Dr. Lalit Choudhary

Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, degree of invasiveness, and special instrumentation.

There are many changes that take place in our face and body as we start ageing. While the face starts to show the signs of ageing earliest-in the form of wrinkles and fine lines as well as a sagging chin and neck, the effect of ageing on the body might be slightly late. The skin may sag or you may end up putting on weight in various parts of the body like upper arms, which may look unsightly and bring down your level of confidence as well. Signs of ageing can often make you shy away from living your life to the fullest.

For the sagging upper arms, one can always get a procedure called an Arm lift. This is also called a Brachioplasty. This is a cosmetic procedure that can be conducted to tighten the skin of the arms from the elbow upwards. Let’s see how this procedure works.

What does it do?

• Excess fat tends to accumulate in both arms togather with weight gain. Person face laxity in this area after massive weight loss or with body ageing.
• Arm Lift is a surgical procedure to tighten the skin in the arms through the removal of excess fat deposits as well as skin.

Who can opt for this surgery?

Any person who is medically fit having arm disfigurement can opt for this procedure. Patients who have signs of ageing or excessive weight gain are the best candidates for this kind of surgery. Also, it may be used by the patients who are suffering from sagging skin after losing a great deal of weight which may lead to an appearance of bat’s wings on the sides.

How is this procedure conducted?

This surgical procedure is conducted by a Cosmetic Plastic Surgeon. It’s a day-care procedure. The doctor begins by marking the various areas of concern having excess fat and flabby skin. Thereafter, the doctor proceeds to remove the excess skin so that the arms are tightened getting more youthful look. This is done under anaesthesia to make patient pain-free. The skin that is removed is usually shaped like an ellipse. In many cases, there may be a need to conduct a liposuction if the patient has excess fat as well. Once the excess skin has been removed, skin edges are approximated with meticulous sutures with various Plastic Surgery techniques.

Recovery usually takes 5-7 days. Person can resume routine activities from very next day. Sometimes you might be advised a pressure garment for better outcome.

In case you have a concern or query you can always consult an expert & get answers to your questions!

It is a condition that causes discoloration and discolored patches to appear on the skin. The color of one’s skin is determined by the production of melanin in the body, and hyperpigmentation is caused by a disproportionate production of melanin. People of any race or skin color can be affected by this condition. The most common pigmentation problems are brown sun spots, melasma, age spots, and pigmented birthmarks.  Pigmentation issues very depending on the natural colour of the skin. Treatments include fade creams, IPL, Elos Aurora, laser treatments like Fraxel Dual and in some cases biopsy or skin excision is required to exclude skin cancer such as melanoma.

Three skin irregularities caused by this condition are; Post Inflammatory hyperpigmentation, Lentigines (or sun spots) and Melasma.

1. Treatment of brown sun spots: Many people have mottled brown spots, freckles and patches on their skin due to excess pigmentation. These are easily treated with medical grade Elos IPL or Fraxel Dual laser. There is a range of different causes of pigmentation. Treatments differ depending on what type of pigmentation is affecting your skin. The brown pigmentation is called melanin and is made by special cells in the skin called melanocytes. The main categories of pigmentation problem are freckles, age spots, (also called liver spots or sun spots) melasma and postinflammatory hyperpigmentation. 
2. Melasma: Women with a genetic predisposition to this condition or those with darker skin complexions and those who have a higher exposure to ultraviolet rays are most commonly affected by melasma. It is a condition that affects the areas of the skin that are most exposed to the sun. It involves female hormones and so women who are pregnant are generally affected by melasma. Melasma is blotchy areas of brown skin pigmentation on the face. Melasma, (also known as chloasma), appears as blotchy pale brownish pigmentation on the face, especially forehead, cheek and upper lip. It is more common on darker skin types. It is especially common in women aged 20-40 and is associated with pregnancy or taking the contraceptive pill or injection. It also happens in healthy, non-pregnant woman taking no medications and men using aftershave. Sun exposure following some cosmetics can cause a phototoxic reaction where the chemical substance absorbs UV light. The resulting pigmentation extends where sun and cosmetic use have coincided, for example down the neck, often more on the right side in countries that drive on the left. Melasma is more stubborn and unpredictable to treat than freckles or age spots because the melanocytes have become sensitized and continue to produce extra pigment with even the slightest hint of sun. Sun protection is an essential part of treatment. Melasma can be treated with Active FX Laser Resurfacing. It destroys up to 80% of melanin, efficiently, which is ideal for cases of melasma that cause excessive pigmentation of skin.
3. Lentigines: Minute brown spots that appear on your face and body, which is the collective result of continuous exposure to the sun, photodamage or chronic sun damage, are called lentigines. The spots usually have a visibly distinct border and appear on areas most exposed to the sun such as the face and hands.

How is one affected by post inflammatory pigmentation?
If there is an excessive production of melanin in the body, it could then overflow to the surface of the skin; this is caused by an inflammation. Post inflammatory pigmentation is the formation of brown patches on the skin that are the result of infection, injury or other conditions. Patients who already have a skin problem are more likely to be affected by this condition.

Post inflammatory hyperpigmentation (PIH) occurs after injury to the skin from whatever cause and is far more prevalent in darker skin. PIH appears as a dark brown area over the area of the previous injury and is due to excess melanin being produced by melanocytes as a result of the inflammation. Typically PIH resolves over several months but can persist for 1-2 years and in some cases can be everlasting. Treatment is generally patience as it will resolve and treatments risk further inflammation and therefore further PIH.  However hydroquinone can be useful in some patients and others benefit from mild treatments of Elos Aurora, IPL or Fraxel Dual laser.

Treatment of freckles

Freckles are small flat brown marks on sun exposed areas. The medical term is ‘ephilide’ and they are an accumulation of melanin in the surface skin cells (keratinocytes). The tendency to form freckles is inherited and is often seen in red heads and younger people. Freckles usually fade in winter and reappear in summer. They need no treatment except sun protection. They can also be faded by Elos IPL, but will reappear with sun exposure. No treatment can transform a skin which freckles, into one which tans evenly.  Of course, further sun exposure can bring the freckles out again so it is very important to apply a good sunscreen following treatment to maximise results.

How does laser treatment help to remedy hyperpigmentation?

• Clear and Brilliant, Fraxel and Photofacial are three types of laser treatment that have been known to resolve hyperpigmentation.
• Short bursts of energy and heat are produced by the laser and aimed at the cells that have a concentration of melanin. The excess melanin from these cells is then broken down and destroyed with the help of the laser.
• Each case of hyperpigmentation varies, and their treatment varies on the extent of the condition as well. The treatment will be administered over a course of sessions.

Though these treatments are effective, one must always stay protected from damage due to overexposure to the sun, by wearing the sunscreen with the correct SPF and other sun gear. 

In case you have a concern or query you can always consult an expert & get answers to your questions!

Cosmetic surgery is not restricted to the top half of your body. Today along with facelifts and breast implants, butt implants are also gaining popularity. This procedure is also known as gluteal augmentation. Butt implants are usually made of silicone. These soft, solid structures are implants under the gluteus maximus muscles and above the pelvic bone through an incision. The incision is typically made in the butt crease so that it is less noticeable. Here are a few others things you should know about butt implants:

1. It is performed under anaesthesia: Butt implant surgery may be performed under local or general anaesthesia and usually takes anywhere between 2 to 7 hours. However, this procedure is usually an outpatient procedure and no hospitalisation is required.
2. It takes time to recover: After the procedure, you will probably notice swelling and tenderness in the area. In most cases, the patient is advised to wear a compression garment for a few days after the surgery. This should resolve itself in about 4-6 weeks but complete recovery can take up to 8 months. This is because the tailbone muscles are cut during the procedure.
3. The effects are permanent: Silicone implants can last a lifetime and hence the results of this surgery are permanent. With time the body’s natural tissues merge with the implant. However, in some cases, the implant may slip with time causing an asymmetrical appearance. This can be corrected through a follow-up surgery.
4. Anyone can get a butt implant: Butt implants are typically used for people with a flat posterior, but you don’t necessarily need to have a skinny frame to undergo this procedure. Also, there are no size or weight limitations to getting the procedure.
5. It is customisable: Butt implants can be customised to suit the person’s size and frame. A surgeon will typically take into account the shape of the patient’s pelvic bone and natural butt contours to create a butt implant that enhances the patient’s frame and does not look unnatural.
6. There are risks: Complications are rare but possible with this surgery. Making an incision under the butt crease reduces its visibility but increases the risk of infections. There is also a risk of allergic reactions to anaesthesia. Other possible side effects include pain, discomfort, nerve damage and reduced sensitivity.
7. They do not feel completely natural: Silicone butt implants may feel harder than normal tissue and at some angles may not look very natural remove these and post more of positive aspects.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Most men, about 60%, see some development of breast tissue in their lifetime. This growth could be round, symmetrical and occurs bilaterally. This growth of breast tissue in males is medically known as gynecomastia.

Causes:

• The most common cause is an imbalance between the oestrogen and androgens, with excessive oestrogens leading to the growth of breast tissue.
• Excessive use of anabolic steroids
• Obesity
• Unknown reasons

It can affect men of all ages, and if this presents as a serious problem, then surgery is the most definitive form of treatment.

Surgical options: There are two major options available for correcting gynecomastia – liposuction and excisive surgery.

Liposuction:

• Done either under local sedation or under general anaesthesia depending on the extent of the tissue proliferation
• A small incision is made either in the armpit or around the areola
• Excessive fat tissue and breast gland tissue are suctioned out
• The chest contour also is altered at the same time, if desirable
• Post-surgery, the person is made to wear a compression garment for the first few days
• This helps in keeping the tissue in place and also helps reduce swelling
• Healing takes about a couple of weeks’ time, depending on the person’s overall health status and the extent of surgery.

Excisive surgery:

• This is done when the extent of gynecomastia is more severe
• These people would have sagging, stretched skin around the breast area
• More amount of fat and glandular tissue can be removed through excision
• This is more often done under general anaesthesia
• The incision is often done around the areala (dark portion around the nipple) so it is concealed or along the natural creases which are formed due to excessive breast tissue
• Excessive breast tissue is removed and the incisions are closed
• There could be swelling, pain, bruising, and higher chances of post-surgical infections
• Recovery will take about ten days to two weeks
• Refraining from exercise is often advised for up to 2 weeks

Benefits:

• Restore a masculine appearance
• Shorter surgery
• Faster recovery
• Minimal or invisible scars
• Almost immediate results that can be dramatic
• Improved confidence and self-image

After the surgery:

• Surgery is definitely a sure way to remove the male breast tissue, it is almost a permanent treatment for this condition.
• It is very important to get a trained, experienced surgeon for the procedure
• It is important to follow post-op instructions including pain management, infection control, and recovery
• If it was caused by use of steroids or obesity, lifestyle modification is essential to prevent recurrence

In case you have a concern or query you can always consult an expert & get answers to your questions!

Losing weight is a challenge for most people but even more so for those suffering from obesity. With rigorous dieting and exercising you may lose fat but in the case of obese patients, this weight loss leaves behind sagging skin. Surgery is the only solution to this problem.

A tummy tuck of abdominoplasty is a procedure that removes excess fat and skin from the abdomen to create a firmer, more appealing silhouette. A tummy tuck may also be advised for women who have recently given birth and want to get back to their original figure. Most people fear going into surgery as every surgery has its own risks but a tummy tuck procedure is considered quite safe and hence need not be a cause for concern.
An abdominoplasty is usually performed under sedation or general anaesthesia. A horizontal incision is made between the navel and the pubic region. The length of this incision depends on the amount of excess skin to be removed. In some cases, an incision may be needed above the navel as well. The stubborn abdominal fat is removed and the muscle structure is repaired before pulling the skin taut and removing all excess skin. In most cases, the naval will also need to be shifted. The incisions are then closed with sutures or staples and allowed to heal.

It can take about 2 weeks for the results of a tummy tuck surgery to be visible. This is because most patients experience swelling for a few days after the surgery. The results of a tummy tuck surgery last fo as long as the patient can maintain his or her weight. For this reason, patients are usually advised to lose some weight and reach a stable weight before the surgery. In cases of excessive obesity, a single surgery may not be enough to recontour the abdomen and a follow-up procedure may be needed.

A tummy tuck surgery is not considered a weight loss procedure and hence putting on weight by following an unhealthy diet and neglecting exercise can detract from the results of a tummy tuck. For this reason, you may be advised to follow a strict diet after the surgery. This procedure is also not advised for women who are planning a family and have a high probability of pregnancy.

In case you have a concern or query you can always consult an expert & get answers to your questions!

One of the effects of ageing is the double chin that is caused due to extra fluid or fat under the chin. It could also be due to increased weight, sagging skin, or merely genetic. Given that it produces an aged appearance, people with double chin are constantly trying to find ways to hide it. There are two main muscles in the neck area, and toning them helps to remove the double chin appearance. There are grooming tips like specific kinds of clothes, hairstyle, and makeup to conceal it. There are also some exercises which are believed to reduce the prominence of the double chin. However, these are temporary measures, and for a permanent solution, surgical correction is the only method of choice.

Some of the new methods to get rid of the double chin are listed below with some important additional details. Talk to your surgeon and understand what to expect before going ahead with the surgical correction.

1. Kybella: Approved by FDA, this is the new wonder drug to correct double chin. With no surgery involved, all it takes is about half an hour. The area is injected with a local anaesthetic and then Kybella. This contains deoxycholic acid, which is an enzyme that the body also produces naturally. This helps break down fat cells and so after a couple of weeks, the double chin gradually begins to literally melt away. Depending on the desired results, repeat injections might be required at monthly intervals. There could be mild swelling in the initial couple of days, which will subside shortly. The result would be a more defined chin line, producing a slimmer appearance.
2. CoolMini: This involves freezing the fat and massaging it to remove the double chin. This is a form of chin sculpting and is preferred in people with good skin tightness. Results will be evident in about 1 to 3 months.
3. Skin tightening using infrared light: A beam of infrared light is aimed at the double chin which causes tightening of the skin by stimulating the underlying collagen and elastin layers.
4. Chin liposuction: In people with excess fat deposition, chin liposuction where the excess fat is suctioned off is a good treatment option. This is a time-tested method and produces results more immediately than the above-mentioned procedures.

Subsequent to any of the above procedures, it is better to make some lifestyle changes so that the double chin does not return. Weight management and regular exercise can go a long way in preventing recurrence of the double chin. Speak to your doctor to draw up a weight management plan and an exercise regimen that can help in the same.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Favorite pastime of most of the people would be to look at the mirror and analyze the skin. While acne is the most common problem, next in line would be pigmentation. One could have light patches or dark patches on the skin. The color of the skin is due to a pigment known as melanin. Greater the amount of melanin in the skin, darker the complexion. Skin color depends on the following:

1. Age
2. Genetics
3. Ethnicity
4. Degree of sun exposure
5. Skin care routine
6. Stress levels
7. Hormonal levels (related to menstruation, pregnancy, breast feeding, menopause, etc.)
8. Food habits

Hypopigmentation is less common and it is better to seek medical advice to rule out other medical conditions. Hyperpigmentation where there are increased amounts of melanin on the skin. This is quite common and happens with increased sun exposure and age. The most common types are as below:

1. Melesma: Caused by hormonal changes, is very commonly seen during pregnancy.
2. Lentigo: Multiple black spots or freckles. This could be caused by ageing or due to sun exposure.
3. Management of hyperpigmentation: This involves two-fold approach with preventing and treatment

Tips for preventing hyperpigmentation:
Reducing sun damage and using optimal sun protection is the best way to prevent hyperpigmentation. The sunscreen should have at least an SPF (sun protection factor) of 15. A common misbelief is that sun damage happens during the bright days. However, even sun during cloudy weather causes damage, so avoid direct sun exposure as much as possible if you have are at risk of pigmentation.

Regularly scrub and exfoliate the skin to remove the dead cells from the top layers. Dry or sensitive skin can be exfoliated 1 to 2 times weekly, and oily skin can be exfoliated 2 to 3 times weekly. This helps constantly remove the top dead layers and fresh skin cells to come to the top, giving a fresher, more youthful look.

Treatment for Hyperpigmentation Pigmentation is hereditary, and so improved skin care routine is useful in improving appearance. When buying skin care products, check whether the SPF is greater than 15 at the minimum, and there are other essential ingredients like alpha hydroxyl acids, glycolic acid, and lactic acid.

These help in skin regeneration and producing a clearer skin with reduced discoloration. Vitamin C, Vitamin E, and kojic acid are also useful in treating hyperpigmentation. Dietary changes like egg white mask, citrus fruit application, potato peel can help in reducing pigmentation.

Other dietary changes to adhere to include a diet that is less in oil and refined sugars. A fresh fruit and vegetable loaded diet, adequate hydration, good skin care, and proper sun protection can go a long way in reducing pigmentation. If you wish to discuss about any specific problem, you can consult a Cosmetic/Plastic Surgeon.

The skin has underlying protein layers, mainly having collagen and keratin. With age, they lose elasticity and the skin begins to sag. This is where facelift gained popularity with various techniques including Botox, chemical fillers, laser beam treatment, and chemical peels. Read on to know how these minimally invasive, economic options work in literally lifting up the face:

1. Laser treatment: A beam of laser (usually CO2 laser) is used to make small dots on the skin with normal skin left untouched in between. This causes tightening of the tissue underneath, producing a firmer appearance which can take off years from the appearance.
2. Botox: This accidentally discovered neurotoxin is used to treat wrinkles and sagging skin. The sagging areas of the face (usually forehead and nasal folds) are injected with Botox. The wrinkles are gone and the fine lines are lost, and the result can last for up to 8 months.
3. Fillers: Chemicals which are naturally present in the skin like hyaluronic acid and collagen extracts are injected into the skin to fill up the underlying skin and produce a fuller, younger appearance. The lower cheeks, corners of the eyes and mouth, and area under the eyes are commonly treated by this method.
4. Chemical peeling: The top layer is often peeled off using chemicals so that fresh, younger-looking skin is generated. This also helps in reducing pigmentation, reducing forehead lines, de-tanning, and producing a glowing, radiant, younger-appearing skin. It also can be used in other skin conditions including rosacea.

While each of these is widely popular, they come with a set of potential risks and complications.

1. Anaesthetic reaction: Most of the above procedures require local anaesthesia and there could be a reaction to this chemical.
2. Hematoma: There could be small hematomas in the underneath layers of the skin, which will take some time but dissolve on its own
3. Numbness/tingling: The face has a rich nerve supply, and if any of these are touched, there could be numbness or tingling or even loss of sensation in some cases. While some may improve with time, there also could be permanent damage
4. Scarring: In chemical peels, there could be minor incisions and therefore scarring can happen.
5. Delayed healing: Depending on the person’s immunity, healing could be delayed, and as it is the face, social and/or professional life can be affected.
6. Infection: As with any surgery, chances of infection arise and can be managed with antibiotics.
7. Bleeding: As most of these are non- or minimally-invasive, chances of severe bleeding are less but still persist.
8. Bruising: The face, in the immediate postop period, can have a bruised appearance, which will improve over 4 to 5 days. If you wish to discuss about any specific problem, you can consult a Cosmetic/Plastic Surgeon.