Sunday, October 26, 2014

Making Little Miss Sunshine

This cheerful two year old girl came for cleft lip surgery .The follow up picture is after three years.

One of the innovations I designed in our mega smile camps was a simple procedures called crescent 
incision or curved line cheiloplasty. I avoid complicated designs so that the tissue heals much faster and looks better after the surgery.
I make a curved incision to bring down the deformed lip to a more horizontal and natural position and advance the other side after making the measurements.The lip is redesigned using a small mucosal flap.
The method is easy to learn and looks like this after the surgery. Many surgeons have attended our camps and workshops and are able to do this surgery.

Saturday, October 25, 2014

U R D 1 i 1 ...:-) a song for my viewers

Hey all,
Thanks for the views which have crossed 305,000 in the last two years alone
I appreciate your helpful and kind comments
Hope to catch up with some of you guys in NYC in about ten days from now and also meet some of ya'll in Las Vegas when we attend the American Aesthetic Medicine Conference.

Here is a clip I made for all you viewers and supporters!..enjoy

Friday, October 24, 2014

Leaving a smile legacy in missions

One of the ways to sustain smile missions is to ensure a good training programme for local surgeons and medical personnel.
Over the years, I have had the privilege of demonstrating thousands of aesthetic plastic and recon procedures to local an expat surgeons in our units.
Cleft palate surgery is not very popular in many developing country units because of the long operating time , bleeding during the surgery and post operative risks like airway obstruction and bleeding.
I am thankful that the large numbers enabled me to design a very safe and useful method of  1:500,000 saline adrenaline hydrodissection so that the operating time is short and post op recovery very fast.
Hundreds of surgeries using hydrodissection ,were demonstrated to trainees during our palate workshops across the nation.

The technique is very safe and has been mentioned in the US Task Force paper on palatoplasty ( The paper is available online in the US as well as in the Hamburg, Euro cleft craniofacial cleft conference(Sept 2013).

 I am thankful to Prof Jeffrey L. Marsh,former Head of of Saint Louis Childrens Craniofacial/ Kids Plastic Centre ,Missouri for inviting me to initiate the online discussions for the US Task Force on palatoplasty  for latecomers ( .The experience helped me to share this innovative and relatively bloodless,palate surgery method in the manuscript for the benefit of doctors and patients alike.

You Tube:

Getting it right the first time in smile surgery

Getting it right the first time in smile surgery is important for the cleft child because subsequent adjustments are much easier.
I am thankful for my time as a visiting craniofacial scholar several years ago at Taipei Chang Gung Craniofacial Centre, where some of the most renowned experts in the field allowed me to scrub with them and learn the newer advances in aesthetic lip surgeries, as well as routine craniomaxfacial surgeries.
We always stress the importance of accurate measurements before the surgery because the aesthetic outcomes are superior to surgeries where measurements are ignored. One of the big challenges in mega smile missions is the mediocre or poor outcome of surgery because of the factory line procedures where details are very often replaced by numbers. 
Aesthetic lip surgery requires good planning  for the lip and nasal floor as well as the alar correction.

The pictures below are from our unit after the time spent with world leaders at Taipei's world famous Chang Gung Craniofacial and Cleft Centre.

Pic: Pic of a baby with a complete cleft lip before and after surgery in Sana city,Yemen

Below: Taiwanese cleft child with a complete cleft lip,Taipei Chang Gung

Thursday, October 23, 2014

The making of an aesthetic smile

There is a huge difference between functional smile surgery and aesthetic smile surgery. Large smile numbers by a surgeon do not necessarily mean good aesthetic outcomes.
Aesthetic cleft surgery always includes lots of imagination on the part of the aesthetic plastic surgeon, as well as experience with routine aesthetic and functional procedures.

I like to compare aesthetic surgery to complicated fingerstyle pieces which require intensive study and practice. Sometimes it takes me several months to master a complicated jazz piece which has lots of variations and tricky chord progressions. I am not always able to master some of the complicated scores and make do with simpler improvisations,which sound reasonably good but need more fine tuning later.

In the photo shown above, the technique involves accurate marking of the proposed philtrum columns, designing the upper lip and Cupids bow,designing the sniffle ridge using sutures at different depths,removing the midline prolabial mucosa an using lateral lip elements, adequate dissection of the orbicularis muscles and approximating the muscles in the midline under slight tension,15-20% overcorrection of the upper lip repair,everting the upper lip with everting sutures, mucosal avancement cheiloplasty and regular post op cleansing and dressings.

Wednesday, October 22, 2014

Bottlenecks in smile charity work

With the growing threat of tribal blood feuds and conflicts across the region,most cleft children are now unable to travel to our charity units.Most of these families come from remote,mostly inaccessible villages where there are no proper health services.
This month witnessed a series of killings and conflicts during the Eid season ,where many were killed in violent and bloody clashes across the whole country.People are afraid to venture out and many who have registered for free smiles under the Smile Programmes now remain behind locked doors or in the safety of their own villages.
Cleft lip an palate surgeries take lots of time and effort .The children often require many interventions before they can have relatively normal lives. Regions in which  regular bloody conflicts occur, have almost non existent smile services because most expat plastic surgeons do not dare venture into places where even angels fear to tread. This is the sad reality of volatile regions where medical teams are often at risk .
The Smile Train  charity is the best legacy for cleft children in any country that needs this service ,but bottlenecks in these troubled and often corrupt places make it very difficult for children to have that second chance at life. That is one of the reasons why available smile services cannot function normally in high risk zones.
Despite all the killings and massacres in this country, we have cleared a huge number of 1336 Smile Train operations in a little over 320 days ,but the number does not mean that all these children are now normal.Each cleft child may need anything between 2 to 4 corrective procedures which means that the wait list for surgery in this group alone is over two thousand surgeries.
A cleft child usually has a cleft lip, a cleft palate,a deformed nose,maladjustments, speech defects and cleft alveolus.
1001 Arabian Smiles is one of the world's greatest smile miracles, because the Smile Train made this happen despite the overwhelming odds against an expat plastic surgeon,when it was launched in January 2010 by Ashish Sabharwal of the Smile Train and some of us.The charity programme was immediately blocked by some corrupt medical doctors and several high ranking officers.

 Thankfully,all the cleft children were saved by many good leaders in the nation .The  highest authorities in the country intervened quickly, and the charity was allowed to work across the entire nation. As a result,poor patients now have easy access to the services ,during more peaceful times.

Severe Acne scarring in Type 4 FP

Treating a Type 4 Fitzpatrick with severe acne scarring poses several challenges because of the problems of post treatment pigmentation.
I usually prefer to condition the skin for at least 6 weeks before the treatment procedure with a regime consisting of alpha hydroxy acids and kojic acid /lactic acid. This prevents any post treatment hyper pigmentation problems.
The ice pick scars are elevated in the first treatment using subcision with a fine blade,sharp scissors or an 18# needle. This decreases the scarring to some extent.
Next I use TCA 15-30 % to reconstruct the scars(CROSS method). This further reduces the depth of scars making them more superficial.
One the scars are more superficial,microdermabrasion can be used along with superficial acid peels over several months.PRPM and some fat grafting may also be used to further improve difficult scars.
The above patient is on follow up treatment for sever scars.The follow up photos will be included when there is significant improvement.

Monday, October 20, 2014

Great pioneers: smile grandmasters

An incredible privilege for me to train under the units started by some of the greatest smile grandmasters in today's smile making world.
 I am uncomfortable with superlatives,but one cannot ignore the work that these great masters have done for the rest of the smile world,where there are millions of cleft patients waiting for a miracle.
The success of my work as a smilemaker today is only because of what was already designed by such masters.

Taipei grandmaster Sam Noordhoff USA, Chang Gung Taipei

Harvard grandmaster John Mulliken  Childrens Boston MA

Sunday, October 19, 2014

Role of expats in smile missions

The role of an expat aesthetic plastic specialist is usually that of a teacher . The above picture is a photo taken almost 15 years ago when the first workshop was held at a local government hospital for local and expat surgeons.
Teaching state of the art aesthetic recon procedures in smile missions takes at least two to three years of intense spadework before any results can be seen.
I always like to start with some well known standardized procedures so that trainees can understand the correct techniques. I prefer to play it safe and  not venture into complicated procedures.
We work ourselves out of a job in this sort of work.Most of our trainees these days have a reasonable amount of experience to be able to do primary lip and palate surgeries. Some of them pursue higher trainings overseas in order to serve their own regions.

Saturday, October 18, 2014

Aesthetic Conference Las Vegas

Discussions and presentations on new aesthetic innovations 7-9 Nov, Las Vegas 2014

Non and Minimally Invasive Procedures for Physicians
  • Using Radiofrequency For Skin Tightening
    Gail Humble, MD, Aesthetic Medicine, Redondo Beach, CA
  • Microdermabrasion With Delivery Of Cosmeceuticals
    Krzysztof Gojdz, MD, PHD, Aesthetic Medicine, Warsaw, Poland
  • Glycolic Acid In Photo Damage Treatment
    Linda C Chung Honet, MD, Dermatologist, Birmingham, MI
  • Microsclerosis Versus Lasers/IPL For The Treatment Of Telangectaesia Of The Lower Limbs
    Prof Alessio Redaelli, MD And PhD, Aesthetic Medicine, Milan, Italy
  • Building Your Aesthetics Practice: Safe Procedures For All Patients
    Gail Humble, MD, Aesthetic Medicine, Redondo Beach, CA
  • The Use Of Cannulas A-Z
    David Melamed, MD, Aesthetic Medicine & Internal Medicine, Los Angeles, CA
  • Concurrent Noninvasive Therapies For Maximum Skin Rejuvenation
    Lewis Feder, MD, Dermatologist & Cosmetic Surgeon, New York, NY
  • An Evaluation Of Efficacy And Tolerability Of Novel Enzyme Production Exfoliation Versus Glycolic Acid In Photo Damage Treatment
    Linda C Chung Honet, MD, Dermatologist, Birmingham, MI
  • Q & A
  • Cosmetic Procedures in Darker Ethnic Groups
    • Essentials For Photoprotection
      Michael Felton, MD, Aesthetic Medicine, New Orleans, LA
    • Performing Microneedling On Dark Skin Types
      Desmer Destang, MD, Aesthetic Medicine, Saint Lucia
    • Melasma, The Asian Nightmare
      John Kim, MD, Laser Surgeon & Cosmetic/Aesthetic Physician, Los Angeles, CA
    • Best In Class Lasers For Hair Removal In Dark Skin
      Desmer Destang, MD,Aesthetic Medicine, Saint Lucia
    • Prevention And Treatment Of Scars On Dark Skin
      Prof Mucio Porto, MD, Plastic Surgeon, Brasilia, Brazil
    • Main Complications Occurring After Any Procedure On Skin Types IV To VI
      John Kim, MD, Laser Surgeon & Cosmetic/Aesthetic Physician, Los Angeles, CA
    • Playing It Safe: Selecting Procedures For Dark Skin
      Michael Felton, MD, Aesthetic Medicine, New Orleans, LA
    • Q & A
    • New Advances in Aesthetic Medicine
      • Newly Introduced LAMS (Local Anesthetics Minimal Invasive Liposuction) For Body Shaping: Technical Keys And Results.
        Minyoung Cho, M.D., PhD, Bariatric Surgeon, Seoul, South Korea
      • Emerging Therapies For Treating Stretchmarks
        Bijan Motamedi, MD, Mesotherapy & Emergency Medicine, Burbank, CA
      • The State-Of-The-Art In Acne Management
        Desmer Destang, MD, Aesthetic Medicine, Saint Lucia 
      • What’s The Current Status Of Mesotherapy In The USA?
        Bijan Motamedi, MD, Mesotherapy & Emergency Medicine, Burbank, CA
      • State-Of-The-Art In Aesthetic Gynecology
        Krzysztof Gojdz, MD, PHD, Aesthetic Medicine, Warsaw, Poland
      • Q & A
      • Aesthetic Medicine and the Concept of Aging in West Africa
        Michael Amalachukwu Okpala, MD, Surgeon, Surrey, United Kingdom
      • New Techniques in Thread Lifting for V-Shape Face Contour Sang-June Rhee, MD, Aesthetic & Anti-Aging Medicine, Ulsan, South Korea
      • Keep More of What You Earn: Tax Deduction Planning for Aesthetic Practices
        David Mandell, JD, MBA, Attorney, Financial Planning Group Principal, Fort Lauderdale, FL 
      • Ask the Expert Breakfast Session
        • Overcoming The Challenge Of Acne Scar Treatments. How And What To Do?
          Davin Lim, M,D., Dermatologist, Brisbane, Australia
        • Uncovering The Mystery Behind Tattoo Removal
          Davin Lim, M.D., Dermatologist, Brisbane, Australia
        • Protect What You Earn: Asset Protection For Aesthetic Physicians
          David Mandell, JD, MBA, Attorney, Financial Planning Group Principal, Fort Lauderdale, FL 
        • What’s Hot in Aesthetic Medicine?
          • The Promise Of Fat Grafting: Why Has It Become So Popular Today?
            Prof Mucio Porto, MD, Plastic Surgeon, Brasilia, Brazil
          • The Unique Combination Of Aptos Threads And Autologous Tissue Transplantation
            Lewis Feder, MD, Dermatologist & Cosmetic Surgeon, New York, NY
          • PRP And Stem Cells: Turning Back The Clock On Aging
            Krzysztof Gojdz, MD, PHD, Aesthetic Medicine, Warsaw, Poland
          • A New Step In The Treatment Of Axillaris Hyperhidrosis
            David Melamed, MD, Aesthetic Medicine & Internal Medicine, Los Angeles, CA
          • Medical Rhinoplasty For All Physicians
            Prof Alessio Redaelli, MD And PhD, Aesthetic Medicine, Milan, Italy
          • Update On Neurotoxins Available On The Market
            David Melamed, MD, Aesthetic Medicine & Internal Medicine, Los Angeles, CA
          • Expert Tips For Laser Vein Removal
            To Be Confirmed
          • Q & A
          • Current Concepts in Hormone Replacement Therapy (HRT) and Anti-Aging
            • The Epidemic Of Metabolic Syndrome And Heart Disease
              Jeffry Life, MD, Family Medicine, Beverly Hills, CA
            • The Best Diets In Treating Your Patients With Obesity
              Derrick DeSilva, Jr, MD, Internist, Edison, NJ 
            • Testosterone Use In Treating The Male Patient
              Prof. Jose Cabo Soler, M.D., Aesthetic Medicine, Valencia, Spain
            • Men’s Sexual Function And Coronary Heart Disease
              Jeffry Life, MD, Family Medicine, Beverly Hills, CA
            • The Debate Over Nutrient Supplements
              Derrick DeSilva, Jr, MD, Internist, Edison, NJ
            • Q & A

Friday, October 17, 2014

Blog Story: Raymond Wah ,VP Samsung" ..remember to leave a legacy in Arabia Felix...

It has been over 10 years since we launched the nation's smile programmes through our aesthetic plastic and support teams in Singapore,from the National University(Prof KO Lee),CIAS Changi Airport(Georgie Ong and friends),Yeap CL (Mount E ),Rodney Lim of Laser Acupuncture,Dr Yong Hak,James,Andrew and several others
So many patients have been helped through this step of faith when we started out in a small way,helping just about anyone who needed plastic surgery
A few years ago, my dear friend and supporter Raymond Wah ,advised me to "leave a smile legacy behind in Arabia.. Raymond is now the VP of Samsung mobiles..
That was over ten years ago;today,over seven thousand plastic surgery patients across the nation have been helped through charity procedures.
Our friends in Singapore meet every year to talk about old times when we launched this programme in a nation that needed help for smile work for cleft children,trauma recon and burns victims
We had a reunion last month at Andrew's Moa grill and pub to share about ways we could continue helping out in places where we are needed....

VP Samsung ,Raymond Wah of Singapore

Smile Legacy: Mount Elizabeth Singapore to 41 Madison Ave ,NYC

41 Madison Avenue NYC

Many years ago, a kind aesthetic plastic surgeon from Mount Elizabeth Singapore took an interest in the smile work I was doing in Arabia Felix and offered to help in whatever way he could. That was over 14 years ago when the work was in its eary stages. The country's smile foundation was laid during those early years and thousands of plastic surgery patients were helped in addition to cleft surgeries.
Yeap CL is one of Asia's leading aesthetic plastic private doctors .He helps med missions with his hi tech expertise so that poor plastic surgery patients can have a second chance at life,especially cleft children.
As one of the Asia’s leading plastic surgeons, Dr Yeap’s patient population comprises Singaporeans, expatriates living  in Singapore as well as surrounding South East Asian countries, and Indonesians. They form an even mix of Asian and Caucasian patients from a wide variety of backgrounds ranging from celebrities in the entertainment industry, socialites, company board directors, and high level executives to middle management executives, working women and men, homemakers and teenage students.

Today, the Smile Train US charity helps all Yemeni cleft chilren.

Thursday, October 16, 2014

News Update: Thousands of Yemeni cleft children registered under Yarim Govt Hospital for smiles

Over the last few years,thousands of Yemeni cleft children have registered under the nation's main smile programmes.
One thousand three hundred and thirty six were operated under the sponsorship of the Smile Train programmes since Jan 2010.
Many more children continue to register under the free smile programmes.

There are no hidden costs at Yarim govt hospital . Under the expert supervision of Mohammed Qabasi,Mohammed Shairi and team, many more  continue to register at the hospital.

A few hundred thousand sms messages were sent out across the nation and enquiries continue to come in. Local newspaper and televisions also cover the programmes,making this the most suitable zone for free cleft surgery.

Patients in Yemen register at Yarim because they feel they are well looked after and there are no hidden costs at the welcome reception.The staff are strictly advised not to make any bills for the patients when they register. The service includes the initial registration,doctor consultations,lab tests ,X ray, surgery and follow up.

Over 97% of the work is done by the Yemeni medical staff.The Singapore,Taipei,Miami trained expat aesthetic plastic surgeon does all the state of the art trainings and all necessary aesthetic corrections.

All Yemeni patients across the country may register for free at the hospital and are welcome to contact Dr.Mohammed Shairi,Chief Anesthetist at his number 777-247-616.

Monday, October 13, 2014

Futuristic Aesthetic Medicine in Las Vegas

The upcoming congress on Aesthetic Medicine in Las Vegas will feature several speakers who are experienced in different aspects of aesthetic treatment.Notably,among the experts is one with experience in pigmentation problems which are common in darker skin types,and include the majority of aesthetic clients seeking help for pigment removal.
I look forward to meeting the experts in this field and listening to their discussions on newer advances in the field.
The congress will be held in an amazing resort called Luxor in Las Vegas, from  7-9 Nov.

Thursday, October 2, 2014

Massachusetts Pilgrimage and Miami Drift

One learns so much from great maestros in the plastic surgical world .Prof John B Mulliken is one of the greatest US legends in this field of smilemaking,and it was an incredible experience to sit with him in his office at the Harvard Chilrens Hospital,Boston MA, to talk about the ways plastic surgeons can improve smile work.
One of the highlights was the generous gift of his 15 year research work on cleft lip and palate children. His expertise has changed the lives of many aesthetic plastic surgeons ,myself included.
He also encouraged me to take up aesthetic medicine as a side business,so that I could have some extra earnings; this lead to my Board Certication under some Beverly Hills experts in Miami , a year later @