Sunday, March 31, 2013

Asiatic Aesthetic Series 100:follow up 2nd stage palatoplasty

the second stage hard palate repair is usually done at 6 months to a year during which time the soft palate repair has healed well and the defect reduced in size
depending on the size of the defect,i close the defect using the following modifications

1.narrow cleft- unilateral modified hinged flap
2.medium gap- langenbeck variation

the procedure is fairly straightforward and the post op period usually uneventful without fistula formation in nearly all the cases;this is mainly because the tissue closure is done without any tension and one does not expect major problems apart from a small fistula in case a stitch falls out due to infection
the results have been encouraging so far for over a hundred cases
the operating time is short and patient recovery quick without any post op complications like hypoxia


Asiatic Aesthetic Series 101:hope for the hopeless

imagine what it would be like for cleft children in poor nations if there were no cleft charity services?
here are some samples to think takes ,time ,dedication and lots of effort to make beautiful smiles...
there are many good expat plastic surgeons who are happy to help such children but some nations are just too dangerous to venture into and so most of these doctors avoid such trips..

thankfully,most of these cleft children received much needed help during more peaceful times in Yemen..

Asiatic Aesthetic Series 102:against the wind...

There is no such thing as a geographical axis of evil on this planet.Religion in itself is merely a content of the human mind that imagines and decides what the definition of good and evil should be,minus God the Creator. The real axis of evil lies in the proud and evil human heart which imagines many vain things and plans evil without any regard for others.There is no difference between Christians,Jews,Muslims,Hindus and others when it comes to human nature.All are equally guilty and capable of perpetrating evil.
What a different world we would be in today if only some world leaders were humble enough to listen to the God of love,compassion and forgiveness instead of being led by their own personal vendetta and flights of fancy.
We landed in Yemen during the worst period in ME history when Iraq was invaded and hundreds of thousands were killed as a result.Many were fleeing the region but we stayed on and worked tirelessly for the poor. The result was healing and wholeness for thousands of families.
The US helped us achieve some of our goals of helping the poor,but sadly we were targeted by terrorists who accused us of being spies of the US govt, for no reason at all ,though we were only a small charity(non western plastic surgery team) helping their poor patients.We almost lost our lives on several occasions because of people who had evil intentions against expats. Some of these folks with evil intentions were medical personnel.
Thankfully ,better sense prevailed amongst the powerful tribes of Yemen and we were  heavily protected by our loyal Yemeni tribal supporters who were very thankful that we had come to Yemen to save the lives of thousands of deformed Yemeni children.I had no hidden agenda or political motives in my work as a plastic surgeon .I helped  impoverished Yemeni children because they were in desperate need of  expertise ,and I had some of the skills needed to help the nation.
We continued to help poor Yemeni families across Yemen despite the dangers and  evils because we knew that no one else would help them.Our target has been achieved and the work completed successfully.
But the whole experience left me totally exhausted and bewildered.Despite our charity work and very long hours in poor government hospitals across Yemen ,there were were still those with criminal minds who wanted to harm us and stop their own deformed children from being helped.I do not want to go through this sort of experience ever again and prefer to forget bad things.
I want to move on to other things elsewhere, wherever God wants me to be. I have handed over all my medical equipment, and office paraphernalia to local institutions and friends. I may visit Yemen for consultations in the future if the situation is stable enough for short visits. But I do not wish to make smiles under the shadow of the gun anymore.I may not be so lucky the next time some get trigger happy.
 I am glad I had this privilege of training good folks who were willing to get involved in the lives of the poor.

Believe in good things guys...there is a world out there waiting for your help!

Friday, March 29, 2013

Asiatic Aesthetic Series 103:A thankful heart this Easter...

Reflections this Easter bring to my mind the many times we traveled around the nation helping those in need of plastic surgery. Giving a second chance at life to those living without hope of a better life.So many dangers along the way,so many obstacles but we overcame all the odds and continued to help a nation in need even when many were not grateful for services rendered, but instead tried to harm us on several occasions.Sadly,some of the trouble makers were local medical personnel who did not want cleft and plastic surgery patients to be helped because they were exploiting them for huge fees.The price of a smile can be very high in some poor developing regions .
All in all, the work was accomplished and thousands given a new lease of life through life changing plastic surgery.
What if some of us  had been daunted by the challenges ahead and abandoned the programme at the outset when we were being opposed by many? Nearly 5900 would not have received the much needed help for their problems.
Well... we did cast our bread upon the waters,believing there would be a change of heart
perhaps one day....

Thursday, March 28, 2013

Asiatic Aesthetic Series 104:using simpler techniques for large volume surgery

using simpler techniques in aesthetic surgery often proves more rewarding for the plastic surgeon who has a large repertoire in cleft lip surgery
in this method, i use a very simple curved line incision and close the adjusted flaps using 4 0 catgut and a few sutures of 4 0 silk  after straightening the bow with a fine skin hook
the procedure takes me about 15-17 minutes  and I am able to do about 10 a day using this modification
the results are comparable to more sophisticated methods of cleft lip repair where many fine adjustments have to be made

Monday, March 18, 2013

Asiatic Aesthetic Series 105:Plastic Surgery Networking

Networking in any sort of plastic surgery mission outreach is essential in order to achieve good outcomes.Sharing ideas and comparing notes about latest innovations or procedures are always helpful and one has so much to learn in the process.
Over the years, I have met many good plastic surgeons from across the world who were involved in different aspects of the speciality. They had many things to teach from their years of experience in the field.
My times in Singapore,Taipei and the United States were especially helpful when the senior experts showed us what they had learnt and developed over many years.
Plastic surgery is a rapidly changing speciality and many new innovations and hi tech gadgets are introduced into the market almost every month.
The regular networking and brainstorming sessions improves ones own practice of the art and patients are able to benefit immensely from these new advances.
In the past, face lifts were often radical where patients had their entire faces peeled down from the skull and the entire unit reconstructed. Several years ago I attended a 72 to 27 facial rejuvenation surgery lesson where the coronal incision and lift was done .The post operative result was a 27 something looking 72 year old lady who had the neck,breasts ,body  and hands of a 72 year old grandmother.Not a wise decision at all on the part of the person performing this radical mask lift!
As I moved on to other tertiary hospitals and hi tech units I realised that this decade is moving into the minimally invasive era where equally good results are achieved with less downtime using finer modifications of facial rejuvenation. Gone are the days of the Jane Fonda plastic facies where American plastic surgeons worked according to the whims and fancies of celebs who demanded extreme makeovers. There are similar tales of the "Japanese doll" double eyelid surgery where Asian celebs had their eyelids operated upon to look more western-the result was abnormally  large eyes which did not suit the facial profile of these Asian women,making them look like dolls.
As we network with others in the business, there will be many changes in our work and the overall results will be better than what we have done in the past,no matter how successful our work might have been.

Asiatic Aesthetic Series 106:new blogs on aesthetic surgery and burns

welcome to the two newly added blogs on aesthetic med /surgery and burnsrecon



some of our work in med missions includes aesthetic surgery as well as burns recon esp for those who are too poor to afford such care,although aesthetic practice is rare in med missions generally.

Sunday, March 17, 2013

Asiatic Aesthetic Series 107:try a little kindness..

Even when times are hard,following one's dream to do good to others can bring so many blessings.Following the vision of rebuilding lives even when times are not easy can have a huge impact on the lives of those around us.
I was googling charities when I came across an interesting charity called 
started by some of  the main people behind the US Smile Train charity who have since moved on to do other things.
What impressed me about this brand new charity is that it tries to help poor patients in developing countries with free plastic surgery for burns and club feet. Their support also extends to those with congenital heart problems and neurosurgical disorders like hydrocephalus.
There are millions of burns victims across the world and those in poor developing countries do not have the  resources to cope with the challenge. I myself have treated hundreds of burns victims across this nation, as well  as some club foot children who needed corrective surgery.
When we start a good work and complete our assignment,the next assignment will always be bigger than the first and as a result many more will be blessed through the work.
follow your dream of helping those in need and see where it takes you...

Saturday, March 16, 2013

Asiatic Aesthetic Series 108:Socotra Island..beyond borders and into the distant seas

Socotra island is situated in the Indian ocean between Yemen and Somalia.The people speak the Socotri language. Our work for Socotra started in late 2006 and lasted several years during which time hundreds were helped for clefts,burns ,trauma and other plastic surgery needs. The island is beautiful and has many exotic plants ,some of which are not seen in other countries. The people are very friendly and supportive of  missions and as a result several medical teams have helped them over the years. The most recent gift was a hospital from the Khalifa foundation of Dubai.

Asiatic Aesthetic Series 109:Types of plastic surgery trainings included in our missions to developing countries

reconstruction of burnt hand

Apart from cleft lip and palate work which made up around 70 percent of our operative work ,the other aesthetic recon surgeries carried out in our medical mission outreach to poor regions in developing countries also included other plastic surgeries for the benefit of plastic surgical trainees:

1.reconstruction of  burns injuries of the limbs
2.congenital malformations like syndactyly,ear defects, and giant naevus
3. recon for trauma and rhinoplasties for saddle nose  and trauma
4. other plastic surgeries like reconstructions for cancer,gunshot injuries,bad scars,ptosis
5.aesthetic surgeries for deformities of the face and body
6.gynaecomastia surgery and genital aesthetic recon surgery for deformities

Cost of Plastic Surgery in the U.S.



$200-400 per area








Eyelid Tuck (upper & lower)





















in the earlier years we also did some club foot corrective surgery like tendo achilles lengthening,triple arthrodosis of the foot, foot manipulation and POP but later these were done ,mainly by ortho colleagues

The main aim was to make aesthetic and reconstructive surgery freely available to those who just could not afford treatment because they were too poor. As a result,thousands were helped.

ptosis reconstruction using frontalis muscle sling to open eye

giant naevus removal using aesthetic correction

recon of burn contracture of the neck

MOOBS removal using subareolar incision(post op not shown here)

fused finger recon using local flaps

trauma eyebrow recon

burn foot recon

burn thumb recon

burn scar aesthetic removal  and recon using local flaps

trauma nose recon

rhinophyma rhinoplasty

gunshot leg recon with medial gastrocnemius myocutaneous  flap

trauma nose recon

congenital haemangioma nose

rhinoplasty for trauma in crooked nose

ptosis correction

otoplasty for big ears

trauma ear recon

craniofacial cleft