Eyelid Surgery (Blepharoplasty)

SURGERY FOR AGING EYELIDS

With age the skin of eyelids stretch and sag, muscles become weak and excess fat collects below your eyelids. This can cause sagging of eyebrows, drooping of upper lids and eye bags in lower eyelids. Baggy skin of upper eyelids can impair vision and decrease field of vision and make a person look older.

Blepharoplasty also called Eyelid surgery, corrects droopy eyelids by removing excess skin, muscle and fat. It repairs the sagging upper eyelids to improve vision as well as the appearance of the person. Removing this tissue can improve vision and make your eyes appear younger and more alert. It also corrects the baggy or puffy lower eyelids to give an alert and crisp look. The upper and lower eyelids are lifted and loose or excess skin and fat tissue are removed from the eye area. The procedure is limited to the eyelids and may be combined with methods to improve other areas of the face. Brow lifts, which raise the eyebrows or keep them from sagging over the eyes, may be recommended along with to help improve the upper third of the face.

Q: Who are the ideal candidates for Blepharoplasty or eyelid surgery and how is it planned?

A: Blepharoplasty is a surgical procedure that can restore a youthful appearance to the eye area. People with sagging upper eyelids and puffy lower eyelids or with lower eyelid eye bags can be good candidates for this surgery. Patient should be physically healthy and have realistic expectations from the surgery. Eyelid surgery cannot remove dark circles and crowfeet lines around eyes that require other procedures like chemical peels and Botox. Person’s medical record is checked and eyes are checked for dry eyes, reduced tear production and lower eyelid laxity. Preoperative markings are made accurately to remove just the right amount of skin from upper and lower eyelids.

Q: How is Blepharoplasty or eyelid surgery performed?

A: There are several approaches to blepharoplasty. One method removes excess skin from either the upper or lower lid, as well as the underlying fat pad when indicated. An incision is made along the crease in the upper eyelid and just below the eyelashes in case of lower eyelid surgery, the skin is separated gently from underlying structures, fat and muscle, and underlying tissue separated to remove the fat pad. The pad is then cauterized (heat sealed). Loose skin and/ or muscle is removed and incision is sutured with fine threads.

The second type of blepharoplasty procedure, Transconjuctival Blepharoplasty, may benefit patients with protruding fat and not too much extra skin. This surgery is performed by making an incision on the inside of lining of the lower eyelids. This approach eliminates the visible scar but does not remove excess skin. In alternative treatment options, Non-invasive radiofrequency treatments can tighten the crinkly skin on the lower lids. The advantages of radiofrequency treatments include no post-procedure downtime or recovery, single treatment, and minimal complications. The crowfeet lines around the corners of eyes can be treated with BOTOX injection treatment.

Breast Reduction Surgery (Female)

Reduction Mammoplasty

Oversized breasts have been seen to cause far more discomfort and loss of confidence than having smaller breasts in women. Apart from large size it is also associated with a host of medical problems like pain in the back, neck and shoulders; shoulder notching due to constant digging in by bra straps; unpleasant smell of sweating under the breasts, sometimes may be accompanied by infection, rashes and dark pigmentation in the folds.

This condition may present itself at puberty, after childbirth, after considerable weight gain or later in life following the menopause or because of the use of hormone replacement therapy (HRT). Breast reduction surgery has today evolved to a much safer procedure with predictable and better cosmetic results, as well as fewer complications making it one of the most frequently requested procedures.

Q: Who are the ideal candidates for breast reduction surgery and how is the surgery performed?

A: Breast reduction can be achieved by either Liposuction or Mammoplasty. Liposuction offers a minimally invasive alternative when the breast tissue has more fat than the glandular part especially where patient is unmarried and want to preserve breastfeeding function. Liposuction, which involves removal of excess fat, is less expensive, causes lesser trauma to the breast, can be done under local anaesthesia with sedation and leaves no visible scars.

The more invasive traditional mammoplasty procedures are preferred when the gland part is of greater proportion than the fat like in women with children and who have completed the family and don’t need the breastfeeding function anymore. Mammoplasty however needs to be done under general anaesthesia and involves removal of excess fat, glandular tissue and skin, makes the breasts firmer and less wobbly as well as lighter than before. In most cases of breast reduction surgeries, the nipples and areolas remain attached to the blood and nerve supplies, while the excess breast tissues are removed. The areolas are also reduced in size. The nipples and areolas are then repositioned at a higher level and the incisions are closed.

Since this procedure is usually combined with breast lift (Mastopexy), the breasts also get lifted, with the nipples pointing forwards instead of downwards making them aesthetically more appealing.

Q: What type of anaesthesia is used in the surgery?

A: Breast reduction surgery is performed under general anaesthesia or local anaesthesia with sedation.

Q: How much time does surgery take?

A: Breast reduction surgery itself takes take about two to five hours and generally an overnight stay at hospital suffices and the patient can get back to office work in 10-14 days. The bruising and swelling usually takes about 2-3 weeks to subside. Complications of this surgery would be similar to those of any invasive surgery and include infection, bleeding and rarely loss of nipple and areolar tissues that may require reconstructive surgery later. The risk of complication can be minimized in hands of an experienced cosmetic surgeon.

Q: What are the precautions and postoperative care after surgery?

A: After surgery rest is advised for about 48 hours. Pressure garment or specialized bra is worn for 4 weeks. Gym exercises are avoided for 4-6 weeks. One should avoid sun exposure on breasts for few months and take special care of the incision sites by applying scar reducing creams and silicone gel sheet.

Q: What are the risks or complications from this surgery?

A: The bruising and swelling usually takes about 2-3 weeks to subside. Complications of this surgery would be similar to those of any invasive surgery and may include infection, hematoma and rarely loss of nipple and areolar tissues that may require reconstructive surgery later. The risk of complication can be minimized in hands of an experienced cosmetic surgeon. There could be scar formation in the lower half of breast after vertical scar mammoplasty. The scars usually fade after surgery depending on individual healing characteristics. However these scars are acceptable and are hidden when you are wearing a bra.

Who are the ideal candidates for due FUE hair transplant?

The following indications need use of FUE technique for hair transplant.

• FUE is very useful in persons who keep small hair or shave their heads, as no scar line is visible after surgery.
• It is also ideal for persons who have tendency of hypertrophic or prominent scars because they will not have a long visible scar.
• FUE is only method by which adequate cover can be given for Norwood Grade VI-VII as the hair can be extracted from the head as well as the body areas in multiple sittings. As compared with FUE, in the strip technique of hair transplantation, the number of hair is limited as only those hair grafts, which are removed in the strip, can be used for transplant.
• FUE is also the preferred technique for eyebrow or moustache transplant.
• It is also recommended for revision cases i.e. those who have already undergone surgery by strip method.
• FUE method is also a method of choice in patients with inelastic skin in the back of head, as strip of skin cannot be removed in these patients.
• With FUE, multiple sittings can be used to give “add-on” hair to improve the density of hair.
• For scarring from dermatologic conditions, trauma or neurosurgical procedures.
• In athletes and persons involved in physical activity, who must resume full activity immediately after the procedure as healing is much quicker in FUE technique.
• In persons with an inordinate fear of pain or scars due to removal of skin and placement of stitches.
• When body or beard is used as a donor area as FUE technique is the only technique useful in body hair transplantation. The earlier indication of limited areas of donor site with FUE technique has been overcome by Body Hair Transplant (BHT).

Post Weight Loss Cosmetic Surgery

Losing a large amount of weight through diet and exercise is a major accomplishment that will enhance your health, your confidence and your appearance. However, many people who achieve great weight loss can be left with large amounts of heavy, loose folds of skin around the abdomen, arms, thighs, breasts, buttocks and face. Skin can sag and lose elasticity as a result of being stretched for a long period of time. After significant weight loss, the skin often fails to shrink back to its former size and shape.

What are the problems of excessive skin?

Excess skin can make getting dressed a difficult job, limit mobility, and cause hygiene and medical problems. Chronic skin- to-skin contact can result in rashes and infection. In addition, excess skin can be a cosmetic issue. People who have lost a large amount of weight often want their bodies to reflect the new, more positive image. Many times, the only way to remove excess skin left after extensive weight loss is through body-contouring plastic surgery.

Areas of Attention

For optimal results, body contouring should not be done for approximately 2 years following the start of any massive weight loss program. This time allows the skin to shrink as much as possible and your nutrition can be optimized.

Skin reduction is done in stages to minimize complications such as infection and blood loss, and is often done over a period of years as one or two areas of the body are addressed at a time. Also, touch-up surgeries are often required later.

These are the areas of the body most often treated through body contouring after great weight loss.

Abdomen

Also known as a "tummy tuck," abdominoplasty involves removing excess skin and tightening of the underlying abdominal muscles. An incision is made just above the pubic area from hip to hip.

Thighs

A medial thigh lift, designed to remove excess skin from the upper leg, involves an incision along the inner thigh starting at the groin and extending as far as the knee.

Breasts

A number of breast procedures are available, including breast lift with or without augmentation (enlargement with implants) and breast reduction.

Arms

In surgery to remove excess skin from the arm (brachioplasty), an incision is made starting at the armpit and extending to the elbow.

Face and Neck

Removing excess skin around the face or neck after weight loss is akin to a traditional face lift, except that more skin is removed.

A combination of surgeries may be done at the same time, as long as safety regarding the multiple procedures can be maintained. An "upper body lift" may include a combination of surgeries to the arms, back, and breasts/chest. A "lower body lift" may include combination surgeries to the hips, thighs, abdomen, and buttocks. The exact procedures to be performed at one time will be individualized by the plastic surgeon and patient. All surgeries are performed in the hospital under general anesthesia, and most patients stay in the hospital one to four nights. Most people can return to work after two to four weeks.

Most body-contouring procedures involve making an incision in the least obvious part of the area to be trimmed, removing excess skin, and suturing the area with fine stitches to minimize scarring. With these types of procedures, scarring is unavoidable. Liposuction may be used in conjunction with some procedures.

Because of the significant amount of skin to be removed during contouring surgery, there are greater associated risks than with standard cosmetic surgery which include separation of incision, skin laxity, and formation of a seroma, asymmetry and rarely deep vein thrombosis.

However, realistic expectations are a must. Surgery will lead to marked improvements in your shape, but it is not completely possible to restore the skin or body to what it would have been without the weight gain.

How are the types of Breast implants selected?

Breast implants come in various types depending on the shape, size, material and surface characteristics, however all implants share the same basic components of having an outer shell and inner filler material enclosed in it. The outer shell is typically either smooth or textured and is made from tough silicone material. The textured implants are supposed to have less incidence of capsule formation and have become more popular these days.

The two common types of implant filler material used are either a Saline solution or a Silicone gel. Silicone cohesive gel implants are most preferred implants as they are almost leak proof and give a very natural appearance and feel. The saline implants are prone to leakage and due to lower density of saline; the feel is also less natural. The saline implants also tend to change shape with body position while this is not the case with thicker gel implants.

As far as the shape is concerned, breast implants come in two shapes, round or anatomical or teardrop shape. The advantage of a round implant is that if it rotates in the pocket created fro implant, it is not noticed as a round implant just rotates on its axis. Anatomical implants give somewhat more natural look but can rotate if the surgical pocket created for implant does not hold them in place. This results in unnatural shape of breasts.

Implants come in various sizes starting from 150cc to 800 cc or even more. The best way to select the size of an implant is to try some different size breast sizers in a bra to give you an idea as to the look you achieve after surgery. This method helps patients to choose the size of implants. Another way to estimate the required size is that approx. 300 cc volume implant can enhance breast by two cup size i.e. from Cup B to Cup D size and accordingly implant size is selected. Currently commonly used implants are Silicone Cohesive gel implants, Round shaped with Textured surface available in various sizes.

Who are the ideal candidates for surgery and how is it planned?

Breast enhancement or augmentation is currently one of the most frequently performed cosmetic surgery procedures in Chennai. It can dramatically improve the appearance and size of a woman's breasts. Breast augmentation is performed for a variety of reasons. The enhancement procedure is used to enlarge smaller breasts, underdeveloped breasts or breasts that have shrunk in size after breast-feeding and to balance a difference in breast size. The breast implants are also used in reconstructive technique following breast carcinoma surgery.

Before surgery, you may try some different size breast sizer in a bra to give you an idea as to the look you achieve after surgery. Approx. 300 cc volume implant can enhance breast by two cup size i.e. from Cup B to Cup D size and accordingly implant size is selected. Often a mammogram (X-Ray) is done pre-operatively. Silicone cohesive gel implants with textured surface are most preferred implants as they are almost leak proof and give a very natural appearance and feel. The saline implants are prone to leakage and due to lower density of saline; the feel is also less natural. The saline implants also tend to change shape with body position while this is not the case with thicker gel implants.

Cosmetic surgery

Cosmetic surgery is an optional procedure that is performed on normal parts of the body with the only purpose of improving a person’s appearance and/or removing signs of aging. In 2014, nearly 16 million cosmetic procedures were performed in the United States alone. The number of cosmetic procedures performed in the United States has almost doubled since the start of the century. 92% of cosmetic procedures were performed on women in 2014 up from 88% in 2001. Nearly 12 million cosmetic procedures were performed in 2007, with the five most common surgeries being breast augmentation, liposuction, nasal surgery, eyelid surgery and abdominoplasty. The American Society for Aesthetic Plastic Surgery looks at the statistics for thirty-four different cosmetic procedures. Nineteen of the procedures are surgical, such as rhinoplasty or facelift. The nonsurgical procedures include Botox and laser hair removal. In 2010, their survey revealed that there were 9,336,814 total procedures in the United States. Of those, 1,622,290 procedures were surgical. They also found that a large majority, 81%, of the procedures were done on Caucasian people. The increased use of cosmetic procedures crosses racial and ethnic lines in the U.S., with increases seen among African-Americans, Asian Americans and Hispanic Americans as well as Caucasian Americans. In Europe, the second largest market for cosmetic procedures, cosmetic surgery is a $2.2 billion business. In Asia, cosmetic surgery has become more popular, and countries such as China and India have become Asia's biggest cosmetic surgery markets.