Tuesday, June 28, 2016

Is Lumina Gel good for superficial acne scars?

 Our signature peel Lumina Gel contains 30 % lactic acid with skin lighteners.

It is good for the following in acne patients:

1. opening up comedones and decreasing the number of comedones

2. prevention and treatment of superficial acne scarring and lessening fine lines.

3. Lightening acne scars. In acne, your inflamed skin undergoes a change known as post inflammatory hyperpigmentation. This is worse for darker skin types.

Lactic acid is a skin lightener and will block your body's tyrosinase enzyme so that melanin synthesis is decreased. As a result, your skin becomes lighter at percentages above 5% .

Lumina gel also contains several other skin lighteners which make the skin a lot clearer and lighter over a few months of regular use.

You can order Lumina Gel at our site below using either paypal or credit card.


Monday, June 27, 2016

SmilemakerNYC aesthetic skin care products

SmilemakerNYC skin care products are reasonablly priced and have significant effects on your facial skin.

You can order our products from the office at Queens NYC by visiting  the site

The range is limited to facial rejuvenation products only.

lighten your face and blemishes

improve your skin tone and glow

safe cleanser herbal

our signature Lumina superficial peel for youthful skin

deep pore cleanser for blemished skin

light cleanser for all skin types

Sunday, June 26, 2016

Aesthetic Blogger Tips on Aesthetic Medicine

As part of my commitment to teaching some aspects of Aesthetic Medical concepts,the sessions will also include several write ups on botox, fillers and newer concepts of aesthetic practice for the benefit of those of you who read and follow the blogs.

Thanks for the useful and helpful advice, and comments.The number of viewers across the US and rest of the world  now stands at above 837,000 views since the first blog post in September 2012.

Aesthetic Medicine a relatively newer speciality that is improving every year. The learning curve includes a few years of intensive study and practice, and requires constant updates to check for what is the best method for patients.
A very fast growing speciality that now takes a huge share of the world's medical market place.

Bon chance!


SMILEXIT ? - the end of smile missions and the last smile

Medical smile missions in newer frontiers can be exciting and also very risky for plastic surgeons .

Our work as a locally grown British International Plastic Surgery charity for the Arabian regions of Yemen and beyond faced a massive  roadblock a few years ago in 2011 during the massive and bloody Arab uprisings when the region went on the warpath, without any suitable alternative .The result was chaotic and horrendous with over 5,500 businesses being wiped out in a few months of violence.

Despite the recurring blood feuds across troubled Yemen Arabia,some of us gave it the benefit of a doubt and continued to help underprivileged sections of the society with much needed free mission plastic and recon surgery. There were no charges for any patient who came to our units across the nation.

The straw that broke the camel's back was the coalition invasion of Yemen. I had just completed one round of plastic surgery demos at the capital Sana for a few dozen children when the city was attacked relentlessly by Saudi Arabia  on the 26th of March 2015 at 2am local time, without any provocation from the Yemeni Houthi militia or opposition political parties.
Our group was forced to close all programmes because the medical infrastructure across Yemen was wiped out by the ensuing war. 
The Smile Train had partnered some of our work in 2010 and was  also left with no choice but to exit Yemen in June 2016 following the horrendous massacres across the nation.

Today,many of our Arab friends look at the ruins they have created in Yemen,as well as in their own countries and wonder why they did such a thing in the first place. No one has gained anything  from the blunderng policies of a few oppresive governments, warlords and militia outfits that do not care about the general good of the population at large.

Saturday, June 25, 2016

The New Era of Medical Missions- Knowledge Factor

Doctors in medical missions often get discouraged and do not READ much! As a result,many of them get left behind and later give up on their much needed specialty.
It is very difficult to get back into mainstream academia when one is left alone in the boondocks for years ,working under spartan conditions.

Thankfully,the world around us is kind to those of us who may have lost many years in academia as a result of involvement in medical missions to difficult regions.
It is hard to get the brain stimulated after a long gap,but determination always wins in the end. The first few months are usually filled with discouragement but over the next few months,the doctor who is determined to learn and move on is often very successful.

The advice is- GET STARTED and move on if you feel jaded and out of sync.

It really is not that difficult to revise all medical facts and up to date diagnoses if you are an older doctor. It will pay to read as much as you possible can and improve your KNOWLEDGE.

Here Comes the SUN.. Chilling out with me Smilemaker hybrid after reading over ten thousand medical pages of info  from premed to specializations...nothing else to do but play on!

Well, 24 years in the wild frontiers of  med missions is a long long time but looking back..I am glad I did it
Cast your bread upon the waters..in fact I know more today than I would have done elsewhere, and in the process , specialized in several fields. Thank God.  Amen.

People out there need you..sometimes, you as a doctor may be the difference between a patient and death. So read on and on..


Monday, June 20, 2016

Formal closure of smile missions in Yemen Arabia from June 2016

Due to the ongoing violence in many parts of the country,all expat missions have either relocated to other countries or closed their work.

Our humanitarian cleft lip and palate services along with mission plastic surgery had to be closed  due to the extraordinary circumstances,where there is no medical infrastructure anymore following the destruction of hospitals ,schools and most businesses.  Despite the war in March 2015,some of us tried in vain to reach out to the country but now find it impossible to continue any sort of work.

Over eight thousand plastic surgery patients have been operated and helped over a long 16 year period and several local surgeons and medical staff were trained in the common techniques.
The hospitals today have  no medicines,water or electricity making medical work impossible except for dire emergencies.

Over 1200 expat medical doctors have left the nation. Many ill patients,cancer patients and kidney dialysis patients have died in the process. Most of the children today are even more malnourished and sickly.

The international community has either done very little to heal the nation or speak out against atrocities by both warring factions of the coalition or local militia that control many sections of this war ravaged country.  Sadly ,some rich nations were complicit in the illegal acts in this humanitarian tragedy we see unfold before our eyes.

Thursday, June 9, 2016

Pink Elephant in the fridge - a hijacked health system

The meek shall inherit the earth.The rest of us will go to heaven.

Eliminating differences in treatment will require systemic changes in health system factors, provider-factors and patient level factors. It is not gonna happen though, because change costs too much time  effort and money.

Minority patients will always be at a disadvantage because of socio economic reasons and will continue to  have poorer health outcomes from many preventable and treatable health conditions.

There are also clearly described racial differences in quality of health care when patients enter the health care system.

Many doctors are victims of their own profession today and have to morphe into different forms to survive in this harsh environment.

Tuesday, June 7, 2016

Beyond the iceberg tip - cleft challenges

I remember reading about cleft lip and palate during my med school years
Ignorance is bliss. No big deal, Cleft lip is caused by the failure of fusion of maxillary and medial nasal processes. (formation of the primary palate).

A cleft palate is due to the fusion of two lateral palatine processes or failure of fusion of lateral palatal shelves with  the nasal septum, or median palatal shelf( secondary palate formation). A bit trickier,but ok enough to grasp.

The lessons ended there, or so I thought.

Many years later, as a primary cleft surgeon I realize how complicated clefts can be. Ignorance is not bliss,especially for the dedicated cleft surgeon who sees thousands of patients. There are over ten million cleft children in the world today, and over one thousand are born every day.
A wrong diagnosis can be costly.

Clinical case: A 3 year old male child presents with midface dysplasia-flat nose,flat cheek bones .His parents noticed that he had a small chin and large tongue, difficulty breathing when supine and better on sitting up.
On examination, he has a flat nose,flat cheek bones, U shaped cleft palate, large tongue and micrognathia(small retracted chin area) . The child also has hearing loss,tender joints, and is myopic.
What is your most likely diagnosis in this case?


The child presents with the classic triad of micrognathia,glossoptosis(large tongue that falls backwards due to small jaw), and U shaped cleft palate ,which is  diagnostic of the Pierre Robin sequence. This can cause severe post palatoplasty airway obstruction with hypoxia.
The presence of arthritis, myopia and facial abnormalities in this child is suggestive of a collagen disorder. The most common underlying syndrome with  Pierre Robin sequence is the Stickler Syndrome,an autosomal dominant disorder affecting connective tissues,especially collagen.

Pics of a child with PR sequence(net)


Saturday, June 4, 2016

Looking for a low downtime in aesthetic procedures -patientcentric woes!

The future of private practice in aesthetic surgery lies in minimally invasive procedures where the down time after any procedure will be very low;in some instances where radiofrequency modalities are used, there will be no downtime.
So much has changed over the years in the field of plastic surgery where invasive surgeries for the face have been replaced by less invasive procedures.It is possible to look younger without having a major facelift where there may be other complications like wound infections and pain.
MOOBS can be removed through a very small subarealar incision, the brows lifted either with threads or botox, the breast reduced by a circumareolar method combined with liposuction of fatty tissue,and rejuvenation performed by microneedling or harmless fillers using small needles.
With the addition of new gadgets almost every month, combined with newer fillers with less side effects ,most patients these days are looking for  procedures that are patient friendly .

Gender amplification ...main reason for this overdrive

With growing worldwide interest in aesthetic medicine over the last decade,a lot of attention is focused on the benefits of gender amplification .The main reason  for this overdrive is arguably the problem of self esteem.

Gender amplification is a hot topic in many aesthetic centres these days. Get it and strut the stuff,to the envy of those less enlightened.Or rather, less amplified.
But the topic is fraught with controversy over the  long term benefits.There are several papers on male and female aesthetic amplification but one wonders what the benefits really are,apart from the obvious psychosomatic well being after such procedures. As far as ultra pleasure is concerned,one has doubts about the efficacy of such procedures .Especially fillers for G spot amplification. What does it really do? It is a well known anatomical fact that the area is a highly sensitive zone with over 90% nerve innervation. So apart from from the mostly subjective, sensational episodes of self flagellation ,what other measures are there to prove claims by a select few that this is just what the aesthetic specialist ordered?
Male augmentation is a fairly simple aesthetic procedure in skilled hands, with or without surgery,and breast implants are very common these days.The persons undergoing such procedures do it for themselves and not for their partners.It does not make the person more desirable to one's long term partner, but one cannot contest the claim that it may increase phantom fantasies in both sexes.
Fat transplants with or without dermal grafts,implants and temporary fillers are some sought after procedures.
Most of the benefits however, will be subjective.

The debates will continue without much consensus, or rational conclusions.Like mind over matter.

Thursday, June 2, 2016

Summertime....sweaty and cornstarch test positive?

Ever heard of this novel concept of taking care of those embarrassingly sweaty armpits with Botox?
Well, it really is quite simple .Exercise till you sweat .We then rub some 10% povidone iodine on your armpits and apply kitchen corn starch. As we dust off the corn starch, the areas with hyperactive sweat glands begin to take on a dark blue black colour after some minutes.
The area that has been mapped out with the corn starch reaction is treated with multiple injections of Botox.
The patient is followed up after two weeks and the test repeated to mark out areas that may need touches of Botox. The technique is easy and the results are very good using Botox as a neuromodulator to stop the hyperactive sweat glands.
The Japanese invented the minimal  vertical incision method of sweat gland removal where fine scissors are used to snip off the sweat glands along with some subcut tissue. A razor is then used to shave off the hair follicles so that the person has a dual advantage of hair and sweat gland removal. An easy procedure done under local anesthesia with little downtime and minimal discomfort.

YO! went in for Botox..came out like the DEVIL

pic:the mephisto complication caused by a wrong injection of botox

"went in for botox at the clinic,
     came out looking like the devil" 
is a common complaint of some patients who have suffered this complication after botox.This is because older plastic surgery journals describe the sites prescribed for botox injection  in an inaccurate manner (like the V technique ),leading to this problem in patients and plastic surgeons alike.Some senior plastic surgeons have also had this complication in themselves because they followed the "journal recommendations". Thankfully, this problem is easily taken care of by a small amount of botox in the lateral hyperactive frontalis muscles which was missed in the injection.

One of the most important things that a patient should know about botox is that the doctor who gives this injection should be well trained in the latest techniques of administration. 
RULE: Never contract your muscles while the injection is being administered. The facial muscles in that area must be completely RELAXED. This will prevent undue complications.

Some doctors try to make more money by over diluting the prescribed does of botox.This is risky because the over diluted medicine will diffuse into surrounding tissue and cause unwanted effects and problems.

Drooping of the brow is a complication caused by injecting the botox in a wrong way without referring to the specific landmark on the forehead and going too low down into the brow region. Thankfully,a drug called iopidine eye drops three times a day cures the problem. Some countries may not have this medicine. The effect will wear off after 4 months or so.

Bruising is not common these days because the needles used are very fine and the patient may not even experience discomfort if the injection is carefully administered. Do not massage the area injected.

More specific uses of botox for the face and neck,excessive sweating of the armpits,ugly calves,scar treatment,gummy smile correction,sad face correction,lower eye injection, face sculpting  in combination with filers ,require a doctor who has had this advanced training at a reputable,internationally recognized speciality.  

Next on the list? Avatar Blue Peel(literally) and Captain Spocks Ears.

Not everyone comes up with regular greatest hits .Folks like Jimmy Buffet and Grant Geissman  became famous overnight with one hit tunes like  Margaritaville and Feel so good .The rest of the people keep on trying out different things but most of it just never seems to work.
For many years, medical personnel have been using platelet rich plasma in orthopedic medicine to improve tissue healing but the idea of PRPM did not really hit the limelight till someone like Kim Kardashian got her vampire lift for a thousand bucks! Now everyone is scrambling madly for this new-old wine in a brand new wine skin,selling for huge sums of money. The next on the list is not just the Dracula lift but Avatar Blue Peel(literally) and Captain Spocks Ears.
The problem with commercial aesthetic practice is that manufacturers and doctors alike take old ideas, re label them  and try sell them for big profits.I often meet plastic surgeons who tell me about their "novel techniques" which are not much more than what someone else used (often without recognition in those days) way back before the 2nd world war.

How is it that researchers in the United Kingdom show that PRPM does not necessarily have to have calcium chloride as the "one and only" matrix former, but that calcium gluconate in a low dose is a much safer alternative? In a higher dose calcium gluconate may be a skin irritant, but a low dose  is perfectly safe without side effects.
And then ,what about the centrifuges? There are so many out there in the market with self timers.Mostly everything comes from China  these days at  affordable prices. The sterile EDTA tubes used for collecting the blood and making PRP are easily available in most pharmacies. Researchers do not always agree about the time needed to spin the tubes and rotation speed per minute.What we then have is a reasonably good average where the results are acceptable.
The future of fillers is probably autologous PRPM and it does not cost a whole lot of money or expertise to make. The cost involved is mainly  in the treatment by a good aesthetic physician  and that is what the patient really pays for. A job well done deserves good returns and if a patient were to pay about 950 to a thousand five hundred dollars or more for  a PRPM session,the reason is because the doctor is highly skilled and does a good job rejuvenating the face . Good instruments,sophisticated fillers, or hi tech gadgets are not substitutes for aesthetic medicine experts. There are countless blotched jobs in Hollywood and other "aesthetic capitals",mostly by overzealous doctors .In some countries,aestheticians do the job of doctors and often make terrible mistakes.

An experienced and highly skilled aesthetic medicine consultant will never lose out in practice ,even if the initial start up is slow in some areas. Like my close friends always tell me.."..always do what you are best at...". It will always pay over time. Better than that one hit song which fades over time. And the risks are also much less. No need to look again for that lost shaker of salt..

Dermnaseum of the skin with Lumina Gel 30%

As one gets older ,there are intrinsic and extrinsic changes that occur due to the ageing process.Over 80% of extrinsic changes are due to photo damage ,which manifest mostly as wrinkles and pigmented marks. Smoking aggravates these changes and make the skin quality worse.

The Dermnaseum of the skin includes some simple tips:

1. removal of those accumulated dead cells ,also known as exfoliation . I commonly use lactic acid 30% which is a great way to exfoliate dead cells through superficial peeling
also stimulates your dermal collagen

2. lightening with the help of chi 7 (smilemakernyc.com)

a great way to keep one's skin clear and healthy
regular maintenence of the skin  using this strict regime prevents the dreaded complications of PIH(post inflammatory hyperpigmentation) when one uses lasers.IPL or peelings later especially in FP skin types 4 ,5,6.