Institute of Plastic & Reconstructive Surgery – Overview

Acute Burns

Burns are categorised into three types based on severity. First-degree burns are mild and only affect the top-most layer of the skin, i.e. the epidermis. Second-degree burns penetrate further, to the dermis. Third-degree burns affect all three layers of the skin – the epidermis, the dermis and the subcutaneous fat layer. Third degree burns usually destroy hair follicles and sweat glands too. Third-degree burns that cover more than 1% of the patient’s body are considered severe, and require hospitalisation. The management of burns depends on the

• Percentage of burns compared to the total body surface area
• Depth of burns
• Cause of burns – flame burns , chemical burns etc
• Structures involved ex: Hand , face , Chest

Deeper burns require skin grafts or flaps to replace the burnt tissue. The skin graft is taken from an uninjured part of the patient’s body. If the patient doesn’t have enough healthy skin available for a graft, skin grafts from a deceased donor or an artificial skin graft may be used temporarily to tide over the emergency situation.

Post-Burn Raw Area

Post-burn raw occurs when the deeper layers of the skin are destroyed by the burn and thus cannot regenerate. This leaves the patient’s tissue exposed and puts them at a high risk of infection. Also infection in a superficial burns can lead to skin loss requiring skin graft. The skin graft is usually taken from the thighs, the buttocks and the back or the abdomen. For aesthetically and functionally sensitive raw areas, the surgeon may be able to harvest sufficient full-thickness skin grafts from the patient, for use in reconstructive surgery. Full-thickness skin grafts are composed of the epidermis and dermis layers. In case the post-burn raw area is extensive, the surgeon may have to go for split-thickness grafts. Split-thickness skin grafts are thinner than full-thickness skin grafts and are composed of the epidermis and only a part of the dermis. In terms of aesthetic appearance, as well as functional performance of the skin (its ability to stretch etc.), full-thickness grafts are preferred, especially in important parts of the body such as the face or the hands.

Burn Scar Management

Burns on the skin cause the affected skin cells to die. The damaged skin produces collagen to heal itself. During this process, the skin thickens and becomes discoloured. This is known as scar formation. Scars caused by minor burns typically fade over time. Second and Third-Degree burns can cause permanent scarring. Burn scars are of three types – Hypertrophic, Contracture and Keloid. Hypertrophic scars are usually red or purple, and raised. The hypertrophic scar may be warm or cause an itch. Contracture scars tighten the skin and muscles around the scar, resulting in restricted movement. Keloid scars are smooth, hard, hairless bumps that occur when the body produces excess collagen during healing. Minor burn scars can be treated with silicone gel and steroid injections. Major burn scars can be treated surgically or with laser therapy. The surgical repair of burn scars is performed using skin grafts / Flaps.

Post Burn Deformities – Contractures

Contractures are formed when a burn scar matures, thickens and causes tightness in the surrounding tendons, muscles and skin. Contractures typically occur in burns on a joint. The patient can take steps during the healing process to reduce the chances of contractures. This includes using a pressure garment dressing, wearing a splint to keep the joint in a stretched position, and keeping the joint active by performing everyday activities. Contractures are treated with serial-splinting or with surgical skin grafts.

Defects of Limbs, Head & Neck, Genitalia

Congenital defects are abnormalities in the anatomy of a body part that are present in the child at birth. The defect could occur in the head, neck, limbs, genitalia or internal organs. These defects cause discomfort, pain or social stigma. Common congenital defects in this category include congenital limb defects, craniosynostosis, craniofacial defects and congenital malformations of the male or female genital organs. Plastic surgery procedures are aimed to restore a more functional and aesthetic anatomy. The surgical procedures are done at specific age of the child , considering the developmental milestones and the function of the specific structure. Some procedures are done at stages in specified intervals.

Congenital Defects of Hand

A congenital hand defect is an anomaly in the anatomy of the hand, present at birth. The defect is usually the result of a developmental disorder while the foetus is still in the mother’s uterus. The formation of the arms and hands happen between the 4th and 6th week of pregnancy, so disruptions in foetal development during this time could cause congenital hand defects. Cleft hand, extra fingers, joined fingers and radial club hand are among the more common congenital hand defects that occur in infants. The aim of treatment is to gain maximum functionality of the hand and improve its aesthetic appearance. Reconstructive surgery at an early stage is desirable.

24 X 7 Hand Injury Service

Hand injuries include lacerations, dislocations, ligament tears, fractures, infections and burns. The injury could affect the nails, fingers, hands or wrist. The hands are the part of the body people use for most of their day-to-day activities and work, so any hand injury must be given immediate medical attention to minimise loss of function of the hands. The overall functional recovery and healing, largely depends on the initial management of the wound. Gleneagles Global Health City has a dedicated 24×7 Hand Injury Clinic. Our team consists of plastic Surgeon with expert Microvascular and hand surgery Training, neurosurgeons, orthopaedic surgeons, vascular surgeon and physiotherapists. The doctor’s work together to develop a holistic treatment plan. The aim is to regain maximum function of the hand, minimise pain and improve the aesthetic appearance.

Replantation of Cut Fingers or Toes

Replantation is the surgical re-attachment of severed toes or fingers. The aim of replantation is to re-join the cut part and restore maximum function. On reaching the hospital, the surgeon will immediately examine the severed part under high magnification microscope and determine if it is possible to attach it. To re-attach the severed finger or toe, the surgeon cleans the damaged tissue from the injury site and aligns the bones using steel pins / Plates and Screws. Then the arteries, veins, nerves and tendons are connected. Joining the blood vessels is the most important part of the surgery which is done under microscope using sutures thinner than the hair. The patient is kept under observation and the re-joined part is monitored continuously to check the perfusion. During recovery, the patient will be recommended physiotherapy to help regain normal function of the injured body part.

The viability of the severed organ depends on the duration since injury, the method of preservation while coming to the hospital and the extent of damaged tissue at the site of injury, especially the condition of the nerves and the blood vessels. Availability of Hand surgeon 24 x 7, helps us to reattach the amputated part in the Golden period of six hours, which has a higher success rate.

If the amputated organ cannot be restored, the doctor may recommend a reconstruction using local flaps and tissues. Sometimes skin and bone from the amputated part can be used as a spare parts graft. Hence it is always prudent to bring the cut part.

Surgery for Hand Fractures

The hand is made of 27 bones. One or more of the bones in the hand could break as a result of an accident, a fall or an injury while engaged in contact sports. A fractured hand is unlike a sprain, which are soft tissue injuries. A fractured hand may result in severe pain, swelling, tenderness, bruising, difficulty in moving the fingers or crooked fingers. After initial clinical examination, an X-Ray will be taken in the emergency department to assess the nature of fracture and the bones involved. Fracture can be simple or Compound. In simple fractures, the skin is intact and in compound fractures there is wound and the fracture segment is exposed. If you suspect that your hand is fractured, immediate first aid must be given – Stop the bleeding; Raise the hand above your heart level, Apply ice and keep the hand immobilised. The broken hand must be treated for the bones to heal in correct alignment. Misaligned bones could affect normal hand function and would require surgical correction. The Plastic surgeons who are trained in Hand surgery, assess the injury and suggest the treatment to ensure that the hand retains full function and an aesthetic appearance. Depending on the injured bones and the type of fracture, the various options of management are

• Closed reduction and immobilisation using splint or POP
• Closed Reduction and Fixation using Steel pins
• Open Reduction and fixation using Steel Pins / Plate & Screws

Post Traumatic Hand Deformities

Traumatic injuries caused to the hands by blunt force trauma, sharp objects, chemical or electrical fires or sudden impact can cause deformities. Most deformities are the result of malunions, which occur when a fractured bone heals in a misaligned position. Post-traumatic hand deformities must be surgically repaired by an orthopaedic surgery specialist. In children, malunions can be corrected over time with external manipulators. Each malunion is unique, so the surgeon studies the patients X-rays and prepares a customized treatment plan for the patient. Malunions are of two types – rotational and angular. The surgeon corrects the defect by breaking the bones at the site of the malunion and realigning them. The realigned bone segments may be fixed in place with plates, bone grafts or any other technique the surgeon deems appropriate. The plastic surgeon takes care to match the skin grafts (used to close the wound) with the surrounding skin to give the patient a hand that feels natural and familiar.

Infections of Hand & Upper Limb

The hands have a unique anatomy that results in the formation of many “compartments”. Infections of the hand can build up in one part of the hand, say a finger, and fester. These infections can grow very quickly and result in loss of function in the finger. Infections that are deep inside the fingers may not respond to antibiotics and will hence require surgical drainage. The hand infection usually causes inflammation and excruciating, throbbing pain. In more serious cases, the patient may also experience fevers. The patient should seek medical treatment immediately if they suspect a hand infection, as early treatment could make the difference between regaining full function of the hand and amputation. The plastic surgeon debrides the infected wound. This cleans the wound, removes dead tissue to allow the wound to heal faster with less scar tissue formation.

Tumours of Hand

An abnormal lump on the hand is considered a hand tumour. Most hand tumours are non-cancerous. Hand tumours can occur on the skin, such as warts or raised moles, or in the soft tissues or bones of the hand. As there are many types of tissues (skin, nerves, muscle, tendon, ligament, vascular and bone tissue) in the hand, there are a range of tumours that could occur. The most commonly occurring hand tumours are ganglion cysts, giant cell tumours of the tendon sheath, epidermal inclusion cyst, lipomas, neuromas, and bone spurs. The tumour is carefully studied to identify the type of tumour and plan a surgical strategy for tumour extraction. The doctor may perform a needle biopsy to extract a tissue sample from the tumour for analysis. The tumour extraction can be performed as an out-patient procedure if the tumour is small. The surgeon will advise the patients of their options depending on the type and size of their tumour.

Nerve and Brachial Plexus Injuries

The brachial plexus is a network of nerves that send electrical impulses from the spinal cord to the shoulders, arms and hands. A brachial plexus injury occurs when these nerves are stretched, compressed or torn from the spinal cord. Minor brachial plexus injuries are common in athletes who play contact sports. Accidents and car crashes are the main cause of serious brachial plexus injuries, in which the brachial plexus tears. Babies sometimes sustain brachial plexus injuries during birth. Depending on the level and severity of the nerve injury, Brachial plexus injuries can range from reversible weakness in the limbs to total palsy (Pan Palsy) of the upper limb. The arms may feel numb or they may feel a tingly sensation passing through them. In case of severe brachial plexus injuries, the patient will also feel severe pain.

Minor brachial plexus injuries respond well to electrical stimulation, physiotherapy, medication and assistive devices like splints and compression sleeves. However, brachial plexus injuries that do not heal on their own will require surgical intervention. The surgeon may opt for a nerve repair, nerve graft or nerve transfer procedure after evaluation of the nerve injury. Prompt and early intervention is important to give the patient the highest chances of recovering full function in the arms. The follow-up treatment is as important as surgery itself and has to be followed meticulously. Nerve recovery is slow and hence the patient may take months to recover, depending on the severity of the case. These patients might require multiple procedures in the later stage like Tendon transfer, arthrodesis, Free Functional Muscle transfer etc depending on the outcome of the initial surgery.

Regular physical therapy and self-motivation can help speed up this process.

Cleft Lip and Palate

A cleft is an opening in the lip and roof of the mouth that an infant is born with. Cleft lip and cleft palate are among the most common congenital defects in infants. The conditions may occur individually or together. Cleft lip and palate can cause problems with chewing, swallowing and speaking. The cleft can be corrected with plastic surgery. The aim of the surgery is to reconstruct the anatomy to allow for proper function of the mouth and restore an aesthetic appearance to the face. The surgical approach for cleft palate is highly customised to the child. The doctors need to consider the patient’s facial structure and extent of cleft while planning the treatment. Cleft lip is usually corrected in a cheiloplasty procedure. The Cleft palate is repaired using a palatoplasty procedure.

Apart from the clinical condition, it gives an immense pressure on the child’s parents and also peer pressure as the child grows. Well defined protocols are available for management of child with cleft. Cleft lip is usually operated around 10 weeks after birth and cleft palate at around one year of age. Multiple surgeries may be required at specified ages, to give the best possible result. Child may also require dental braces for teeth alignment.

Craniosynostosis

Craniosynostosis is a condition in which the bones of the skull fuse too early in the development of the foetus. This means that as the brain grows and expands, it is limited by the fused skull bones. This results in slow growth of the brain and also pushes against the skull, causing it to become misshapen. Intracranial pressure also increases. Craniosynostosis is of four types, according to the skull suture that has prematurely fused – Sagittal craniosynostosis, Coronal craniosynostosis, Lambdoid craniosynostosis and Metopic craniosynostosis. Most cases of craniosynostosis require surgical correction within the first year of the infant’s life. The surgery will relieve pressure on the brain and produce a more aesthetic appearance of the skull.

Craniofacial Clefts

A craniofacial cleft is a malformation in the skull and facial bones. The other soft tissues that make up the face are also affected. Craniofacial clefts are very rare congenital abnormalities. There are many types of craniofacial clefts including intranasal dysplasia, nasal dysplasia, maxillary dysplasia and nasomaxillary dysplasia. The cause of craniofacial clefts in infants is still unclear, but a healthy folic acid consumption by the pregnant mother appears to prevent it. The treatment of each craniofacial cleft is unique. The surgeon studies the patient’s facial structure and reconstructs it without the cleft. The correction may be done in steps as the child grows.

Deformities of the Ear & Nose

The anatomy of the ears and the nose could become deformed by injury, congenital developmental disorders or diseases like cancer. Deformities in the outer ear could be purely aesthetic or also cause functional deficits. The anatomy of the ear is corrected in an otoplasty procedure. Deformities of the nose can be an isolated entity or part of the craniofacial cleft. The deformity could be in the septum, bone, skin or combination of these. The corrective surgery is done after thorough assessment of the deformity.

Wound Cleaning Surgery (Debridement)

Debridement is a procedure of cleaning of wounds. The wound is cleaned thoroughly during the procedure and any dead or infected tissues are removed. The wound is then washed out with medication and saline to clean the wound. Surgical debridement allows the wound to heal better and reduces chances of inflammation and infection. The procedure is generally done under anaesthesia and the patient also experiences less / no pain. Debridement is commonly recommended to patients with diabetic foot ulcers, traumatic injuries and wounds that repeatedly do not heal. Additional procedures will be required later to provide skin cover to the wound, if the wound is large. Proper post-operative care is important to ensure the wound heals well. The dressings must be changed periodically as per the doctor’s instructions.

Blood vessel, Nerve & Tendon Repair

Traumatic injuries are severe physical injuries that are caused by blunt force trauma, impact or sharp objects. Car crashes, accidents, physical assault and falls are examples of events that could cause traumatic injuries. Traumatic injuries typically affect the blood vessels, the nerves, the muscles, the tendons, the skin and possibly the bones. They may also affect the internal organs, depending on the location and nature of the trauma. Repair of the blood vessels is known as microvascular surgery. Repair of traumatic injuries require a combined approach of plastic surgery, microvascular surgery, neurosurgery, Gastroenterology surgery and orthopaedic surgery. The surgical approach is formulated through co-ordination between the departments for the best possible outcome. Quick treatment is critical to restoring maximum functionality to the injured body parts.

Wound Cover – Skin Graft / Local flaps/ Microvascular Free flap

A skin graft is used to cover a portion of exposed flesh, where the skin has been removed, burnt or torn. This surgical procedure involves removing a piece of healthy skin (called the graft) from another portion of the patient’s body, and surgically patching the wound with the graft. The donor site is chosen based on the type of skin tissue, skin tone and the size of the graft needed to close the wound. A local flap is a skin graft harvested from adjacent to the wound, and retains its network of blood vessels keeping it alive. Microvascular free flaps are completely detached from the donor site, and the surgeon reconnects the blood supply at the wound. Depending on the defect, the exposure of vital structures and availability of surrounding tissues, the surgeon chooses the appropriate tissue for wound cover.

Diabetic Foot study

A comprehensive diabetic foot exam checks diabetic patients for infections, injury, inflammation and bone abnormalities in the foot. Diabetics face a higher risk of developing these conditions. Nerve damage and blood circulation problems are the main cause of foot problems in diabetic patients. This also makes it more difficult for the patient to heal. A regular comprehensive diabetic foot exam can ensure the patient doesn’t develop serious ulcers, gangrene or infections in the foot. This is important, as early detection of foot problems could help avoid complications such as amputation of the foot.

Podiatric Care

Podiatric medicine deals with diseases of the feet, toes, ankles and soles of the feet. Podiatric care includes treatment of nail disorders, bunions, hammertoes, heel pain and thickened skin. Taking care of the feet can help reduce pain, inflammation and improve the patient’s quality of life.

Wound Cleaning Surgery (Debridement)

Debridement is often recommended to treat diabetic foot ulcers. The procedure involves removing dead or infected tissue and pus around the wound surgically. Debridement helps restart the healing process and reduces inflammation, pain and chances of re-infection. It also helps minimise scarring.

Nerve Decompression Surgery

Nerve decompression surgery is used to treat the complications of diabetic peripheral neuropathy (DPN). Diabetic peripheral neuropathy causes a tingling sensation or numbness. Surgery is only recommended for patients with DPN when medication and non-invasive therapies have proven ineffective. Depending on the location of the compressed nerve, the surgeon may choose to operate using minimally invasive techniques or open techniques. The patient may experience some pain following the surgery. Evidence says that nerve decompression could partially recover the sensation and also prevent deterioration of the existing sensation. Nerve release procedures for Diabetic foot are commonly done for common Peroneal Nerve below the knee, Superficial Peroneal nerve on the lateral aspect of leg and Posterior Tibial Nerve in the ankle.

Wound Cover

Diabetic foot ulcers are prone to infection, inflammation and extreme pain. The wound can get large and may require surgical closure if it fails to heal using more conventional treatment methods. The surgeon may use a skin graft to cover the wound. A local flap or a microvascular free skin flap may be used for the procedure.

Bone Reconstruction of Jaw – Upper Jaw and Lower Jaw

Tumors of the jaw bone most often require surgical removal. This will leave a gross deformity and also affects the basic function of chewing and speech. Hence reconstruction of such defects is mandatory. As the principle of Plastic Surgery states “Like with like tissue”, the defect in the jaw is to be replaced with bone. This bone is generally harvested from leg. The bone is contoured as per the defect dimension and fixed with plates and screws. The bone is harvested with its blood vessels and these vessels are connected to the neck vessels, to re-establish the blood supply. The new jaw bone joins with the existing jaw bone like fracture healing. Once the bone heals completely, teeth can be placed on this bone by a process called Osseo integration.

Reconstruction of Tongue, Lips, Buccal Mucosa

Oral cancer affects the tongue, the inner lining of the cheek and the lips. The treatment for oral cancer is usually to remove the cancerous tissue. In most cases, reconstructive surgery is required to maintain normal function of the mouth. The reconstructive procedure is usually a part of the cancer surgery. This reconstruction generally involves free tissue transfer involving microsurgery which gives a better functional and aesthetic outcome compared to conventional flaps. We may take tissue from the abdomen, back, or muscles of the arm to replace tissue in the mouth or throat. Tongue reconstruction generally involves creating a mound which assists in speaking and swallowing.

Reconstruction of Breast & Nipple Areola Complex

Breast cancer is typically treated with a mastectomy or a lumpectomy procedure, in which the breast is surgically removed to prevent further spread of the cancer. The patient usually opts for breast reconstruction to re-gain the shape and aesthetic appearance of the breast. The reconstruction is usually performed soon after the mastectomy or lumpectomy, but it can also be performed later. The breast reconstruction can be done using an artificial implant made of silicone or an autologous transplant made of the patient’s own tissue, harvested from the abdomen, buttocks or thighs. Autologous transplants are said to feel more natural than artificial transplants. The surgeon will educate the patient on their options and answer any questions the patient may have regarding the long-term outlook. Nipple reconstruction is performed after the breast reconstruction, to achieve a more aesthetic appearance. Skin grafts from the back or stomach are used to construct the nipple. It is then tattooed to match the patient’s nipple colour.

Management of Radiation Ulcer

Radiation ulcers are wounds formed as a complication of long-term radiation treatment. The ulcer could affect the skin, underlying soft tissues and even the bone. The ulcers could turn chronic because of the repeated radiation therapy to treat the underlying cancer or because of the patient’s lowered healing capacity. Radiation ulcers are treated with topical creams, non-steroidal anti-inflammatory drugs, special wound dressings or hyperbaric oxygen therapy. Correct nutrition and wound care protocol can also help the patient recover faster. In some cases, especially when vital structures and bone are exposed, it will require a flap cover to heal the wound.

Hair Transplant

A hair transplant is an aesthetic plastic surgery, during which the surgeon moves hair follicles from the back of the scalp to a more desirable part of the scalp (where the patient has less or no hair). Generally, several transplant sessions are required to achieve a desirable hair density. The surgeon may do slit grafts (Follicular unit Transplant), Follicular graft (Follicular Unit Extraction) or a combination of both. In FUT, a slit of scalp skin is harvested from the back of scalp. The hair follicles are harvested from this scalp skin on the back table and then transplanted. The donor site will be closed with sutures. In FUE, each follicle is harvested separately using micro punch and then transplanted. FUE is technically more demanding and time consuming. FUE is the most favored nowadays, because of the inconspicuous scar. After the transplant, the patient may have to prevent dryness of the scalp. The patient will also be put on antibiotics, painkillers and anti-inflammatory medication after the hair transplant procedure. It is normal for the hair to fall out 2 to 3 weeks after the transplant. New hair grows from the transplanted follicles about 8 to 12 weeks after surgery. It is safe to avoid shower bath also during this period. Men with male pattern baldness, women with thinning hair and patients with severe burns that have resulted in baldness are good candidates for hair transplant procedures. Hair transplant can also be done in other areas like moustache and eyebrow.

Liposuction/Body Contouring

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.

Rhinoplasty

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.

Orthognathic Surgery

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 procedures

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.

Abdominoplasty/Tummy Tuck

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.

Facelift

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.

Aesthetic Genital surgeries/ Procedures:

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.

Scar Reduction

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.

Chemical Peels (Pigmentation, Acne)

Chemical peels are cosmetic treatments applied to the skin on the face, neck and hands. The chemical peel treatment removes the top layer of the skin and allows for the regeneration of new, healthier skin. Different types of chemical peels are recommended to different patients based on the intensity of the exfoliation they require. Chemical peels can help in the treatment of wrinkles, fine lines, sun damage, acne scars, uneven hyperpigmentation or melasma. Nowadays combination peels are used to improve the result and minimize the complications.

Before the procedure, the doctor may recommend a specific skin care routine to prepare the skin. Chemical peels are usually performed as an outpatient procedure and may last from 30 to 90 minutes. For deep chemical peels, the doctor may use a topical anaesthetic to numb the face. After the procedure the patient will be advised to use special lotions, avoid facial scrubs and stay out of the sun. Chemical peels could have possible side effects including redness, dryness, pain and swelling. Recovery time may range from 3 days to 2 weeks depending upon the peels used.

Microdermabrasion (Machine for Smoothening Skin)

Microdermabrasion is a minimally-invasive procedure used to improve the appearance of the skin. The procedure uses a special instrument to gently scrub away the dead cells and rough outer layer of the skin, allowing for the regeneration of new, healthy skin. Microdermabrasion is effective in reducing the appearance of fine lines, wrinkles, hyperpigmentation, acne and acne scars, dull skin, sun damage and blackheads. The patient may be advised to avoid sun exposure, waxing and exfoliants for a period of time before the procedure. The microdermabrasion procedure takes about an hour. The patient is likely to see immediate results after the procedure. The patient will be advised to moisturize and apply sunscreen regularly after the procedure. The patient may feel redness of the skin, swelling and tenderness. This should normally go away within a day.

PRP (Platelet Rich Plasma) Treatment

Platelet-rich plasma treatment is a medical technique used to speed up healing and stimulate tissue regeneration, by injecting growth factors and platelets isolated from the patient’s blood into specific sites in the body. This technique is also used to stimulate hair growth in the scalp. Before the procedure, the patient’s blood is drawn and passed through a centrifuge. The centrifuge isolates the platelet cells of the blood. Sometimes the isolated platelet cells are run through the centrifuge again to concentrate them further. The platelet serum is then micro-needled into the patient’s scalp. The PRP is injected into the root of the hair follicle. This stimulates the growth of dermal papilla cells which contribute to hair growth. PRP injection is also used for facial Rejuvenation, Scar modulation and adjuvant treatment of chronic wounds.

LASER Procedures

Hair Reduction

Laser hair reduction or removal is a permanent hair removal method and it is the most common application of LASER. It is a medical procedure that uses laser beams to eliminate unwanted hair. The laser emits light energy that is absorbed by the melanin pigment in the hair follicle. This damages the hair follicle and limits future growth. With repeated laser hair removal sessions, most patients achieve a permanent loss of hair growth. The result depends on the hair color. White / brown hair will have less optimum results compared to Black hair. Some patients may require periodic follow-up treatments. The doctor will be able to advise the patient on their chances of success with laser hair reduction therapy after a physical exam.

Laser hair removal can be performed on any part of the skin, except around the eyes. The doctor will give the patient specific instructions about their pre-procedural care. This may include avoiding direct sunlight, wearing moisturizer and sunscreen and avoiding blood thinners. During the procedure, the doctor places a hand-held laser device against the skin and operates on the desired areas. The device usually has a cooling mechanism that will continuously counteract the heat produced by the laser on the skin. It may feel prickly and uncomfortable, but should not burn intensely. To reduce any discomfort after the procedure, the doctor may recommend ice packs. The patient will also be advised to avoid sunlight and use a broad-spectrum SPF sunscreen.

The Triple wavelength FDA approved Diode laser at the advanced centre of aesthetics will help you to remove the unwanted hairs of all types with optimum result.

Acne Scar Treatment

Laser treatment for acne scars aims to minimize the appearance of scarring caused by old acne. The treatment focuses laser beams on the acne scars to break up the tissue and remove it. The treatment also encourages new, healthy skin to grow and replace the scar tissue. The treatment does not completely remove scars but can reduce their appearance and relieve pain and swelling. The procedure may cause side effects including redness, swelling and pain that will subside within a few hours.

Tattoo/Pigment Removal

Tattoos are skin modifications created by inserting ink or pigments into the dermis layer of the skin to form a pattern or design. Laser tattoo removal is used to remove the tattoo when the person no longer wishes to keep it. The technique uses laser beams to break up the pigments in the skin. This lightens or fades the tattoo. Over a number of sessions, the appearance of the tattoo can be significantly reduced. The duration of the treatment depends on how much lightening the patient expects. Typically, a gap of 6 to 8 weeks between sessions is recommended. Different Lasers are used depending on the pigment color. Black ink tattoos are the easiest to fade because the pigment absorbs all wavelengths of the laser.

Skin tag/Wart Excision

These can be removed using Radiofrequency or Laser. For very precise excision, surgical Laser beam is used. The heat from the laser destroys the minute capillaries to the skin tag and eliminates its blood supply. Without oxygen, the cells die and the mass eventually falls off. If the warts are caused by the growth of a virus, the laser treatment will eliminate the infection as well. Laser treatment is useful for warts in areas that are inaccessible, such as the genitals or urethra. Laser removal of warts can cause scarring. If the cause of the warts is a viral infection, recurrence is a possibility. In that case, the laser removal procedure may have to be repeated.

Facial Rejuvenation (Treatments of Wrinkles)

Laser skin resurfacing is a facial rejuvenation procedure to reduce wrinkles, fine lines and other irregularities in the facial skin. The technique uses lasers to remove layers of the skin in targeted areas in a precise manner. The FDA approved Fractional CO2 Laser at the advanced Centre for Aesthetics is used for the Facial rejuvenation. The doctor will advise you about whether laser skin resurfacing is the right procedure for your aesthetic goals.

Vaginal Tightening

Laser vaginal tightening is a painless procedure to restore the tightness of the vaginal. The procedure can improve the elasticity of the vaginal mucosa. The procedure typically involves two sessions of treatment, with a gap of 4 to 6 weeks in between. Some patients may require more sessions. During the procedure, the doctor inserts a medical probe slowly into the vagina. The probe is then retracted slowly while the laser focuses its beams on the walls of the vagina. The stimulus from the laser causes improved blood flow, collagen remodulation and contributes to elasticity and tightness.