People believe cosmetic plastic surgery to be totally scar free. Cuts are made during all surgeries including cosmetic surgery. Cosmetic surgery cuts are originally sutured very finely and after healing they look like a fine line which fades gradually over a period of one year or more. Extra care is taken during surgery by using fine instruments, suture materials and special techniques to make the finest scar possible. But just having a cosmetic surgery done does not guarantee good fine scar. There are many other factors that can make difference in the final result, like individual skin type and care after the surgery.
Whatever may be the skin type good care after surgery always improves the results. Care is essential with Indian skin which is not very favorable from scar point of view and also tends to have excess pigmentation. General tips are:
- Timely stitch removal: If removed too late marks can form.
- Sun protection: Regular usage of sunscreen cream of SPF 20 or more every 3 hourly when outdoors is essential during first 6 months
- Massage with certain creams: Massage is more important than cream itself. Gently massaging the scar twice daily for 5 minutes with a simple cream like Nivea for 3 to 6 months on a fresh scar can work wonders. At times some other creams like silicone may be prescribed if the scar is not favorable.
- Pressure: Wherever it is possible to apply, pressure helps. Like wearing a headband for a forehead scar and elastic band on arm or leg scar. Elastic compression garments can be specially made to fit any body part for this purpose. Proper pressure band/garment should be worn more than 12 hours a day for 3 to 6 months.
- Taping: Paper tape application on the fresh scar helps in early maturation and fading.
Regular monthly followup of scar especially during first 6 months after surgery is important. Early detection of problem and timely action prevents bad scar. Signs of problem are:
- Elevated, red and itchy scar: It requires immediate attention. Injections of steroids into the scar, silicon sheet or gel and pressure may be needed to suppress this kind of scar.
- Hyperpigmented (dark) scar: This type of scar responds to special creams and sun protection.
First 6 months after surgery is the golden period during which scar is fresh and can be improved by timely action. Once scar is old repeat surgery to improve the scar will be needed. Good care and regular follow up visits during this period can help you get the best and the finest possible scar.
How has your face aged? Sit down with a mirror and one of your younger photographs. The photograph should be of your face as a younger adult. To project how your face may age, look at an image of your parents or family members at an older age. See how time can change facial features. If you bring your pictures with you during your consultation, I can better understand your particular aging patterns.
- Gravitational changes
- Loss of volume
- Loss of skin elasticity
- Superficial skin changes
The aging brow can have
- Descent of tissue and lowering of the eyebrows
- Horizontal furrows and folds
- Vertical lines between the eyebrows
- Elevated hairline – loss of hair
The aging eyelid tissue can have
- Folding of redundant tissue of the upper eyelid that can make it difficult to keep the eyelid open.
- Weakening of support for the lower eyelid that can let the lid sag away from its protective position against the eye.
- Sagging of skin and muscles of the lower lid robbing a youthful appearance and in extreme cases creating festoons (folds of tissue) above the cheek.
- Transparency of eyelid skin revealing the darkness of the eye socket behind them.
- Wrinkling of skin at the outer corners of the eyes extending towards the hairline – “crow’s feet.”
The aging face has a downward migration of facial structures
- Descent of tissue from the cheekbones towards the cheeks resulting in less prominent cheeks.
- Deepening of the nasolabial folds (the lines between the nose and the corners of the mouth).
- Extra tissue below the jaw line creating bulges called jowls.
- Redundant tissue about the neck, when excessive producing a turkey gobbler like waddle.
- Sagging neck muscles that can tighten into bands with expression.
- Blunting of the angle between the chin and the neck with a loss of jaw definition.
Facial skin ages creating lines (rhytids)
- Shallow wrinkles that disappear with stretching of the skin.
- Deeper wrinkles that do not disappear with skin stretching.
- Lines of facial animation.
Once I asked a group of first year medical students “what is plastic surgery”. Not surprisingly many answered that it was removing skin from a part of body and putting it elsewhere. This is what a lot of patients believe- that their face can be improved by putting new skin from their thighs.
Skin grafting is often considered synonymous with plastic surgery. This is a misconception which is slightly more educated than the older version when plastic surgery was thought to involve putting plastic in the body. Skin grafting and using synthetic materials like silicon (not plastic) to enhance the body are certainly the techniques used by plastic surgeons, but only occasionally. That is not what plastic surgery is all about.
Let me first explain how the skin grafting is done and why. Skin grafting is done when there is a large area where the skin is lost- because of burns or accidents. Skin from another part of the body (like thighs) can be used to cover the raw area to allow it to heal. The donor area is usually a hidden part like thighs, hips. Only a thin superficial layer of skin is removed from the donor area. The remaining skin of thigh grows back from its roots (sweat and oil glands) and heals in less than 2 weeks time. It’s like taking cuttings from plants to grow more plants. This is called partial-thickness skin grafting or simply skin grafting. Skin grafting is also done when a tumor or large mole is removed and there is a large gap. This can be covered with a skin graft.
Skin grafting is used extensively by plastic surgeons when dealing with burns, trauma, and cancers. Skin grafting is a lifesaving surgery in major burns. After accidents, it allows the wound to heal fast, and the person can go back to work. But skin grafting to improve a person’s skin or for removing scars is another story – with a not-so-happy ending!
Skin grafting is not a good tool for cosmetic plastic surgery because skin from another part of body will never match. After grafting the grafted skin tends to become darker than surrounding skin and has a different texture. This mismatch improves with time and care but never completely goes. So there is a good chance of a patchwork look. To overcome this full thickness skin graft from certain areas of body is used. Matching with full thickness graft is better than partial thickness graft- but still it is never a total match.
Whenever a mole, scar or a tattoo is removed from any part of body stitching the cut ends together with a line like scar, gives the best cosmetic result. Skin grafting can never match this and, therefore, it is done only as a last resort. True skills of the plastic surgeon lies in the ability to close the gap without using graft. Common situations where patient comes asking for grafting are:
- Burn scars on face or body: Sometimes these patients have already had partial thickness grafting and they are unhappy with the look. If the scar is very bad and limited, full thickness grafting can Improve the scar by fifty percent. Still makeup will be required to look completely normal.
- Acne scars on face: Patients who are very distressed about their acne scars request to replace the face skin with grafting. The face may look worse after skin grafting. These patients improve a lot with skin resurfacing procedures like dermabrasion and skin grafting is not required.
- Tattoo marks: Cutting out the tattoo mark and stitching, or Q switched NdYAG laser is the best option. Skin grafting can be done if nothing else is possible.
- White patches (vitiligo): Cutting and stitching is best for small patches. For larger patches thin partial thickness skin graft is used and patients are usually happy to get rid of white patch even if there is now a darker patch instead.
- Pigmented patches: Here again skin grafting is not of much use because graft itself becomes darker. Only in few instances of dark birthmarks grafting is used.
Skin grafting has limited usage in cosmetic surgery and it is certainly not done by choice but only as a last resort when nothing else is possible.
You have the most important role to play in choosing the right implant size, because its your body and no one knows more than you, what you want. Leaving the decision entirely to your plastic surgeon is may lead to possible future disappointment. So how do you know what implant size would look best on you?
Female breasts come in a variety of sizes and shapes. Breasts should be generally in proportion with your body and equal to or slightly less than your hip size. Personal preference, culture, trends, lifestyle, dressing style, hobbies and profession are some other variables that will determine the size chosen by you. Women usually have a good idea about how they want to look like but they are not able to effectively convey it to plastic surgeon. They are commonly referring to their bra size as 30, 33 inches etc without knowing their cup size which is more important because only cup size changes after breast augmentation. So basically there is communication gap leading to confusion.
Knowing your present breast size is the first step. You should know both your band size and cup size. Roughly A cup is 236 cc, B cup 384cc, C cup 621cc and D cup 798 cc. Average woman seeking breast augmentation is A or B cup and wants to be enhanced to C or D . Breast implants are available from less than 100 cc to more than 1000 cc size. Most commonly used implants are 250-450 cc. A 150-200 cc implant will enhance the breast by one cup size. This can be further confirmed by trying sizer implants inside the bra that you would like to wear after surgery.
You can show also the doctor some pictures of women (from magazine/net) whose breasts you like. You can request the doctor for seeing pictures of patients with implants of various sizes
Plastic surgeon will then assess your tissue elasticity and chest wall measurements to determine whether the tissues will allow the size you have chosen to be inserted. The placement of implant whether below or above the muscle also will affect the choice of size. The pocket under the muscle being tight usually does not allow very large implants. While inserting the implants through areola, if areola is small then very large silicon implant can not be inserted. Larger implant can be inserted through inframammary incision in the breast crease.
Implants are available in round and teardrop shape, low, medium and high profiles. Your surgeon can help you choose the best one for you based on your tissue characteristics, measurements and breast shape.
Choosing the right implant is important. Studies have shown that most common cause of second surgery after breast augmentation is woman seeking to change her implant size. This can be avoided by choosing the right size carefully. Its advised to try the sizer implants and check yourself in full length mirror from all angles with and without clothes. Some women are apprehensive about looking too big and therefore choose smaller implants. Not uncommonly, after surgery they get used to the new breast size they find it small and want bigger implants. Hardly any woman complains about being too big after surgery I therefore suggest my patients to err on the side of bigger size. Choosing the right implant carefully is the best way of avoiding disappointment and secondary surgery.