what is liposuction?

“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?

“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?

“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?

“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?

“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

what is liposuction?

“Lipo” (from the Greek “lipos) means fat. And liposuction is a cosmetic surgical procedure by which excess fat is broken down and sucked out from under the skin. ​​Liposuction can be used to target fat under the chin, neck, cheeks, upper arms, breasts, abdomen, buttocks, hips, thighs, knees, calves, and ankle areas.

When performed by our expert plastic surgeons, liposuction can help reshape your contours – body and face. While it is certainly not a shortcut to drastic and instant weight loss, It eliminates those stubborn pockets of fat and restores youthful definition where it matters most: your midsection, thighs, flanks, and arms.

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March 21, 2020

Massive weight loss is a common thing these days. People are losing weight dramatically sometimes more than 50% of their body weight. This is scientifically defined as “massive weight loss”.  There are many weight reduction methods such as dieting, lifestyle changes, over the counter pills, paranormal ways such as bulimia and bariatric surgery.

Even after losing a large amount of weight, simply being within normal range is insufficient for most people. They want look as attractive and as normal as possible.

Often after massive weight loss, people end up having loose and saggy skin, lax muscles, oddly shaped protuberances, vestiges of fatty tissue (bags containing fatty acids and triglycerides) remain in form of flabs and unexpected folds, pleats, puckers and creases. [Reference- An outcomes analysis of patients undergoing body contouring surgery after massive weight loss. Shermak MA, Chang D, Magnuson TH, Schweitzer MA Plast Reconstr Surg. 2006 Sep 15; 118(4):1026-31.]

According to Pittsburgh rating scale there are ten anatomical areas that undergo maximum changes after excessive weight loss-

  • Arms
  • Breasts
  • Abdomen
  • Flanks
  • Mons pubis
  • Back
  • Buttocks
  • Inner thighs
  • Hips and lateral thighs
  • Lower thighs and knees

In my opinion there are two other areas that get significantly affected face and neck and hair loss.

The deformities range from

  • Grade 0 meaning appearance is within normal range.
  • Grade 1 is mild deformity that may require some minimal invasive procedure
  • Grade 2 is moderate deformity that often requires correctional surgery and
  • Grade 3 is severe deformity that requires multiple procedures.

What happens when you lose weight quickly?

Weight loss not only causes loss in volume but it has detrimental effect on skin collagen that reduces the elasticity and quality of skin.  What that means is when you stretch the skin normally it recoils back immediately, but when elastin and collagen is reduced the skin does not recoil back and keeps stretching as you keep pulling it.

How to Lose Weight Correctly?

I always recommend my patients to gradually loose weight and ensure that they eat healthy nutrition with supplements to ensure the skin and hair integrity are significantly affected. I also recommend to do muscle building exercises because as you loose fat and volume the skin sags, but if that volume is compensated by muscles to some extent the skin will drape back.

Men have advantage as they can build up muscles and beef up in the chest, arms, back and thighs thus firming up the skin. The only problem area that remains are abdomen, face and neck because you cannot beef up the muscles in these areas.

Women have more challenges; they cannot beef up significantly to prevent masculinization. Yet I do recommend them to build muscles in chest, back, arms and thighs.

What happens after massive weight loss?

Let me explain what happens after excessive weight loss in different regions of the body.

  • Face and Neck: Due to weight gain fat cells increases in face and neck and stretches the skin but as you loose weight the volume reduces and skin starts sagging. The face may appear gaunter and emaciated and neck develops loose skin folds like “turkey neck”.
  • Chest in Men: Men develops a condition called pseudogynaecomastia where the skin sags along with residual fat bags and gives an appearance of man breasts.
  • Breasts: There is extensive thinning of breasts and sagging and they develop loose folds in bra roll areas.
  • Abdomen: Both in men and women form folds and rolls of skin in the tummy region sometimes one or two and in many cases three rolls. The skin is not only saggy in vertical direction but they have excess skin in horizontal direction. Often the underlying muscle is also stretched out and weak.
  • Mons Pubis: There is significant changes in mons region with hanging skin, droopy genitals, buried penis etc.
  • Back and Buttocks: Multiple rolls develop in the back region and the buttock sags with wrinkling and distortion of the shape. Hip fat and skin forms rolls and folds laterally.
  • Thighs and knees: excess skin develops in thighs in both directions circumferentially and vertically causing sagging, skin folds, cellulites and abnormal protuberances. The kneecap disappears due to skin folds over the knees.
  • Arms: likewise develops flabs like “bat wings” and skin folds develop above the elbows.

Body Contouring Surgery and Body Lift Surgery

Body contouring surgery involves removal of loose skin and residual fat bags along with suspension of skin.

The wide breadth and variety of deformities means surgical options are also endless. If one has to address each and every problem than one may have to go through the following list of surgeries.

  1. Face and Neck lift with or without fat grafting
  2. Breast lift with or without implants
  3. Tummy tuck- only conventional or T shaped abdominoplasty also called as “Fleur De Lyse”
  4. Brachioplasty- vertical and or horizontal
  5. Lateral chest lift or axillary lift
  6. Back lift
  7. Buttock lift
  8. Thigh lift- vertical and or horizontal
  9. Knee lift
  10. Male breast lift

This is an exhausting list of surgeries to correct all most of the problems. But surgeries come with a cost not only financial burden but trauma, pain, scars, risks and side effects.

Over past 25 years I have integrated some refinements and combinations of procedures that is safer and has better long-term results.

I thoroughly counsel the patients followed by complete tests and examinations to ensure their fitness for surgeries. I help make a plan for the patients with various permutations and combinations of the surgeries.

My recommendations begin with following advice:

  1. Work hard to replace some volume by building muscles.
  2. Ensure you have stabilized your weight and health with good nutrition and regular exercises.
  3. It is not possible to chase all the loose skin
  4. Goal is to minimize number of scars and number of surgeries
  5. There is a limitation on number of surgeries that can be performed in one person.
  6. Time is essence to minimize risks and complications, so my goal is to limit surgeries to 4-5 hours. Less time of anesthesia means better recovery and minimal complications.
  7. Although the skin appears very tight immediately after the surgery but depending upon your collagen it will loosen up in 5-6 months time. There is a thin line between over tightening of skin and wound breakdown or scar stretching and migration.

Preoperative assessment before a Body Lift Surgery

I prefer to do a complete medical checkup with blood tests to minimize risks and complications. The key tests include bleeding and coagulation profile, protein and haemoglobin level and kidney and liver function tests. An ECG and X ray chest may be necessary in patients above 40 years of age, chronic smokers and other comorbid conditions.

A well controlled diabetes mellitus and or hypertension is not a contraindication for surgeries.

Planning of Body lift Surgery

The commonest procedure people need after massive weight loss is Abdominoplasty or tummy tuck and breast/chest lift in male or female.

Abdominoplasty can be an extended abdominoplasty with incision from one hip bone to the other or a circumferential body lift with incision going around to the back also called a Belt Lipectomy. This procedure allows some extent of buttock lift as well.

Very few people may need a combination of vertical and horizontal tummy tuck called as “Fleur De Lyse” abdominoplasty however the vertical scar is not a very pleasing scar and I recommend only for people who has very unsightly abdomen with huge excess skin, than scar is not a big deal.

If I am doing a buttock lift, I recommend “autoaugmentation gluteal lift” which means I will use the fatty tissue around the buttock area to augment and give volume to the buttocks. [Ref- Hunstad JP, Repta R. Purse-string gluteoplasty. Plast Reconstr Surg. 2009;123:123e–125e.]

Augmentation Mastopexy is a procedure that combines use of breast implant along with lift and skin tightening of the breasts. Very few patients may get away with just a breast lift if they have good volume or they choose not to have any implants. The preferred breast lift technique is anchor shaped to give a good long-lasting lift.

Arm sagging is the next common area of concern mostly in female patients. Brachioplasty is a arm lift procedure and it can be done as a vertical only or “T” or “L” shaped brachioplasty.  I prefer to keep the scar at the seam of the arm so it is less visible from front and back and can be seen if patient lifts her arms.

I use “J Plasma” from Bovie Company to further tighten the skin internally. It is a new technology that is now used in combination with Vaser during liposuction to improve the collagen in the skin.

Thigh lift is necessary in patients with excessive sagging thighs. The ideal technique is “T” thigh lift that addresses removal of excess circumferential skin and also lifts the thigh upper in the groin crease areas.  In some patients doing limited thigh lift in combination with Liposuction and J plasma skin tightening can minimize the scars.

Face and Neck Lift is rarely necessary in patients as there are many nonsurgical and minimal invasive options to firm up the skin in face and neck.  Ultherapy lift, Thread lift, filler injections and fat grafting are some procedures that helps improvement of face and neck skin.

Procedural Combination

The combination of procedure depends upon the priority given by patients, the severity of the problem, medical fitness, duration of surgery and recovery period available for the patients.

My recommended combinations are-

  • Lipoabdominoplasty with lateral thigh lift
  • Circumferential abdominoplasty with buttock lift
  • Lipoabdominoplasty with breast lift/ augmentation mastopexy
  • Lipoabdominoplasty with brachioplasty
  • Brachioplasty and back lift/ bra roll lift
  • Thigh lift and breast lift

How to prepare for Body Lift surgery?

  • A thorough understanding of the procedure and its limitations are important. Ensure you get all the information.
  • Stop Smoking at least 2 weeks prior to the surgery day
  • Get all the necessary tests recommended by your surgeon
  • Eat healthy to ensure your protein and haemoglobin levels are good.
  • It may be required to have iron injections or even blood transfusion before or after the surgery, a good haemoglobin level is key to good healing and recovery.
  • Ensure you have all the pressure garments and medications necessary after the surgery.

What is the postoperative care after body lift surgery?

  • You will require 5-7 days of good rest at home; some procedures may require you to stay for 2-4 weeks.
  • It is recommended that you move around at home and do regular breathing exercises to prevent risks of deep vein thrombosis and chest infection.
  • Stop smoking preferably forever, but at least 2-4 weeks during the recovery period.
  • Keep taking your prescribed medications
  • Keep in touch with your surgeon and ensure you attend all follow up schedules
  • I personally prefer to keep the wounds dry and cover only with soft pads such as sanitary pads that absorb moisture and keep wound clean. I recommend not applying strong antiseptics/ alcohol or sealing the wounds, as it may be the cause of skin inflammation and infection.
  • Eat healthy

What are the risks and how to avoid them?

  • Any surgery may have risks of bleeding, hematoma, infection or wound breakdown. The surgeon would recommend you to stop all blood thinners such as aspirin, vitamin supplements etc. ensure you do not have any preexisting infection like boils, skin ulceration or cold and flu. During the surgery we take special precautions to avoid the above risks by giving Perioperative IV antibiotics, using tumescent fluid to prevent excessive bleeding and secure the wounds with multiple level of repair.
  • Risk of Deep vein thrombosis can happen if the surgery is prolonged and if there are comorbid conditions such as varicose veins, obesity, chronic smoking etc. I strongly follow DVT prevention protocol that includes stockings stating previous night of surgery, sequential pneumatic compression during the surgery and postoperatively while in hospital, injectable Klexane that helps thin the blood without increasing risks of bleeding.
  • Scar migration or stretching may happen due to inherent tissue weakness and collagen deficiency. We try and secure the wound along with anchoring to prevent this complication. Over-excision or overambitious tightening may also cause poor scar formation.
  • Residual skin laxity and bulges with asymmetries may happen and is often due to primary asymmetry in body, poor skin quality and lack of perfect judgment due to position of patient during surgery.
  • Changes in the result with time may happen due to continuing gravity effect, weight fluctuation, collagen breakdown. The tissues that appear very tight in the beginning always loosen up with time, the surgeon uses strong sutures to anchor the tissue but the body needs to eventually hold and heal in that position by producing enough and strong collagen.
  • Breast surgery carries the highest risk of dissatisfaction and loss of result with time. The surgeon will do his/ her best to choose the correct size implant with adequate breast lift. But it’s a marriage of inconvenience between two opposing forces of breast skin tightening and implant volume that may have unpredictable long-term outcome. Hence a revision surgery may be necessary in 6-9 months period. [ref- Paolo Montemurro,Mubashir Cheema, Per Hedén, Benchmarking the Outcomes of Single-Stage Augmentation Mastopexy against Primary Breast Augmentation: A Single Surgeon’s Experience of 905 Consecutive Cases Plastic and Reconstructive Surgery • August 2019 ]

Classification of Contour Deformities after Bariatric Weight Loss: The PittsburghRating Scale Angela Y. Song, M.D., Raymond D. Jean, M.D., Dennis J. Hurwitz, M.D., Madelyn H. Fernstrom, Ph.D.,John A. Scott, M.S., and J. Peter Rubin, M.D. Pittsburgh, Pa.


About Me.

I am Dr. Sanjay Parashar and have spent several years working with and learning from some of the best plastic surgeons in the world. I have been practicing for almost 3 decades and have performed over 12,000+ surgeries. My primary practice is based out of Dubai, UAE, but I travel to Delhi, mumbi and Ludhiana frequently to attend to VIP and celebrity cases in India. My specialties include:

  • Breast Surgeries
  • Breast Augmentation using Implants or/and Fat Grafting
  • Breast Lift
  • Body Lift
  • Breast Reduction
  • Facial Aesthetic Surgery
  • Rhinoplasty
  • Facelift
  • Occuloplastic Surgery (Eye surgery)
  • Reconstructive Surgery
  • Robotic Hair Transplant
  • Body Contouring –Liposuction and Liposculpting
  • Six Pack Surgery using Vaser Technology
  • Chest and Biceps Augmentation
  • Abdominoplasty (Tummy tuck)
  • Mommy Makeover
  • Facial Contouring
  • Fillers and Anti-ageing treatments
  • Brazilian Butt Lift
  • Gynecomastia (male breast reduction)

Dr. Sanjay Parashar


March 16, 2020

The advantages of modern Microneedling were first discovered by Dr Andre Camirand in 1997. He had been trying to camouflage enlarged hypertrophic scars by tattooing skin color pigment. He started to notice that the tattooed pigment was completely dissolving and being replaced by actual melanin, the skin¹s natural pigment. Furthermore, he also noticed the scar itself also was improving in texture. This discovery led to the idea of mechanically puncturing the skin with micro needles resulting in improved appearance of texture and appearance of the skin.

The microneedling treatment works by causing controlled micro injuries to the superficial skin. These superficial wounds stimulate the brain to start the body’s natural healing process. During this process the body produced more collagen and elastin. Both Collagen and Elastin is a protein. Collagen is what gives our skin structure and elastin gives the skin the ability to stretch and content. As the volume of these proteins increase in the targeted injury area and whence the healing is finished, a new better-looking supple skin appears.

Microneedling and its uses for skin

During the microneedling treatment, very tiny needles are used to create controlled punctures to the skin. During this process old collagen fibers are reorganized and hence place for new collagen, elastin and micro-capillaries is created. As the body produced these, a younger, tighter skin is achieved.

Microneedling is also an effective indications for acne scars, skin rejuvenation, wrinkles, stretch-marks, alopecia, superficial drug delivery and many more.

The treatment is very safe, as long as performed by an experienced medical professional.  It is also suitable for most skin types, including darker skin tones, who are prone to post-inflammatory hyperpigmentation as it is a very high risk in darker skin types.

The procedure is performed under topical anesthesia. The procedure is well-tolerated by the patients. One may experience slight erythema (redness) and edema (mild swelling) lasting for about 2 to 3 days post procedure.

No. of Sessions recommend for Microneedling and expected results

Significant increase in collagen is observed in about 6 sessions in an interval of 3 to 4 weeks apart. This collagen induction leads to overall youthful appearance of skin by reducing fine-lines and wrinkles, reducing the pore size and adds flexibility and elasticity to the skin.

The final results of the treatment cannot be viewed immediately. The individual will notice small changes and tighter skin due to the micro injuries, but the new collagen continues to generate for approximately 3 to 6 months of the treatment. Depending on the lifestyle of the individual.

Microneedling is also successfully used to increase penetration of drugs and vitamins across the skin barrier. It enhances the delivery of various drugs and vitamins as it bypasses the stratum cornea and deposits the drug directly up to the vascularized dermis.

Microneedling and Scars

Microneedling has been found effective to treat post-acne scars (facial atrophy scars) as boxcar scar and rolling scars.

An atrophic scar or acne scar is an indented scar that while healing leaves a depression on the skin as the skin is unable to regenerate tissue. They are often the result of severe acne or chickenpox. With Microneedling, we can reduce the appearance of these scar by promoting natural healing and regeneration of tissues in the skin.  Working on the same principal, its also helps treat boxcar scar and rolling scars.

Post-surgical scars: It was first studied by Dr Camirand found that microneedling has helped reduce the appearance of almost all types of surgical scars, it has also been effective in reducing post burn scars, post traumatic scars, hypertrophic scars and varicella scars. The premise is same, micro-injuries to promote regeneration and healthier  looking skin and increased collagen volume.

Microneedling and Melasma

When Microneedling is combined with skin lightening agents and vitamins, it also helps manage melasma. In this treatment, the micro needles also deliver these agents to the targeted treatment area. Which promotes quicker resolution of the problem. It takes a multiple session to see results and regular maintenance is required, as the body continues to produce pigment that is causing melasma. Its not a cure, its only management and appearance correction that can be done with mirconeedling when it comes to melasma.

Microneedling and Alopecia

Microneedling when combined with drugs for hair loss and growth factors that promote healing can help effectively treat hair loss. Both Androgenic Alopecia and Alopecia Areata respond well to this, and results are visible 3 weeks after the first session. however, 6-8 sessions are recommended to achieve good results and maintenance session to sustain results.

Microneelding and Skin Laxit

Microneedlign is also effective for improving skin laxity. It can be done by delivering vitamins like Vitamin C and A directly under the skin on the targeted areas, like skin of the face. In addition to the collagen regeneration, the vitamins also help getting a better-looking glowing skin. It is however, very important to prepare the skin two to three weeks in advance with the use of vitamin C and vitamin A.

About Me.

I am Smita Smita Sonavane, a Beauty and laser therapist at Cocoona Centre for Aesthetic Transformation.  I specialize in Lasers for hair reduction, skin rejuvenation, skin peeling systems for Acne and Acne scars treatment

I love talking about all these procedures

Dr. Sanjay Parashar


March 11, 2020

Plastic Surgery and Women, the various kinds of private surgeries women do and what they are.

Documented since the time of the pharaohs in ancient Egypt, women throughout history have modified their genitalia via adornments, devices, colorations, bleaches,

and reductive and expansive techniques.

Women are often embarrassed to discuss their desires for aesthetic surgery of the genital region with others but rather choose to research the topic anonymously on the Internet. They have heard of labiaplasty in the media (e.g., Plastic Wives, The Doctors, Dr. 90210) and understand that their requests for aesthetic improvement of the vulva are not unfounded.  Liao LM, Creighton SM. Requests for cosmetic genitoplasty: How should healthcare providers respond? BMJ 2007;334:1090–1092.

As women become more comfortable with the idea of elective procedures on their faces, breasts, skin, and so forth designed to enhance their appearance and self confidence, it is not surprising that they may wish to alter, change, “rejuvenate,” even more intimate areas of their bodies. Goodman MP. Female cosmetic genital surgery. Obstet Gynecol 2009;113:154–96

A woman has the opportunity to request alteration of her vulva and/or vagina for a variety of reasons. There are cosmetic and self-esteem rationale as well as functional complaints.

Some common complaints are:

Loss of “feeling” with intercourse?
Vagina feels “loose and floppy?”
Intercourse is “just not the same?”
Labia minora (vaginal lips) looks cosmetically unappealing or “in the way” during intercourse?

Regarding the vulva, distress with the appearance of “flaps” or “elephant ears” or other protrusions beyond the labia majora; self‐consciousness; and distress over potential prominence or slippage of enlarged labia from beyond the confines of thong‐type undergarments or swimwear predominate on websites, blogs, and office commentary. Discomfort (“chafing”) with sports, sexual, and other activities; discomfort with tight clothing; necessity to “re‐arrange” the labia for sexual intimacy; and hygienic difficulties predominate the functional complaints. Redundant labia majora are described as “droopy,” or the patient dismays over the appearance of “camel toe.”

Pregnancy as well as weight gain will produce an increase in size of mons pubis, the area immediately below the abdomen overlying the pubic bone extending upto to the clitoris and labia majora (outer lip). Weight loss and natural involutional changes following delivery or with age will commonly result in unpredictable degrees of skin laxity and ptosis. Some women are made acutely aware of the condition because it may become even more obvious following abdominoplasty when the veiling fat and skin has been removed. Patients have reported difficulties with maintaining hygiene that commonly results in rashes and fungal infection like candidiasis.

Sexual issues dominate pelvic floor complaints in women inquiring about a vaginal tightening procedure. They describe a “sensation of wide/smooth vagina” with secondary diminishment of friction, less sensation, and greater difficulty achieving orgasm, at times concomitant with displeasure regarding the visual appearance of the introitus.

Motivations for genital cosmetic surgery typically fall into one of three categories: physical, psychological, or sexual. Physical complaints may include dyspareunia (pain during sexual intercourse), discomfort, chafing, and rubbing. Psychological complaints may include displeasure with one’s appearance, embarrassment, and shame. Sexual complaints include decreased sensation, reduced orgasm, and the perception of decreased partner satisfaction.

Awareness of the availability of these procedures has been driven in large part by the Internet and the lay media’s fascination with this topic. This has driven demand for these procedures.

Honore and O’Hara in 1978, Hodgekinson and Hait in 1984, and Chavis, LaFeria, and Niccolini in 1989 were the first to discuss genital surgical alterations performed on adults for purely aesthetic reasons. (a. Honore LH, O’Hara KE. Benign enlargement of the labia minora: Report of two cases. Eur J Obstet Gynecol Reprod Biol 1978;8:61–4.      b. Hodgekinson DJ, Hait G. Aesthetic vaginal labiaplasty. Plast Reconstr Surg, 1984;74:414–6.    c.  Chavis WM, LaFeria JJ, Niccolini R. Plastic repair of elongated hypertrophic labia minora: A case report. J Reprod Med 1989;34:3737–45. )

FGPS (Female Genital Plastic Surgery) is surgery on the female external genitalia and vagina designed to subjectively improve appearance, diminish discomfort, and/or potentially provide psychological and functional improvement in sexual stimulation and satisfaction.

Following are increasingly common women’s cosmetic genital surgical procedures:

  • Size‐reducing labia minoraplasty and/or majoraplasty (LP‐m; LP‐M)
  • Size reduction of redundant clitoral hood folds (RCH)/Clitoral hood remodeling
  • Monsplasty
  • Vaginoplasty (VP), colloquially termed “vaginal rejuvenation” (VRJ)

Labiaplasty: Labiaplasty is the most commonly performed cosmetic genital surgical procedure. It involves surgical alteration by reducing of the size of the labia. Although this usually involves reduction of the labia minora (LP‐m, the inner lips of labia) or, less frequently, labia majora (LP‐M, outer lips of labia), occasionally LP involves reconstruction after obstetrical injury or, more rarely, enlargement via injection of bulking agents or fat transfer.

LP-m can be either a straight line excision of excess tissue or a wedge resection. This is decided depending upon individual patient presentation and surgeons preference.

Clitoral Hood Remodelling: it involves excising extra fold of skin hanging over the clitoris like a curtain. The procedure is often combined with labiaplasty.

Monsplasty: simple volume reduction to address deposition of fatty tissue is accomplished with “liposuction” where as Mons reduction is often performed at the time of abdominoplasty when sagging droopy mons is rejuvenated by excising excess skin and soft tissue. Treatment goals are to accomplish a smooth transition from the abdomen to the pubic region.

Vaginoplasty: Vaginal rejuvenation is a relatively new term that refers to repair of the vaginal canal and opening of the vagina by reducing the vaginal caliber by tightening its wall for enhancement of sexual function.

However, sexual dysfunction is very complex and multifactorial, and of course a surgical procedure to repair vaginal support and reduce the vaginal caliber will not

reverse or change psychological or psychosocial sexual dysfunction arising from previous abuse, relationship issues, depression, or other more complex psychological dysfunction. Decreased sensation and difficulty achieving orgasm may be secondary to nerve damage from childbirth, muscular changes, or soft tissue changes, and to date we have no way of studying or confirming the exact cause prior to surgery.

Researchers have found that nearly 50–75% of patients who present for vaginal rejuvenation have symptoms including leaking of urine, incomplete urination, incomplete passing of stools, painful sexual intercourse which result from an additional underlying problem called as Uterine prolapse, cystocoele and rectocoele. It should be noted that vaginoplasty does not address these problems. We determine what surgery will need to be undertaken as the prolapse must be corrected first, prior to any rejuvenation procedures being completed. In patients who present with these symptoms we involve a gynecologist or a urologist to perform additional procedures to address these issues.  Ozel B, Whiute T, UrwitzLane R. The impact of pelvic organ prolapse on sexual function in women with urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2006;17:14–17

Combination of procedure:

Labiaplasty and Clitoral hood remodeling can be combined in one procedure with or without Vaginoplasty. However, recovery takes longer with combined procedures.

Patients at higher risk for medical or surgical complications and poor wound healing are:

  1. Smoker: smoking should be withheld 3–6 weeks prior to and 3–6 weeks post‐surgery
  2. Diabetic (should be meticulously controlled before the surgery),
  3. Poorly controlled hypertensive,
  4. Significant pulmonary, renal, neurological cardiovascular disease,
  5. Patients with vulvar disorders or history of vulvar or vaginal area radiation

Why do these procedures appear to “work?”

The answer for the external vulvar procedures may differ from internal tightening procedures. For Labiaplasty (LP), Clitoral hood remodeling (RCH) and Monsplasty the reasons appear obvious, and opinions grace the literature. Any procedure that diminishes self‐consciousness, improves self‐esteem, and diminishes coital discomfort might be expected to, generally, improve sexual pleasure and response. For vaginal tightening procedures, there appears to be an evidence‐proven anatomic justification. Evidence in the literature confirms that orgasm and orgasmic intensity may be produced by, and intensified by, pressure on the more intensely innervated anterior vaginal wall.  ( a. Miklos JP, Moore RD. Postoperative cosmetic expectations for patients considering labiaplasty surgery: Our experience with 550 patients. Surg Technol Int 2012;21:170–4.    b. Rouzier R, LouisSylvestre C, Paniel BJ, Hadded B. Hypertrophy of the labia minora; experience with 163 reductions Am J Obstet Gynecol 2000;182:35–40.  c.  Miklos JR, Moore RD. Labiaplasty of the labia minora: Patient’s indications for pursuing surgery. JSex Med 2008;5:1492–5.   d. Goodman MP. Female cosmetic genital surgery. Obstet Gynecol 2009;113:154–96.)

Results: Be Realistic- What to you expect: :

Genital tissue is rarely “smooth and regular” prior to surgery, and that it will not be so after a surgical procedure. Patient can realistically expect reduction in size, and the cosmetic and functional benefits that may accrue from that, but they cannot expect “perfection,” exact symmetry, or a specific outcome.

Postoperative care:

Labiaplasty/Clitoral hood remodeling:

It is uncommon for patients to have significant post‐operative pain. Patients will uniformly experience some degree of swelling or bruising that is frequently asymmetric. We begin icing the labia while in the recovery room immediately in the postoperative period. Patients are instructed to continue icing 15–20 minutes of every hour for the initial 48–72 hours after surgery. Patients are prescribed anti-inflammatory medications to control pain and reduce the swelling. Patients are instructed to only wear loose fitting clothing and no tight undergarments. Patients may shower the following morning and are encouraged to avoid touching the operative area with fingers when possible to decrease risk of infection. They are also counseled to refrain from sexual intercourse and placing anything in the vagina (like tampons) and only to shower (no submersion/using bath tub) for a period of 6 weeks. Post‐operative visits should be regularly scheduled to monitor residual swelling. Patients should expect pruritus upon suture dissolve, and anti-histaminics can be prescribed to ease these symptoms. At 4–6 weeks initial results may be appreciated, and full activities, including sexual activities, may be resumed. However, it will be 3–6 months before final results are manifested. Michael P. Goodman. Female Genital Plastic and Cosmetic Surgery. 2016 th Edition.

Monsplasty: Since it is usually combined with abdominoplasty, the patient requires pressure garment to be worn to achieve compression. If monsplasty is performed as a solo procedure then, gauze with a gentle abdominal compression band is applied. Swelling and bruising is expected for 2 weeks. Wound care is advised and the area should be kept dry to avoid skin maceration. Scar modulation takes several months and scar remodeling creams are advised from 3 week after the surgery. Abdominal compression is continued for 6 weeks postoperatively followed by commercially available compression garments (i.e., Spanx™) for a total of 6 months after surgery. Michael P. Goodman. Female Genital Plastic and Cosmetic Surgery. 2016 th Edition.

Vaginoplasty: Many of the procedures are completed on an outpatient basis and the surgery is completed under local, spinal, or general anesthesia. Vaginal packing is left in post‐operatively and removed prior to the patient being discharged. Routine instructions for vaginal surgery are given to the patient and she is seen for follow‐up at 4 weeks post‐operatively or sooner as indicated. The vaginal introitus and caliber are

assessed and if felt necessary the patient will begin perineal massage in a warm water bath for 1 to 2 weeks prior to resuming penetrative sexual intercourse. Michael P. Goodman. Female Genital Plastic and Cosmetic Surgery. 2016 th Edition.

Complications: Michael P. Goodman. Female Genital Plastic and Cosmetic Surgery. 2016 th Edition.

In general, pain, bleeding, infection, hematoma, wound breakdown or delayed healing (more common in smokers), unfavorable scarring, contour irregularity, asymmetry, swelling, altered sensation, pigmentation irregularities, dyspareunia (Painful Sexual intercourse), need for additional surgery or revisionary procedures should be understood.

The potential complications of vaginal rejuvenation are infection, bleeding, wound dehiscence, dyspareunia (pain upon sexual intercourse), inadequate tightening, narrowing of vaginal opening, and rectoperineal/rectovaginal fistula.

Whom should you approach for Female Genital Cosmetic Surgery?

A Plastic Surgeon Or a Gynecologist are appropriate surgeons to perform the surgery. Hence chose your surgeon wisely!

Dr. Sanjay Parashar


February 24, 2020

A ‘Hollywood’ Smile Makeover is a cosmetic procedure that aims at achieving a beautiful, perfectly shaped, righty colored and sized teeth for an individual.  The procedure is performed using thing Veneers which are placed on top the individual’s existing teeth.

Almost 100 years ago, in 1928 Dr. Charles Pincus invented veneers to change the appearance of an actor’s teeth temporarily. Which later on became the preferred procedure for celebrities to correct their smiles and always be ahead in the game. Hence the name Hollywood smile makeover.

Today, the Hollywood smile makeover is a very common procedure, especially in Dubai. You will hardly find a known personality or an individual with the means, who cares about his or her appearance and was not born with a perfect smile, who has not had a smile makeover.

Let’s talk about What are veneers?

Veneers are thin, yet very strong layers material which are placed over a tooth. Veneers not only improve the aesthetics of the smile; but also protect the tooth’s surface from damage.

There are two main type of materials used to make a veneer – porcelain and composite. Porcelain is stronger than composite, as it is made in labs. Composite is also strong, but not as strong as porcelain, though offers the advantage – that they can handcrafted directly in the mouth of the individual. Which gives more control to the dental doctor and individual on how the outcome is. The shape, color, size can be enhanced to achieve perfection immediately on-site. Whereas in porcelain veneer, the teeth impressions are taken and send to a lap to fabricate the veneers and it’s very difficult to make changes once the veneers are fabricated. Though we make temporary veneers first in case we are doing porcelain veneers, to ensure the new smile suite the individual and is happy with it. And we can make the changes needed, before the final veneers are fabricated in the lab. This does add more time to deliver the new smile and can take 3-4 weeks to finish the full makeover. Whereas in composite based makeover, I can do it in a single sitting.

What to expect when going for veneers or smile makeover?

First things first. The Dentist will evaluate the individual’s oral heath first to see are you a right candidate for the procedure. At my practice here at Cocoona Centre for Aesthetic Transformation Dubai, I see about 5-6 news patients every week looking for a smile makeover. Not everyone is an ideal candidate to start immediately. Some needs simple correction before we are able to proceed, some need lengthy orthodontist treatments like braces before we proceed with the smile makeover. Examination and correcting the necessary is the most important not only to achieve a perfect smile, but also to ensure the life of the veneers.

During this stage we take X-rays and impressions of the teeth as well, to analyze everything thoroughly.

Once both me and patient are satisfied with the outcome of the examination it will be time to choose the new smile.  I then counsel the patient on the kind of smile that will look nice on him or her. First, we decide the shape and number of the teeth, I show them pictures, actual samples of veneers and advice on what can be achieved. During this stage is when we decide on the number of veneers needed.  Some patients with minor imprecations only need one or two, some need only the top 5 ,but most of the patient need 10 top and 10 bottom teeth which are visible in smile.. The number entirely depends on how many teeth are visible when the individual smiles.

An import thing I insist on while advising my patients on the shape is: Perfection is not in having perfectly even teeth. It having a smile that make the other person admire it beyond his or her control. I like natural shapes and contours as oppose to the common box shaped teeth, that run through an individual’s mouth. Such smile may stand out from a mile, but will tell everyone that you have had a smile makeover. The beauty and art of a smile makeover is in delivering a smile that people lovely madly and cannot tell if was from birth or made in a clinic.

Now we move on to the next step, which is deciding the color. This is easy, most people want white, but the right shade of white that complement the complexion of the individual is also very important. So we ensure we have the right shade. I always want the veneers to look as natural as real teeth , so for that I always prefer the veneers with translucency and this can be done with porcelain veneers.

Now we finalize the material: porcelain or composite. I take the patient through the advantages and disadvantages of both kinds, the steps and time involved for treatments and the associated costs. I also recommend what will work best for the individual based on her/his oral health, kind of corrections needed and results wanted. More information can be found at here

How to differentiate, with a smile makeover.

The answer to this is simple, keep it as natural as possible. We don’t want our patients to look like billboard for a smile makeover, we want you and your teeth to look healthy, beautiful and perfect.

After care process for Veneers:

It’s very important to take care of one’s oral hygiene. I recommend all my patients:

  1. to maintain good oral hygiene by brushing at least twice a day and preferably after every meal.
  2. Floss at least once a day.

These two steps are critical to minimize the risk of gingival (Gum) diseases and teeth decay.

  1. Regular dental examination with Dentist. It is recommended to do checkups each six months for scaling or cleaning and polishing of your veneers. This as well will let your dentist to detect any sign of dental cavities or issues.
  2. I also advise on using a night guard, if the individual has teeth grinding habit. A night guard will protect your Veneers and give you a sounder sleep.


About me.

I am Dr. Homeira Ahmadi , graduated from Ajman University and have five years’ experience in UAE. At my dental practice here at Cocoona in Dubai I do the following treatments and procedures.

  1. Veneers
  2. Root canal therapy
  3. Crown and Bridges
  4. Scaling and polishing
  5. Teeth whitening
  6. Pediatric (children) dental treatments
  7. Extraction
  8. Preventive Dental treatments

You can read more about me at here


Dr. Sanjay Parashar


February 17, 2020

Since the existence of mankind, human body has been seen as a work of art. Throughout the history, human form has been elaborately expressed by artists and sculptors. It all began in 5th century BC by the Greek sculptor Polykleitos with his bronze sculpture Doryphorus. It showed the perfectly harmonious and balanced proportions of human body.

This was followed by artistic versions of human body by various artists and sculptors. The merging of art and anatomy is perhaps most evident and glorious in the works of Leonardo da Vinci.

(De Humani Corporis Fabrica by Vesalius)

Michelangelo’s David represents one of the most recognized sculptures and showcases the human body in all its strength, athleticism, and youthful beauty.

(Michalengalo’s David)

It is very interesting how the ideas of art based on perception of genius artists in the past can be used with a deep knowledge of human anatomy to carve a beautiful structure in a human body through liposuction (hence the term ‘Liposculpture’)

(Some of my sketches on artistic presentation of an aesthetic muscular male and female body)

Using the artistic perception from the historic times, plastic surgeons have been inspired to recreate a similar form in their surgeries. This takes liposuction or fat removal to the next level and gave rise to the concept of lipo-sculpture or 3D/4D liposuction.


Liposuction isn’t a new technique and it has been done since 1980s.

The market has seen changes from traditional liposuction (manual liposuction) to the use of energy based devices like Laser, Vaser, Radiofrequency assisted and J Plasma (Plasma with Radiofrequency).

Also there have been different methods of performing liposuction like Manual Liposuction, Power-assisted liposuction, Vibration assisted Liposuction, Nutational Infrasonic Liposuction, etc.

“Using the knowledge of anatomy and infusing it in science with an artistic perspective is High definition liposuction.”

High definition Liposuction is a form of liposuction which not only removes fat excess but in addition removes fat between muscle groups accentuating the margins and the lines of light and shadows between the muscles creating a more athletic appearance.

 Ref. : (VASER-Assisted High-Definition Liposculpture : Alfredo E. Hoyos, MD, John A. Millard, MD. Aesthetic Surgery Journal, Volume 27, Issue 6, November 2007, Pages 594–604)


The above patient is a 40-year-old male who had stubborn resistant fat in the tummy and love handles which despite regular exercises and good diet refused to shed off.

He promised to be committed to exercise and diet. I removed 3 liters of fat from the abdomen and defined his muscles (body sculpting). Following the surgery, he started working out while recovering and here he is after 3 months.

The Six-pac abs are very prominent, and most importantly they are natural. it’s the patients own muscle, and not FAT bases packs that looks extremely fake and poor.

The above patient is a 25 year old female who had stubborn resistant fat in the tummy and love handles despite regular workout and good diet.

I removed 3.5 liters of fat from the abdomen and defined her muscles (body sculpting). Following the surgery, she works out 3-4 times a week, focusing mainly on her abdomen and lower body.


FAQs on Liposuction

At my practice here at Cocoona Dubai, I frequently come across patients pre-occupied by misleading information. Our duty as plastic surgeons lies in not just performing the surgery, but also to educate people about the procedure and its intricacies. I have listed some of the most common questions we as plastic surgeons encounter during our consult regarding high definition liposuction.

Who is the right candidate for high definition liposuction?

Any individual (male/female) who meets the following criteria is a good candidate:

  • Low visceral fat
  • Good skin elasticity
  • Minimal to no excess skin
  • Motivated patient committed to working on lifestyle change in terms of diet and exercise

Do I need to be muscular to get better results out from a High Definition Liposuction surgery?

I classify my patients into three categories :

  1. Poorly muscular: These patients need to work-out on their abdominal muscles to get the best shape after the surgery. Also need to make sure they don’t gain fat in the same area by focusing on their diet and cardio (HIIT). They typically see their 6-pack result after a longer duration. Could take 5-6 months or even more.
  2. Slightly muscular: Need to work-out on a regular basis and keep their diet in check. However, they tend to see the results faster and its less difficult for them to maintain their results.
  3. Very Muscular : These patients usually are athletes or bodybuilders, who are usually extremely cautious about their diet and exercise. They see the results the fastest and maintain them very well for a very long period. Needless to say, these patients have the best results and are a treat for any plastic surgeon.

How do I do Liposuction or What technique do I use?

I infiltrate tumescent fluid in the fatty layer to numb the area. This helps in post-operative pain control. The fluid also helps in vasoconstriction which reduces the amount of blood loss during the procedure.

I use vaser to help me in emulsification of fat and skin retraction which in the end translates to a well sculpted slimmer look of the body.

Ref. Click here

This can also be done using laser, J plasma or other energy-based devices. No single device has been shown to be more superior than the other for this purpose.

However, worldwide Vaser is the commonest tool used for high definition liposuction.

Once liposuction is done and the patient is slimmed down in an aesthetic way, etching is done using special cannulas.

The end result is a combination of various factors like surgeon’s skills, technology that’s used, post-operative protocol and a healthy lifestyle on the part of patient.

Is the liposuction technique different for males and females?

Muscle definition (or Etching) is commonly done in the midline above the belly button (Linea alba) and by the sides of the two rectus muscles (Linea semilunaris) in females.

Most females don’t prefer the six-pack look. They like a softer look.

Males usually prefer the six-pack look. I have had few female clients in my practice requesting the same. Hence etching in them besides Linea alba and Linea semilunaris is also done in the transverse lines to create the packs. (Transverse inscriptions)

How do I make the results of the liposuction long lasting (or sustainable)?

I do not prefer leaving fat over the muscles to create Abs as this fat has the potential to grow in later life leading to an abnormal bulge.

Remember ‘Abs are muscles not fat’.

Leaving fat or injecting fat under the muscle to make it look like abs only creates “Fat packs” or “Fake packs”.

Also, the patient is strictly advised to adopt a heathy lifestyle with clean diet and regular exercise to make the rectus muscle grow bigger (Ab muscle hypertrophy).

What is the post-operative care after getting liposuction?

Patient is advised to go for manual lymphatic drainage massages from day 2 or 3, after the surgery to help swelling go off faster and also to aid in skin retraction.

Pressure garment is given on the second day after surgery while Foam dressing is given to be placed along with the garment from day 3 or 4, which helps in avoiding swelling in the etched areas and preserves the etching that was created during the surgery. This is typically given for about 2-3 weeks.

Pressure garment is advised for 1.5-2 months following the surgery. This duration could be shorter or longer depending on how the patient is healing.

Follow ups are recommended at 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months and 1 year after the surgery.

I am strict with my follow ups to ensure high patient satisfaction and long-lasting good results.

When do my patients see results after liposuction?

Typically, patients see good results between 2-3 months.

Different patients swell and heal differently, but most of them see a good result by 3 months and that keeps improving till about 5-6 months.

Results also depend on patient compliance in terms of diet and exercise.

When can a patient start exercising after the liposuction surgery?

My patients start light exercises from 2nd week after the liposuction surgery and progressively increase the intensity every week.

Patients usually begin their routine exercises (workout, dance, Zumba, Pilates, etc.) in a month’s time.

What exercises do I recommend after the liposuction surgery?

I usually customize an exercise plan for each client considering their goals, the area that I have worked on (abs, glutes, shoulders, chest, back, etc.) and looking at how much time and effort they are ready to put in.

I have been trained by some finest bodybuilders in the world and my experience in bodybuilding helps me shape up my clients post operatively.

Sample exercise plan

At 1 week – Long distance walking, walking on a treadmill

At 2 weeks – Running on a treadmill, Mild intensity exercises on uninvolved areas (like exercise for arms and legs when only tummy liposuction is done)

At 3 weeks – Moderate intensity exercises on uninvolved areas, Passive exercises for operated areas (like Planks for abdomen, stretch and hold for arms, buttocks)

At 4 weeks – Moderate to severe intensity exercises for all parts

More about Myself

I am a Board-certified plastic surgeon with a 7 years’ experience in plastic surgery. I perform both aesthetic surgical and non-surgical procedures.

I like to scribble, sketch, sculpt, inject, cut and stitch.

My hands are my biggest asset and I try my best to create something beautiful with them, at or out of work.


Surgical Procedures

Body Contouring

  • Vaser / Laser Liposuction
  • Slim Down Liposuction
  • 3D / 4D liposuction (6 packs liposuction)
  • Tummy tuck
  • Brazilian Butt Lift
  • Arm Lift / Thigh Lift

Facial Surgeries

  • Blepharoplasty
  • Buccal fat pad removal (Bichectomy)
  • Face Liposuction
  • Face fat grafting

Breast Surgeries

  • Breast Augmentation (Implants/Fat transfer)
  • Breast Lift / Breast Reduction

Genital Surgeries

  • Labiaplasty
  • Labia Majora Fat grafting
  • Vaginoplasty

Non Surgical Procedures

  • Botox
  • Fillers (face/hands/buttocks)
  • Platelet Rich Plasma (PRP)
  • Microneedling
  • Fractional CO2 Laser
  • Mesotherapy



Dr. Sanjay Parashar


February 3, 2020

Evolution of Breast Implants

The first thought of using implants to enhance breasts was sowed in 1962. Frank Gerow was a surgical resident and while he was carrying a bag of blood from blood bank to the wards, he felt the bag felt like breasts. The crazy idea was shared with Dr Thomas Cronin who liked the concept and started working on the idea along with Thomas Biggs. I have been fortunate to meet Thomas Biggs and listen to this story several times.

Prior to this there were medical records of industrial silicone being injected directly into breasts as early as 1945. (Ref: Reuters World news)

From 1951-1962 a number of different materials were used such as Ivalon. A polyvinyl alcohol sponge that was inserted under the breasts but eventually was removed as it caused hardness.

Dr Thomas Cronin and Dr Thomas Biggs developed the first Silicone filled implants and used it in 1962 on a woman who has now turned 80.

In 1976 The US Food and drug administration (FDA) regulated the silicone breast implants to ensure its safety.

But in 1991, there were several incidences of rupture of implants leading to leakage of liquid silicone.  In April 1992 The FDA advised its use only for reconstruction after surgery or to correct congenital deformities. The silicone-based implants were pulled out of the market in US, UK and several countries.

In 1995 the silicone implants were replaced by saline filled implants (inflatable). The first saline filled breast implant was created in France in 1965 by Dr H G Arion. However it had very high incidence of rupture, leak and abnormal “sloshing sounds”.

After several modifications of silicone gel to make it more medical grade and safe, it cam back in market and year 2000 France lifted its ban on silicone implants and 2006 FDA did that in the USA.

There was a brief period of time when other materials were used inside silicone bags such as Soy oil and Polypropylene string but it had other risks that lead to its disrepute.

After the first, second and third generation implants silicone breast implants; there were significant improvement in its development to make it safer.

The fourth and fifth generation Implants used more cohesive gel and newest highly cohesive implants were approved in 2012 and 2013. The fifth-generation implants are also strong with low- bleed shell.

As the internal silicone material improved with time the shell covering also went through several changes.

In the beginning the silicone bag or shell was thinner to make it feel softer and more natural, however the combination of liquid silicone and thin shell had higher risk of leakage and rupture.  Yet another risk was capsular contracture that was assumed to be due to smooth wall of the shell.

The smooth shell was than replaced with textured shell to reduce risk of contracture.  A newer implant type with polyurethane sheath was introduced; however partial degradation of PU foam led to speculation of carcinogenesis. The FDA estimated higher risk of cancer with PU foam implants. (Ref W Peters. The evolution of breast implants. Can J Plast Surg 2002;10(5):223-236.)

Textured implant certainly had lowered incidence of capsular contracture. McGhan in 1987 developed Biocell surface implants, Mentor in 1988 developed siltex technique and these implants are still very popular. Some of the companies developed other techniques of texturing the implant that fell out of disrepute. The reason was under some circumstances there could be collection of fluid around the implant that could lead to immunogenic reaction.

Recent studies have shown that textured implants carry higher risk of a rare form of cancer called Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA ALCL). It is not a breast cancer but a cancer of the immune system. As of June 2019 732 cases of BIA ALCL have been reported worldwide (Published by International Consortium of Investigative Journalists)

The new era of implants is developed with principles of “microtexturization and Nanotexturization. The velvet surface and silk surface are some newer breast implants that have low roughness and implies low friction and therefore no lose particles (ref- Nanotechnology, nanosurfaces and silicone gel breast implants)

Evolution of the procedure for Breast implants

The earlier practice was to insert the implant in front of the muscle. For many decades the implants were placed above the muscle just under the gland. The approach was different, either from an incision underneath the breast or around the nipple. Because the scar was located on the breast region, surgeons developed new approach either through the under arm called axillary approach or through the umbilicus called as Transumbilical breast augmentation (TUBA).

As not all people were ideal candidate for above the muscle implantation, a technique was developed to place the implants under the muscle called as submuscular breast implantation.

However, as the breast is dynamic and changes its position over time whereas the muscle does not, a submuscualr implant has risks of high riding implant and water fall deformities. So, a technique was required to ensure that the implant follows the breast over a period of time.

In 2006 Dr John Tebbetts who described an innovative method called dual plane breast implantation that ensures the implant is covered partially with muscle and remaining implant is placed in the lower pole of the breasts published a research. This ensured that the implant moved with the breasts as it sags. This technique adjusts implant and breast tissue position to ensure the implant is protected in the upper part while optimizing the position of implant in the lower pole of the breasts (ref Plast Reconstr Surg. 2006 Dec;118(7 Suppl):81S-98S; discussion 99S-102S.

Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types.

Tebbetts JB1.

This procedure is still very popular and widely used worldwide. In my experience of 25 years, I select the patient based on the size of their breasts, position of the breasts in relation to their chest muscle and predicted drop in breasts as they age.

Evolution of surgical technique

With the advances in technology and better understanding the surgical technique has evolved to make it safer with early recovery and stable long-term outcome.

In the past the risks of bleeding, hematomas, capsular contracture, and infection were a big concern. The surgery time was often longer extending for few hours in many cases. The anesthesia was a concern, risks of blood clots, embolism were higher. Continuous research and studies have helped to improve the quality of the surgery.

The general anesthesia now used in most cases is called “laryngeal mask” or “supraglottic mask) in opposed to intubation. This has minimized the use anesthetic drugs. Patients recover early without much PONV ( postoperative nausea and vomiting) and grogginess (Ref: anesthesiology.pubs.asahq.org › article)

Laryngeal Mask Anesthesia – Anesthesiology – ASA

by A Ovassapian – ‎2006)

Tumescent infiltration that contains cocktail of medications such as lidocaine, adrenaline and normal saline has revolutionized the whole procedure.

This injection is done prior to the surgery is started. This allows the blood vessel to shrink temporarily and enables us to perform bloodless surgery.  Hence the risk of  haematoma is dramatically reduced. In my practice in Dubai, UAE since 2005 I have had 0% hematoma in total of 1500+ that I have performed.

Use of lidocaine has reduced postoperative pain so most of the patient either is discharged same day or next day.

The surgery now lasts anywhere between 40-50 minutes reducing the morbidity of the procedure.

Evolution of Protocols for a successful Breast Implantation

There are several protocols to predict and prevent complications in Breast Implant surgery.

In our series of 1500+ breast augmentations that I have performed here at Cocoona in Dubai, risks of infection, DVT, embolism has been 0%. The reason being the protocol ensures identification of risk factors in patients and selection based on fitness for surgery. Secondly protocols also guide us to follow steps to prevent such complications. These pertain to Infection control policy, DVT prophylaxis policy, ASA (American Society of Anaesthesiologists) criteria to predict operative risks ( Ref: American Society of Anesthesiologists Classification (ASA Class)Daniel John Doyle; Emily H. Garmon.)

Selection of Implant Size and type of surgery

An Ideal breast implant surgery is where the size and position of the implant is appropriate to the anatomy of the breasts. We thoroughly analyze the breasts and follow established protocol.

Breast anatomy-based planning implant-sizing system offers superior outcome longevity as compared to just patient preference.   On the other hand, if the implant size is selected based on patient or surgeon preference the result may be short term with higher risks of complications such as thinning of breast tissue, sagging and visible implant distortions (Ref Matching the Implant to the Breast: A Systematic Review of Implant Size Selection Systems for Breast Augmentation

Adams, William P. Jr. M.D.; Mckee, Daniel M.D Plastic and Reconstructive Surgery: November 2016 – Volume 138 – Issue 5 – p 987-994)

The new innovative method of assessment also allows determining if implant alone is suitable or patient may need breast lift as well. This combined procedure is known as augmentation mastopexy.

Safest Technique for breast augmentation

Breast augmentation can be very safe surgery if all the parameters are fulfilled. It starts from ideal patient selection who is a fit and healthy female with stable weight and who has enough fatty tissue with some breast tissue to give a nice envelop over the implants.  The size and position of the implant is appropriately chosen based on the anatomy. The recommended implants are fifth generation, gummy bear type or cohesive implant with nano or microtextured preferably FDA approved.

However, the most important factor remains the follow-up in short and long term.

Regular follow up with the surgeon immediately after the surgery will minimize surgical risks. In long term a yearly follow up is recommended with a Plastic surgeon who may advice USG or MRI to ensure the integrity of the implant and body’s response to it. Any breast implant is not considered a permanent implant and it may require a change after 10 years based on the clinical situation. Modern implants carry warranties for several years and also options of extending the duration of cover, one such example can we looked at motivaimplants.com › docs › motiva-warranty-program-terms-and-co…Motiva Warranty Program Terms and Conditions)

About Me.

I am Dr. Sanjay Parashar and have spent several years working with and learning from some of the best plastic surgeons in the world. I have been practicing for almost 3 decades and have performed over 12,000+ surgeries. My primary practice is based out of Dubai, UAE, but I travel to Delhi, mumbi and Ludhiana frequently to attend to VIP and celebrity cases in India. My specialties include:

  • Breast Surgeries
  • Breast Augmentation using Implants or/and Fat Grafting
  • Breast Lift
  • Breast Reduction
  • Facial Aesthetic Surgery
  • Rhinoplasty
  • Facelift
  • Occuloplastic Surgery (Eye surgery)
  • Reconstructive Surgery
  • Robotic Hair Transplant
  • Body Contouring –Liposuction and Liposculpting
  • Six Pack Surgery using Vaser Technology
  • Chest and Biceps Augmentation
  • Abdominoplasty (Tummy tuck)
  • Mommy Makeover
  • Facial Contouring
  • Fillers and Anti-ageing treatments
  • Brazilian Butt Lift
  • Gynecomastia (male breast reduction)

Dr. Sanjay Parashar

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