Tuesday, September 30, 2014

When the laser goes wrong

Laser removal of fine lines,wrinkles,age spots and other blemishes is becoming more and more popular in today's aesthetic practice. People want a quick fix to most of their aesthetic needs.
This may be okay for the Type 1 and 2 Fitzpatrick skin types.The results are often quite remarkable, to say the least.
On the flip side,if one does not take adequate pre treatment regimes ,at least 6 weeks before a major laser procedure,the results will be less then optimal,and even disastrous especially for those with Type 3,4 to darker skin types.
The skin type you see below is a typical fair Asian with Type 3 plus skin type;this is very deceptive because fair Asians are prone to hyperpigmentation following lasers and chemical peels,or aesthetic surgery.
She is being treated with lactic acid 10% peels every 2 weeks and lots of sunblock.It will take several months for the effects to take place and lighten these laser induced dark spots.

moral: always make sure your doctor prescribes a skin conditioning regime with exfoliants and skin lighteners before any major peel or laser procedure.(previous blogs on skin conditioning)

Saturday, September 27, 2014

Taking aesthetics to cleft children



Aesthetic innovations can add refreshing and significant changes to mundane cleft lip humanitarian mission work,where most procedures are predictable.
Using well standardized cosmetic procedures ,using fine sutures,and micro instruments can make post operative pictures look impressive and near normal.
Aesthetic procedures always take a lot more time and effort than the usual recon functional procedures in mega smile camps. 
Unfortunately,cosmetic procedures do not work for all cleft children because some of the deformities require many interventions ,and a previously scarred repair may not return to normal despite the best aesthetic advances.
However,an aesthetic med and plastic procedure can address most of the common aesthetic problems that cleft patients face.
I am thankful for the many aesthetic sessions @ Mount Elizabeth Singapore with my dear mentor and friend Yeap CL @ www.dryeapplasticsurgery.sg and some Beverly Hills experts during my Board Cert trainings in Miami Fla ,www.aaamed.org where I board certified,learning many newer and useful aesthetic avances.I am glad I can use some of my skills to change faces.

Friday, September 26, 2014

Smooth Operator at home using the mini home spa kit



 Several clients have been using this mini home spa kit for the last 5-6 months with impressive results.Continued use of the kit will ensure even more benefits for the facial rejuvenation process at an affordable cost.

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:

Inside the kit you will find a container of aluminium oxide 

microcrystals (Merck,Germany)which are inert,and without side 

effects .

Take about one eighth of a teaspoon on your palm and add a 

bit of water  and olive oil soap ,to make a  watery paste.

Apply this paste to your face,taking care not to go too close to

 the eyes.Wait a few seconds for it to dry .

Using your palms,massage both your cheeks in an upward and

 outward direction for about 3-4 minutes.

Do the same on your forehead and chin areas.Using your fingers

 ,gently massage below your eyes as well.

Wash your face and pat it dry with a small towel.

Next ,apply the 10% lactic acid  using the roll on bottle,all over

 your face but avoid the eye areas. 

Keep it on for 2 minutes and wash your face thoroughly.

Use Sunblock 30 SPF twice a day

You can repeat this procedure every ten days for best results


Your  skin will appear clearer,smoother and finer as a result.

Complicated reception at charity smile camps

Sadly, with increasing corruption and fraudulent practices across health systems in hospitals,several patients end up having to shell out money to receive the charity services promised to them in GSM and other advertisements.

Several patients have complained to our team that they have attended charity camps only to be informed by some local medical personnel and touts that they would have to pay some extras at the welcome reception desk. Some have been told by criminal doctors and their cronies not to attend our charity camps.This happened a few times during the last four years. But patients were aware of some fraud and instead of shying away,came in larger numbers than ever before.In 2010,when some criminal medicos tried to dissuade poor Yemeni villagers from coming to our free smile camps,the patients were more determined than ever to attend in large numbers and so far more than 1500 of them attended the camps.
For a poor villager, an amount of $ 100 to $150  at a charity camp is exorbitant.This sort of practice is not uncommon in many developing country smile missions where poor patients are made to pay to see the charity plastic surgery doctor and team.
Having experienced this sort of practice in some of our camps, we have set some very strict guidelines.Patients are informed in a very direct manner by our staff that if they pay bribes or extra money to staff members,the operation would be postponed for at least six months. This idea worked mostly , and we do not face this problem these days.However there are some unscrupulous persons who still try to cheat poor patients who come to visit our clinics.
One of the signs we get from a person who has paid a bribe to hospital touts is the aggressive attitude and demand for an immediate operation for their child.We have cancelled some operations indefinitely for such people and sent them back to their towns to seek other places .
Thankfully,patients have known us for several years now and today 1337 of them have benefited from our free smile surgery camps without much trouble.
Keeping all charity work above board is a necessary step to make any smile mission camp sustainable and successful.

Thursday, September 25, 2014

Palmabrasion using microcrystals in smooth operator

Mini Home Spa is a useful innovative concept designed in NYC during my time there this January.
The list of clients for this trial includes:

1. Type one to Type 5 Fitzpatricks
2.Patients with acne scars
3.Patients with melesma
4.Patients with fine lines
5.facial rejuvenation patients who want to look "plumper and more youthful"


The ongoing clinical trials have been used in several cities across the universe  since January this year and will continue for another 6-7 months.

The results are impressive:

1. Acne scars show significant  improvement
2.fine wrinkles show improvement with this combo treatment of microcrystal and lactic acid 10% prepared at my office
3.significant reduction in melesma
4.clearer and plumper facial skin ,taking several years off the face
Overall ,a promising innovation and will launched through a reputable pharmaceutical in NYC soon.

Tuesday, September 23, 2014

1371 new smiles ..just do it!

Lots of trouble in the ME regions
Many stranded and lost.
Millions are homeless and desperately searching for hope and meaning. Tribal blood feuds are on the rise,making the situation even more fatalistic.
The 1371 smiles from Jan 9th 2010 till yesterday were a result of intense team effort to rebuild from the ashes of a broken and downtrodden system.My friends wanted to make smiles happen in their troubled and broken country and spent countless hours helping these kids smile again for the first time in their lives.
Their hearts desire was fulfilled.Today,this country has the highest number of new smiles in the Arab world. One of them received his PhD recently from Bonn  Univ Germany,using our smile numbers for his genetic research.The manuscript has been accepted across the EU and US. The palate technique has been published in the US Task force paper@ at CPJ cleft craniofacial journal Aug 2014 on palate repair and shared at the Disneyland craniofacial conf www.cleft2013.org  in April this year as well as the Europlast Hamburg conf in Sept 2013.
The  report for the recent 1371 smiles has been submitted as a short paper on ideas and innovations for next year's craniofacial conference in Palm Springs,California.
Good can come out of seemingly hopeless situations.



Minor details in palate surgery




Demonstrations in the OR:

1. In stage two palate surgery ,if the defect is wide, I prefer to avoid the hemi flap and perform  a routine two flap repair using lateral incisions
2. after distending the area with 1:500,000 saline adrenaline solution ,i start the incisions at the midpalate level close to the rugae, which are generally less vascular
3.next, the flaps are raised from a lateral to medial direction and all bleeders cauterized under direct vision
4.the nasal flaps are then dissected off the palatal bone,staying on the bone at all times to prevent any tear in the fragile mucosa,( with a small elevator after the uvularis attachment to the posterior nasal spine is detached with a fine blade)
5.the neurovascular bundle is carefully dissected and all small bleeders cauterized;i use a fine right angle to release the bundle
6.to increase flap mobility and closure without tension, the hook of hamulus is fractured,tensor tendon incised and palatal aponeurosis incised with a fine blade
7.the levators which were already repositioned in the first stage are further relased from the mucosa to ease closure; small punctures in the posterior mucosa are okay since they allow for drainage and prevention of any hematoma. However i do not make raw surfaces ,like in the Onizuka method, which creates a raw surface posteriorly.Meticulous closure of the nasal mucosa is an essential stepo and must not be compromised .Time saving tactics ,used by some plastic surgeons  is to be condemned because the fistula rate wil be above 60%.It is also unethical to do such studies at the expense of patients.
8.palatal fixation is a necessary step to prevent post op pain and discomfort;the uppermost flaps are sutured to the thicker nasal flap below to prevent any loose space in between
Surgicel works well as a filler for the dead space and hastens healing

Overall,this technique is good and patients have done well so far in more than 400 procedures and my palate junctional fistula rate is about 1.5% ;the cause is  a loose stitch generally.

Braving all odds to get a child to smile



The heroic father of this young girl told us last week how he had to travel over eight hours by road to get to our Yarim camp. He traveled on the day there was a huge gun battle in Sana city last week between security forces and tribal forces. Hundreds of people died that day and the father mentioned to our staff that he saw a lot of dead bodies on the streets of Sana.This incident took place about three days ago ,when we were at Yarim helping cleft children.
Eid was only a week away and he wanted his girl to look good before the festival.
We did the first aesthetic adjustment for the child who did well post operatively. They will return later for another touch up aesthetic procedure.

An arm and a leg for poor patients



The distraught father of this young cleft patient came to us two days ago during our free smile camp at Yarim village

He had been referred to Egypt some months ago where the plastic surgeon had operated on his child's soft palate cleft which broke down after 3 days and so he had to go back for another treatment which failed ,leaving a fibrotic and scarred soft palate.He had spent a huge amount of money on the treatment , airfares and hotels.
Last week he took his child to another charity camp announced for cleft children at a huge private hospital in Sana,where he was asked by some to pay $110 for prelim investigations only to be told later that his child had an inflamed palate and the surgery could not be done.He heard about us from local friends and so rushed to our village camp where we operated his child. 
The palate was badly scarred but not inflamed, and the levator muscles not dissected at all.
The muscles were repositioned and the palate closed.The happy father could not believe that his son's palate could be operated for free in a Yemeni  hospital ! The child did well post op and was discharged a few days later.
Thanks to my friends at Yarim  who also feed poor patients for free during the free camps.

Saturday, September 20, 2014

Junctional fistula-a thorn in the flesh

The junctional fistula is a common thorn in the flesh for many plastic surgeons who practice palatoplasty.
In my experience of over 276 cleft palate repairs in this new smile project since 2010 Jan ,I have had this annoying problem in about 1.5% of my operations. The fistula was mostly due to a stitch infection or a loose suture.It responded well to secondary correction.



Crescent flap cheiloplasty

Crescent flap cheiloplasty was designed here during our mega smileathons for over 700 unilateral cleft lip presentations.The technique is an addition to modifications of Millard and is easy to execute in large volume surgery camps.
I use this flap often to design the unilateral cleft lip repair and have found the pot op outcomes satisfactory.
The operating time is about 15 to 20 minutes and post op recovery very fast,making this a procedure of choice for our large smile camps.



Monday, September 15, 2014

I want to go back to school but can't



This ten year old boy came to our clinic yesterday.He has a  younger sister who is not a cleft patient.She is in grade 6 but he did not make it beyond grade 4 .He was teased and bullied regularly by other children.
We asked him if he would go back to school after surgery and he said he would.
The first stage is a functional correction only, but we will do the aesthetic adjustments later.
The surgery went well and he is recovering well.

Sunday, September 14, 2014

K wire in premax reduction and fixation

I prefer to use a K wire to fix the protruding premax in difficult bilateral cleft lip cases
I usually resect a few mm of the premax and insert a K wire for 6-8 weeks
The lip adhesion is done as a first stage treatment
Later,in about 3-4 months time the child is re admitted and  an aesthetic lip procedure performed after removing the K wire.
The patients do well with this staged correction of their lip deformities.




Wishing upon a smile

This week's cleft camp registered over 37 children from different regions across the country.So far, we have completed 17 smile operations in the last two days alone.All the children did well post operatively.
With the Eid season just a few weeks away,most parents of cleft children long to see their children smiling again.
If all goes well,according to plans made earlier this month,we should see at least thirty children smiling again by Tuesday afternoon.


Saturday, September 13, 2014

World Smile Day coming soon,get involved!

Hi all,
Thanks for the blog and google post views which have crossed 287,000 views in the last one and a half years alone.I appreciate it very much and thanks for your helpful comments too. Some of you here may want to help cleft kids but do not know how.Below is a message from our NYC HQ to share about world smile day and how folks can be involved.
thanks again.
bona
abc.the speakingpalate.org





Thank you for being such a strong supporter of Smile Train. I'm reaching out with an exciting announcement about this year's World Smile Day celebration on October 3.

In the month leading up to World Smile Day, Smile Train and A Cleft Mommy's Bond of Friendshipwill be teaming up to support children living with unrepaired clefts in the developing world. Through the support of business partners like you, our goal is to fund 120 free cleft surgeries with funds raised during this time period.

Interested in participating? It's easy!
  1. Pick a day, week, or the entire month from September 3 - October 3 during which your business will support Smile Train.
  2. Decide how to support Smile Train during that time. Donate a percentage of your sales. Raise funds in your store or online. Ask your family, friends, and colleagues for their support.
  3. Register and order your fundraising kit.
  4. Take pictures of your business/your smiling face/your customers and upload them to Facebook, Twitter, or Instagram with the hashtag #SmileTrainWSD.
  5. Smile powerfully because you are creating new smiles for children with clefts all over the world!
Visit smiletrain.org/wsd to learn more, and feel free to reach out to Adina atawclouser@smiletrain.org with any questions.

We can't wait to hear how your business is creating new smiles.

Warm regards,

Spacer Image*

Susannah Schaefer Signature Image
Susannah Schaefer
Chief Executive Officer

Thursday, September 11, 2014

Cultivating your own collagen


One of the innovative ways to improve the way you look is to use your own "collagen cultivating treatment," called PRPM or platelet rich plasma matrix.The technique involves removing some blood(about  5-10 ml only) and separating the platelet rich plasma after centrifuging the test tube for 5-6 minutes. I use this method often for my clients who want this type of treatment for facial and hand rejuvenation. 
This is not a filler as some mistakenly believe,but a way to increase your collagen which takes place in a few weeks time. To improve results,one can add varying percentages of fat to plasma so that there is a filler effect .It can be used to fill out the naso labial folds,and plump the face and ageing hands.The treatment takes about 15-25 minutes to perform and the results are generally good and last approx 9-10 months,when another session is needed. You can also continue treatments of lactic acid peels and microdermabrasion to get even better results.


Tuesday, September 9, 2014

Friends across the miles making smiles happen

Making smiles happen takes time and effort. I am so thankful for friends who lend a helping hand to make sure the smilemaker gets to chill whenever needed; friends across the universe who have opened their homes,offices and hearts to me during the years. These are precious times spent,discussing newer strategies and ways to reach out to more folks who might need us.
People from all walks of life ,doctors,homemakers,business people and others have all been such a support all these years.Ferrying me across states and cities,time spent traveling,fishing and sightseeing.
All the work done in Arabia was because of good friends who wanted to make a difference in the lives of others. All the way from UK, Europe,Singapore,Sana'a to the USA ,friends have been a major part of this exciting smile mission.
Thanks to all.












Using picture perfect aesthetics to improve results




Aesthetic solutions using picture perfect aesthetics can play a huge role in improving the lives of patients who  long to look better. I use my skills as an aesthetic med and plastic surgeon to improve the appearance of cleft children as well as other plastic surgery patients.
So long as one is satisfied with mediocrity in plastic surgery,the results will continue to look plain and even disappointing. Aesthetic innovations are a result of hard work and experience with routine standardized procedures over several years. Successful innovations are always a result of years of hard work and dedication to one's given speciality.
We can use picture perfect aesthetic concepts to help our clients achieve impressive outcomes in aesthetic procedures.



Friday, September 5, 2014

Smiles can change your life forever


When you make others smile again, your entire world is going to change overnight.
I work in a very fragile and troubled region where people have lost their reason for smiling.
But when they see little babies and children smiling again,it takes away their pain and sorrow.
We are in the business of making children look good and feel good. The smiles will go on and on,even after we are gone.






Keep on smiling


This little guy's new smile in 1998, during my early years in Yemen, changed the history of cleft children forever in Arabia Felix. 
Since Jan 2010 all cleft children in Yemen have hope because of free smiles from the US Smile Train.

miss congeniality

miss sunshine

baby issac

little abdalla we found on the streets of sana



baby qabasi