-esteem due to small breasts. The breasts can be easily enlarged and made of desirable and proportionate size using breast implants.

Breast implants are commonly made of a silicon envelope filled either with saline, silicone gel or cohesive silicone gel. You should discuss the details, advantages or disadvantages of various types of implants with the cosmetic surgeon at Ruby Hall Clinic. The UK Independent Review Group and the FDA of USA have concluded that Silicone implants are SAFE for use in the human body. The appropriately sized silicone implant is placed through a small cut in the fold under the breast. This procedure is usually done under a general anaesthetic with a day or overnight stay in the hospital. Enhancement in size is instantly visible, although the breast may be swollen, bruised and slightly tender for a few days after the operation. This rapidly improves in 6-8 weeks’ time. Infection, bleeding, numbness, implant rejection and hardening of the scar around the implant are some of the possible complications. Reputed implant manufacturers give a lifetime warranty for the implants, so they do not need to be changed if not causing any problems.

Breast Reduction

Many women with large breasts frequently complain of backache, neck ache, shoulder bra strap pain, poor posture, skin irritation, infection under the breast folds, embarrassment and lack of confidence. Reducing the size of the breasts can reduce these symptoms and make the breasts look more proportionate. This procedure is done under general anaesthetic and involves a hospital stay of 2-5 days in the depending on how major the surgery is. There are three basic types of breast reductions depending upon the type of scars. The standard technique leaves an anchor-shaped scar, modern techniques leave a single vertical scar. The scarless technique involves liposuction, a procedure that can be used only in a few selected patients. All scars are BELOW THE NIPPLES and never seen on the upper parts of the breasts. There may be tube drains to remove excess blood and fluid out of the wounds and are usually removed 2-3 days after the surgery. Bleeding, infection, delayed wound healing, nipple numbness, partial or total nipple loss are some of the possible complications. Post-operative swelling, bruising, firmness improves in 2-3 weeks and the final result is seen after 3 months.

Rejuvenation

It is now possible to make you look more youthful with the latest aesthetic surgery techniques. These procedures are collectively called rejuvenation procedures. As you grow older the tissues become lax and with the effect of gravity you start seeing drooping of various body parts. The eyebrows droop, eyelid become loose and bags develop, wrinkles appear on the face and the groove between nose and cheek deepens, Breasts and buttocks sag.

Brow lift

The Brow lift is done to lift your eyebrows through either small cuts in the hair bearing area above and behind the forehead or through an endoscope. This gets rid of your tired look and makes your forehead look more youthful with no wrinkles and creases.

Blepharoplasty is a procedure that removes the excess skin folds or bags around the eyes. This can be done under Local or General Anaesthesia as a day case without the need for hospital admission. Possible problems with the surgery are bleeding and unsatisfactory shape of the eyelids.

Rhytidectomy (Facelift)

Face lift is done to tighten and lift the sagging skin and muscles of the face. This operation is done through an incision that circles around the lower part of the ear and in then goes into the hair bearing area behind the ear so that scars are not seen after the wounds are healed which normally takes 2-3 months. It can be done under general or local anaesthesia with a possible hospital admission of one day. There would be tube drains to remove excess blood and fluids from the wounds but are removed in a day or two. The face may be swollen and bruised for 2-3 weeks. Some possible problems are bleeding, delayed wound healing and rare possibility of weakness of the muscles of the face. A properly trained aesthetic plastic surgeon will be able to avoid these problems and deal with them if they occur.

Cervicoplasty (Neck lift)

This surgery is advised if there are skin folds or bands in the neck. These can be corrected by tightening the skin and muscles of the neck. Many times, it can be combined with liposuction which removes excess fat and gives a nice jawline. These procedures can make you look younger by 10 to 20 years.

Mastopexy (Breast lift)

Sagging of the breasts is a common problem seen after pregnancy and breastfeeding. It occurs because of shrinkage of the breast gland, while the skin which was stretched stays the same.

This procedure removes the excess skin and lifts up the breasts to more youthful appearance. It is possible to do this operation with a single vertical scar, which fades very well. Infection, bleeding, are some of the few possible problems.

Non-Surgical Methods

There are procedures to improve your looks and make you look younger without any surgery. These ‘no surgery’ techniques include injections of Botox, Fillers (Restylane and Perlane) and own body fat and using chemical peels of TCA/Phenolic acids and Glycolic acids. Botox is injected under the skin to inactivate the muscles to remove wrinkles. The effects last for about 3-6 months after which the injections can be repeated. Fillers are similarly injected under the wrinkles. They are also used to make lips look fuller. The result from fillers also lasts for 3-6 months. Chemical peels remove the top layers of the skin, so the new fresh skin grows over and finer wrinkles disappear.

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Cosmetic Surgery

Scope Of Aesthetic Surgery

Aesthetic Plastic Surgery can be broadly classified into two categories – surgery to make you look younger, more youthful, fresh and to reshape your body to improve your proportions. Liposuction is the commonest procedure to reshape the body in the West. Other procedures such as Rhinoplasty (Reshaping the nose), Chin and Cheek augmentation, Breast enhancement or reduction, Abdominoplasty, Calf, and Gluteal augmentation are few of the other popular reshaping operations. Sometimes, after massive weight loss, the skin of the arms, thighs, and abdomen have to be tightened and this can be done surgically. Lips can be augmented by injection of Hyluronic acid and depressions can be corrected by Fat injections. Rejuvenation procedures or operations to make you look younger include Brow lift, Face-lift, Neck lift, and Breast Lift. Non-surgical options to get rid of wrinkles and creases on the face include injections of Botox, Restylane, and similar hyluronic acid analogues. The finer wrinkles and sun damaged lusterless skin can be improved with Facial peels such as Glycolic acid, and TCA.

Treatments

Liposuction

Liposuction is a procedure in which a suction device is used with a cannula to suck fat cells from under the skin. The fat cells that are sucked and destroyed in this process are lost permanently. This is a quick, easy and definite way to get rid of fat that refuses to disappear even after vigorous exercise and dieting. It works best for localized fat deposits around the lower abdomen, hips, flanks, and thighs. Newer techniques such as Power Assisted Liposuction with Super wet infiltration allow sculpturing of the body surface, hence called liposculpture. It can be done under general or local anesthesia. Minor liposuctions can be discharged on the same day, but it is preferable for major liposuctions to stay in the hospital for a day or two. After the operation, it is usual to find swelling and bruising. This subsides by 3 – 6 weeks. This is a reasonably safe procedure in the hands of well-trained Aesthetic Plastic Surgeons. There are risks associated with general anesthesia. Thrombosis of leg veins is a risk associated with age and lying in one position for a long time. Adequate precautions are taken to prevent this. Other risks include contour irregularities, which can be corrected by further liposuction or fat injection.

Abdominoplasty

This is an operation in which the excess fat and skin folds of the abdomen are removed surgically. It is advised when the skin is in excess along with the fat and is unlikely to contract after liposuction. Many women develop a skin fold in the lower abdominal region and weakness of the abdominal muscles, especially after a caesarian section. This causes protrusion of the abdomen below the umbilicus. It can affect the posture and cause low backache as well. This operation can get rid of the skin fold. At the same time, the muscles of the abdomen can be tightened, a procedure called “correction of divarication of rectii”. This whole operation is done through a caesarian type low transverse scar, which heals very well and fades over time. In a full abdominoplasty, the umbilicus has to be re-sited, in a mini-abdominoplasty- the umbilicus is left in the same place and only the lower abdominal skin is removed. A newer technique that we follow combines liposuction with abdominoplasty, thus providing the benefits of both operations. Risks and complications are the same as for liposuction. There might be delayed healing of the wound. Drains may have to be placed in this operation to remove accumulated fluid. They are usually removed in 2 – 5 days. Sometimes, after the drains are removed, fluid may re-accumulate and may need aspiration in the clinic. The results are instantaneous and go on improving for the next 6 – 8 months as the scar softens and fades and the swelling and hardness from the surgery goes.

Rhinoplasty

Rhinoplasty or cosmetic nose operations can change and improve your personality. It is one of the most prominent parts of the face and gives character to the face. The common cosmetic procedures done to reshape the nose include removal of nasal humps, correction of depressions of the nose, shortening of the nose, narrowing a wide nose, elevation of drooping nasal tips, correction of boxy nasal tips, and correction of the deviation of the nose. Cosmetic surgery on the nose is usually done under General but can be done under local as well. Patients usually stay overnight and then are discharged the next day. The nose is usually swollen, there might be bruising around the eyes for a few weeks, and the nose is quite congested for a few days.

Cheek Augmentation And Chin Augmentation/Reduction

A balanced proportionate face is an aesthetically beautiful face. The width of the face and the length are governed by exact ratios, which makes the face attractive or handsome. To make the face proportionate, often the placement of implants on the cheeks is helpful. These are placed through either an incision in the mouth or through the lower eyelid. These can be done as day procedures. Many people often do not realise that along with a nasal hump they have an under projecting or an over the projecting chin. A simple silicon chin implant or reduction osteotomy can correct the imbalance. It also helps to improve the definition of the jawline. Some risks associated with this kind of surgery are infections, which may or may not respond to antibiotics. Some hardness and swelling after surgery should be anticipated and may need 3 months to resolve. Other rare problems are hardness, mobility, and extrusion.

Breast Augmentation

Breasts form an important part of the female anatomy. They contribute to augmenting female body proportions. Many women suffer from a lack of confidence and self-esteem due to small breasts. This is usually a developmental problem and can be either genetic or hormonal. After excluding any pathological cause, breast volume can be increased by adding volume to the breasts using breast implants. Breast implants are commonly made of a silicon envelope filled either with saline, silicon gel or cohesive silicon gel. You should discuss the details, pros and cons of various types of implants with the cosmetic surgeon at Ruby Hall Clinic. The UK Independent Review Group and the FDA of USA have concluded that Silicon implants are safe for use in the human body. The appropriately sized silicon implant is placed through a small incision either under the chest muscle or on top of the chest muscle but under the breast tissue. This procedure is usually done under a General anaesthetic with a day or overnight stay in the hospital. Enhancement in size is usually instantly visible, although the breast may be swollen, bruised and slightly tender for a few days after the operation. This rapidly improves in 6 – 8 weeks’ time. Infection, implant extrusion, bleeding, numbness, hardening of the scar around the implant are some of the rarely recognised complications. Reputed implant manufacturing companies give a lifetime warranty with modern implants, but we advise the patients to have the implants routinely reviewed and screened. They do not need to be changed if they are not causing any problems.

Breast Reduction

Many women with large breasts frequently complain of backache, neck ache, shoulder bra strap pain, poor posture, and general diffidence. Reducing the size of the breasts can reduce these symptoms and make the breasts more proportionate to the body. This is a procedure done under general anaesthetic and involves a stay of 2 –5 days in the hospital depending upon the amount of reduction. There are three basic types of breast reductions depending upon the type of scars. The standard technique leaves an anchor-shaped scar, modern techniques leave a single vertical scar. A scarless technique involves liposuction, a procedure that can be used in selected cases only. Delayed wound healing, nipple numbness, partial or total nipple loss, bleeding, and infection are some of the complications. Post-operative swelling, bruising, firmness, and shape may take 12 weeks to improve.

Rejuvenation

It is now possible with the latest Aesthetic surgery techniques to make you look more youthful and fresher. These procedures are collectively called as rejuvenation procedures. As you grow older, gravity affects various tissues of your body, which start drooping and become lax. The eyebrows droop, eyelid folds and bags develop, wrinkles appear on the face and the nasolabial folds deepen. Breasts and buttocks sag. The brow lift is done to lift your eyebrows through either small incisions behind the frontal hairline or through an endoscope. This gets rid of your tired look and makes your forehead look more youthful, as there are no wrinkles and creases. Blepharoplasty is a procedure that removes the excess skin folds or bags around the eyes. This can be done under Local or General anesthetic as a day case.

Usually, along with the excess skin, some excess fat is also removed or re-draped. This procedure makes the eyes look youthful and fresh.

If not done properly, there can be problems such as the inability to close the eye properly, asymmetry in lid margins, etc. Rhytidectomy or Facelift is done to tighten and lift the skin and the superficial muscles of the face. This operation is done through an incision in front and behind the ear and in the temporal hair and hence is not visible after wounds have healed. The face may appear swollen and bruised for a few weeks. Some recognized complications include a collection of blood under the skin (hematoma), delayed wound healing, skin necrosis and weakness of select branches of the nerves of the face.

A properly trained aesthetic plastic surgeon will be able to avoid these problems and deal with them if they occur. Cervicoplasty (Neck lift) is advised if there is the presence of skin folds or visible bands in the neck. These bands consist of the edges of the muscle called Platysma and are present just under the skin. To smooth the neck, these muscle bands need to be divided and the muscle lifted up and sutured at the back. Liposuction is also frequently performed to give definition to the jawline. These procedures all together have the potential to make you look younger by 10 to 20 years. Mastopexy or breast lift. Sagging of the breasts is a common problem with aging and is also seen after pregnancy and breastfeeding. It occurs because of shrinkage of the breast glandular tissue, while the skin envelope stays the same.

This procedure removes the excess skin and moves the nipple and breast gland to a higher and better location on the chest. It is possible to do this operation leaving a single vertical scar, which fades very well. Infection, bleeding, decreased sensation are some of its few complications. Apart from surgical means to make you look younger, there are non-surgical means as well, such as using injections of Botox, Hyluronic acids (Restylane and Perlane) and fat. Chemical peels using TCA/Phenolic acids and Glycolic acids. Botox is a very mild derivative of botulinum toxin, which when injected under the skin can temporarily paralyse the muscles that cause wrinkles and creases. Its action lasts about 8-12 weeks. Hyluronic acids are similarly injected under the wrinkles. It can also be used to enhance the lips. They last for 3-6 months. Chemical peels remove the superficial layers of the skin and encourage new fresh skin growth.