Surgical Procedures

Liposuction is an aesthetic surgery in which fatty tissue is removed from undesired locations such as the hips, thighs, buttocks, arms, stomach or neck. Liposuction is not recommended for general weight loss, but is used as a technique for spot reduction which may not be possible through diet or exercise. Liposuction is also used to reduce the appearance of gynecomastia or male breasts. During the procedure, a hollow tube known as a cannula is inserted beneath the skin and the fat is removed through the tube by a powerful vacuum suction device. The risks of liposuction include seroma, contour deformity, infections and potential scarring. Liposuction works best in patients with good skin elasticity and even skin tone, and when the surgical intervention is intended to be subtle. The procedure is also combined with abdominoplasty for contouring.

A rhinoplasty, colloquially referred to as a “nose job”, is an aesthetic procedure to improve the shape of the nose. A rhinoplasty may also be performed to improve the patient’s breathing. The procedure typically involves altering the bones, cartilage and skin of the nose. The plastic surgeon will develop a customized surgical plan for each patient, after having studied their facial features, skin texture and tone, as well as the patient’s aesthetic considerations. The surgery is usually performed through a small incision at the base of the nostrils. The septum (wall between the two halves of the nose), nasal bones and nasal cartilage are adjusted through this incision. Cartilage grafts are usually required during Rhinoplasty and is harvested from the septum or ear cartilage. When large grafts are required, the rib (costal) cartilage is harvested from the chest. Though the patient is usually discharged in a day, it is comfortable to plan for a week for recovery after the procedure, as there will be dressing / splint in the nose along with swelling. They may experience some pain at this time. They will also have to take precautions to ensure the newly constructed structure of the nose does not get displaced during recovery.

Jaw deformities are treated with orthognathic surgery, performed by specially trained ortho-maxillary facial surgeons. Abnormal growths, developmental disorders, facial injuries and arthritis of the jaw are treated with orthognathic surgery. Corrective surgery can help correct problems with jaw alignment and facial imbalance. The surgery can help relieve chronic jaw pain, difficulty in biting or chewing and sleep apnea.

The surgical plan is developed in consultation with orthodontists and dentists. The patient may be required to wear braces before or after the procedure to ensure correct alignment of the teeth. The surgery is usually performed from inside the mouth, and hence the patient is not left with any facial scars. The jaw bones are re-aligned and fixed in position with screws and bone plates. If an extra bone needs to be added for stability, it is fixed in place with wires. The bone graft could be taken from the patient’s hip, rib or leg.

• Breast Reduction

Breast reduction surgery, also known as a reduction mammoplasty, is a surgery to remove extra fat and breast tissue along with the excess skin to shrink the size of the breasts. This elective procedure is offered to women with disproportionately large breasts that cause chronic back and neck pain. The surgeon will perform a physical exam and measure the breasts. The patient will undergo a mammogram and get a general physical work-up to assess the fitness for surgery. The patient may be advised to go off certain medications and quit smoking for a period of time before the procedure. Recovery time for a breast reduction mammoplasty varies according to the patient. During recovery, the patient needs to be careful with their movements and avoid lifting weights. A supporting sports brassier is advised for 6-12 weeks till the breast edema settles and the breast attains the final contour. Follow-up surgery may be required to refine and alter the shape or size of the breast.

• Breast Augmentation

Breast augmentation, also known as an augmentation mammoplasty, is a surgical procedure performed to increase the size of the breasts. During the augmentation mammoplasty, a breast implant is placed under the breast tissue or chest muscle. Breast augmentation can help enhance the patient’s appearance. Discuss your goals openly with your plastic surgeon to achieve optimal results and a realistic understanding of what breast augmentation can achieve for you. The implants are made of silicone. The plastic surgeons will take you through the various implants available and suggest the one that suits you.

The procedure is performed commonly through an inframammary incision – incision below the breast. Sometimes the surgery is done through a trans-axillary incision in the armpit or a peri-areolar incision around the areola. The implant is inserted through the incision and located in position below the pectoral muscle, or under the breast tissue. The incision is then closed. The scars will generally become less obvious over time. The patient will be advised to avoid physical activity or heavy lifting during the recovery period, until the incision heals. The patient may also have to take care of the kind of brassier they wear, to minimize distorting the implant.

• Gynecomastia (Male Breast Reduction)

Gynecomastia is a common condition in teenage boys and men, wherein the breast tissue swells. Gynecomastia could present as a small tissue growth around the nipple, or as pronounced breasts in men. The condition may affect just one or both of the breasts. The condition could be caused by obesity, hormonal imbalances, kidney or liver failure or by certain medications. If the patient is worried or uncomfortable with the excess tissue growth, it can be removed surgically. Suction assisted lipectomy with Gland excision is the commonly done procedure. This is usually a day care procedure. The patient has to wear compression garments for 8-12 weeks, to contour the chest wall skin.

• Breast Reconstruction

Patients who have undergone mastectomy (removal of the entire breast) or lumpectomy (removal of portion of the breast) procedure for breast cancer may be recommended breast reconstruction surgery to restore the appearance of the breast. The goal of breast reconstruction is to create a breast mound which is symmetrical and has a nipple areolar complex. There are various options available for breast reconstruction – The procedure can be performed using tissue from the patient or using artificial implants. The native tissues for breast reconstruction are taken from the abdomen below the navel, upper thigh or back. The nipple and areola may be re-constructed after adequate healing of the reconstruction of the form of the breast . The surgical approach for breast reconstruction is unique to each case.

• Breast lift/Mastopexy

The breasts could sag or droop because of pregnancy, breast feeding, old age and gravity. A mastopexy surgery, also known as a breast lift, is a procedure performed to improve the projection of the breast and also move the areola and the nipple higher on the breast. The surgeon may also remove surrounding tissue and skin to tighten the appearance of the area. If you are considering a breast lift, a test to check if you could be a candidate is to place a pencil beneath your breasts and see if it stays there. If it does, you might be a candidate for a breast lift. A breast augmentation may be recommended in addition to a breast lift to achieve the patient’s desired appearance.

An abdominoplasty is a surgical procedure used to remove excessive abdominal fat and tighten the abdominal muscles and skin. This creates a more conventionally flattering silhouette and is desired by some patients. The abdominoplasty is not a weight loss procedure and will not prevent the patient from regaining the weight. A complete tummy tuck will require a wide horizontal incision from one hip bone to the other. Patients who are generally healthy non-smokers are candidates for an abdominoplasty. During the procedure, an incision is made along the waist line and the undesired skin and fatty tissue is removed. The surgeon tightens the muscles, repositions the navel in the ideal position and removes the extra skin before closing the wound. It is important to follow the doctor’s post-surgical care notes to minimize scarring, bleeding and infection. Patient is advised abdominal corset for 3- 6 weeks to assist in skin contouring. Abdominoplasty is usually combined with liposuction to achieve the desired contour. A partial tummy tuck is performed to remove the extra skin in the lower abdomen without much tightening of muscles or change in navel position. Abdominoplasty can also be combined with anterior abdominal defect /hernia repair in the same procedure.

A facelift is a surgical procedure to reduce the sagging folds of the skin on the cheeks, the neck and the forehead that occur due to aging. The aim of the surgery is to provide a tighter face and a more youthful appearance. During the face lift, the plastic surgeon makes incisions in either side of the face and lifts up a skin flap. The tissues under the skin are tightened to achieve a more aesthetic facial appearance. Excess skin is removed and the skin flap is closed. The patient will need about 3 to 4 weeks to recover after the procedure. The doctor’s post-surgical care instructions need to be followed correctly to ensure a more aesthetic result. Another minimal invasive procedure for face lift is the “Thread Lift “ Procedure where threads are inserted onto the face at specific angle. This raises the skin, reducing the sagging. Effects of the procedure are usually short acting for 4-6 months and the intensity of the lift is less compared to conventional face lift.

• Labia Reduction

The labiaplasty surgery is performed to reduce the size of the labia minora (inner vulva) to be in line with the labia majora (outer vulva). Although the labiaplasty procedure is often classified under the “vaginal rejuvenation” umbrella, it is a serious surgical procedure and comes with the associated risks of infection, bleeding and scarring. It is important to reiterate here that labia come in a range of shapes and sizes, all of which are normal. Labiaplasties are beneficial to women who experience discomfort due to enlarged labia, have difficulty exercising, engaging in sexual activity and suffer from frequent urinary tract infections. The patient is advised caution before proceeding with this procedure for purely aesthetic purposes. Two techniques are generally used to perform a labiaplasty. Depending on the end goal of the procedure, the surgeon may opt to use a “Trim” or a “Wedge” procedure. The “Trim” procedure involves trimming the labia minora in accordance with the labia majora. During the “Wedge” procedure, the surgeon removes a partial-thickness wedge from the thickest part of the labia minora. This allows the labia to retain their wrinkled edges, offering a more natural look.

• Hymenoplasty

A hymenoplasty is a cosmetic repair to the hymen. The hymen consists of tissue that resembles an oval rubber washer. It covers the vaginal opening partially or completely. Contrary to popular belief, the hymen is not an impenetrable seal. Like the appendix, the hymen does not appear to serve any purpose. However, in society, it is incorrectly associated with female virginity and purity. In many cases, the hymen breaks due to physical activity, insertion of a tampon or a gynecological exam and not due to sexual intercourse. Hymenoplasty can be an empowering procedure for victims of sexual assault to help them reclaim their narrative. It is a simple out-patient procedure, in which the surgeon trims any excess tissue and closes up the skin flaps to recreate the form of the hymen. The patient may experience spotting for up to 72 hours after the procedure. This is normal. It may take about 6 weeks for the hymen to heal completely.

• Vaginal Tightening

The vagina is an elastic organ that can expand to accommodate the birth of a child. The vagina, contrary to popular belief, does not actually become loose forever after childbirth. It contracts again to its former shape and size. However, with repeated child birth, the vagina can become slightly less elastic than its default state. However, this has more to do with a loss of strength in the pelvic floor muscles along with the vaginal muscles themselves. A vaginoplasty procedure may be recommended to patients who wish to tighten their vagina. The procedure can help eliminate problems such as stress incontinence as well.

Depigmentation Treatment:

Focal chemical peels are generally done over the genitalia for the depigmentation treatment.

Scars are fibrous tissues formed when a wound heals. Scar reduction surgery can help improve the appearance of scars and match them to the surrounding skin tone and texture. Scars can form as a result of injury or a surgical incision that has not healed under optimal conditions. During the surgery, the surgeon incises around the scare tissue and removes it. The surgical plan may include implanting a skin graft using artificial skin or skin from an alternative donor site on the patient’s body. The skin graft is matched carefully for the tone and texture of the skin surrounding the scar.