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February 17, 2020 cocoonaLiposuction

Since the existence of mankind, human body has been seen as a work of art. Throughout the history, human form has been elaborately expressed by artists and sculptors. It all began in 5th century BC by the Greek sculptor Polykleitos with his bronze sculpture Doryphorus. It showed the perfectly harmonious and balanced proportions of human body.

This was followed by artistic versions of human body by various artists and sculptors. The merging of art and anatomy is perhaps most evident and glorious in the works of Leonardo da Vinci.


(De Humani Corporis Fabrica by Vesalius)

Michelangelo’s David represents one of the most recognized sculptures and showcases the human body in all its strength, athleticism, and youthful beauty.


(Michalengalo’s David)

It is very interesting how the ideas of art based on perception of genius artists in the past can be used with a deep knowledge of human anatomy to carve a beautiful structure in a human body through liposuction (hence the term ‘Liposculpture’)


(Some of my sketches on artistic presentation of an aesthetic muscular male and female body)

Using the artistic perception from the historic times, plastic surgeons have been inspired to recreate a similar form in their surgeries. This takes liposuction or fat removal to the next level and gave rise to the concept of lipo-sculpture or 3D/4D liposuction.

APPLICATION OF ART IN SCIENCE GAVE US HIGH DEFINITION LIPOSUCTION

Liposuction isn’t a new technique and it has been done since 1980s.

The market has seen changes from traditional liposuction (manual liposuction) to the use of energy based devices like Laser, Vaser, Radiofrequency assisted and J Plasma (Plasma with Radiofrequency).

Also there have been different methods of performing liposuction like Manual Liposuction, Power-assisted liposuction, Vibration assisted Liposuction, Nutational Infrasonic Liposuction, etc.

“Using the knowledge of anatomy and infusing it in science with an artistic perspective is High definition liposuction.”

High definition Liposuction is a form of liposuction which not only removes fat excess but in addition removes fat between muscle groups accentuating the margins and the lines of light and shadows between the muscles creating a more athletic appearance.

 Ref. : (VASER-Assisted High-Definition Liposculpture : Alfredo E. Hoyos, MD, John A. Millard, MD. Aesthetic Surgery Journal, Volume 27, Issue 6, November 2007, Pages 594–604)

TWO TYPICAL RESULTS OF HIGH DEFNITION LIPOSUCTION

The above patient is a 40-year-old male who had stubborn resistant fat in the tummy and love handles which despite regular exercises and good diet refused to shed off.

He promised to be committed to exercise and diet. I removed 3 liters of fat from the abdomen and defined his muscles (body sculpting). Following the surgery, he started working out while recovering and here he is after 3 months.

The Six-pac abs are very prominent, and most importantly they are natural. it’s the patients own muscle, and not FAT bases packs that looks extremely fake and poor.

The above patient is a 25 year old female who had stubborn resistant fat in the tummy and love handles despite regular workout and good diet.

I removed 3.5 liters of fat from the abdomen and defined her muscles (body sculpting). Following the surgery, she works out 3-4 times a week, focusing mainly on her abdomen and lower body.

 

FAQs on Liposuction

At my practice here at Cocoona Dubai, I frequently come across patients pre-occupied by misleading information. Our duty as plastic surgeons lies in not just performing the surgery, but also to educate people about the procedure and its intricacies. I have listed some of the most common questions we as plastic surgeons encounter during our consult regarding high definition liposuction.

Who is the right candidate for high definition liposuction?

Any individual (male/female) who meets the following criteria is a good candidate:

  • Low visceral fat
  • Good skin elasticity
  • Minimal to no excess skin
  • Motivated patient committed to working on lifestyle change in terms of diet and exercise

Do I need to be muscular to get better results out from a High Definition Liposuction surgery?

I classify my patients into three categories :

  1. Poorly muscular: These patients need to work-out on their abdominal muscles to get the best shape after the surgery. Also need to make sure they don’t gain fat in the same area by focusing on their diet and cardio (HIIT). They typically see their 6-pack result after a longer duration. Could take 5-6 months or even more.
  2. Slightly muscular: Need to work-out on a regular basis and keep their diet in check. However, they tend to see the results faster and its less difficult for them to maintain their results.
  3. Very Muscular : These patients usually are athletes or bodybuilders, who are usually extremely cautious about their diet and exercise. They see the results the fastest and maintain them very well for a very long period. Needless to say, these patients have the best results and are a treat for any plastic surgeon.

How do I do Liposuction or What technique do I use?

I infiltrate tumescent fluid in the fatty layer to numb the area. This helps in post-operative pain control. The fluid also helps in vasoconstriction which reduces the amount of blood loss during the procedure.

I use vaser to help me in emulsification of fat and skin retraction which in the end translates to a well sculpted slimmer look of the body.

Ref. Click here

This can also be done using laser, J plasma or other energy-based devices. No single device has been shown to be more superior than the other for this purpose.

However, worldwide Vaser is the commonest tool used for high definition liposuction.

Once liposuction is done and the patient is slimmed down in an aesthetic way, etching is done using special cannulas.

The end result is a combination of various factors like surgeon’s skills, technology that’s used, post-operative protocol and a healthy lifestyle on the part of patient.

Is the liposuction technique different for males and females?

Muscle definition (or Etching) is commonly done in the midline above the belly button (Linea alba) and by the sides of the two rectus muscles (Linea semilunaris) in females.

Most females don’t prefer the six-pack look. They like a softer look.

Males usually prefer the six-pack look. I have had few female clients in my practice requesting the same. Hence etching in them besides Linea alba and Linea semilunaris is also done in the transverse lines to create the packs. (Transverse inscriptions)

How do I make the results of the liposuction long lasting (or sustainable)?

I do not prefer leaving fat over the muscles to create Abs as this fat has the potential to grow in later life leading to an abnormal bulge.

Remember ‘Abs are muscles not fat’.

Leaving fat or injecting fat under the muscle to make it look like abs only creates “Fat packs” or “Fake packs”.

Also, the patient is strictly advised to adopt a heathy lifestyle with clean diet and regular exercise to make the rectus muscle grow bigger (Ab muscle hypertrophy).

What is the post-operative care after getting liposuction?

Patient is advised to go for manual lymphatic drainage massages from day 2 or 3, after the surgery to help swelling go off faster and also to aid in skin retraction.

Pressure garment is given on the second day after surgery while Foam dressing is given to be placed along with the garment from day 3 or 4, which helps in avoiding swelling in the etched areas and preserves the etching that was created during the surgery. This is typically given for about 2-3 weeks.

Pressure garment is advised for 1.5-2 months following the surgery. This duration could be shorter or longer depending on how the patient is healing.

Follow ups are recommended at 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months and 1 year after the surgery.

I am strict with my follow ups to ensure high patient satisfaction and long-lasting good results.

When do my patients see results after liposuction?

Typically, patients see good results between 2-3 months.

Different patients swell and heal differently, but most of them see a good result by 3 months and that keeps improving till about 5-6 months.

Results also depend on patient compliance in terms of diet and exercise.

When can a patient start exercising after the liposuction surgery?

My patients start light exercises from 2nd week after the liposuction surgery and progressively increase the intensity every week.

Patients usually begin their routine exercises (workout, dance, Zumba, Pilates, etc.) in a month’s time.

What exercises do I recommend after the liposuction surgery?

I usually customize an exercise plan for each client considering their goals, the area that I have worked on (abs, glutes, shoulders, chest, back, etc.) and looking at how much time and effort they are ready to put in.

I have been trained by some finest bodybuilders in the world and my experience in bodybuilding helps me shape up my clients post operatively.

Sample exercise plan

At 1 week – Long distance walking, walking on a treadmill

At 2 weeks – Running on a treadmill, Mild intensity exercises on uninvolved areas (like exercise for arms and legs when only tummy liposuction is done)

At 3 weeks – Moderate intensity exercises on uninvolved areas, Passive exercises for operated areas (like Planks for abdomen, stretch and hold for arms, buttocks)

At 4 weeks – Moderate to severe intensity exercises for all parts

More about Myself

I am a Board-certified plastic surgeon with a 7 years’ experience in plastic surgery. I perform both aesthetic surgical and non-surgical procedures.

I like to scribble, sketch, sculpt, inject, cut and stitch.

My hands are my biggest asset and I try my best to create something beautiful with them, at or out of work.

KEY INTERESTS

Surgical Procedures

Body Contouring

  • Vaser / Laser Liposuction
  • Slim Down Liposuction
  • 3D / 4D liposuction (6 packs liposuction)
  • Tummy tuck
  • Brazilian Butt Lift
  • Arm Lift / Thigh Lift

Facial Surgeries

  • Blepharoplasty
  • Buccal fat pad removal (Bichectomy)
  • Face Liposuction
  • Face fat grafting

Breast Surgeries

  • Breast Augmentation (Implants/Fat transfer)
  • Breast Lift / Breast Reduction

Genital Surgeries

  • Labiaplasty
  • Labia Majora Fat grafting
  • Vaginoplasty

Non Surgical Procedures

  • Botox
  • Fillers (face/hands/buttocks)
  • Platelet Rich Plasma (PRP)
  • Microneedling
  • Fractional CO2 Laser
  • Mesotherapy

 

 


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February 3, 2020 cocoonaBreast Clinic

Evolution of Breast Implants

The first thought of using implants to enhance breasts was sowed in 1962. Frank Gerow was a surgical resident and while he was carrying a bag of blood from blood bank to the wards, he felt the bag felt like breasts. The crazy idea was shared with Dr Thomas Cronin who liked the concept and started working on the idea along with Thomas Biggs. I have been fortunate to meet Thomas Biggs and listen to this story several times.

Prior to this there were medical records of industrial silicone being injected directly into breasts as early as 1945. (Ref: Reuters World news)

From 1951-1962 a number of different materials were used such as Ivalon. A polyvinyl alcohol sponge that was inserted under the breasts but eventually was removed as it caused hardness.

Dr Thomas Cronin and Dr Thomas Biggs developed the first Silicone filled implants and used it in 1962 on a woman who has now turned 80.

In 1976 The US Food and drug administration (FDA) regulated the silicone breast implants to ensure its safety.

But in 1991, there were several incidences of rupture of implants leading to leakage of liquid silicone.  In April 1992 The FDA advised its use only for reconstruction after surgery or to correct congenital deformities. The silicone-based implants were pulled out of the market in US, UK and several countries.

In 1995 the silicone implants were replaced by saline filled implants (inflatable). The first saline filled breast implant was created in France in 1965 by Dr H G Arion. However it had very high incidence of rupture, leak and abnormal “sloshing sounds”.

After several modifications of silicone gel to make it more medical grade and safe, it cam back in market and year 2000 France lifted its ban on silicone implants and 2006 FDA did that in the USA.

There was a brief period of time when other materials were used inside silicone bags such as Soy oil and Polypropylene string but it had other risks that lead to its disrepute.

After the first, second and third generation implants silicone breast implants; there were significant improvement in its development to make it safer.

The fourth and fifth generation Implants used more cohesive gel and newest highly cohesive implants were approved in 2012 and 2013. The fifth-generation implants are also strong with low- bleed shell.

As the internal silicone material improved with time the shell covering also went through several changes.

In the beginning the silicone bag or shell was thinner to make it feel softer and more natural, however the combination of liquid silicone and thin shell had higher risk of leakage and rupture.  Yet another risk was capsular contracture that was assumed to be due to smooth wall of the shell.

The smooth shell was than replaced with textured shell to reduce risk of contracture.  A newer implant type with polyurethane sheath was introduced; however partial degradation of PU foam led to speculation of carcinogenesis. The FDA estimated higher risk of cancer with PU foam implants. (Ref W Peters. The evolution of breast implants. Can J Plast Surg 2002;10(5):223-236.)

Textured implant certainly had lowered incidence of capsular contracture. McGhan in 1987 developed Biocell surface implants, Mentor in 1988 developed siltex technique and these implants are still very popular. Some of the companies developed other techniques of texturing the implant that fell out of disrepute. The reason was under some circumstances there could be collection of fluid around the implant that could lead to immunogenic reaction.

Recent studies have shown that textured implants carry higher risk of a rare form of cancer called Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA ALCL). It is not a breast cancer but a cancer of the immune system. As of June 2019 732 cases of BIA ALCL have been reported worldwide (Published by International Consortium of Investigative Journalists)

The new era of implants is developed with principles of “microtexturization and Nanotexturization. The velvet surface and silk surface are some newer breast implants that have low roughness and implies low friction and therefore no lose particles (ref- Nanotechnology, nanosurfaces and silicone gel breast implants)

Evolution of the procedure for Breast implants

The earlier practice was to insert the implant in front of the muscle. For many decades the implants were placed above the muscle just under the gland. The approach was different, either from an incision underneath the breast or around the nipple. Because the scar was located on the breast region, surgeons developed new approach either through the under arm called axillary approach or through the umbilicus called as Transumbilical breast augmentation (TUBA).

As not all people were ideal candidate for above the muscle implantation, a technique was developed to place the implants under the muscle called as submuscular breast implantation.

However, as the breast is dynamic and changes its position over time whereas the muscle does not, a submuscualr implant has risks of high riding implant and water fall deformities. So, a technique was required to ensure that the implant follows the breast over a period of time.

In 2006 Dr John Tebbetts who described an innovative method called dual plane breast implantation that ensures the implant is covered partially with muscle and remaining implant is placed in the lower pole of the breasts published a research. This ensured that the implant moved with the breasts as it sags. This technique adjusts implant and breast tissue position to ensure the implant is protected in the upper part while optimizing the position of implant in the lower pole of the breasts (ref Plast Reconstr Surg. 2006 Dec;118(7 Suppl):81S-98S; discussion 99S-102S.

Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types.

Tebbetts JB1.

This procedure is still very popular and widely used worldwide. In my experience of 25 years, I select the patient based on the size of their breasts, position of the breasts in relation to their chest muscle and predicted drop in breasts as they age.

Evolution of surgical technique

With the advances in technology and better understanding the surgical technique has evolved to make it safer with early recovery and stable long-term outcome.

In the past the risks of bleeding, hematomas, capsular contracture, and infection were a big concern. The surgery time was often longer extending for few hours in many cases. The anesthesia was a concern, risks of blood clots, embolism were higher. Continuous research and studies have helped to improve the quality of the surgery.

The general anesthesia now used in most cases is called “laryngeal mask” or “supraglottic mask) in opposed to intubation. This has minimized the use anesthetic drugs. Patients recover early without much PONV ( postoperative nausea and vomiting) and grogginess (Ref: anesthesiology.pubs.asahq.org › article)

Laryngeal Mask Anesthesia – Anesthesiology – ASA

by A Ovassapian – ‎2006)

Tumescent infiltration that contains cocktail of medications such as lidocaine, adrenaline and normal saline has revolutionized the whole procedure.

This injection is done prior to the surgery is started. This allows the blood vessel to shrink temporarily and enables us to perform bloodless surgery.  Hence the risk of  haematoma is dramatically reduced. In my practice in Dubai, UAE since 2005 I have had 0% hematoma in total of 1500+ that I have performed.

Use of lidocaine has reduced postoperative pain so most of the patient either is discharged same day or next day.

The surgery now lasts anywhere between 40-50 minutes reducing the morbidity of the procedure.

Evolution of Protocols for a successful Breast Implantation

There are several protocols to predict and prevent complications in Breast Implant surgery.

In our series of 1500+ breast augmentations that I have performed here at Cocoona in Dubai, risks of infection, DVT, embolism has been 0%. The reason being the protocol ensures identification of risk factors in patients and selection based on fitness for surgery. Secondly protocols also guide us to follow steps to prevent such complications. These pertain to Infection control policy, DVT prophylaxis policy, ASA (American Society of Anaesthesiologists) criteria to predict operative risks ( Ref: American Society of Anesthesiologists Classification (ASA Class)Daniel John Doyle; Emily H. Garmon.)

Selection of Implant Size and type of surgery

An Ideal breast implant surgery is where the size and position of the implant is appropriate to the anatomy of the breasts. We thoroughly analyze the breasts and follow established protocol.

Breast anatomy-based planning implant-sizing system offers superior outcome longevity as compared to just patient preference.   On the other hand, if the implant size is selected based on patient or surgeon preference the result may be short term with higher risks of complications such as thinning of breast tissue, sagging and visible implant distortions (Ref Matching the Implant to the Breast: A Systematic Review of Implant Size Selection Systems for Breast Augmentation

Adams, William P. Jr. M.D.; Mckee, Daniel M.D Plastic and Reconstructive Surgery: November 2016 – Volume 138 – Issue 5 – p 987-994)

The new innovative method of assessment also allows determining if implant alone is suitable or patient may need breast lift as well. This combined procedure is known as augmentation mastopexy.

Safest Technique for breast augmentation

Breast augmentation can be very safe surgery if all the parameters are fulfilled. It starts from ideal patient selection who is a fit and healthy female with stable weight and who has enough fatty tissue with some breast tissue to give a nice envelop over the implants.  The size and position of the implant is appropriately chosen based on the anatomy. The recommended implants are fifth generation, gummy bear type or cohesive implant with nano or microtextured preferably FDA approved.

However, the most important factor remains the follow-up in short and long term.

Regular follow up with the surgeon immediately after the surgery will minimize surgical risks. In long term a yearly follow up is recommended with a Plastic surgeon who may advice USG or MRI to ensure the integrity of the implant and body’s response to it. Any breast implant is not considered a permanent implant and it may require a change after 10 years based on the clinical situation. Modern implants carry warranties for several years and also options of extending the duration of cover, one such example can we looked at motivaimplants.com › docs › motiva-warranty-program-terms-and-co…Motiva Warranty Program Terms and Conditions)

About Me.

I am Dr. Sanjay Parashar and have spent several years working with and learning from some of the best plastic surgeons in the world. I have been practicing for almost 3 decades and have performed over 12,000+ surgeries. My primary practice is based out of Dubai, UAE, but I travel to Delhi, mumbi and Ludhiana frequently to attend to VIP and celebrity cases in India. My specialties include:

  • Breast Surgeries
  • Breast Augmentation using Implants or/and Fat Grafting
  • Breast Lift
  • Breast Reduction
  • Facial Aesthetic Surgery
  • Rhinoplasty
  • Facelift
  • Occuloplastic Surgery (Eye surgery)
  • Reconstructive Surgery
  • Robotic Hair Transplant
  • Body Contouring –Liposuction and Liposculpting
  • Six Pack Surgery using Vaser Technology
  • Chest and Biceps Augmentation
  • Abdominoplasty (Tummy tuck)
  • Mommy Makeover
  • Facial Contouring
  • Fillers and Anti-ageing treatments
  • Brazilian Butt Lift
  • Gynecomastia (male breast reduction)


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