Frequently Asked Questions

• What is Plastic Surgery?

  A Plastic Surgeon is most usually equated to Cosmetic problems & next to a Burns injury. However, Plastic Surgery is essentially a surgical super-specialty that deals with healing of any wound/ulcer, correction of deformity-disability and improving the form or beauty of the human body. What began as a specialty to treat complex wartime injuries now has now developed to include a lot more.

• What the various procedures done in Reconstructive and Plastic Surgery?

  As Plastic Surgery techniques slowly developed from 1950 onwards, two essential benefits of the techniques became obvious. To do surgeries previously thought impossible-eg. Reattaching a hand that has be completely cut (amputation); to do surgery with dramatic difference in the results compared to conventional techniques-eg. Hand surgery or face surgery. Slowly, the Specialty expanded to include the following sub-specialties today:

  1. Care for complicated wounds
  2. Burn injuries: fresh wounds & old burn complications
  3. Trauma Reconstructive Surgery-restore or repair body parts damaged by injury
  4. Cranio (Maxillo) facial surgery- Surgery of the face
  5. Trauma reconstructive Surgery
  6. Hand and Nerve Surgery
  7. Microvascular Surgery
  8. Cancer Reconstructive Surgery

  And finally Aesthetic (Cosmetic) Surgery

• So what are the principles of Plastic Surgery that are common to all these procedures?

  Reconstructive & Plastic Surgery, as the specialty is correctly called, involves use of certain fundamental principles that include sound planning, delicate technique, gentle tissue handling and giving predictable results. The change in condition of a person following a Plastic Surgery procedure is evident to the naked eye of a even a layman; this places an enormous responsibility on the Plastic Surgeon to achieve perfection as even minor shortcomings are very obviously seen.

• In that case, what does the 'Plastic' in 'Plastic Surgery' mean?

  'Plasticos' is a Greek word meaning 'to mould' ; a Plastic Surgeon usually needs to cut and reshape body tissues to achieve desired results-just as the material Plastic can be molded into various shapes for different purposes. A Plastic surgeon does the same to body tissues to achieve the required goals. Unlike commonly thought, we do not use any 'plastic' material in our work. Sometimes, we use more advanced 'artificial material' for some problems. This is similar to using rods, plates, screws for fracture surgery.

• What is Cosmetic Surgery?

  Cosmetic (aesthetic) surgery involves use of Reconstructive Surgery techniques/principles for either restoring beauty of a body part when it is lost, or occasionally even enhancing it beyond normal
  The loss of beauty may be due to birth problems, age related changes, accidents, infections or any other cause.

• What are the benefits of Cosmetic Surgery?

  A pleasant appearance can open doors to new opportunities whereas unattractive looks may find the same avenues closed. People decide to have cosmetic surgery to correct or improve their appearance; this improves their self esteem and confidence
  On the face, even minor changes in the shape, size or position of any part can dramatically change existing appearance to give the desired look. Eg: cheek dimple creation, baggy eyelid correction or wrinkle removal. There are different procedures for each part such scalp, hair, as forehead, eyes, cheek, ears, lips, chin and neck.

• What cosmetic surgery procedures are performed to improve the aging face?

  There are various degrees and stages of facial aging that can be caused by the natural aging process, heredity, and lifestyle choices. Different procedures are available to correct these problems to restore a youthful look (facial rejuvenation). It may involve office (day care) procedures that can be done without hospitalization such as dermabrasion, Botox or filler injections. When needed, surgical procedures are used to address particular problems A face lift tightens and lifts the redundant skin in the face and neck. Additional procedures are available to improve the aesthetics of other parts. Fine wrinkles of the face may be best treated by skin resurfacing techniques, like laser resurfacing, chemical peels or other skin care treatments.

• What surgery can improve the appearance of breasts?

  Three common procedures are performed: breast augmentation, breast lift, breast reduction.

  Augmentation mammoplasty is a procedure that can safely enlarge a small breast or increase an undesired size. Though there were some safety concerns about silicon breast implants a decade ago, it is now widely used with approval of the US-FDA. A standard surgical procedure can bring dramatic improvement in physical appearance and personal life of judiciously selected patients.

  Breast lift is used when the patient is happy with the size of her breasts however due to aging and pregnancy the breast gland has begun to droop. Various techniques are employed to accomplish a breast lift and results are generally excellent.

  Breast reduction is designed to make overly large breasts smaller. Patients seeking this type of surgery often have multiple severe physical symptoms secondary to their large breasts including neck, shoulder, back pain, paresthesia of the arms and bra strap grooving of the shoulders; most are almost always improved after a breast reduction if not completely eliminated. This procedure is often covered by insurance.

  Enlarged male breasts that cause major embarrassment in teenagers & adults can be corrected effectively by Liposuction.

• Doctor, can you give us some idea of Liposuction, which seems to be popular nowadays?

  Liposuction is typically performed in patients that have an area of fat they find hard to lose. The fat removed does not weight a lot, so patients should expect a shape change, not a weight change. Liposuction is not used for weight loss, rather to correct problem areas or fat bulges. A suitable candidate will be close to their ideal weight. Liposuction results are long lasting, as long as the patient maintains a healthy life-style, including exercise and a sensible diet, If the patient gains weight after surgery, the shape correction may be lost
  Though most body areas can be treated with liposuction, the most common areas in females are the abdomen, hips, and thighs, and in men are the breasts, hips, and abdomen. Liposuction is not limited to these areas, though other places may include the upper arms, under the chin and the buttocks.

• Will I have a scar after plastic surgery?

  Scarring is inevitable of healing, however a very fine lined scar placed in the correct orientation may be virtually invisible. A plastic surgeon spends years trying to master techniques to place scars in the most desirable location. Plastic surgeons will try to make incisions in areas that will not show, like under undergarments or along natural creases. Scars will normally fade over time, but certain areas of the body such as the back and chest, produce more severe scarring regardless of the technique used for reconstruction and closure. The severity of the scarring varies from person to person.

• Are there any risks involved in doing a Plastic Surgery procedure?

  The general risks are as with any other surgical procedure, such as bleeding and infection-these do not cause a problem usually. One risk unique to Plastic Surgery is from an attempt to overdo the procedure. Our team has devised few simple but effective ways that have kept these risks to the bare minimum in all our cases.

  1. Use good quality human and material infrastructure.
  2. Adequate pre-operative consultations, to emphasize.
     • main aim is to provide a natural result
     • to avoid overdoing, as this increases risks & complications.
     • to ensure the patient's expectations are justified by the surgeon's findings.
     • suggest the various available options for the given problem; suggest the simplest one to provide safe & predictable results.
  3. Post-operative care to address all concerns adequately.
  4. Make sure the procedure is tailor-made for each patient by paying attention to even the minor variations, though the basic problem might be the same

• What precautions/preparations are needed before a Plastic Surgery procedure?

  1. Smoking, if any, needs to be stopped at least 3 weeks before surgery.
  2. Blood thinning medicines such as Aspirin need to be stopped 2 weeks before surgery.
  3. One adult person has to accompany the patient while in the hospital at all times.
  4. Fasting for about 7hours prior to surgery is essential to ensure the anaesthesia proceeds smoothly.
  5. Details of medical problems, past surgery-anaesthesia and allergy/reactions have to be informed to the surgeon at the first meeting to ensure adequate precautions are taken.
  6. Clipping of hair in the operative area is usually not needed, especially over the face.

  Specific preparations for each surgery will be mentioned by the surgeon as needed.

• How is Plastic Surgery different from other other similar superspecialty branches such as Neurosurgery or Cardiac Surgery?

  The vast variety in treatment options & the risk of even minor variations/errors causing dramatic, easily visible changes to the final result make this specialty unique. The essential similarity in all the specialties is the dedicated, intense training needed to qualify as a Specialist after initially qualifying as a General Surgeon.

• Why do people hesitate to approach a Plastic Surgeon?

  It is the fear of the unknown. I use this opportunity to clarify few wrong notions.

  1. Plastic Surgery is expensive.
  2. Plastic Surgery is only for cosmetic purposes.
  3. Plastic Surgery is only available in the metro cities.
  4. Cosmetic Surgery is only for the rich & the Elite.

  Answers to each of these are as follows:

  1. cost of Plastic Surgery procedures is similar to the cost of an average Orthopaedic, Gynaec or General Surgery procedure. only when artificial materials are used in the surgery, as needed sometimes in cosmetic surgery, does the additional cost come in. finally the benefits of doing the procedure in a Tier C city are tremendous. Usually only the costs of procedures in Metro cities are usually heard of, creating the wrong notion.

  Indirect cost benefits from efficiently done procedures include those due to early recovery & discharge from hospital and due to minimal disability & early return to work.

  2. This i have explained just before.
  3. My work in Mangalore just disproves this.
  4. Cosmetic (Beauty/Appearance) problems in the rich & affluent have one fundamental difference in similar problems among the average/lower economic class.

  While the former seek to enhance beauty that is presently normal, the latter seek to restore to normal what is presently lost /damaged. The former is to cater to a person's vanity, the latter caters to a social need, especially when beauty/appearance is severely abnormal/distorted.

• do you find family members reluctant to support when someone wants correction for cosmetic problems?

  Yes, I have seen this quite often. It is mainly due to the wrong notions that I have mentioned before. The relatives are usually not as well informed as the person who is searching for a remedy for his or her problem.

  As part of our work, a Plastic Surgeon has an obligation to society to create awareness among general public that

  1. The latter (restoring beauty from abnormal to normal) need is socially & medically justified,
  2. Corrective surgery can be done safely by using scientific methods, so long as the person's expectations are reasonable.
  3. Treatment for these problems are accessible & affordable.
  4. While the former may be medically risky, the latter can usually be done safely by sticking to scientific methods.

  I shall give 2 examples to illustrate the difference between cosmetic problems that are medically/socially justified and when they are not.

  Consider an adult, male or female, with a deviated nose; at one end is a minor tip deviation/enlargement and the other side is a similar person with gross deviation of the entire nose resulting in difficulty in breathing & nasal blockage. The former problem may not be appreciated by everyone, the latter nobody can deny. Attempt to do the surgery in the former has a higher risk of complications, the latter has lesser risks. Successful surgery and a satisfied patient are very likely in the latter-provided a trained surgeon does the job; in the former case, there is very high chance of post-operative problem and unhappy patient-even in the hands of a qualified surgeon.

  Another common issue among ladies is a loose/sagging breast. Loss of a normal condition due to sagging or enlargement is a major psychological blow for a modern lady, which a male partner or even a lady from the older generation may not appreciate. Very often, the breast size problem can be socially embarrassing and even lead to strap marks, shoulder & neck arthritis. (joint problems). Safe, smooth correction of these problems by surgery is extremely gratifying.

  Once family members realize this, they are very supportive.

• What should the common man look for in a Plastic Surgeon before a consultation?

  As with any other service, the risk of poor quality service can be minimized prior to using the facility.

  1. As Plastic Surgery procedures have a high level of sophistication, look for training and experience in choosing your Surgeon, this is more so with Cosmetic Surgery. Even in the US, inadequately trained/self-proclaimed Cosmetic Surgeons are available at every nook and corner.
  2. Don't compromise on cost beyond an extent for sake of quality. A qualified Plastic Surgeon needs 14-15 years of rigorous medical training before beginning to work independently.
  3. A Cosmetic Surgeon without a training/background in Reconstructive surgery is an invitation to disaster, both for the surgeon & the patient. Cosmetic surgery, when it began 25yrs ago, essentially involves reconstructive surgery principles applied to restore/enhance the form/appearance/beauty of the human body. The same principles, when applied in someone with a disability/deformity, is called as Reconstructive Surgery.

  One simple way to ensure the above is by verifying the Surgeon is a member of the local Plastic Surgery Association, members of the Indian association are listed statewise on their webite www.apsi.org.in

• Since Cosmetic Surgery is mainly to make a person happy, is there any way to predict how happy the person will be after undergoing the surgery?

  Yes, it can be reasonably predicted, it is essential to predict this, as it is better to avoid a situation where patient is unhappy in spite of surgery. When the physical findings (on examination) are out of proportion to the severity as perceived by the patient, risk of an unsatisfied patient after surgery is high.

• What is the need for Plastic-Reconstructive Surgery services in India?

  Unlike the west, the need for Reconstructive Surgery procedures in our population is very high. Poor awareness leads to people being deprived of the benefits of medical advancement. Our needs are mainly treatment of chronic wounds as in diabetic, bed sores, correction of hand, limb & face deformities as in leprosy, birth defects of hands-face and deformities due to accidents.

  In the absence of reconstructive surgery, such a problem in the working age group leads to prolonged loss of wages, high treatment costs due to lengthy conventional treatment. Suitable involvement of the Reconstructive surgeon will prevent these problems from arising, and minimize treatment problems once they have appeared.

  The cost savings for the individual & the health care system, whether pubic or private are enormous.

  We Plastic Surgeons, regularly hold camps in urban & rural areas with the help of public organizations such as Rotary, to improve awareness & provide better services.