Wednesday, January 31, 2018

In Aesthetic Plastic Surgery- Remember the 1-3-5 if you are planning on smiles!

Always like to tell my trainees that you gotta get your 1-3-5 right before venturing into the smile making world. A lot of my aesthetic work revolves around a user friendly pivot point. It works well for most common cases. If you a music buff and like to listen to the classical heroes, listen to some of Tarrega and Bach. The pieces are easy to understand and sound great.
Plastic surgeons should focus more on accurate and simple interventions and save themselves a whole world of  trouble trying to demonstrate heroic feats of expertise, only to land on one's butts,sooner than later. Many of the exotic techniques described were mere fads or flights of fancy,and cause more distress than good.The botched job syndrome serves as a good reminder not to tread where even angels fear to tread.
I am always in favour of innovations that have stood the test of time,like Millard or Mohler techniques that have been modified time and again by many plastic surgeons.None of us can claim to have created a design ,because most of the best techniques were already made long before any of us were born! Think of the Rose method which most use with a slight curve modification and  z plasty.

Some inaccurate modifications would probably be the Black technique of bilateral lip repair which incorrectly uses  the central lip flap which all of us have learnt to discard,since it causes the proverbial whistle deformity.

Enjoy plastic surgery,but remember we guys are only trying to fill in the shoes of great pioneers and maestros. I,for one,prefer the simple things in life these days. Sleep is precious and one's heartstrings cant be allowed to stretch too often.

1490- the smile equation in Arabia Felix

Introduction : Arabia Felix, the name given to an erstwhile happy place,is presently one of the most depressive places on the face of the earth. Arabia Felix is nothing short of an oxymoron,given the man made humanitarian disaster caused by war.
There was a time in the recent past when underprivileged smile children were adopted under our smile programme.
The invasion of Sana in 2015 ended whatever remained of the smile equation.
Patients desperately hope for that past miracle smile.
1490 is the miracle smile equation that brought hope to thousands of cleft children.It ended with the war.Instead, there is only despair and hopelessness now.
The challenge remains.Will the lost smiles ever come back?

(Intro to an abstract 1490-smile equation;references  not mentioned here )

Materials and methods:
Our smile work in Yemen Arabia began way back in Jan 1998. Many years later, Yemen Smile as we were known then, became a partner of the US NYC Smile Train.
Our goal would be to provide free smiles across every governorate and village.
The common methods used for publicity:
a. local newspapers,TV
b.informing villages and local hospitals
d. GSM companies across all regions

As a result of intense campaigning,thousands registered for the surgeries.

The surgical protocol we followed was a routine standardized international protocol followed by Smile Train, with a few modifications.Most were latecomers and hence our repertoire included a few innovations along the way,like button hole mini palatoplasty using 1: 500,000 adrenaline saline.
Most came back for secondary revisions and procedures.The follow up rate was good,with over 90% compliance at follow up.

The main setbacks during the camps were the frequent blood feuds and political turmoil across factions. However, we could successfully complete the initial list of 1490 cleft lip and palate surgeries under the Smile Train partnership programmes.
As the invasion took place in March 2015, all our programmes were suspended indefinitely.

Observations: on a more simplistic note,the smile equation works as a cause and effect progression. 
The delivery of 1490 free smiles to all= smiles of hope and happiness for entire communities.
On the contrary,the minus smile effect could be interpreted as war and conflict leading to despair and hopelessness.
As doctors who adhere to to the Hippocratic oath," do no harm" we observed positive attitudes when proactive efforts were made to reach out with love and compassion to all. One could play a prominent role as peacemaker ,speaking out against injustice and oppression of marginalized societies.

Conclusions: Rich nations have ample resources to help poorer nations with much needed humanitarian medical aid and expertise.On the flip side,when discretion and altruism are sidelined by misguided policy, eg. war and sales of wmds to oppressive and autocratic regimes,all the records of good deeds fade away immediately.
1490 was a window of opportunity for New York City's Smile Train to stand in the gap for a cleft population in need. It did have a huge positive impact on many lives by virtue of a ripple effect, and helped encourage the nation.Thousands came forward to show their appreciation at the camps.

Gifting a smile back to an underprivileged cleft child is priceless.And so the smiles went on and on,despite some major bottlenecks along the way.

1490 was the smile equation that changed not only the lives of thousands of underprivileged patients across Arabia Felix,but my whole worldview as well.

Bona Lotha
"Consultant Aesthetic Plastic and Surgery General
...starts with the lip and stretches upto the valves of Giovanni Battista Morgagni and a wee bit beyond,sphincter intact."😅

suggested reading: It was an honor to initiate the US Task Force online discussions for on palatoplasty in latecomers

1. Palatoplasty in latecomers The Cleft Palate–Craniofacial Journal 51(6) pp. e122–e128 November 2014
2.abstract for the 72nd Annual Meeting of the American Cleft Palate-Craniofacial Association ,April 22-25, 2015  Westin Mission Hills Resort in Palm Springs, California, USA.
3.short oral presentation for the 5th European Plastic Surgery Research Council, 22-25 August 2013 in Hamburg, Germany, Minimal blood loss palatoplasty using saline hydrodissection Program ID: SOP39 Presentation Day: Saturday, 24.08.2013
4.Developing an international plastic surgery NGO in a developing nation : Bona SL Yemen Smile, 7th Asian Pacific Craniofacial Association Congress TPE 2008 Oct
5. Smile Train NYC Yemen
6. Initiating the US Palate Task Force online discussions on palatoplasty for latecomers,Bona S Lotha (Yemen)

Friday, January 26, 2018

Pre Shampoo treatment for thinning hair

Pre shampoo for dry hair and dandruff with oils, allantoin, fruit extract;I use a bit of ketaconazole for treating dandruff . Good for healthy hair growth. Suggested for dandruff and dry scalp.


Pearls in plastic surgery 1: Thoughts on Vitiligo that requires skin grafting

Vitiligo that is refractory to medcial treatment can be treated with laser removal/dermabrasion and split skin grafting

*"Thin split-thickness skin grafts (0.2 to 0.3
mm in thickness and the same size as the recipient
site) harvested from the pigmented
thigh region

The treated sites are immobilized with plaster
splints for 5 days, and dressings changed
every 3 days for 15 days.

Patients are advised to
protect their operation sites, including the
graft donor areas, from the sun for at least 6
months and to use broad-spectrum sunscreens
and skin moisturizers."

*(May not be useful  to treat facial
vitiligo since perfect color match is critical for
the face. A demarcation between skin graft and
normal skin may exist, especially for smaller
areas. For such situations, blister grafting or
medical grade tattooing might be a better

Generally useful if not too large areas are treated;the technique has limitations because sometimes the vitiligo may recur after a few years. However,the cosmetic results are satisfactory and may help the patient for some time.
For smaller lesions, one could try the dermapen to allow for re epithelialisation of the achromic regions of the skin.

*ref:Cengiz Acikel, M.D.,Turkey Dept Plastic Surgery, PRS 111: 1291, 2003.)

Wednesday, January 24, 2018

Favorite things..the art of soap making in the aesthetic world

Art of soap making in the aesthetic world

From moisturizing soaps with soft oils like olive,almond  to melt and pour variations;I use only vegetable sources and no animal fat, or chemicals like sodium laureth sulfate which is a skin irritant
The soaps are mild and moisturising and good for all skin types

I also like to make pigment lite soaps with kojic acid and other  tyrosinase inhibitors

Microcrystal dermabrasion liquid soaps with pigment lighteners are useful for hand and face

The new addition includes colourful variants  with red wine,vodka and beer.

The list of ingredients and patterns is long and one can  create many designs and types with some exotic ingredients

Here are some of the types I usually make for my clients

Tuesday, January 23, 2018

Networking in med missions

One of the biggest obstacles to missions these days is micromanagement. Without a common consensus, one cannot hope to achieve any sustainable goal.

It is only through networking and accountability that work can be done for the benefit of those who need some support and help in med missions.

Work done in one's way alone will inevitably lead to frustration and failure,no matter how noble the good intentions are.
The road to this hell are always paved with good intentions.

Better to understand the value of teamwork and networking than to struggle with the world on one's shoulders.

2018 a year of changes and new direction

As this year starts with many good things for those of us who have been actively involved in missions,
I would like to thank all of you for the supportive comments and help. My medical work for the time being is mostly with missions.

The previous site has now been replaced by my new site which I will be updating soon. For the time being the site will direct you all to my regular mission blogposts here on google.

Keep smiling, and hope and pray for good things to happen in 2018!

Thursday, January 4, 2018

2018 introducing some handcrafted aesthetic products for from India

Thanks for all your views and supportive comments

Thanks for continuing to use my range of aesthetic skincare products; as I had mentioned earlier,the long term effects of my range of pigment lighteners and anti ageing gels will be evident in your skin tone,texture and improved appearance.

This season,several of you are already using the new handcrafted aesthetic gels for antiageing and pigment correction. You can find the items on my website at: 


There is a speedpost charge(500gm package)  of $12 for clients in the US and Singapore

a. handcrafted  gels for pigment

b. pigment lite soap with kojic acid and handmade moisturiser soaps