Structural fat grafting is a procedure that involves the transfer of fat cells from one part of the body to another. It is done because of various benefits such as improved volume of the treated areas, and tissue regeneration. Emulsified fat grafting is a different procedure during which the tissue is transferred without viable (living) adipocytes (fat cells). The emulsification helps get rid of any viable (living) fat cells.
Why is emulsified fat grafting done?
Unlike structural fat grafting, emulsified fat grafting does not result in increase in the volume of the treated areas. Instead, it leads to an improvement of the regenerative properties of the tissues. This results in improvement in the texture of skin, scars, or enhanced healing of wounds.
How does emulsified fat grafting work?
The fat containing tissues in have fat cells and supporting cells that help in growth and regeneration. The supporting cells are referred to as ADSC. During harvest, both adipocytes (fat cells) and the supporting cells are obtained together. The adipocytes or the fat cells are removed by mechanical disruption. The supporting cells are not affected by this process. These are injected into the body for their beneficial properties. Due to the absence of adipocytes, emulsified fat grafting does not lead to an increase in the volume of the grafted part.
What are the various applications of emulsified fat grafting?
Emulsified fat grafting helps the tissues in growth and repair. The various applications include
How is emulsified fat grafting performed?
Emulsified fat grafting is usually carried out under local anesthesia as an outpatient procedure. The common areas for the harvest of fat are the abdomen or thighs. Small volumes are needed for this procedure. The harvested fat is then processed. The emulsified fat is then injected with the help of fine needles into the treated area. The treated areas are left open. The donor areas are treated with simple dressings that are removed after two days.
What is the recovery from emulsified fat grafting?
The donor area will have some firmness and induration that subsides over the next few weeks. The treated areas can show some swelling that subsides over days to weeks. The improvement in the texture of the skin takes a few weeks to become noticeable. In case of fat grafting into wounds, the following weeks may show accelerated healing. The changes in hair growth in case of injections for male pattern baldness may take a few weeks to become visible.
What are the advantages of emulsified fat grafting?
Emulsified fat grafting is beneficial across a variety of indications. It is also attractive since it is done as an outpatient procedure with a rapid recovery. The beneficial effects of the procedure are also long lasting.
There is an increasing demand for cosmetic procedures with minimal downtime. The advantages are shorter recovery and the ability to return to normal life. One such procedure is non-surgical rhinoplasty.
What is a non-surgical rhinoplasty?
It involves the injection of fillers into the nose to bring about a difference in appearance. It has more in common with a filler injection into the face than with a routine rhinoplasty. The 'rhinoplasty' in non-surgical rhinoplasty comes because the filler is being injected into the nose to alter its appearance. Non-surgical rhinoplasty is also referred to as liquid rhinoplasty. Why 'liquid'? Because the filler that is injected is a liquid.
What are the advantages of doing a non-surgical rhinoplasty?
The main advantage of such a procedure would be the minimal downtime. Since fillers are injected the time taken to complete the procedure would be very short and would not need any hospital admission.
What can be achieved with non-surgical rhinoplasty?
Compared to a surgical procedure, the benefits of a non-surgical procedure are limited. The benefits of a non-surgical rhinoplasty include,
What are the changes that can't be achieved with rhinoplasty?
It is not possible to make a large nose smaller using injection non-surgical techniques. It is also not useful for the management of a bulbous tip. It is not possible to improve septal deviations with non-surgical rhinoplasty. Surgical rhinoplasty is the gold standard for the management of the deformities of the nose.
How long does the effect of non-surgical rhinoplasty last?
When compared to a surgical procedure, the effects of non-surgical rhinoplasty are temporary. In most cases, hyaluronic acid fillers are injected during this procedure. Hyaluronic acid breakdown with time. The effects may last approximately one to two years. In certain individuals, the effects tend to last for a shorter period. In case of an unfavourable result, it can be removed with the help of a hyaluronidase injection.
What are the risks associated with non-surgical rhinoplasty?
The risks associated with a non-surgical rhinoplasty are similar to those seen with filler injections into the face. These can include tissue death and involvement of the vessels of the eyes and brain. Skin necrosis results due to impaired blood supply of the skin. Embolization of the filler into the vessels of the eyes can lead to blindness. These adverse events have been reported with filler injections, they are uncommon.
Who is a good candidate for non-surgical rhinoplasty?
It would include patients who want a change in the appearance of the nose without any downtime or need for aftercare associated with a conventional rhinoplasty. Patients should have realistic expectations and understand that not all deformities can be improved with a non-surgical rhinoplasty. The effects are temporary and need repeat injections for maintenance of the results.
For more information about rhinoplasty please visit: www.amicusclinic.in/rhinoplasty
Secondary corrections refer to operations undertaken to improve the outcome after primary surgery. Secondary corrections for gynecomastia are done to improve the appearance of the operated site.
Some of the deformities that may be corrected with secondary surgery include the following:
Timing of secondary corrections of gynecomastia.
We usually wait for a year before undertaking secondary corrections. This has some advantages. They include the following,
Various procedures are undertaken during secondary gynecomastia corrections. These may be carried out in isolation or as a combination. They include,
A surgical plan is based on the appearance of the deformity and concerns of the patient. In other words, such plans are customized. Two patients with a similar-looking deformity may undergo different types of surgical correction. A realistic expectation is important since it is usually only possible to make some improvements in the appearance. Also, secondary corrections are usually taken after a year following the primary surgery. During this period patients can help optimize their appearance by the following activities.
Secondary corrections of gynecomastia can help improve the appearance of selected individuals.
For more information about gynecomastia please visit: https://www.amicusclinic.in/gynecomastia
I could also have gone for a title called ‘why am I fond of syringe liposuction?’. Liposuction is a technique in cosmetic surgery for removing fat cells from certain parts of the body. The fat cells amenable to liposuction are between the skin and muscles. We do not perform liposuction on fat deeper than the muscles. Liposuction may be part of another procedure like abdominoplasty or gynecomastia correction.
Liposuction involves the creation of a vacuum. This vacuum helps remove fat cells with small cannulas. Such cannulas are called liposuction cannulas. Cannulas vary depending on their diameter, length, and shape of openings near the end. We use different types of cannulas based on the area treated.
During liposuction, a vacuum is obtained by a machine or a syringe. Syringe liposuction employs a syringe for generating liposuction. A cannula is attached to one end of the syringe. After insertion of the cannula inside the body, the surgeon pulls back the piston and locks it in place. The vacuum created inside the syringe helps move the fat cells into the syringe during to and fro movement. Once the syringe gets filled, the cannula is disconnected and the fat is emptied. The same process gets repeated till the desired endpoint is reached. This constitutes syringe liposuction.
Syringe liposuction is a simple technique with a lot of benefits. This makes it popular among many practitioners. Some of the benefits include the following,
Syringe liposuction was introduced by Toledo in 1989. The advantages of this technique make it very endearing to some practitioners of liposuction. One of them includes me.
For more information about liposuction, please click here.
For more information about gynecomastia, please click here.
Do I have gynecomastia?
'I don't know if I have gynecomastia. Maybe it is fat. So, I came.'
I hear this often in my practice. Gynecomastia is male breast enlargement. It can be diagnosed easily because of its appearance. But sometimes, the presentation can be a bit confusing.
The breast tissue is seen under the nipple and areola. The areola is the pigmented skin immediately surrounding the nipple. Depending on the severity of enlargement, gynecomastia can present as puffiness of the nipple and areola, or it can extend towards the sides of the chest. It can affect one side or both sides. Both sides can look different. In other words, there can be asymmetry.
The word, ‘gynecomastia’ comes from ‘gyneco’ and 'mastia'. 'Gyneco' means female, and ‘mastia’ means breast. Thus gynecomastia translates into the female-looking breast. This occurs due to an enlargement of the breast tissue. Compared to female breasts, male breasts are positioned more laterally (meaning to the side of the chest). Hence, the deformity of gynecomastia is also especially pronounced when viewed from the side.
Hypertrophy of the underlying muscle (pectoralis major) looks different from that of the breast. The muscle animates (moves) in certain maneuvers. This means the muscle contracts during certain activities like flexing the arm against resistance. Also, the lower border of the muscle usually stops at the level of the nipple. Any enlargement that significantly extends below the level of the areola is usually due to breast tissue. The lower border of the muscle is straight or flat. This is easily made out in men who perform weight training. The presence of breast tissue tends to make the inferior border curved. The curved lower part of the breast gives it a feminine appearance.
It is also possible to pinch the breast tissue separately from the underlying tissues. We usually carry this out during a clinical examination of an individual presenting with gynecomastia. Puffiness of the nipple and areola is also associated with enlargement of the breast tissue. It is not associated with hypertrophy of the underlying muscle.
There is an entity called pseudogynecomastia. ‘Pseudo’ means false. This is due to increased fat deposits in the chest. There is no glandular enlargement in pseudogynecomastia. It is usually seen in the setting of obesity with fat deposits that mimic the appearance of male breast enlargement. Losing weight will lead to an improvement in the deformity associated with pseudogynecomastia.
It is usually simple to diagnose a case of gynecomastia during a clinical examination. We sometimes request additional investigations to look for any underlying cause for gynecomastia. Imaging can help us to confirm the condition. Most cases of gynecomastia are benign and are self-limiting. Surgery is undertaken when gynecomastia results in significant distress in the affected individual.
To learn more about gynecomastia, please visit, https://www.amicusclinic.in/gynecomastia
Recently I was asked about home remedies for scars. I usually don't suggest any. Some of my patients describe the benefits of certain types of oils. I do not promote or recommend the use of any particular type of medication on settled scars. Also, I do not caution them against the use of any particular oil.
But there is a definitive role of certain conservative measures that can help improve scars. They are not advised in all cases. The effect of these measures should be understood by those using these. They should be carried out as per the guidance of the treating doctor. Some of the commonly advised measures for scars include the following,
Certain other non-surgical measures are carried out to help improve a scar. Examples would include laser and intralesional injections. But these are carried out by a doctor. Even though home remedies may not have many roles for optimizing scars, certain conservative measures are frequently advised. Most of them help in scar remodeling.
Rhinoplasty is a commonly known plastic surgery procedure to improve the appearance and function of the nose. The function of the nose relates to breathing. As in all surgical procedures, complications can happen. The goal of preoperative evaluation is also to seek out any potential problem. But despite the best efforts, complications can occur.
The incidence of the complications varies. It can vary depending on the type of procedure, and patient factors. It is more common to have a greater incidence of complications in difficult (challenging) cases. Some of the complications are uncommon when compared to others. The complications can be seen under those that are nonspecific to rhinoplasty and those specific to rhinoplasty.
The nonspecific complications can occur in any surgical procedure. It need not be in rhinoplasty alone. These include,
The specific complications of rhinoplasty are those related to aesthetic (appearance) and functional (breathing).
The aesthetic complications include,
Functional problems associated with rhinoplasty include,
Some of the complications are more serious when compared to others. Also, the difficulty level in performing a rhinoplasty can vary depending on the presentation. It is also more so in previously operated noses. It is not possible to eliminate the possibility of complications. However, it is usually possible to reduce their incidence with careful planning and attention to detail.
For more details about rhinoplasty, visit here.
Beauty is associated with proportions. A body part that is disproportionate to the rest of the body can impair appearance. An example would be women with arms that are large when compared to the torso. It is a common aesthetic concern in plastic surgery practice.
Arms are tubular structures. They consist of soft tissues around a bone. The soft tissues are made up of structures like fat, muscles, and vessels. It is surrounded by skin. Large arms usually involve a relative excess of fat and skin. The fat occupies the layer deeper to the skin. As the volume of fat increases, the overlying skin stretches to adjust to the increased volume. Hence, a reduction in the size of the arms involves a reduction in the size of the fat and skin excess. We can achieve this through surgical, and non-surgical techniques.
Why do some individuals get big arms?
The increase in the size of the arms is associated with excess weight. This excess fat gets deposited in various areas of the body. Some of us tend to deposit this fat more in our arms. This intrinsic tendency varies from one individual to another.
Other conditions can be associated with an increased size of the arms, lymphedema, soft tissue swellings, etc. But they are relatively less common causes of big arms. This article deals with the management of the arms as a result of excess fatty tissue.
What can be done to improve the appearance?
A reduction in the size of arms has to address the two types of tissues involved, namely fatty tissue and skin.
First, the fat. Fat occupies the area between the muscles and skin. The amount of fatty tissue correlates with the amount that can be rolled between two fingers. Fat is amenable to dietary modifications. A reduction in body weight usually leads to a reduction in the amount of fatty tissue and a resulting in a decrease in the size of arms.
Liposuction is a surgical technique to remove the fatty tissue with the help of small tubes (cannula). It is useful for individuals with fatty tissue that is resistant to dietary modifications. A good candidate for liposuction is someone with close to ideal body weight. Liposuction does not directly address the excess skin.
Next, the skin. The skin stretches to accommodate the excess fatty tissue. Once there is a reduction in the fatty tissue with diet or liposuction, there is a recoil of this skin. Recoil is the shrinking of the skin to a smaller area. However, this recoil of the skin takes time. It can take as much as a year for the skin to maximally recoil. In cases of massive weight loss, the recoil can be incomplete. This is seen as a persistent loose fold(s) of the skin. It is usually seen on the undersurface of the arms. Skin recoil is also reduced with advancing age and in smoking. Brachioplasty is a surgical procedure to remove excess skin. During brachioplasty, skin is removed as an ellipse from the medial surface (inside) of the arm. This is the part of the skin that abuts the torso. The decision to undertake a brachioplasty is taken after waiting for the skin to maximally recoil. Hence, it is usually not carried out during liposuction. The extent of skin removal is customized depending upon the extent of skin excess. Brachioplasty helps in improving the contour by removing the loose skin folds.
What are the advantages of the management of this condition?
It helps in improving the appearance of the arms in individuals with disproportionately large arms. The role of diet and exercise play a very important role in the appearance of the arms. Liposuction and brachioplasty are two surgical procedures that help to further optimize the appearance of arms.
Gynecomastia is an enlargement of the male breast. It is a common condition. Surgical correction of gynecomastia achieves a reduction in the excess breast tissue. A reduction in the breast tissue helps improve the aesthetics of the male chest. In most cases, surgery involves liposuction and gland excision. Liposuction addresses fat, and direct removal addresses the gland. These two steps are usually adequate for most individuals with gynecomastia. However, this may be insufficient to restore the aesthetics in those with excess skin. They may require additional treatments.
The stretched-out skin usually recoils adequately after reduction in most of the individual. The problem relating to excess skin is observed commonly in two subsets of patients. They are,
How do we manage excess skin while treating gynecomastia?
The treatment approach depends on the presentation. We tend to follow a conservative wait and watch in younger individuals, and those with a less severe presentation. This is because of better skin recoil in younger individuals. Also, the removal of the gland will reduce the effect of the weight on the skin. This helps the skin to recoil better. It is common practice to wait for more than ten months to assess the full extent of skin recoil. Any secondary corrections are done after this period.
The conservative approach may not help in older individuals and those with severe forms of excess. In such cases, we may opt to add a skin removal procedure during the management of gynecomastia. Good candidates for primary correction of the skin would include nonsmokers. They must have a stable weight. Skin removal procedures in those with unstable weight may result in suboptimal outcomes.
The design of the skin excess is variable. This is based on the extent of skin excess and patient preferences. A circumareolar (around the areola) approach is preferred in milder cases. In individuals with severe excess, we prefer extensile (long) incisions with the grafting of the nipple and areola. Needless to say, individuals with longer incisions have longer scars.
What is the advantage of staging a skin removal procedure?
In other words, why wait between a gynecomastia correction and a skin excisional procedure.
Skin can recoil significantly with time. It may not be able to predict the full extent. Adequately recoiled skin results in acceptable aesthetics. The full extent of skin recoil after gynecomastia correction takes time. Avoiding a skin removal procedure means lesser scars. However, this approach may not be suitable in those with severe forms of skin excess.
Are there any approaches to prevent this issue with excess skin?
They would include the following.
Avoiding excess body weight. The excess skin problem is not common in individuals with normal or ideal body weight.
Early treatment of gynecomastia. The ability of the skin to recoil reduces with age.
Smoking is bad for skin recoil. Nonsmokers tend to have better outcomes when compared to smokers.
What is the advantage of managing the excess skin in individuals with gynecomastia?
It leads to better aesthetic outcomes.
For more information about gynecomastia please visit here.
Should one lose excess weight before a body contouring surgery? Or should it be postponed to sometime after the surgery? Many of the patients I come across seem to have this dilemma. It is common for individuals to delay losing any excess weight until after the surgery.
Does it make any difference if the excess weight is reduced before or after liposuction? It does make a difference. It is better to lose excess weight before rather than after the surgery. This is best achieved with a healthy lifestyle. Both exercise and adequate diet play an important role.
What are the reasons? A few of them would be as follows,
Hence, it is better to bring the bodyweight close to ideal before undergoing a fat reduction procedure. Liposuction or lipoplasty can then help target resistant fat.
To summarise, should one lose excess weight before a body contouring procedure? Yes. It has its benefits. Ideally, weight loss is attained using sustainable lifestyle modifications. It is associated with better outcomes and lesser complications. They continue to reap the benefits of the procedure long after the surgery.
I like to keep it simple.