Monday, March 28, 2016


All  our aesthetic skin care items at reasonable discounts now.

Sales in New York city @ Elmhurst,Jackson Hts and behind Rockefeller Centre, New Haven CT,and online

 Microderma needles available only in Elmhurst NYC

Please note that some are almost SOLD out and Chi 7 may not be available after a few weeks.


Wednesday, March 23, 2016

Lipo abdominoplasty fine tuning

Lipoabdominoplasty is a common procedure for those seeking reduction of abdominal fat and waist reduction. It involves surgical removal of fat combined with limited lipo contouring.

A person loses the natural contour of the abdomen as a result of pregnancies,trauma,
weight variations,  changes  in the skin, cellular tissue,muscles, and fasciae.

Plicature of the rectus abdominis and oblique aponeurosis with limited undermining,combined with lipo contouring of the flanks is a relatively safe procedure with few complications. Undermining of the skin is minimal to prevent fluid collection under the flap(seroma) post operatively and troublesome oozing.

In a fat abdomen,generally the biggest protrusion is below the umbilicus(hypogastric region)

The plastic surgeon's  objective is to create an ideal waist size for each patient. This is done by tightening the muscle fascia at selected points by a limited surgical intervention. The downtime after such a procedure is usually about one week,because there will be some amount of oozing after a combined procedure.
A low pubic hairline incision makes the scar less conspicuous.Persons who want zero scars are not good candidates and should opt instead for VASER lipocontouring and etching where very small stab incisions remove fat.Later,multipolar radiofrequency is used to further tighten the abdomen.The procedure is exorbitantly expensive and not for all.

pic:example of  waist reduction surgery (journal pic)

pic: plicating the rectus sheath and lateral aponeursis in very lax abdomens

The results are predictable and patient satisfaction generally high. Patient selection is important in determining the type of modification required .For instance,tightening is reserved for those with loose fascia ,whereas more intense lipocontouring for those who have larger amounts of fat in their flanks.

Overall,waist tightening is an achievable goal for most ,and best results are seen in those who follow a strict diet and exercise regime before and after the procedure. One of my best patients was a middle aged mother from Paris who followed a very strict exercise and diet regime before and after the procedure.As a result she had very impressive post op results and continued to maintain her slim waist with regular maintenance programmes for weight control.

Tuesday, March 22, 2016

Ever heard of ROING Smiles?

Smile Missions will go on because there are over ten million cleft lip and palate children who need help.
Our most recent prelim smile outreach to some of the uttermost parts of the earth ,included a visit by some of our doctor friends to a place called ROING in North East India in the state of Arunachal ,close to the Tibet border. The only way to reach the place is by motorboat .Information was sent to locals that they could receive help for cleft children through a Christian Referral hospital in nearby Nagaland ,India.
Some other friends will visit nearby areas,including the Myanmar border areas to see how cleft children can be helped. There are no roads and villagers often have to walk over a day to the nearest station.Some take five days to reach the nearest mission post.

pic: Myanmar cleft child in a region where there are no roads

pic:Christian Referral hospital Dimapur Nagaland which provides very low cost care and even has four free wards donated by a local church for poor patients;over 80% opd patients are from nearby Assam .Some come from faraway Myanmar for treatment.

Facts on plastic surgery missions and support for Yemen Arabia by expat NGO charity missions

As countries are devastated by bad governance,terrorism and radical ideologies, many expat humanitarian medical missions have either evacuated or postponed life changing projects for large sections of underprivileged patients who have no other hope.

In our case, we have faced many hurdles and threats to our very existence over the years working for socially ostracized rural patients across Yemen Arabia;thankfully,at that time some kind officials made it easy for us to help an entire nation in need of plastic surgery care. Thousands were operated for free and even supported for transport,food and medicines. The Ministry of Planning and International Cooperation of Yemen has received detailed reports of our work for their people;the records have also been entered in the country's govt hospital files as well as our databases.

The last few years ,till the  disastrous war of March 2015 saw an increase in smile aid by the US Smile Train NYC for 1490 extra cleft patients across the nation.  The report below is self explanatory, and provides enough information to some groups in Yemen(thankfully a small minority) who are trying to rewrite history and ignore this contribution.I have included this and others,following their recent allegations that the expat NGO work  for their entire nation was not official ,but a fabricated one . Our work has since moved on to other countries where we are  needed and genuinely welcome.

There are many nations around the world,who long for plastic surgery missions to their poorer and underprivileged sections of society but do not receive such help because of huge obstacles within the system. We are thankful that we  could use the small window of opportunity to help some in Arabia Yemen.

I would like to thank all our friends in Singapore,Taipei,UK ,EU and the US for their sacrificial support for a nation in need from 1998-2015. Over seven thousand five hundred patients have received direct help through their efforts.

Charity Support: Cleft lip and palate children Yemen Arabia 2010-2015 March

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    Surgical InterventionAllMarch

    Last updated —Tuesday, March 22, 2016 8:00:01 AM, New York

    Saddle nose rhinoplasty-fine tuning implant surgery

    This young adult patient had a long standing saddle nose deformity following trauma.
    1. normal thickness nasal skin
    2.saddle nose deformity
    3.bulbous tip
    4. deformed naso labial angle

    A DMK Tokyo hi grade implant was planned and inserted via a total rhinoplasty incision using the columella pink line incision. The bulbous tip was adjusted and the implant modified by making it softer at the tip.It was further covered with a strip of cartilage to protect it.A subperiosteal pocket was made over the nasal bone where the implant was made to sit comfortably. A course of antibiotics was given for five days to prevent any infection.

    The patient did well post operatively and there were no complications on follow up after three years.

    Nasal implants can sometimes get infected and extruded if there is too much pressure on the overlying skin;it is better not to use implants if the nasal skin is thin and atrophic. To play it safe ,I modify the implant by reducing it's angulation and covering part of it with a cartilage(septum). This proves to be an effective way of preventing any extrusion or infection.
    Tip modification for the bulbous tip and alar cartilage trimming and modification are needed in some cases to give a finer post operative result.

    Monday, March 21, 2016

    Finer aspects of eyelid and eyebag rejuvenation

    Eyelid rejuvenation for both upper and lower eyelids are commonly sought after aesthetic procedures by most people in their forties and older.
    Done properly with accurate markings,the results of both procedures are very good and long lasting.

    One of the most common complications is eyelid asymmetry. This can be prevented by an accurate pre op design. I have designed the cross incision for upper eyelid rejuvenation  to prevent and also correct asymmetry. The results have been consistent and patient satisfaction is generally high.

    In the cross incision ,I use a line from the centre of the pupil and both limbal margins to the desired height  of about 7-8mm. The amount of skin to be resected is measured on both sides.If there is asymmetry, I adjust the  amount  by removing  less on one side.

    Some tips:

    1. Sometimes,in older people in their late forties onwards, one might have to plicate the loose orbital septum with 6 zero pds or vicryl and fix to the periosteum of the rim;care should be taken not to be too aggressive in your plication so as to prevent excessive scleral show. A moderate amount of plication is sufficient-test the septum laxity by pressing on the lower and upper eye during upper and lower procedures.

    2. I like to re drape the fat to avoid the post operative hollow and cadaveric look years later, which is common when all the fat pads are excised.

    3. The pinch test with fine forceps for lower eyelid rejuvenation is useful;only a small amount of skin is removed here.If septal plication is done,it my not be necessary to remove skin and muscle. The baggy eyes can be corrected  satisfactorily by rim fixation after plication .Fat re draping also gives a better and more youthful look post operatively.

    4. In the oriental "double eyelid" procedure , I prefer to use a height of about 7-8mm so that the look is more natural. Too big a crease in Asians may look abnormal compared to the rest of the face structures. The septum is opened,and a few figure of 8 sutures with 6 0 pds or proline/nylon placed between the tarsal plate and levator aponeurosis-this everts the upper eyelids and increases the interpalbebral distance giving the eye a bigger and rejuvenated appearance.

    5. If there is brow drooping in older patients.I also add a brow elevation procedure-brow lift ,sometimes or a mini lateral direct brow lift procedure.

    Sunday, March 13, 2016

    Lumina Gel peel follow up after six months

    Lumina gel peel after six months follow up for age and sun spots,fine lines has shown some significant benefits.

    1.  Used every ten days ,the peel has improved facial skin tone and texture
    2.  decrease in melesma and blemishes
    3.  reduction in wrinkles and fine lines
    4.  plumper and more youthful skin

    The only precaution one has to take is to use sun block SPF30 3-4 times a day. Lumina peel makes your skin more sensitive to the sun's rays.

    Patients with hypothyroid problems should not use lumina gel because those with hypothyroidism have high amounts of glycosaminoglycans in their skin which makes their faces become puffy and edematous. Vegetable peels are more suitable for such groups.

    Friday, March 4, 2016

    Charity Smile Support @ SmilemakerNYC

    "Smilemaker custom made hybrid electric is now ready. This model will be auctioned later to supporters who wish to support underprivileged cleft lip and palate children."

    * This original signature custom made Smilemaker hybrid is NOT FOR SALE.     We will introduce other models later for customers.
     The proceeds of the sales go fully towards cleft children support .

    The classic hybrid Smilemaker electric ,designed by  the founder of SmilemakerNYC
    This is an unusual hybrid electric with an mp3 function on the body using a Polaroid mp3, 4GB unit

    A great guitar to play in bands, solo performance for classical,country,rock, blues,jazz  all in one guitar without having to change instruments;" I always wondered what it would be like to design a hybrid . That way I could play country, fingerstyle,classical,gospel,r­ock,blues,pop,jazz all in one. 
    Have a look and listen to my SMILEMAKER! That is the story of SmilemakerNYC "

     Demo on you tube:       SMILEMAKER HYBRID GUITAR

    Reviews:  US musicians

    1.          Boston
    Very cool! Looks amazing! Bravo....p  .. Tres cool!  

    2.      California LA 
                Sounds really nice. Good name… Bruce Guynn and Big Rain

    3.      Florida   That's awesome! It's gonna look beautiful Congrats! 

    4.        Colorado
    That is an amazing, highly creative way of impacting the life of others. 
     Dr.Ren Merry PhD(classical guitar), Guitar/choral/AP Music teacher at Frontier Academy,Denver

    Thursday, March 3, 2016

    Type 3-6 FP patients and post laser hyperpigmentation

    Post laser/IPL  inflammatory hyperpigmentation usually occurs because the patients have not been adequately treated for at east six weeks with superficial peels and lightening agents.

    In my earlier blogs, I have mentioned the importance of skin conditioning where the dead cells are exfoliated with superficial peels and the skin lightened with tyrosinase inhibitors for at east six weeks prior to any laser peel,IPL or dermabrasion.

    If you condition your skin, it will heal better and the chances of  PIH or post inflammatory hyperpigmentation are going to be reduced significantly.
    So take care and follow the simple rules of skin conditioning mentioned in my earlier blogs.

    Board Certified
    American Academy of Aesthetic Medicine, Miami,Fla (under Bev Hills CA leaders)

    Leaving a smile legacy wherever you go

    Raymond Wah ,VP Samsung mobile units

    Years ago, a dear friend and well wisher,Raymond Wah of Samsung advised me to leave a smile legacy during our mission camps in Arabia.Many surgeons are now able to perform the cleft lip surgeries independently.

    The measure of a smile mission's success is not just in accurate surgery or numbers but whether or not the work is being continued by local surgeons.

    If you have trained local surgeons to get the work done when you are gone,that would be considered a fruitful smile mission.A legacy for thousands of cleft lip and palate children.

    Our contribution from is free training manuals and hands on demos for cleft trainees.
    Later, many of the children are sponsored for free smile surgery by the US Smile Train. logistics centre,CT

    Smilemaker Junction @ 7am Moriani Assam Express Train

    Hi all,

    Busy doing some spadework to get the Smile Train US cleft lip and palate centre set up at the Christian Referral Hospital Dimapur, Nagaland. The paperwork should be done soon.
    This hospital is a joint venture of the Nagaland govt,CMC Vellore and Emmanueal Hospital Association India.
    Every morning, the 7am Moriani Assam Express Train brings in a load of over 500 -600 patients to this hospital from all over  upper Assam state.
    Several Myanmar patients also come here for treatment .

    If all goes well,the Smile Centre should be able to help patients from
    1. Nagaland
    2. Assam
    3. Manipur
    4. Arunachal Pradesh and Tibet borders
    5. Myammar
    6. Bhutan
    7. Other states of India-UP,Bihar etc. where there are EHA units.

    The 3 day Intensive Cleft Workshop ,"Smiles 4 All" sponsored by our group, went well and altogether there were 8 trainees:  6 local specialist surgeons and two DNB Family Medicine trainee doctors from Patna and Maharashtra state.
    The primary  manual on cleft techniques "Smiles 4 All" was presented to each trainee. Intensive lectures and Q and A sessions  lasting over 5 hours were held  over a two day period.
    A live demo was held on the modified  Mohler reconstruction of a complete unilateral cleft lip and floor of nose reconstruction. The other patients will be sponsored later under the US Smile Train charity programmes.