Wednesday, April 30, 2014

Not being teased anymore at school

Over 600 registrations in one week;a very busy week with 49 smile surgeries in 5 days.Tired. This girl said," My schoolmates used to call me funny names because of my deformity." Not anymore.

Thursday, April 24, 2014

Smile Train USA sponsorships in Arabia Felix opens doors for international research

Over the years, I have been encouraging Yemeni doctors to take this opportunity to study proper cleft lip and palate techniques under our aesthetic charity programmes for the nation of Arabia Felix. Some took us seriously and learnt some useful primary aesthetic procedures to further their careers and practice. Others approached me to help them complete their PhD research in Bonn Univ,Germany using the non syndromic clefts on my mega list,since over 95% of the nation's cleft children pass through our Yemen Smile and Smile Train charity programmes.
Since 2010, a very dear Yemeni friend and PhD researcher Dr.Khalid Durai from Bonn Univ PhD programmes for cleft lip problems has been taking hundreds of genetic blood samples from my unit in Yarim and Ibb in order to complete his PhD paper on genetic analysis of Arab non syndromic cleft patients. He has since published his impressive manuscript (the first in the Arab world) in prestigious journals in Europe and Boston. His research was presented at a major conference in France this year.
 Dr.Khalid will continue to do this genetic research on our Yemen Smile & Smile train sponsored children for another batch of 300 unoperated cleft children who are over 8 years of age. I am happy that this would be a good opportunity for this nation to have the world's largest series in this research. The researcher is an ethical doctor who always tries to make it easier for cleft children and I am glad our paths could cross during my time in this country's charity programmes.

Our US Task Force on palatoplasty paper for has been accepted for publication in the journal of craniofacial surgery. I am glad that Prof Jeff Marsh of Saint Louis invited me to initiate the online discussions on palatoplasty in latecomers last year,for the Task Force. It has been an incredible experience for me to share my innovations in "bloodless palatoplasty(almost!)" to plastic surgery groups across the world this way.

Tuesday, April 22, 2014

Palatoplasty in an adult cleft patient

This adult patient had a complete cleft of the soft palate.
Saline hydrodissection was used with 1:500,000 adrenaline saline and the mucosal flaps dissected off the levator,which was retropositioned.The innovation is mentioned in www.cleft2013 and our US task Force paper has been accepted for publication in the Craniofacial  Cleft Palate Journal
The uvula incision was made in such a way that the posterior aspect was thicker.This makes the uvula fall backwards more easily.
I have treated several hundred cleft palate patients using this technique which I developed over a few years.
One advantage of this method is the short operating time as well as minimal oozing from the surgery which makes the surgery very safe and effective,even for speech.

Mega smile campaign this season

This is a busy week for smiles.
Have completed 120 smile operations so far this season,but there are over 400 cleft lip and palate children registered for surgery this week.
We will clear the list in batches of 35-40 every 14 days in order to help as many as possible.
Large volume cleft surgery needs a lot of precision skills which come only as a result of intensive training over the years.

Tuesday, April 8, 2014

Hypertrophied adenoids in cleft palate repair

Hypertrophied adenoids in cleft palate patients can cause problems during surgery. In this child,the adenoids were very large,almost obstructing the posterior palate . If I closed the muscles too tight ,the post operative period could be stormy. In this case, I used a bipolar cautery to reduce the adenoids so that the airway could remain open during the postoperative period. Using saline hydrodissection in such cases is an advantage because one can do a light muscular closure followed by mucosal approximation .The posterior mucosa is closed before muscle closure. Radical veloplasty is contraindicated in these patients who are sure to develop airway problems in the post operative period.
The patient did well after this minimal procedure and was discharged without any complications.

Monday, April 7, 2014

Living with a second deformity

Iatrogenic deformities are common after cleft lip and palate surgery procedures by untrained surgeons.This young girl was operated in Sana by a visiting expat team when she was seven years of age and has lived with her second deformity ever since.She had her secondary repair done last week.The right side of the lip will need further aesthetic improvement after 3 months.The whole lip was fibrosed and difficult to adjust in one sitting.
Our advice to expat mission visitors to poor nations and local surgeons is to stay safe and do only those surgeries that one is familiar with. Thankfully ,this problem is much less in Arabia Felix now that most cleft patient families know what can be done for them through proper units,specialized in this aesthetic art.
"Get it right the first time and avoid headaches later"

Saturday, April 5, 2014

Dermnasium Series 46: Lifecell for dark eye circles and wrinkles

A good  product for reducing fine wrinkles around the eyes and treating dark circles

  • 15g/0.50 oz
  • promotes firmness in the delicate eye area
  • acting as an eyelid lift,diminishes the appearance of wrinkles,fine lines and expression lines
  • reduces the appearance of dark circles
  • anti inflammatory action,reduces puffiness and minimizes the risk of allergies
  • Item #: 14531/039
  • Manufacturer: Nelly De Vuyst

1001 Arabian Smiles

Thanks to all our friends who started this mega smileathon many years ago;apart from the thousands of cleft and plastic surgery patients helped through this small unknown charity in Sana city, we have also had the privilege to join the race for a million smiles with the US Smile Train this year.
The Smile Train US target has finally been achieved because of many smile teams across the universe that took part in this grand smileathon.
1001 Arabian Smiles was the result of incredible team effort along with the US Smile Train to help thousands of Yemeni cleft lip and palate children over the years. The book will be published soon in Sana city with the help of some friends.

Dermnasium Series 45: Smooth Operator mini home spa kit

Designed in Queens NY this January, the first series of Smooth Operator mini home spa kit contains aluminium oxide microcrystals from Merck, Germany and cellular matrix cleansing milk from Nelly de Vuyst (50ml refill jars from 500ml main jar). Only US and Western European skin care products are used in this kit.
The microcrystal palmabrasion is easy to learn and the instructions come in the kit . Cellular matrix keeps the skin healthy and youthful;it has antiageing properties and also decreases the appearance of wrinkles.
Smooth Operator mini home spa kit  is followed by another kit which contains  a microneedling device and anti ageing serum.
I use this regularly for facial skin rejuvenation and the results are very good.

If the patient has pigmented areas or melaesma, I add a pigment removal regime of 4% hydroquinone or lactic acid with kojic acid. The solutions work well and there is significant reduction in the pigmented areas.

At present,the kit is available only in my office in Sana'a. 

Dermnasium Series 44: CROSS for Severe Acne Scar treatment

CROSS or chemical reconstruction of severe acne scars is done with TCA 30%. It can be used safely as a superficial peel at this concentration.The skin is conditioned for at least six weeks before the procedure and stopped three days before acid application. This is to prevent side effects like pigmentation problems esp in type 4-6 FP types.
This technique is useful for icepick scars which are difficult to treat.
Focal application of TCA causes frosting on the sopts applied.The scars will flatten out a result ,making subsequent treatments a lot easier.
The treatment is done every three months till the skin shows improvement.
Follow up  procedures to rejuvenate the skin include light acid peels,microdermabrasion and microdermarolling ;antiageing serums are included in the older patient with chronic scars. PRPM and fat grafting is also an option for some areas.