Thursday, March 27, 2014

Dermnasium Series 43:Mini Home Spa rejuvenation


As you reach your thirties, skin cell renewal takes about 8-12 weeks.Dead cells accumulate on the surface and give the skin a dull appearance. This can be taken care of by following a few simple steps:
1.        Inside the kit you will find a container of aluminium oxide microcrystals (Merck,Germany)which are inert,without side effects and non carcinogenic. Take about one fourth of a teaspoon on your left palm and add a bit of water to make a slightly watery paste.
2.        Apply this paste to your face,taking care not to go too close to the eyes.Wait a few seconds for it to dry on your face.
3.        Using your palms,massage both your cheeks in an upward and outward direction for about 2-3 minutes.Do the same on your forehead and chin areas.Using your fingers ,gently massage below your eyes as well.
4.        Next,wash your face and pat it dry with a small towel.
5.        Apply  moisturizer and sunblock SPF 30.
6.        You can repeat this procedure every ten days for best results.
7.        Use NDV anti ageing cellular matrix (Brussels) the following day(3gm sample). To lighten skin  and pigment,apply  a small amount of 4% hydroquinone (Swiss) on the whole face every morning and evening before using sunblock.
Your  skin will appear smoother and finer as a result.

Smooth Operator is an innovative aesthetic regime for facial skin rejuvenation designed by  Bona  Lotha ,Board Certified , Aesthetic Medicine , Miami . The kit contains aluminium oxide microcrystals 30gm,skin care sample 3gm,and  a medium sized tube of 4% hydroquinone (US and Western European products).

E mail: estheticderma@gmail.com

Instruction Leaflet Inside the kit

Tuesday, March 25, 2014

Dermnasium Series 42: LA for microneedling acne scars


Microneedling for acne scars requires some form of topical anesthesia to decrease patient discomfort.
I prefer to use a combination of lidocaine 2.4% with prilocaine 2.5% on the skin thirty minutes before the procedure.
The scars are needled in a horizontal and vertical direction,till there is some spot bleeding. Once this level is reached,the area is dressed with fucidin .Healing takes place in a few days.
The scars become less conspicuous after this procedure.
Further improvements can be done at follow up after a month.
I also use a small amount of 30% salicylic acid in between treatments to remove superficial scars and comedones.
The skin is protected with sunblock and moisturizers. The range of acne skin care products is available at our site www.aestheticsolutions.co

Monday, March 24, 2014

Early Years:Cleft Forum with the Royal College of Plastic Surgery , UK 2005

Cleft Forum with the Royal College of Plastic Surgery , UK  2005
Our early years

      UK- 1. Mr. Nigel Mercer, MB ChB ChM FRCS, FRCPCH,
      Consultant Plastic Surgeon, Frenchay hospital, Bristol , President BAAPS
           2.Mr. Tony Moss, MB BS FRACS (Plast) FRCS
          Consultant Plastic Surgeon, St.Georges Tooting, London
          Coordinator  :  Bona, Yemen Smile
Nigel Mercer, President of the British  Association of Aesthetic and Plastic Surgeons: questions  to YS
The techniques you use are reasonable. Do you use vomer flaps in the primary repair? They significantly reduce the cleft width.Do you use lateral releasing incisions or Veau  Kilner  Wardill flaps? The Langenbeck type will give a lower fistula rate. I don't think that hamulus fracture is indicated any more. The anatomical studies show that it has very little effect on the tensor or the palatine aponeurosis.In my series we have 10% with some delayed healing and a 5% rate of fistula repair using Langenbecks.  
Nigel
Do you use vomer flaps in the primary repair?
yes
 They significantly reduce the cleft width.Do you use lateral releasing incisions or Veau  Kilner  Wardill flaps?
yes both,including a few modified types
  The Langenbeck type will give a lower fistula rate.
 tried it a few times
  I don't think that hamulus fracture is indicated any more. The anatomical studies show hat it has very little effect on the tensor or the palatine aponeurosis.
thanks,points noted
hey Nigel,tried Langenbecks on two case-went ok
glad to hear the Langenbecks went well

Tony Moss: comments - questions on cleft repair


re cleft lip repairs-
Q: Bona, Yemen Smile 
1. the short columella in bilateral cleft lips- is it wise to elongate it in the primary repair?What do you think about the US technique where they make a prolabial flap based on a superior blood supply( fibrofatty tissue in front of the membranous septum);in this ,the prolabial flap with two side wings(for the nasal floor) is raised right up to the level of the membranous septum- or should that be done later?even though the first stage repair gives a somewhat shorter columella;they say the vascularity is not compromised ,but what if some infection occurs and the flap gets messed up?
2. the retracted premax in some kids- what is the best way to handle this?Miki,what was that US technique you used in the Pacific-was it an inferior septal flap?
thanks and look fwd to feedback
> bona




Tony Moss: reply

Hi
We have learnt that the Millard forked flaps for columella lengthening  OK in babies but awful in the adult...therefore many have abandoned this procedure.My personal preference would be to accept the position, and do a nasal tip projection procedure later....
The retracted maxilla....this is a bony problem......needs osseo distraction or maxillary advancement, with prior orthodontics... If you don't have this service, then you can try soft tissue augmentation, eg Abbe flap....
I hope this helps  Let me know...
 
Nigel Mercer:
[Nigel Mercer] 
Don't lengthen the columella at any stage . The primary problem lies in the position of the medial crura of the alars and the domes. i correct these later with a tip rhinoplasty when the child can cooperate.  
the retracted premax in some kids- what is the best way to handle this?
[Nigel Mercer] Not by surgery, they need othodontics when the adult teeth are through. 
should i raise the alar cart on the affected side in the first stage repair by extending the incision or should it be done later?
[Nigel Mercer] Later, after the bone graft. If the alar is raised when the alveolus is open it will just be pulled back by scarring no matter what. 




Small fistula palate


What about the small fistula bet the hard and soft palate? 

The issue of small fistulae is that usually they tend to be
asymptomatic....and not need to do anything.
Depending where they are, islanded tadpole flap, unilateral Langenbeck
flap, etc variations on a theme........

Hope this helps
Best wishes
Tony
St.George's London
Hi Tony,
Thanks
here is a pic for advice
6 mth old with hydrocephalus(shunt by neurosurg later),hypertelorism 1 and cleft nose with ? nasal /?ethmoidal sinus dermoid


Nasal Cleft:

Q: for the nasal cleft - i tried a turn in flap last time and then cover with nlf
what options?

thanks
bona

Bona
If purely cosmetic, then options inlcude using 'tissue expanded' nasal
skin, another turn down with FTSG, composite ear graft with large
inset, etc etc...However, this babe has other problems ....
Hope this helps...
Best wishes
Tony




 
Yeap Choong Lieng, Mount Elizabeth Cosmetic and Reconstructive Surgery, Singapore
Try to get it right the first time because secondary revisions are troublesome.
Sometimes I use two mucosal cheiloplasties to avoid an inverted and notched mucosa



Philip Chen Taipei 2006  - It is important to make  accurate lip measurements with a caliper ; When Sam Noordhoff used to insist on that in the past I did not think it was so important but now I realize why it is so important to take proper measurements. It took us over 25 years to standardize this technique of unilateral cheiloplasty.

Sam Noordhoff: 2006 ..don’t be discouraged even if your mission is small..I started very small in Taipei in the early sixties ..it was difficult but we persevered…(movie interview) on CD



Dermnasium Series 41: Fat and PRP as filler

One of the ways one can rejuvenate the ageing face is to use autologous fillers which are safe and without side effects.
I normally use a combination of PRP and fat in varying proportions ,sometimes 50% each ,at other times less. Usually,about 3-4 ml is sufficient. I like to wash the fat in normal saline 2-3 times and then mix it with an equal volume of PRP without the activator (calcium chloride 0.1ml or gluconate) .
The procedure is a bit time consuming and can be done safely in one's own office clinic,taking all sterile precautions.The results are good and can be repeated after a month is touch up procedures are needed. I use this for the tear trough,naso labial folds and temple areas.

pic: rejuvenating the sunken tear trough with prp and fat (0.3-0.4 ml on each side)



 naso labial rejuvenation with fat and prp using about 0.5-0.6 ml;this also decreases the concavity causing the "natural face lift".The natural face lift is one of the ways of lifting the mid face region of the naso labial folds.When the concave area is filled,the region gets lifted ,giving the face a younger appearance.


Dermnasium Series 40: Deux Gommage

3 minute gommage is an exfoliating cream suitable for all skin types.It removes all traces of dead cells and impurities that accumulate on the surface of the skin.Regular use smoothes out irregularities,promotes cell renewal,tightens pores and brightens the complexion.3 minute Gommage refines skin texture for a radiant and healthy glow.
In my technique of deux gommage, I use inert aluminium oxide microcrystals to palmabrade the face and then use the 3 minute gommage for better results.
The palmabrasion technique in my kit is used every ten days for best results.
I also recommend antiageing cellular matrix after each treatment.This makes the skin even better.
http://www.shop.estheticderma.com/Gommage-S-12513-013.htm


Dermnasium Series 39: Combining kojic acid with low % GCA and 2% HQ


Treating hyperpigmentation and melesma can be a tricky challenge and requires several applications of melanin inhibitors before one can see reasonably good effects.
A combination of low % glycolic acid with kojic acid and hydroquinone can lighten pigment in a more effective manner than by using single lighteners .
Glycolic acid separates epithelial cells making it easier for lightening agents to penetrate the skin.The effects are seen in about a month's time.I have used this combination on several pigmented areas of the face with some significant improvement in the lesions.
Regular applications for a several months to a year, are recommended for long term pigment treatment because recurrence is common in type 4 FP and above.

Saturday, March 22, 2014

Dermnasium Series 38: Smooth Operator Kit and cellular matrix

Smooth Operator Kit


As you reach your thirties, skin cell renewal takes about 8-12 weeks.Dead cells accumulate on the surface and gives the skin a dull appearance. This can be taken care of by following a few simple steps:
1. Inside the kit you will find a container of aluminium oxide microcrystals which are inert,without side effects and non carcinogenic. Take about one fourth of a teaspoon on your left palm and add a bit of water to make a slightly watery paste.
2. Apply this paste to your face,taking care not to go too close to the eyes.Wait a few seconds for it to dry on your face.
3. Using your palms,massage both your cheeks in an upward and outward direction for about 2-3 minutes.Do the same on your forehead and chin areas.Using your fingers ,gently massage below your eyes as well.
4. Next,wash your face and pat it dry with a small towel.
5. Apply moisturizer and sunblock.
6. You can repeat this procedure every ten days for best results.
7. Use anti ageing cellular matrix (NDV) from the next day  onwards
Your skin will appear smoother and finer
google: dr bonalotha

Thursday, March 20, 2014

Wednesday, March 19, 2014

microform cleft lip in bilateral cleft lip

Sometimes an inexperienced cleft surgeon misses the diagnosis of a microform cleft lip on one side and mistakenly treats the bilateral cleft lip as a unilateral defect.This causes an abnormally large lip with a philtral and mucosal defect.
The phitrum is redesigned and cheiloplasty done to correct the discrepancy.


Neo concept-Unilateral vomer flap in stage 2 palatoplasty

Sometimes a second stage palatoplasty cannot be done in a single stage because of a prominent vomer bone. I came across a few such cases during the camps. In this child the prominent vomer bone made it difficult to close the entire flap in one sitting because I could not use a bilateral vomer flap,which can lead to flap necrosis and fistula. I prefer to raise a unilateral vomer flap and close the rest after a few months with a hemi palate flap.
This is not a commonly performed procedure for most plastic surgeons ,and such presentations may cause problems in management.



Philtral redesign and augmentation cheiloplasty

This cleft patient has a scarred and distorted phitrum and a thinned out central lip



I use arbitrary measurements in adult philtral reconstruction ,keeping the lower end about 3mm wide on each side and about 3 mm above.The sutures are placed superficial on the lateral side and deeper on the central flap to allow a slight depression in the philtral region.
The thinned out lip is augmented with a lower end Z plasty and closed with 5 zero catgut.
The nasal deformity can be addressed at a later stage.
Most patients show significant improvement in appearance after this procedure.

Tuesday, March 18, 2014

Bone wax in adult palatoplasty

I recently came across an annoying problem in adult palatoplasty where there was troublesome oozing from  anterior palate formina in an adult cleft palate patient .The only way to stop the oozing was to detach the hemiflap completely and suture it back firmly with a piece of surgicel under the flap.The patient did well and the oozing stopped after closure, but this made me change my approach to palatoplasty in older patients where one can often come across such problems because the anterior palate formina are usually larger.
Hemi flap palatoplasty is a suitable alternative to 2 flap palatoplasty when the defect is not large;I also add a button hole release on the contralateral side to ease closure. The procedure is fairly straightforward and all my patients did well after such procedures.
In future, I will use bone wax for sealing off foramina in the anterior palate.