Monday, August 25, 2014

Aesthetic rejuvenation ,not longevity

Aesthetic rejuvenation is not about longevity ,although life style changes can promote one's health and prevent complications. But the bottom line in all aesthetic rejuvenation is about looking good while one still can, and taking care to look better than one was before. With newer and safer technologies,it is possible to actually look good, and feel good.
This brings us back to our initial premise-the dermnaseum,where one works on the skin at frequent intervals so that collagen synthesis takes place and the skin is rejuvenated,making one lose years  in appearance . Regular conditioning of one's skin brings many desirable results and makes aesthetic procedures much safer,with predictable good results.You can follow a few simple rules of the dermnaseum and cut remove several years off your face.
It takes time and effort,especially when one is dealing with a scar or pigment problem, but patience in aesthetic medicine always pays off, with significant transformations occuring over weeks and months.
The long term results can be guaranteed through regular maintenance procedures.
One can age gracefully as a result of taking adequate advice on diet,health,lifestyle and derma exercises.

Look /live  good and feel good  while you still can :-)

Difficult premaxilla protrusion

The complicated premaxilla deformity in bilateral cleft lip defects is difficult to treat and one always has to do some sort of resection or reduction to make the first stage lip adhesion possible.
Later,the lip is corrected by aesthetic surgery.I usually reduce the bone by thumb pressure and later if needed,put a K wire . The lip repair can be done after 3-4 months.

Sunday, August 24, 2014

Ordinary folks changing the world

As I travel around the US,often coast to coast, I meet a lot of kind folks who live ordinary lives and try to make a difference in the world around them.

Life for the ordinary American is not glamourous Hollywood stuff,but a daily grind of long hours of work and paying the bills,like everyone else, elsewhere in the world. People are generally kind and generous and  always involved in helpful activities in their own communities and towns. What we see in the news does not represent the dreams of most in the US who just want to get on with their lives and live peacefully,without minding other peoples business.Life is hard enough today without interfering in very complicated and often meaningless interventions.Makes more sense to focus on doing good and building one's own system and communities.
I was invited on many occasions by complete strangers into their offices, and even into their homes. Life is not all peaches and cream here, but the kindness of folks have left a lasting impression in my life. I was inivted to do some impromptu guitar concerts for homeless folks in LA,folks who had fallen on hard times and were sleeping in shelters and cars. Lots of homelessness and pain.There were lots of volunteers who made life easier for them by way of donations,concerts and food and monetary support.
Now that we have crossed over 1287 smiles in a troubled nation because of the generosity of friends in NYC and across America, I would like to thank friends in the US for what they have done . The generosity of US friends made this miracle happen for thousands of cleft children in Yemen.

Not all are grateful,and some even threaten to finish us off because we represent a US med group for helpless children and babies,but everyone needs to know that good will always prevail and defeat evil. I am in NYC and the beautiful state of Pennsylvania this week ,attending meetings and discussing new strategies to get more people to benefit from our smilemaking services.
We are thankful for the vast majority of Yemeni Arab families who shun violence and want to live normal lives.Most of all,they want all their deformed children to live normally again,and oppose those who try to harm us.The smiles must go on...and we are ready and willing to step in with our aesthetic skills whenever there is a need for a cleft child to smile again..

Observations on smooth operator facial rejuvenation

This season's studies on the effects of smooth operator which includes aluminium oxide palmabrasion followed by lactic acid 10% and intense sunblock ,included patients of all skin types ranging from the very light skin Type 1 Fitzpatrick to the dark Type 5/6 FP.
No untoward effects were noted in any of the clients in the last 3-5 months of application,

There were significant changes in the appearance of the facial skin which appeared well hydrated,fresher  and more youthful with less fine wrinkles and pigmented spots.

The precaution I would advise one to take seriously is to use lots of sunblock SPF 30.The skin becomes more sensitive to the sun as a result of lactic acid. If adequate care is not taken to prevent sunburn,the second or third application of smooth operator may cause some bruising and scabbing in an already sensitised skin. Be sure to wait at least 2-3 weeks if you feel that your skin has sun damage.
One of the signs that your skin has become more sensitive is some discomfort when you do the second round of microabrasion .In this case,wait for 2 weeks at least and do not apply lactic acid.
Once your skin heals completely during that period ,you can start the regime again. People who have this complaint should use the it only once a month and avoid the sun as much as possible.

Overall,the results of smooth operator will benefit your facial appearance significantly,and you will look much fresher and younger as a result of continued use over the next few weeks and months.

Complicated aesthetic surgery

\Secondary aesthetic revision of a maladjusted cleft lip deformity can become complicated when the patient also has dental deformities.
This patient with a maladjusted cleft lip on the left side has severe dental deformities involving the incisors and canine teeth,making it impossible for a satisfactory aesthetic correction of the lip.

The Cupids bow was brought to a more horizontal position,but the central lip notch cannot be made normal by aesthetic cheiloplasty alone.Although I added two z plasties to decrease the whistle deformity, (the lateral swellings are due to local injection) the patient needs to see an orthodontist to correct her dental problem before any other aesthetic lip surgery can be considered.

Music of a smile :-)

Above all....and to all my friends who made it happen

Been a long time moving from country to country,all the way from Singapore, London,Taipei and New York city
learning many new ideas,making friends,studying,joining forces to help underprivileged kids smile
So many obstacles,so many dangers
Times when we gave up all hope of going on ,or even staying alive
But life goes on and on,and we are glad that times are not always the same...we have moved on
and best of all,the smiles will remain forever
Thanks,above all......


New York




Saturday, August 23, 2014

Some variations on palatoplasty

There are many ways one can perform cleft palate repair
In my practice,I try to minimize bleeding as much as possible ,either by doing a two stage procedure in older palates,or by using 1:500,000 saline adrenaline hydrodissection before the operation.I use very small incisions whenever possible.This makes the blood loss insignificant and hastens post op recovery .

Below are the three variations on palatoplasty which I designed during  smile workshops across the country:

a. a button hole incision just below the maxillary tuberosity to identify the hook of hamulus and tensor tendon,which is divided and the hamulus hook fractured.This decreases the tension on the repair siginificantly.

b. b is the area of the palatal ruguae where i make my first incision on the anterior palate;this is relatively avascular and allows me to separate the mucoperiosteal flap easily from this  point

c. C is a technique I developed using a curved sharp scissor to dissect the levators from their insertion on the hard palate .I make an incision on the medial side,detach the muscle insertion on the posterior spine,and detach the muscle from a medial to lateral direction. Later, I use a fine blade to divide the underlysing aponeurosis.This is a relatively bloodless technique.

Complicated asymmetrical ,deep,fibrotic cleft palate

This is a case of a deep,asymmetrical, and fibrotic left half,cleft palate

Normally، the distance of the uvula from the posterior pharyngeal wall should be about 5mm
 or less، which ensures effective closure of the velo pharyngeal port.
But one often encounters hard,short,fobrotic and very deep palates.The speech outcome for these group of patients is usually unsatisfactory. The anterior palate is also partially collapsed which makes it very difficult to close the defect  properly.
I did an initial soft palate adhesion with levator muscle repositioning.The follow up surgery will be done within a year.

Friday, August 22, 2014

1-11-V Innovations in aesthetic surgery

When I started my first journey into aesthetic surgery and cleft work many years ago,all I had at that time was a middle C basic progression .
The well tempered clavier progression of Bach worked fairly well and a few were helped but later as i ventured into more cleft work, my gears shifted to the C maj7 Ionian mode.Not a bad sound at all.Along with it came the exciting Cmaj 7(9/11/13) dorian in Dm7(9/11/13) and mixolydian (9/11/13) G7 progressions.
I use this progression when I think about improved and better designs for aesthetic cleft procedures,keeping in mind the basic structure is the most important foundation one needs to have.
Standardization of a routine procedure sounds mundane,but is a necessary element in any work,be it music or aesthetic surgery.
Today,several thousand aesthetic surgeries later,I still go back time and again to the basic Ionian mode before any major innovation. The result is a large list of variations in cleft surgery,much to the benefit of folks who want to look good after aesthetic surgery for clefts.
In the early 1920s , when Millard revolutionized cleft lip surgery with his famous rotation flap, many were excited.The technique was imperfect,unlike Bach's well tempered clavier with it's perfect pitch. Many innovations were added over the last century ,some helpful,others not so.
Noordhoff was one of the great post Millard innovators who changed the face of cleft surgery forever with his modifications of the Mohler C flap. Many others have added useful innovations.

Innovations in aesthetic surgery will continue,but the basic structure will never change.We all need that constant in our lives.

Living normally again after smile surgery

With the growing interest in aesthetic plastic surgery and medicine across many nations,it is hard to find medical centres or hospitals that want to cater to the needs of underprivilged patients.Some of these patients are too poor to travel even for free camps in some government units. To make matters worse,social unrest and economic downturns following tribal blood feuds,clashes and threats are making it more and more difficult to deliver services .Most of the patients come from remote regions with little access to water ,roads or electricity.

What an observer sees is probably only the glamourous result after aesthetic plastic surgery.Little do some know how hard it is for some of these families to even travel to the smile units,even during more peaceful times.Most expats medical teams have either been evacuated ,or refuse to travel for such smile missions,because that would mean sticking their own necks out too far.
Our own work in the country is beset with numerous bottlenecks and our patients are well aware of the inconveniences.As a result many of them give us moral support and inform us that they are willing to wait even for a few months,because the smiles are always delivered, as announced.
Smile missions can never succeed or make headway unless local communities and medical communities lend a helping hand. We are thankful for the support folks have given us here ,despite the precarious and capricious circumstances under which medical work is carried out in remote rregions of the nation.
The patients are happy, as long as they get their smiles back and are able to live as normal people in their homes and communities.

Thursday, August 21, 2014

Happening in New York City

It all started years ago in New York City. Get cleft children to smile again,no matter what the challenges are. The message spread like fire and today hundreds of thousands of cleft children from all walks of life are smiling for the first time in their lives. Lots of hiccups to get the smiles across the miles,but the work goes on and on.
I am glad to be a part of this happening-it gives me a lot of satisfaction when I see little cleft children looking and feeling so good again.
As I follow the progress of thousands of cleft patients,it is heartening to know that new technologies are being harnessed to make even more beautiful smiles.
Feels good to know that there are many good people out there who want to make a difference in the lives of underprivileged cleft lip and palate children.
There is so much happening right now and those of us who are involved in this smile making business,know it is well worth the time and effort when the smiles are done.

Looking good and feeling good!