Rotation flap, plastic surgery, tendon injury, hand injury, finger injury, pre and post, before and after pictures, accident, dr alexander plastic surgeon India cosmetic surgeon India, cochin, kerala, kochi, medical tourism+

Plastic surgery involves molding of tissues or acquiring adjoining or distant tissues to replace that which has been damaged or lost. The picture above is of an unfortunate lady who was involved in a road traffic accident and suffered severe injuries to her had with loss of skin and tissues over the dorsum of her hand. She also had an injury to her tendons (string like structure that helps to make the finger move up or down). God has endowed man with laxity of tissues which we can take advantage of. The lax skin and tissues in the adjoining region of the wound is identified and a flap is planned depending on the best geometric design. In this case a rotation flap was carried our (shown by arrow) which helped to effectively cover the wound and important structures underneath +

Introspection- an original oil painting by Dr Alexander, plastic surgeon, India, Cosmetic surgeon India, cochin, kerala, Kochi, medical tourism, India++

God made Eve from Adam’s rib- and I must say she has been the most exquisite form of art that has ever been produced. When you look at a woman, you realize how fascinating she is, not only physically in form and shape but also psychologically how complex she can be. Every woman is different and though we may understand particle physics, set foot on Uranus, or find the secrets of eternal youth, even after years of dedicated study and research, we will still be unable to unravel the secrets that coerce her brain to function the way it does. 

The picture above is an original oil painting that signifies the inner self that one tries to understand and the outer self that one presents to the world. As she attempts to look at herself – she is often amazed at her own feminity and at what she sees. All this is in the background of the male sexuality- for if there were no men or male sexuality- I guess there would be no humans, but only the simple 'womans' without their complexities ….. 

+

'Faces' - an original sketch pen art by Dr Alexander, plastic surgeon, India, Cosmetic surgeon India, cochin, kerala, Kochi, medical tourism, India+

We all have our 'faces'- that we knowingly or unknowingly present to our colleagues, friends, relatives and family. Often it may be difficult to judge what lies behind that face you see everyday. The sketch art shown above exemplifies our daily tryst with the people around us. To the plastic surgeon there is another angle to it- while planning surgery we have to look at the physical and mental makeup of the patient as well. The results of our surgery must not only look good anatomically but must appeal to both the patient as well as the people around- something that makes this specialty an unique one- and something that puts tremendous pressure on the surgeon. This painting is dedicated to all the people around us who prop us up with their positive energy and make life worth living + +

Face burns, plastic surgery, cosmetic surgery, Dr Alexander, plastic surgeon, medical tourism kochi, cochin, kerala, India+

Face burns can be a painful and dispiriting experience. This child suffered burns to the face with hot water. Fortunately the burns are 2^nd degree superficial that usually heal in 2 to 3 weeks. Pain is an important factor as in superficial burns the nerve endings are not burnt or damaged. Facial swelling or edema usually follows as happens after most cases of trauma or injury or surgery on the face. The swelling occurs even on the uninvolved side as seen in this child. However one must make sure that the swelling is not due to burn that has been infected. Also burns to the eye, oral and nasal cavities must be ruled out. Often the burns of the face must have a more conservative approach as healing frequently results due to the good blood supply. Antibiotics are given to avoid or treat infection+

An original oil painting, 100x71cms by Dr Alexander, plastic surgery India, cosmetic surgery India, plastic surgeon, cosmetic surgeon, cochin, kerala, kochi + medical tourism +

We are all passionate about something in life. Be it books, sports, work, cooking or whatever, as long as it is productive and not destructive- it is acceptable. Plastic surgery is actually an art form where God has given the surgeon the opportunity to draw, mold and design on the human body. The painting shown above is dedicated to the all the mothers who toil ceaselessly to bring up their little ones. A lot of plastic surgeons have been know to be involved in some form of artistic work. Gillies one of the founder fathers of modern plastic surgery  was an avid painter and golfer as well.Those interested may find his art at +  http://www.gilliesarchives.org.uk/

Allopecia scalp, hair loss, treatment, hair graft, surgery hair, Dr Alexander , Plastic surgeon, India, cosmetic surgeon, India, cochin, kerala,medical tourism +

  

Loss of hair can be a troublesome problem. Sometimes hair loss on the scalp may be localised and can be removed by plastic surgery as shown above- instead of trying to graft  some hairs into this area++

Rhinoplasty, nose job, plastic surgery India, cosmetic surgery India, Dr Alexander, plastic surgeon, cosmetic surgeon, cochin, kerala, kochi, + pre and post, before and after , medical tourism +

'Beauty lies in the eyes of the beholder'  It depends who the beholder is...
Our perception of beauty depends on a variety of factors like what race we belong to, what religion we follow, our childhood, family, friends, the books we read, the soaps we watch, the movies we go to ... and many more. We have our own idea about how we can be more pretty or handsome. The plastic or cosmetic surgeon who examines you  will have his own idea about what will make you more pretty or handsome. Whatever happens, in the end the patient has to be happy because he is the one undergoing surgery and responsible for whatever changes he wants to undergo. In our clinics we see a lot of people who ask for very subtle or minor changes. They are very specific in their demand and are happy when they get what they have asked for. The picture shown above is of a young woman who wanted the dorsum of the nose raised and the tip refined- both of which were carried out and made her happy+

Face injury, road traffic accident, upper lip injury, before after, Dr Alexander, plastic surgery, plastic surgeon, India, cosmetic surgeon, surgery, India, Cochin, kerala, kochi, medical tourism +

 This unfortunate lady was hit by a speeding car causing severe injury to her face, upper and lower lip all of which were treated by plastic surgery+

Ear tumor, ear surgery, otoplasty, plastic surgery India, cosmetic surgery, plastic surgeon, cosmetic surgeon India, Kerala, Kochi, Cochin, medical tourism, India++

Tumors can occur in the ear too. They may be of different types and the plastic surgeon aims at maintaining the shape and form of the ear while surgically removing them. The gentleman shown above (picture taken during surgery) had a tumor of the upper helix of the ear which needed to be removed. Surgical excision of the tumor was done without distorting the shape of the ear using plastic surgery techniques+

Thumb injury, nail, nail bed, finger injury, machine injury, hand injury, plastic surgery India, cosmetic surgery, plastic surgeon, cosmetic surgeon India, Kerala, Kochi, Cochin, medical tourism, India+

The term 'Plastic' is derived from the Greek word 'plasticos' meaning to mold or shape. Plastic surgery is therefore the art of molding tissues and reconstructing lost tissues to get the desired effect. To the true plastic surgeon every part of the body is beautiful and molding and trying to recreate what God has endowed the human being with, remains his primary aim.It may not be possible all the time and is never a hundred percent match. Often the results by God's grace as above surprises the surgeon as well!!!+

Rubber sheet machine injury, crush injury, hand injury, finger injury, treated by plastic surgery, Dr Alexander, plastic surgery india, cosmetic surgery india, Cochin, kerala, kochi, medical tourism +

Natural rubber latex is derived from the Pará rubber tree (Hevea brasiliensis), a member of the spurge family, Euphorbiaceae.   Primarily found in South America. Charles Marie de La Condamine is believed to have introduced samples of rubber to the Académie Royale des Sciences of France in 1736. A paper by François Fresneau published in 1755 describing many of the properties of rubber has  been referred to as the first scientific paper on rubber.  Joseph Priestley, in 1770, noted that a piece of the latex material was very effective for rubbing off pencil marks on paper, hence the name rubber. In 1876, Henry Wickham in 1876 is believed to have  gathered thousands of para rubber tree seeds from Brazil, germinated them  in Kew Gardens, England and then sent them over to India, Ceylon (Sri Lanka), Indonesia and other countries. Rubber is drawn out into sheets by passing it through a roller machine. workers making sheets of rubber is shown below. The picture is from http://www.thehindubusinessline.com/industry-and-economy/agri-biz/rubber-production-up-62-in-april/article2009391.ece

The picture at the beginning of the article shows the hand of an young gentleman who was making sheets from raw rubber material. The hand was drawn into the machine and crushed  in between the rollers which resulted in injuries to the skin, nails and tendons, all of which were treated by plastic surgery. while attempting to get a good functional repair one must also attempt to get a good cosmetic result. It is important that safety guidelines be immediately incorporated into this small scale rubber cottage industry since one can see how in the picture above how easy it is for the worker's hand to get drawn in between the rollers. A safety grid that prevents the hand from approaching the rollers would be the simplest safety measure+

Finger tip injury, amputation, machine, plastic surgery India, cosmetic surgery , dr alexander, plastic surgeon, cosmetic surgeon, cochin, kerala, kochi, Before and after , medical tourism+

The picture shown above is of a young gentleman who had a machine injury which resulted in a finger tip amputation. The reconstruction was done using a v-y advancement flap and a fairly acceptable cosmetic result was achieved+

Axillary breast, breast liposuction, breast surgery, plastic surgery India, cosmetic surgery India, Dr Alexander, plastic surgeon, cosmetic surgeon, cochin, kerala, kochi, medical tourism +

Charles Darwin changed the course of our thinking with his revolutionary theory in the 'Descent of man' first published in 1871. That we could have evolved from apes as mutations occurred in the 'evolution of species' and the 'survival of the fittest', was put down as a possibility. Yet all life seems to be connected, though we may not be able to prove it conclusively. The organic molecules that joined together to form the first living structures that were able to multiply must then be considered our original forefathers. We must then believe that inanimate gave way to animate, that life originated from non living... Can we then imagine that one day our tables and chairs, our pots and pans, under unknown conditions may evolve into something living??

It is funny that we consider them non living. Every atom has protons electrons and other particles that are constantly moving and performing some specific functions-- wonder whether we should call them non living or living??? radioactive particles even set of chain reactions ….

On the other hand our understanding of the divine is miniscule, the cosmos remains proof of that. We can hardly fathom the universe we understand, the universes beyond remain a mystery. The big bangs, the black holes and the unending space theories makes us realize that little do we know about anything, including ourselves.

What existed before the big bang????

Because we are unable to see or feel God, we fail to accept him. Yet God has continued to exist only because people are able to experience him. There are things that one cannot explain and must be left at that- till something crops up or an explanation is offered.

Medicine is the same- though we presume to know much, our understanding is naught. Little do we know the micro mechanisms that go on in a cell, nor do we know why our genomes are so long, what mysteries do they code and when will we encode them meaningfully....we make observations and then we make conclusions.... what prompts the DNA to decode, copy and multiply??? who programmed it or does it auto program itself ?? where did it get this ability?? can we presume that the the first DNA blocks that were formed from the soup of organic molecules are part of our DNA codes as well??Why does evolution prefer beauty to ugly...the trees, the leaves, the flowers, the mountains, the rivers, the birds, the bees, the human being, all prove that even evolution favors beauty to ugly... why does mutations not lead to healthy monstrous off springs ??

well- we are diverging from the point- 'axillary breast'

Animals like dogs have multiple breasts along what is referred to as the milk line. This line extends from the axilla to the groin. Going by Darwin's theory, in our evolution we lost many of those breasts and retained the ones over our anterior chest. However sometimes one of these breasts may occur along other positions on the milk line. When it does occur near the axilla or in it, it is referred to as the 'axillary breast'. Sometimes fat deposition at this site may mimic this as well.

Axillary breasts may cause pain, produce milk or discharge or become a cosmetic deformity preventing a lady from even wearing appropriate attires.

Treating an axillary breast will depend on whether it is predominantly fatty or has hard glandular tissue and whether the skin is in excess and overhanging.

When fat is a problem liposuction will help.

When breast tissue is tough and liposuction fails then open surgery may be needed.

When the skin is in excess then the skin also will need to be removed by keeping the incision cosmetically acceptable +

Actor Dileep, star, sound Thoma, bollywood, cleft lip, cleft palate, nose, plastic surgery, India, cosmetic surgery, India, Dr Alexander, cochin, kerala, India, medical tourism, kochi+ +

A lot of people - friends, patients, relatives and well wishers have been asking me about Dileep's new movie "Sound Thoma', in which Dileep plays 'Thoma', a gentleman from an affluent family, who suffers from a cleft lip deformity, with Namitha Pramod playing the heroine. The movie, produced by Anoop and directed by Vysakh, promises to be another hit. The picture below is from WWW. kerala9.com

Dileep is a wonderful and versatile actor who has wooed the audience with his acting skills in movies like ‘chandupottu’ and ‘kunjikoonan’ besides others. I too am a fan of Dileep having watched many of his movies and feel that he is now moving slowly into the class of Mamooty and Mohanlal.

That brings us to the topic of cleft lip and the question which everybody is asking me- do all cleft lip patients have speech abnormalities?

Not really!!

Cleft lip is part of a congenital (From birth) abnormality that may manifest by itself in its minor form or may be associated with other defects off the palate, jaw, and nose.

As the child grows in the mother’s womb the lip and palate start developing in the first 4-6 weeks. The clefting occurs because of the failure of the tissues to unite from either side as the face begins to develop.

Depending on the degree of failure of fusion the baby may have any of these abnormalities

Cleft lip only

Cleft lip and alveolus (the area where the teeth are attached to the jaw bone)

Cleft lip+ alveolus + nose deformity

Cleft lip + alveolus + palate + nose deformity

Cleft lip + alveolus +palate +nose deformity +premaxillary deformity (Upper jaw)

Cleft lip is more common in males as compared to females (2:1) and the overall incidence is 1 in every 1000 live births.

Interestingly the ration of cleft lip and palate deformity to cleft lip is only 2:1

The picture below is of a cleft lip and palate child. 

Why does cleft lip occur?

Sometimes they occur because the abnormality runs in the family or is carried in the genes. They can be part of a syndrome where other organs are affected. At other times, they may occur spontaneously without any family history.

Are there any risk factors that we can avoid to reduce the occurrence of cleft lip?

Yes during pregnancy avoid the use of these medications when possible- phenytoin, methyl prednisolone, steroids, Phenobarbital, diazepam, isotretinoin. Older parents (>30years) have a higher chance of getting a cleft lip baby. So plan your babies at an early age. Avoid smoking during pregnancy.

What abnormality does Dileep as ‘Sound thoma’ have?

From the movie still pictures he seems to have

1.     A cleft lip

2.     A nose deformity

What about a palate deformity and speech problems?

Well, since ‘Sound thoma’ has a significant speech defect, he must have a cleft palate or palate deformity. The whole movie is based on his speech problem and patients with only cleft lip do not have a significant speech problem as with cleft palate patients, except for certain alphabets and words. If the palate is clefted, air escapes into the nose, while we try to speak and a nasal toned speech develops and sounds funny and difficult to understand.

What can we do for ‘Sound Thoma?’

Well normally a cleft lip is operated at 3 months and the cleft palate at 6 months. Speech deformity is evaluated at 2 to 4 years and operated on if necessary if speech therapy fails. Teeth and alveolar deformity is corrected by 7 to 10 years. Nose deformity is corrected as it develops. Sometimes even jaw surgery may be needed. ‘Sound thoma’ has past all these ‘ages’. Still his lip and nose can be cosmetically corrected to make him more handsome. The palate can be operated and along with speech therapy the speech can be improved, but a normal speech is unlikely as speech in a baby develops by 2 years and it is very difficult to correct brain patterns and habits developed over years.

 

The secret in treating a cleft lip/palate baby is timing. By subjecting the child to surgery at the right time we can try to minimize his defects and problems and make him lead a normal social life. A child with a cleft lip operated as per the protocol is seen below.

Dileep has done a great service to the cleft lip patients by creating awareness through his film.

May this film be a super hit!!

+Am off to watch this movie…………..

Earlobe defect, wide hole, repair, ear, plastic surgery India, cosmetic surgery India, cosmetic surgeon, plastic surgeon, Cochin, kerala, Kochi, medical tourism ++

                                            

Torn ear lobes or wide ear lobe  holes can be a problem  as they prevent us from wearing different ear rings. Ear studs tend to fall our while larger ear rings hang down and look unsightly. The picture above shows a wide ear hole with marginal tear. Repairing these defects can help women wear different sized ear rings that match their appearance and styles. Picture below shows a repaired ear lobe after surgery. The ear lobe can now be planned for ear piercing and creation of a new ear hole.