Hair transplant is a surgical procedure for redistribution of hair from areas of relative abundance to those with deficiency. It is most often carried out for male pattern baldness (MPB). In MPB, the hair of the posterior (back) of the scalp is relatively spared when compared to the hair in front of the scalp. The word, 'relatively' is important since the hair in the posterior part of the scalp is not completely unaffected by the changes in MPB. However, this property of relative sparing of the posterior scalp hair in MPB continues even after grafting (transplant).

Hair shafts occur as small groups called follicular units. During a hair transplant, a follicular unit is removed from the donor area (usually the posterior scalp) and implanted at the recipient area (usually the front of the scalp). A follicular unit may contain one, two or three hair shafts. The number of follicular units transplanted in a procedure depends upon the donor and recipient areas. Male pattern baldness usually requires the transfer of a large number of grafts. This is in contrast to the small numbers required for hair loss associated with small scars.

As mentioned previously, the posterior (back) part of the scalp is usually used as a donor area for hair transplants. Less preferred donor areas include beard and body hair. In certain individuals, the posterior scalp hair may be inadequate as a source for donor grafts. This can be due to the progress of MPB. This is observed as reduced density (hair follicles per square cm) and thinning (miniaturization) of hair follicles. It can also be as a result of a previous harvest of hair follicles during a hair transplant. An individual with a poor donor area also tends to have an advanced stage of MPB.

In spite of these challenges, it is possible to improve upon the appearance of those with a poor donor area. In such a situation we try to achieve improvement with the help of fewer grafts. Frontal forelock occupies the portion behind the central part of the forehead. Many individuals with advanced male pattern baldness tend to retain hair in this region. A relatively full forelock does not give an unnatural look in an individual with advanced hair loss. The forelock helps frame the face when an individual is observed from the front. It would be the part of the scalp that would be visible as a person steps out of an elevator. Increasing the density in the forelock region would require lesser grafts when compared to the rest of the scalp.

In patients without donor deficiency, other areas that are addressed include the hairline and mid-scalp. These occupy the area adjoining the forelock. The crown is given lesser importance when compared to the previously mentioned areas because of the lesser aesthetic significance and the requirement of a large number of grafts.

Salvaging the remaining hair follicles is also important in a person with MPB. MPB is usually a progressive condition and left untreated many can progress to more advanced stages of baldness. This is especially true in the case of younger individuals in whom the hair loss has not stabilized. Preservation of remaining hair follicles is achieved by means of medications. These medications include nutritional therapy, topical Minoxidil, and Finasteride. It is important for individuals to make an informed decision about the use of these medications. They should be taken for long periods for adequate results.

Male pattern baldness with poor donor areas offers some challenges for hair restoration. But often it is possible to improve upon the appearance with the help of medications and a limited hair transplant.

For more information on hair transplant please visit, https://www.amicusclinic.in/hair-transplant

Breast augmentation is an important part of sex reassignment surgery (SRS) in transwomen. It helps avoid the use of external padding to achieve a feminine appearance. It enables an individual to integrate better with the body image.

There are both similarities and differences in breast augmentation in SRS when compared to augmentation carried out in women to enhance the appearance of breasts. Breast augmentation is usually achieved with the help of silicone implants. The technique is largely similar to breast augmentations carried out in women for hypomastia. However, there are certain differences relating to the preoperative requirements, and outcomes.

As in other procedures carried out in SRS, breast augmentation requires the clearance and referral letter from a mental health professional. Most individuals are also on hormonal therapy under the guidance of a physician.  Hormonal treatment helps in breast development and the enlargement of the nipple and areola. Improvement in the size of breasts with hormonal treatment leads to better soft tissue coverage over the implants. This helps in optimizing outcomes. Breast augmentation is usually carried out after two years of hormonal treatment.

The contour of a male chest is different when compared to a female chest. The male chest tends to be wider and more muscular. Also, the soft tissue cover including skin tends to be less yielding in a natal male when compared to a natal female. The crease that separates the breast from the lower part of chest is known as the inframammary fold (IMF). The distance between the nipple to IMF is lesser in men when compared to women. Breast augmentation leads to an increase in this distance. The nipple and areola (pigmented skin surrounding the nipple) are more laterally (towards the sides) placed in men when compared to women. In women, the nipple-areola is more centrally located in the chest. These variations in the anatomy also influence our decision making relating to the implant selection and outcomes.

Ideally, the nipple and areola should be on the apex of the breast mound. The lateral position of the nipple relative to the chest in a natal male can lead to a lateral position of the nipple after the placement of a large diameter implant. This is factored into the decision making during implant selection. Traditional silicone implants are hemispherical. Profile or projection refers to the height when the implant is kept on a flat surface. A high profile implant also has the advantage of helping us to achieve the maximum projection for a given breast volume.  It is common to opt for a relatively lesser diameter and high profile (projection) implants.

The placement of the implant can be under the breast tissue (sub-glandular) or partly under the muscle (sub-pectoral). Both approaches have their relative advantages and disadvantages. The decision is taken after taking into account clinical examination findings and discussion with the individual. Breast augmentation is carried out as a short stay procedure. The recovery is similar to breast augmentation carried out in females for hypomastia. Most individuals return to work within a week of undergoing the procedure. The implant is initially found to have a prominent upper pole fullness. This settles into a more natural-looking appearance over the next few months.

Breast augmentation is a relatively simple procedure with significant benefits in suitable individuals. It is an important part of the gender confirmation procedures. It is associated with positive effects on body image, self-confidence.

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A + B = C. So C - B = A. This may apply to simple arithmetic, but things get a bit complex when we are dealing with weight gain and weight loss.

We store our excess energy in the form of fat. Excess calories we may have acquired from our diet. This excess of fat gets stored in our body as fat deposits in different locations. Fat immediately under the skin can be pinched. This layer of fat is found between the skin and muscles. This is also the layer that can be removed with liposuction. Fat also gets stored deep inside our body, close to our internal organs. This is visceral fat. We can neither pinch this fat nor get it removed with plastic surgery.

A proper diet can help us get back to our ideal body weight. In some situations, bariatric surgery achieves the same end. However, a prolonged period of increased fat has effects beyond the fatty tissue. It stretches out the overlying skin. Visceral fat also stretches out the fascial layer. This layer is closely associated with the abdominal muscle layer. When we lose fat, the size of the fatty layer reduces. This may be dramatic in cases of severe weight reduction as with weight loss (bariatric) surgery.

The stretched out skin and fascia may not get back to the dimensions before the weight gain. As a result, individuals end up with loose folds of skin. To improve this appearance, we have to surgically remove the excess folds of skin. These surgeries are together clubbed under body contouring procedures. We usually wait for a year or more for the weight to stabilize and allowing the skin to recoil by itself before attempting any skin correction. The same approach is used for different body parts, arms (brachioplasty), abdomen (abdominoplasty), thighs (thighplasty) and torso (body-lift).

The presence of stretched out skin and fascia is the reason why liposuction may not be the right procedure for abdominal fat. Liposuction can't do much to tackle the laxity of skin and underlying abdominal fascia. With liposuction alone, we may worsen the skin laxity of the abdomen resulting in an increase in loose folds of skin after the procedure. The same line of reasoning is applied to individuals who present for a reduction in the size of arms. We undertake it in two stages, with the first being deflation with diet or liposuction and a second stage with the removal of loose folds of skin.

To conclude, we have to tackle the laxity of skin and deeper fascia in cases of weight loss following periods of excess weight gain. These may have undergone irreversible changes. Treatment of such deformities often requires the management of tissues like skin and fascia with the help of body contouring procedures. Such an approach helps us to optimize aesthetic outcomes.

Visit the following to learn more,
1. Liposuction
2. Brachioplasty
3. Abdominoplasty

Male pattern baldness (MPB) is a progressive condition. The extent of baldness in MPB is described using Norwood classification wherein I is the mildest and VII is the most severe. Male pattern baldness (MPB) begins with the recession of the hairline in front and progresses to involve the hair on the top of the head (mid-scalp) and the back of the head. It is difficult to predict the extent (severity) to which a person with MPB will lose hair and the speed or rate at which the hair would be lost.

We adopt two strategies for the management of MPB. They include those for the prevention of hair loss and those for redistribution of the hair follicles. The former involves medications and the latter is achieved with hair transplantation (surgery).

With the progress of MPB, there are certain changes observed in the appearance of the hair shafts. They become smaller in length and diameter. Hair shafts in the scalp occur in bunches of single, two, three or four shafts. These are referred to as follicular units (FU). In MPB, the average number of shafts in an FU reduce with a predominance of singles and doubles. The number of hair follicular units in a given area (hair shafts per square cm) reduces with the progression of baldness.  All of the above changes contribute to the seemingly less dense look with increased visibility of the scalp.

With preventive strategies, we are trying to halt these changes found in the scalp. Prevention is important because this alone tries to preserve the total number of follicular units. Hair transplantation (HT) on the other hand is essentially a redistribution of FU. Hair transplantation does not do anything for preventing the progress of MPB. Both these modalities are adopted together in the management of MPB. The relative importance of prevention versus surgery in a given individual depends on the clinical presentation. In cases of early MPB with ongoing loss, prevention is more important when compared to individuals presenting with a stable pattern of MPB (without significant ongoing loss). In other words, the treatment plan is customized based on the findings seen in an individual. Prevention is undertaken using medications. These include oral and topical (local application) medicines.

Oral medications include, nutritional therapy wherein nutritional supplements are given regularly to take care of the nutritional deficiencies associated with hair loss. The supplements include vitamins, minerals, amino acids, and essential fatty acids.

Another oral medication for MPB is Finasteride. Finasteride blocks the conversion of testosterone to dihydrotestosterone (DHT). In MPB, the hair follicles in the loss prone area of the scalp have an abnormal sensitivity to DHT. The effect of DHT mediates the changes observed in MPB. Finasteride thus helps reduce the effect of DHT on the hair follicular cells. Finasteride is uncommonly associated with loss of libido and associated symptoms. Studies have reported an incidence of these effects of one in fifty individuals. Despite this Finasteride is an important medication for the management of MPB.

Topical Minoxidil is another useful drug in MPB. Minoxidil was first introduced as an oral medicine for the treatment of hypertension. It was soon found to have positive effects on the growth of hair. Minoxidil comes in various strengths. Minoxidil is usually applied twice daily on the scalp. Minoxidil should be allowed to have a scalp contact time of more than an hour before it is washed away. Individuals are asked to apply minoxidil after drying hair following a shower. Minoxidil is useful in the mid-scalp region. Continuous use over a few months is needed before optimal results are seen.

Preventive strategies are important in the management of MPB. They help preserve the existing hair follicles. The use of the medications also needs a high level of motivation and they give the best results with continued use. Both preventive medicines and surgery play an important role in achieving a good outcome in MPB. Both of these strategies are complementary. One can't substitute the other. In other words, a good transplant can't reduce the importance of steps for the prevention of hair loss. 

Scars are an inevitable consequence of injuries. The deeper and more severe the injury, the greater the resultant scar. However, in certain situations, a scar can be unduly prominent. The scar tissue may raise above the surrounding skin. It may also be associated with symptoms such as itching and deformity. Such a presentation is usually suggestive of a hypertrophic scar.

What causes hypertrophic scarring?
Prolonged healing times can contribute to a hypertrophic scar. In other words, wounds that take a long time to heal are more likely to end up as hypertrophic scars.
In some individuals, there is an inherent tendency to have hypertrophic scars. Sometimes milder injuries can end up as very prominent scars in such individuals. Unfortunately, we can't get rid of this tendency of such patients to have prominent scars.

What are the treatments available for hypertrophic scars?
Certain treatment modalities help prevent and achieve early resolution of hypertrophic scarring. Prevention is recommended in individuals who are prone to such scars. If an individual is prone to such scarring it would be wise to deliberate before going for procedures such as tattoos or piercings. It is also better to bring this to the attention of a surgeon before elective surgery.
The modalities used for prevention and treatment are similar. These include the application of silicone sheet, pressure garments and intralesional injection of immunomodulatory substances. These are usually carried out for prolonged periods for sustained benefits. Surgery has a limited role in the treatment of hypertrophic scars.

Can hypertrophic scars be prevented?
Some measures can reduce the likelihood of such an outcome. They include steps to hasten wound healing. Wounds that take more than two weeks to heal have a higher likelihood of ending up as hypertrophic scars. In individuals who have a history of prominent scars use of silicone sheets and pressure, garments are recommended. In certain situations, we also recommend the use of intralesional agents.

What is the role of surgery in the treatment of hypertrophic scars?
After treatment, the hypertrophic scars usually flatten out and become atrophic. Atrophic scars appear as thinned out and shiny. Surgery is a good option for the management of atrophic scars. The surgical procedures for atrophic scars include scar revision and fat grafting.

To learn more about scars and various treatments please click here.

In this age, it is almost essential to look lean and fit. Lean is associated with health and vitality. It is common knowledge that a large waistline is contributed by excess fat deposits. And because of this many individuals turn to plastic surgery for liposuction as a solution to this problem. However, all cases of the protuberant belly cannot be tackled by plastic surgery.

 Excess deposits of fat can be found in many places within the abdomen. They are found in the layer between the skin and the muscles of the abdominal wall. This is the layer that can be pinched between the fingers as a roll. Fat is also deposited deep inside the muscle layer. This fat is referred to as visceral fat and is found in association with our gut and the area behind it.

Other than fat deposits, laxity of the abdominal wall can contribute to protuberance. Laxity of the abdomen can be seen as a result of changes due to aging and pregnancy. A separation of the abdominal muscles in the midline, known as divarication is often seen in such individuals. Some of the above-mentioned deformities can be tackled with the help of plastic surgery. The modalities used for correction include procedures such as liposuction and abdominoplasty.

Liposuction involves suction of fat with the help of small cannulas inserted through the skin. Fat is aspirated with the help of a vacuum producing device. Advantages of this procedure include the treatment of relatively large areas with the help of tiny incisions. Patients usually recover fast and are ambulant as soon as they are awake from the effects of anesthesia. It does not involve a prolonged stay in hospital. Liposuction targets only fat that is superficial to the abdominal muscles. We are not able to access the deep or visceral fat with liposuction. Another limitation of liposuction is that it does not address the laxity of the abdominal wall or skin.

Abdominoplasty translates into reshaping the abdomen. During an abdominoplasty, we tighten the layer of the muscles. This helps tackle the laxity of the muscle layer. Liposuction is often carried out as a part of abdominoplasty. Liposuction is used to reduce the fat deposits on the flanks and in the upper abdomen. This improves the appearance and increases the safety of the procedure by limiting the areas of surgical dissection. We also reduce the excess skin as an ellipse from the lower abdomen. The rest of the skin is draped to result in a tighter-looking abdomen. As with liposuction, abdominoplasty can't address the visceral fat.

A clinical examination helps reveal the cause of the deformity and arrive at a treatment plan. Ideal candidates for both the procedures include patients close to their ideal body weight. They should be non-smokers and have reasonable expectations about the procedure. It is also important to be aware of what can be achieved using plastic surgery. We can achieve a reduction in the fat deposits that are external to the muscles and obtain a tightening of the muscle-fascia layer and skin. Plastic surgery does not address the visceral fat. And because of this, patients need to adopt a dietary and exercise regimen to maintain appropriate levels of visceral fat.