Plastic Surgery

Plastic surgery is a very wide field and has its application in rather every surgical speciality. The word “plastic surgery” has been taken from Greek word “Plastikos” meaning “fit for moulding”. This reflects the theme and basic work of speciality in best possible way.

This speciality is concerned with correction of externally apparent deformities and functional deficits. By different techniques we change / mould the size, shape of or form of various tissues or parts of body to give these desired and acceptable look or to restore function e.g. reconstruction of lost nose by using bone or cartilage graft and skin flap cover, reconstruction of lost thumb, restoration of lost hand function (after trauma, nerve injury, tendon injury, contracture etc.) or reanimation of paralysed face.


Ancient Indian Plastic surgeon Sushrut (Father of Plastic Surgery) was famous for performing various reconstructive procedures especially of nose and ear. Modern Plastic surgery started to grow as separate surgical branch during Ist world war for reconstructive procedures for/on war victims.


Purpose of plastic surgery is to restore the individual to normal whereas cosmetic surgery is an attempt to surpass the ‘normal’ e.g. reconstruction of ‘cut’ nose is plastic or reconstructive surgery. Whereas if a person is dissatisfied with the looks of his/her ‘normal’ nose and wants an improvement; in that case it is known as cosmetic surgery. Both types of procedures are performed by same surgeon and basic principles are also the same. Cost of most of the surgeries is within the limit of middle class families.


“Job of plastic surgeon is to restore, repair, make or do aesthetic correction of whole those parts…which nature has given but fortune has taken away, not so much that they may delight the eye but they may buoy up the spirit and help the mind of the afflicted.”


Details about common procedures and problems addressed by it are as follows:

Trauma

Most important role of plastic surgery is in injuries involving skin, muscle, tendons, nerves, vessels, facial bones. Reconstruction of damaged or lost structures is better done by principles & techniques of plastic surgery. Plastic surgeons are an important part of a trauma management team. Role/services of plastic surgeon are essential in restoration of form or function of different parts, especially of face, hand, neuro-vascular injuries, injuries of lower limb associated with skin loss and burn injuries. Plastic surgeons are better trained for management of skin, nerve, vascular, tendon and muscle injuries. Plastic surgery is basically reconstructive surgery that may be related to any part of body from head to toe; be it loss of scalp, cranium, facial fracture, hand injuries, avulsion injuries or compound fractures. Aim in trauma management is early healing.


Aim is to achieve healing by primary intention so as to minimize scaring. Healing by primary intention means that after injury, wound is repaired by surgical means so as to close the gap between damaged tissue margins.


If a wound is treated by dressings only, the body’s own defence mechanisms gradually clean the wound and this gap between tissue margins slowly gets filled with granulation tissue (red vascular tissue)
(Deep burn wound where few area have been cleaned and covered with red granulation tissue where as in some areas there is still dead skin (white areas) present). With the passage of time this granulation tissue shrinks thus reducing the wound size. Together with this process, skin cells from the periphery of wound margin migrate toward center of wound to cover the granulation tissue.
Ultimately both these mechanisms together are responsible for healing of wound. This is known as healing by secondary intention. In smaller wounds this will lead to ugly scar but may not produce noticeable deformity. However in larger wounds or wounds across joint surface contraction will hamper movement of the affected joint.

Facial injuries

Face is our most important means of identity and interaction in society; also it houses all the five sense organs of body. Goal of management is not only restoration of appearance but also of function, which is so much important for day to day activities. Patient’s sagging self-esteem and his faith in treating doctor gets restored only after his acceptance in social life without any adverse remark that many times comes from his/her family members only. There may be injuries to soft tissue only, facial bones only or both. Apart from good management of injuries psychological support of patient and at times his/her immediate relatives is must. They must have patience and must realize that treatment is not like magic and recovery and scar maturation take time.


A small cut may later turn out to be a cosmetic blemish. Suturing of simple facial wounds is not a job to be done in outdoor clinics with relatives holding a crying child and doctor putting stitches with local or even only vocal anesthesia. In cases of polytrauma priority of management depends on general condition of patient and other associated injuries. Maintenance of airway, control of bleeding and management of shock always take precedence. Most common cause of major facial injuries is motor vehicle accidents. Minor injuries are usually result of outdoor sports, domestic accidents or altercation. Injuries may be in form of abrasions, lacerations, contusions, incised wounds, maxillofacial fractures, partial or total loss of parts of face (nose, ear, lip, eyelid) or burns. Deep lacerations may be associated with facial nerve, salivary duct or even salivary gland injury. A black eye and subconjuctival haemorrage must arouse suspicion of fracture zygoma or orbit similarly as a nasal bleed indicates injury inside nose that may be any laceration inside or nasal bone fracture or even fracture of upper jaw bone (maxilla). Numbness of upper lip is usually seen in fracture zygoma and maxilla, as that of lower lip is associated with fracture of body of mandible. Improper dental occlusion is hallmark of fracture of jawbones ie maxilla and mandible. Trismus (difficulty in mouth opening) is associated with fracture of zygoma, maxilla or mandible. Diagnosis of facial bones fracture is always clinical. X-rays of face AP view or lateral view are usually not helpful; rather x-rays in other special positions (Water’s view, Panoramic view, oblique views of mandible) are needed for confirmation and treatment planning.


Management of wounds especially facial and hand is no longer governed by rule of 6 hours though earlier the repair better it is. At times in badly contaminated wounds, repair may need a stage of debridement before final skin cover. Correction of lacerations may be simple straight line closure or may need some plastic surgery procedure like Z – plasty, W – plasty etc so as to give final scar line parallel to skin creases. Nasal bones, mandible and zygoma are the most commonly affected bones followed by maxilla and frontal bones in decreasing order of incidence. History of any impact on chin / chin laceration with tenderness in preauricular region may be associated with fracture of mandibular condyle or temporo-mandibular joint injury. If not treated this may lead to ankylosis of the joint.


Over the past years there has been tremendous change in management of facial bone fractures. CT scan especially 3D CT gives a very good view of facial skeleton and is the best tool to map out bony injuries. Open reduction and fixation of facial bones by miniplates and screws obviates the need of keeping mouth closed by inter maxillary fixation in majority of cases. Facial fractures tend to get sticky in about ten days time and so should be tackled early.


One must remember that no surgery is 100% free from scars. Once there is breach in continuity of skin it will unite only by scarring. The job of plastic surgeon is to minimize and camouflage the scars as much as possible. Scarring depends on many factors such as magnitude of trauma, type of wound, type of skin, age of patient, genetic predisposition of person for scaring etc. Restoration of facial bony framework is always given priority over treatment of facial wounds. Facial scars can be managed at a later date but it’s difficult to treat a malunited fracture.


Skin lacerations: All lacerations of face should be treated by using plastic surgery techniques so as to get better cosmetic and functional results and early recovery. If these lacerations are left to heal by dressings only scar will be like a wide line. If laceration is repaired by ordinary suturing there may develop cross hatch marks of sutures as shown in photo. Surgical repair by plastic surgery techniques usually gives results as in photo.


Bony injuries: Gross facial swelling and bruising after injury usually means underlying fractures of facial bones e.g. mandible (lower jaw), maxilla (upper jaw), zygoma (cheek bone), orbital fractures, fractures involving frontal sinus (sinus in middle of forehead), nasal bone. Facial bone fractures lead to facial contour irregularities and disfigurement.
Jaw bone fractures (upper as well as lower) are associated with malocclusion loss of appropriate relationship between upper & lower teeth.
Nasal bone fracture is the cause of bleeding from nose and depression or deviation of the nose.
Cheek bone (Zygoma) fracture leads to depression (deformity is very obvious), loss of sensation (numbness or feeling of heavyness) on upper lip and difficulty in opening of mouth
These fractures tend to get sticky by tenth day so it’s always better to start treatment as early as possible.
Forehead fracture usually involves underlying sinus and must be treated in time otherwise this may in future be a cause of osteomyelitis (infection of bone). Untreated forehead fracture (if not infected) will lead to odd looking depressed forehead.


Firearm or blast injuries: These injuries are always associated with extensive tissue loss (soft tissue as well as bony) and wound contamination. Reconstruction in such injuries is always in stages.


Amputation / total or partial loss of parts: Reconstruction of lost parts is always staged procedure. Reimplantation by microsurgical techniques or as composite graft may be the modality of treatment in selected acute injuries.


Avulsion injuries: Scalp or limbs are the usually affected parts. In most of the patients it’s possible to do early wound debridement and skin grafting. Reimplantation of avulsed scalp skin is possible in selected cases and hence it should be preserved (as described in Microsurgery- reimplantation surgery) and brought to hospital with patient as early as possible.


Congenital problems

Clefts: Cleft lip & palate is one of the most common congenital anomaly with incidence of about one in every 600 child. This problem may run in family. Cleft lip may be partial or complete or may be associated with cleft palate. These children may also have some associated anomalies. Rarely we may see cleft of the other parts of face as well e.g. from lip to eye (oro-ocular) or from lip to ear (oro-aural). Surgical correction of cleft lip is done after the age of ten weeks. In cases of complete clefts (cleft lip & palate) lip, alveolus and part of hard palate is repaired in first stage (after age of ten weeks). Remaining part of palate is repaired at about 15 months of age.
Cleft lip alone is mainly a cosmetic problem and can be corrected by the age of 3 months. Cleft palate children are difficult to feed. They can’t suck. They have to be fed by spoon. It’s preferable not to use bottle for their feeding. Special care is needed for their feeding otherwise growth may not be proper. Also they are at higher risk of catching common cold and ear infection. Management of this problem starts early in infancy. Surgical repair of cleft lip and anterior part of palate is done at about 3 months of age provided child’s weight is appropriate to its age. Cleft palate surgery is done between age of 12 to 18 months. This is important for proper speech development. These children have deformed nose that becomes more apparent as the child grows. This may be corrected at the time of lip repair or at a later age. As these children grow, they need visit to speech therapist and orthodontist. With proper management and follow up till the age of about 15 years child can attain normal facial development Absence, hypoplasia or other deformities of nose, eyelids or other parts.


Congenital nevi (black spots): Small spots may be removed in single stage with local skin flaps but method of tissue expansion is better for larger lesions.

Congenital Problems of Ear: Ear deformities may be
1. Congenital 2. Acquired - causes are usually trauma or burn injury
  • Partial
  • Total loss of ear

Congenital problems are:
  • Absence of ear
  • Hypoplastic ear – with or without atresia of ext. auditory meatus
  • Hypoplasia of a part of ear
  • Cup shaped ear
  • Prominent ear

Some of the problems {e.g. cup ear, small colobomas} may be corrected in single sitting in early childhood but reconstruction of a major part of ear is always a staged procedure. Total ear reconstruction is done after the age of 7-8 years. Ear framework is inserted under the skin at the site where ear is to be reconstructed. In second stage this framework covered with skin, is elevated from the site where it was implanted and the defect (thus created – on posterior aspect of reconstructed ear and the site from where the framework has been elevated) is covered with split skin graft.
Two important things needed for total ear reconstruction are ear framework that is covered by skin on both sides.
Ear Framework- Ear “framework” may be made from patient’s own rib cartilage (preferable) or commercially available silicon or porex implant. Use of artificial material {silicon or porex} carries some risk of extrusion.
Skin Cover- Skin on mastoid bone area ie behind the actual site of ear, is used for the cover. This skin may be expanded (by tissue expander) before insertion of “framework”. Results of pre-expanded skin cover are better. With the expansion of skin we can avoid the need of skin graft.
Completion of all stages may take one year or more. In cases of congenital absence of ear {microtia} there is also atresia of external auditory canal. These children may have problem in binaural hearing and in recognition of direction of sound {if deficiency in hearing is more than 15 decibel}. However any scar at the site of external auditory meatus may have its adverse impact on reconstructive ear surgery hence no surgery should be done for meatus or atretic canal before ear reconstruction.
Facial asymmetry,
Torticollis,
Neck folds,
Low set hairlines


Vascular malformations or hemangiomas: Modalities of treatment are sclerosant inj., local steroids in selected cases or surgery.

Facial palsy: Bells palsy usually recovers with time. In certain cases however residual weakness and asymmetry may persist e.g. incomplete eye closure, flattening of nasolabial fold or incompetence of oral commissure. These problems can be addressed by temporalis muscle transfer or other procedures.


Maxillofacial surgery

TM Joint ankylosis,
Surgery for recurrent TM Joint dislocation,
Management of all facial bone fractures

Hand surgery

Congenital deformities: Syndactyly, polydactyly, absence of thumb, contractures, constriction rings, cleft hand, macrodactyly, hypoplasia etc.
Age for surgery: As far as possible all major surgical reconstructions should be complete before school going age so that maximum possible function can be achieved during development period.

Hand injuries: Howsoever minor, it definitely affects the working of concerned person. In many situations injured person is the sole earning member of the family and any such incapacitating injury may deprive the family of its livelihood. Goal of treatment should be restoration of a functional hand in least possible time and not just wound healing. Injuries may be-

  • Simple lacerations,
  • Finger tip injuries – nail bed injuries,
  • Tendon injuries,
  • Vascular injuries,
  • Nerve injuries,
  • Avulsion injuries,
  • Crush injuries,
  • Firearm / Blast injuries

In fingertip injuries nail bed is usually damaged and if left unrepaired it may cause tender scar or odd looking non-adherent nail. In case of fingertip amputations every effort is made to restore or at least preserve the remaining finger length that is so much necessary for optimum hand functioning. One should never attempt to shorten the phalyngeal bone and suture the stump. Seemingly minor looking lacerations may have underlying tendon, vascular or nerve injuries. Results of primary repair are always better in such cases. Crush injuries (combined soft tissue and bony injuries) are best managed by a team of plastic surgeon & orthopaedician. Management in such cases is wound debridement, skeletal fixation followed by skin cover as early as possible. Time should not be wasted in waiting for good granulation tissue. In most of the cases of avulsion and crush injuries it’s possible to provide skin cover in 3 – 5 days. Delay in provision of skin cover increases the chances of infection, fibrosis, scarring leading ultimately to restriction of joint movement and poor results.

Severity of hand injury may vary from a simple skin laceration to loss of a major part or whole hand. There are certain important aspects of structural and functional anatomy of hand, which we must honour while managing an injured hand:
1. Length of digits,
2. First web space i.e. gap between thumb and index finger,
3. Unique position of thumb which is important for it’s opposition,
4. Quality of skin on palmar and dorsal aspects of hand.
In finger tip injuries nail bed is usually damaged and if left unrepaired it may cause tender scar or odd looking non-adherent nail. Hence nail bed must always be repaired. Most often these types of injuries are caused by door hinges and children are the usual victims. In case of finger amputations every effort is made to restore or at least preserve the remaining finger length that is so much necessary for optimum hand functioning. This is more so important in cases of multiple finger tip amputations, commonly seen in factory workers. Seemingly minor looking lacerations may have underlying tendon, vascular or nerve injuries. Results of primary repair are always better in such cases. Avulsion injuries are best managed by wound debridement and provision of skin cover as early as possible. In most of these cases it’s possible to graft these areas with in 4 – 5 days. Crush injuries (combined soft tissue and bony injuries) are best managed by a team of plastic surgeon & orthopaedician. Orthopaedician does the skeletal fixation and plastic surgeon does wound debridement and provides skin cover. Gone are the days when these injuries were treated by dressings and dressings… till granulation tissue was fit to accept skin graft. Time should not be wasted in waiting for good granulation tissue. In most of the cases it’s now possible to provide skin cover with in a week after injury, which not only improves results but also saves time and ultimately money of the patient. Delay in provision of skin cover increases the chances of infection, fibrosis, scarring leading ultimately to restriction of joint movement. Once the skin cover has matured, next step is surgery for tendon or nerve repair or even tendon transfer in selected cases.


Tendon transfer: For –
Ulnar nerve palsy (claw hand) e.g. in patients of leprosy,
Radial nerve palsy (wrist drop),
Median nerve palsy.

Microsurgery

Incised or lacerated wounds on wrist or forearm are associated with tendon or neuro-vascular injuries. These neuro-vascular injuries need to be repaired under magnification. Results of primary repair are always better. With the help of microsurgery we can not only do reimplantation but also we can transfer certain body tissues (free flap) along with their blood and nerve supply (optional) to other parts of the body according to requirement. This method is used for transfer of vascularised skin or muscle flaps.
Peripheral nerve injuries,
Vascular injuries,


Recanalisation of fallopian tube or vas: After tubectomy or vasectomy.
Reimplantation surgery: Amputated part should be cleaned, wrapped in moist saline gauge and put in a dry polythene bag. This bag should be put in another bag containing ice. Ice should never come in direct contact of amputated part. Amputated part should neither be frozen nor water logged. Patient must be sent to a referral center as soon possible. Bleeding from major vessels should be controlled by local pressure. As far as possible, hemostat, ligature or proximal tourniquet should not be applied.
Re-implantation is usually not possible in cases of crush injuries. However it’s better to refer a non-candidate then to miss a deserving candidate.


Urogenital surgery

Congenital:
Hypospadias: It may have other associated anomalies also. Surgical reconstruction should be complete before school going age. Single stage repair is possible in distal penile or selected cases of mid penile varieties.
Epispadias,
Vaginal agenesis: In most of these patients uterus is rudimentary or absent. Vaginoplasty is preferably done approximately one to two years before marriage is planned.
Ambiguous genitalia,
Chordee without hypospadias,


Acquired:
Urethral stricture,
Fistula,
Penile or vaginal reconstruction,
Lymphoedema
Penis,Scrotum & Limbs
Apart from artery and vein our circulatory system consists of lymphatic vessels that run approximately parallel to blood vessels in superficial plane. These minute vessels start as blind conduits in peripheral areas. Main role of these is to carry away proteins and other substances that can’t be reabsorbed in venous capillaries. Approximately 2-4 lt. of lymph is carried in blood stream by these lymphatics daily. Lymph nodes are clustered in certain parts of the body in the path of lymphatics and act as filter for lymph.
Water along with certain nutrients, O2 and small amounts of plasma proteins are continuously filtered away from arterial capillaries in tissues and substances to be excreted are similarly taken back by venous capillaries. Plasma proteins and other large molecules that can’t be taken back by venous capillaries, seek its way through lymphatics. Blockage in the path of lymphatics by any means leads to lymph edema. This may be congenital (absence of development or insufficiency) or acquired due to trauma, burn, infection, malignancy, radiotherapy etc. Substances that can’t be taken back because of this blockage or insufficiency, get pooled up in subcutaneous tissues and lead to swelling. It’s rich in plasma protein that forms coagulum, may act as substrate for thriving of bacteria and itself may lead to chronic tissue inflammation. Person gets repeated infections due to increased susceptibility that further accelerates lymphatic blockage and it may become a vicious cycle.


Causes:

Congenital- Though congenital it may not manifest clinically for a variable age. It may be apparent in early childhood, after puberty or even in adulthood depending on severity of blockage.
Acquired- Bacterial infection (Filariasis),
Malignancy- Surgical excision or Radiotherapy,
Trauma, burn injury leading to extensive skin loss.
Treatment- Rest, Limb elevation
Physical decongestion by massage, elastic pressure garments and other mechanical Methods
Surgery in selected cases.


Burn injuries

Acute burns:
Indications of hospitalisation:
  • >15% total body burns,
  • > 10% burns in children or old adults,
  • > 5% full thickness burns,
  • Burns of hands, feet, face, eyes, ears or perineum,
  • Suspected inhalation injury,
  • All electric and chemical burns,
  • Any associated injury,
  • Any pre-existing illness.

First-aid:
  • Remove the person from further danger.
  • Neutralise chemicals - water in copious amounts is good.
  • Specific agents:
    • For acid - 3% sodium bicarbonate.
    • For alkali - 1% acetic acid (vinegar).
    • Phosphorous Burns - keep wet at all times, irrigate with 1% copper sulphate.
    • Hydrofluoric acid - apply calcium gluconate gel.
  • Wound - cover with a clean wet towel.
  • Fluids - Major burns - nil by mouth; start an I/V line by 18 G cannula.
  • Analgesia - Narcotic analgesics are best suited for burn patients.

Evaluation of the ABC’s:- AIRWAY - BREATHING - CIRCULATION
Indications for referral to a burn specialist:
  • >20% second degree burns,
  • All deep burns,
  • Respiratory burn,
  • Electric burn,
  • Chemical burns,
  • Associated injuries.

Aims of treatment:
         Prevention & treatment of shock,
         Prevention of complications,
         Closure of wounds.
Other important considerations:
         Maintain and preserve body function and appearance as far as possible,
         Healing in least possible time with minimal scarring,
         Mental and emotional stability of patient and family members.

In the field of burn management focus has been on development of techniques so as to achieve complete healing of injuries and return of the patient to his/her schedule in least possible time so as to save the valuable time & money and to avoid the psychological trauma and agony to patient and his/her family members. All this has been possible because of the better understanding of –

  • Avoidable causes of infections,
  • Factors responsible for delay in wound healing,
  • Factors leading to fibrosis & scarring,
  • Importance of early provision of healthy skin cover &
  • Importance of early mobilisation.

Trend now a days is of management of deep burn injuries by early excision of burn wound and skin grafting wherever possible. The superficial burns almost always (unless infected) heal without any significant scarring in two to three weeks time. Deep burns need specialised management so as to avoid the menace of fibrosis, scarring, disfigurement and joint contractures. The practice has been to treat the deep burns by dressings & dressings & dressings… until the granulation tissue is fit to accept skin graft. Granulation tissue gradually matures into fibrous tissue that is the precursor of the most of the ill effects of burns. This can largely be avoided by early excision of deep burn areas and at the same time by providing cover by split skin graft. This should always be considered for deep burns on hands, neck, face & across flexor aspect of joint surfaces.
Post burn scars, contractures, other deformities and disfigurements,


Cosmetic surgery

At times people are dissatisfied from their looks or body shape that may be changed by means of cosmetic surgery. These problems may be congenital or acquired with aging e.g. depressed or parrot beak shaped nose, facial wrinkles, sagging breasts, disproportionate fat deposits etc. One of the main aims of cosmetic surgery is to restore the mental health of the person thus permitting return to social participation.
Rhinoplasty (change in shape of nose): For broad, depressed, deviated nose, parrot beak shaped nose, acquired defects or other unsightly problems. Incision / scar is almost always inside the nose and doesn’t show up. Hospitalisation is usually needed for a day.
Genioplasty (change in shape, size of chin): For disproportionately protruding or recessed chin. Incision / scar is almost always inside the mouth and doesn’t show up. Hospitalisation is usually needed for a day.
Otoplasty (change in shape, size of ear): For large, prominent or cup shaped folded ears. Scar is usually behind the ear. Hospitalisation is needed for a day only.
Facelift, browlift and necklift: For aging face — to correct wrinkles & sagging skin of face, neck and sagging eyebrows.
Blepharoplasty: For correction of sagging eyelids or wrinkles on eyelids.


Mammoplasty (change in size shape of breast):

Breast augmentation — For underdeveloped and small breasts that may be a cause of lack of self-confidence and depression. It’s done by silicon prosthesis and it doesn’t interfere with breast-feeding at all.
Brest reduction — For hyperplastic, large, ptotic breasts, which not only look awkward, but are also a cause of shoulder, neck and back-ache.
Breast reconstruction — It’s needed in patients of breast cancer whose disease has been cured or in some girls with congenital absence or hypoplastic breast. Reconstruction is done by flap from abdomen or back with silicon prosthesis.
Gummy smile (exposure of gums while smiling): In few persons upper teeth and gums are excessively visible while smiling. This can be corrected by a day care surgery.
Congenital black spots (nevus), moles: Excision of small nevi or moles is an outdoor procedure. Large nevi on face need excision and cosmetic reconstruction of the area. Tissue expander is an useful device for better results in these situations.


Change in size of lips:

Reduction - For overly thick, unsightly lips. It’s an outdoor procedure and scar is always inside the lips.
Augmentation - Usually done by lipofilling and is a day-care surgery.
Scar revision: Revision of most of the facial scars is an outdoor procedure and hospitalisation is usually not needed. However in case of large scars which can’t be removed under local anesthesia, hospitalisation for a day may be needed. We should remember that “once scar, always scar; it’s quality can definitely be improved”. At times it may be possible to vanish a scar but it’s not the usual story.
Post acne scars: These scars need correction by dermabraision. Sun exposure has to be avoided for 3-4 months after surgery.
Post burn scars: Deep burns if left to heal by secondary intention, always leave scars. Modalities of treatment vary according to size, sight and nature of scar. Large scars on face are best managed by tissue expansion.
Baldness: Surgical options for correction of baldness are hair grafting, scalp flaps or tissue expansion.
Vitiligo / Leucoderma: Surgical options are adopted only in cases where lesion has been stationary in size for at least last two years. Small facial spots may be excised and defect repaired by suitable plastic surgery procedure. Larger lesions elsewhere on body are managed by excision and skin grafting. Tattooing is good alternative and gives satisfactory results in experienced hands.
Liposuction: some people develop fat deposits that don’t respond to exercise or dietary restrictions e.g. over abdomen, waist, thighs, gluteal regions, neck, below chin (double chin) or subscapular region which looks awkward under the blouse in females (blouse bulge). It’s a safe procedure and may be combined with other surgeries also. Once treated these fat deposits don’t recur. Now days it’s done with special syringes (tumescent liposculpture technique) that offers better results with negligible complication rate. This is a very good technique for correction of gynecomastia. This is usually a day care surgery or at maximum, hospitalisation for a day may be needed.
Lipofilling: This is used for cheek or lip augmentation or correction of facial asymmetries by fat injections. Fat is retrieved by liposuction and is injected in desired areas under strict aseptic and anaerobic conditions. Fat retrieved by machine liposuction is not suited for injection.
Abdominoplasty: It’s indicated where fat deposition is associated with loose sagging skin e.g. after multiple pregnancies. Besides removal of excess fat and loose sagging skin, abdominal muscles are tightened also so as to restore their tone.
Gynecomastia (Breast enlargement in males) : Liposuction is the best way to manage this problem if there is no glandular tissue. Glandular tissue can be removed by surgical excision only.
Peri-ocular melanosis (dark circles around eyes), Melasma / Chloasma: These can be effectively treated by chemical peeling, without any surgery. Sun exposure has to be avoided during treatment.