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One of the earliest signs of aging is appearance of facial lines and wrinkles. While we cannot prevent aging, we can certainly delay the appearance of facial wrinkles and hence the visible signs of aging.

Face is a very dynamic part of our body. The muscles of the face can be divided into two groups: the muscles of facial expression and the muscles of mastication. Interestingly, unlike other parts of the body, the muscles of the facial expressions are inserted in the skin. Normally, the muscles of facial expression communicate emotional states. Where as muscles of mastication are deeper in location and involved in the movement of jaws.

Fig: 1 Check the Dynamic lines appearing with different facial expressions

A permanent crease on the face can send an inappropriate message. A permanent glabellar crease (skin folds between the eyebrows) communicates anger or worry when the person feels neither.

Fig. 2

Many people in the course of normal activity over utilize certain group of facial muscles: thus the muscle is hyper-functional and over active. In some individuals these muscle gets bulkier.

FACT #1

Botox has been the #1 aesthetic procedure performed since 1999

Fig. 3

Movement or contraction of facial muscles result in development of skin folds that are are called Dynamic wrinkles. With time these dynamic lines become deeper and eventually develop into Static lines, which means the lines /creases remain in the skin even without making any facial expressions. If the dynamic lines are treated at an early stage development of static lines can be delayed. This is where Cosmetic Surgeons and dermatologist use Botox.

FACT #2

The FDA approved the use of BOTOX for Cosmetic in 2002

Fig: 4

What is Botox?

Botox is a neurotoxin derived from clostridial bacteria. It contains an active substance called botulinum toxin type A. It can be injected into the muscles or deep into the skin. It acts by relaxing the muscles by causing temporary paralysis of the muscles in which it is injected. When injected into the skin it works on the sweat glands to reduce the amount of sweat produced.

Botox and anti aging: Scientific evidence

Clinicians have observed a long-term and preventive benefit of botox for patients beyond muscle relaxation particularly in patients who receive repeated treatments over time. These changes include progressive reduction of wrinkles, prevention of dynamic wrinkles, and improvements in skin quality.

Humphrey S. Neurotoxins: Evidence for Prevention. J Drugs Dermatol. 2017;16(6):s87–s90.

Histometry of skin biopsy specimens before and after 3 months of BTX-A, showing significant increase in wrinkle width, rather than decrease in wrinkle depth (b) when compared to baseline biopsies (a) (H&E; Å~ 200).

Dermal collagen and elastin before and after 3 months of BTX-A. Immunoperoxidase staining of skin biopsy specimens for collagen types I (a, b) and III (c, d) and elastin (e, f) showing no significant difference in collagen types I and III and elastin content between baseline (a, c, e) and post-treated biopsies (b, d, f), but with better organization and more compact collagen fibers after BTX-A injection (b, d) (original magnification; Å~ 100).

Fig. 5

Ref : El-Domyati M, Attia SK, El-Sawy AE, et al. The use of Botulinum toxin-a injection for facial wrinkles: a histological and immunohistochemical evaluation. J Cosmet Dermatol. 2015;14(2):140–144.

Areas of the face that can be treated with Botox:

Most commonly treated areas of the face are glabella/frown lines, the forehead lines and the crows feet. However, patients also request treatment of bunny lines on the nose, elevation of droopy eyebrows, under-eye lines, chin wrinkles, lip lines, drooping corners of the mouth, neck lines and cords and sometimes the definition of jaw lines.

Fig. 6

Fig. 7

Botox for Facial slimming.

Some individuals have heavy lower face due to enlarged jaw muscles and find themselves unattractive. They request for a slimmer and softer appearance of the face. Botox injection in the masseter muscle (muscle of the jaw) helps in slimming down the lower third of the face. I also help in relieving teeth grinding and clenching known as bruxism. And thereby avoids TMJoint dysfunction. Below is an Asian male who had botox injected in the masseter muscle. The after picture of the patient shows slimming of the lower face with a softer look 10 days following the procedure.

Fig. 8

What is Nefertiti lift?

The procedure is named after the Egyptian queen with the perfect jawline. The technique aims to lift and improve the definition of the border and angles of the jaw, elevate the corners of the mouth and drape the skin of the jawline giving the visual effect of a ‘mini lift. Tiny amounts of Botox are injected into the muscles of the neck – specifically the ones that create a downward pull on the jawline.

Fig. 9

Botox for Gummy smile.

Some individuals have exposed gums when they smile due to overactive lip muscles. They are found in 10.5% to 29% of the population and are more common in females. For these individuals a small dose of botox at strategic locations around the lips can help in achieving their goals. The effect typically lasts for three to six months and must be repeated every six months to one year.

Fig. 10

BROTOX– Botox in men

Fig. 11

There is an increasing trend of Botox among men. Male patients who have tried Botox look better, feel better, and believe it gives them a competitive edge. There are significant differences in the outcome of injectables in women and men. We need to take into account each patient’s muscle mass, muscle fiber pattern and hair distribution. Due to greater muscle mass, men require higher doses of Botox than their female counterparts.

What is “Microbotox”/”Mesobotox” ?

It is a newer technique where smaller droplets of lesser concentrated botox is injected under the skin which acts on the sweat and sebaceous/oil glands along with superficial fibres of the facial muscles. It causes

Tightening of skin pores
Fresher look
Smoothing of fine lines
Subtle tightening of the skin
Improving texture and tone of the skin
Helps with facial flushing and sweating

Other indications for BOTOX:
There are other extended indications for Botox in medical management of patients. These are:

Upper and lower limb spasticity
Cervical dystonia
Blepharospasm
Strabismus
Urinary incontinence
Overactive Migraine
Axillary and palmar hyperhidrosis
Bruxism

What does a Botoxtreatment feel like?

Upon consulting the doctor and after the facial assessment, a realistic plan is laid out in tandem with the patients desire. The nurse removes all the makeup and applies numbing cream on the face for 20 minutes. After cleaning the numbing cream, with all aseptic precautions, botox is injected in the areas to be treated. These are tiny injections placed under the skin and in the facial muscle that needs to be relaxed using very thin needles. Pain depends upon individual’s level of threshold. Following which some ice is applied to reduce the swelling

Pre treatment Instructions:

Schedule your treatment at least 2 weeks in advance before a special event or vacation.
It is recommended to discontinue the use of aspirin, motrin, ginko biloba, garlic, flax oil, cod liver oil, Vitamin A, Vitamin E or any other essential fatty acids at least 3 days to 1 week before and after treatment to minimize bruising or bleeding.
Avoid alcohol, caffeine, niacin supplement, high sodium and high sugar containing foods, refined carbohydrates, spicy food and cigarettes 24 – 48 hours before and after your treatment.
Discontinue Retin A 2-3 days before treatment.
Wait at least 2 weeks to to have botox treatment if you had LASER, Ultrasound, chemical peels or microdermabrasion.

Post treatment instructions:

Do not lie down flat for at least 4 hours
Do not touch or rub the treated area for 4 hours
Avoid wearing hats and headbands immediately after the treatment.
Do not use of aspirin, motrin, ginko biloba, garlic, flax oil, cod liver oil, Vitamin A, Vitamin E or any other essential fatty acids at least 3 days to 1 week after treatment to minimize bruising or bleeding.
Avoid alcohol, caffeine, niacin supplement, high sodium and high sugar containing foods, refined carbohydrates, spicy food and cigarettes 24 – 48 hours after your treatment.
Avoid cosmetic treatment like LASER, Ultrasound, chemical peels or microdermabrasion for 2 weeks after the treatment.
Avoid make up until the day after treatment. Earlier use may cause pustules. If you must wear make up we recommend a good quality mineral make up for the face.
Should you develop increased pain, swelling, redness, blisters or itching please report to your provider.
Effect of botox takes about 2 – 10 days for its full effect. Touch up if needed should be done no longer than 2 weeks after the initial treatment.

SIDE EFFECTS:

Although generally safe, botulinum toxin side effects and complications can include:

Bruising and pain at the injection site
Flu-like symptoms
Headache
Nausea
Redness and swelling
Temporary facial weakness or drooping
It is very unlikely that the toxin might spread beyond the treatment area, causing botulism-like signs and symptoms such as breathing problems, trouble swallowing, muscle weakness and slurred speech

Contra-indications: Botox should be avoided if you suffer from one of the following conditions.

Infection at the site of injection
Past history of allergy to botulinum toxin/BOTOX
If you have had any surgery or injury that may have changed the muscle to be injected in some way
If you have had an operation or injured your head, neck or chest.
Disease affecting the nervous system: Peripheral motor neuropathy, Lou Gehrig’s disease
Muscle disorders: Myasthenia gravis/Lambert Eaton syndrome
Progressive muscle weakness with an underlying cancer
Double vision: condition where one object appears as two or more object
Blurred vision
Drooping of the upper eyelid
Pneumonia due to accidental inhalation of vomit: especially if you will be treated for persistent muscle spasms in the neck and shoulders
Decreased lung function and trouble breathing
Difficulty swallowing
Involuntary leakage of urine
Heart disease
Suffer from seizures
Closed angle glaucoma

How soon are the results visible ?

Effect of botox takes about 2 – 10 days ( 3-5 days on an average) for its full effect. Touch up if needed should be done no longer than 2 weeks after the initial treatment.

How long does the effect of Botoxlast?

individual patient’s genetics and the target muscle (mass, size, thickness, and depth below the skin and structure) determine really how long the effect of botox can last. In general, the effect lasts between 3 – 4months. The results may last longer for some patients, especially after repeated treatment. Studies have shown that in individuals who use their facial muscles a lot the effect of botox wears of faster.

About myself : I am a board certified Plastic surgeon with over 10 years of experience. I love beauty as much as science and research. So when beauty is backed with science it can only get real and that’s what we call as scientific beauty. You can reach me at [email protected] for any further enquiries on botox. I will be happy to answer them for you.

Dr. Sanjay Parashar

For the last two decades, breast augmentation remains at the top of the chart of all plastic surgery procedures performed world wide. Breast Augmentation has evolved significantly since the time of its inception in terms of implants, technique and overall safety of the procedure. A better understanding of the surgical planning and surgical technique has resulted in improved results and more predictable outcomes.

The FDA has approved implants for increasing breast size in women, for reconstruction after breast cancer surgery or trauma, and to correct developmental defects.

Today we have three different options available for Breast Augmentation.

1.Breast Implants remain the gold standard procedure for Breast Augmentation as it provides definitive and predictable enhancement in the size of the breast.

Autologous fat transfer: in this procedure one’s own body fat is harvested from areas where it is in excess and transferred to the breast in specific planes to increase breast volume. Since some amount of fat is resorbed by the body, the resulting volume augmentation in the breast is very modest. Hence patients more often require a repeat session to achieve desired augmentation.
Composite Augmentation: it is a relatively new technique of Breast Augmentation

where breast implant and fat transfer are combined to enhance the breast volume.

Breast Augmentation in the 1980’s and 90’s largely focused on volume augmentation where the sole aim of the procedure was volume increase. Today we focus on techniques that help in better coverage of implants even in the skinniest breast. Composite Breast Augmentation allows us to add volume in specific areas of breast especially in upper part of the breast and allows possible cleavage enhancement. Composite breast augmentation is a great addition in our armamentarium especially in patients who have tuberous breast ( patients suffering from underdevelopment of breast with a constricting band of tissue within the breast).

Earlier breast augmentation approach was limited to subglandular or submuscular

Fig : 1 Different planes of breast implant placement.

placement of implant. In present time we have options of placing implant in the subfacial plane and dual plane. We choose these approaches based on clinical evaluation, hence the procedure is customized to ones need. Therefore, we are now able to give predictable outcomes and improved results.

The FDA has approved two types of breast implants: saline-filled (salt water solution) and silicone gel-filled. Both have a silicone outer shell and vary in size, shell thickness, shell surface texture, and shape (contour).

Breast implant design and manufacturing process has continued to improve and evolve. Successive developments of breast implants are referred to as generations. The most current breast implant in the market are 5^th generation device. These implants are characterized by high standards of manufacturing, they have a reliable barrier levels in the shells that makes them quite resilient to damage there by reducing the incidence of implant rupture or tear. The gel is form stable and they come in wide range of anatomic and round matrices. The implants come in a range of textures, from smooth to nano, micro and macrotexture as well as polyurethane. Perhaps the most recent innovation in breast implant design has heralded the era of 6^th generation breast implant devices which are called as light weight implants- these are claimed to be 30 % lighter than silicone gel filled implants. It is composed of cohesive silicone gel bonded with lightweight microspheres there by making them lighter than the conventional silicone implant. Light weight implants aren’t approved by FDA yet and not available in UAE or USA.

Phasing out of “Textured Implants”

In recent years, textured breast implants have been linked with a rare type of immune system disorder called as breast implant associated anaplastic large cell lymphoma (BIA-ALCL). This was first reported in 1997. So far around 800 cases have been reported with textured implants worldwide. Treatment in patients with BIA-ALCL is aimed at implant removal and total capsulectomy. Worldwide textured implants have been phased out and currently smooth implants are being used to prevent occurrences of BIA- ALCL.

Proper Implant size selection :

Implant size selection is mainly determined by the breast foot print, which is the width of the breast, also taking into consideration patients desires. Many times there is significant difference in the volume of right and left breast. We now have technologies to three dimensionally evaluate the breast volume and hence choose different size of breast implant to make the augmented breast look more symmetric.

Fig. 2 : 3D analysis of breasts show left breast smaller than the right, hence a larger size of implant was used on the left side ( 335cc) and a smaller one on the right side(315cc) based upon the pre operative evaluation and patient agreement.

3D – analysis of the breast gives an objective quantification of breast volume and predictable outcome of the results.

Post Breast Implant screening :

The FDA recommends that people with silicone implants get regular screenings to detect silent ruptures.

For asymptomatic patients, the first ultrasound or magnetic resonance imaging (MRI) should be performed at 5-6 years postoperatively, then every 2-3 years thereafter. For symptomatic patients or patients with equivocal ultrasound results for rupture at any time postoperatively, an MRI is recommended, whether implants are for cosmetic augmentation or reconstruction. These recommendations do not replace other additional imaging that may be required depending on medical history or circumstances (i.e., screening mammography for breast cancer).

Additionally, FDA is also recommending ultrasound as an acceptable alternative to MRI for screening asymptomatic patients with breast implant in situ. These additional labeling recommendations were discussed at the March 2019 Panel Meeting.

Breast implant aren’t lifetime devices. FDA advices that they need to be changed after 10 years of surgery.

Breast Implant warranty:

Ask your Plastic Surgeon regarding the Implant warranty. Many implant manufacturers provide implant warranty against implant rupture and capsular contracture.

Silicone breast implant are not akin to silicone, so beware:

Lastly, silicone used for breast implants is different than injectable silicone. Injectable silicone is not FDA-approved for breast augmentation, breast reconstruction, or for any body contouring.

Always chose a board certified Plastic Surgeon to undergo breast augmentation or any cosmetic and other plastic surgery procedures to assure safety and predictable outcomes.

About myself: I am a Board Certified Plastic Surgeon with over 10 years of experience. Breast Surgeries remain among the most skill based procedure performed by Plastic Surgeons. I enjoy performing the surgery but more content to see when my patients step in our clinic with greater confidence and a whole new and improved version of themselves. You can reach me at [email protected] for any further enquiries on Breast Augmentation. I will be happy to answer them for you.

Dr. Sanjay Parashar

cocoona.ae-faqs-about-mommy-makeover-mommy.jpg

Motherhood and pregnancy are among the most gratifying periods of a woman’s life. However, there comes along a lot of changes in the physical appearance following pregnancy. We all know that during pregnancy the abdomen is stretched to accommodate the growing fetus and there is a lot of weight gain. Infact, the body undergoes a lot of unseen changes due to physical nature of the pregnancy itself but most importantly from the hormonal changes.

Mainly changes result in the breast and abdomen, though other areas like the arms and thighs also undergo changes. Some women may have significant fluctuations in weight.

Most common breast changes include skin laxity and sagging, nipple enlargement, volume depletion and stretch marks. Some women develop enlargement of breasts following pregnancy and lactation.

Similar changes can occur in the abdomen. Stretch marks, lax skin and increase fat are all common changes. In addition, the muscles of the abdominal wall can become become weak and separated in the midline which is called “divarication of recti”.

These changes can be addressed by multiple procedures and some can be performed simultaneously. The optimum results are achieved when diet and exercise are used in combination with surgical and nonsurgical modalities.

What is a mommy makeover?

“Mommy Makeover” is a term mainly used to describe rejuvenation of the breasts and abdomen, to address some of the common physical changes that can occur following pregnancy.

What are the different options for a Mommy Makeover?

Surgical options vary depending upon a woman’s personal goals.

In general, it is some combination of the following:

Breast lift, with or without augmentation if a woman has sagging breast with or without volume depletion
Breast reduction if the breasts are excessively large and causing discomfort, the size may be reduced.
Abdominoplasty (also known as a tummy tuck); mini-abdominoplasty (mini tummy tuck). In abdominoplasty, the abdominal muscles are tightened and excess lower abdominal skin with stretch marks is removed.
Liposuction: stubborn fat is removed from areas like the abdomen (which is often combined with abdominoplasty), back, thighs, arms etc.
Some women request genital rejuvenation.

Fig. 1

Fig. 2

Above patient underwent lipoabdominoplasty along with augmentation mastopexy after completing her family. She now exudes more confidence and self love.

Is it safe to combine multiple procedures in a mommy makeover?

It is a common practice to combine breast and abdominal surgery and it is safe in experienced hands. However, every patient is unique and should be properly evaluated by the surgeon to make sure the candidate is fit to undergo a combined procedure.

Who is an ideal candidate for a mommy makeover?

An ideal candidate is a woman who has completed her family and has achieved a stable weight and a healthy BMI. Significant weight gain or loss after surgery may compromise the final result.

How soon after having children can I have a mommy makeover?

Women considering mommy makeover should wait until six months after completing breastfeeding. This allows your hormones to return to normal levels and the breasts to stabilize in size and shape, hence allowing accurate surgical assessment. It will also give you enough time to hit your target weight as it recommended that you maintain a stable weight and healthy BMI before seeking a mommy makeover.

Can I have more kids after my Mommy Makeover?

If more children are planned in the near future for instance next 2-3 years, then it is best to postpone the surgery, especially on the abdominoplasty. However, if you intend to wait for several years to have more children, then surgery can help you enjoy your body during the long interval. Additional pregnancies are possible following mommy makeover and it will not affect your pregnancies or ability to become pregnant in any way. However, the result from surgery may be compromised if the tissues are stretched again with another pregnancy.

Will a caesarean section or hysterectomy affect Mommy Makeover results?

No, the incision for the abdominoplasty is at the same level on the lower abdomen. Infact, abdominoplasty can remove this scar and skin in order to smoothen the contour.

How can I maintain results after a mommy makeover?

You will be able to enjoy the results of mommy makeover by maintaining a healthy lifestyle and an ideal body weight, avoiding smoking and excess weight gain. With regards to the breasts, we recommend that you continue to wear breast support to minimize gravitational effects on the breasts.

About myself : I am a board certified Plastic surgeon with over 10 years of experience. Mommy makeover is my favorite of all plastic surgery procedures. I enjoy performing the surgery but more content to see when my patients step in our clinic with greater confidence and a whole new and improved version of themselves. You can reach me at [email protected] for any further enquiries on mommy makeover. I will be happy to answer them for you.

Dr. Sanjay Parashar

what is liposuction?

what is liposuction?

what is liposuction?

what is liposuction?

what is liposuction?

what is liposuction?

Botox – are we really dealing with the art and science of antiaging?

FACT #1

Botox has been the #1 aesthetic procedure performed since 1999

FACT #2

The FDA approved the use of BOTOX for Cosmetic in 2002

Safety and breast Implant: Can they co-exist?

FAQ’s about “Mommy Makeover”

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