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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February 11, 2021

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.


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.


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.



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


December 30, 2020

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.

  1. 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.
  2. 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 5th 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 6th 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


November 9, 2020

Right Nutrients in right composition at right time can make a big difference in your workout performance 

There are certain foods which should not be had before the sports event or a workout as it may drastically affects your performance are:

  • No High-fiber foods like Whole-grain foods, vegetables, legumes, and fruits that are high in fiber can cause gastrointestinal distress or diarrhea.
  • No High-fat and protein foods: These foods are best post workout but not before the exercise as they take longer time to digest and stay in the stomach for longer time. This makes you feel uncomfortable while working out. Foods with a lot of fat — such as fried foods, cheese, hamburgers, or bacon can also make u feel sluggish.
  • Caffeine: Coffee or other caffeinated beverages can cause stomach issues or diarrhea. Instead, stick to plain water or electrolyte based fluids like isotonic drinks.
  • Don’t overeat before workout . Everybody has different dietary needs. So to be sure talk to your healthcare professional about eating and exercise, since exercise has a serious impact on your body’s processes.
  • Avoid aerated drinks like soda or alcohol . As these are diuretic and can lead to quick water loss from your body . Also soda is high in sugar and it can spike your insulin levels, and throw your system off balance.
  • Avoid Pain killers before exercise. It can lead to intestinal injuries.
  • No Gas forming foods – like broccoli ,beans ,legumes ,cabbage can make you uncomfortable while exercising .At times can also lead to reflux.
  • No Spicy foods as can cause heart burn or reflux while doing any kind of cardio activity. Prefer to have simply salted mild flavored foods.

Selection of the right foods for pre work out meal can enhance your workout performance. Remember carbohydrates should be the main component of your pre workout meal.

Dr. Sanjay Parashar


October 29, 2020

Did you know when and what you eat can have an impact on your workout?

Many people/athletes who are trying to enhance their fitness levels and do extra workouts or practices often leave out one of the important aspect of fitness – Nutrition. They just can’t get serious about taking a balanced diet that can give them an extra edge.

Eating and exercise are connected. To keep your body working and give optimum performance there are 5 golden rules which should be followed

  • Never Go for the workout empty stomach . Load your body with good carbohydrates. This will give you energy and raise your blood sugar. If you don’t eat, you might feel sluggish or lightheaded when you exercise. 3 hours before the workout one can choose to have complex carbs like bagels , muffins , pasta , pohe , Arabic bread .
  • Avoid very large meals before your sport event /competition. Large meals before workout can make you uncomfortable and cause gastrointestinal distress.
  • Always Keep yourself hydrated . This practice will optimize your performance. Having 2 cups of water 20 mins before your exercise /race and 2- 3 cups of fluid for every pound you lost after your exercise is ideal . For further details contact a professional nutritionist to craft a detailed chart for you.
  • Always eat after exercise as it is very helpful for speedy recovery of muscles. Make sure to combine carbohydrates and protein in your after exercise meal.
  • Don’t ignore fat completely . Fat provides energy and helps your body absorb some essential vitamins like A, D, E and K. Be sure to pick unsaturated fats. Good sources are avocado, olive and canola oils, flaxseed and nuts.


Dr. Sanjay Parashar


October 5, 2020

“GROW MODEL” for your weight loss journey

Obesity is a chronic disease & its management should include not just losing weight but how to maintain the lost weight.

Dr Girish, weight loss surgeon Dubai apply the GROW model of coaching with good results in obesity management, (the GROW model, by Graham Alexander, is one of the commonly used models of performance coaching). it has 4 steps

G- Goal setting

R- Options

O- Reality check

W- Will

He believes that weight loss is a journey & as a bariatric surgeon along with his team he can help in planning and execution of this journey with excellent results.

In his words– Generally in first consultation ( I label it as exchange consultation) I make you understand  where you are (Reality check) & i learn from you that where you  would like to be (Goal setting),then offer you the various means  available to you (Options), and finally, help you to focus & develop determination along with behavior change(Will) to start  the journey with me & my team.

Dr Girish (best bariatric surgeon Dubai) is practicing obesity surgery/ management since 2005 in UAE (rich experience) with excellent results in his patients that makes him one of safest bariatric surgeon in the Dubai with a follow-up of each case by his team.

Dr. Sanjay Parashar


September 7, 2020

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


July 2, 2020


Corns and calluses are fairly common problem in male and female that occurs in soles, toes, palms and fingers. It is a benign condition caused by constant pressure and friction.


Corns are small round hard lesion that is painful on pressure and commonly occurs at the bottom of the sole, over the toes and in between toes. It is very uncommon in hands.

On the other hand, calluses are flakes of hard keratinized skin that forms like an onion layer. It is painless unless infected or inflamed due to injury. They are Irregular and broad in shape unlike corns that are small round and often well defined.

Are Corns and calluses the same thing? Although the causes are the same but they behave differently.

  • Corns: It is also called as clavus. It is thickening of the skin due to pressure and friction resulting in hyperkeratosis and is associated with pain. It appears like a “top” with round elevated surface but has a narrow deep root that reaches deeper than dermis and hence it is painful on pressure. There are three kinds of Corns- Hard corn or heloma durum that is dry; soft corn or helom molle that are macerated and soft and occurs in between toes and periungual corn occurs on the top of toes.
  • Calluses: Are flaky hyperkeratotic layers over the skin also due to excess friction and pressure. They develop over a broader surface and grow outwardly and do not have a root or deep core. It is not painful and can occur in soles, toes, and dorsum of foot, hands and fingers. It is very common among atheletes like weight lifters and tennis players. It is also very common among physical labors and people who do not wear footwear most of the time.


When to see a doctor

It is best to see the doctor as soon as you notice the lesions. As with correct advice it can be controlled. And also it is easier to treat in the early stages.

Causes- Both are caused by constant or intermittent pressure and friction, corns are due to localized pressure points whereas callosities are due to more wider pressure areas hence corns are smaller and narrower than calluses. Corns are also known to form within a callus.

Risk factors. Apart from pressure and friction some deformities can also cause corns and calluses eg hammer toe, telipus equinovarus, amputated stumps etc. The risks are higher in people with diabetes and neurological problems.

Prevention. Wearing correct footwear avoiding excessive pressure is key to prevention. But moisturizing foot and hand also helps. If there is tendency for excessive dryness in the foot, apply moisturizer and wear socks.


Some FAQs

  1. How effective is salicylic acid for treating corns and calluses?
    – SA is very effective as it works as Keratolytic agent by increasing moisture in the skin and dissolving the keratin layer allowing it to flake off. It can them be gently scrubbed off with puma stone.
  2. Is salicylic acid as a calluses remover painful?
    – It is not painful at all when it is applied on thick kearitnised skin. It may have burning sensation when it is applied to think skin or after the callus is peeled off.
  3. What happens when you cut off a corn or calluses yourself?
    – Corns and calluses should be gently and carefully shaved layer by layer. If not done carefully you can injure your skin and cause bleeding and infection. An experienced doctor can carefully shave off using a magnification to ensure safety.
  4. How should I get rid of corns or calluses permanently?
    – Apply SA once daily , after 304 days start using puma stone or gently scrub off during bathing. It may help to soak feet in warm water before scrubbing. Check with the doctor regularly to get it examined. At the same time get correct footwear and use soft silicone pads at pressure points. If the cause is removed the treatment can have longlasting results.
  5. What is the safest way to cut off corn or calluses?
    – There are two ways to treat Corns, First apply SA solution until it is soft then visit a doctor who will use sterile instrument to gradually shave the corn until it reduces in size then rest of it is surgically excised under local anaesthesia. I personally don’t prefer suturing the wounds after excising the corn as they break and cause more pain and discomfort. I allow it to heal by secondary intention.  Second option is to keep apply SA lotion until it flakes off completely.On the other hand callosities are never surgically excised. They are shaved down to skin level and then the area is protected using silicone cushion.
  6. How to painlessly remove a corn or calluses?
    – By regularly applying SC lotion and scrubbing with puma stone or careful shaving is a painless way to remove.
  7. Is there any side effects of using salicylic acid?
    – SA is very safe to use on the keratotic skin. In normal skin or thin skin it may cause skin burns. So careful application is necessary.
  8. Do treatments for removing corns or calluses cause them to spread?
    – Corns and calluses do not spread like warts which are due to virus. Corns and calluses can only increase by continuso pressure and friction.

Dr. Sanjay Parashar


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

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