Decision Making

Choose Surgery

Breast Augmentation (Enlargement)

Once the decision to undergo breast augmentation, the surgeon assesses you on clinical examination. The next decision is the route of implant placement, ie, inframammary approach (through an incision on the breast) or the transaxillary endoscopic approach (scarless breast augmentation). The surgeon will assess for amount of breast tissue (glandular tissue), any breast sagging, nipple deformities, difference in shape of the breast, which may be corrected at the time of the surgery. The decision to go for the type of incision depends on - where you are more comfortable with the placement of the scar. If you are a model or are used to wearing sleeveless shirts, then the incision in the axilla may not be suitable for you, since the scar many show for a few months. On the other hand, if you are a housewife or do not wear sleeveless shirts, then the axillary incidsion is best suited for you, since there is no scar on the breast at all.

I always do the sub- fascial placement of implants. This involves the placement of the implant below the pectoral muscle fascia. This placement gives the best benefits of the subglandular as well as the subpectoral approach, while minimizing the problems of both.

It is best to discuss these issues with your Plastic Surgeon

Breast Reduction

Conventionally breast reduction involves an inverted T scar on the breast with the vertical limb running from the nipple to the lower part of the breast. Short scar techniques are now also very popular. However short scar techniques require upto 3 months to give final breast shape and depend a lot on skin elasticity . Therefore if you one with lot of skin laxity, or want a breast reduction after severe weight loss, then a vertical scar may not be the best solution. Also in situations where lot of skin needs to be reduced, a T scar pattern would be most ideal, since a vertical T scar allows greater amount of skin reduction and the results of a T scar process are immediately observed.

Breast reduction with VASER - VASER allows a virtual scarless breast reduction by emulsifying the tough fat in the breast. It is possible to remove 1-1.5 litres of fat from the breast.

Breast Lift

Sagging of breasts is treated surgically with or without breast (silicone) implants. If the breast size is adequate, breast tissue can be rearranged to give good breast projection and upper fullness, and there is no need for implants. If the breast size is small, then the breast lift is achieved with the use of implants.

Tummy Tuck - Lipoabdominoplasty

An abdominoplasty (or a tummy tuck) involves removal of extra hanging skin in the lower abdomen with fat to give a flat abdomen, while liposuction only removes extra fat, but does not address the skin. Therefore in a patient who has extra skin, like after pregnancy or after weight loss, a liposuction may not be the best modality if done alone, but is an excellent procedure if combined with a tummy tuck. Please remember, that after a tummy tuck, pregnancy is to be avoided for at least 2 years.

Face Lift

With newer techniques like MACS Lift, and many short scar face lift techniques now becoming popular in the US and Europe, the place of a conventional face lift and neck lift procedures is being argued. Remember, in all procedures, the SMAS must be tackled with either excision or plication, otherwise the results will be very short lived. Now MACS lift, in my view tends to address a heavy neck or a neck with vertical bands poorly, and therefore neck lift should be done in these patients. MACS Lift also tends to produce a more rounded appearance in the cheek region. Thus if your older photographs, have more bulk in the cheek region, then a MACS lift will be good for you. Otherwise most face lifts may be done with short scar.

Lasers

Lasers are really misused today, with almost every clinic claiming to be laser experts. A lot of clinics are treating everything with IPL lasers. Please remember, that IPL is not a laser, it is light; and is not the treatment for problems like acne scar, hyperpigmentation, chicken pox scars, birthmarks etc. These problems are specific and each has its own specific laser for the best result. Even for hair removal, results with IPL are not upto the mark. There are more specific lasers for hair removal like DIODE laser and SHR laser. A guide to some problems and their lasers is as under

Hair removal – SHR Laser is the best. DIODE comes a close second, in terms of results. SHR works even on fine hair as well as on endocrine problems like PCOD

Tattoo removal – QS-NDYAG laser

Acne scar/ face scar/hyperpigmentation – Erbium PIXEL laser.Pixel has the least down time, while FRAXEL tends to have a higher down time

Birth marks -QS NDYAG or a Long pulse NDYAG for different conditions

Facial rejuvenation – PIXEL laser

Mole removal – CO2 or Erbium ablative laser

Rhinophyma – combination of CO2 and Erbium Laser

Choose Surgeon

Please keep a few things in mind as you go on the most difficult take of first making up your mind to undergo an Aesthetic Surgery Procedure, and then the even more difficult one to select your surgeon. If I was in your position, I would probably think of some of these points.

First of all, it is YOU who is most important. If you are unhappy with the way you feel and, would like to change the way you look, its time for a professional consultation. Discuss with you friends and colleagues. Get as much information on the media as is possible. Now days, the internet is such a great source of information, but REMEMBER, the internet is an incomplete source. Some of the pictures shown are touched up, some are just anecdotal reports, and this information can never actually substitute for actual face to face discussion.

In the second step, question yourself, what expectations do you have, and how much of this is realistically possible. REMEMBER, unrealistic expectations are the most important cause of post procedural dissatisfaction. Set some of the key features you are troubled with. Be clear what you want, because no surgeon can read your mind; he cannot help you unless you have clarity of thoughts in your own mind.

And now the toughest part. Selecting your Plastic Surgeon.There are few Yes’s and some No’s when we come to decide about our Plastic Surgeon. In my view the most important thing is, how comfortable do you feel in the presence of your doctor. Even a hint of feeling a bit unsure or uncomfortable, should caution you. After all it is your life at stake. If your surgeon is reluctant to answer your queries, think again. Having said that it is important to remember that surgeons are busy people and often find it irritating to repeat the same thing again, so never try to fool your surgeon into believing that you know nothing about the procedure, and try to take out information from him. That is the biggest put off for any plastic surgeon.

Do not think that a Plastic Surgeon who advertises the most is the best. There may be a young Plastic surgeon, who is starting out, and is not so good at advertising, but is very good professionally. So keep this in mind. Make sure, you meet your Surgeon, and not some of his assistants. A surgeon who has no time for you in the preoperative consultation, will never have time for you after surgery.

Getting the best results in a Cosmetic Surgery case is like fitting a jig saw puzzle together. It is important for the surgeon to be skilled, understanding, and selective, while the patient needs to be realistic, relaxed, and patient for the results.

IN the end remember, it is YOU who is the most important, A cosmetic surgery procedure has to make you feel liberated from anxieties within, and confident to face the world in a better manner. In my view a result is only good if it makes you want to love yourself.