Scars are common and vary from mild to severe. They are the natural result of healing of injury which can be as a result of infection, trauma, burns or other causes. When scars are severe it can lead to cosmetic and functional problems. These, in turn, can cause psychological impairment of the affected individual. Even though it is impossible to completely eliminate scars, it is possible to improve them.

The various procedures for improvement of scars range from less invasive techniques to surgical correction. Each of these procedure has certain advantages and disadvantages compared to others. So a technique that may be effective in a certain type of scar may not have a similar benefit in another. It is seldom one approach suits all. Less invasive techniques include dermabrasion, peels, and LASERS.  These are useful for mostly superficial scars. Superficial scars do not involve all the layers of skin. 

Type of scars amenable to surgical procedures
Such type of scars would include the following
1. Deep scars  
2. Contractures (scars with distortion of surrounding structures)

Deep scars involve most of the layers of skin. In some cases,  scars can draw attention due to their orientation across the natural skin creases (lines). 
Contractures occur due to the progressive contraction of scar tissue. Across mobile areas like joints, these contractures can limit the movement. For example, a burn contracture across the fingers can reduce the function of the hand. During surgical correction, these contractures are first removed and the resulting wound is covered with a graft or flap such that free movement is possible across the joints. 

Treatment options for surgical correction of scars 
The goal of plastic surgery would be an improvement in appearance and function. This is brought about by redistribution of tissues. The most commonly applied techniques include, 

Scar revision: During scar revision the scar is removed and neighboring tissues are brought together. Stretched out scars can be narrowed down with an approximation of dermis. A straight line scar can be broken down for a more pleasing outcome. In mild contractures, Z-plasty and Y-V plasty can be used for scar lengthening and functional relief. Most of these cases are carried out as outpatient procedures and patients can return home soon afterward. 

Serial excision: Sometimes it may not be possible to remove an entire scar and close the wound by approximation of the neighboring tissues. In such situations, it may be possible to remove the scar in stages. This is commonly adopted for removal of burn scars and naevi. 

Split thickness skin grafts: This is indicated when large areas need to be covered after a release of extensive contractures. Skin grafts are obtained from the top layers of skin and transferred for coverage of wounds. An advantage is the ability to cover large wounds in a single stage. The release of burn contractures and coverage with split thickness skin grafts result in a dramatic improvement of function. Skin grafts are usually obtained from lower extremity. The donor site heals by itself. 

Full thickness skin grafts: The full thickness of skin is used to cover the wounds following removal of the scar. These are cosmetically superior compared to split thickness skin grafts. Full-thickness grafts are limited by the limited availability.  The donor site can usually be managed with straight line closure. 

Flaps: Flap surgery involves recruitment of neighboring or distant tissue with its blood supply for coverage of the wounds. They have the advantage of mobilization of tissues with similar texture and appearance. 

Tissue expanders: These are inflatable devices placed under the skin and adjacent to a scar. Once the operated site heals, these expanders are gradually inflated with saline. Over a period of time, this leads to stretching of the overlying skin. Once an adequate expansion is achieved the expanders are removed and the redundant skin is used to cover the wound after removal of the scar. Tissue expanders are useful in coverage of large areas with tissues similar to the native tissue. 

Timing to undergo plastic surgery for scar improvement
It is advisable to undertake surgery once the scar has matured. This can take more than a year. During this time, the scar tends to become soft and supple. An exception to this would be cases with contractures causing significant impairment of function. For example, a scar of the neck which prevents the patient from carrying out daily activities needs early release and coverage. Patients should be in good health at the time of any elective surgery. 

Recovery following scar revision 
Most of the procedures are outpatient or short stay procedures. Depending upon the location and extent of the procedure, anesthesia can be local or general anesthesia. Patients need to follow up regularly after surgery. Use of silicone sheet, splints, and pressure garments form a part of the post-operative management. 

Benefits of undergoing surgical scar revision 
These would include, 
1. Improvement in appearance and function.
2. Improved confidence and self-esteem. 

​To learn more about scars, click here. 

 
Nose occupies a central location in the face and thus any change in the appearance of the nose becomes immediately apparent. Nose is divided into different parts known as  aesthetic subunits. This helps in a better understanding of variations in appearance of the nose and it's management. One of the aesthetic subunits is 'tip' of the nose. Tip occupies the central area of the lower part of the nose. Rhinoplasty is the surgery for improvement of the appearance of the nose and surgery for improvement in the appearance of the tip is known as 'tip-plasty'.  Tip-plasty thus forms one of the components of rhinoplasty. 

 Parts of nasal tip 
The tip of the nose is made up of skin, fatty layer and cartilages. The differences in the shape of individual parts and their inter-relationships determine the appearance of a tip. 

1. Skin is the outermost covering. The skin over the tip tends to be thicker than elsewhere in the nose. It is rich in sebum producing glands. 
2. Cartilages provide structural support to the tip. They are paired domes attached in the midline with ligaments. The size and shape of the cartilages influence the projection of tip. 
3. Fat comprises a layer found between cartilages and skin. Excess of fat leads to a loss of definition of the tip.
 
Variations in appearance of tip 
These variations of tip are commonly observed:
1.  Boxy or bulbous tip: Tip lacks definition in such individuals.
2.  Bifid tip: A vertical groove is seen in the midline. 
3. Drooping tip: The tip is displaced inferiorly. 
4. Dipping of the nasal tip during smiling.
 
Plastic surgery of the tip commonly involves the modification of the underlying cartilages and fatty layer.  This is achieved by means of 
 
1. Cartilage trimming: The excess of cartilage is removed thus weakening them. 
2. Tip suturing: Different type of sutures modify the shape of the domes of cartilages. These sutures can also help elevate the tip in relation to the septum. 
3. Cartilage grafting: Cartilage grafts are used to augment the tips. Grafts can be obtained from within the nose or from elsewhere. Depending upon the need grafts of different shapes are used. 
4. Trimming of the fatty layer: An abundance of the fatty layer may lead to a lack of definition of the nasal tip. 
5. Modification of the muscles of the upper lip is performed in cases where there is dipping of the tip during animation. 

 It would be uncommon to undertake tip-plasty alone for the improvement of aesthetics of nose. It is usually accompanied by modification to other parts of the nose. Any change brought about to one part of nose tends to have a cascading effect on its neighboring structures. Thus, any surgical plan for improvement of the tip should also take into account the effect on rest of nose as well as the face. A sense of balance and harmony is important when trying to undertake a cosmetic improvement. 
Rhinoplasty is divided into open and closed rhinoplasty depending upon the incisions. Open rhinoplasty involves placement of incisions on the under-surface of the nose. Most of the incision is hidden. This approach gives a  surgeon a good exposure of the operative field and allows direct visualization and modification of the tip structures. 

Who is a good candidate for tip-plasty?
These would include those
1.  with reasonable expectation about rhinoplasty or nose job.
2. with good health and do not have any serious co-morbid illness.
3.  do not smoke.

How does one get a tip-plasty?  
In case one is bothered about the appearance of the tip it is advisable to discuss it with a friend or partner. This can help you put things in a proper perspective. 

Preoperative consultation: You can bring along another person during a pre- operative consultation. During an interview with the doctor, you will be asked about your concerns relating to your nose and treatment expectations. You should also come prepared to disclose the history of previous treatments and other medical conditions such as allergy. This helps in making the procedure safer. After clinical examination, the surgeon will be able to suggest treatment options. These differ based on duration, downtime, and outcomes. A consultation is a good time to clarify any doubts. Further tests or investigations may be ordered. In some cases, an ENT consultation may be requested. Images are obtained either in the office or surgical facility. A second consultation may be scheduled in some cases. 

Anesthesia: Rhinoplasty can be carried out under local anesthesia with or without sedation or general anesthesia. The type of anesthesia is often recommended by the anesthetist. 

Procedure and recovery: Rhinoplasty is usually carried out as a short stay procedure. Patients can move around as soon as they are awake. Discomfort is usually well controlled with the help of pain medications. Tapes are usually attached to the nose. A drip pad may be taped below the nostrils for the first few days. Patients can usually return home after an overnight stay at the surgical facility. You should arrange for a relative or friend to drive you back to your home. Patients are advised to cleanse the suture lines with a cotton tip applicator during the first week.  
Swelling is maximal during the second post-operative day. Thereafter it gradually subsides. Sutures are usually removed during the first week. Even though most of the swelling is gone by the end of the first month the nose takes some time to settle into its final shape. Post-operative images are obtained at six months and during subsequent follow-up visits.  

Risks of tip-plasty: 
The risks include, 
1. Infection. It is uncommon due to the abundant vascularity of nasal tissues.
2. Prominent scarring: It may be seen in some individuals. Only a small part of the scar is visible on undersurface of the nose. Prominent scars usually respond to measures such as the application of silicone tapes and intralesional injections. 
3. Unfavorable results: This can sometimes happen. It is important to understand that the final shape of the nose takes nearly one year to become apparent. Revision surgery is carried out after one year.
 
Benefits of tip-plasty: 
These are, 
1. Improved balance and harmony of the nose and facial features. 
2. Better self-confidence and esteem. 

To learn more about nose job (rhinoplasty)​Nose job (Rhinoplasty), click here. 

Split earlobe injuries are common. Even more common are the wide apertures which result from wearing heavy earrings for many years. As a result, the ornaments end up dangling instead of lying side by side with the ear lobe skin.
Split earlobes and wide openings can be repaired with a short office procedure. The site is treated with local anesthetic making the procedure painless. The edges of the opening are removed and are then approximated using fine sutures. We modify the technique which enables the local tissue to form a narrowed aperture at the same sitting. This obviates the need for a subsequent piercing of the earlobe.
It takes approximately 30 minutes to perform the repair on each side. Patients can return home soon after the procedure. Sutures are removed at 7 days. Light earrings can be worn at the end of 3 weeks.

Advantages of Pardue flap technique:
1. There is no need for a subsequent piercing.
2. The original site of the aperture is retained.
3. It is possible to start wearing earrings by the end of 3 weeks.
The procedure is safe and does not need any complicated post-operative care. We advise our patients to wear light earrings for a year after the procedure.

What are keloids?
They are prominent scars which grow beyond the boundaries of the original wound. They can follow trauma, infection, burns or any other type of injury. 

What are the symptoms of keloids?
They are commonly associated with the following,
1. Pain
2. Itching
3. Cosmetic deformity

What causes keloids?
The exact reasons are not known. It has been found to occur in all types of skin. It is less common among elderly. A tendency for keloid scarring is known to run in families. 

What are the most common sites of keloids?
These include,
1. Ear lobes
2. Chest
3. Back
4. Jawline

What are the treatment options for keloids?
Large keloids are more difficult to treat when compared to smaller ones. The treatment options include,
1. Intralesional injection of steroids: These have to be repeated at regular intervals for improvement in appearance and texture. 
2. Silicone sheet application: Silicone sheets have to be applied for prolonged periods. 
3. Pressure garment: These can be applied with the help of a custom made garment. 
4. Radiotherapy
5. Intralesional injection of 5 fluorouracil
6. Surgery 

The combination of more than one modality of treatment is advised in case of large keloids. Surgery is useful for debulking ( reducing the size ) a keloid. It has to be followed up with another modality like intralesional injections or use of pressure garment. 

What is the role of prevention?
The possibility of keloid formation following surgery should be borne in mind in persons with a tendency for keloid formation. Measures such as the use of silicone sheet and pressure garment are advised early in the post operative period. 

To learn more about other types of scars, click here.Scar revision

Nose job, otherwise called rhinoplasty is the surgical alteration of the nose. Nose is a midline structure that occupies a central part of the face. Needless to say, it's appearance can be a cause of concern to some. A rhinoplasty is considered to be a demanding surgery where a difference of a few millimeters can bring about a profound change in result. Compared to cosmetic surgery elsewhere it is more difficult to obtain a predictable result with a nose. 

So, what is a good nose? 
There are many proportions which describe what is ideal. But a nose also has to fit the face. A good nose is supposed to be one that does not attract attention to itself. Rather it directs the attention of the beholder to the eyes. 

What can be achieved with a nose job? 
It can improve the function and aesthetics of a face. Here the function refers to breathing. The following can be altered,

Aesthetics:
1. Height of the bridge ( dorsum )
2. Width of the bony part ( it can be narrowed )
3. Width of the base can be narrowed ( base is what is seen when looking from below )
4. Appearance of the tip ( it can be slightly pushed up, narrowed or made more prominent )
5. Deviation of the dorsum can be corrected
6. Abnormalities of the nares and ala can be corrected ( nares are the apertures through which air enters inside nose )

Function: Certain causes of obstruction are tackled with a nose job. These include:
1. External valve collapse ( this is seen as collapse of the opening of nose )
2. Internal valve collapse
3. Septal deviation and turbinate hypertrophy ( these are present inside nose and if these are present they can be addressed along with correction of external nose )

What is a revision rhinoplasty? 
This is when one rhinoplasty is done to improve upon a previous rhinoplasty. Revision surgeries are  more difficult than the primary rhinoplasty. This done when an individual is dissatisfied with his or her previous nose job.

To learn more about rhinoplasty (nose job), click here. 

Our lips vary in height and volume. Some of us would rather have them to be smaller in size. Lip reduction is a plastic surgery procedure to permanently reduce the size of lips. 

Lip reduction may be performed on the upper or lower lips or both. The amount of the reduction is based on patient expectations. Also, the size of lips has to match rest of the facial characteristics like chin and jaw line. In the absence of ideal lip dimensions, the procedure is as much an art as it is about surgical technique.

It is a simple office based procedure. It is carried out under local anesthesia. Sometimes it may be combined with sedation to make it more comfortable. After anesthetizing the lips with local anesthetic, a wedge is removed from the inner aspect of lips. The wound is closed using dissolving sutures. The patient can return home the same day after the procedure. Cold compresses and pain medications are prescribed for a few days.

It is common to have post-operative swelling of the operated site for a few days. Post-operative discomfort is easily managed with the help of pain medications. Over the subsequent days, the swelling gives way to an improved appearance of lips. In most cases the scar settles very well. In some individuals, there may be an altered sensation of lips which usually settles without any further treatment.  

A dimple is considered as cute by many. In some cultures, it is regarded a sign of good luck and prosperity. It results from a difference in the insertion of a cheek muscle into the overlying cheek skin. It can be found on one or both sides of a cheek. In case one does not have a dimple, it is possible to get one with the help of a short plastic surgery procedure. After the small surgery, the individual can soon return home.
Creating a dimple begins with a consultation when the patient and doctor together decide on the location of the dimple. Once the position has been marked the doctor anesthetizes the site by injection of a local anesthetic. An incision is placed inside the cheek and a small bit of tissue is removed between the skin and the muscle. A dissolving stitch is used to tether the dermis of the cheek to the underlying muscle. The incision inside the mouth is closed with dissolving stitches. Medications are prescribed for the discomfort which may last for a few days. Antibiotics are advised for five days.
Initially, the dimple is seen at rest. As the suture dissolves, the dimple becomes evident only during a smile. During this period scar tissue that forms between the cheek and the muscle is responsible for the dimpling. It is not possible to precisely control the depth of a dimple due to the presence of multiple factors that affect wound healing. In some cases, the dimple may be shallow and can be made deeper with the help of a revision procedure. It is difficult to undo a dimple once it has been created. This should be borne in mind before undertaking the procedure.

Yes, it can, when the obstruction is due to structural abnormalities. Nasal obstruction is a common symptom and it can be as a result of :
1. Structural causes
2. Infection
3. Allergies
4. Vasomotor rhinitis
Structural abnormalities which lead to nasal obstruction include a deviated nasal septum and associated hypertrophy of turbinates, growths and collapse of the internal and external nasal valves.
The cause of nasal obstruction is determined after history taking, clinical examination and investigations like endoscopy. Treatment is based on the cause and it is usually possible to alter the abnormal anatomy to improve air flow. The deviated septum can be re-positioned in the midline. In adults often a part of the septum is removed when it is referred to as septoplasty. Hypertrophy of turbinates (shelf-like protrusions from the sidewalls ) is treated by conservative reduction. Sometimes the abnormal air flow patterns can be as a result of a collapse of internal and external nasal valves. This can be as a result of trauma or surgery. The collapse of the valves is usually managed with cartilage grafts. Addressing the abnormality of the obstruction as well as preventing them becomes an important part of a rhinoplasty. Rhinoplasty is one area of plastic surgery where both appearance and function are equally important and inseparable.

​To learn more about rhinoplasty, click here. 

Discover Youthful Radiance with Amicus Clinic's Anti-Aging Treatments

At Amicus Clinic, we understand that aging is a natural process, but that doesn't mean you can't look and feel your best at any age. Our comprehensive range of anti-aging treatments for the face is designed to rejuvenate your appearance and boost your confidence.

We offer both surgical and non-surgical options to cater to your individual needs and preferences:

Surgical Treatments:
1. Brow Lift: Elevate drooping eyebrows for a more alert and youthful look.
2. Blepharoplasty: Rejuvenate tired-looking eyes by addressing excess skin and fat in the eyelids.
3. Face and Neck Lift: Tighten sagging skin and reduce signs of aging in the lower face and neck area.
4. Fat Transfer: Restore volume to sunken areas using your own fat for a natural-looking enhancement.

Non-Surgical Treatments:
1. Filler Injections: Restore volume and contour to various areas of the face for a more youthful appearance.
2. Creams: Topical treatments to improve skin texture and address specific skin concerns.
3. Resurfacing Procedures: Revitalize your skin's surface for a smoother, more radiant complexion.

Our experienced team at Amicus Clinic will work with you to create a personalized treatment plan that addresses your unique concerns and goals. Whether you're looking for subtle enhancements or more dramatic results, we have the expertise to help you achieve the refreshed, youthful look you desire.

Visit www.amicusclinic.in or contact us today to schedule a consultation and take the first step towards a more youthful you. Let Amicus Clinic be your partner in turning back the clock and embracing your timeless beauty.

Blepharoplasty is the surgery of the eyelids. Depending on which lid is being treated it is referred to as upper or lower lid blepharoplasty. It is one of the more commonly performed cosmetic  procedures of the face. 

Our eyes are considered to be the most important aesthetic units of our face. They are considered as  windows to our soul probably because they easily reflect our level of alertness, mood, and sense of well-being. The eyes are also subject to early signs of aging. These changes reveal as extra folds of skin in the upper lid which in some advanced cases can hamper our visual fields. This may be accompanied by loss of definition of the area immediately below eyebrows. The lateral corners of eyes may shift downwards giving rise to a tired appearance. Lower lid undergoes changes as a result of the loss of support of eyelid tissues. They may shift downwards with more display of the white  below cornea. There may be baggy swellings of lower lid as a result of protrusion of fat around the eyes. The lower eyelid appears lengthened with an abrupt demarcation between lower lid and cheek. The youthful 'blending' of lower lid and cheek is lost with age.

Blepharoplasty benefits those with aging changes of the eyelids. It is also undertaken for those who need an alteration of their prominent epicanthal folds. It can also be undertaken for individuals who desire an extra fold in the upper lid.

Evaluation for blepharoplasty begins with a preoperative consultation when a patient indicates her concerns to the physician. Patients should come prepared to reveal details of the previous treatment of the eyes (for example, LASIK, use of contact lens) and systemic illnesses. The physician suggests treatment options based on changes present in the eyelids and neighboring structures. A consultation with an ophthalmologist is also arranged.  The patient is advised to stop all forms of herbal supplements and blood thinners for two weeks before the scheduled procedure. Isolated blepharoplasty of the upper lid is usually carried out under local anesthesia with sedation. More extensive procedures involving the lower lid may necessitate general anesthesia for the comfort of the patient. The choice of anesthesia is decided in consultation with the anesthetist. Patient recovery is usually rapid and she can return home the same day or the next. Sutures are pulled out by the end of the first week. Swelling starts to subside after the first 36 hours. If the surgery involved a number of steps, the swelling may take longer to subside. Patients are usually presentable at the end of second to the third week. 

When properly executed, blepharoplasty is one of the most gratifying procedures in cosmetic surgery. It gives rise to alert and youthful looking eyes. 

To learn more about other facial plastic surgery procedures, click here.