Fat Injection (Fat Grafting)

Fat injection or grafting has broad applications in cosmetic surgery. Fat injected into areas requiring volume-enhancement produces safe, long-lasting, and natural-appearing results as volume is replaced to tissues where fat is diminished. Fat grafting usually involves harvesting fat from one part of the body,  purifying it, and the carefully re-injecting it with specially designed needles into the areas requiring augmentation. The procedure may need to be repeated several times to achieve the desired result.

Swelling, which is commonly seen after fat injection, usually resolves within 2-3 weeks. The degree of swelling is most dependent on the area injected.

Am I a good candidate for fat grafting?

Patients who benefit from fat grafting are people who desire augmentation or filling of volume-deficient areas. The most commonly grafted areas include the hands, face (including the lips), and depressions in the skin contour such as those that have developed following liposuction and scarring.

Generally, patients who are considered for fat injection are in good health. If you have a history of abnormal bleeding or swelling following a procedure you should notify your surgeon. A smoking history should be disclosed to your surgeon. Each patient’s anatomy and proportions vary, and the decision to utilize fat injection techniques depends on the goals of the patient as well as the surgeon.

Fat Injection Standard Procedure Techniques

All patients requesting consideration for fat injection require a thorough pre-procedure evaluation. This may require several visits to your surgeon before the procedure. A full history and physical examination will be performed prior to the procedure. Your surgeon may take pre-procedure photographs, an informed consent will be obtained, and your skin may be marked. Either local or general anesthesia may be used, depending on your surgeon’s preference.

Fat is harvested using a special suction cannula using sterile technique. Once enough fat is obtained from the donor area, it is then purified. This often requires the use of a centrifuge which spins the fat and removes impurities. The fat is then placed into the areas requiring augmentation. The injection needle is usually passed in and out of the areas to be augmented multiple times. This creates a ‘grid’ of threads of fat graft. The areas that were injected may then be massaged by the surgeon to create a satisfactory contour. A dressing may then be placed.

Fat Injection Benefits/ Advantages

Fat injection or grafting is a technique that is growing in popularity. Fat is one of most well-tolerated fillers available to aesthetic surgeons, and thus has broad applications. It is natural-appearing, lasts a long time, and is safe. It is an effective filler used for changing body contour, revising scars, filling depressions created by liposuction, and rejuvenating the hands and face. Perhaps most importantly, it spares the patient the inherent risks associated with fillers derived from animals or cadavers.

Fat Injection Risks/Complications/Patient Safety

  • Swelling is the most common post-operative side effect. Most of the swelling settles down within several weeks.
  • Bruising in both the donor and recipient areas as a result of bleeding. It is unusual to require a transfusion.
  • Numbness of the skin overlying the donor and injected areas. This is usually temporary.
  • Slight asymmetry or contour irregularity. This usually improves as the swelling resolves.
  • Under or over correction of the defect
  • Infection
  • Loss of fat viability, with resultant failure of the desired augmentation

Fat Injection Recovery Process

Dressings may be placed on the injected areas. These dressings may include the use of  tapes or compressive-type dressings. Your may also be instructed regarding a massage program after the procedure. Swelling and bruising usually resolve within 2 to 3 weeks.

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Tummy Tuck (Abdominoplasty)

Many have loose abdominal skin and fat that is concentrated in the abdomen and hence can benefit from abdominoplasty. Sometimes these conditions are inherited. In other instances, substantial weight loss may cause abdominal skin to become flaccid. Abdominoplasty also can tighten muscles that have been separated and weakened by pregnancy. The procedure may somewhat improve the appearance of stretch marks, especially those located below the navel.

Your Personal Consultation

During the consultation, you will be asked about the results you would like to achieve from abdominoplasty. This will help your surgeon to understand your expectations and determine whether they realistically can be achieved.

Am I a good candidate for abdominoplasty?

You may be a good candidate for abdominoplasty if you have one or more of the following conditions:

  • excess or sagging abdominal skin
  • an abdomen that protrudes and is out of proportion to the rest of your body
  • abdominal muscles that have been separated and weakened
  • excess fatty tissue that is concentrated in your abdomen

If you plan to become pregnant or lose weight in the future, you should discuss this with your plastic surgeon. Scarring from previous abdominal surgery may limit the results of your abdominoplasty.

How will my plastic surgeon evaluate me for abdominoplasty?

Your plastic surgeon may examine your abdomen while you are standing as well as lying down. Your skin tone and the degree of loose skin in the abdominal region will be assessed. Your surgeon also will evaluate the amount of excess fat in your abdomen and the condition of your abdominal muscles.

You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, pregnancies, previous surgeries and medications that you currently take. It is important for you to provide complete information.

Will my insurance help cover the cost of surgery?

Abdominoplasty, as an aesthetic (cosmetic) procedure, generally is not covered by insurance. In some instances, however, a patient may have a hernia and not just a spreading of the abdominal muscles. Insurance reimbursement may be available for that portion of the procedure that is not cosmetic.

Many factors determine your eligibility for coverage, including the specific terms of your insurance policy. A letter of predetermination may be required by your insurance company prior to surgery. Your plastic surgeon or a staff member in your surgeon’s office will discuss these matters with you.

How Abdominoplasty Is Performed

Individual factors and personal preferences will determine the specific technique selected to smooth and flatten your abdomen.

Where are the incisions placed?

Generally, a horizontal incision is placed just within or above the pubic area. The length of the incision, which extends laterally toward the pelvic bones, depends largely on the amount of skin to be removed. The contour of this incision will vary somewhat according to the structure of your abdomen and the style of bathing suit or undergarments that you prefer. Your plastic surgeon will try to keep the incision within your bathing suit lines, but this may not always be possible.

Generally, a horizontal incision is placed just within or above the pubic area. If there is loose skin above the navel, the surgeon may make a second incision around the navel. Skin in the shaded area is separated from the abdominal wall.

Some patients have loose skin above the navel. In such cases, the surgeon may make a second incision around the navel so that the redundant skin above it can be pulled down. The excess abdominal skin is then removed. The position of the navel remains unchanged.

To tighten the abdominal wall, the surgeon brings loose underlying tissue and muscle together with sutures.

Skin of the lower abdomen that contains stretch marks may be removed as well. Any remaining stretch marks may be somewhat flattened and improved, but you should not expect a dramatic change in their appearance.

Abdominal skin is pulled downward, and the excess is removed. A small opening is made to bring the  navel through.

The procedure may include tightening of the underlying abdominal muscles using sutures.

What are some variations to the common abdominoplasty technique?

There are many variations both to the design of the incisions and the technique itself. In some instances, it may be possible to avoid an incision around the navel. When the amount of loose skin is minimal and the excess fat deposits are located below the navel, a short horizontal incision is all that is necessary. This procedure is called a partial, or “mini,” abdominoplasty.

Sometimes liposuction may be used alone, or in conjunction with abdominoplasty, to remove abdominal fat. Endoscopic abdominoplasty is another technique for minimizing scars and may be useful when patients have only a mild degree of excess fat and muscle laxity.

Your plastic surgeon will discuss with you the particular method that he or she recommends for achieving the best result in your particular case.

Understanding Risks

Fortunately, significant complications from abdominoplasty are infrequent. Every year, many thousands of people undergo successful aesthetic surgery of the abdomen, experience no major problems and are pleased with the results. Anyone considering surgery, however, should be aware of both the benefits and risks.

I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?

The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your plastic surgeon, or with a staff member in your surgeon’s office.

Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Tissue loss along portions of the horizontal incision is a possibility when the abdominoplasty is very extensive. This complication, which delays healing and prolongs recovery, is more common in patients who smoke or have medical conditions such as diabetes. Revisionary surgery is sometimes helpful in certain instances where incisions may have healed poorly.

Following surgery, occasionally, fluid may accumulate under the skin. Removal of this serum is a painless process but may require several visits to the plastic surgeon’s office.

You can help to lessen certain risks by following the advice and instructions of your plastic surgeon, both before and after surgery.

Your Surgical Experience

The goal of your plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible.

How should I prepare for surgery?

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Abdominoplasty may be performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you for at least the next day or two. When abdominoplasty is performed in conjunction with medically necessary procedures such as hysterectomy or hernia repair, a short hospitalization may be required.

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How will I look and feel initially?

The day after surgery, you will be encouraged to get out of bed for short walks to promote blood circulation. Although you may not be able to stand up completely straight, it is best if you do not sit for long periods of time during the first several days. Straining, bending and lifting must be avoided, since these activities might cause increased swelling or even bleeding. You may be instructed to sleep on your back with a pillow under your knees.

Any surgical drains probably will be removed within a week following surgery, at which time your dressings may also be changed or removed. Depending on the abdominoplasty technique used, you may be instructed to wear a support garment for several weeks. Generally, stitches will be removed in stages over a period of approximately one or two weeks.

You will notice swelling and bruising, which is to be expected. The bruising and much of the swelling will disappear over a period of weeks. However, it may be months before all swelling subsides and you see the final result of your abdominoplasty. You may also notice some numbness over portions of the abdominal area, and this may persist for several months. Incisions will initially be red or pink in color. They will remain this way for many months following surgery and may even appear to worsen before they finally begin to fade.

When can I resume my normal activities?

It is important to realize that the amount of time it takes for recovery varies greatly among individuals. Depending on the extent of your abdominoplasty and your general physical condition, you may be able to return to non-strenuous work anywhere from one to three weeks after surgery. In many instances, you can resume most of your normal activities, including some form of mild exercise, after a few weeks. You may continue to experience some mild, periodic discomfort and swelling during this time, but such feelings are normal. Severe pain should be reported to your doctor.

Any sexual activity should be avoided for a minimum of two weeks, and your plastic surgeon may advise you to wait longer.

Results of Your Abdominoplasty

Abdominoplasty will enhance your body contour by making your abdomen firmer and flatter. You may find that you feel more comfortable in your clothing and are more confident about your appearance.

The incisions from the procedure will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible. In some instances, they will eventually be only faint lines. Certain individuals may have incision lines that are more noticeable. Fortunately, the incisions for your abdominoplasty are usually in locations concealed by most bathing suits and undergarments.

How long will the results last?

Unless you gain or lose a significant amount of weight or become pregnant, your abdomen should remain firmer and flatter for many years. However, gravity and the effects of aging will eventually take their toll. If, after a period of years, you again become dissatisfied with the appearance of your abdomen, you may choose to undergo a second procedure to restore a more youthful body contour.

For appointments call

Dr Sreekar harinatha 9902223733 or email at drsreekarh@yahoo.com

Courtesy- ASAPS

Breast Reduction

Patients who undergo breast reduction surgery frequently are seeking relief from physical symptoms caused by the excessive weight of large breasts. Breast reduction usually can solve these problems as well as improve the size and shape of your breasts. Following breast reduction, your breasts will be more proportional to the rest of your body, and clothes will fit you better.

Before

Am I a good candidate for breast reduction?

You may be a good candidate for breast reduction if you have one or more of the following conditions:

*breasts that are too large in proportion to your body frame heavy,

*pendulous breasts with nipples and areolas that point downward

*one breast is much larger than the other

*back, neck or shoulder pain caused by the weight of your breasts

*skin irritation beneath your breasts

*indentations in your shoulders from tight bra straps

*restriction of physical activity due to the size and weight of your breasts

*dissatisfaction or self-consciousness about the largeness of your breasts.

Breast reduction can be performed at any age. Childbirth and breast-feeding may have significant and unpredictable effects on the size and shape of your breasts. Nevertheless, many women decide to undergo breast reduction before having children and feel that they can address any subsequent changes later. If you plan to breast-feed in the future, you should discuss this before surgery.

During the consultation, you will be asked about your desired breast size as well as anything else about your breasts that you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they realistically can be achieved.

How will yo be evaluated for breast reduction surgery?

Your plastic surgeon will examine your breasts and taking measurements for your medical record. The size and shape of your breasts, the quality of your skin, and the placement of the nipples and areolas will be carefully evaluated. You should tell your plastic surgeon if you plan to lose a significant amount of weight, particularly if you have noticed that your breasts become smaller with weight loss.

Will my insurance help cover the cost of surgery?

Insurance coverage is sometimes available for breast reduction surgery. Many factors determine your eligibility, including the specific terms of your insurance policy and the amount of breast tissue to be removed. A letter of predetermination may be required by your insurance company prior to surgery. Your plastic surgeon or a staff member in your surgeon’s office will discuss these matters with you.

Where are the incisions placed?

Individual factors and personal preferences will determine the specific technique selected to reduce the size of your breasts. The most common method of reducing the breasts involves three incisions. One incision is made around the areola. Another runs vertically from the bottom edge of the areola to the crease underneath the breast. The third incision follows the natural curve of the breast crease. After the surgeon has removed excess breast tissue, fat and skin, the nipple and areola are shifted to a higher position. The areola, which in large breasts usually has been stretched, also is reduced in size. Skin that was formerly located above the nipple is brought down and together to reshape the breast. Liposuction may be used to improve the contour under the arm.  The nipple and areola remain attached to the underlying tissue but are shifted to a higher position. The size of the areola is often reduced at the same time. The ability to breast-feed may also be preserved by this method, although this cannot be guaranteed. Skin that formerly was located above the nipple is brought down and together to reshape the breast.

I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?

The subject of risks and potential complications of surgery is best discussed on a personal basis. Some of the potential complications that may be discussed with you include bleeding, infection and reactions to anesthesia. Following reduction, sometimes the breasts may not be perfectly symmetrical or the nipple height may vary slightly. If desired, minor adjustments can be made at a later time. Permanent loss of sensation in the nipples or breasts may occur rarely. Revisionary surgery is sometimes helpful in certain instances where incisions may have healed poorly. In the unlikely event of injury to or loss of the nipple and areola, they usually can be satisfactorily reconstructed using skin grafts.

How should I prepare for surgery?

Depending on your age, or if you have a history of breast cancer in your family, your plastic surgeon may recommend a baseline mammogram before surgery. Following breast reduction, you will still be able to perform breast self-examination. Breast reduction surgery will not increase your risk of developing breast cancer. If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions. Breast reduction surgery may be performed on an inpatient or outpatient basis. If you are to stay in the hospital or surgical facility, it will most likely be for only one night. Whether you are released the day of surgery or the following day, you will need someone to drive you home and to stay with you for the next day or two.

What will the day of surgery be like?

Usually, a general anesthetic is administered, so that you will be asleep throughout the procedure. When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. In many instances, small drain tubes will have been placed in your breasts to help avoid the accumulation of fluids. Gauze dressings will be placed on your breasts and covered with an elastic bandage or surgical bra.

How will I look and feel initially?

The day after surgery, you will be encouraged to get out of bed for short periods of time. After several days, you will be able to move about more comfortably. Straining, bending and lifting must be avoided, however, since these activities might cause increased swelling or even bleeding. You may be instructed to sleep on your back to avoid pressure on your breasts. Any surgical drains will be removed a day or two after surgery, at which time your dressings may also be changed or removed. You will be instructed to wear a support bra for a few weeks, until the swelling and discoloration of your breasts diminishes. Generally, stitches will be removed in stages over a period of approximately three weeks, beginning about one week after surgery. You may notice that you feel less sensation in the nipple and areola areas. This usually is temporary. It may, however, take weeks, months or even more than a year before sensation returns to normal. Your breasts may also require some time to assume a more natural shape. Incisions will initially be red or pink in color. They will remain this way for many months following surgery.

When can I resume my normal activities?

After breast reduction surgery, it is often possible to return to work within just a couple of weeks, depending on your job. In many instances, you can resume most of your normal activities, including some form of mild exercise, after several weeks. You may continue to experience some mild, periodic discomfort during this time, but such feelings are normal. Severe pain should be reported to your doctor.

How long will the results last?

Unless you gain or lose a significant amount of weight or become pregnant, your breast size should remain fairly constant. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman’s breasts. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast “lifting” procedure to restore their more youthful contour. Results of Breast Reduction Breast reduction surgery will make your breasts smaller and firmer. Without the excessive weight of large breasts, you may find greater enjoyment in playing sports and engaging in physical activity. The incisions from your breast reduction surgery will heal and fade over time. It is important to realize, however, that the incision lines will be permanently visible, more so in some individuals than others. Fortunately, the incisions for breast reduction are in locations easily concealed by clothing, even low-cut necklines. Breast reduction often makes a dramatic change in your appearance. For this reason, it may take some time to adjust to your new body image. Most women, however, eventually become comfortable with their smaller breasts and feel very pleased with the results of surgery.

For appointments call Dr Sreekar Harinatha at 9902223733.

email: drsreekarh@yahoo.com

website: www.bangalorecosmetic.com

Courtesy- ASPS