Cosmetic Surgery

“Blepherum” means “Eye Lid” and “Plasty” means “Construction”.
Attractive and youthful eyes are supposed to be Bright Eyes and bright eyes have globes framed in generously sized horizontal apertures, often accentuated by a slight upward tilt from medial to lateral.
In upper eyelid excessive skin due to loss of elasticity and sun damage is one of the major causes of an aged appearance in the periorbital area and there appear multiple folds in upper eye lid. In addition to relaxed skin changes, excessive fat herniation can cause bulging, resulting in heavy appearance of upper eye lid area. This fat is normal eye lid fat and not an abnormal accumulation, but it is herniating due to weakness of orbital septum which supports these fat columns. A repositioning and sometimes careful excision of this bulging fat helps getting a rejuvinant appearance.
In lower eye lid aging changes include wrinkling of lower eye lid, excessive show of sclera(white part of eye ball), weakness of septum resulting in fat pads herniation and hollowing of tear trough. This hollowing of tear trough(Nasojugal groove) appears as a dark circle around eye.
In both upper and lower eye lid rejuvination, also called as BLEPHEROPLASTY, an appropriate approach is used to give minimal scarring and correction of skin and supporting tissue laxity. The fat bulges are corrected by replacement of fat pads in their respective places and anchoring them with support structure plication(tightening). Excessive skin and loose muscle are excised and sometimes a minimal amount of fat is also excised. The whole procedure is tailored for each patient depending on the nature and severity of deformity. The aim is to give youthful, wrinkle free and brighter looking eyes without obvious scarring at eye lids.

Cheeks provide the most prominent feature to shape a face. They are supposed to be most prominent just below the eyes, the region called Malar Region. Below the malar region there is some flattening in aesthetically pleasant and youthful face. Even more important to the bulge at malar prominence is the smooth transition from a convexity to a concavity.
With aging, in this individuals and also after massive weight loss, the malar prominences become flatter, giving an aged and exhausted look to the face. The fullness of malar region can be re-achieved by fillers and fat grafting. sometimes there is also bony atrophy or naturally flatter cheek bones. In such cases customised silicon cheek implants can make a world of difference to over all outlook and shape of the face. Face can be made more balanced, youthful and aesthetically pleasant by appropriately sized, shaped and placed cheek implants.

A well defined chin helps give balance to the face and creates a major part of one’s profile. When people look in the mirror, chin is not the first feature they notice, but having a weak chin is certainly not an asset. Considering the whole face in aesthetic units, alteration of one unit may disturb the balance of whole face. So if a surgery on nose is being considered, it render an already weak and retruded chin even more obviously weak and unsightly. Sometimes the chin is too pointy and prominent, again rendering the balance of the face disturbed. In these cases a REDUCTION GENIOPLASTYis needed to make chin less protruding.
There are multiple ways in which the shape of chin can be altered depending on nature and severity of condition.
Fillers:
Synthetic Fillers in the form of Restylene or autologous fat can be used as filler material. This is especially helpful in mildly smaller, retruded or too pointy chin.
Bony Genioplasty:
In severely protruding or retruded chins filling with fillers ones not get desired results. Similarly the implant has chances of giving an overly made look. In these cases, the alteration in chin’s own bony framework by osteotomies and re-placement of bony architecture at desired projection gives a far natural and aesthetically pleasant result.
Chin Implants:
in severely weak and retruded chin a silicon, customised for a specific patient gives the best result.

The face is carpeted with a layer of fat, that lies just below the skin and it is mainly the arrangement and distribution of this fat, in addition to of course the bony framework, that gives specific facial features to an individual. It is also the redistribution of this fat by ptosis, volume loss and volume gain, with age, which is responsible to giving the face an aged look.
Generally in youth, facial fat is tightly packed, creating surface contours which undulate smoothly from convexity to concavity. The malar fat pad forms the key facial feature by mounting over most prominent part of the cheek. In the aging face the fat is less tightly packed and facial contours become more abrupt. There is malar fat atrophy, leading to skeletonised appearance to upper face. Simultaneously there is ptosis of malar fat pad which causes bunching of fat and deepening of folds especially in lower half of the face and jaws.
All these changes result in reversal of the volume balance in the face. The more youthful fullness of cheeks is lost, while fullness of the lower face in the form of heavy jaw, jowls and heavy neck(Double Chin). The more pleasant heart shaped facial appearance is lost and is practically reversed.
The aim of FACE LIFT Surgery is to re-establish the balance and symmetry in upper and lower halves of face, including the the neck. This does not only involve the the redraping of skin but also fat and suspension of muscles. The aim is to elevate the tissue that has drooped down and anchor it with fixed points. The volume rebalancing sometimes requires removal of some fat that is taken out by liposuction, while sometimes some volume needs to be added which is deposited in the form of fat grafting. Excessive skin needs to be excised in all cases. All this is achieved by the scar in the most hidden areas of face like behind the ears or under the chin. The key to this procedure is to achieve a non-artificial or in other words a non flat appearance. Face Lift is often needed to be combined with Blepheroplasty and other allied procedures to give aesthetically more pleasant results.
Like all Aesthetic Surgery procedures Face Lift also is tailored according to the needs and wishes of a particular patient. There are a number of modifications of Face Lift that include:

• Skin only Face Lift
• MACS Face Left
• Composite face Lift
• SMAS Plication
• SMASectomy.

The ultimate dream and challenge for medical science is to find a way to reverse the effects of body deterioration all the way to the cellular and molecular level. This deterioration can be due to a disease process or simple sequelae of the aging process and affects all the body systems. Skin is subjected to such wear and tear with deterioration on daily basis and for prolonged periods of time. Extrinsic factors like sun exposure, gravity, smoking, stress, nutritional imbalance and dehydration all expedite this process of deterioration. The search for a method of reversing this cellular deterioration has led to the identification of STEM CELLS. Stem cells by definition are those neutral reserve cells in the body that, when needed are called upon to be converted into specialized cells, for performing specialized tasks. These Stem cells given proper environment can develop into any line of cells. They specially have healing and regenerative characteristics. This has led to opening a new era of medical science because these Stem cells can potentially reverse the deterioration in another cellular system of the body.
Human fat has been found to have these Stem cells in abundant numbers. Blood also has a considerable supply of these unique cells. The fat harvested from one s own body is used in following ways:

Lipofilling, Micro and Nano Fat Grafting:

Human fat has a rich reserve of STEM CELLs. Fat is harvested from one body by liposuction technique by variable size cannula, depending on the need. The fat is then treated for Stem cells and injected at required areas. In addition to Stem cells the fat is also used an autologous filler for various soft tissue volume needs. The advantages of this technique are multi fold some of which include:
– Own tissue being used as filler material so no risk of adverse reaction or allergy.
– Fat is readily available in bulk in the body.

Facial Filler for Static Wrinkles:

Synthetic Filler Injections are the 1st option for static wrinkles for face, but they last for only 6 months, so a re-filling is required. A more permanent solution can be injection of MICRO FAT Graft, that is body’s own tissue and setttles well for longer periods. The added advantage being the rejuvinating characteristics of autologous fat.

Acne Scar:

Acne and post acne scarring can be most tormenting feature in any individual. The more severe the acne the more severe is the scarring that it leaves behind. These scars can be deep and irregular streaks or pits. This scarring is probably the most difficult problem to address. INjection of Micr and Nano Fat under such scarred skin has double beneficial effects.. First, it decreases the contour abnormality. Second, the STEM CELLs in fat help in healing the scars, making them less conspicuos and re-vitalising the over all skin quality.

Older Skin Grafts and Radiation Skin Damage:

OlderSkin grafts from burns and trauma have a tendency to darken and become hard and contracted, no matter what amount of scar therapy is carried out. Similarly, the irradiated skin has a tendency to become atrophied, pigmented and scarred.
In such cases, the role of of STEM CELLs from fat have a profoundly remarkable role. The Stem cells help improving the blood supply of the gramakings a result making scarred skin better and aesthetically more acceptable.

Soft Tissue Loss by Disease Process:

Some diseases like Romberg’s and Morphia cause a localised loss of soft tissue, mainly fat, from various areas of body including face. Also in aging and with massive weight loss, the face may become too thin and skeletonised giving an old and unwell look.
In all such cases fat is the best replacement in areas where volume of fat is needed. Fat is the most abundant and readily available Filler material.

Breast and Buttock Augmentation:

Volume to the breasts nod buttocks can be added both by Implants as well as by autologous tissue in the form of fat. Fat can also be used for breast augmention in cases of breast surgery for cancer and infection where large and sometime whole of the volume is lost. In such cases fat grafting in single stage or in serial stages can provide large volumes of own tissue for reconstruction with minimum donor site morbidity. Fat grafting is also done in conjunction with breast implants to add volume and to prevent capsular contraction.
In Buttocks Fat grafting be done to add volume and shape to have a body contouring better sizing of modern clothes.

Osteoarthritis of Joints:

In old age due to repeated wear and tear, and some times after a trauma knees and other joints develop osteoarthritis. These joints develop a chronic painful condition and become stiff. Bones and cartilages in joints undergo degeneration with inflammatory changes in adjacent soft tissues.In this condition the STEM CELLs derived from fat are especially helpful in symptomatic relief as well as radiographic evidence of healing.

Facial aging is a complex process that is the cumulative effect of simultaneous changes of the many components of the face as well as interaction of these components with each other.
The peri-orbital region is the most expressive part of the human face. The eyes are central, framed above by eye brows and below by cheeks. Alteration in the components of the orbital frame as well as the eye lids themselves will profoundly affect facial appearance. The aesthetic balance created by nature can project human emotions ranging from joy to sadness and from restfullness to fatigue.
In men the eye brows are more horizontal while in women the eye brows arch higher with the highest point lateral to the centre of the eye. Over time with aging the supporting ligaments and tissue becomes atrophied and lax, so the eye brows droop down giving one a flatter appearance in both men and women. This downward drooping also creates hooding over upper eye lids. These changes not only alter the shape and appearance of eyes but also give a tired and sad look to eyes and the face in general.
In younger individuals with premature eye brow ptosis and sagging, BOTOX Injection is helpful, but in more advanced cases and in older individuals the best option to correct this hooding and descent is by Surgery. Eye Brows and also the hooded upper eye lid skin, which actually belongs to the forehead are returned back higher and suspended with sutures or screws for longer lasting results. This returns the more fresh and youthful appearance to the eyes and the face.