Sunday, December 30, 2012

Smoking and poor wound healing, non healing wounds, chronic wounds, ulcers, injuries, plastic surgery, cosmetic surgery, Dr Alexander, Cochin, kerala India+


Blood vessels are like roads that lead ‘to and fro’ the damaged wound sites. The body sends workers and supplies to repair the damaged site by these blood vessels. Further adequate oxygen (carried by red blood cells) cannot reach the wound site and good oxygenation is required for proper functioning of all cells. If blood supply to the wound area is decreased from any reason then the ‘worker cells and specialist cells’ as well as nutrients and repair materials cannot easily reach the wound to begin the process of repair and healing effectively.
Smoking hampers wound healing and in fact the use of tobacco in any form must be avoided. This is because use of tobacco releases nicotine which in turn causes the blood vessels to contract (vasoconstriction) and reduce the blood flow to the wound. Similarly it also increases the platelet adherence (blood cells that stick together or clump together) which again diminishes the blood flow; all of which will lead to poor wound healing. To quit smoking suddenly may be difficult, but one could drastically reduce the frequency of smoking, or at least stop smoking during the time your wound needs to heal.

HAPPY NEW YEAR

As we cherish your friendship and love
your support and encouragement
and thank God for having carried
 us through this year

we wish you all a happy new year
!!!
may all your dreams and wishes come true
may joy, peace and happiness be yours
all
through this year and the coming years !!!
+

Thursday, December 27, 2012

Scar removal, Scar management, breast scar, flame burns, fires, post burn scar, skin grafting, cosmetic breast surgery, burns, plastic surgery, Dr Alexander, Cochin, kerala, India+

The picture above is that of an young unfortunate girl who suffered a flame burn in her childhood resulting in an unsightly scar over her right breast. She wanted to get the scar removed as she wished to get married. The scar was removed and a skin graft was applied. An immediate post operative picture is shown. The donor skin was taken from her lax lower abdomen and the defect was closed primarily. However one has to wait for a year to see how the final result will look like as the new skin applied has to 'take' and settle down. In this case miss A was quite satisfied with the results+

Wednesday, December 26, 2012

Breast surgery, breast enlargement, breast implant, increase size of breast, big breasts, small breast, Dr Alexander, plastic surgery, cosmetic surgery, Cochin, India+






Big arms, fatty arms, arm reduction, liposuction, brachioplasty, body reshaping, sculpturing, Dr Alexander, plastic surgery, cosmetic surgery, Cochin, India+



Big arms, fatty arms, arm reduction, liposuction, brachioplasty, body reshaping, sculpturing, Dr Alexander, plastic surgery, cosmetic surgery, Cochin, India+

Ear surgery, helix loss, lateral ear loss, ear deformity, ear injury, ear reconstruction Dr Alexander, plastic surgery, cosmetic surgery, Cochin, India+



Ear surgery, helix loss, lateral ear loss, ear deformity, ear injury, ear reconstruction Dr Alexander, 2plastic surgery, cosmetic surgery, Cochin, India+

Diabetic wound, bedsore, trochanteric wound, bedridden patient problems wounds ulcers, flap cover, Dr Alexander, plastic surgery, cosmetic surgery, Cochin, India+



Diabetic wound, bedsore, trochanteric 2 wound, bedridden patient problems wounds ulcers, flap cover, Dr Alexander, plastic surgery, cosmetic surgery, Cochin, India+

Diabetic wound, ankle wound, heel wound, lateral calcaneal flap, leg wound, traumatic wounds, ulcers, flap cover, Dr Alexander, plastic surgery, cosmetic surgery, Cochin, India+


Diabetic wound, ankle wound,calcaneal flap, leg wound, traumatic wounds, ulcers, flap cover, Dr Alexander, plastic surgery, cosmetic surgery, Cochin, India+

Chest wall keloid scar, scar, hypertrophic scar, Dr Alexander, plastic surgery, cosmetic surgery, Cochin,








Keloid scar, scar, hypertrophic scar, ear keloid, post auricular keloid, Dr Alexander, plastic surgery, cosmetic surgery, Cochin,

Diabetic wound, fournier gangrene, scrotal wound, necrotising fasciiatis, Dr Alexander, plastic surgery, cosmetic surgery, Cochin, India+

Monday, December 24, 2012

TISSUE LOSS, WOUNDS, ULCERS, INJURIES, SKIN LOSS, BONE LOSS, PLASTIC SURGERY, COSMETIC SURGERY, DR ALEXANDER, COCHIN, KERALA, INDIA+


When large area of skin or tissue is lost the body cannot heal itself or replace it. The human body only repairs the tissue – it cannot regenerate tissues. Therefore plastic surgery will help to replace skin or tissue loss from other areas of the human body by skin grafts or flaps (skin, fat, fascia, bone muscle etc) and experience with cosmetic surgery will help to do the operation in a more aesthetic manner.
The plastic surgeon works on two basic principles:
1) What is the defect (tissue that needs to be replaced like skin, fat, bone, muscle, etc)
2) Replace the lost tissue by a similar tissue
This is simple to understand: if your son has lost his shoes, you have to replace them with a new pair of shoes. You can’t buy him a pair of gloves instead!!
Once the wound is cleaned of all dead tissue, we need to evaluate the defect and the missing tissue. The next step is to replace it. If skin is lost- replace skin, if muscle is missing- replace muscle, if bone is missing –replace with bone and so on. Tissue transfers form an important part of plastic surgery and all qualified plastic surgeons spend their initial training period in trying to master this art. This process however continues throughout his career....as the experienced plastic surgeon will realize.

Sunday, December 23, 2012

Merry Christmas and happy new year to all
may the love of Christ touch your hearts and
fill your life with joy and gladness!!!
Dr Alexander+

non healing wounds, chronic wounds, heart failure, kidney failure, varicose veins, wounds, injuries, accidents, ulcers, Dr Alexander, plastic surgeon, cosmetic surgeon, cochin, India+

We often feel that wounds are a surgeon’s domain. This is true to a great extent but in a number of patients there are a lot of general conditions and diseases of the body that affect the wound healing locally. In many patients the local factors in and around the wound appear not to be the cause of poor wound healing. These patients fail to realize that cause of their poor wound healing lie elsewhere. In patients with cardiac failure the heart is unable to pump the blood efficiently. The blood flow to the wound is poor and oxygen delivery to the tissue is decreased both of which impairs wound healing. Further since the heart pump is ineffective, the back pressure (increased pressure in veins) cause more swelling (edema) of the tissues (and wound area). Tissue edema can also result in patients with renal failure where the kidneys fail to excrete the body wastes and urine.
 This swelling or edema is bad because
 a) It prevents good oxygenation of wound.
 b) It prevents the smooth flow of ‘worker cells’, ‘specialist cells’, growth factors and other repair materials into the wound area.
A physician, cardiologist or a nephrologist will need to assess and help to correct these problems.
 The same mechanism is true for patients with varicose veins.  One of my patients, a healthy gentleman of 35 years, was going around with an accidental injury and wound on his leg for months. He had been on treatment for his diabetes (mild), and then treated with antibiotics, thinking it was infection till we evaluated his leg veins and found that he had underlying varicose veins without any apparent complaints, which was preventing the wound from healing. As the back pressure increases in the blood vessels some of the constituents of blood that normally does not pass through the wall (off capillaries) now filter out by pressure. This build up of fibrin, haemosiderin and fluid in the tissues cause firm swelling of the limb (induration) that is typically seen in blood outflow disorders (venous insufficiency).

Non healing wounds, chronic wounds, ‘why wounds fail to heal’, wound debridement, slough, foreign body, bone infection, osteomyelitis, Dr Alexander plastic surgeon, cosmetic surgeon, cochin India +

we often come across some wounds that fail to heal. There are number of factors that hamper the normal wound healing process. It is important for us to recognize this so that we can address the problem. 

A large number of patients go around from doctor to doctor with chronic nonhealing wound though their diabetes and other contributing factors are corrected. A look at this wound may show dead and devitalized tissue (slough, necrotic tissue) that releases endotoxins, which hamper the healing process (decreases epithelisation and fibroblast activity). Further a large number of traumatic wounds have some foreign bodies- like sand, dirt, glass pieces and others that get embedded within the wound during the accident. The presence of foreign bodies in the wound has been scientifically shown to increase the incidence of wound infection- which again hampers wound healing as we have already seen. Therefore it is logical that all the dead tissue and foreign bodies must be removed from the wound to help the healing process. Sometimes the cause of a non healing wound is an underlying bony infection (osteomyelitis) or infected fracture site that is constant discharging material (pus, serous fluid) that prevents the overlying wound from healing.
In all these cases the body can do nothing to heal the wound and needs external aid. A surgeon will debride (remove all dead tissue) and clean up the wound using his knife. He will manage the underlying bone problem and treat the bone infection or the dead bone which prevents the wound from healing. If the blood flow to the limb or wound area is decreased or stopped due to diseased blood vessels, one has to evaluate (Doppler study / angiogram- will help to find if the blood vessels are patent and functioning) and repair these blood vessels to increase the blood flow (angioplasty or arterial bypass grafting) thereby removing the blockage and increasing the lumen of blood vessels or replacing the damaged or blocked blood vessels by a new blood vessel from the person’s own body or by using an artificial graft. The same is true for peripheral vascular diseases of the blood vessels that result in the poor blood supply to the wound.

Tuesday, December 18, 2012

Wound healing, scars, mature scars, hypertrophic scars, keloids, atrophic scars, Dr Alexander, plastic surgeon, cosmetic surgeon, Cochin, kerala, India+

 

As human beings, we tend to falter and fall (physically and mentally as well), and when that happens we suffer cuts, bruises burns and other injuries. Every day we use sharp objects like knives, razors, saws etc and accidently cut ourselves. Children injure themselves while playing. The world is full of glass, metals, chemicals, electricity, machines and others - sources of injuries and burns; we have now come to accept them as part of our everyday life. While we can be careful and reduce the incidence of injuries we can never completely eradicate them like polio or small pox.

‘Even a beautiful rose –hides a lowly thorn.’

The point of this entire introduction is that when injuries result we often ask

‘why did this happen to me?’

We need to put aside this question and turn to the important issue- managing the injury and its complication.


First of all how does a normal wound heal?
When the skin is cut or injured the first protective body mechanism is to stop the flow of blood by contraction of the blood vessels and forming blood clots (haemostasis). Once this is done the body decides to repair the damage. It does this by sending certain cells to the area of damage (macrophages, neutrophils, monocytes and lymphocytes). These ‘worker cells’ do the following
- They clear the wound of debris and dirt
- They fight infection
- They send signals to bring in ‘specialists’ who will rebuild the damaged tissue.


Growth factors are chemical substances released by a lot of cells (macrophages, platelets, endothelial cells, fibroblasts, lymphocytes) that encourage and promote various activities needed to heal a wound like –cell multiplication, matrix synthesis, blood vessel growth. A lot of studies are underway to determine if we can externally add some growth factor and influence or encourage or hasten the wound healing and avoid scar formation.


The next step is to start rebuilding the damage and so the wound needs some ‘specialist cells’ called fibroblasts. These cells lay down a strong scaffold with collagen fibers and ground substance or matrix which will provide a basic structure and strength to the healed area. New blood vessels (angiogenesis) form and grow into the healing area to bring in more ‘workers and specialist cells’ to rebuild the damage. During this time some worker cells are repairing the skin surface (called epithelisation). This hyperactivity (proliferative phase) is needed in the initial phase to repair the wound. This phase of repair (3-4 weeks) then slows down and the body starts to focus on remodeling the tissues (remodeling phase) so that they will start to look like normal skin. Remodeling of the tissues can go on up to a year.


During the repair –a lot of collagen (scaffold) and ground substance(cementing substance, extra cellular matrix) is laid down to strengthen the wound and during the remodeling stage the extra collagen is removed or replaced to get the end result to resemble normal skin. These are also some specialist cells called myofibroblast that cause the wound size to decrease by contracting the wound edges. As long as these process are going on normally there may be no scar or a fine mature scar may develop.


When the baby is in the womb (in utero), wounds heals without scarring, but we lose this ability after birth. We are still unable to understand why exactly fetal wounds heal without scars. However when there is an imbalance of the repair phase, and the remodeling phase i.e. when the fibroblast cells in the remodeling phase lay down too much collagen and the body is slow to remove it- the problem starts to manifest in the form of a hypertrophic scar or keloid. Beside the liver which minimally regenerates tissues, we don’t have the capacity to regenerate limbs or organs as we see in lizard which can regenerate the whole tail that is lost.


figure: showing the stages of wound
healing and how scars result.


Why do we need to understand wound healing?
Wound healing is a complex process. As we have discussed, there are four phase or stages of wound healing. Understanding the stages helps us to realize that wounds take time to heal and that we need to be patient. It also helps us to look closely at wound healing and our researchers and doctors can work on various parameters to hasten wound healing. We can evolve and develop better wound care products like different wound dressings for better wound management. Growth factors play a very important role and studies are underway to introduce growth factors into the wound and hasten wound healing. By studying the healing process in different types of wounds and ulcer like diabetic wound, surgical wounds, pressure sores, burn wounds, acute, chronic and non healing wounds, venous ulcers etc we are able to individualize treatment for each case and help the patients have a faster recovery.


We now understand non healing wounds and ulcers in a better way and treat them. Wound care companies are involved in serious research trying to outdo their competitors by providing the best wound care products. Newer techniques in wound management like VAC( vacuum assisted healing),enzymatic wound debridement, hyperbaric oxygen therapy, maggot therapy, growth factor therapy, skin substitutes, advanced wound dressings, keratinocyte culture (skin culture) have all developed from our understand of wound healing. Even plastic surgeons, burn surgeons, general surgeons and others decide how and when to interfere surgically to heal a wound through their understanding of the wound healing processes. In addition we are now able to establish wound assessment and wound care guidelines for proper wound management.


Following a minor injury the skin heals without any visible mark. If this was not the case, our body would be a museum of scars as we suffer minor injuries almost daily that we hardly notice.


So then what exactly is a scar?

The word scar simply means any visible mark left on the skin or mucosa in the process of healing of any injury or wound.

What are the types of scar?
There are four Scenarios:
1. No scar
2. Mature scar
3 atrophic scar
4. hypertrophic scar
5. Keloid scar



What are mature scar?
Mature scar are scars that develop in the course of wound healing. These scars are not physically troublesome- they do not cause pain, itching, are not thickened or red in colour and do not tend to grow in size. The main problem with this scar are they are they are a cosmetic problem especially when they are on the exposed parts like face, arms, or legs.


Related sites:

Wound Healing Society - What's Happening Now
http://www.woundheal.org/

Canadian Association of Wound Care
http://www.cawc.net/

WUWHS - World Union of Wound Healing Societies
http://www.wuwhs.org/

Road traffic accident, face injuries, forehead injury, lip injury, plastic surgery, cosmetic surgery, Dr Alexander, Cochin, Kerala, India +


Friday, December 14, 2012

What does liposuction fat look like? liposuction, fat aspiration, Dr Alexander, Plastic surgeon, cosmetic surgeon, kims hospital, cochin, kerala, India +

ever wondered what your body fat looks like? well, a lot of people have been asking me that question and so I have put up this picture that shows the liposucked fat from the tummy area. The yellow is obviously the fat while the fluid below is a mixture of injected fluid, blood and tissue fluids.

Gynecomastia correction, surgery, Dr Alexander, kims hospital, cochin, India, plastic surgery, cosmetic surgery, male breast surgery+


Nail bed injury, finger tip injury, food processor injury, mixer grinder finger injury, finger tip reconstruction, repair, plastic surgery, hand surgery, Dr Alexander+


Foot injury, Ankle injury, skin loss, bony injury, muscle injury, road traffic accident, Dr Alexander, kims hospital, Cochin, India, plastic cosmetic surgeon+


Breast reduction, mammoplasty, cosmetic surgery, plastic surgery, breast ptosis, boob job, Dr Alexander, cochin, India +


Plastic surgery, cosmetic surgery video: An interview with Dr Alexander, kims hospital, cochin, India, plastic and cosmetic surgeon on liposuction: what it means, the technique and how it can benefit us+

painful gynecomastia, male breast surgery, glandular enlargement


Sometimes the gynecomastia though small may be painful and tender. Minor pressure or hitting against any object lightly may cause pain. When the enlargement is from the mammary gland, liposuction may not be helpful as the gland will refuse to be sucked out through the canula. In such cases a surgical excision may be a good option. The gentleman shown above had open surgery to remove his painful gland causing gynecomastia and was quite pleased with the results. The excised gland is shown in the first photograph. The incision is placed in the aerolar margin so that it does not show on healing and drain tubes are put in to avoid any blood or hematoma collection+

Thursday, December 6, 2012

PROMINENT EARS OR BAT EARS

(this image is from : http://www.ryanphotographic.com/images/JPEGS/Antrozous%20pallidus%20Pallid%20bat.jpg )
Prominent ears are also referred to as bat ears as they tend to stand out like the ear of a bat. Bats rely heavily on their ears for echolocation which is an important process for finding prey and survival. Humans need not have such ears and they look more decent and handsome with their ear not being as prominent as the bats. Prominent ears can be corrected by plastic surgery by a setback procedure.

BAT EARS, PROTRUDING EARS


Protruding ears, prominent ears, bat ears.
Have you seen the ears of a bat? Well they are mammals that posses the largest ears when compared to the body size. Size is not the only feature, in addition they stand out and are prominent and protrude outside. Children are ridiculed in schools and made fun off for the prominent or bat ears. Long hair is often used to hide the prominent ears.
 However the ears become a source of embarrassment especially when the hair has to be combed back or tied up over the head.

 Ear setback is a special procedure to correct the position of the ears and reduce their prominence usually the cut or incision is made on the inner side or medial side of the ear i.e. ear side facing the head. In this way the incision line is not seen. The ear cartilage is then exposed through this incision and then shaped to let it gently fall back.

This position is decided proportionately in discussion with the patient as the level of setback varies from person to person. I once had a police man who asked me if I could actually stick his ears to his head as he shaved his head regularly and the ears were a big source of embarrassment

REMOVAL OF SPOTS OR MARKS ON THE FACE

These pictures show common skin lesions that tend to draw the attention and can often be a source of embarrassment.  Plastic surgery can help by removing these lesions by using the least scar forming techniques.

FACE NAVUS REMOVAL, FLAP SURGERY OF EYELID

Skin lesions like the one shown above can grow to large sizes. Often they look bad on the face as well as can interfere with the person's vision.  Plastic surgery helps to remove these lesions by properly planned flap surgery which removes the lesion and at the same time attempts to cause less scars. The picture shown above is an immediate post operative one and it takes 6 months to a year to see the final result. One of the main rules of plastic surgery is that it should not distort the normal anatomy or disturb the other structures around.

RHINOPLASTY, NOSE JOB - IN A CLEFT LIP PATIENT


Rhinoplasty (plastic surgery of the nose)

The nose forms an important part of a man's face and often defines his personality.  A small sized or flattened nose may be looked on as a person with a weak character while the opposite may be true. Similarly a beaked nose may be looked upon as a crooked person.

Changing the shape of ones nose will improve the appearance and personality.

Sometimes there may be a large hump on the dorsum of the nose that  makes the person look unattractive.

  Rhinoplasty is an operation that opens the skin envelope and reshapes the cartilage to get the desired shape. The tip of the nose which may look bulbous or big can also be reshaped and made finer. Finally the septum can be corrected while reshaping the nose to tackle any nose breathing problem.

BREAST REDUCTION SURGERY, MAMMOPLASTY, BREAST LIFT, COSMETIC BREAST SURGERY


Breast reduction and surgery

Large breasts that don’t match a woman’s body frame can make her look very unattractive. In addition the  heavy breasts can affect the person’s posture and cause shoulders and back pain. The skin underneath the breasts also tends to by soggy and sweaty- thereby causing hygienic issues.

Breast reduction surgery helps in a number of ways:
By reducing the size of the breast the person looks more attractive as her breast now match her body frame and the sagging nature of the breast is taken away. The weight of the breast being reduced, shoulder pain decreases posture improves. Better hygiene is possible as the overhanging breasts are corrected. It is also difficult to find proper fitting bras for their breast. So breast reduction helps them to get a proper fitting breast as well.

Sagging breasts or ptotic breast:
Some women have adequate sized breasts. However their breast may sag down and give them an older look. Mastopexy or breast lift is a commonly referred is a surgical procedure to uplift the breast and reposition them.
The normal nipple areola position should be a mid arm level lie midway between the shoulder and the elbow. It should neither be stargazing nor foot gazing. It must also form the center of the breast mold. This position must be decided in agreement with the patients body frame

BREAST IMPLANT, SILICONE IMPLANT, BREAST ENLARGEMENT SURGERY


TUMMY TUCK, ABDOMINOPLASTY, MINI ABDOMINOPLASTY, APRONECTOMY


In males having a six pack is considered to be handsome. In females however having a flat tummy is considered as beautiful. Potbelly and large abdomens are a major cosmetic and functional problem. In addition,  the skin underneath the flabby stomach gets itchy and becomes a hygienic problem. Getting proper sized dresses clothing is another issue. Husbands and wives in general will like to see their partners in good shape and have a happy sex life  by maintaining their physical attraction.
  Tummy tuck or abdominoplasty is an operation that can help to tackle these troubles.

There are three main problems that can lead to large tummy or potbelly: +

  1. Excess fat: in some people the fat gets selectively deposited over the tummy area and refuses to go away with any number of exercises or regimes. When fat deposition is the only problem then liposuction or sucking the fat by using a canula put through a 1 cm keyhole can be the answer. You need to be examined to rule out the other problems and see if you are the ideal candidate for liposuction.

  1. Poor tone of muscles: Most of us are employed in sedentary jobs where we sit for long periods or long hours without any exercise. Very few of us actually have a regular exercise regime. Also after a number of pregnancies the abdominal muscles loose their tone as very few women actually have an exercise regime after delivery. The abdominal muscles therefore become lax and the pack muscles actually spread out (Divarication of rectus abdominals muscle). Abdominal surgery will help in these patients as the muscles will be moved back to position and stitched back together.

  1. Excess skin: When the belly skin is excess- it leads to overhanging skin that looks unattractive, besides being a hygienic problem. Removing this excess skin by tummy tuck or abdominoplasty will help to improve the abdominal contour and make it attractive.
Tummy Tuck is usually performed in a hospital, under general anesthesia. There are many variations of the procedure varying from a mini abdominoplasty , apronectomy to a complete abdominoplasty with fat, skin and muscle tightening. Please discuss with your doctor as to which procedure would be ideal for you.  Women who are planning future pregnancies must defer this surgery .
While discussing with the doctor, you must tell him about your medical problems like diabetes, hypertension, allergies, previous hospitalizations, previous operations, smoking, medications like aspirin or oral contraceptives as well as risk factors for deep vein thrombosis ( DVT or leg vein clots) as this will influence the surgery.
Bed rest is recommended for the first day. Some pain is expected but the doctor will prescribe adequate pain killers to tackle this problem.  If drains are used, they may remain for 2 to 4 days usually or until discharge fluids decrease significantly. Sutures will have to be removed in a few days . During your recovery, you must refrain from any strenuous activity or rifting. Most patients are back to work in two or three weeks.
A tummy tuck or abdominoplasty operation will improve your self confidence and give you an increased enthusiasm to exercise by making you tummy firm and shapely as well as removing excess skin and fat along with tightening of the tummy wall muscles.
Fix up an appointment today with Dr Alexander at kims hospital cochin, kerala, India to know more about tummy tucks or abdominoplasty operation and how it can change your life.
0091 4843041000

GYNECOMASTIA, MALE BREAST ENLARGEMENT, PRESSURE GARMENTS


GYNECOMASTIA - LIPOSUCTION - SURGERY, TUMMY LIPOSUCTION



picture shows an young gentleman who had a liposuction for his large 
breasts  or gynecomastia along with a circumferential skin
 tightening around the aerola. he also had a liposuction of his tummy or abdomen


BODY FAT: IS LIPOSUCTION THE ANSWER?

Since the origin of mankind, human beings have relied on their body fat as an energy source. Early man maintained a balance between body fat storage and fat utilization. As he hunted for food, he could not afford to be obese. He had to be slim, sturdy & strong in order to arrow a rabbit, spear a deer or run away from a wild beast in the jungle. Our present day man lives in a concrete jungle with no place or need to walk or run. Confined to his house or forced into a sedentary job, he stores body fat but hardly utilizes it. Modern indoor means of entertainment has added to his sedentary ways. Advances in science and technology have further reduced his fat burning channels. All this means that we cannot blame modern man for his tendency to become overweight or obese.

Is fat needed in the body?
Besides being a source of energy, fat in the right proportions deposited in proper anatomical locations provides both beauty and functional advantage to the human body. The secondary sexual characteristics that differentiate a woman from a man rely heavily on body fat deposits. Till the 19th century voluptuous women were considered beautiful and attractive and painters like Michelangelo personified them in their art. The soles of our feet that carry our body weight are supported by fat deposits and our bones, muscles and organs are protected by fat as well. We have now come to realize that fat is more like an organ in the body with complicated hormonal mechanisms that are still being investigated. More recently our researchers have found that fat is a good source for stem cells which are basic cells that can be made to differentiate into other tissue types. These stem cells have the potential of treating many medical diseases.


How can we lose our unwanted fat?
Body mass index (BMI) was developed by Belgium statistician Adolphe Quetelet (1796-1874) and  is used as a standard to know if a person is overweight or obese.
BMI =    weight (in kgs)
            Height x height (in meters)
A person's weight is acceptable if the BMI < 25. Between 25 – 30 BMI the person is considered overweight. 30-35 BMI signifies an obese person, while > 35 implies morbid obesity. To lose weight simple measures like diet control and exercise regimes are advised. Healthy eating habits with diets that are less in fat & carbohydrate along with plenty of greens, fruits & vegetables can help an individual control his weight. However in morbid obese patients when these measures are not helpful bariatric surgery where surgical measures on the stomach and intestines are used to reduce food intake or decrease absorption are used. Often in normal persons who do diet control & exercise regimes there are areas of fat deposits which fail to go away. Familial traits are another reason for these fat deposits. In such patient who has troublesome & stubborn fat deposits, Liposuction – a simple technique can be used successfully. When the tummy look large, arms look flabby and fat, thighs cause discomfort medially  while walking, hips have fatty deposits, body has fat that hangs around like love handles or chin appears double, then one should consider consulting a plastic surgeon to consider if liposuction can be of help.

What is Liposuction & who can benefit from it?

Liposuction as the word implies is a simple technique of sucking the body fat out through an opening (about 1 cm). Liposuction should not be looked at as a mode of weight reduction and is not a replacement for diet control and regular exercises. However liposuction can effectively remove stubborn fat deposits in different parts of the body like the ankle, calves, inner knees, inner and outer thighs, abdomen, buttocks, hips, waist, (love handles) arms, neck, chin & cheeks. Sometimes liposuction is done alone but one can combine it with a tummy tuck (abdominoplasty) where the muscle tone correction and excess skin removal are done concurrently. For male patients who have enlargement of their breast (gynacomastia) liposuction is an effective procedure that can be done to bring the breast back to normal size, primarily or in combination with excess skin removal. Certain cases of fat deposits called lipomas can also be treated by liposuction and we can avoid a large incision or scar lines. Individuals with stubborn areas of fat that do not respond to exercises and diet control are excellent candidates for liposuction. Fatty areas that protrude and deface the body contours can be effectively tackled by liposuction. Many obese patients undergo bariatric surgery to reduce their stomach size, food intake and absorption. However following this procedure they may still have large areas of fat deposits they fail to go away. Such patients must also consider having liposuction.

What precautions should be taken before undergoing Liposuction?
Before undergoing liposuction, the surgeon should make sure that the patient is healthy and fit to undergo the procedure. Patients who are diabetic or hypertensive must have their blood sugars and blood pressure well under control. Those with lung or respiratory diseases like chronic obstructive pulmonary disease (COPD) must be examined and cleared by a physician. Similarly those with heart diseases must be cleared by a cardiologist. Patients taking anticoagulants (drugs that reduce blood clotting) will need to stop them prior to surgery. Smokers should withhold smoking and alcoholics must stop drinking prior to, during and after surgery if they wish to have good results. The surgeon must be informed of present drug intake or allergy that the patient has as well as any previous surgery that the patient has undergone, as this may influence the liposuction. A few laboratory blood tests will help to make sure that all the organs are properly functioning. The surgeon will also explain the benefits, risk & complications after which consent form will need to be signed.


What happens during surgery? 
The patient is usually admitted a day prior if the surgery is under general anesthesia and the anesthetist will review the patient's fitness for this procedure. Sometimes the procedure is done under local anesthesia if small areas to be liposucked. Once the patient is put to sleep (under anesthesia) the surgeon will make a small incision(1cm) near the fat deposit. He will then introduce a canula ( metal tube) to inject a special fluid and then apply suction to gently suck the fat out. The amount of fat sucked out will depend on the body location. For example the chin area may have little fat as compared to the tummy or hips. The surgeon will also make sure that the appearance is asthetically pleasing and symmetrical. A pressure garment is applied post operatively to support the liposucked areas and allow the skin and tissues to evenly settle down.

What happens after the operation?
Mild to moderate pain can be expected post operative, which can be treated with analgesics. The patient can be discharged the same evening or the next day once he is fully awake and all body systems are stabilized. Some bruising, redness & edema are expected, but they usually settle over a few weeks. The pressure garment must be worn for 3 months  or more as decided by the physician. This will help the skin to adapt to the new contours and the edema or swelling will reduce significantly. The operated sites should be protected post operatively from any excess force, movement or trauma, since these areas are still healing. Normal activities can be resumed postoperatively depending on the surgery. For small localized deposits and fat done under local anesthesia the patient can return to work in a day or two. For larger areas and multiple areas like arms, chest, abdomen, thighs two or more weeks of rest may be advised postoperatively. While diet control should be started immediately after surgery, exercises regimes should be delayed to later than 6 weeks or more as decided by the surgeon. Smoking should also be avoided during the healing period as it hampers the normal healing processes.

What is the risk of Liposuction?
As with any surgical procedure there are also risk associated with liposuction:- Infection, hematoma (collection of blood), Seroma (serum collection) and operated site asymmetry, uneven contours, loose skin, scars, sensory changes, persisting pain and swelling. Uncommonly cardiac, pulmonary complications, tissue or organ injury and deep vein thrombosis can occur.  Any shortness of breath, chest pain or unusual heart beats post operatively must be immediately reported to the surgeon. Fortunately, this risk is not common and surgeon takes utmost care precautions to see that the patient has a very satisfied experience by selecting the right candidate, doing a thorough preoperative fitness test, meticulous surgery and sharp postoperative follow up. The patient and the doctors must have a very candid discussion about the entire procedure. Sometimes an additional touch up procedure maybe needed to correct minor residual defects.

Can Liposuction change your life?

Fat is universal and fatty deposits in the body will continue to be a problem that most individuals face in spite of healthy food habits and regular exercise regimes. These fat deposits are often a source of embarrassment and there are a large number of young women and men suffering from a poor body image due to these fatty deposits. In your personal life or professional life liposuction can help remove these fatty deposits on your body and enhance your body image. It can ensure your self esteem and boost your self confidence, though it cannot change your personality. Liposuction can help turn you into a new person and make you stronger to face the world. Individual undergoing liposuction must take care that they do not gain weight significantly again as this can reverse the results of liposuction. The results of liposuction can be long-lasting & satisfying when one maintains a healthy life style, diet control and regular exercise regimes after a liposuction procedure. To know more about liposuction and  how you can benefit from liposuction- schedule an appointment with Dr Alexander at KIMS Cochin.


Dr. Alexander G
Consultant Plastic Surgeon
KIMS Hospital
Cochin +
Phone: 00914843041000

LIPOSUCTION CANULA