Your Guide to Cosmetic Rhinoplasty/Nose Surgery

Know everything about the most popular cosmetic surgery – “Rhinoplasty/Nose Surgery”

Rhinoplasty surgery in Delhi

Dr. Sandeep Bhasin

Dr. Sandeep Bhasin has done his MBBS and MS from Aligarh Muslim University with top honors. He  is one of the few cosmetic surgeons in Delhi who has been certified by the Indian Medical Council, and is a board certified Laparoscopic & Cosmetic Surgeon with 10 years of residency training in both the specialties.

 

Introduction 

Hi, I am Dr. Sandeep Bhasin from Care Well Medical Centre. Today I will share with you some details about Rhinoplasty which can give you a deeper understanding of the subject.

So tell me friends, how many of you are happy with the size and shape of your nose?

I know, some people are not happy with the structure and functioning of their nose and want a change. Don’t worry I am here to help you. I am sharing few insights with you which allow you to make good decision.

Let me start with basics. The main aim of Rhinoplasty is to create an Aesthetic Nose which fit and creates a balanced Face profile. At the same time it allows for easy flow of air in the nose. So it aims at

  • Aesthetic Improvement

 

  • Functional Improvement

 

In this Rhinoplasty guide, I will share the little nuances of

  • What must be done before Rhinoplasty?
  • What happens when you visit me for consultation or procedure?
  • What happens post-surgery?

This report gives you in-depth information what you might feel during the routine and care that needs to be taken post- surgery.

I begin with a proper consultation of anyone interested in the Rhinoplasty procedure.

I try to understand what the needs of my clients are and how best we can achieve them.

Through years of experience and research I’ll discuss the benefits, risks, and limitations, so that it becomes easier for you to decide if Rhinoplasty is the right choice for you.

As a surgeon, it is absolutely rewarding to share my personal experience through patient satisfaction and personal confidence after experiencing Rhinoplasty.

 

Best Regards,

Dr. Sandeep Bhasin

MBBS, MS, (hons) Aligarh Muslim University,

Board Certified Laparoscopic and Cosmetic Surgeon

This guide is created through one-on-one conversations that I’ve had with my Rhinoplasty clientele. I can share this knowledge on an online platform as well. I hope you will appreciate the depth and quality of the conversations in this guide.

 

  1. 1. What are the Benefits of Rhinoplasty?

Rhinoplasty & nose job treatment

As we commence this conversation on Rhinoplasty, I would like you to tell me

What kind of post-surgery benefits you are looking for?

Rhinoplasty is a technical surgery that is performed to achieve aesthetic and functional goals.

Some benefits are :

  1. Improve breathing problem.
  2. Fix broken nose.
  • Sinus problem can be alleviated through Rhinoplasty.
  1. Correct birth defects like lumps, clefts, underdevelopment etc.
  2. Restore facial symmetry.

People have unrealistic expectations from Rhinoplasty which cannot be achieved. For example, often someone will come and say, “Dr. I want my nose like XYZ Bollywood star.”

To this I would like to say “Dear …. Your nose is unique as your signature. We cannot change your nose into someone else’s nose. All we can do is improvise the features and make them well proportionate to your face profile.”

For those with realistic expectations we can strive for better Aesthetic and Functional Nose. This will boost Self-confidence and Morale of Clients.

 

  1. 2. What are the limitations of Rhinoplasty?

The results of Rhinoplasty depend on many factors

 Nose Job treatment

  • The overall structure of nose and face.

 

  • The type of skin especially the thickness of skin.

 

  • The length of Columella.

 

  • Any pre existing deformity as Cleft lip, Maxillary bone hypoplasia etc.

 

Of these factors Skin quality and thickness is of great importance. As a rule people with thicker skin will have moderate results as compared to people with Thin Skin.

Clients with thin skin, whatever changes we do to the tip of Nose are easily seen and appreciated.

 

  1. 3. What are the risks of Rhinoplasty?

Friends, from my experience in surgical Rhinoplasty, I don’t believe there’s an operation that does not carry any risk.

 rhinoplasty treatment

Rhinoplasty just like any other surgery has its own risks and rare complications.

Each nose is different so its consequences of surgery would be different. In Care Well Medical Centre we are very diligent, but still few complications should always be kept in mind.

  • Post operatively bruising and swelling of Face for 3 weeks is common. This should be kept in mind
  • As Rhinoplasty is done under General Anesthesia so all the risks of Anesthesia are applicable here too.
  • Chances of Infection and bleeding as in any Surgery are possible. Though with strict Asepsis and refined techniques these are very rare in Care well Medical Centre.
  • Most common complication is many patients may not be happy with final results if they had unrealistic expectations.

 

  1. 4. Is it right for me?

Rhinoplasty-treatment

As we are moving toward surgery, I would like to tell you if Rhinoplasty is right for you or not. The right candidates for Rhinoplasty are people:

  • Who have a nose problem that can be corrected & it is not possible to alter a nose with very thick skin
  • Who have larger noses and require surgery to make it small. It is difficult to make smaller noses big
  • Who have realistic expectations from the surgery
  • Who are healthy enough to undergo Rhinoplasty

Getting your nose in shape isn’t the final goal; it’s whether this procedure is going to make a significant difference or not.

At Care Well Medical Centre, if we feel you’re the right candidate, and we’re the right doctors for you, then we can achieve the perfect results for you as well.

 

  1. 5. What happens when you ring our clinic for Rhinoplasty?

Speaking about Care Well Medical Centre, when you give us a call for Rhinoplasty, the first thing that you’ll hear is “hello”, and…

  • I will fix an appointment with you.
  • If “yes”, then I’ll organize a time that suits your requirements.
  • As your Rhinoplasty surgeon, I would ask you about your expectations from the surgery.
  • I would also get to know more about your general health condition through a list of questions that are easy to answer.
  • I’ll have a detailed look at your history and examine your nose condition thoroughly.
  • I would take some photographs of your nose to understand your problem and determine the best surgical treatment for you.
  • If everything goes well, and you’re the right candidate, I shall fix a surgery date for you, and my assistants at Care Medical Centre would explain more about the treatment and care that needs to be taken before surgery.

 

  1. 6. What do you need to think about when selecting a surgeon?

When you’re thinking about how to select a surgeon, you need to consider several aspects. The first being –

surgeon for hair transplant

  • How well is my surgery planned?
  • They should listen and understand your expectations, and give the right advice
  • If they haven’t, you should take a step back and not go to surgery with that particular surgeon
  • Have they analyzed my general health condition and the case of my nose?
  • We use sharp and clear photographs; At Care Well Medical Centre, I use the latest computer software and technology to measure precise angles and lengths.
  • At Care Well Medical Centre, I have the best team available for you, and we have pre-built care through which you’re looked after completely

 

  1. 7. What must you do before Rhinoplasty?

When you book your surgery date with us at Care Well Medical Centre, we will –

Provide you with a list of instructions to follow

  • I would advise you to avoid medication that can cause excess bleeding.
  • Food and medication like garlic and aspirin are things you need to cut down on.

If you go through and follow these instructions thoroughly, you wouldn’t have a problem.

 

  1. 8. What happens when you come for the surgery?

When you enter Care Well Medical Centre for Rhinoplasty-

  • You will be taken to your room before surgery.
  • I’ll be coming to check before we go to the operation theatre.
  • I should have reviewed all the important notes, photographs, and the analysis.
  • The next thing you see is my anaesthetic, and he’ll be telling you about what he is going to do.
  • He will answer any queries, and you’ll know everything before the procedure starts.
  • It’s not too long wherein you’ll be escorted by nurses to the operation theatre, and you’ll be asleep and the surgery will be accomplished.

 

  1. 9. What happens after surgery?

I like my Rhinoplasty patients to stay overnight just to know they are alright

  • That way I can see you before you go home and tell you that the surgery was successful.
  • The nurses at Care Well Medical Centre will clean your nostrils and provide instructions on what needs to be done for your dressings.
  • You get a dose of antibiotics from us as well before you leave.
  • I would also prescribe the best medicines that you need to take for a few months, and a week later I would remove the dressing from your nose.
  • This wouldn’t hurt as I have used dissolvable stitches.
  • I would do a thorough check of the inside of your nose, and make sure you are healing well.
  • Then, I’ll see you six to twelve weeks later.
  • At that stage, the swelling will subside and then we can have a clear picture of how things have and will turn out.
  • It can take about a year to 18 months for everything to settle, in that time I would like to see you to make sure you’ve achieved great results for your nose.

 

  1. 10. When can you go back to work and hit the gym?

After Rhinoplasty, I would advise at-least 3 weeks off from hitting the gym or any vigorous exercise.

  • There’s a chance that you may get a nose bleed, or get swelling as well.
  • Thus, it is best advisable not to hit the gym for at least 3 weeks.
  • When can you go back to work depends on the kind of work you do.
  • For most patients, it would be 5 – 7 days.
  • I would suggest gentle work after a week to be productive and stay healthy as well.

 

Conclusion

How do you decide, if you want to take a step forward and have Rhinoplasty?

It’s not going to be the same answer for everyone, but there are common things that can be considered.  I cannot guarantee your result, but I will do everything through experience to get you the best results possible.

If your gut instinct says “I trust you” and you accept the final consequences, then it’s time to say yes to Rhinoplasty.

How to make your Hair Transplantation painless?

Friends I would like to ask you, when you go for hair transplantation what comes first in your mind?

Well I’ll tell you, the first thing that comes in your mind is ‘pain’. The only question in your mind is: Will I feel pain whilst undergoing hair transplantation? This is a very genuine anxiety because hair transplant is done under local anesthesia, and not under general anesthesia.

 

How can we make your hair transplant painless in our CareWell Medical Center?

It is a pretty long surgery that takes up to 7 – 8 hours, so obviously you will feel whether it’ll be comfortable or uncomfortable to go for a hair transplant. Let me tell you what is important, and how do we help you out in this.

1.      First thing is to reduce anxiety.

  1. If in the initial stage, the anesthesia is given without taking any precautions, then it would become uncomfortable and painful as well. But, if it is done with some special techniques, which are good practices for pain management then it would be painless.
  2. Pain management needs to be followed in a clinic to reduce the patient’s pain and discomfort.
  3. Before we take you in as a client for hair transplantation, we always put a cannula and give you some anxiolytic medicine like alprazolam or midazolam, a small doze that reduces anxiety.

2. The second thing is, we use a special technique called Painless Vibratory Anesthesia.

  1. This is a very special technique through which the pain is reduced to almost a very low level, wherein pain is not felt at all. In this technique, we use vibration, ice packs, breathing techniques, and very fine needles to administer injections.
  2. 90% of the patients with whom this technique was used confessed on feeling no pain at all. It was at a score of less than 2 from a scale of 0 – 10. This was really remarkable, because before this technique was being used, my average patient’s pain score was 7 or 8 when the anesthesia was being given.

3. Nerve block and ring block

  1. We use both — nerve and ring block. When we use nerve block, it’s just four injections; the entire back portion of the head becomes numb and anaesthetized.So, we need to administer injections at specific spots to make that entire area numb. That is called a nerve block.
  2. We have to be careful about the nerves like lesser occipital nerve and greater occipital nerve. These are the nerves we block by these injections.

4) Short acting and long acting anesthesia

  1. We use two different kinds of anesthetics – short acting and long acting. For a long acting anesthesia, surgeons mostly use Sensorcaine. Sensorcaine is very cardio toxic which is very dangerous for the
  2. In my clinic, we’ve stopped using Sensorcaine; we’ve shifted to a medicine called ropivacaine, which is very safe and freely available. But, you know friends my study and data states that, 70% of the doctors in hair transplant are not aware, that this medicine also exists.
  3. This is something which I know as I keep myself upgraded by going to conferences and engage myself in reading and understanding about new inventions because patient’s safety is my prime concern. So, I take utmost care of my patients.

We never use Sensorcaine with xylocaine as there have been reports of cardiac problems happening during the hair transplantation.

So they had to be shifted to ICU’s, or they did require medications from the cardiac doctors because their heart rate became irregular during the hair transplant. It happened because Sensorcaine was used.

  1. Ropivacaine is a very safe drug with no cardio toxicity, and it is long lasting as well, for about 7-8 you don’t feel any pain.
  2. These are things that we follow, in case you still have discomfort, we have some special drips that we can give you like dextroamphetamine, which can make you fall asleep, and you may not feel any pain at all.

So when all these practices are followed, it becomes a virtually painless way of doing the entire surgery. Do not be afraid of pain because we follow the latest technology and use them.

So, friends, be sure and comfortable. Come and walk-in for the hair transplant. It is safe, secure, and painless.

Precautions before and after Hair Transplant

Okay friends, so let me describe the kind of precautions that are required to be taken before hair transplantation. If you’ve chosen a clinic, and a doctor, you are ready to get your hair transplantation done.

 

What are the precautions that need to be followed before hair transplantation?

Hair-transplant-services

1. My advice to you with 17 years of experience and as a friend,

  1. Please do not undergo hair transplantation without proper investigations.
  2. Investigations generally include tests for – diabetes, liver and kidney function, bleeding profile, viral markers and complete blood count.
  3. I can tell you examples where young patients in the ages of 28-29 came to us for hair transplantation, and we got the investigations done, and found that their blood sugar was very high i.e. above 400, and we had to stop the hair transplantation process. Thus, if you have diabetes, and you undergo hair transplant, it could lead to serious complications. So, please get the investigations done first.
  4. Similarly, we got some patients wanting hair transplantation, and we checked that the platelet count was very low. Without the investigation of the platelets done, the bleeding would not have stopped whilst undergoing transplantation.
  5. Thus, blood investigations are very essential.
  6. 2. If you’re a diabetic or heart patient, please get clearance from your physician..
  7. If you’re on some medications like aspirin, dispirin, and blood thinners, or some vitamin supplements like Vitamin E, be sure to stop them 3 or 4 days prior to the transplant.
  8. We generally advise our patients to come after having a good breakfast and avoid coming empty stomach as that can cause the whole procedure to become difficult.

 

Above mentioned are few things we tell our patients to follow before going for hair transplantation.  

Now friends I will tell you, what are the precautions that need to be followed after hair transplantation?

Hair-transplant-after-&-Before

1. Suppose you’ve undergone hair transplantation and assume that you have opted for FUE  transplant as it is a most preferred choice.

  • For the next three days, you should spray a saline which has some antibiotic in it.
  • In my clinic, it is our practice to give a small saline bottle that is amikacin or gentamicin that has antibiotic inside it and we ask them to spray or sprinkle it on the head, in every two or three hours, so that the hair roots are constantly hydrated. This is one thing that you have to keep in mind.

 

What kind of clothes you should wear after hair transplantation?

Let me tell you friends, you should wear clothes that can be removed from your shoulder or arms; you don’t have to take them overhead. So, be very careful about this.

 

  1. When you are coming for hair transplant, or after hair transplant, do not wear t-shirts or blazers which need to be removed from the top of the head, as there is a chance of the dressing coming out if done that way. This can make you lose a lot of the grafts, so avoid wearing t-shirts or blazers after hair transplantation.
  2.  We normally tell patients not to touch the dressing for at least 3 days, as that dressing can come out accidentally if touched.
  3. Avoid smoking or alcohol for a week to ten days after the hair transplantation. This is something you need to keep in mind.

5.We always tell patients to use antibiotics and pain killers. Another thing is after hair transplantation, on the       3rd to 5th day, there might be swelling around your eyes, but there is nothing to worry about.

It settles in two days’ time& is something you should not be worried about.

  1. You have to avoid heavy exercises and sweating after three weeks of the hair transplantation. Mild exercises like yoga do not cause much sweating & also do not cause dramatic changes in the body.

7. Head wash is done after the 4th day of the transplant. Every clinic has a different protocol. We do a head wash on the 4th and 10th day. So, see what your doctor is prescribing you.The first head wash should ideally be done by your doctor, or by the team who has done your hair transplantation, because that is indeed a crucial element in this process.

  1. For the first ten days, there will be scabs, or blood clots sticking to your hair roots. You need not worry about it. These scabs will automatically be removed when you get a hair wash done in about ten days. This is another important thing which needs to be kept in mind after getting your hair transplantation done.

What is done in Rhinoplasty?

Following are the things that can be performed in Rhinoplasty

 Rhinoplasty-surgery

  1. After opening the nose in Rhinoplasty, extra soft tissue is removed, this helps us to make the tip of the nose sharper.
  2. If the cartilage is excess or broad, then we can narrow them and pointed, so that the tip can be made more sharper.
  3. If the nose is wide, the nasal bones are cut and brought closer. This is also called This makes the broad nose narrow.
  4. If the height of the nose is less, a graft is taken from the ribs or the ear, and put it on the nose to improve the height of the nose. This procedure is known as dorsal augmentation.
  5. If there is a hump in the nose, it can be removed by extracting the extra tissue.
  6. If there is nasal flare, then Alarplasty is done to rectify it.

 

The common things that can be done is:

  • Tip Plasty
  • Alarplasty
  • Dorsal Augmentation
  • Humpectomy
  • Osteotomy

 

Tip Plasty

Tip Plasty is a nasal surgical procedure to increase the aesthetic value of the nose, or it can be simply defined as a visually appealing nasal tip.  This surgery is performed exclusively for the nasal tip, and not for any other part of the nose viz. bridge, roof, cartilage or bones.

People having a fat nose, or simply a fat tip require corrections to elevate the nasal tip, so that it looks raised through a proper angle.

nasal-tip-surgery.

The benefits of Tip Plasty can be listed as –

  • Giving definition and a proper structure
  • Enhancing the overall look and feel of the nose and face
  • A surgical procedure that is short and not extensive by any means

 

Alarplasty

Alarplasty is done for patients who have wide nostrils. The procedure involves the removal of a wedge tissue from the sides of the nostrils. The wedge base is situated at a level at the rims and pointed apex near the sides of the cheek groove. The removal amount depends on how wide the nostrils are to give a narrow look.

Alarplasty-treatment

Once the procedure is done, the open area is sutured, there are two ways this can be done, viz. Weir Incision and Inside the nose incision.

The benefits of Alarplasty include –

  • Immediate visibility of results
  • Smaller nose or nostrils
  • Symmetrical nose structure
  • Balanced face

 

Osteotomy

Nasal osteotomy is done to remove a greater nasal dorsum or hump removal and a wide nasal base. This procedure also removes an open roof deformity after the dorsal hump surgery is done.  An osteotomy in Rhinoplasty can also widen a narrow pyramid or straighten a deviated septum.

 

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The Best Technique for Nose Surgery or Rhinoplasty?

Hi, I am Dr Sandeep Bhasin a Cosmetic Surgeon from Care Well Medical Centre Today I will discuss about Nose surgery called Rhinoplasty

Nose-Surgery-or-Rhinoplasty-treatment

Rhinoplasty can be defined as a surgery that is conducted to change the shape of the nose, or improve it’s ability to function.

 

Lets see the types of Rhinoplasty

Rhinoplasty can be categorized into two forms :

 

Aesthetic Rhinoplasty:   

Aesthetic-Rhinoplasty-in Delhi

 It is done to improve or change the shape of the nose.

 

Functional Rhinoplasty:    

Functional-Rhinoplasty

If there are breathing problems in the nose then Functional Rhinoplasty is done. The procedure of Functional Rhinoplasty is conducted for symptoms like a blocked nose, sinusitis, or nasal polyps.

 

We also need to understand that there isn’t a concept of a perfect nose. These procedures can only enhance facial characteristics and improve nasal functionality if there are symptoms mentioned above.

So, I begin with Clinical and Radiological investigations of my clients planning for Rhinoplasty. I look in structure of nose and any difficulty in breathing if they are facing.

 

Techniques of Rhinoplasty

Rhinoplasty can be classified into two types, based on technique viz. Open Rhinoplasty and Closed Rhinoplasty.

  • Open Rhinoplasty is more useful for Cosmetic Nose Reshaping
  • Closed Rhinoplasty is better for Breathing difficulty etc.

Open Rhinoplasty

In open Rhinoplasty, incision is given on the skin, so that the entire skin over the nose can be raised.

This incision is called  trans-columellar incision, this gives surgeon a clear view of the nasal skeleton. All this can be achieved through an undisturbed alignment , and it also improves the result of the surgical process through trans-columellar incision.

Open Rhinoplasty is quite useful for aesthetic Rhinoplasty where significant improvements can be done for the tip, dorsum, and the shape of the nose.

Closed Rhinoplasty

As compared to open Rhinoplasty, closed Rhinoplasty is done without opening a part of the skin, and special incision is made inside the nose. This procedure is useful for functional Rhinoplasty.It is also called as endonasal Rhinoplasty, where a surgeon makes parallel concealed incision for no external scarring to occur.

This procedure limits the visibility of the surgical process, and needs to be done through a narrow opening in the nostrils.

Thus, we have defined Rhinoplasty and its types.

 

Grafts and Rhinoplasty

So, if you plan for Nose Reshaping what would you need?

If I plan to change the shape of nose I will need some material to redefine it. This material can be taken from the body itself or from the artificial source.

  • If it is taken from the body, it is called Autologous Graft
  • If it is taken from artificial source it is called Graft

Autologous Graft is usually taken from 3 sources

  • Nasal Septum Cartilage
  • Ear Cartilage
  • Rib Cartilage

 

Now cartilage is like a soft and flexible tissue,which helps to give support and shape of the nose.

 

If we use Artificial Material or Implant it is usually taken from:

  • Silicone Implant
  • Gortex

 

Let us understand a common thing that is performed in Rhinoplasty, and some doctors do practice it. Grafts are used to improve the shape of the nose, to do this, surgeons use a cartilage that is taken from the Nose, Ear, or Ribs to correct nose deformity, and get the nose in a good shape.

Rhinoplasty-Nose-reshaping

Not all nose jobs require grafts, these are only used for structural support or create a better breathing space for the nose. Grafts are predominantly used for the specific locations like the tip of the nose, the bridge, and mid third part of the nose.

A graft is a tissue that is taken from another part of the body, in terms of nose grafts, it can be cartilage, bone, or soft tissue that is used to improve the structure and shape of the nose.

 

Synthetic materials like Silicon or Goretex are also used instead of Grafts & these are called Implants.

 

So what are these Grafts meant to do?

Well, they may help in:

 

Grafts are made through pieces of cartilage , and shaped as per the shape of the nose to reinforce or replace weak tissues with stronger ones. There are two types of grafts – Contour Grafts and Structural Grafts. A Contour Graft is used to smoothen the surface or appearance of a nose.

These are put on the bridge side of the nose where it looks low,  there is a depression, or we need to change the shape of the tip. Structural grafts are used when there is a requirement of support for the nasal tip, or if there are breathing issues due to a very thin bridge.

 

So  Now we can use either the Graft or an Artificial Implant  for Rhinoplasty

Great !!!

Which one should a patient opt for?

 

Let me tell you advantages and disadvantages of both:

Lets begin with Implants which are made from Silicone or Gortex. Well, if you know something about Cosmetic Surgery Industry you would have heard about Silicone Implants in Breast Enhancement.

So the same Silicone is used here.  Advantages of Silicone Implants are:

  • The surgery time is short as we are using premade Implant to improve the nose shape.
  • The immediate result of Implant are great .Nose shape looks excellent.

 

Lets compare this with normal Grafts,  which we take from Clients own body.

Well here:

  • The Surgery time is much longer at least 3-4 hours. As we have to design the shape from body’s own tissues.
  • The immediate results and shape is moderate not as great as Implants

 

So it looks that Implants as Silicone are Best Choice. Right?

 Nose-treatment

But Wait !!!

I am going to reveal to you something that you should understand before you fix your Rhinoplasty if you do not wish to repent later.

So the deep Secret which is not often revealed is here:

  • The Implants i.e Silicone etc. though looks great, but in 2-3 years get infected or move from their position and a second surgery would be needed
  • If you are willing for this; a second surgery or any infections in the future, then you should think of implant.

 

For most of My patients I tell them not to go for Implants. I use Natural Grafts only.

 

Why ?

 

Because we care for you. We have seen some patients  operated somewhere else with Silicone Implants few years back ,coming to us with the pus, drooling from their nose or some complications needing another Surgery for Nose.

 

So My friends, be aware & avoid Implants as they are foreign body and can get infected.

I choose Grafts mostly from Nasal Septum. In some cases where we need more Structural support I prefer to look into Ear Cartilage or Rib Graft.

 

Well, we have moderate to great results, but I do not have to handle problems as Infection or Implant displacement.

If you need a second opinion, kindly visit me at Care Well Medical Centre. You can drop me a mail at info@carewellmedicalcentre.in

 

Conclusive facts

Cosmetic surgeries can be easier than Rhinoplasty wherein the complete surgery can be done in 30-40 minutes. But, for a Rhinoplasty procedure, it could take 3- 4 hours. Results with the graft are better than Rhinoplasty, but after 3-4 years it becomes necessary for the patients to remove the grafts as there could be infection.

In our clinic, we normally recommend Autologous Rhinoplasty, wherein a cartilage can be used from the nose, ears, or from the ribcage. If a patient wants to undergo surgery with grafts, then our clinic go ahead with the procedure.

 

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Know How To Make Liposuction Risk Free & Get Best Results

Hello Friends,

I am Dr Sandeep Bhasin, an industry-leading and trained cosmetic surgeon who specialises in offering a wide range of cosmetic surgery solutions.

Nowadays, liposuction is the most frequently performed cosmetic surgeries for removing excess fat. Today, I will tell you everything about liposuction.

You may have many questions in your mind about this aesthetic surgery procedure. For example, what it is, how it is performed, what should be done and what should be not, what results you can expect from this procedure and more.

I will educate you completely on this procedure so that you can take an informed decision if you are planning for this procedure. Through this report, I will virtually walk you through this popular way of getting rid of excess fat.

So, let me start now.

 

What is Liposuction?

liposuction-surgery-Care-Well-Centre

Liposuction is a procedure by which we surgically remove excess fat from your body. And this is done with the help of instruments and machines. This procedure is performed under local and general anesthesia.

 

What are the various types of liposuction?

It can be done by normal suction, by power assisted suction, by ultra assisted liposuction and Vaser assisted liposuction.

 

What are the methods involved in liposuction?

The methods can be dry, wet, super wet and tumescent liposuction.

 

Dry Liposuction is no longer used.

In Wet Liposuction, we put some fluid, remove the fluid with suction, but that is also no longer used.

What is being used now is super wet or tumescent. In super wet liposuction, we put 2 liters of fluid inside the fat, and then we remove two liters of fat.

In Tumescent Liposuction, we put 4 liters of fluid and then remove 2 to 3 liters of fat out. This is what the difference is between tumescent and super wet liposuction.

 

Which among them is the best technique for liposuction?

What we find now is that super wet liposuction is the best technique as chances of fluid overload is less as compared to tumescent liposuction that was done in the past.

liposuction

In the past, people were given large amount of fluid to the body and the procedure was done under local anaesthesia.

So friends – my advice is if you are going for liposuction, do not go for tumescent liposuction as this procedure can be dangerous too.

If it is a big area, the chances of fluid over load are very high. Some clinics still follow this procedure. As long as the area is small, it is ok. But for large area, it is not recommended.

This is my first recommendation or advice to you.  Super wet liposuction is safer than tumescent liposuction.

 

Now let me come to another very important point.

Many clinics started doing liposuction procedure in local anaesthesia and still many are doing. But now there is a caveat.

A very important point you should understand that the medicines used in local anaesthesia are xylocaine and lidocaine which are toxic to the body after a particular limit. It starts causing problems to nervous system, heart and it can also be dangerous to the entire body.

The maximum limit of using lidocaine is 35mg/kg according to the American Plastic Association.

Many times when we give local anaesthesia to bigger area, the limit of xylocaine and lidocaine can exceed.

What we do in our practice or clinic, we don’t do the procedure in local anaesthesia. We do liposuction in general anaesthesia. So, we don’t use xylocaine and lidocaine in that amount. We use them in low dose, such as 10 mg/kg or 15 mg/kg so that doses do not exceed and the chances of toxicity is minimised to a great extent.

 

So, my recommendation is if you are going for liposuction for bigger area, do not go for local anesthesia, and go for general anesthesia.

 

For you, it may sound interesting or cool that you are undergoing the procedure under local anaesthesia and going back home the same day. But if bigger area is involved, go for general anaesthesia.

Spinal anaesthesia is not good for many reasons, your blood pressure can drop, and many other things can happen. So, epidural spinal anaesthesia is not very good option to be used in liposuction. So, in liposuction, the best option is to go for general anaesthesia and reduce the doses of xylocaine.

Can excess of fat be removed by liposuction?

Liposuction-Weight-Fat-loss-treatment

We come across many people who say – doctor, remove 20 liter or 15 liter fat in me…

Let me come to this point how much fat we can remove safely from your body through liposuction.

This is a very crucial question, and you have to take it very seriously. Liposuction has its own problems and complications. Don’t ignore that. 10% of your body weight can be removed in one session.

Suppose, your weight is 70kg, up to 6 to 7 liters of fluid can be removed. But according to safety norms of liposuction, we can remove 5 litre of fluid in one sitting. If we remove a very large amount of fat, say 15 liter or 20 liter is to be removed, chances of complications are going to increase a lot.

You will be required to prolong your stay in the hospital. Chances of blood transfusion, electrolytic imbalance can be there. A lot of such complications can happen.

So, large volume that is called mega liposuccion is something which should be taken up with a lot of precautions and care, because if the complication happen, then it is very difficult to handle.

The situation gets difficult for both the patient and the doctor.

 

So, the volume of fat we remove in one sitting should be less than 5 liters or not more than that for safety reasons in my view. This is about the volume of liposuction that we do.

 

Fluid management and discharge

Normally, when we do liposuction in our set up, we never allow the patient to go back home the same day.

I know 80% of the centers send the patient same day but my advice is to keep them overnight. We give them sufficient fluids, intravenous fluids and hydrate them well. We observe them for 24 hours.

The reason is we give them xylocaine and the side effects of xylocaine may not happen immediately but can happen after few hours.

Secondly when we remove a lot of fat, there can be dizziness, difficulty in walking and the patient may feel pain and discomfort. For that reason, we do not advise patients to go back home the same day but after 24 hours when they are comfortable and okay. Then only we discharge them. This is something important practice that we follow in our setup.
Another thing that is important for patient and we practice in our centre is we ask the patient to move as soon as possible after the surgery. The reason is if they do not walk or move after this surgery or any other surgery, the chances of venous thrombosis increases. Either, we give them the medications to prevent thrombosis or we ask them to move as soon as possible.

If they move soon after the surgery, the chances of this thrombosis would be minimized. If the chances of thrombosis is high risk, then we make sure we give them injections like the blood thinners.

 

Liposuction is an inch loss procedure

Liposuction-inch-loss-treatment

Another thing I would like to tell you here that when a patient comes to us for liposuction, we do a proper counseling and tell them clearly that it is not a weight loss procedure but an inch loss procedure.

It is an inch-loss procedure. What you can expect after liposuction is an inch loss and not a weight loss. That is something that we tell them very clearly. And if they really want weight loss, we have a very special protocol which we follow after liposuction.

We give them high protein low carbohydrate diet which they have to follow. We ask them to take some supplements which can increase their metabolic rate and after 3 to 4 weeks, we ask them to do some exercise that are called high intensity workouts and weight training that can help them in weight loss.

My patients who have undergone liposuction, who have followed high protein diet, who have done high intensity exercise and taken supplements, we have seen, average in about two months, they lose 15 kg to 20 kg, sometimes 10 kg, which is a very good weight loss.

And this does not happen normally with liposuction alone. But when combining with these programs which we give them, there is a good weight loss that they can expect.

 

So, if you are motivated, you can lose weight, this is, what my thinking is.

 

Which all tests are done in liposuction?

When we take any patient for liposuction, we do a very thorough examination, we don’t take it lightly. We do all your blood tests, ECG, cardiac check-up, ultrasound, high resolution ultrasound or MRI to rule out any hernia.

 

Things to keep in mind:

Friends, if there is a hernia and it is missed by any chance, I am telling you liposuction can be very dangerous.

So, it is something which has to be done. We are very meticulous about that before liposuction. We go for high resolution ultrasound of abdomen to rule out any missed hernia.

If it is there, we refuse the patient for liposuction. We ask them to get hernia treated first.

Another thing is we always look for bleeding time and clotting time and all other factors. If there is any bleeding disorder and you undergo liposuction, your bleeding will not stop.

That can be very fatal. We always look for your bleeding profiles before taking you for liposuction procedure.

These are protocols we follow in our clinic.

Another very important thing is, after liposuction, we always get ultrasound done and we also look into your blood profile to see that you are comfortable with no accidental injuries in liposuction.

Now, understand, liposuction is a blind surgery, a blind procedure, complications can or may happen.

We are very careful before we do liposuction, when we do liposuction and after liposuction.

It should not be ignored something, what we tell people. Don’t take liposuction very lightly.

Clinics may have a good team, have good doctors. In Spite of all that, things do happen. So, be careful on that regard.

 

Vaser Liposuction

Another thing we tell people is that you know we are using vaser liposuction quite a lot. The advantage with laser liposuction is skin tightening and it gives a better body contouring. And my advice is not to go for tummy tuck and try to avoid tummy tuck. Because the wound healing time in tummy tuck procedure takes normally much longer time and liposuction is much less invasive.

Conclusion

Hopefully, I have cleared all your doubts or confusion that you had about liposuction procedure. And also I am confident that I have educated you well about this procedure. If you want to gather more information about it or have any questions in mind, please do contact me. I will assist you in the best possible manner.

 

Some Misleading Practices in Hair Transplant

Some Misleading Practices in Hair Transplant

I will be talking about common misleading practices in hair transplantation. Hair transplantation is a very lucrative field in which surgeons are earning very well, and that’s good.

I’ll talk on how hair transplantation has changed in the last 5 years & will discuss about misleading and unethical practices.

This all is a insiders information which no center will reveal & you will definitely going to get benefit…

 Hair-Transplant-treatment

First very important thing is –

Graft Vs. Hair

Most of the time, clinics mislead or confuse patients when it comes to tell the difference between a hair and a graft.

 

A follicle/graft contains 1 to 5 hairs.

Now, suppose the clinic A tells you that they would do 3000 hair in Rs. 60,000, and another clinic say Clinic B proposes doing 1000 grafts for patients for a cost of Rs. 30,000.

follicle-graft-Hair-transplant

So, what do you think, which offer is the better one?

You may think the clinic that is providing 3000 hair for 60,000 is a better offer. Is this right?

No, it isn’t. The reason being, 3000 hair are equivalent to 800-1000 follicles/grafts only & thus patient is paying Rs. 60,000 for the same no. of grafts which clinic B was offering in Rs. 30,000.

So be sure about what clinic is offering, hairs of grafts.

 

Count Check

The next thing that needs to be understood is – Many clinics claim of providing 3000 grafts, and when patients undergo hair transplantation, there is no valid system to check how many grafts have been taken out, and how many grafts have been implanted.

Patients have to agree to whatever is said by the clinic. If they say it’s 3000, then you have to agree it’s 3000. Well, there is a way to know this, which very few clinics practice, and in my clinic we very strictly adhere to this practice.

Whatever grafts are taken out, we put them on a wooden spatula. We normally put 150 grafts on one wooden strip, but that varies from clinic to clinic. Suppose 10 such strips are made with 150 grafts each, thus we know the number of total grafts are 1500.

You can check any of the strips, and there will be a uniform count of 150 grafts in all the strips. That is how transparency is maintained at our clinic.

In some clinics, people use counters, these counters when pressed, give you the count on how many grafts are implanted. So, this is something that some clinics do practice.

 

Fancy Names

Fancy names are used for doing hair transplantation, let’s take something like ROBOTIC HAIR TRANSPLANTATION. One of the authority is Wikipedia, I would advise you to go to Wikipedia and write robotic hair transplantation. Till yesterday, what I read in Wikipedia was that Robotic hair transplant still poses many problems due to:

A robotic hair transplant is using a punch of 1.2mm which is considered big nowadays and causes lot of scarring, whereas we are using a punch size of 0.8mm, to reduce scarring and to increase the number of quality  grafts.

 

What goes wrong with big size punch:

  1. Bad scarring
  2. Usually get less no. of grafts
  3. Damage to the graft is much higher in a robotic transplant as compared to a good manual transplant if the surgeon & team is good
  4. It is said to be 15% trensaction rate in Robotic Hair Transplant in comparison to only 10% in manual hair transplant
  5. Almost double charges

 

Robotic Hair Transplant has been popularized & it may have a role in the future, but at the present it is not giving good results. Thus, Robotic hair transplant by itself is a big gimmick in the market. Many doctors who are experts would actually tell the patients that Robotic advertising is one of  the advertising methods to get more money for the hair transplantation.

 

Why Hair Transplant Fail?

Reasons, why patients do not get good results after Hair Transplant?

There are times where you would be thinking about your friend spending lot of money on hair transplantation, even then the results are not 3.

Let me share with you, why the results were not observed. From my experience, the most important factor in the entire transplantation process are, how the grafts (hair roots) are extracted from donor area, stored & implanted in the bald area.

The results are usually good when all the above processes are carried out with care.

Lets explain each one of them one by one

When the grafts are extracted or taken out, we need to consider the size of the punch

Previously, various surgeons would use a punch size of 1.2mm, with greater technology and technique innovation, it came down to 1mm, then 0.9 mm. In the present scenario, surgeons use a punch size of 0.8mm.  The smaller size of the punch create lesser scarring, this increases the number of grafts being extracted.

Extraction

The handling of an FUE hair transplant machine to remove the punches or bursts. For this, we need to keep in mind the angle, direction, and depth of the probe. When this is done, surgeons receive greater number of follicles per graft.

follicles per graft

For example, a graft contains 3 follicles. If the surgeons technique is perfect, the success rate of getting 3 follicles per graft would be above 90%. But, if a surgeon uses an incorrect technique, then they would receive only 1 or 2 hair roots. This is called as partial transection.

Partial transaction can be outlined as a graft that is not totally damaged, but out of the three roots, one or two roots may get cut off. This means a surgeon and the patient will only get a single graft, or lesser number of follicles, rather than the complete set of follicles.

Now, lets say a person named Harry wants to undergo hair transplantation with 1000 grafts. Each graft has 3 follicles. There are two clinics performing the transplant.

Clinic A follows all the best practices, and receives 1000 grafts with 3 follicles each. It is also implanted by the surgeon in the clinic in the perfect way. Thus, Harry would receive 2700 – 3000 hair roots coming out of all the grafts.

Whereas the surgeon at Clinic B charges less amount for hair transplantation surgery but, do not follow the best practices & usually have high transection rate. Due to this, the patient will only recieve 1 or 2 follicles per graft, thus receiving only 1500-2000 follicles or even lesser with same 1000 grafts.

 

Once the grafts are extracted, how do surgeons store the grafts in the clinic also contributes to the quality of grafts

In my clinic and under strict supervision, we store our grafts in a proper solution known as Graft Holding Solution which improves the lifespan of gratfs. Vitamins and minerals are also added to the solution and the solution is kept at 40C. This creates minimal damage to the graft.

The next thing that needs to be taken care of is – when the grafts are being implanted they should always be kept hydrated or wet. In my clinic, I have assigned one or two assistants with the task of keeping the hair hydrated whilst the transplant is going on.

If the surgeon uses 3 or 4 assistants to handle various tasks, the cost would go up considerably, but the results would be exceptional whereas surgeons transplanting hair with a single assistant will not be able to provide the desired results.

 

Implantation Technique

It is a good practice for surgeons to make the holes closer. If the holes are closer, the density increases. The angle of the holes needs to be 300 , and the holes need to be very close to each other. If the angle of the probe is 900, then the hair would actually stand up like spikes, which would expose the scalp in-between.

 

No. of Grafts per Sq cm

If a surgeon implants 30-50 grafts per square cm, the results would be excellent in compariosn to implanting 15-20 grafts per square cm.

 

Benefits of No Root Touch Technique

One more thing surgeon need to consider is the process of implanting grafts. If surgeon use a single forcep, the graft survival rate is less than 50%. If double forceps are used, then the graft survival rate is 70-80%. Using the no root touch technique, the survival rate of the graft is 90%.

Thus,it is very important for surgeons to use the right technique for graft implantation. The no root touch technique or using two forceps is the most ideal way to implant the grafts. The single forcep technique should not be followed at all.

So, these are few important practices and techniques I follow to perform hair transplantation for my patients. These techniques garner excellent results for my patients.

Losing Hair After Hair Transplant Surgery

Why patients, initially having excellent results after hair transplant, lose hair?

This is a very valid question.

Let me share the facts & causes behind losing hair even after getting excellent results initially with Hair Transplant. So let’s start with hair transplantation.

Suppose a patient with mild hair loss opt for Hair Transplantation & assuming that the technique was perfect and the patient got excellent results after the transplant surgery  but  with time the result has gone back.

shedding hair transplant

BALD SPOTS

New patches of baldness may appear & even transplanted hair may start falling. This process could take 2-7 years, depending on severity of the problem.

Now one very important reason is, I’ve said it many times, hair transplantation is a surgery, it is like sowing seeds in the ground, and if the soil is not good, you need quality fertilizers & water to make the soil fertile. Same stands true with the scalp area which is suffering from baldness.

The most important action before starting any treatment must be the diagnosis of the scalp area to trace out the key problems & to cure it first.

In absence of proper diagnosis & the treatment of the root cause, partial hair transplant may be successful but the condition will remain same & your original hair will continue to fall.

 

Few medicines like:

  • Minoxidil in combination with other medication
  • Minerals & vitamin substitutes
  • Lasers
  • PRP
  • Microdermabrasion

helps to cure the root causes of baldness.

So, Hair transplant considers to be successful when we get the excellent results after the surgery & with the help of medications & other therapies the surgeon is able to save the native hair (natural hair) which other wise patient may lose in the span of say 3-5 years.

That is one reason, now the second thing which I want to tell you is when we do hair transplantation specially FUE transplantation, there are zones on the back of the head.

From the back of the head, the occipital protuberance, the bone which is very prominent at the back of the head, up to 7 cm above that is called the permanent zone. Above the permanent zone there is the temporary zone.

FUT-vs-FUE-donor-area-600w

Now if you’ve been to any transplant clinic, and if they suggest you to take out 5000  or 6000 graft, (which  is commonly practiced now) they have to  go into the temporary zone.

Means, surgeon has to infringe upon the temporary zone because they want to take more grafts. What will happen after sometime is, the hair in the temporary zone would be lost just like your native hair.

So, my advice is, do not do more than 3000 or 3500 grafts in one sitting during FUE. as 5000 to 6000 grafts will not be long-lasting. So, be very careful of this.

One more fact, which we as a surgeon have to take care.

As I’ve mentioned earlier, you need to use minoxidil and medications to prevent your hair loss but It has been found that only 60% patients respond to minoxidil, and the other 40% do not respond to minoxidil as minoxidil needs to be converted to minoxidil sulfate inside the body. There are specific enzymes in the skin to makes this happen. Patients who’s body cannot convert minoxidil to minoxidil sulfate will not be able to stop their hair loss with this medicine.  

It is my advise for patients not to rely on minoxidil alone, but also use medication and topical treatment like DHT blockers – Finasteride & Dutaseride, PRP, laser therapy, anti-dandruff treatment, and nutritional supplements. Additionally, it is very important for patients to maintain a good lifestyle.

Smokers and Diabetic patients lose a lot of hair and are succeptible to baldness. It is advised for such individuals to stop smoking and control their diabetes.

Another reason for people to lose more hair is lack of sleep as inadequate sleep increases the chance of baldness, I would advise patients to sleep better, and improve their habits and lifestyle.

remain stress free to stop hair fall

                                                               Healthy Lifestyle & Meditation Helps to Combat Hair Loss                                                        

It is very important for patients to keep a healthy lifestyle after transplantation. If the patient has a hectic lifestyle, and is under heavy stress, and continues to smoke without adequate sleep, they are going to suffer with hair fall for sure.

https://www.carewellmedicalcentre.com/wp-content/uploads/2018/09/anabolic-steriods-not-good-for-Hair.jpg

Anabolic Steroids, A BIG NO

Another important pointer that needs to be taken care of is the use of anabolic steroids. Bodybuilders who use anabolic steroids are completely susceptible to damaging their hair.  Greater baldness is seen in individuals who take anabolic steroids.

Thus, these are some of the factors that contribute to hair fall after successful hair transplantation.