Friday, April 28, 2017

Surviving on a song..from war torn Sana Yemen to Mussoorie and New York City

Notes about a war torn zone: Pray for the suffering in war torn Yemen where many are starving due to a blockade on the poor country and blood feuds all across . As we eat our meals,let us take time to remember the suffering there.

Think of the incredible sufferings in the poor country ,devastated by war and blood feuds. Playing a few riffs to promote the needs of children and others in war torn Yemen.

Facial aesthetic surgery: Variations on eye sculpting and challenges of the Asian eye

One of my favourite areas of facial sculpting is in designing the Asian eyelid.
Asian double eyelid surgery can be a very challenging surgery even for experienced facial aesthetic plastic surgeons because of the different presentations.

Some of the complicated questions one has to deal with are:

1. How much fat sculpting is needed in creating that well defined upper neo sulcus ,so that the new eye does not look hollow after a few years?

2. How does one maintain that non Caucasian look in a neo eyelid?

One important observation I have made over the years,  is the common, large amounts of pre septal fat in Asians.
To create a reasonable acceptable sulcus, I  usually trim off excess fat and also reduce the fat pads after opening the septum and adjusting the tarsal plate to levator fixation sutures.
This leads to a pleasant appearance post operatively for all the patients.
Note the excess pre septal fat deposits in most Asian eyelids.

The hands on demos are done at our demo clinics only.

Aesthetic medicine for acne treatment and care @ smilemakernyc

Lessons in Acne treatment: Ongoing hands on training sessions in Aesthetic Medcare

Thanks to all of you who continue to attend the hands on demo sessions on aesthetic medcare;the next topic of importance is acne treament options in aesthetic medicine

My focus will be mainly on the aesthetic medical internventions in acne

1. what sort of peels are good for acne treatment?

My preference for acne treatment is:

a. for small superficial scars and milder acne- lumina gel lactic acid 30% peel with tyrosinase inhibitors
b. regular skin conditioning

c.Otherwise I use the Jessner peel 40% salicylic acid to treat comedones,scars; the results are predictable and good

2. the use of the electric dermapen and microdermarollers

This is reserved for scarring and often combined with other modalities of treatment like subcision,TCA CROSS and other techniques,not mentioned here
Most of this section is through hands on demos on our clients ,and trainees get to understand the basic concepts and applications of these devices on acne patients.

Melesma campaign @ smilemakernyc : use of regular peels and tyrosinase inhibition

Lessons in melesma treatment: Ongoing hands on training sessions in Aesthetic Medcare

The melanin in the skin is produced by melanocytes,
 which are found in the basal layer of the epidermis.
melanin is the primary determinant of skin color.
Melanin is produced by the oxidation of the amino acid tyrosine
Tyrosinase enzyme controls the production of melanin in our body

Common causes:
 Photopigentation sun/uv
Other causes of hyperpigmentation:
Tetracycline induced pigmentation
Tanning bed
Topical antibiotics
OCP,PIH, ,hormonal(pregnancy),DM

Also known as the Asian nightmare,it is common in type 3 and 4 skin types mostly.

Sun reactive skin types:
1.white,always burns ,never tans 
2 white, usually burns,tans with difficulty 
3 white, sometimes mild burn,tan average 
4 moderate brown-rarely burn,tan with difficulty 
5 dark brown, very rarely burn,tan very easily 

6 black, no burn,always tans

How we treat melesma:
Block tyrosinase enzyme by tyrosinase inhibitors ; using a combination of alpha 
arbutin,licorice extract, light lactic acid and kojic acid .
All of these are powerful and safe pigment lightening agents which  are very 
Sun protection: SPF 30
Chemical peels every week using our brand of lumina gel 30%

Smilemakernyc skincare products are primarily for melesma and rejuv in all skin types.

How long is the treatment?:

1. upto a year and when there is significant improvement,the treatment is done about 
2-3 times a month
2. pigment lightening can be done daily ,and when there is improvement it is reduced 
to 2-3 times a week.
There are no untoward effects of our skin care products,except some sensitivity to the
 sun after lactic acid;this is taken care of by regular sunscreens SPF 30.

Friday, April 21, 2017

AESTHETIC SKIN PEEL and care : basic training and safety

Lessons in aesthetic skin conditioning : Ongoing hands on training sessions in Aesthetic Medcare

What is skin conditioning?

Pic: skin layers
       The skin renews itself every 20 days in those between 15-20 years of age
       From the age of 30 onwards, the process is slower ,skin renewal taking place every 12 weeks :“ the sebaceous or oil producing glands become less active leading to dry skin”
       Skin conditioning is a process by which you remove the  dead cells on the surface of your skin by a method known as exfoliation
       You should condition your skin for  6 weeks before any deeper peel or laser

Result of skin conditioning
       Your skin will be clearer,and more youthful – the skin will also heal faster
       If you neglect skin conditioning,your skin will look dry,dull since dead cells accumulate on your skin
       80% of skin damage is caused by UV rays,so protect your skin from the suns rays by using sunblock,umbrellas,hats

Common regime for skin conditioning
       Microcrystal  palmabrasion using aluminium oxide microcrystals to scrub and exfoliate dead skin
       Lactic acid peel with skin lighteners
       Kojic acid application to lighten spots and pigment
       Important: use sunblock SPF 30 daily to protect your skin from getting pigmented and darker ;at 30 SPF –sunblock will be 91 % effective in blocking the UV rays A and B- any SPF above this will still be 91 % effective and you will only pay more money
       Add a little liquid soap and water to a bit of microcrystal;Scrub face gently for 2-3 minutes
       Wash and apply lactic acid peel 4-5 drops,using your finger, but avoid the eyes
       Wash face with cold water after 1.5 to 2 minutes
       Apply moisturizer   Use sunblock daily SPF 30
       After peeling, use kojic acid skin lightener every night
       Apply a small amount of the liquid kojic acid on your face and leave on for the night
       Wash your face in the morning and use sunblock
       This will lighten  your skin pigment and fine wrinkles will decrease

What is the value of skin conditioning  ?
       You can improve the colour and tone of the skin
       Make it clearer and  more youthful
       You can correct bad acne scars and pigments like melesma and correct sun damage and also remove fine wrinkles
Melesma wil take several months to get lighter ; if your pigmentation is superficial it will get lighter faster.If it is deeper it will take longer to lighten.
Note that your skin melisma can return even after several months or years after it gets lighter.
So use this skin pigment lightening treatment regularly. It is not harmful to your skin or body.

Present promotional package:
You need 3-4 sessions a month for the next year to look and feel great!

Sponsor for products and training   :

Thursday, April 20, 2017

Value of skin conditioning

Value of skin conditioning

You can improve the colour and tone of the skin
Make it clearer and  more youthful

You can correct bad acne scars and pigments like melesma and correct sun damage and also remove fine wrinkles

How often does this have to be done?

Once every 7-10 days

Are there side effects?
No,but since superficial peels make your skin sensitive to the sun, use sunblock SPF 30 regularly

How long does this go on?
You can use it regularly for many months ( 10-12 and beyond) ;there are no restrictions on use

Tuesday, April 18, 2017

Expensive aesthetic treatments RF Venus Freeze etc

Radio frequency energy *1, is high frequency alternating electrical current that passes into the dermis and hypo dermal tissues without disruption of the epidermal dermal barrier.
The high frequency oscillating results in collisions between charged molecules and ions and the micro molecular mechanical energy from these collisions is transformed into heat .
The biological RF heat occurs irrespective of of chromophore or skin types and is not dependant upon selective photothermolysis.

In the dermis  the primary cellular element is is the fibroblast and the extra cellular matrix(ECM) which is comprised of collagen,elastin and ground substances.
RF causes thermal stimulation of the ECM and this results in an immediate and temporary shrinkage of the collagen triple helix. It also results in neocollagenesis and neoelastogenesis,as a result of the micro inflammatory stimulation of fibroblasts.

As a result ,the dermis will exhibit enhanced tensile strength,elastic properties,from the newly produced proteins and protogylcans .The end result is a smoother  and more youthful skin.

RF also causes egress of triglycerides out of the of adipocytes which causes shrinkage of fat cells leading to cellulite improvements and some body contouring(as an adjunct to liposelection methods).

*1 RF in body contouring and skin laxity Rx  R Stephen M  , MD Toronto Canada (article for Venus Freeze)

Saturday, April 15, 2017

Shangrila of the Arab world?- Socotra island..Praying this Easter weekend for an Arabic nation in need

This Easter, as all of us pray and worship,let us remind ourselves of God's grace and blessings. One of countries that needs divine intervention right now is the nation of Yemen Arabia where many are suffering an unjust and cruel war.
Many of them will be traveling to India this week for treatment under the sponsorship of the ruler of Dubai.
Socotra island Yemen, is one of the peaceful spots in the region and could become a centre of hope and healing for many in the troubled region.

All about the nose..aesthetic rhinoplasty considerations

Aesthetic rhinoplasty requires a long learning curve because of the numerous variations on the theme of rhinoplasty.Not an easy surgery,but it is worth learning the technqiues to perfection.

Aesthetic rhinoplasty for nasal deformities can range from the simpler solutions like silicon nasal implants to the more complex osteotomies and cartilage repositioning methods. In my experience of several hundred rhinoplasties over the last 17-18 years, I have used different methods of rhinoplasty with reasonably good results (photos).
In the past, I used an internal incision and later on changed it to the stair step incision which proved to be a useful adjunct in nose surgery.These days I prefer to use the columella "red line" incision (below)which gives very good results.

pic: Silicon implant rhinoplasty using the columella red line incision and defatting of tip.Patient did well at 5 year follow up.

One of the big challenges is the Arab crooked nose rhinoplasty which requires different types of nasal osteotmies using 2mm chisels,cartilage repositioning and grafting. Thankfully,my results have been fairly constant over the the years ,using well established techniques of repair. I have not added any innovations in this complex field and prefer to use techniques which are well standardized.
Especially in cartilage resection,my approach is to use a minimalist resection of the caudal septum to prevent the pug nose deformity , matchstick grafts to camoufalge moderate deviations ,conservative resection of the septum,repositioning caudal deviations/subluxations,osteotomy of the bony septum in some cases of deviated caudal septum and conservative trimming of the lateral crural catrilages.
For the bulky nasal tip I trim the domal cartilages, and do some defatting of the tip ,use domal sutures to narrow the tip .If there is an additional droopy nose dues to a prominenet caudal septum,i use a fine blade to resect a few mm of the caudal septum .
The bony hump is reduced with a fine rasp if the hump is not too distorted;in more complicated cases I have had to trim the cartilage and also use a fine 2mm chisel to reduce the hump. I align the cut at an angle to prevent an iatrogenic deformity of the nasal bone which is usually due a straight cut.
Some amount of alar nasal skin may have to be trimmed in the very big nose.

pic:the Arab crooked nose rhinoplasty using nasal osteotomies and cartilage grafts

In a few instances of silicon implant rhinoplasty for the flat nose,I have used the complicated  blind technique of intra oral rhinoplasty which require a lot more precison and dexterity. I do not use this routinely because it takes more time.The results with the other methods are equally good.

Rhinoplasty for the ugly rhinophyma deformity is achieved by shaving, or laser resection.The raw surface is allowed to epitheliaze.The results of this shaving technique are good and patient satisfaction is high.( pic)
pic: rhinoplasty for rhinophyma

The patient with a congenital haemangioma of the nose requires a more complicated surgery(pic). Often I have noted that the nasal skin is very thin over the haemangioma.In this case,I prefer to use a nasal flap combined with a naso labial additional flap to provide some aesthetic coverage for the deformed nose. Fine tuning can be done at a later stage for the rest of the nose.

pic:two flap rhinoplasty using a nasal flap with naso labial flap

Conchal cartilage grafting is a useful technique and I use it for those with small deformities of the middle section.This technqiue is quite easy to perform and provides good long term results.(pic)

pic: conchal graft rhinoplasty(stable at 5 year follow up)

pic: reduction rhinoplasty for bony hump using a fine 2mm chisel and rasp & cartilage trimming

pic: the diffcicult cleft nose rhinoplasty -reshaping the nasal tip and naso labial angle

Some thoughts:

I personally think that diced cartilage rhinoplasty is a bad idea because of the long term ugly effects when the cartilage descends by gravity and creates a bulky nose,necessitating repeat revisions and treating other problems like bad scarring.

Unfortunately,there is no suitable minimalist solution for rhinoplasty. Surgery alone seems to be the gold standard for aesthetic rhinoplasty for most defects. Injections of fillers etc are temporary  "quick fixes "for complicated problems and should not be used  as long term solutions.

Suggested read:

1. The boxy nasal tip- Rod Rohrich Tx, PRS 107: 1849, 2001

2. Dorsal hump reduction-Rod Rohrich Tx, PRS 114:1298,2004