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what is liposuction?

“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?

“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?

“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?

“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?

“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?

“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.


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DermatologySkin

Corns and Calluses

July 2, 2020

Overview

Corns and calluses are fairly common problem in male and female that occurs in soles, toes, palms and fingers. It is a benign condition caused by constant pressure and friction.

Symptoms

Corns are small round hard lesion that is painful on pressure and commonly occurs at the bottom of the sole, over the toes and in between toes. It is very uncommon in hands.

On the other hand, calluses are flakes of hard keratinized skin that forms like an onion layer. It is painless unless infected or inflamed due to injury. They are Irregular and broad in shape unlike corns that are small round and often well defined.

Are Corns and calluses the same thing? Although the causes are the same but they behave differently.

  • Corns: It is also called as clavus. It is thickening of the skin due to pressure and friction resulting in hyperkeratosis and is associated with pain. It appears like a “top” with round elevated surface but has a narrow deep root that reaches deeper than dermis and hence it is painful on pressure. There are three kinds of Corns- Hard corn or heloma durum that is dry; soft corn or helom molle that are macerated and soft and occurs in between toes and periungual corn occurs on the top of toes.
  • Calluses: Are flaky hyperkeratotic layers over the skin also due to excess friction and pressure. They develop over a broader surface and grow outwardly and do not have a root or deep core. It is not painful and can occur in soles, toes, and dorsum of foot, hands and fingers. It is very common among atheletes like weight lifters and tennis players. It is also very common among physical labors and people who do not wear footwear most of the time.

 

When to see a doctor

It is best to see the doctor as soon as you notice the lesions. As with correct advice it can be controlled. And also it is easier to treat in the early stages.

Causes- Both are caused by constant or intermittent pressure and friction, corns are due to localized pressure points whereas callosities are due to more wider pressure areas hence corns are smaller and narrower than calluses. Corns are also known to form within a callus.

Risk factors. Apart from pressure and friction some deformities can also cause corns and calluses eg hammer toe, telipus equinovarus, amputated stumps etc. The risks are higher in people with diabetes and neurological problems.

Prevention. Wearing correct footwear avoiding excessive pressure is key to prevention. But moisturizing foot and hand also helps. If there is tendency for excessive dryness in the foot, apply moisturizer and wear socks.

 

Some FAQs

  1. How effective is salicylic acid for treating corns and calluses?
    – SA is very effective as it works as Keratolytic agent by increasing moisture in the skin and dissolving the keratin layer allowing it to flake off. It can them be gently scrubbed off with puma stone.
  2. Is salicylic acid as a calluses remover painful?
    – It is not painful at all when it is applied on thick kearitnised skin. It may have burning sensation when it is applied to think skin or after the callus is peeled off.
  3. What happens when you cut off a corn or calluses yourself?
    – Corns and calluses should be gently and carefully shaved layer by layer. If not done carefully you can injure your skin and cause bleeding and infection. An experienced doctor can carefully shave off using a magnification to ensure safety.
  4. How should I get rid of corns or calluses permanently?
    – Apply SA once daily , after 304 days start using puma stone or gently scrub off during bathing. It may help to soak feet in warm water before scrubbing. Check with the doctor regularly to get it examined. At the same time get correct footwear and use soft silicone pads at pressure points. If the cause is removed the treatment can have longlasting results.
  5. What is the safest way to cut off corn or calluses?
    – There are two ways to treat Corns, First apply SA solution until it is soft then visit a doctor who will use sterile instrument to gradually shave the corn until it reduces in size then rest of it is surgically excised under local anaesthesia. I personally don’t prefer suturing the wounds after excising the corn as they break and cause more pain and discomfort. I allow it to heal by secondary intention.  Second option is to keep apply SA lotion until it flakes off completely.On the other hand callosities are never surgically excised. They are shaved down to skin level and then the area is protected using silicone cushion.
  6. How to painlessly remove a corn or calluses?
    – By regularly applying SC lotion and scrubbing with puma stone or careful shaving is a painless way to remove.
  7. Is there any side effects of using salicylic acid?
    – SA is very safe to use on the keratotic skin. In normal skin or thin skin it may cause skin burns. So careful application is necessary.
  8. Do treatments for removing corns or calluses cause them to spread?
    – Corns and calluses do not spread like warts which are due to virus. Corns and calluses can only increase by continuso pressure and friction.

Dr. Sanjay Parashar

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Body Lift

Body Lift Surgery – Challenges, techniques and what patients need to look for before going for a Body Lift surgery after Massive Weight Loss

March 21, 2020

Massive weight loss is a common thing these days. People are losing weight dramatically sometimes more than 50% of their body weight. This is scientifically defined as “massive weight loss”.  There are many weight reduction methods such as dieting, lifestyle changes, over the counter pills, paranormal ways such as bulimia and bariatric surgery.

Even after losing a large amount of weight, simply being within normal range is insufficient for most people. They want look as attractive and as normal as possible.

Often after massive weight loss, people end up having loose and saggy skin, lax muscles, oddly shaped protuberances, vestiges of fatty tissue (bags containing fatty acids and triglycerides) remain in form of flabs and unexpected folds, pleats, puckers and creases. [Reference- An outcomes analysis of patients undergoing body contouring surgery after massive weight loss. Shermak MA, Chang D, Magnuson TH, Schweitzer MA Plast Reconstr Surg. 2006 Sep 15; 118(4):1026-31.]

According to Pittsburgh rating scale there are ten anatomical areas that undergo maximum changes after excessive weight loss-

  • Arms
  • Breasts
  • Abdomen
  • Flanks
  • Mons pubis
  • Back
  • Buttocks
  • Inner thighs
  • Hips and lateral thighs
  • Lower thighs and knees

In my opinion there are two other areas that get significantly affected face and neck and hair loss.

The deformities range from

  • Grade 0 meaning appearance is within normal range.
  • Grade 1 is mild deformity that may require some minimal invasive procedure
  • Grade 2 is moderate deformity that often requires correctional surgery and
  • Grade 3 is severe deformity that requires multiple procedures.

What happens when you lose weight quickly?

Weight loss not only causes loss in volume but it has detrimental effect on skin collagen that reduces the elasticity and quality of skin.  What that means is when you stretch the skin normally it recoils back immediately, but when elastin and collagen is reduced the skin does not recoil back and keeps stretching as you keep pulling it.

How to Lose Weight Correctly?

I always recommend my patients to gradually loose weight and ensure that they eat healthy nutrition with supplements to ensure the skin and hair integrity are significantly affected. I also recommend to do muscle building exercises because as you loose fat and volume the skin sags, but if that volume is compensated by muscles to some extent the skin will drape back.

Men have advantage as they can build up muscles and beef up in the chest, arms, back and thighs thus firming up the skin. The only problem area that remains are abdomen, face and neck because you cannot beef up the muscles in these areas.

Women have more challenges; they cannot beef up significantly to prevent masculinization. Yet I do recommend them to build muscles in chest, back, arms and thighs.

What happens after massive weight loss?

Let me explain what happens after excessive weight loss in different regions of the body.

  • Face and Neck: Due to weight gain fat cells increases in face and neck and stretches the skin but as you loose weight the volume reduces and skin starts sagging. The face may appear gaunter and emaciated and neck develops loose skin folds like “turkey neck”.
  • Chest in Men: Men develops a condition called pseudogynaecomastia where the skin sags along with residual fat bags and gives an appearance of man breasts.
  • Breasts: There is extensive thinning of breasts and sagging and they develop loose folds in bra roll areas.
  • Abdomen: Both in men and women form folds and rolls of skin in the tummy region sometimes one or two and in many cases three rolls. The skin is not only saggy in vertical direction but they have excess skin in horizontal direction. Often the underlying muscle is also stretched out and weak.
  • Mons Pubis: There is significant changes in mons region with hanging skin, droopy genitals, buried penis etc.
  • Back and Buttocks: Multiple rolls develop in the back region and the buttock sags with wrinkling and distortion of the shape. Hip fat and skin forms rolls and folds laterally.
  • Thighs and knees: excess skin develops in thighs in both directions circumferentially and vertically causing sagging, skin folds, cellulites and abnormal protuberances. The kneecap disappears due to skin folds over the knees.
  • Arms: likewise develops flabs like “bat wings” and skin folds develop above the elbows.

Body Contouring Surgery and Body Lift Surgery

Body contouring surgery involves removal of loose skin and residual fat bags along with suspension of skin.

The wide breadth and variety of deformities means surgical options are also endless. If one has to address each and every problem than one may have to go through the following list of surgeries.

  1. Face and Neck lift with or without fat grafting
  2. Breast lift with or without implants
  3. Tummy tuck- only conventional or T shaped abdominoplasty also called as “Fleur De Lyse”
  4. Brachioplasty- vertical and or horizontal
  5. Lateral chest lift or axillary lift
  6. Back lift
  7. Buttock lift
  8. Thigh lift- vertical and or horizontal
  9. Knee lift
  10. Male breast lift

This is an exhausting list of surgeries to correct all most of the problems. But surgeries come with a cost not only financial burden but trauma, pain, scars, risks and side effects.

Over past 25 years I have integrated some refinements and combinations of procedures that is safer and has better long-term results.

I thoroughly counsel the patients followed by complete tests and examinations to ensure their fitness for surgeries. I help make a plan for the patients with various permutations and combinations of the surgeries.

My recommendations begin with following advice:

  1. Work hard to replace some volume by building muscles.
  2. Ensure you have stabilized your weight and health with good nutrition and regular exercises.
  3. It is not possible to chase all the loose skin
  4. Goal is to minimize number of scars and number of surgeries
  5. There is a limitation on number of surgeries that can be performed in one person.
  6. Time is essence to minimize risks and complications, so my goal is to limit surgeries to 4-5 hours. Less time of anesthesia means better recovery and minimal complications.
  7. Although the skin appears very tight immediately after the surgery but depending upon your collagen it will loosen up in 5-6 months time. There is a thin line between over tightening of skin and wound breakdown or scar stretching and migration.

Preoperative assessment before a Body Lift Surgery

I prefer to do a complete medical checkup with blood tests to minimize risks and complications. The key tests include bleeding and coagulation profile, protein and haemoglobin level and kidney and liver function tests. An ECG and X ray chest may be necessary in patients above 40 years of age, chronic smokers and other comorbid conditions.

A well controlled diabetes mellitus and or hypertension is not a contraindication for surgeries.

Planning of Body lift Surgery

The commonest procedure people need after massive weight loss is Abdominoplasty or tummy tuck and breast/chest lift in male or female.

Abdominoplasty can be an extended abdominoplasty with incision from one hip bone to the other or a circumferential body lift with incision going around to the back also called a Belt Lipectomy. This procedure allows some extent of buttock lift as well.

Very few people may need a combination of vertical and horizontal tummy tuck called as “Fleur De Lyse” abdominoplasty however the vertical scar is not a very pleasing scar and I recommend only for people who has very unsightly abdomen with huge excess skin, than scar is not a big deal.

If I am doing a buttock lift, I recommend “autoaugmentation gluteal lift” which means I will use the fatty tissue around the buttock area to augment and give volume to the buttocks. [Ref- Hunstad JP, Repta R. Purse-string gluteoplasty. Plast Reconstr Surg. 2009;123:123e–125e.]

Augmentation Mastopexy is a procedure that combines use of breast implant along with lift and skin tightening of the breasts. Very few patients may get away with just a breast lift if they have good volume or they choose not to have any implants. The preferred breast lift technique is anchor shaped to give a good long-lasting lift.

Arm sagging is the next common area of concern mostly in female patients. Brachioplasty is a arm lift procedure and it can be done as a vertical only or “T” or “L” shaped brachioplasty.  I prefer to keep the scar at the seam of the arm so it is less visible from front and back and can be seen if patient lifts her arms.

I use “J Plasma” from Bovie Company to further tighten the skin internally. It is a new technology that is now used in combination with Vaser during liposuction to improve the collagen in the skin.

Thigh lift is necessary in patients with excessive sagging thighs. The ideal technique is “T” thigh lift that addresses removal of excess circumferential skin and also lifts the thigh upper in the groin crease areas.  In some patients doing limited thigh lift in combination with Liposuction and J plasma skin tightening can minimize the scars.

Face and Neck Lift is rarely necessary in patients as there are many nonsurgical and minimal invasive options to firm up the skin in face and neck.  Ultherapy lift, Thread lift, filler injections and fat grafting are some procedures that helps improvement of face and neck skin.

Procedural Combination

The combination of procedure depends upon the priority given by patients, the severity of the problem, medical fitness, duration of surgery and recovery period available for the patients.

My recommended combinations are-

  • Lipoabdominoplasty with lateral thigh lift
  • Circumferential abdominoplasty with buttock lift
  • Lipoabdominoplasty with breast lift/ augmentation mastopexy
  • Lipoabdominoplasty with brachioplasty
  • Brachioplasty and back lift/ bra roll lift
  • Thigh lift and breast lift

How to prepare for Body Lift surgery?

  • A thorough understanding of the procedure and its limitations are important. Ensure you get all the information.
  • Stop Smoking at least 2 weeks prior to the surgery day
  • Get all the necessary tests recommended by your surgeon
  • Eat healthy to ensure your protein and haemoglobin levels are good.
  • It may be required to have iron injections or even blood transfusion before or after the surgery, a good haemoglobin level is key to good healing and recovery.
  • Ensure you have all the pressure garments and medications necessary after the surgery.

What is the postoperative care after body lift surgery?

  • You will require 5-7 days of good rest at home; some procedures may require you to stay for 2-4 weeks.
  • It is recommended that you move around at home and do regular breathing exercises to prevent risks of deep vein thrombosis and chest infection.
  • Stop smoking preferably forever, but at least 2-4 weeks during the recovery period.
  • Keep taking your prescribed medications
  • Keep in touch with your surgeon and ensure you attend all follow up schedules
  • I personally prefer to keep the wounds dry and cover only with soft pads such as sanitary pads that absorb moisture and keep wound clean. I recommend not applying strong antiseptics/ alcohol or sealing the wounds, as it may be the cause of skin inflammation and infection.
  • Eat healthy

What are the risks and how to avoid them?

  • Any surgery may have risks of bleeding, hematoma, infection or wound breakdown. The surgeon would recommend you to stop all blood thinners such as aspirin, vitamin supplements etc. ensure you do not have any preexisting infection like boils, skin ulceration or cold and flu. During the surgery we take special precautions to avoid the above risks by giving Perioperative IV antibiotics, using tumescent fluid to prevent excessive bleeding and secure the wounds with multiple level of repair.
  • Risk of Deep vein thrombosis can happen if the surgery is prolonged and if there are comorbid conditions such as varicose veins, obesity, chronic smoking etc. I strongly follow DVT prevention protocol that includes stockings stating previous night of surgery, sequential pneumatic compression during the surgery and postoperatively while in hospital, injectable Klexane that helps thin the blood without increasing risks of bleeding.
  • Scar migration or stretching may happen due to inherent tissue weakness and collagen deficiency. We try and secure the wound along with anchoring to prevent this complication. Over-excision or overambitious tightening may also cause poor scar formation.
  • Residual skin laxity and bulges with asymmetries may happen and is often due to primary asymmetry in body, poor skin quality and lack of perfect judgment due to position of patient during surgery.
  • Changes in the result with time may happen due to continuing gravity effect, weight fluctuation, collagen breakdown. The tissues that appear very tight in the beginning always loosen up with time, the surgeon uses strong sutures to anchor the tissue but the body needs to eventually hold and heal in that position by producing enough and strong collagen.
  • Breast surgery carries the highest risk of dissatisfaction and loss of result with time. The surgeon will do his/ her best to choose the correct size implant with adequate breast lift. But it’s a marriage of inconvenience between two opposing forces of breast skin tightening and implant volume that may have unpredictable long-term outcome. Hence a revision surgery may be necessary in 6-9 months period. [ref- Paolo Montemurro,Mubashir Cheema, Per Hedén, Benchmarking the Outcomes of Single-Stage Augmentation Mastopexy against Primary Breast Augmentation: A Single Surgeon’s Experience of 905 Consecutive Cases Plastic and Reconstructive Surgery • August 2019 ]

Classification of Contour Deformities after Bariatric Weight Loss: The PittsburghRating Scale Angela Y. Song, M.D., Raymond D. Jean, M.D., Dennis J. Hurwitz, M.D., Madelyn H. Fernstrom, Ph.D.,John A. Scott, M.S., and J. Peter Rubin, M.D. Pittsburgh, Pa.

 

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
  • Body 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)

Dr. Sanjay Parashar

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Breast Clinic

Breast Augmentation – Evolution over the years and safest technique today

February 3, 2020

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)

Dr. Sanjay Parashar

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