Cosmetic Surgery in India

PIP Breast Implant Controversy

2012-01-09T16:00:00.002+05:30

Hi everyone,

This is to enlighten the public and patients of CosmesisIndia, regarding the recent notice for recall and removal of PIP breast implants.

The following is the advisory issued by ISAPS regarding the same

Clients of CosmesisIndia can be rest assured that none of our implants were from PIP and there is no reason for an implant removal or exchange because of the recent developments.

Notice to ISAPS Members
8 January 2012
PIP Implant FAQs

To all ISAPS members: the following 10 Frequently Asked Questions (FAQs) have been developed to help our members respond to patients' questions about the PIP implant controversy. If you would like this document sent to you in another format so you can share it with your patients or post it on your website, contact the Executive Office at isaps@conmx.net We will upload it to the home page of the ISAPS website as soon as possible.
co

International Society of Aesthetic Plastic Surgery
45 Lyme Road, Suite 304 - Hanover, New Hampshire 03755 USA
t / 1-603-643-2325 f / 1-603-643-1444
e / isaps@conmx.net w / www.isaps.org

ISAPS has two missions: ongoing education of our member surgeons and the safety of their patients. In the following Frequently Asked Questions (FAQs), our Board of Directors provides patients who have breast implants with information about the ongoing PIP/ROFIL breast implant controversy.

1. What is wrong with the affected PIP/ROFIL implants?
The French manufacturer Poly Implant Prostheses (PIP) and the Dutch company Rofil Medical used inferior, industrial grade, silicone in the breast implants they produced and sold. These products have a higher rupture rate than other available implants. Rupture can cause inflammation from silicone leaking out into surrounding tissue.

2. Which implants are affected?
Affected products are PIP breast implants that were used since 2001. These implants were also marketed under the name M-implant by the company Rofil Medical in the Netherlands and distributed in Germany by the company Rofil Medro. Affected Rofil implants are designated as IMGHC-TX, MX-IMGHC, and IMGHC-LS. There is strong suspicion that PIP and ROFIL implants that were manufactured before 2001 are also affected and are prone to a higher rupture rate and therefore silicone leakage.

3. How do I know what brand of implants I have?
Typically, patients receive an implant ID card after such an operation which gives information about the implant, the size and the batch number. The surgeon's name and the date of implantation should also be recorded. If you do not have such a card, we recommend that you contact the surgeon who performed the procedure to check his records and tell you.

4. How high is the risk that the implant shell can rupture and for silicone to leak out?
Recent studies by the French authorities determined a risk or rupture of up to 11.1% for PIP implants. In conventional implants, the rupture rate is up to 2%. The durability of the PIP/Rofil implants appears to be much lower than normally accepted standards.

5. What happens when silicone leaks from an implant?
Cracks in the outer shell of the implant can allow silicone to leak out and enter the body. First, the silicone passes through the lymphatic system into the lymph nodes in the armpit. From there it can move into the internal organs, which is rare. This industrial grade silicone can cause severe inflammation, irritation, and in some cases effusion. On the basis of previous studies, no increased risk of cancer was shown.

6. Do I notice when an implant ruptures?
Probably not because a crack in the implant shell can remain unnoticed, or it can lead to non-specific changes. Enlarged lymph nodes in the armpit should always be an alarm signal that leads the patient to consult with their doctor. After an accident or violent blow to the chest, you should see your doctor so he can decide if an ultrasound or magnetic resonance imaging (MRI) examination is appropriate. These tests will offer clues to determine if there is a rupture or leakage, but often provide false negative results - meaning that no silicone leaks are seen.

7. What should I do if I have a PIP or Rofil implant?
Definitely go promptly to the surgeon who operated on you for a consultation. The International Society of Aesthetic Plastic Surgeons (ISAPS) strongly supports the recommendation of the French authorities to remove the implants as a precaution, even if no symptoms or hints of rupture or leakage are present. Of course, you can decide after consulting with your doctor not to have surgery and to return instead for regular checkups. If you decide not to have the implants removed, we recommend ultrasound or MRI scans twice each year to check for ruptures.

8. Will my health insurance cover the surgery costs to remove or replace the implants?
As an international society with members in 93 countries we cannot provide an exact answer to this question. We advise you to check with your plastic surgeon and your health insurance provider.

9. If I have my implants removed, is it possible to put new implants in at the same time?
If the implants are intact, it is always possible during the same procedure to replace them. If, however, there are complications because of the state of the implant, it may be that insertion of new implants in the same operation is not possible if rupture has been undetected for a longer period and if the industrial silicone has caused an inflammatory reaction in the surrounding tissue.

10. Do I need to look for a special surgeon?
As the implant removal may be complicated, you should always look for a board certified plastic surgeon as he will have the experience to deal with unexpected problems. The forty-one year old International Society of Aesthetic Plastic Surgery is the largest international society of individual board certified aesthetic plastic surgeons with more than 2,100 members in 93 countries. Surgeons undergo a strict application process to determine their qualifications to join the society. You will find a list of ISAPS members in your country on our website www.isaps.org

___________________________________________________________________________________
Dirk F. Richter, MD, PhD Joao C. Sampaio Goes, MD, PhD
Chair - Patient Safety Committee Chair - Communications Committee
Member, ISAPS Board of Directors ISAPS Past President
Wesseling, Germany São Paulo, Brazil
Email: dr.dirk.richter@t-online.de Email: clinica@sampaiogoes.com

Post Cancer Breast Reconstructions

2010-11-25T13:02:00.007+05:30

Hello Everyone….

Back to the blogging board. This time I’m trying to write about something that every woman should know about and be aware about.

Yes, I’m talking about “Breast Cancer Awareness” and the “Pink Ribbon Run 2010” to be held this year.

Many of you must have also noticed the strange facebook satus messages which were again put out there to create awareness, regarding breast cancer.

But, what I’m going to be writing today here, is taking it a bit further. Yes, prevention is better than cure… and awareness to identify the problem early and deal with it is very important. But I deal with people who are already diagnosed and are operated on or have had their breasts removed in part or completely as a result of this disease.

I’m talking about “Rehabilitation awareness or Reconstructive awareness” as I would like to call it. Most if not all the women who have an established breast cancer are subjected to severe mental trauma for having to loose a breast – a sign of womanhood. That, many of them find more traumatic, than dealing with the actual disease - cancer.

The low awareness regarding the reconstructive options for such patients is appalling. We need to spread awareness to tell these women… this is not the end, they don’t need to feel inadequate or incomplete. There are options to reconstruct the lost part of your body and help them feel complete again.

As with anything in the world, the old adage holds true here too – “A stitch in time saves nine”. Early detection might help with getting away with only a lumpectomy rather than a full mastectomy.

So, yes early detection is the key, and for that awareness is a must. But, in cases with an established lesion, we have found that it is easier for patients’ to fight it knowing that they can be treated to get rid of the disease and it need not come at the cost of losing a part of their body leaving them “incomplete”. Of course many of them even if not reconstructed, over a period of time do reconcile to the situation, but the “quality of life” is not the same.

" Reconstruction is not an option….. in fact it must be the right of the patient. "

Every patient who undergoes a deforming surgery should be offered a reconstruction. It is her choice whether she goes ahead with it or not and this has to be discussed with them right at the outset when a treatment plan is made. Nowadays, every Oncology center has a good reconstructive team which is capable of planning and executing the same so that no patient has to go home feeling incomplete. With newer modalities of treatment and diagnosis, the reconstruction can be performed in the same sitting without the need for a secondary procedure later on.

There are many significant advantages of such an approach. The patient find it easier to deal with the trauma of deforming surgery, the quality of life is better and acceptance of curative resections will be more. There are some more advantages from the medical point of view with an immediate reconstruction which I will discuss during the course of this blog.

Now that we have established the need for reconstruction of the breast, let me just briefly highlight the various reconstructive options. For ease I will broadly classify the treatments into:

Variations in treatment itself
Reconstructive options
Ancillary procedures.

Variations in Treatment:

Early detection helps giving us more options from the treatment point of view as in instead of doing a radical surgery to remove the full breast, variations such as Lumpectomies, Quadrantectomies, Partial mastectomies, Nipple sparing mastectomies or skin sparing mastectomies and the likes have come in. Of course as these fall into the purview of an Oncosurgeon and it would not be prudent on my part to be commenting on them.

But, it’s just to say that now, with early detection and by combining different modalities of treatment, the need for radical surgeries can be reduced.

Reconstructive Options:

But, when there is a situation wherein a part or the whole breast needs to be removed, we come into the picture to help with reconstruction of the breast.

Breast reconstruction involves using tissues from the body to reconstruct the breast either with or without an implant.

Implant Reconstruction:

In skin sparing mastectomies, partial removals or major lumpectomies, when the skin cover is more or less intact, then a reconstruction using a Silicon implant with or without a muscle flap is done. A muscle flap is combined along with the implant if only a think skin envelop remains to give better contour and also protection to the implant.

In cases where the skin envelop is more compromised and necessitates removal, then a combination procedure is done, where in a muscle flap is rotated from the back and then a tissue expander is inserted under this muscle to create a space for an implant. After 2 months or so, once the space is adequate, a silicone implant can be inserted or alternatively fat grafting to the breast can be done.

Breast reconstruction with Muscle & Skin Flaps:-

This kind of reconstruction is done using muscle and skin from other parts of the body to reconstruct the breast, when there is skin loss as well.

When a partial mastectomy is done or the native breasts are small, we could reconstruct using a Latissimus Dorsi Myocutaneous flap which is rotated from the back into the chest to reconstruct the breast. This can be combined with an implant as well. This muscle can be harvested to reconstruct the breast without too much of a deformity to the back and without significant loss of function. But this cannot be used when larger reconstructions are required.

For larger reconstructions the flap used is called the TRAM flap. This flap has been the workhorse for breast reconstructions for many years now. The main advantage of this flap is it provides good bulk for larger reconstructions and by removing it the patient gets an added advantage of having a flat tummy. This flap uses the fat and skin from the lower part of the tummy which is rotated into the chest to reconstruct the breast. This skin is normally discarded when we do a tummy tuck. So the patient get a tummy tuck as well as breast reconstruction in the same sitting.

Now there are more modifications to this flap allowing for more significant reconstruction with better aesthetic results.

Nipple reconstruction is usually done as a secondary procedure at a later date.

Ancillary procedures:

These are procedures done after the initial reconstruction to improve the result of the reconstruction and or the aesthesis.

Nipple reconstruction: this is done as a secondary procedure. This is a minor procedure done to reconstruct the nipple using tissue from wither the opposite nipple or a skin graft of vulval skin.

Reduction of the opposite breast.: Sometimes the native breast maybe too large, in such cases the reconstructed breast will be smaller than the native opposite breast. To help give a better balance a reduction mammoplasty of the unaffected opposite breast maybe required, but is not necessary. The choice is left to the patient.

Scar revisions: sometimes rarely the scars can thicken or some scars may widen needing a scar revision later on.

So, from this brief write up, you can see that there are well established procedures for breast reconstruction after a mutilating procedure following cancer of the breast. But the awareness amongst patients is still low and hence patients need to understand and ask for reconstructions.

As I said before, in today’s day and age, no patient should go without a reconstruction. There are enough and more plastic surgeons in private and in government hospitals, capable of providing these reconstructions.

Hope we can spread the word around so no woman who has had to deal with a cancer of the breast be allowed to suffer the added pain of feeling incomplete after a mutilating procedure.

It is no longer a question of if one lives but also a question of how one lives – The quality of life….is point of emphasis here.

Dr.Surindher

www.cosmesisindia.com

Mummy Makeover - II

2009-09-11T15:04:00.002+05:30

Mum Makeover Part II – Interventional options

In Mummy makeover part I we discussed about some options of preventing problems & non-interventional options to get back to the pre pregnancy state.

Here in this post we shall discuss about the interventional options available and a few of the same.

For ease of understanding, let me divide them according the regions of involvement and the options.

Broadly we can divide the changes into:
1. Generalized skin changes.
2. Changes to the face
3. Changes to the breasts
4. Changes to the Abdomen
5. Changes to the hips / thighs

GENERALISED SKIN CHANGES:

Generally there aren’t too many changes that occur in the skin proper except for maybe more of dryness, cracking of the lips, and most importantly the “dreaded Stretch marks”.

Dry Skin:
As with any other reason for dryness, keeping the skin soft and supple is accomplished by using moisturizing & body lotions. Generally twice a day massages will help take care of this problem.

Cracked lips:
are problems especially during the later stages of pregnancy and early period post delivery. Same as with the skin, moisturizing with the use of lip balms and keeping yourself hydrated will go a long way in controlling this problem. Wetting the lips by saliva and biting them will only worsen the problem and also cause the lips to darken.

Stretch marks:
I wish I had a sure shot solution to this problem. If I did, I would be a millionaire in a few years. But, as I already mentioned in my previous blog on the same subject, the best way to treat stretch marks is to prevent them. But, am sure many of you are thinking that I’m the doctor here and I should be offering some solutions instead of saying it is untreatable. Well, there are a few options, but all have their limitations and none of them has a 100% success rate. This is because the stretch marks are due to breakage of the inner elastic dermal layer of the skin while the epidermis is still intact over it and all the treatments we have are external and aiming at promoting collages and scar deposition in the broken dermal layer of the skin.

The treatments work better in early stretch marks which are “pinkish or reddish” in appearance but not very promising in late established “white” stretch marks.

1. Chemical peels: there are various types of chemical peels which are basically long acting peels which promote collagen deposition in the deeper dermal layers of the skin. Some of the peels also tend to lighten the hyper pigmented areas, which are often associated in the stretch marked areas, which causes them to stand out more. By lightening the darker areas it helps camouflage the stretch marks better.

2. Dermaroller: This is an instrument, which works on the principle of “Microneedling” which basically means to puncture the skin with small micro needles so that there is no pain but the injury promotes collages synthesis in the deeper layers of the skin where the actual problem lies. This has shown decent results but it takes a long time for the results to be apparent. The procedure itself takes around 15 minutes to an hour depending the size of the affected area. The procedure is repeated every 4-6 weeks for 5/6 times..

3. LASER: Laser’s use the power of light to heat the deeper layers of the skin thereby promoting collages synthesis in the deeper layers. This works well in early stretch marks (pink stretch marks). Multiple sittings are required, at intervals of @ 4 weeks.

CHANGES TO THE FACE:

Most of the changes that occur during pregnancy like puffy face, dry skin and lips, are reversed post delivery. The most common change that stays on usually are pigmentation problems especially in the cheek area called “ Melasma”.

This is a problem that can be treated with a combination of peels, microdermabrasion and some skin lightening medication. But of course, skin protection from sun is an important part of the post treatment care.

As the hormonal status returns back to normalcy, the water retention and puffiness of the face also comes down. But gentle toning exercises help speed up the process.

CHANGES TO THE BREASTS:

The breasts and the abdomen are the commonest areas to bear the brunt of pregnancy. The most common problems following childbirth and breast feeding are, loss of breast volume, sagging breasts, stretch marked skin excess.

This is because during pregnancy the milk glands in the breast enlarge to replace fat in the breasts and post breast feeding involute to their original size. But, sadly the fat does not return to the breasts and if the skin has a lot of stretch marks, it does not shrink to the new reduced volume, causing sagging.

There are a few options when it comes to correcting these problems. If one feels comfortable with the size of her breasts when wearing a bra and is worried only about the sagging, she needs a “Breast Lift”. If she feels, the size in a bra is small, then an increase in volume is also needed, wherein a “Breast Augmentation or Breast Augmentation with Lift” is indicated.

1. Breast Lift (Mastopexy): This is a procedure designed to address the sagging glandular tissue of the breast as well as removing the excess skin. The basic procedure is the same, but many approaches like the classical “anchor incision”, “short scar vertical mastopexy” or a “circum areolar mastopexy” can be used. The gland is reshaped and suspended to the chest wall, the excess skin being tailored to the new breast mound to give it a proper shape.
Problems with a breast lift are usually a scar and the healing time. But apart from that it is a reasonably well tolerated procedure.

2. Breast Augmentation +/- Mastopexy: When the skin excess is not much, only an increase of breast volume in the form of an implant would suffice. In cases where the skin is in excess, augmentation using an implant is combined with a mastopexy. Here the augmentation is performed first and the breasts reassessed for residual sag. If present, the sag is taken care of by a mastopexy at the same sitting.

CHANGES TO THE ABDOMEN:

The abdominal changes are the most common and the most “visible” stigmata of pregnancy and childbirth.

The most common changes seen are loose flabby skin, stretch marks, fatty deposits, lower abdominal bulge and sometimes an upper abdomen bulge too.

The reasons for this have been discussed in the previous post “Mummy makeover- I”. Stretch marked skin does not contract and shrink, hence the loose flabby skin. Because of it the fat deposits stay and the loose muscles inside also contribute to the bulge.

The procedure to correct this deformity is commonly called the “Tummy Tuck” or an “Abdominoplasty”. There are two main variants to this procedure.

1.Regular Adbominoplasty: This is the classical method of correction of the problem. Skin excess is removed (the stretch marked skin below the level of the umbilicus), fat is sucked out with liposuction, the muscles are repaired and the hanging umbilicus, is repositioned to a normal position. This involves hospitalization for a day or two and a scar within the panty line, basically like an extension of the usual “Caesarean scar” but extending from one flank to the other. Simultaneously in selected cases the muscles can be tightened inside to bring the waist in also.

Usually there are drains left in after the surgery to drain out any excess secretions. These come out in 24-48 hours.

It is a common and well tolerated procedure, the main drawbacks being a long scar, though within the panyline. Getting back to routine activities takes around 3-4 days and regular normal work can be resumed within a week in normal circumstances.
Exercises can start within 2-3 weeks but abdominal exercises can be started only after 6 weeks. The patient has to wear a pressure garment (corset) for 6-8 weeks to help with swelling.

2.Mini Abdominoplasty: This is a variation of the regular abdominoplasty in the fact that skin excision is limited and there is no umbilical repositioning. But, liposuction and muscle repair are often needed. This is indicated when the skin excess is not much but there is muscle weakness. The scar is not as extensive as a regular abdominoplasty.

CHANGES TO HIPS / THIGHS:

Changes to the hips and thighs are usually related to weight gain. As mentioned in my previous posts, hips and thighs are genetically prone areas for weight gain in women. Pregnancy weight gain in this area is just an extension of the same. Post delivery exercising does help to get rid of this excess.

In case it cannot be done for whatever reason, then operative options are there in the form of a liposuction. Liposuction as mentioned in previous posts is a procedure to contour certain areas of the body by sucking out the excess fat using small 1cm cuts.

As you can see, many changes do occur during pregnancy leading to changes in the body, some temporary and some permanent. There are options to try and get the body to the way it was but maintenance is required.

As mentioned before, there are no short cuts. All the surgeries are procedures are aimed at bringing the body as near to as it was, but maintenance is required to keep it that way.

Also, as mentioned in my previous post “Mummy makeover –I”, many of these problems can be avoided by a little care during pregnancy and post child birth. So spread the word, pregnancy and childbirth doesn’t have to be so problematic for a woman.

Try and prevent these problems and if you already have them, most of them can be corrected. There is no reason for one to live with them, as there are “options available”!!!

Dr.Surindher

CosmesisIndia

Cosmetic Surgery in India - Understanding the Battle of the "BULGE" !

2009-03-07T16:42:00.005+05:30

Hi everyone… back after a long break.

I have often been asked that the blog dealing with the issues it does, has not yet touched upon an issue that every one of us tries to cope with at some point in our lives. You may ask what issue that is……. It is the issue of weight management.

I know each and everyone of us (including me) at some point in our lives are fighting the “battle of the bulge”, hence I thought of putting down a few of my thoughts on the same from a personal point of view and from a health professional’s point of view.

Another reason for this delay in writing about this could be fact that notwithstanding the “magical guaranteed weight loss” adverts that I’m sure everybody has seen, this is a difficult issue deal with. Let me be a party pooper here by saying emphatically…there are no and I mean NO SHORT CUTS.

So let us see why this is such a big problem and what are some of the factors that play a role in weight gain. I would call it weight gain rather than obesity because the term obesity does not include overweight people by definition.

This brings us the fundamental question, when would one be called normal / overweight/ obese or morbidly obese? This classification is based on BMI or Body Mass Index, which is basically a product of a person’s bodyweight divided by a person’s height. A BMI of 18-25 is normal, 25-28 over weight, 28-35 obese and above 35 morbidly obese.

You can calculate your BMI using this online link below:

BMI Calculator

Why does one gain weight? This is a question the answer to which each and everyone wants to know, because if we know the answer to this, very easily we can avoid the causes thereby avoiding weight gain.

Sounds pretty simple, doesn’t it?? Sadly it isn’t that simple.

But to take a common analogy that I give to my patients’ weight gain is like a bank balance, there are only to ways to increase your bank balance (weight) either you earn more (increased intake) or spend less (decreased output).

But sadly I’m sure all of us agree it’s easier to gain weight (except for the lucky few who have genetics on their side), than increase your bank balance. Now once we have the grass root level basic fundamental cause of weight gain let us examine a few reasons as to why and how it actually happens.

I’m sure we all have read enough and more about all this in all kinds of forums and media, let me just recapitulate a few of the reasons which most of us commonly face. I’m specifically not going too much into the technical details and trying to give you the gist of things. Secondly, I’m not touching upon certain medical conditions for weight gain, which I will briefly discuss during the course of the blog entry.

INCREASED INTAKE / WRONG INTAKE / IMPROPER INTAKE

As you can see from the heading, it is not only increased intake but also the intake of wrong kinds of food and improper intake, which also contributes to weight gain.

1.Over eating: Though most of us tend not to agree to it, it is often the most common cause for weight gain. Every time you have that extra spoonful, it adds up in the long run. It is said that after a meal one should feel that he can have a little more…. that, is the time one should stop. But more often than not, we stop when we feel full and that is already too much.

2. Fast food: Fast food is fast to make and convenient to eat can be eaten on the move but more often than not is full of fats/cheese & salt.

Anyone who has read science in school knows that fat has more calories (9Kcals/gm) as compared to protein (4Kcals/gm) or carbohydrates (4Kcals/gm). So, the more fats you eat the more calories you are putting in. Carbohydrates are easy to absorb and after your basic energy requirements are met, are converted to fat for storage.

Chips – a favorite amongst most is another common cause. An old saying for them, which holds very true, is “ A minute on your lips & a lifetime on your hips”, hence avoid them.

Increased salt intake causes more water retention in the body and hence is also an important factor for weight gain.

3.Improper timing: The time of a meal also is an important factor. Food should be eaten at least 2 hours before one goes to bed to allow digestion to occur properly. So, siesta’s after a heavy lunch or eating just before going to bed are not such good ideas after all.

There is research also to suggest that, the later in the night one eats, the more chances are that all that food is being converted to fat. So, having “ a midnight snack or munchies” is again not such a great idea.

4.Alcohol: Alcohol has often been blamed for gaining weight but the gain in weight is more related to the increased snacking, which goes along with consumption of alcohol.

5.Fizzy Drinks: These are aerated drinks with empty calories, which are of no use and add up to the over all “Bank Balance of Calories”. Instead, substitute it with fresh fruits or fresh lime, which is much healthier but of course try and avoid excess salt or sugar in them.

DECREASED OUTPUT:

This is now turning out to be an important part of the whole weight gain process, especially so in youngsters and children.

1.Sedentary lifestyles: Now with the comfort levels increasing, activity has reduced. We use the lifts instead of stairs, vacuum cleaners instead of brooms, cars instead of walking, etc. The amount of calories burnt per day is decreasing with more mental activity than physical.

Some amount of physical activity is needed daily to keep the Basal metabolic rate higher so that you can burn more calories. Of course though ideal, considering family and work pressures, it is understandable that a regular gymming schedule is not always possible.

But, one can incorporate small things into the daily schedule to increase the output like taking the stairs instead of the lift, walking to the nearby store instead of driving, morning or evening walks, etc which do not take up too much of your time but help in spending those calories.

2. Children especially should have some regular physical activity in their daily schedule or we are going to be waking up to a generation of overweight youngsters. It is already happening in the west and is a major health hazard. We can see it happening around us in India too.

Real games instead of Video Games, fruits instead of chips or pizza & fruit juices instead of a fizzy drink should be the mantra for the kids.

MEDICAL CONDITIONS FOR WEIGHT GAIN:

There are a few medical conditions that can be a cause for weight gain. These are usually hormonal imbalances. The most common being:

1.Hypothyroidism: Here there is a decreased secretion of “Thyroid Hormone” which is responsible to maintain the Basal Metabolic Rate and hence there is a tendency towards weight gain. This is a treatable condition and after proper tests to find out the hormonal levels, replacement of the hormones causes a reduction in weight.

2. PCOD: Poly Cystic Ovarian Disease or PCOD is another condition associated with weight gain. Here again the hormonal imbalances cause weight gain and the weight gain in turn worsens the PCOD. Medical & surgical options are available for treatment of this condition. A curious thing seen here is that weight reduction helps with the gyneacological condition with normalization of hormones.

3. Adrenal Hormonal Imbalance: This also can cause weight gain because of water retention.

WEIGHT GAIN & DIETING

A lot has been written n said about dieting and weight loss. Every other person is an expert in some sort of a diet. But a recent study has brought the proper perspective, as I have been saying for quite some time now, its not what kind of a diet you follow but the total intake versus the total output.

So whether it’s a low carb diet, a low fat diet or an only protein diet, it doesn’t really matter. What matters is,the total amount of calories going in.

Crash Dieting is a not a way to loose weight at all. You might loose weight initially but you are loosing muscle bulk and replacing it with fat. And most of the food that one eats gets converted to fat directly because of the body’s survival mechanisms. Secondly, with crash dieting there is a tendency to alternate binging with crash dieting and this doesn’t help.

So, what one needs is a proper balanced diet according to the work he or she does, which has all the necessary nutrients.

TREATMENT OPTIONS

I’m sure all of us have heard or read quite a bit on the treatment options. I’m not going to discuss exercise, lifestyle modification and diet control which are essential to all treatments as an adjunct.

For the ease of understanding, I will divide the treatment options according to the BMI.

BMI of 25-28(30) – Overweight Category:

This is the category for which we have the most number of options.

1. Isometric Exercise/ Non Surgical Body Contouring – This is an option where in, with the help of targeted muscle stimulation & Infra red waves, isolated areas of the body are treated to achieve targeted contouring and inch loss. Here the patient comes in twice or thrice a week to the center, where the machine does the work for them and helps to achieve targeted contouring.

Very good for people in whom muscle laxity is a cause for bad body contour especially in the tummy area. Also very good immediately post pregnancy to help reduce the flab and tighten the muscles which have become loose post pregnancy and child birth

2. Ultrasonic Lipolysis: This involves breaking down the fat cells directly with the use of a non-invasive ultrasonic wave. The patient comes in once a month for the treatment, which lasts 45 mins to an hour. The released fat has to be reabsorbed and excreted by the body. It works well for small isolated areas like the saddlebags, lower tummy. This doesn’t work for large areas.

3. Injection Lipolysis or MESOTHERAPY: This involves giving multiple injections in the target areas to help dissolve fat in that area. The injection is usually of a derivative of Soya protein, which helps the cell membranes of the fat cells to break down and release the fat into the body. This is absorbed by the body and excreted.

It requires injections maybe once a month for 4 or 5 times. It works well if given properly and for small areas like the double chin or the saddlebags. Contrary to what people might claim it is not for large areas. Complications in the form or small injections abscess or collections of liquefied fat, which may require drainage, are occasionally seen.

4. LASER Lipolysis: This is a minimally invasive procedure which involves insertion of a small LASER probe in the affected area help break down the fat cells in the track of the probe thereby releasing fat into the body which is reabsorbed and excreted. This is also an office procedure and requires multiple sittings maybe a month apart.

Works well again for isolated areas like double chin, cheek fat, saddlebags, arms, etc. Large volume Lipolysis again is technically possible to a certain extent but not practical. The patient does need to use pressure garments, should have the patience to wait for the results for a few months and of course undergo multiple sittings.

5. Liposuction: This is a surgical procedure where a cannula is inserted under the skin by small 1-1.5 cm incisions in hidden areas to suck out the fat. This again is a procedure for body contouring. Though one does loose weight, he will loose more in inches

There are various techniques like the mechanical, ultrasonic, VASER, power assisted. All these are different methods of suction depending on the type of probe used to breakdown the fat cells.

As regards to the technique there is also the tumescent technique which is the preferred technique nowadays and basically involves infiltrating large volumes of saline along with some drugs to help minimize bleeding and trauma to other structures in the vicinity.

Liposuction can also be classified according to the volumes to be removed. Small, moderate or mega liposuctions. Small volume suction can be done under local anaesthesia. Moderate volumes can be done under local anaesthesia with sedation or general anaesthesia depending on the patient’s comfort level. Mega liposuctions require anaesthesia, hospitalizations and in some rare instances blood transfusions.

Internationally, the accepted volumes of fat that can be safely sucked out at one sitting is @ 8% of body weight in men and @ 9-10% of body weight in women. This is because of the fact that men tend to have an equal amount of fat inside the abdomen, whereas in women most of the fat is extra abdominal and also the fat that men have more fibrous fatty deposits. Hence, women are good candidates for liposuction.

Problems after liposuction are because of the swelling. Here as the fat is physically being sucked out, the effects are noticed immediately, but in a few days swelling sets in and takes around a month before significant changes can be felt. This also depends on the areas targeted and the amount removed. Full healing takes around 3-4 months and during this period the patient needs to wear a pressure garment to help the skin shrink. Some amount of unevenness maybe present which gradually settles with time and massages.

Rarely in smokers, there maybe areas of skin necrosis. Sometimes especially with large volume liposuctions, there maybe some collection of fluid called seroma’s which might require drainage.

BMI of 30-35 – Obese Category:

This category is the so-called “Grey Zone” of weight loss treatments. As these patients are not yet candidates for a Bariatric procedure and the procedures for the overweight category cannot fully help in treating these patients. But increasingly we are seeing patients in this category.

In these patients it has to be a combination of procedures and sometimes multiple sittings are needed to get the desired changes.

More often than not we do large volume liposuction in such cases, maybe one or two sittings with a gap of 6 months in between combined with a proper diet and exercise schedule. The procedure of Liposuction has already been discussed.

BMI of 35 and more – Morbidly obese Category:

These patients have other metabolic problems along with the fact that they are overweight. These are candidates for Bariatric procedures that are procedures aimed at reducing the intake drastically (Gastric banding or Sleeve gastrectomy) or reducing absorption of food (Gastric & Duodenal bypass procedures).

These are major surgeries and have to be done in specialized centers and involve a multidisciplinary approach with the involvement of plastic surgeon, gastroenterologist, psychiatrist, dietician, physical therapists, anesthetists, etc. This itself is a topic by itself.

The aim of this blog was to try and bring things into perspective for a person looking at weight loss or to just get in shape. Ultimately, “ a Stitch in time does save Nine”! So the earlier we wake up to the fact that weight is becoming a problem to all of us, the better it is. If not to reduce, at least try and modify our lifestyle and being about some changes in how we do things, it might help prevent the problem from becoming worse, where a much more drastic and major procedure might be required.

As you must have seen in the course of the blog that, this is not a simple topic and I have not even scraped the surface of the problem. But, the aim is to try and simplify things so one can understand what are the little things we can do to bring about a bigger change.

Whatever said and done, all the procedures are only an adjunct to lifestyle modification to get the full benefits in the long run. Change in dietary habits, maintaining a negative intake output balance, increasing physical activity will all go a long way in helping one keep fit and stay healthy.

So let us bring about the change… by being the change!!!!

So here’s to a new, fit, healthy, better looking you..!!!

Dr.Surindher

www.cosmesisindia.com

"Mummy Makeover" ... I

2008-07-24T17:24:00.005+05:30

“A Mom Makeover!”

Sounds trendy doesn’t it???

Well not really, it’s new packaging of the procedures already being done, as we shall discover in the process of this blog and the next.

Why the mom makeover at all?

The woman being the one to create life, goes through many changes physically during the process of pregnancy, giving birth & nursing the child. In a way, it is a sacrifice she makes to create and bring forth a new life.

But, the question still remains, why the makeover at all. What are the changes that occur which need to be corrected.

Doc, I jus saw myself in the mirror today and I was shocked, as I couldn’t recognize the person I saw in the mirror. It was definitely not me..!!!

This is a common complaint women come to us with. During their pregnancy, the mother and everyone around are concentrating on the eating, weight and the unborn child’s well being. After birth it is again the child who is the center of attention, after that till the child starts going to play school, the mother is totally neglecting herself. Then one fine day when she has a little free time from kids and family, she looks at herself and cannot recognize the person in the mirror.

It is not intentional, that this happens. It’s just how things are prioritized in life. I’m not saying that we do not need to give attention to the child during that period. Just that, a little bit of attention to the mother during the pregnancy, childbirth and post birth period, will go a long way in her not having to feel that way a few years down the line.

So what exactly am I talking about here?

To simplify the understanding of what needs to be done, let me first start by enumerating and discussing few of the issues that form the basis of the problems to be corrected in a Mum Makeover.

The Tummy: The abdomen, especially the lower abdomen is the area which bears the most insult during pregnancy. Because of the growing womb, the skin is stretched, the muscles are stretched, and there is collection of fat because of the weight gain. Post childbirth, the skin stays loose, has lot of stretch marks, there is a prominent bulge in the lower abdomen because of the loose muscles. All these are compounded by lack of physical activity concentrated to the specific area. Also, with more women now going in for cesarean sections, the lack of activity in that area get further delayed.

The Hips: This area is genetically programmed to carry more fat in a woman (the pear shape). More so during pregnancy and post pregnancy. This is genetically the reserve, which the woman accumulates during pregnancy. Combined with less physical activity in the immediate post partum period, tends to get worse.

The Breasts: The breasts also bear equal brunt of the pregnancy and post delivery period. During pregnancy and lactation there is development of the milk glands to produce milk for the newborn and hence as they develop they replace the fat that is present in the breast. Once the period of breast-feeding is over, the glands get back to their pre pregnancy state, but the lost fat doesn’t come back and that is the reason for the breast looking empty and sagging. Also because of the stretch marks on the skin of the breast, the skin doesn’t shrink back to the reduced volume giving it the appearance.

The Vagina: Post childbirth, the vaginal canal is stretched and like any muscle that is stretched a lot, it needs toning to bring it back to its normal size and tone. In fact in the west this has been used as a punch line to ask people to go in for caesarean sections… “ Have your child the C sec way and keep your passage the honeymoon way”. But that is not required, the vaginal passage was physiologically meant to stretch and contract. But a few things have to be kept in mind, as we will discuss later on in this blog.

The Face: Post pregnancy and childbirth many women tend to have pigmented patches on their faces called “ Melasma” which just persists even after childbirth. This occurs due to hormonal changes during pregnancy. Also some patients might have a double chin or a more rounded face as part of the generalized weight gain seen during this period.

Now that we know what are the few changes, which occur during the period starting from getting pregnant to one realizing that their whole body image has changed, is there something we can do to reduce these insults if not prevent them altogether?

The good news is YES…!!! There are things, which one can do during pregnancy and in the immediate period following childbirth to help prevent or at least reduce the changes that are occurring in the body.

Pregnancy Care:

The whole aim of the “pregnancy care” concept is to help the mother to be to take care of her body by doing small things to prevent future problems. The main problem during pregnancy is the weight gain and the increasing abdominal girth. When this rapid weight and circumference gain is more than what a person’s skin can tolerate, the dermis which is the supporting layer of the skin ruptures leading to stretch marks. So to prevent stretch marks the best thing that one can do it just spend 10 minutes each in the morning and night out of 24 hours to do a little something to help keep the skin supple to prevent stretch marks. The areas to be concentrated on are the abdomen (more so the lower abdomen), the breasts, the buttocks and the thighs.

The best way to keep the skin supple is to moisturize it. It could be with the help of oils or body lotions. Just take 10 minutes out of your daily schedule to gently massage the areas with a body oil or body lotion. This when done over the period of the pregnancy will make the skin supple and allow it to stretch easily as the mother gains weight and the abdomen gains circumference. This is true for the breast as well as other areas as mentioned before.

This simple step can prevent a lot of the problems later on. Also the second trimester is the most important period to do this because in the last trimester the weight gain and the circumference gain is very rapid and doing it then will not give the skin sufficient time to become soft and supple enough to stretch.

Post Child Birth:

Post delivery the single most important thing a mother can do to help her regain her figure and push her tummy back is the same thing that our grand mothers used to advice. That is the use of a binder or as the grand mothers would advice tying a sari around the abdomen tightly.

This helps in two ways, firstly it is pushing the skin back to its normal position and allowing it to shrink as it normally should and secondly it is also pulling the muscles together to the normal position they should be in. Hence, this when done properly for the next few months will greatly help in one getting back to the pre pregnancy state. Of course if the stretch marks are too bad then the shrinkage might not be to the extent that is desired for, as the skin is like a rubber band broken at multiple places, but even then the muscle toning itself is enough reason for one to use the binder.

This can be done for patients who have undergone C-Sec’s too. After the initial week or two of the healing time for the wound, the binder will help as mentioned above.

The other things that the mother can do are to continue the oil massages to the body and to get into some sort of regular physical activity. Be it morning walks or evening walks or treadmill, etc. I know there would be lot of women shaking their heads n saying… “ What does he know.. He’s not a woman! How do we find time for it? ” But for that, ladies.. let me just say one thing… “Its not easy agreed but if you do it.. it will benefit you. You are preventing a surgical procedure and getting back to how you were and not letting things get out of hand…!” So you work out the math!

As far as the vagina goes, the easiest way to help tone the pelvic musculature to get back to what it was is to do some basic exercises called Kegel's Exercises. The aim of these exercises is to strengthen and fortify the muscle tone of the muscles of the pelvic floor which in turn. It basically involves contracting your pelvic muscles and keeping them contracted for a period of time and doing this in cycles all through the day. The best part of this exercise is that it can be done anywhere and anytime and doesn’t need any equipment.

So now that we know what are the few things one can do to prevent things from getting out of hand and one finally landing up in the so called “ Clutches” of the “Cosmetic Surgeon”, I hope more and more to be mothers will take better care of themselves to prevent or reduce these problems.

As, I will be dealing with the specific surgical management of these problems and the actual “Mummy Makeover”, I think this blog should have been titled…” Tips to prevent a Mom Makeover”.

Happy reading…

Dr.Surindher

Cosmetic Gyneacology - A new concept???

2008-07-11T17:54:00.004+05:30

Hi all.....

Today, I'm gonna be talking about a relatively new topic ( at least in the general public's mind) especially in the Indian scenario. I have been getting many queries and emails regarding this, but the common factor in all those being the fact that very little is know about it and there seems to be a lot of confusion regarding the same.

The topic is “Cosmetic Gynaecology”.

Though the procedures that come under this heading have been performed for quite a few years now, the term seems to be recently coined. It basically involves correcting cosmetic problems related to the female genitalia. The procedures which come under this are:

Labioplasty ( Reducing size of the lips)
Hymenoplasty
Vaginoplasty or Vaginal Rejuvenation ( Tightening of the vagina)
G spot amplification

These procedures can be done together or separately or in various combinations depending on the need of the patient. Sometimes certain other urological or gynaecological procedures maybe be combined if there is a associated medical problem.

Let us briefly discuss each of these procedures separately.

1.Labioplasty:

This refers to the procedure by which the labia ( lips) minora most commonly or sometimes both the majora and minora are reduced surgically if they are too long. Many women are bothered about it as they know how it was and they feel it is not the same as time progresses and they feel uncomfortable about it. In normal course the labia minora are smaller and hidden within the labia majora as in the younger age groups. So, this is an attempt to bring it back to the way it was.

It is a relatively simple procedure which can be done under local anaesthesia or regional anaesthesia and the patient can go home the same day.

Some times this maybe be accompanied by fat grafting of the labia majora to increase their volume & give them a more youthful look.

2.Hymenoplasty:

This refers to a procedure of recreating the Hymen. Also called "Revirginization".

Not very commonly a part of the combination of procedures. It involves recreating the thin layer of skin at the vaginal opening to give it an impression of being virginal. Though the fact remains that the hymen can rupture because of many reason other than intercourse. But it is done more for personal and religious beliefs than for medical reasons.

The procedure involves recreating the hymen with the help of tissues in and around the vagina. It is a relatively simple procedure and the patient can go home the same day. The stitches dissolve on their own in a week or 10 days.

3.Vaginoplasty or Vaginal Rejuvenation:

Classically vaginoplasty refers to recreating the vagina in patients with a congenital absence. But here in context of cosmetic gynaecology, it refers to tightening the vagina. Because of child birth and repeated intercourse and lack of exercise the pelvic muscles surrounding the vagina become loose. This may sometimes cause problems during intercourse because of the lack of proper grip for both the partners.

Vaginal tightening can be done with the help of LASER's where the light from the LASER tighten's the mucosa and some part of the underlying muscle. This is a good option if the patient has a decent muscle tone. The other procedure is to surgically tighten the muscles outside the vagina. The procedure is done from within the vagina and the stitches dissolve on their own. The patient can go home the same day or the day after.

This is usually combined with a labioplasty and fat grafting of the labia. The patient can resume normal sexual activity in three to four weeks time. There is an increase in sensations and pleasure during intercourse for both partners.

There are some pelvic exercises which all women can do to naturally tighten their pelvic muscles and delay the need for such a procedure. Some centers also have equipment which will help tighten and strengthen the pelvic muscles.

4.“G Spot” Amplification:

This is a relatively new addition to the procedures. The “G Spot” or The Gräfenberg spot, is a female erogenous zone, which when stimulated leads to high levels of sexual arousal and powerful orgasms.

Though anatomically the “G spot” has not be identified as a distinct physical entity some studies and anecdotal evidences from different women have shown a very sensitive and thickened area in the anterior wall of the vagina. Some studies done also showed this thickening when the women is sexually aroused. Women claimed the experience of a “deeper” orgasm when their her G-spot was stimulated.

Despite professional and scientific criticism and skepticism in general by the public, the G-spot, as a concept, has been widely accepted. Even in India judging by the mails, the awareness has definitely increased.

“G Spot” amplification is an extension of the same concept. As stimulation of the “G spot” is supposed to give greater arousal to the woman, the procedure involves identifying the spot and increasing the size by an injection. It is a relatively safe and simple procedure done as an office procedure. The injection lasts for 6-8 months and can give enhanced pleasure during intercourse by increasing the size of the “G spot” during that time.

But in some cases the results may not be up to the mark because of the difficulty of finding the “G spot”. The injection can be repeated as and when the effect wears off and the woman feels she wants the extra help to get aroused.

The awareness of these procedures and the inquiry regarding the same has increased over the past few years as woman are becoming more aware of their bodies and their own needs. Though there will always be controversies regarding the procedures, like for all other cosmetic procedures the options are there for people who want to get it.

As one of my patient's said... "Doc...I know it's not a necessary procedure... but , Its nice to know we have options !!!!!"

Dr.Surindher

www.cosmesisindia.com

Saddle Bag's... Not the bags women want...!!!!

2008-06-09T14:17:00.007+05:30

I HATE my cones...!!! I was surprised when I heard that from a patient of mine. “Cones?? I asked...”

“Yeah.... these...” she answered, pointing out to the sides of her hip. Well that was the first time I heard someone refer to them by that name.

The area she was talking about is an area which has had different names,the most common unflattering ones being "saddlebags" and "riding breeches".

This refers to the hips, upper outer thighs and buttocks that are disproportionately large relative to the rest of the body.

A woman's hips are an overt sign of her fertility and sexuality. Ask your friends, and they'll probably agree that the hips should be part of that classic hourglass figure that women constantly seek. However, there's a big kink in that goal. Most women are genetically programmed to store fat in their hips and outer thighs... the “pear shape” as compared to the “apple shape “ of a man.

As men and women pursue more idealized body proportions, they usually find that they cannot rid themselves of their saddlebags with diet and exercise alone. The reason for this is that the shape and size of our hips is largely determined by our genetic makeup. There's nothing to be ashamed of. The fat in the hips and thighs are highly resistant to diet and exercise. Even women with small frames can have a large lower body that is simply too full to be proportionate. In other words, fat deposits on the sides of the legs tend to be the last fat to go.

Many patients do ask me why they have it, in spite of having a good exercise regime. Various reasons apart from genetics. Its the area where you first put on fat and the area where you loose it last. Secondly its situated above an area which has a tendon rather than active muscle, which makes it all the more difficult to get rid of by exercise alone.

Many women are experience frustration when large thighs and/or saddlebags force you to buy clothing with different sized tops and bottoms and many of them try to squeeze into their clothes and have the saddle bags sticking out more prominently rather than going in.

Though it's an unfortunate situation, it's not beyond fixing.

What are the options one may ask?

Exercise: Lie on your side, head waist and legs in straight line, suck your tummy in and raise your leg straight up from the hips without bending your knees. Repeat this for 10 times and repeat the cycle 3-5 times according to your comfort level. Breathe out while raising the leg and breathe in while lowering it. Repeat on the opposite side too.
Injection Lipolysis: This is a good area to be treated with Injection Lipolysis if that is the only problem. Multiple small injections of the lipolytic solution are injected in the area. The dissolved fat has to be absorbed by the body and eliminated. The injections are repeated every 3-4 weeks for about 4-5 times.
Liposuction: Offers a one time and immediate solution to the problem. The procedure involves inserting a small canula though a 0.7-1cm incision and suck out the fat and contour the area in proportion to the hips. Post operatively a pressure garment is necessary for the next few weeks to help the skin mold to the new shape of the hips.
Lipo Contouring: Sometimes it may be required to inject fat into the in between segment between the two bulges to give it a more proper contour which is call “ Lipo Contouring”. Post operatively a pressure garment is necessary for the next few weeks to help the skin mold to the new shape of the hips.

It is therefore no surprise that saddlebag liposuction is the most requested type of liposuction. Since the area is mainly meant for fat storage, a liposuction operation to remove your saddlebags can completely alter your waistline. You could have a smooth hourglass figure without those bulges if you combine a hip and outer thigh liposuction together. That's because the fat in your hips and thighs doesn't grow back. Once you've got the right curves, your new body shape will not revert.

After a successful saddlebag liposuction, you'll be able to fit into jeans, dresses, and skirts in a way you've never imagine before. Your entire body will feel more complete and you'll have a big boost in confidence.

So ladies, do not fret, its not a major problem. It can be treated. But, if you opt for surgery then make sure you go to the proper trained surgeons and not to untrained people claiming different things.

Dr.Surindher

Man Boobs or "MOOBS"...!!!

2008-04-22T22:55:00.005+05:30

MAN BOOBS or “MOOBS”

This word came as a surprise to me initially when a patient of mine mentioned the term to point out to his problem. But then on doing a search, I found that its the common term used to describe the condition of “Gynecomastia”.

This is a condition where in the chest area of the male is more prominent. This is usually seen in the peri pubertal age group, when it starts to develop because of the hormonal changes going on in the body. The condition normally resolves as he grows up into adulthood. But, in a fair percentage of men this involution does not happen and they carry it into adulthood too.

Classically, Gynecomastia is referred to “painful enlargement of the breast tissue in a male”, but nowadays enlargement of the chest area, whether painful or not is commonly clubbed under the heading of “Gynecomastia”

This condition can be of three types in common terms. It could either purely fat which is seen in obese patients or it could be purely glandular – the classical Gynecomastia. But, most commonly it is a combination of both that is seen. Approximately 80% of patients belong to this category. All these could be without without skin excess.

I have had many patients come to me saying that they have been working out in the gym really hard but can't seem to get rid of the bulges in the chest area. The reason is because of the presence of the gland tissue. Another common question I get from these patients is regarding hormonal imbalances. Though in specific conditions it is because of a hormonal imbalance, it is usually not the case. In most cases the cause is not specified.

This is one of the few conditions that we as plastic surgeons operate on, even when the patients are young. This is a cause of embarrassment and ridicule among friends for a young adolescent which can lead to significant psychological trauma.

Over the years there has been a change in the treatment protocols too. Nowadays the most accepted mode of treatment is a surgical removal of the glandular part along with liposuction of the fatty part. Previously skin excision were common but with increased understanding and with the aim of reducing the ghastly scars on the chest, skin excisions are now limited to patients with severe grades of the condition along with significant skin excess.

The surgery is usually done via a cut under the nipple so that the scar merges well with the nipples without leaving behind a stigmata of a surgery. The gland is removed from the same cut and the suction is also done through the same incision Post operatively, the patient is supposed to wear a vest or pressure garment. This will help in skin shrinkage and also aid the healing process. This is worn for a period of @ 3 months. The patient can start routine activities usually very early, including return to the gym and exercises.

Though it is a simple procedure it has to be done by qualified people well versed with the anatomy of the area to reduce the scarring and to address all the problems as well. The most common problems are usually in the healing process which are swelling, pain. Rarely there maybe infections and sometimes the skin excess may remain which has to be dealt with.

Many patients come for secondary procedures after being operated elsewhere where a proper excision or suction was not done. Another problem of improper technique is where an excess of tissue is removed leaving a crater deformity or “Saucer deformity” which is much more difficult to correct.

But, overall it is a very satisfying procedure for the surgeon as well as the patient, when done properly. The transformation is dramatic and heartwarming especially in youngsters who have been withdrawn and embarrassed because of this and have been watching life from the sidelines.

Dr.Surindher

Celebrating 'Woman's Week"

2008-03-05T11:08:00.003+05:30

Hi all,

CosmesisIndia

on the occasion of World Woman's Day

Celebrates

" Woman's week"

Between 10-15th of March

Cosmesisindia
17/1, Hosur Road, Richmond Town

Opp.Fatima Bakery

Bangalore 25

FREE CONSULTATION FOR WOMEN..!!!!

& Many more discounts on packages and surgeries

Timing : 12-6pm

For appointments contact: Ph: 080-41750075

9945780075

Risk Benefit Ratio and Regular people

2008-02-03T19:14:00.000+05:30

Hi all...

Welcome back to my blog.

This is in continuum with my previous blog regarding the program related to Cosmetic surgery. Now, in this blog, let us address the issue of cosmetic surgery as related to the “regular Joe or regular Jane” if I may.

Because of my first hand interaction with the people opting for cosmetic surgery , operating on them and then following them up, I would really like to put to rest a few common notions that are doing the rounds and which were also highlighted in the program.

Not on impulse: Contrary to what one may believe, none of my patients to date has come to me asking for a procedure just as a dare. Nor for the fact that they just woke up one morning and said..” Hmm what can I do different today.. OK!!! let me get a nose job!!” Most, if not all of them have had it in the back of their mind to do something about it and they would have thought about it many times even before picking up the phone to call for an appointment. This is true even for the west but more so in our country..
For others: It's usually said that one was forced to get something done by the husband, wife , mother in law, friend, so on and so forth. From what I have seen the actual percentage of people actually forced is minuscule. Most of such instances are only the final call that brought them to my office, which could be the husband or the wife. On inquiring more, its seen that it was something they themselves had been thinking about for quite a while. And as a rule I DO NOT operate on a patient who comes seeking a correction because someone else suggested it.
Only for Narcissistic People: I sincerely feel that everyone first has to love themselves before they can love others. If one feels good about oneself then his or her outlook to life changes. There is nothing wrong in trying to look good. One might argue that its whats inside that counts... Never judge a book by its cover..!!!
But talking honestly, who has the time nowadays to really see inside? STOP .. Read this carefully... I'm not saying what's inside doesn't count... what I am saying is that, in today's fast paced life no one has the time to really see inside. It's like choosing amongst the so many books lying on a book shelf. How does one pick up a book to read what is inside??? Yes... it's by looking at the cover. Once the cover has caught your attention, then it's easier to find out what's inside. Of course, if the content is worthless then anyway doesn't matter cover or no cover. Similarly beauty plays an equally important part in our daily lives to bring people closer to one another , to get to know the qualities one possesses.
Only for women: A totally wrong statement. Nowadays we have more men coming in for cosmetic procedures than ever before. Previously we used operate on 1 male for every 10 females. Nowadays we operate on 5-6 men for every 5 women. In many cases the wives come with their husbands. Yes the “ Metro sexual Male “ has arrived.

So , it would be very wrong to judge anyone without knowing their reasons for doing anything. And it cannot be an easy decision to take, be it for a female or a male. Unlike the west where mostly the decision to do a certain procedure is only limited to him or his immediate spouse, here the whole family and relatives have a say. People who have had surgery done and have lost weigh or look fitter, wouldn't want anyone to know that it was because of the surgery. They would rather talk about how they starved themselves and put themselves through a fitness regimen in spite of their busy busy schedules. That shows that the acceptance levels are still low. But anyway after a few days everything is forgotten and people move onto the next best thing to criticize.

It's sad that we criticize any effort anyone makes to look good, but at the same time if you look at the matrimonial columns and the glitzy advertisements, one can see the hypocrisy existing in our society.

But, the heartening fact is that (notwithstanding the so called “moral brigade”) at least in the general population there is more tolerance to the way people are reacting to what others do. Isn't it what democracy is all about? Accepting people for what they are and allowing them to do what they feel right without injuring or hurting others. But, then again its digressing from the topic of this blog.

So ,to put it in perspective, whether one likes it or not, this is a branch of medicine that is here to stay and grow. And medically speaking, it has improved how we treat reconstructions. Reconstructive surgery down the ages was always more concentrated towards function rather than aesthetics. But now the trend is changing to make reconstruction aesthetic too, along with being functional , which is a welcome change, be it in a child with a cleft lip or a man with a crushed hand.

Controversy regarding whether it is good or bad will be on for a long time to come. As a person involved in providing the service I would put in as a procedure which gives best results for those in whom it is indicated and for people with realistic expectations with good awareness of the pro's / con's and options.

As long as the complications do not outweigh the risks involved I wouldn't mind doing them, which again brings us to the “ RISK BENEFIT RATIO” which is not as skewed in favor of a procedure as in celebrities . So awareness is the key, knowing all your options is the key and of course knowing whom to go to for the said procedures.

So for anyone out there contemplating a procedure, go meet someone qualified to do your procedure, do your due diligence in finding out all you can about the procedure.

Once you have done that, do your own Risk Benefit Ratio analysis. It will help you take an educated decision about your procedure. And trust your doctor and share all your doubts with him/her and make that educated decision.

And remember it “HAS” to be “YOUR” decision ,,, not your husband's/ wife's/ relative's / friend's or doctor's decision.

'm sure everyone has a point of view on this and would really appreciate comments.

Dr.Surindher

Bolly wood Nip Tuck and the Risk Benefit Ratio !

2008-01-27T16:33:00.000+05:30

Hi all...

Sorry for the long break...!

Day before yesterday I was watching a programme on a news channel dedicated to Bollywood stars undergoing cosmetic surgery to improve their looks.

The issue was that is it a good thing and also if they should do it. Second part of the programme was discussing about the fact that men and women ( regular people) are going in for cosmetic procedures more now than in the past. Let me also divide the issue into two parts.

The issue reminds me of one of my earlier posts....

Cosmetic surgery a Taboo??

So taking off from there after seeing the programme I though I could pen down a few of my views on the topic....Open to comments of course!!

I personally feel that there is no need to make such a big issue about it. The first thing that we need to realise is the fact that we cannot equate them to the regular joe's and jane's. A cosmetic procedure for most of these people might be something that they do to further their respective careers apart from the fact that it might be something they did want to do even otherwise. This is a facts that we know when we interact with the people from the "glamour industry".

They have to look good to stay in the business its a plain and simple fact. We could be all judgemental and talk about the cliche's like " Inner beauty is what matters! / If you have talent it will take you places.." and all that.. But, fact of the matter is that though you cannot judge a book by the cover a good cover definitely makes people reach out to it to at least read a little to find out whether the contents are good enough. Secondly if they were not without talent they would not survive anyway not by looks alone but good looks can definitely compliment talent.

Would any of us complain if Sachin bought a new bat to help him score better?? I don't think we would . So why complain when bollywood stars are getting cosmetic surgery done on themselves to help their careers? Yes, it is not as simple as buying a new bat& hence that brings us to the so called " Risk benefit ratio".

The "Risk benefit ratio" is a factor which will help decide whether to go ahead with the proposed procedure for that particular individual. I'm sure all plastic surgeon use this in their own ways to assess the need to do any procedure or anyone.

The Risk Benefit Ratio is used to see if the benefits in doing a particular procedure on the said individual is worth the risk to make it justifiable to that individual. In the case of someone in the "glamour industry" the risk/benefit ratio balance shifts and hence the benefits make the risks worth it which is why people opt for it.

Sometimes the people from the glamour industry are better patients from regular patients. This is because once educated about it they are more open minded to accept the risk and the scars than most of the regular patients who want the best results but totally without the risks. As I always say.. its true for anything in life.. " No Pain No Gain".

But then , we have people like " Micheal Jackson". The host of the show called him the poster boy " for Cosmetic Surgery". I would say that he is a poster boy for "Whom not to do cosmetic Surgery On". In normal circumstances we see about 10% of patients who come in with unreasonable demands but in the segment of people coming in from the glamour industry the percentage maybe as high as 30%. These are patients with unreasonable demands or requests and these are the patients who ultimately end up with problems.

I have people telling me that why this issue is important is because of the fact that people in general can be influenced and they might try to emulate their stars.. But with all due respect to these critics, getting cosmetic surgery done is not as easy as maybe picking up and lighting a cigarette. Its a much more serious and longer process and involves many more people. I think we as doctors too believe and practice ethical medicine where the risk benefit ratio is brought into the picture to help educate the patient and help him / her make and educated decision regarding the same.

Secondly I think by saying this the critics are not giving the general population its due credit. Am sure the public at large is much more mature and discerning.The percentage of people who would blindly follow anything that a star does is very small.

I'm not here to justify anything. Its just that there is no need to make such a big fuss about who's bust is becoming bigger or lips are becoming fuller, as long as they are not hurting anyone else. I think we have that freedom in our country.. at least when I last checked.

So , without being hypocritical, everyone wants to look better and feel good. If you don't believe me just open today's paper and check out the matrimonial columns or check out the social networking sites or fashion and clothing wear and the cosmetics sales. Everyone wants to look the part so to speak.

I have restricted myself in this post to only to the issue about cosmetic surgery and glamour industry. I will talk about the regular people in my next blog to take this discussion further.

I'm sure everyone has a point of view on this and would really appreciate comments.

BREAST CANCER AWARENESS

2007-10-17T12:48:00.000+05:30

Hi friends... sorry for the long break in between..just been lazy I guess.

What spurred me to write my next post on the blog was an interview by RJ Malvika with Mrs.Jayshree on RadioIndigo ( fm91.9). Mrs. Jayshree is a Breast Cancer Survivor and she was talking about her whole experience with the disease and its aftermath and how she coped with it.

Nice to hear her experience and am sure it will help other women too. But I thought that some issues needed to be emphasized more from the point of view of the disease process and the options. So this being a awareness month with special emphasis on Breast Cancer, i thought i need to try and compile certain aspects of the same.

I think the first aspect to be dealt with should be the awareness issue regarding breast cancer, then comes the issue of dealing with it , then the treatment options and of course the rehabilitative aspect.

Awareness regarding breast cancer though picking up, is still not reach the extent to which it should. Many reasons behind it and one of the main reasons in our context is the taboo behind talking about anything related to sex. As the breast is a sign of femininity and female sexuality any talk about it is taken as taboo and hence women also tend to shun away from seeking knowledge about the same. Education is the only way to improve awareness. We see many women with advanced stages of breast cancer because they were shy to seek treatment or talk to anyone.

The first thing that any women should know and realise is that breast cancer is another disease and as with any other disease the earlier it is detected the easier it is to handle. The most important person in this “ early detection” sequence is the woman herself. “ Self Breast Examination” is an easy,simple, quick, painless test that any woman can do at her convinience.

Not every cancer can be found this way, but it is a critical step you can and should take for yourself.

Many a times the reason a woman does not want to do a SBE is because she feels so many things and feels confused. The more you examine your breasts, the more you will learn about them and the easier it will become for you to tell if something unusual has occurred.

Try to get in the habit of doing a breast self-examination once a month to familiarize yourself with how your breasts normally look and feel.

Examine yourself several days after your period ends, when your breasts are least likely to be swollen and tender. If you are no longer having periods, choose a day that's easy to remember, such as the first or last day of the month.

Don't panic if you think you feel a lump. Most women have some lumps or lumpy areas in their breasts all the time. Eight out of ten breast lumps that are removed are benign, non-cancerous.

What's important is that you get to know the look and feel of YOUR breasts' various quadrants. Has anything changed? Bring to the attention of your doctor any changes in your breasts that last longer than you monthly period cycle or are getting bigger with time.

Studies show that regular breast self-exams, combined with an annual exam by a doctor, improves the chances of detecting cancer early.

How to do a Self Breast Examination?

I could also write about self breast examination but will only serve to increase the already 1,630,000 pages on breast examination which you get on doing a google search. I'd like to highlight a few pages one could visit to know more about it.

1.Cancer patients Aid Association(CPAA) which has a lot of information and free download brochure

http://www.cpaaindia.org/infocentre/bookreview_breast.htm

http://www.cpaaindia.org/infocentre/SelfBreastExamination.doc

2.DOCTOR NDTV which has an article on breast examination

http://www.doctorndtv.com/topicsh/Breast%20Self-Examination.asp

3.Breast Self Exam is another good site which will talk you through it

http://www.breastselfexam.ca/

4.The Susan G. Komen Breast Cancer Foundation has a online breast self examination module which is also available in Hindi

http://www.komen.org/intradoc-cgi/idc_cgi_isapi.dll?IdcService=SS_GET_PAGE&nodeId=480

Here's hoping this can spur some if not all women to start making self breast examination a part of their routine and help create more awareness regarding the same.

My subsequent blogs are going to be dealing with some of the surgical options for breast cancer and more importantly I will be touching upon the options for breast reconstruction which is a topic many of the breast cancer patients are not aware of or do no even consider.

Dr.Surindher
www.cosmesisindia.com

Patient Speak -III ! " Breast Augmentation"

2007-06-13T22:18:00.000+05:30

There isn't a single person in this world who can look into the mirror and go "Fantastic! I love the way I look! There isn't a thing I'd like to change".

We would all like to change one thing or another about our appearance. Say a smaller nose, bigger eyes, bigger breasts, flatter stomach and so the list goes on. However, not everyone is so troubled by their flawed appearance that they actually want to do something about it and change the way they look be it via simpler ways such as makeup and exercise or through slightly less common and more intimidating measures like cosmetic surgery.

Having undergone one such cosmetic procedure about six months ago, I guess I can say I was too troubled for comfort about a flaw I had perceived in my appearance....the size and shape of my breasts.

I have always been very conscious about my looks, I love to dress up and although one of the popular notions is that "Looks don't get you anywhere....they're superficial and not important....Beauty isn't skin-deep...blah....blah". I firmly believe that knowing she looks like a million bucks can do wonders to a woman's psyche, her confidence levels and self-esteem both in her personal as well as work life. The modern woman wants to look her best 24/7 and in today's world where everything has a price, if there's a way by which money can get you something that "god" and nature failed to gift you with, y not go ahead and get it? What's stopping anyone?

People say looks are insignificant...you're gonna get old...you are gonna loose your looks...they ain't gonna stay with you forever. But when you're young and looking good gives you a kick, if something as "insignificant" as a flaw in your appearance becomes a significant cause for your being unhappy and a safe solution is right under your nose, you would have to be of below average intelligence to ignore it.

In no way am I trying to justify letting your flawed looks bother you too much or going under the knife to change this and that, but I believe the bottom line is to live a happy life and if anything is a hindrance to that, but can be uprooted without hurting anyone, it should be done.

It was with a lot of apprehension that I went to meet Dr.Surindher for the very first time. I had never discussed my problem with anyone before and was anxious about several things such as letting someone see my flaws for real for the very first time, the pain involved in surgery, the cost of surgery, my family's reaction to this, etc.

However, Dr.Surindher was very professional and put me at ease very soon after I walked into his chamber. Before examining my breasts, he gave me an overview of the breast augmentation procedure explaining the different kinds of implants, the types of incisions, the expected results,the likely risks involved, common myths about the procedure, etc. I was fascinated by the amount of information he gave me. There was so much I hadn't known, although I had done some research myself about the procedure.I asked him a few questions about the surgery and what happens thereafter and got enlightening answers.

He then examined my breasts, made me try on some sample implants so that we could decide on the appropriate size for me. He also explained to me very clearly in what way the appearance of my breasts would change after implantation. One of the main problems with my breasts was that I had flatness on the upper side of my breasts as compared to the lower side where I was a little fuller. As a result, I've always had to wear slightly busty bra's to give me a fuller look. Dr.Surindher told me that implants would give me a good rise on the upper side of my breasts and also enhance the projection of my breasts to give me a fuller look. After a few trials, my asking some questions and stuff, we decided on a size and I was told I'd have to take up some routine tests before deciding to proceed with surgery. Dr.Surindher had also penned down details about the procedure so that I could review them and perhaps come back with more questions later.

Hence after a very satisfactory first visit, I made up my mind and decided to go ahead with the surgery. Just a few routine blood tests and I was back at the hospital where the physician declared me fit for surgery. Surprisingly, I was hardly nervous the morning I was to undergo surgery. I was thrilled actually 'coz I had never undergone surgery before and was curious about various things including anaesthesia. Once I was wheeled into the OT however, I was completely relaxed and the staff there were very cheerful and amicable and made it seem like I was there to have some fun.

Anaesthesia was hardly disturbing and when I came to after like I don't know how many hours, I was in hell. I don't know if it was just my extremely low threshold for pain or what but yes, I was hurting terribly. I was unable to move any part of my body. I was quite confused actually 'cos I had read women don't go through much pain and are up and about in like 48 hours after breast augmentation.

My breasts felt like lead and my back and arms were rendered immobile. It was sometime in the afternoon when I woke up from surgery and I knew I had to wait at least another couple of hours before I could see Dr.Surindher and ask him why I was in so much pain. I was given strong painkillers and sedatives for three days and while they did ease the pain a little, when the effects wore off after a few hours, I would get all impatient and desperate for relief once again. What bogged me down most was I was unable to leave my bed for almost four days after surgery despite Dr.Surindher constantly pushing me to get up, move my arms, take a walk, etc. I don't know if it was because this was my first surgical experience or due to my low tolerance for pain, I felt more agonized every time I was urged to move around. While I understood that constantly trying to move around would definitely ease the pain and make me more comfortable,it was simply too difficult.

I remember feeling like a school girl at one point of time when I started dreading Dr.Surindher's visits 'cause I knew he'd pull me up from bed and urge me to walk around and try moving my arms. He had begun to be more stern with me 'cause I was always refusing to leave my bed out of fear of pain. I think it was on the fourth day after surgery that I finally decided I couldn't do this alone and asked my mom to come over. She did and I don't know if it was the work of that magic wand all mothers have or what but I felt instantly better after she arrived and showed tremendous progress both physically and psychologically within 24 hours.

The next time Dr.Surindher came to visit me, he was very happy because I was up and walking around pretty effortlessly. I was immediately taken off the strong painkillers and was put on some mild tablets and antibiotics instead. On the fifth day,when I left the hospital,I hardly felt any pain,just a little tightness in my breasts. I had started wearing a supportive bra on the fourth day itself and that made me feel better.

Before I underwent surgery, Dr.Surindher had also explained to me what kind of bra's I should wear to ensure that my breasts are well supported. For a week after I was discharged, I stayed home, took some mild painkillers and antibiotics and kept myself as active as I could. By then I was pretty much able to indulge in my everyday activities and at the end of two weeks I felt well enough to travel by myself to visit Dr.Surindher again. This time, Dr.Surindher taught me how to massage my breasts regularly for the next 6 months and also gave me some creams to lighten the surgical scars under my breasts.

As for the way my breasts looked two weeks after surgery,the projection was certainly enhanced,my breasts were bigger and there was a good rise on the upper side of my breasts(not the flatness I had before) but since a pretty big implant had been fitted into me, my skin was all tented which gave my breasts more of a cone-shaped look rather than rounded fullness. However, Doctor told me that with regular massaging over the next 6 months the breasts will eventually fill up and take on a fuller look.

It has now been about 6 months since I underwent surgery and although I can't say I have been perfectly regular with my massages (twice everyday,mornings n evenings...it ain't easy :-) ), I have carefully followed Dr.Surindher's instructions and have been using the scar-lightening creams he gave me and have visited him for periodical examinations and the progress has been great. Like he said, within a couple of months after I began massaging, my breasts started losing their tented look and took on a rounder, fuller shape.The scars have become way lighter than they were before and will continue to fade over time is what I've been told.

The truth is I'm a much happier person today than I've ever been before. It has been a great relief to ditch the busty,uncomfortable bra's I used to wear before. The surgery and the entire process of healing and development had been a life-altering experience for me and the results were exhilarating. The way my body looks now has done wonders to my self-esteem and confidence levels and this has had a positive impact on both my professional and personal life.

Considering I had several apprehensions about undergoing the surgery and was in hell a lot of pain once i did, was it all worth the trouble??? Hell yeah!!

I'm sure Dr.Surindher can never really completely understand what a big difference this has made to my life. To me, this is the best decision I have ever made and if I had been able to do it sooner, I would have. I feel complete now and absolutely wonderful and one can't put a price on that!!

....................................................................................................................................

Dr.Surindher : - I would like to thank KS for this write up to help other patient's understand the procedure and be of help to other people who might be considering such an option.

The reason I asked her to write about it because this is the patient's point of view. I might write and explain a lot but, when it comes from the patient herself, then the whole experience is different.

She has been a wonderful patient and has been very patient even with my firmness at time understanding that it was for her own good. So as always, I once again take the opportunity to thank all my patients and for her article, especially KS.

Read more about breast augmentation on my blog http://cosmesisindia.blogspot.com/2007/02/mammamia.html

Patient talk- II

2007-05-18T00:00:00.000+05:30

Hi Doctor Surindher,

I have written a testimonial for the rhinoplasty procedure. I hope you publish this on your website so that others can benefit from it too :)

Regards,

*****************************************************************************************************************

I am very grateful to Dr Surindher and Dr. Shekhar for the change they have made to my appearance. My nose was hooked and too long for my face, and I wanted to get it corrected by means of cosmetic surgery.

After reading a lot on the internet about the procedure as well as patients' experiences, I decided to go forward with it. I mailed doctor Surindher about my problem and got a very prompt reply, after which we fixed an appointment to examine my nose. Subsequently, I underwent reduction rhinoplasty to correct the hump on my nose.

After the surgery, I had a plaster/splint on for about a week, after which it was removed and I must say, I was very satisfied with my new nose. I didn't experience any pain as such, because of the pain killers administered to me during the first 5-6 days.

It's been almost 4 months since I was operated on, and everyone compliments me about how perfect my nose looks on my face--and there are absolutely no marks left-over from the surgery.

If you're looking for a nose job too, my sincere advice is to have complete trust in your doctor and have patience to see the full result.

****************************************************************************************************************

NDTV " We the people" Experience

2007-04-29T17:18:00.000+05:30

Hi all......

Sorry for the break!!!

Been busy sorting out a few things. But, I had a nice experience of being invited to the NDTV studios for a talk show hosted by our favourite show anchor " Barkha Dutt" !!!!

Yes I'm talking about the show " We the People"! Well, it was a nice experience, though rush rush and of course an eye opener in many ways to me. The topic was whether cosmetic surgery is becoming a dangerous trend and whether people are willing to undergo cosmetic surgery just to look good to conform to social " beauty preferences"!

I won't go into the things that people felt and said but yes there were a few things I thought I should highlight. I felt that there are a lot of misconceptions about the whole plastic surgery and cosmetic surgery issue as a whole.

1. One recurring theme that came out during the discussion was about " putting people into a mould" or like something that came out of an assembly line.

Firstly, I would like to refute the fact that we try to put people into moulds. Which mould are we talking about? Is there a mould at all? In fact this is what we try to emphasize that, the essence of cosmetic surgery is to bring about the necessary changes BUT preserving the attributes which make the individual the person he or she is...... which is the real challenge.

Also, what looks good on one person will not necessarily look good on another because every individual is different, so it can't be one size fits all. This is what makes it all the more challenging. So, the concept of having assembly line beauties will never happen.

Who wants to be similar to the rest... everyone is fighting to be unique .. don't you think?

2. The other thing that came up was that, we are forcing people to change .. which is an uncalled for statement. We are offering a service but not forcing anyone to come and undergo a procedure. One can't even force another to have coffee with them, let alone ask them to undergo surgery. Right???

So, it is basically people who have always thought about it or felt the need to have a certain feature corrected who come enquiring for options. And when they do, our job is to guide them.

Of course we talk to people who come with unreasonable demands asking for unnecessary things and I can speak for my fraternity when I say that most will refuse to do something which is not warranted or is potentially dangerous for the patient. This is the reason for such blogs and discussions, so that people are aware of what is good and what are the risks involved.

And as even the panelists said that day .. We are not asking people to change- if one is happy the way he/she is.... then one would NOT come asking for a change in the first place.

Ever so often in any party or get together that I go to, the Q that I'm most often asked when people get to know I'm a plastic surgeon is " What would u like to do on me?? or What should I get done? ".... and for all these questions there is only one answer.. " NOTHING".

We do no solicit patients.

3. Another thing which came up was, if it was such a good thing then why don't people come out into the open and "admit" they have undergone a cosmetic procedure.

I think there are quite a few who do. But since most of them get it done for their own satisfaction I don't think there is any need for them to advertise it openly. Like one of the patients said... " do you go out and tell people that you had waxing done?? " Similarly, where is the need to tell anyone that they had a cosmetic procedure done? A fair argument one would say.

4. Cyrus Sahukar, brought out a valid point that a beautiful face always elicits more responses. A child responds more positively to a beautiful face so who are we to fight something that is natural.

Everything in nature has a balance. When things are in balance there is equilibrium and harmony ensues from it. Hence the aim is to bring things into balance thereby paving the way for harmony.

5. Ms.Akhila, my co panelist brought out a point that not much is being done for people with leprosy and transsexuals who are in the hands of wrong people.

With due respect I would like to say that, many of my colleagues are performing free surgeries for leprosy patients in many of the leprosy missions. DO I do it?? No, I don't now!!! I Salute my colleagues doing the less glamorous tasks of our profession.

I'd like to bring out a point though. Though there are many centres doing such surgeries the sad part is people themselves do not want to go and get the corrections done.

A prime example is the the " SMILE TRAIN PROJECT " which I am a part of .. providing free surgeries to children with cleft lip and palate. We at our hospital along with Smile Train have provided free surgeries to around 1200 children suffering from cleft lip and palate, free of charge. BUT, at the same time there are two children at the traffic junction next to the hospital with the condition and we have not been able to get them in for surgery. the reason for this being.... if they get corrected then no one will give them alms...!!! THAT is the sad fact, which holds true for many poor leprosy patients too and yes I'm not generalising the statement. Just stating what we do come across.

As for surgeries for transsexuals and them being in the clutches of middle men and other's, it is a political and social issue. We can do the surgeries provided they come to us instead of going to quacks.

6. Another factor which was brought up was, the affordability factor. Yes it is not an essential procedure so it need not be done as an emergency . People can go for it as and when they are comfortable. And previously the cost factor was a major issue but nowadays as more and more people have come forward to take up the profession , the costs have come down.

7. Is it a dangerous trend?

Yes, like anything in this world it can get dangerous when people start getting strange ideas about what all can be done. Which is the reason I made the following statement on the show - " I DO NOT operate a patient after the first consultation itself."

I give them the risks involved, the possible complications and the expected results. By doing this, we are giving the chance to back off if they are not keen on it.

If a survey is done, I'm sure all doctors will tell you that there are many patients who are refused surgery because either they do no need it or their demands are unreasonable.

And, of course, its not a miracle solution to anything. We doctors, DO NOT claim any miracles like " loose 5 inches in 1 week"..." get fair glowing skin in 15 days ".. so on and so forth because, we best know that the body doesn't work that way.

Apart from surgery and drugs, proper care of diet, exercise and lifestyle changes are necessary to have a lasting effect.

Overall, it was a nice experience. All the panelists were brilliant. The audience was very co-operative though many said they wouldn't undergo a cosmetic procedure.

Lastly, but not the least... the crew and support staff of NDTV both in front of and behind the camera... were all awesome and very helpful. A few names I'd like to mention are - Vasudha, Neha, Lancy, Chitrita, Maya.... and of course our favourite TV host - Barkha Dutt.

It was a wonderful experience, though only the tip of the iceberg could be scraped because of lack of time. Hope we have more such similar shows which will help dispel myths about plastic and cosmetic surgery!!!!

Dr.Surindher
www.cosmesisindia.com

Whom to Meet ??? What to do next???

2007-03-11T00:50:00.000+05:30

I think these are the most common questions that pop up in any one's mind when he or she is contemplating a bodily change.

Day in and day out we are bombarded with ads promising the earth, the sky and everything in between. Marketing is meant to sell a product and hence needs to highlight only the positives and hide the negatives of any product. So on we go checking “ it” out.

Guaranteed fairness , guaranteed inch loss, guaranteed weight loss, guaranteed hair growth, guaranteed this guaranteed that!!! Sounds familiar??? I'm sure it does.

I have nothing against these ads but as the saying goes... “ If its too good to be true.. most probably it isn't true !!!” Similarly promising guaranteed, results on a body where no two bodies are similar is “too good to be true”.

All this adds to the confusion already prevailing in one;s mind. So one might say, that then why do people go for it? I think it all is because of :

The basic fear people have regarding going under the knife, hospitals, doctors and all that.
That treatment has “ Guaranteed results”
We as doctors tell the limitations of the procedure and the possible complications which puts people off.
As doctors we cannot take short cuts, the basic work up and the whole procedure has to be done , which is another deterrent.

So just to put things into perspective, I thought of putting all the points one has to think about before going for a modification of one's body. Sort of like a “ DUMMIES guide to .......” Ill put it in three headings:

From a patients point what one should know
What and how to know about the procedure
What to look for in the treatment provider

What a patient should know:

Read about it in my blog link already posted here

http://cosmesisindia.blogspot.com/2007/01/whos-up-for-makeover.html

Know about your Procedure:

Once you know what you want to get done, read about the procedure.
You can find information about the procedure on the net by doing a search on any of the popular search engines. Google, Yahoo, Alta Vista, etc being a few of them
Read about all the options available for what you want to get done
Search for possible complications with regards to the procedure.

Educating your self about the options and the procedure will give you new insights into the procedure and will help you mentally prepare for them.

What to know about your treatment provider:

Read about your procedure and know who is qualified to such a procedure. You will find lots of people claiming to do certain procedures in certain center's.
Surgical procedures are done by plastic surgeons, only they are trained to do them and licensed by the Medical Council of India to perform them.
The Association of Plastic Surgeons of India ( APSI) is the the authority granting certification to all the plastic surgeons in India.( www.apsi.in)
Don't feel shy of asking your doctor about his certification and training. I have many of my patients asking me these questions. Patients coming from abroad make it a point to find out these details.
Talk to your surgeon in detail. Place in front of him all you fears and apprehensions. Most of your doubts will be cleared but don't get offended if they do no respond to some questions by giving you the worst possible scenario. It is done so you realize that all surgeries are serious matters .
Always beware a doctor who does not tell you the complications or tell you that there are no complications at all. Either, he hasn't done enough surgeries to see complications or he is lying about them.
Don't rush into a procedure. Always take your time to think about it after discussion with your doctor. I NEVER operate on a patient after one consultation. I always call them at least a second or third time before I operate on them. This is because I want them to be sure of what they are undergoing.

So keeping all these in mind, just to recapitulate:

Be clear about what you want.
Vague requests get vague results, if at all anyone operates on them.
Educate yourself about the procedure, who should do them, the various options and the possible complications.
As far as the body is concerned “ Guarantees don't work !!!” Every thing has its limitations and one has to work within those limitations to achieve the best results.
Know about the credentials of your doctor.
Surgical procedures have to be done in properly equipped Operating theaters and not in some “ clinic”, with care regarding sterility and safety equipment.
Please remember if a doctor is saying “NO “ to a procedure there must be a reason behind it. Ask him the reasons and trust his decisions. All doctors want to provide you with a good result and most will refuse a patient if they know what he or she expects is unrealistic.
Always follow orders with regards to quitting smoking , cleaning the wound, wearing garments, taking medicines and taking rest.
Remember you can rush yourself and the surgeon but you cannot rush your body to heal. It will take its own time.
Trust your doctor ,be sure to keep in touch with him and inform him of any problems you might be facing, instead of going to another doctor who doesn't know what exactly was done.

The aim of this blog is to help you make educated decision about the procedure , to educate you as to where to go to and what to do as a next step, once a decision to undergo a procedure has been taken. A well educated , motivated patient is a happy patient as he is fully aware of the consequences and the expected outcome.

Hence don't be afraid, go ahead, take the decision, but just make an educated decision which will be of a great help to you and to your doctor.

Dr.Surindher

www.cosmesisindia.com

Move over ladies... The Men R Here!!!!

2007-03-08T00:16:00.000+05:30

Any reporter or journalist who has met me has invariably put this question to me....." do men get cosmetic surgery done too???"

Well, the answer to this is very simple.. " Yes!!!"

But hidden in that " yes" are a lot of other things. Men have been getting cosmetic surgery even in the past but the ration of women is to men undergoing the procedure was maybe 9 women to 1 man or less. But in the last few years there has been a sea change in the number of men who are exploring surgical options, with the ratio almost coming to about 5 women to 5 men. So hows that for equality?

With a change in attitudes in today's world , the classical image of a man rugged n unkempt has taken a beating. Women of today like their men well groomed, smelling good, with manicured hands as well as a close shave and of course they want their men to be fit too, hence emerges the " New METRO SEXUAL Male " of today.

So the man of today doesn't mind taking care of what he wears , how he dresses and how he looks. I can tell by my own experience, when 11 years back my sister suggested I get a facial before my marriage..Ii scoffed at the idea and threw a tantrum at her ,but recently when my dermatologist suggested I come in for a peel, Ii said yes... though haven't been able to get to it. But it surprised me as just as much as it did my sister when I told her this.

Skin, be it a man's or a woman's needs to be taken care of in the same way.. and more for the man because of repeated trauma daily in the form of shaving, traffic and being out, etc. Similarly as people are becoming more health conscious, so also there is a perceptible increase in consciousness about their " Body Image".

More and more men are coming in asking for solutions to a variety of problems. But each problem has its differences as to the approach to it in a male and in a female because of differences in the body composition . Hence this blog will just try and touch on different aspects of cosmetic surgery for men and the common sought out procedures.

1.Gynaecomastia: ( Male Breast)
A very common condition. Here there is a slight increase of tissue under the nipple areas on the chest. This usually starts in adolescence due to the pubertal hormonal changes and in many it persists into adult hood. This becomes very embarrassing when a person goes to the gym, swimming pool or in the locker room. This is one of the few conditions where we operate on teenagers too, when the condition warrants it. This has taken over the number one spot as the most commonly sought after procedure by men.
The treatment consists of liposuction of the fat with or without a gland removal. The excess skin has to shrink back, for which the patient is required to wear a custom made pressure garment to give him the best results. This is a procedure that definitely gives immense satisfaction to the patient as well as the plastic surgeon. But this is a surgery which can be very easily botched up also, so proper doctor selection is again important.

2.Rhinoplasty( Nose Job)
Till a few years back this was the most common surgery even in men. The procedure is the same as for women with a few basic differences, like the skin in males being more thick, nose tip surgeries have limited results as far as sharpness of tip is concerned, which is one of the commonest requests that we as surgeons get.
Read more about rhinoplasty at

http://cosmesisindia.blogspot.com/2007/02/i-hate-my-nose.html

3. Liposuction :
This is another procedure which is often asked for by men and women equally. The areas to be targeted being the famous " INDIAN PAUNCH" and the "LOVE HANDLE'S". Here fat is sucked out from the abdomen and flanks through small 1cm cuts, 2 or 3 of them, depending on the amount of fat that has to be sucked out and the areas to be targeted.
Post operatively the patient is required to wear a pressure garment vest for the next 3 months to help the skin shrink back and as also helping the swelling go down.

4. Scar Revisions:
"Scarface", was a rage once upon a time , though the movie is still a rage, a scarred face doesn't hold the same charm or intrigue it used to. So scar revision is another common procedure performed. But the problem here is that " Once a scar always a scar"!!!! The only way to correct a scar is by not having it in the first place. A scar can only be revised, reduced, camouflaged.. it can never be erased.
Depending on where and how many scars are present various procedures are done to help reduce the scars or camouflage them into normally present facial creases.

5. Problems with deep lines and wrinkles
Fillers ,BOTOX and CONTOUR threads are now equally becoming a part of a man's schedule as a females. Be it forehead wrinkles, laughter lines around the eyes, deep nasolobial creases all are being tackled with increasing frequency.

6. Hair Transplants :
Another area which is very unique to men and very common affliction with genetic and hormonal influences. Its a whole chapter in itself and just enough to mention here that its a time consuming process and needs a very motivated patient to be able to go through with the procedure and wait for the hair to grow to the necessary length and also go in for second sittings as and when required.
Nowadays, follicular hair transplants are being done where a strip of skin from the back of the head is taken out and from it single hair follicular units are dissected out and transplanted into the bald areas.

Apart from these common operations, other procedure performed for males in varying frequencies are chin and malar implants, jaw reshaping, dermabrasions, calf augmentation , lip reductions, penile lengthening, etc.

So to wrap it up, cosmetic surgery for men is on the rise and is here to stay. But as mentioned earlier properly motivated patient with valid reasons to have a surgery will have the best effort to satisfaction ratio.

So men don't need to be ashamed of attempting to look good. You are not the first one taking the decision to undergo a cosmetic procedure and believe me you wont be the last. But educate yourself properly as to what can be done safely and who is qualified to do it.

Along with proper diet, nutrition , exercise, grooming and clothes, a cosmetic procedure will definitely help in improving one's own body image , helping you feel good about yourself when you look in the mirror or wear that tight t shirt when u go to the gym to work out.

Dr.Surindher
www.cosmesisindia.com

FREE Cosmetic Surgery Consultations for Women

2007-02-27T23:49:00.000+05:30

Cosmesisindia proudly wishes to announce

FREE Cosmetic Consultations for Women

on the occasion of " World Woman's Day"

I. On 4th March Sunday 10 AM - 1 PM

Venue : The Bangalore Hospital, 202 R.V.Road, Bangalore, 4

Contact: 41187628 for registration and details

II. On 11th March Sunday 10 AM - 1PM

Venue : The Apollo Clinic, 51. Jyothi Nivas College Road, 5th Block Koramangala, Bangalore -95

Contact:25633833 for registration and details.

Dr.Surindher
www.cosmesisindia.com

Body Piercing and Body art !!!!

2007-02-24T01:17:00.000+05:30

BODY PIERCING

" Doc, I got my belly button pierced at C. Street and now its got infected, I'm afraid!"

" Doc , I got my ear pierced at my local jeweller, now its paining and scar is growing!"

Very common complaints that one sees in consultation room's. Is it avoidable? Is it necessary? Is it just a fad that youngster's get into? Well, not really..!

Body piercing has been in vogue in our culture from times immemorial. So also the case in many other civilizations across the ancient world as a way of beautifying the body.

But now it has moved to a different level with people becoming more adventurous and wanting to make a statement. It may be done alone as in most of the cases or in some cases as a part of a whole body modification process which is the other extreme.

Piercings can be done in different areas of the body depending on the personal preferences. The most common in INDIA being the ears, nose and navel. The more adventurous go onto to the lips, cheeks, eyebrows and even genitals.

Though a very simple procedure in terms if it being done, there are lots of things that can go wrong if not done properly by properly trained professionals. It has to be done by people well versed with the anatomy of the part, versed with sterility techniques and after care.

From the point of view of the person undergoing the piercing, some points to remember.

Know what you want , understand the healing time for the piercing, take care of it as advised, don't neglect any problems that you might have with it and don't remove or change the jewelry until it has completely healed.

Healing time after a body piercing varies according to the pierced area. Ranges from 6-8 weeks in the ear or eyebrow to a year in the navel and ear cartilage. In this too, there is the initial healing phase which lasts for a week or so where the body forms a lining to cover the raw area, but it takes the specified amount of time for it to heal completely. This healing period will be explained by the surgeon performing the procedure.

Though it is a simple procedure certain problems can occur, which should be kept in mind before undergoing the procedure. The common ones being infection ,non healing and Keloids. Care should be taken to have it done from properly trained personnel to prevent infection. Secondly till the healing is complete do not change over to normal jewelry.

Keloids are scar tissue that continues to form even after the healing process and some areas and some people are very prone to form keloids. As of now there is no effective way to cure Keloids, they can only be controlled.

Points to remember :

1. Read about the procedure and assure yourself that you want it. Remember that once done it's going to be there for life if not the jewelry, at least the scar.

2. Always go to a qualified professional or a surgeon. Most importantly if the centre looks unhealthy or dirty ...Walk right out.

3. Allow the piercing to heal properly before you change the ornament.

4. Clean the piercing regularly as advised and don't neglect any signs of infection or pus

5. "Spin" the ornament (turning the jewelry to allow the ointment to reach all areas of the piercing) as advised regularly.

6. Look for jewelry where the gems are mechanically set into the metal rather than glued. Glued jewelry cannot be sterilised

Remember you can rush yourself and the surgeon but you cannot rush your body to heal! So, give it proper time according to the area.

Daily Care Routine

· Do not touch your piercing unless you are cleaning it.

· While healing, your piercing will need to be cleaned once daily.

· Cleaning more often than this will harm your piercing.

· You will need to use an antibacterial soap (e.g. Dettol Liquid Soap).

1. Wash your hands with antibacterial soap and wet the piercing with luke warm water.

2. Put a few drops of antibacterial soap on the piercing and work them into a lather with a cotton bud(ear bud).

3. Try to loosen any crusted discharge and tease it off the jewelry and your skin with the cotton bud.

4. Leave the antibacterial soap on the piercing for a few minutes while moving the jewelry back and forth( spin), allowing the disinfectant to penetrate the piercing.

5. Rinse with water and air dry thoroughly. Do not dry with a towel, which may get entangled and pull on the jewelry and may also carry bacteria.

So the best way to have a beautiful body accessory is to be educated about the procedure, knowing what you want, taking care to get it done by qualified professionals, using proper medical grade jewelry and not neglecting any problems that may arise.

By keeping in mind all the necessary points in mind you will be able to make that statement, look sexy, look different and at the same time keeping your body safe.

Dr.D.S.A.Surindher
http://www.cosmesisindia.com/

Mamma...mia.!!!!

2007-02-15T21:26:00.000+05:30

Since times immemorial breasts have always held the fascination of mankind irrespective of the age. And the fact is just as true today as it was many years ago. But the only thing that has changed is the fact that women themselves also are starting to take notice of them. So let us examine and learn a few things about breast augmentation or as it is fondly called " A boob Job!"

Who undergoes a breast augmentation….?. Is it the celebrities or routine people?? What drives them to get the operation? Do they understand the risks involved and about the procedure???

For the first question the answer is no! It is not only the celebrities, but routine people, the housewife, the teacher, the software engineer, the doctor… people from all walks of life who undergo the procedure.

What drives them to get the procedure done?? Well a few have pathological problems in the chest area and hence have to go in for an augmentation. But, majority of the women undergo the procedure because either the volume was less to start off with or decreased with age and multiple pregnancies or sudden weight loss.

What drives them is the fact that breasts are a sign of femininity and these women feel that the decreased volume of the breasts affects the way they see themselves.

First of all let us understand some facts regarding breasts :
1. Breast size is variable in people and there is no fixed size which is the norm. Several deciding factors like the amount of breast tissue, heredity, how fat the person is and the fact that whether the person has been pregnant before all contribute to breast size. And of course age is a contributing factor as always

2.There is nothing like a perfect breasts.Usually perky breasts without a sag and nipples pointing forwards and a little laterally are acceptable as the norm but they vary with the size. Small perky breasts look good if the person is thin but not on a well built female. So its all about proportion.

3. 99.9% women have asymmetrical breasts the left usually being larger than the right. The nipples may be erect, flat, inverted, the areola may be large or small, with or without few hairs growing long, or the areola may be bumpy all of which are normal.

Regarding understanding the procedure and the risks involved, I’m sad to say that though most of the patients are educated women, hardly 10% of them really know about the procedure and the risks involved.

Broadly there are two categories of women undergoing the procedure. The first category or age group is the young women who are in their 20's who want to increase their bust size because they have underdeveloped breasts.

The second category or age group of patients are those in their 30's who are usually mother's who have finished with their families and now have their children off to school and have done with their responsibilities and want to get back into shape and feel they way they used to maybe 10 years and two children back. This section of patients has seen a steady increase and I'm sure we are going to see more of them. But in this group many a times they might require certain ancillary procedure along with a breast augmentation which is usually a breast lift or a areola reduction or the such.

Breast augmentation surgery was first performed in 1962 by a Texas plastic surgeon who used silicone breast implants to enhance the size of a woman’s breasts. 1997 HBO film "Breastmen" starring David Schwimmer and Chris Cooper shows a cinematic representation of the introduction of the concept of the breast implant to increase breast sizes and the early days of breast augmentation surgery and its pitfalls. Breast augmentation surgery has come a long way since then with lots of advancements in the type of implants and techniques, though the basic methods remain the same.

A common fear amongst women is the fear of cancer with implants. This is totally unfounded as per research done by various medical fraternities. Recently even in the US, the FDA has cleared the use of Silicone Gel implants. Otherwise, silicone gel implants are used widely all over Europe, South America, and Asia, though saline implants are also equally in vogue though more in North America..

Implants are commonly filled with saline or silicone gel. Both implant types have advantages and disadvantages. The saline implants are silicon bags into which saline is injected to fill it up. The advantage of this is that smaller incisions to place the implant can be used and the sizes can be increased or decreased in case of volumetric discrepancies between the right and the left breasts. But the disadvantage is that some of the saline may leak over a period of many years and the implant may have to be replaced.
The silicone gel implants are permanent as they do no deflate. But they require a larger incision size. They have a natural feel and the new highly cohesive gel implants do not leak even if they are punctured or cut. The choice of the implant is usually left to the patient.

The implant can be inserted in three ways either through the armpit or through a cut below the breast or through a cut around the nipple/areola. The approach is determined by the size of the implant and the individual patient. Recently the so called “Scar less Breast Augmentation” has been in demand also known as the “TUBA” Here a saline filled implant is inserted through the belly button and hence the scar is hidden giving it the name scar less.

The implant can either be placed in front of the muscle of the chest wall, “Sub glandular” or behind the muscle, “Sub muscular”. Placement of the breast implant under (behind) the pectoralis muscle is preferred in women with anatomically less breast tissue since the results are more aesthetic. Placement behind the muscle does not stop you from using those muscles, though body builders and weight lifters tend to prefer placement over the muscle.
Placement under the muscle allows for a more natural look and feel than placement over the muscle. Also, the incidence of capsular contracture is decreased with this placement. Placement behind the muscle allows easier breast self-examination and improved images with mammography when compared to placement in front of the muscle, all this because it is far away from the normal breast tissue.

The common problems after a breast augmentation surgery are mild pain and discomfort after the procedure. This is a little more in the sub muscular placement of the implant. Scar maybe a problem if you have an incision below the breast which will be seen in the initially but fades over a period of time. You might be required to do some regular massages for the next 6 months which your surgeon will explain after the surgery.

The most common cause of dissatisfaction amongst women undergoing the procedure worldwide has been the size of the implant with most women feeling that they should have gone in for a bigger implant. The cause for this is that initially because of the swelling the size looks more and as the swelling settles down the size feels a little smaller . But the size has to be determined by the amount of tissue she has, the incision , the type of implant.

In the end one has to realize that the final decisions are taken after a proper consultation and examination. Also the fact that, all surgeries have their associated risks and complications, which every surgeon operating on you will surely address.

This article was aimed at educating women about the procedure of breast augmentation, allay few fears and misconceptions and to help them make educated decisions regarding the same.

Dr.Surindher
www.cosmesisindia.com
#Note: This article is the sole property of cosmesisindia.com and Dr.Surindher. No part may be reproduced in complete or in part without permission from Dr.Surindher.

I Hate my Nose..!!!!!!!!

2007-02-12T19:47:00.000+05:30

RHINOPLASTY :
“I don’t like my nose!!!!”
How many times have we heard that statement by people around us?
“My nose is too big / small!!”
“Because of my nose deformity I feel that I’m not able to perform well at work…!!!”
“People make fun of me, because of my nose!!!”
These are a few of the remarks with which patients come to us. If we ask 100 people 95 % will say that they are not satisfied with their noses. But not everyone is so dissatisfied, that they come seeking correction.
For the ones who come for correction a few things we have to think about. Are they really so dissatisfied with their noses?? Will a correction help them?? Will they be satisfied with the new nose?? Will it be acceptable??
Rhinoplasty is one of the most common operations performed by cosmetic surgeons. This procedure is designed to improve the appearance of the nose & involves any or all of the following procedures:
 Reduction of forward projection of the nose
 Removal of humps
 Correction of deviation of the nose and the septum
 Narrowing of the bridge of the nose
 Narrowing the tip
 Reduction of nostril size
 Correction of depressed nose
Rhinoplasty in most cases involves modifying the underlying skeleton (bones and cartilage) to produce the necessary changes. The aim is to bring the nose in balance with the rest of the face. The nose has to be seen as part of the face rather than as a single entity alone.
No single nose can be an ideal nose! A nose which looks beautiful one person will not necessarily look good on another person. Attempts are made to keep the nose in conformity with the rest of the face, keeping in mind the necessary specific changes which the patient came to us for.
Many patients feel that the change in shape will be so much that it might be the subject of discussion amongst family & friends. But, in reality neither the patient nor the patient’s relatives or friends really remember the original shape of the nose a few weeks after surgery.
The incisions for rhinoplasty are usually made inside the nose. The nasal skin is lifted away from the cartilage & bones. Then the necessary modifications to the skeleton (bones and cartilages) are made. The excess skin re drapes itself onto the new framework over a period of time.
The procedure of rhinoplasty involves very minor changes in the region of millimeters, but the overall effect is of a balanced nose as with respect to the shape and size. Also the final result of the procedure is evident only after 3 months when all the swelling abates and the skin is well draped over the new framework. This is the normal healing period.
The final results depend on the initial deformity, the healing capacity of the person and most importantly the skin type. People having thin skin have the best results as the results are better seen through thin skin. Hence females have better results as compared to males and westerners have better results as compared to most of our patients.
In some cases the bridge of the nose is depressed whereas the rest of the nose is apparently normal. In such cases an augmentation rhinoplasty is performed. Augmentation is done by inserting either cartilage from the nose / ear or bone from the rib / hip or silicone implants. Each of the materials which are inserted, have their pro’s and cons which the surgeon will advise you about when you go in for the surgery.
In others the whole nose is bulky where a reduction rhinoplasty is performed which will involve reduction of all the structures of the nose.
As the face has to be viewed as a whole unit and the nose not being seen separately, sometimes it is seen that the chin is disproportionate making the face seem unbalanced. In such cases chin enlargement or reduction might be needed, which can be performed simultaneously to enhance the facial balance.
Another aspect of rhinoplasty that has to be touched upon is the fact that so many people blame the nose for their lack of progress in work or life in general. The nose cannot be seen separately it is a part of the person and hence it alone cannot be the cause for any problems in life for the patient. Because it is the first thing that anybody sees as he or she wakes up in the morning, it’s the first to be blamed. In such cases a rhinoplasty might not solve the inherent problems and may not help in other aspects of a person’s life.
Dr.D.S.A.Surindher
www.cosmesisindia.com
#Note: This article is the sole property of cosmesisindia.com and Dr.Surindher. No part may be reproduced in complete or in part without permission from Dr.Surindher.

Take care of ur skin.!!!!!

2007-01-25T22:13:00.000+05:30

SkinCare
Skin is the largest organ of the body, it forms the protective covering over our body and bears the brunt of all that we do and all that we consume. So, care of this protective covering is as essential as taking care of your cholesterol or your blood pressure though the ill effects of not doing so, are not fatal.

The condition of the skin also reflects about the general health of a person. When a person is happy and healthy you find people commenting on how glowing they look and similarly a person who is sick, they can be seen to have dry dull lifeless skin.

Basically, there is not much that it asks you to do for it and most of the time it looks after itself. Even in the ancient times all major civilizations have had their own methods of skin care, which have been written down in their texts. But going down to it, the basics have always remained the same.

But firstly we have to understand the different skin types. Normal skin is clear, soft, supple, uniformly textured & pigmented, neither too oily nor too dry. Normal skin is not too sensitive to climate, cosmetics or the body’s own internal environmentDry skin is dull, feels tight on washing, even with the mildest of soaps flakes, scales and chaps easily. Oily Skin feels relaxed and supple,but thicker,looks shiny and is much more prone to outbreaks of spots. Mature Skin is leathery and has wrinkles and folds, loss of elasticity.

Understanding the factors which damage or affect the skin will go a long way in understanding the care which has to be taken.

External factors most important of which is the sun, which causes photodamage to the skin because of UV rays and the next being pollution and dust. Apart from these, are air conditioning which causes dehydration of the skin, smoking , stress, late hours, etc all of which harm the skin.
Internal factors like diet which forms the major form of insult, not enough intake of water, minerals, vitamins and taking too much of junk food and alcohol. All these damage the skin or inhibit its reparative capacity, hence there is no time for the skin to recover from one insult before another is added.

Skin care can be divided into generalized care and then local care.

Generalized care- being in the form of eating healthy, drinking plenty of water at least 3 liters a day, eating plenty of green vegetables and fresh fruits, which have antioxidants. Avoiding smoking goes a long way in getting healthy skin because, apart from the fact that smoke harms the skin it also produces constriction of small blood vessels in the skin. Vitamin C is very good for the skin as it is important for regeneration as well as the fact that it is the most natural sun block one can get which acts from within the body.

Local care- basically consists of cleansing, toning and moisturizing.

Cleansing and toning - Wash the face with a mild unperfumed soap, lather briefly and rinse thoroughly. Because soap is an alkaline substance, washing will temporarily raise the ph of the skin, which is normally slightly acidic . Most skins have an inbuilt ability to readjust the balance within 20 minutes of washing, though sensitive skin types take longer. If the skin is oily, citrus based toning lotions or astringent can be used after cleansing.
If the skin feels dry and tight after washing, try using a super fatted soap that incorporates emollients such as lanolin or mineral oil into the soap base. Other causes of dryness are over washing, incomplete rinsing, hard water (calcium and magnesium salts in the water combine with the soap to form a drying scum on the skin) or sensitivity. In case of very dry skin try a cream cleanser.

Moisturizing - Moisturizing cream is used for dry skin and lotion for oily skin. All moisturizers can be made to work more effectively by dampening the skin first

The use of exfoliating agents to peel the epidermis & superficial dermis dates back to ancient Egypt. Sour milk baths were used by ancient Egyptians to soothe the skin. This helps by removing the dead cells which are clogging the new skin giving you a new glow to the skin. It can be either mechanical or using various agents commercially available in the market. This need not be done everyday.

Sun Protection- Dark skinned people have natural pigment which acts as protection but even then sun block will help prevent damage to the skin as has been proven by studies. Sun block or sunscreen with an SPF(sun protection factor) 20 to 30 should be used, unless you are planning to go to the beach or swimming when a higher SPF would be useful. The sun screen should be ideally applied at least 15 minutes before one goes out into the sun and should be reapplied every 3 hours.

Some people might say that they are in cold climates or if cloud cover is present, you don't need sun protection. the statement is False, UV damage can occur even other wise and reflected sunlight is enough to cause damage so using sun screen will go a long way in protecting your skin.

Taking care of your skin will go a long way in keeping it healthy and preventing the inevitable signs of aging from creeping in on you suddenly. Yes, turning back the clock or rather keeping it at the same hour for a longer time is possible to a certain extent naturally, by some simple measures.

So take that few minutes out from your daily routine and pamper the largest organ of your body.

Patient Talk- Post 1- Tummy Tuck

2007-01-15T00:24:00.000+05:30

This was a feed back I got from a very sweet patient of mine. SO i thought I had to share with you all. And she even offered to talk to anyone who is contemplating a surgery.

I thank her for her kind comments. SO here goes.....She call's it...

Absolving the Ab

All my life, I had always been careful and particular about my appearance, though only to the point of looking well-groomed and neat. My self-esteem needed that and so did the job I was doing.

After my son was born, for ten years now, every morning, when I looked in to my wardrobe trying to decide what to wear to work, I would get in to a fit of depression. None of my favourite blouses fit well any more, my favourite trousers wouldn’t hide that bulge any longer. I am not fat as in fat, I was alright from the front but I hated my silhouette from the side as there was no hiding that tummy, the big fold of skin in the lower abdomen that no tights or body shapers could flatten. I would settle for clothes which were made of thicker firmer material, 2 sizes larger than what I should actually wear, desperately trying to hide the ab’s abnormalities.

I have been in to exercising for as long as I can remember, inconsistently yes, but enough to realize that no amount of crunching had any effect on those bulges. That’s when I read about abdominoplasty.

As the days went past, and fitness caught on as a raging fire in India, I saw more and more folks my age around me, doing things to get fitter and look better. I felt more compelled to do some thing and soon. Every time there was a milestone in my life, I would say this is the time to do it.

But then fear of pain from past surgeries (have gone through 2 earlier) and lack of enough awareness about these options, would scare me away. I would put it off.

Another reason I was putting it off each time, was because I was misguided in to thinking that I would need to take 4-6 weeks off to do this. Given my current commitments, there was no way I could afford to take this much time off for something that wasn’t mandatory.
So came another of that milestone thing and here I was reconsidering surgery. I said I would at least ask around and gather information afresh. That’s when I chanced upon the website of “Cosmesis India( www.cosmesisindia.com)” – a group of doctors in India, with a presence in Bangalore who were in to cosmetic and plastic surgery.

I decided to go for a consultation – a single consultation wouldn’t harm, would it? So I was talking to Dr. Surindher and I went to meet him. He confirmed the same inference – only surgery could get rid of that skin fold. When I asked him the benefits of this non-compulsory procedure, all he said was that his earlier patients came back and told him that they can now look at themselves in the mirror without hating themselves. He also said I would recover in 1 week – I could go back to normal routine in a few days as opposed to the 4-6 weeks I had heard earlier.

So this is quite feasible, isn’t it ? – I began thinking. The more I talked to the doctor, the more convinced I was that I wanted to do it now and with this institution.

I was very apprehensive about the whole procedure, knowing fully well what a surgery entails having been through 2 earlier. I knew I wanted to do it – been wanting to for years now. After talking to the doctor, I was quite convinced now that they only way to get rid of the ugly bump in my lower ab was through this surgery, but garnering courage to face it was quite a feat.

I must thank the doctors(anaesthetist included) for trying to put me at ease. They assured I will be covered by pain killers for the first few days. I am terrified of pain, so no matter what they said, I WAS terrified.

But somewhere at the back of mind, based on the diagnosis and explanation of the doctor, I knew I had to go through it. So I mustered courage and prepared to face it. Having thus made up my mind, I tried not think anymore about the decision…I did not let anyone talk me out of it.

I went through the pre-op motions like an automaton – trying not to let my mind think..blanking out completely. Actually on the operating table as I waited to get in to the OT proper..I shut my mind, closed my eyes and drifted off to sleep until a nurse woke me up.

Then I was asked to pose for “Before” pictures, I wish I could have seen my own dead-pan face at that time..pity the doctor took pictures of my ab only.

During my previous surgeries, I had tried to fight the anaesthesia…but of course nobody wins the fight, just that it takes longer to settle down in to that deep sleep and I used to come around out of it in quite a troubled way.. So this time, I just decided to give in to it quietly and calmly.
But I do know I was breathing hard out of tension, again both the Surgeon and the Anaesthetist tried to relax me. The Anaesthetist, true to his word, fixed the IV with little pain and then gave me heads up that he was going to give me anaesthesia. I then just closed my eyes and let myself fall asleep. And I did, real real quick.

When I came around, it was trouble less and peaceful this time. I looked around, strange surroundings, I knew I was in the post operative ward. I asked the nurses for the time, they said 3.00 p.m. and I was like..Wow…I remember only up to about 10.30 a.m. I kept feeling thirsty and wanted to keep sipping some water.

Not much of pain, just a weird feeling lingered. Then, they wanted to shift me to my room. This was quite a job and since they moved and jostled me a little bit, it hurt.

Then I was back in my room, but kept drifting in and out of sleep. Did not feel nauseous until the doc asked me if I was..then I did. Retched and puked a few times – this hurt too. The doc said that he thought I must have been cursing him. Truth is, I wasn’t cursing him, but the agony of it all had begun to catch up with me, and I was beginning to curse myself for the decision to get this surgery done.

Can I forget the mother of all surgical agonies ? The IV drip and the endless bottles the nurses keep changing ? Needless to add, the thrombosis and the coldness in the arm. I couldn’t sleep at all, kept looking at the fluid go drip drip drip into my other arm (cause the previous one had already bulged). My thoughts on whether all this was really worth it, began to strengthen. I begged the nurse to not add another bottle, but she wouldn’t give in. She finally did, at about 3 a.m., only after which, I fell asleep.

Second day – I woke up to a good cup of coffee. The nurse promptly came back and started the drip again. Legs and whole ab area felt like dead wood. I noticed there were two blood drain pumps on either side of me and one end of each… long tubes..were inside my ab!!! Yes, really inside. The nurses came frequently to clear the blood that collected in these pumps. Wasn’t a pleasant sight for sure.

And you know what was more frightening than the sight of those pumps ? The thought that they had to come out sometime and surely that wasn't going to be painless. Then another doctor came- I did not know what he was up to, but he was trying to get me to sit up. Sit up, can you imagine that on the very next day ? – he explained that it was necessary to move to ensure the seeping blood does not clot. But I just couldn’t, was feeling so tired and faint, not to mention the pain. It was such a big effort, thought I will just pass out. After a lot of hard work, I was finally on my feet, but then I couldn’t walk !! Fear..nothing else, the doctor assured me. He helped me sit in a chair, wasn’t too bad once I sat down, just a very tired feeling. So that was my first attempt at getting out of bed post surgery. Of course, I got back in to bed with some difficulty(nurses again helped me a lot here), vowing never to get up again !!

But no, come evening, and the doctor had a mind of his own !!! He promptly came and made me get up again, this time made me walk a bit too. Not too bad again. Slept peacefully that night because I had succeeded in cajoling them in to removing the IV drip even though I could still see a couple of bottles remaining on the table. To top it, he made me put on a tight garment on the abdomen as if the existing agony there wasn’t enough. He said that was important to keep the swelling in check. Yeah ok..whatever !!

Day three – so far so good. My worst fears were going to come true…the doctor came by again – this time with an agenda to remove those tubes stuck inside me. I was hoping he wasn’t serious but he was. He wouldn’t give me local anaesthesia, said it won’t pain much. It did – to be honest – not much though. But like I had been reassured, I was indeed feeling less constrained now and bolder to sit up, walk about a little more.

That night, I couldn’t sleep – was this all worth it ?? That question kept coming back to me.

Day four, woke up to renewed energy, got up, freshened up and was cleaning the room. Yes, cleaning the room myself, putting things in proper places. The Doctor walked in on me, he said he was happy to see me up and about. I forced a smile on my face.

He said I could go home.
So again, I went through the process of getting discharged like an automaton. Reached home – climbing 2 flights of stairs – was in deep pain.

Physically, I was a lot more comfortable now. And I actually began realizing that the tight pressure garment that the doctor gave me, was indeed helpful in feeling more secure about the tummy whenever I moved.

The medicines I was asked to take, covered most of the pain unless of course I was delaying the next dose. There was intense burning under the skin of my stomach some times. There was also the feeling of lots of creepy crawlies playing under the skin – this was something the doc had warned me about. If not for his warning, I would have surely been petrified by that feeling – since its truly weird and something one wouldn’t have experienced earlier.

A few more days passed. Each day, I was visibly feeling better physically. I was moving around more and more. But what about my mental state ? Still confused, as I was feeling like there is a big block of dead wood tied to my stomach. A few folks who visited me did say I looked like I had lost weight – that did not help much. Also, the next event – Suture removal, was on the top of my mind now. I had had a bad experience (appendicectomy) – a very painful suture removal it was. I now couldn’t think of anything else.

I talked to the doctor about it and he suggested I apply a local anaesthetic cream before going for it. So, I did that and went to see him..gingerly…tensed. But just as he said, it wasn’t bad at all. Only thing was, he revealed then, that there is an inside layer of sutures that he would remove a few days later. My heart sank again (how do you apply local anaesthetic cream for internal sutures ??)

So one week had now passed, I was back to doing my usual stuff at home but did not feel good enough to go to work – so I decided to take that week off too. Stayed at home, relaxed, read, ate, slept – blissful existence, coming to think of it. But wait, what about my mental state again ?

That was worse, none of my clothes fit – I was so miserable. Here I was thinking I would be trim again and may have to buy smaller sized trousers, etc – and none of my existing clothes fitted..they were actually tight !!! I cant explain in words, how disappointed I was. So was all this effort just to come to this point ???

I asked the doctor this, he said, it’s the swelling, which will subside soon and I shouldn’t worry. But to us women, unless we actually can get in to those sizes we want to and zip up easily, no amount of anyone else telling helps. I tried not to be miserable, kept trying to hope based on what the doctor said.

New years eve came, decided to get out of this place as I badly needed the change, the doctor said it was ok to travel short distances if I were flying. I did get a change from the miserable disappointing feeling I was having though I still couldn’t sit up or move around for too long without having to lie down flat on my back at regular intervals.

Second week was over too, had to go back to work – also had to remove those internal sutures. Again, I applied the local anaesthetic cream and went to see the doctor on my way to work that morning. Yes, it did hurt a bit more burning than pain though. Subsided quickly and I went to work.

So I went to work wearing my loosest pair of jeans – others still did not fit. Everyone I met remarked that I looked trimmer. But remember that supreme validation that only clothes can give to women ??? I wasn’t convinced still.

The first few days at work were trying. With every passing day, it improved dramatically. By the end of the third week, I was feeling almost normal. Buoyed by this feeling of normalcy, I began trying my other old clothes again. Voila, more were fiiting me now and better than before !!! This edged me on and I mustered enough curiosity to try the acid test – my sheer georgette saree – which I had long given up wearing since georgette has no mercy on unwanted bumps. I actually wore the saree, looked at myself in the mirror – and…and…. I couldn’t believe my eyes !!! It was so nice, my stomach and the whole mid-section looked so neat, due to which the saree draped so well !!! Cry, I did… I wish I could have danced too at that moment. So was this really true ? Had I gotten my contour back after more than 10 years ???? I kept rechecking to confirm. I was thrilled !!

I hadn’t felt that happy in a long time. Believe me, it does wonders to one’s self-confidence. The first person I shared this with was my doctor, without whose firm and gentle support, I couldn’t have gotten to this point at all – I would have chickened out some time earlier and continued to be truly miserable about my tummy for ever.

The fourth week has just ended – a very significant month has flown past !!! I did go and buy a pair of smaller size trousers and a blouse last evening !! And when I try them on now, I cant help spiraling around and preening in front of the mirror. I looked trimmer, firmer and shapelier – therefore younger.

The most impacting comment I got – my father remarking that he felt I was now looking more like his young daughter’s image that was imprinted in his mind (an image that had frozen a few years back for him). Did I need more validation ???

It was worth it after all !! Well and truly worth every moment of it !!

I feel on top of the world !!! Something has changed for me this year...can you guess what ???

Dr. Surindher, Cosmesis India and Bangalore Hospital, Cant thank you folks enough !!!!
I wish more and more women will come forward to help themselves. We are worth it !!

aashu

aashuthegreat@hotmail.com

Who's Up for a Makeover??

2007-01-10T01:14:00.000+05:30

Often wondered about the whole " Cosmetic Surgery thing???"

Well here are a few questions answered and few points one should know before considering a cosmetic procedure.

Q. What is the difference between cosmetic surgery and reconstructive surgery?
A. Cosmetic surgery enhances specific features to improve one’s appearance and boost one’s self esteem. Reconstructive surgery is done to provide or improve / restore form and function in patients affected by birth defects, trauma, tumors, infection or developmental abnormalities.

Q. Who is a good candidate for cosmetic surgery?
A. A good candidate for cosmetic surgery is one who understands the procedure, is realistic about the expectations and risks of surgery and of course is motivated by his/ her own desire. Also, the candidates must be willing to follow orders and willing to tolerate unavoidable inconveniences like healing time, time for the swelling to come down, avoiding exposure to direct sunlight, refraining from smoking, etc.

Q. Will it hurt?
A. During the procedure our anesthetist’s will ensure that you are comfortable and feel no pain since you will be asleep. In cases where local anesthesia is used only the initial discomfort of a needle prick is felt. After surgery any pain or discomfort you experience will be dealt with by medication and usually subsides within a few days.

Q. How soon can I get back to work?
A. Depends on the procedure done. In procedures not requiring hospitalization, usually 2 – 3 days is enough, but larger operations may require some additional time away from work. But remember, you can rush urself and the doctor but u cant rush ur body to heal. So, give it the necessary healing time.

Q. How long before the final result can be seen?
A. This varies with the type of operation. Generally, there will be swelling and bruising for some time. 80% of the swelling abates within a few days, but it takes 3 – 6 months for the final results to be seen.

Q. Will there be scars?
A. Yes, but they probably won’t be noticeable. All efforts are made to keep the scars as minimal as possible and to try and hide them in natural lines and skin creases. In majority of the cases the scars settle with time and are barely noticeable. In few cases they might become hypertrophic, this depends on the person’s healing capacity. So, if you have any hypertrophic scars please bring it to the notice of the surgeon.

Q. Are there any risks and complications?
A. As with any operation, there are risks. But in an otherwise healthy individual there is no increased risk of any kind. The most common risks are anesthesia related, bleeding, infection and significant scarring. Though these are infrequent, they do occur sometimes. Since potential complications vary with each procedure, these are usually discussed with you at the time of the consultation.

Points to ponder before coming for a consultation:

# Take some time to think about the specific problem you have.
# Think and mark the specific attributes accounting for your dissatisfaction with your appearance.
# Have realistic expectations.
#Be ready to bear the inconveniences related to the procedure like healing time and to refrain from smoking temporarily.
#Examine the benefits and limitations of the procedure and carefully weigh your options before making a decision to undergo a procedure.
# Each patient, operation, surgeon and result is unique.

SO make it a pleasurable experience to yourself by taking care fo these things and preparing yourself for the procedure so you can enjoy the benefits of it.

Dr.Surindher
www.cosmesisindia.com

Why the need for this blog?

2006-12-29T15:04:00.000+05:30

I think every one who visits my blog is going to have this thought at the back of his or her mind.

True, why is there a need for this blog. In fact, even I didn't think that it was necessary until it was suggested to me by a patient of mine. The blogs that I hope to put here under this heading are in a way to create awareness regarding cosmetic surgery and its present status in India. Also aim to provide necessary information for anyone and everyone who is contemplating a change.

India is not only seeing an economic change but also change in lifestyles and thinking. People are becoming more open to all ideas be it political or personal. I see a change also in the number of people becoming more aware and concious of their body image and looking for ways to improve it. This can be achieved by various means ,of which cosmetic and plastic surgery is one.

But along with the need to have themselves subjected to these procedures, I haven't seen an equal increase in the awareness about these procedures or their antecedent risks , limitations , indications and contraindications.

Towards the same aim , I put up two websites with the necessary details of the procedures, their risks, limitations , etc. Also started writing in magazines and news health supplements. But still I recieve numerous responses on my website with vague details and strange requests. And all these from educated people, which suggests that awareness on these is very low. These are people from all walks of life like housewives to models, from youngsters to aged people, from engineers to shopkeepers and an equal or more number of men asking for such procedures.

Hence with this blog site I hope to provide information, clear doubts, increase awareness and provide a platform where in people can get more aware of these procedures and not necessarily be afraid of them. But also be educated about the " FACTS' so that they can make and educated decision to the procedure they want.

Hence with the changing trends in India may be with more people opting for such procedures there is also an increased awareness about them and also awareness as to who are the people who are qualified to do the procedures....

Dr.Surindher

www.cosmesisindia.com

Why is Cosmetic Surgery still on the Taboo list in India?

2006-12-29T03:19:00.001+05:30

Is the above statement true??? Why is Cosmetic Surgery still on the “taboo” list in INDIA?
Is undergoing a cosmetic procedure a bad thing?? I think not. If that were the case then the insurance companies would not be excluding cosmetic procedures from their purview. It goes to show that even the medical insurers are aware of the fact that if given a chance many of their clients would be willing to undergo a cosmetic procedure.

A few years back there was an article in a leading magazine written by a socialite about “ the Great Indian cover up!” It referred to the common dress in India, the salwaar kameez, which worked well in concealing a lot and also worked well in covering up a lot of excess baggage, only to be revealed after marriage.

Well, as more and more people, especially women are coming out to work or party and the attire changing from the traditional salwaar to a more corporate one and trousers, jeans or even our traditional Indian sari in a new look becoming the norm, the Indian woman is being uncovered.
Now, people want to look good in their new roles be it as officers or corporate employees or even as young mothers, let alone celebrities in the limelight like, actors or models. Also, it is no more a bastion of the fairer sex, so to speak.

Even the “ metro sexual “ male of today is bothered about his appearance, be it a paunch, a receding hairline or a crooked nose. Keeping fit, being healthy and looking good is the “ new mantra” of the young and not so young generation equally. This can be seen by the tremendous increase in the number of procedures performed on men in the last few years.

Does cosmetic surgery really have an impact on person undergoing the procedure?? Sure it does. Ask the teenager who wears a cap so his scar doesn’t show, the lady who wears a baggy dress to cover her love handles or post pregnancy stretch marks or an adolescent boy who doesn’t go swimming at school because his friends tease him about the little excess breast tissue he has. In some cases the psychological impact is huge and very palpable.
Let us examine a bit more closely the enigma called "Cosmetic Surgery". Yes, it is not necessary like maybe a cardiac bypass or an appendicectomy, but it sure helps the person it is intended for.

An ideal cosmetic procedure is one, which tries to correct the problem but, preserving the attributes, which make the person the individual, he or she is.
But, care has to be taken from the patient’s point of view to the fact that they understand the procedure, they are realistic about the expectations and risks of surgery and of course are motivated by their own desire

Is cosmetic surgery associated with any risks? Yes, as any other surgical procedure a cosmetic procedure has its share of risks, which any plastic surgeon operating on a patient will always explain. But, the risks are not always appreciated because the procedure is not “a necessity”. This is the reason why a complication, which may be accepted elsewhere, is not accepted in a cosmetic procedure. But, these instances are rare.

The problem if any is not because of cosmetic surgery per se’ but more because of it not being done properly and not being done by qualified personnel.
With so many “Cosmetic centers” burgeoning all over the place, people tend to be enamoured by the so called “ guaranteed results” which is shown in block letters and miss out on the “ results may vary from person to person” which is in small letters in one small corner of the advertisement.

Hence being well aware and educated of the procedure is the first step before you actually go ahead with the procedures. There is enough and more information available on the World Wide Web about all these procedures, which will help you know, about the risks, problems and results.

So, cosmetic procedures like any other surgical procedure require proper personnel to perform it, along with all the proper pre and peri operative care. It also requires co-operation of the person undergoing the procedure in terms of regular follow-ups care as advised by the surgeon and undergoing minor inconvenience in the form of quitting smoking or alcohol or fatty / junk food.

Also, the candidates must be sure of the credentials of the surgeon and most importantly should be willing to follow orders and willing to tolerate unavoidable inconveniences like healing time, time for the swelling to come down, avoiding exposure to direct sunlight and refrain from smoking, etc.

Cosmetic surgery is no more only for the rich and famous and is here to stay, with more and more people going in for that nose correction, tummy tuck, breast augmentation or liposuction.
Combined with proper nutrition and exercise, an aesthetic procedure may help you look good, feel better about the way you look and improve your overall self-image. It is not a fly by night operation and is definitely not a miracle solution as nothing in this world is.

Cosmetic surgery is coming out of the “ taboo” list as can be seen from the fact that China hosted the first ever “Ms.Plastic Surgery Contest”!!!!
There is no need for it to remain an enigma!!!

Dr.Surindher
www.cosmesisindia.com