A WORK OF ART

Specialist in Rhinoplasty Surgery

Procedures

Facial Procedures

  • A neck and face lift is a procedure whereby your facial muscles are tightened or stretched and the removal of excesses fat from the neck and face, to give the patient a more youthful look. A neck and face lift can be done independently, but they are commonly done in one procedure.
    How are they performed

  • A traditional face lift incision: The incision begins in the hairline above the temple and continues behind the ears until it reaches the lower scalp. In cases where a neck lift is required this will include an incision under the chin.

  • A limited incision: Is similar to a traditional one, however it does not proceed to the lower part of the scalp.

    What are the advantages?
  • A neck and face lift will help modify age related changes that occur the older we get, such as sagging, decreased elasticity and fat composition changes in the face and neck. The appearance of other features may also improve such as the folds of the sides of the nose and mouth.

A brow and forehead lift corrects the flowing:

  • Creases in the forehead.
  • Hooding of the upper eyelids
  • Sagging of eyebrows

    These corrections are achieved by removing or raising the muscle tissue or skin in the forehead region. This muscle tissue or skin is responsible for wrinkles/deep frown lines and any drooping.

How is this procedure performed? There are two primary procedures:

  • The classical (coronal) lift: An incision is made in the forehead area extending from one ear to the other. In other cases, it is done in the hairline to to deal with the correction of issues with a high forehead (a large space between the top of the head and the eyebrows).

  • The endoscopic lift:
    This is a less invasive method in which smaller incisions are made in the forehead to pass through a thin tube mobilized with a camera to view the tissue and muscle. Simultaneously another device is placed through another incision to make the alterations.

What are the advantages?

  • The forehead is given a more refreshed look.
  • Improvement of the appearance of frown lines.

An eye lift is a procedure that aims to correct deformities, defects, the sizes of the eyelids and to aesthetically modify the eye region of the face. This may involve the removal of excess fat, skin or muscle both in the upper and lower lid of the eye.

How is it performed?

An eye lift can be done on both the upper and lower lid:

  • On the upper lid an incision is made along the folds of the eyelids to extract the excess skin, fat or muscle.

  • On the lower lid an incision is made underneath the lashes in the natural crease.

    Other eyelids problems such as an eyelid that droops excessively affecting a patient’s vision may require an additional procedure called Ptosis (this provides additional support to the eyebrow muscle).

What are the advantages?

  • Improvement of baggy/droopy upper eyelids.
  • The removal of any excess skin that may interfere with peripheral vision or result in any other eye difficulties.

A rhinoplasty is a procedure aimed at correcting and reconstructing the nose. The motivation behind rhinoplasty can be characterized as reconstructive surgery and cosmetic surgery , as it is focused on the alteration of either the bone, cartilage, skin or all three.

How is this procedure performed?

It is highly dependent on the area of the nose that requires alterations resulting in a tip only or full rhinoplasty.

  • Tip only rhinoplasty: This procedure is done to improve the shape or look of the nose to deal with issues such as any drooping, asymmetry, a bulbous tip and a hanging columella.

Full rhinoplasty: A full rhinoplasty modifies the bone and cartilage in the nose through an incision made at the base of the nose. Cartilage and bone may be utilized from other parts of the body to meet the desired look. For the purpose of improving a patient’s breathing a Septoplasty can be performed to straighten the nasal septum (the
wall dividing the nasal passage into a left and right side).


What are the advantages?

  • Aids breathing difficulties.
  • Slight changes can improve the look of the nose.
  • Can improve the disruption of snoring.
  • Deals with injuries such as a broken nose.
  • Improves confidence as it can provide an aesthetical identity

A lip enhancement is also commonly known as a ‘lip augmentation’it is a surgical or non-surgical procedure that aims to change the appearance of the lips by altering the shape, structure and volume of the lips thus creating lips that are visually fuller.

How is it performed?
There are a variety of methods that can be used to achieve a desired look and feel such as:

  • Lip fillers: Are often made from injectable dermal substances (which are taken from the patient’s skin) that can be absorbed by the body at a quicker rate than others such as hyaluronic acid and collagen. These are then injected either in your lips or around the mouth.

  • Fat grafting/transfer: This is done through the harvesting of fat from other parts of the body such as the abdomen; it is then purified and then injected into the lips.

  • Lip implants: Are used as an alternative to temporary lip fillers.
    Once the lips are anesthetized and sterilized a cut is made in the corners of the mouth to create a tunnel the shape of the lip which is then used to insert the implant.

    What are the advantages?
  • Patients are able to see the results right away.
  • With lip filler the amount of substance inserted can be controlled, and the treatment can be supplied in gradual doses over a specific time.
  • Certain types of Lip implants are solid and therefore are less prone to leaking or rupturing.
  • Fat grafting/transfer often last for 5 years or longer at the most.

Fat injections can also be referred to as ‘autologous fat transportation’ that uses body fat as a filler agent. This is done to re-contour the face, reduce frown lines, crow’s feet, smile lines (nasolabial folds), and to give definition to the cheeks and chin. Fat injections can also be used in other parts of the body to fill
depressed scarred areas.

How is it performed?

A donor site (where the fat will be extracted) and a treatment site (the body part receiving the filler) need to be located. These sites are then both injected with a local anesthetic, and then an IV (intravenous fluid) is injected into the donor site only to facilitate fat collection. The fat is then processed to remove unwanted
fluids and is injected into the treatment site in multiple thin strands.

What are the advantages?

  • It is natural; non allergic.
  • Injections may last for several months.
  • Little to no downtime.
  • Usually no pre-testing required because the fat is from the patient’s body.

Abdomen

ABDOPLASTY (TUMMY TUCK )

Removal of excess flesh from the abdomen

Abdoplasty (Tummy tuck)

This is a procedure whereby the excess skin around the abdomen is reduced and the stomach muscles are tightened as a result eliminating abdominal creases.This results in a flatter and a more toned appearance of the stomach.

What are the benefits?

  • The procedure can correct a ventral hernia which is formed when the bowel or abdominal tissue breaks through your abdominal wall to create a type of pouch or sack.
  • Uncontrollable leakage of urine caused by sneezing, coughing, laughing and exercising.
  • Reduces back pain, as the muscles in the abdomen are now strengthened. 
  • Improves posture by improving the abdominal muscles, which will support you spine.

LIPOSCULPTING

What is liposculpture?

Liposculpture is a surgical procedure that is used to give you more muscle tone and shapeliness. It treats little pockets of fat, unlike liposuction which covers larger areas. 

How does liposculpture work?

  • A surgeon uses liposculpture to remove fat and move some of the fat to certain areas of your body creating a more desirable figure / body shape.
  • It isn’t used for weight loss, but rather to tighten up areas that already have good elasticity.
  • It can improve contours such as accentuating abdominal muscles or narrowing a waist.
  • Many patients combine liposculpture with other procedures, like tummy tucks. Combining different procedures can help you achieve desired results, since liposculpture is only used for a specific purpose.

Types of liposculpture?

  • Liposculpture generally takes between two and four hours. You will receive local anesthesia and may receive oral sedation. If the area is larger, you’ll receive general anesthesia or intravenous sedation.
  • After the surgery is complete, you might stay at the treatment center overnight. Usually only one treatment is needed to achieve the results you desire.

There are three techniques for tumescent liposculpture:

    • Power-assisted liposculpture (PAL):
      • Uses a vibrating tool to help break down fat faster and remove it more easily.
    • Ultrasound-assisted liposculpture (UAL):
      • Fat is melted with ultrasonic energy through a hand-piece. This makes it easier to remove large amounts of fat, but takes longer.
    • Laser-assisted liposculpture:
      • Fat is melted through low-energy waves.
      • This procedure also takes longer. 

Targeted areas for liposculpture:

The most common areas of the body that liposculpture is used for are:

    • ABS
    • Back
    • “love handles”
    • Thighs
    • Arms
    • Under the chin

GENITAL

VAGINOPLASTY

What is a vaginoplasty?

Vaginoplasty (also known as posterior colporrhaphy) is a procedure designed to tighten the vagina. 

Reasons patients want a vaginoplasty

After childbirth, women may complain of vaginal laxity, resulting from stretching of tissues and separating of muscles, sometimes to the point that a tampon falls out, and this lack of tone can contribute to sexual dysfunction.

What does a vaginoplasty do?

A vaginoplasty brings the separated muscles together, and the extra mucosa skin from the back side of the vagina is removed.

The external skin can also be removed for a more aesthetic appearance.

LABIOPLASTY

What is Labiaplasty?

Labiaplasty (also known as labioplasty, labia minora reduction, and labial reduction) is a plastic surgery procedure for altering the labia minora (inner labia) and the labia majora (outer labia), the folds of skin surrounding the human vulva.

Advantages of a Labiaplasty:

As a result of child birth/aging the size/colour and/or shape of the labia may change a Labiaplasty will restore the labia to the size/colour and/or shape that the client is used to. 

In a male-to-female sexual reassignment vaginoplasty for the creation of a neovagina, labiaplasty creates labia where once there were none.

O-SHOT

Who may require the Genital PRP injection or ‘Orgasm’ shot?

The Genital PRP injection or ‘Orgasm’ shot has become sought-after worldwide by women seeking enhanced sexual pleasure.

It can benefit women who have experienced a loss of orgasm post natural childbirth or menopause, suffer from vaginal dryness, pain during sexual intercourse, or find themselves leaking urine when sneezing, coughing or jumping.

What does the treatment involve?

There is an Injection of PRP (platelet rich plasma), made from patients’ own blood.

The blood is taken from patient’s arm and spun in a special machine to remove red blood cells.

The O-shot is an injection of PRP into the area of the G-spot – underneath the urethra.

PRP can also be injected into the clitoris to stimulate orgasm and into the vaginal wall to treat vaginal dryness and painful intercourse as well as frequent vaginal infections.

GALLERY

Hands

When we talk about hand trauma, we mean major injuries that have been sustained to the hand. The primary treatment of hand trauma frequently requires access to microsurgical facilities for small vessel and nerve repair.  Such facilities need to be available on a 24 hour-a-day basis. 

What surgery is available, and what techniques are used?.

  • Burns and skin loss, for instance, will require surgical flaps and grafts, while the traumatic loss of digits may be treated by what is known as toe to hand surgery. 
  • Toe to hand surgery involves the microsurgical transfer of digits from the foot to the hand. The absence of a finger does not usually have much effect on either the function or the appearance of the hand, but when the missing digit is a thumb, or when many digits are missing, surgery may be needed.
  • Generally, the guideline in considering reconstruction is whether or not the overall function of the hand may be improved, although it is also natural and necessary to take into consideration the appearance of the hand.
  • Whichever toe is transferred, its blood vessels (artery and nerve) must be successfully joined to similar vessels in the hand for it to survive.
  • Tendons (to allow movement where required), nerves (to allow feeling), and the bone must also be rejoined to suitable counterparts in the hand.

Description:

Carpal tunnel syndrome occurs when the tunnel becomes narrowed or when tissues surrounding the flexor tendons swell, putting pressure on the median nerve. These tissues are called the synovium. Normally, the synovium lubricates the tendons, making it easier to move your fingers.

Risk factors for carpal tunnel syndrome include:

Heredity: 

    • The carpal tunnel may be smaller in some people or there may be anatomic differences that change the amount of space for the nerve—and these traits can run in families.

Repetitive hand use:

    • Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.

Hand and wrist position:

    • Doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time can increase pressure on the nerve.

Pregnancy:

    • Hormonal changes during pregnancy can cause swelling.

Health conditions:

    • Diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.

Symptoms:

  • Numbness, tingling, burning, and pain—primarily in the thumb and index, middle, and ring fingers
  • Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
  • Pain or tingling that may travel up the forearm toward the shoulder
  • Weakness and clumsiness in the hand—this may make it difficult to perform fine movements such as buttoning your clothes
  • Dropping things—due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)

 

Treatment:

  • Nonsurgical therapy (If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome): 
    Wrist splinting:
    • A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness.
    • Nighttime splinting may be a good option if you’re pregnant.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs):
    • NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal tunnel syndrome in the short term.

Surgical Treatment: 

Endoscopic surgery:

    • A telescope-like device with a tiny camera attached to it (endoscope) is used to see inside your carpal tunnel.
    • The surgeon then cuts the ligament through one or two small incisions in your hand or wrist.
    • Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.

Open surgery:

    • The surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.

Definition: 

Dupuytren’s contracture is a hand deformity that usually develops over years. The condition affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin — eventually creating a thick cord that can pull one or more fingers into a bent position.

Symptoms:

  • Dupuytren’s contracture typically progresses slowly, over years.
  • The condition usually begins as a thickening of the skin on the palm of your hand.
  • As it progresses, the skin on your palm might appear puckered or dimpled. A firm lump of tissue can form on your palm, this lump might be sensitive to the touch but usually isn’t painful.
  • In later stages of Dupuytren’s contracture, cords of tissue form under the skin on your palm and can extend up to your fingers. As these cords tighten, your fingers might be pulled toward your palm, sometimes severely.
  • The two fingers farthest from the thumb are most commonly affected, though the middle finger also can be involved. Only rarely are the thumb and index finger affected. Dupuytren’s contracture can occur in both hands, though one hand is usually affected more severely.

Treatment:

Treatment involves removing or breaking apart the cords that are pulling your fingers toward your palm. This can be done in several ways: 

Needling:

    • This technique uses a needle, inserted through your skin, to puncture and break the cord of tissue that’s contracting a finger.
  • The main advantages of the needling technique are that there is no incision, it can be done on several fingers at the same time, and usually very little physical therapy is needed afterward.\
    Enzyme injections: 
      • Injecting a type of enzyme into the taut cord in your palm can soften and weaken it — allowing your doctor to later manipulate your hand in an attempt to break the cord and straighten your fingers. 

Surgery:

    • Surgically remove the tissue in your palm affected by the disease.
    • The main advantage to surgery is that it results in a more complete and longer-lasting release than that provided by the needle or enzyme methods.
  • In some severe cases, especially if surgery has failed to correct the problem, surgeons remove all the tissue likely to be affected by Dupuytren’s contracture, including the attached skin. In these cases a skin graft is needed to cover the open wound. This surgery is the most invasive option and has the longest recovery time. People usually require months of intensive physical therapy afterward.

Dermal Surgery

Melanoma occurs when the pigment-producing cells that give colour to the skin become cancerous.

 Treatment:

Treatment for Melanoma depends on the size and stage of the cancer and the patient’s overall health and personal preferences.

Treating early stage melanomas:

  • A very thin melanoma may be removed entirely during the biopsy and require no further treatment.

 Treating melanomas that have spread beyond the skin:

Surgery to remove affected lymph nodes:

    • If melanoma has spread to nearby lymph nodes, the affected nodes will be removed.
    • Additional treatments before or after surgery also may be recommended.


Chemotherapy:  

  • Chemotherapy uses drugs to destroy cancer cells.
  • Chemotherapy can be given intravenously (Intravenous therapy (IV) is a therapy that delivers fluids directly into a vein), or in pill form or both so that it travels throughout the body.

Chemotherapy can also be given in a vein in the arm or leg in a procedure called isolated limb perfusion. During this procedure, blood in your arm or leg isn’t allowed to travel to other areas of your body for a short time so that the chemotherapy drugs travel directly to the area around the melanoma and don’t affect other parts of your body.

Radiation therapy:

  • This treatment uses high-powered energy beams, such as X-rays, to kill cancer cells.

Radiation therapy may be recommended after surgery to remove the lymph nodes. It is sometimes used to help relieve symptoms of melanoma that has spread to another area of the body.

Biological therapy:

  • Biological therapy boosts the immune system to help the body fight cancer.
  • These treatments are made of substances produced by the body or similar substances produced in a laboratory.
  • Biological therapies used to treat melanoma include interferon and interleukin-2, ipilimumab (Yervoy), nivolumab (Opdivo), and pembrolizumab (Keytruda).

Targeted therapy:

  • Targeted therapy uses medications designed to target specific vulnerabilities in cancer cells.

Basal cells produce new skin cells as old ones die. Limiting sun exposure can help prevent these cells from becoming cancerous. This cancer typically appears as a white, waxy lump or a brown, scaly patch on sun-exposed areas, such as the face and neck.

Treatment:

Surgery:

Basal cell carcinoma is most often treated with surgery to remove all the cancer and some of the healthy tissue around it, surgery options include:

 Surgical excision:

  • In this procedure, the doctor cuts out the cancerous lesion and a surrounding margin of healthy skin. The margin is examined under a microscope to ensure that there are no cancer cells.
  • Excision might be recommended for basal cell carcinomas that are less likely to recur, such as those that form on the chest, back, hands and feet.

Mohs surgery:

  • During Mohs surgery, the doctor removes the cancer layer by layer, examining each layer under the microscope until no abnormal cells remain.
  • This allows the surgeon to be certain the entire growth is removed and avoid taking an excessive amount of surrounding healthy skin.

 Non-surgical treatments:

  • Curettage and electrodessication (C and E):
  • C and E treatment involves removing the surface of the skin cancer with a scraping instrument (curet) and then searing the base of the cancer with an electric needle.
  • C and E might be an option for treating small basal cell carcinomas that are less likely to recur, such as those that form on the back, chest, hands and feet.

Radiation therapy:

  • Radiation therapy uses high-energy beams, such as X-rays and protons, to kill cancer cells.
  • Radiation therapy is sometimes used after surgery when there is an increased risk that the cancer will return. It might also be used when surgery isn’t an option.

Freezing:

  • This treatment involves freezing cancer cells with liquid nitrogen (cryosurgery). It may be an option for treating superficial skin lesions.
  • Freezing might be done after using a scraping instrument (curet) to remove the surface of the skin cancer.

Topical treatments:

  • Prescription creams or ointments might be considered for treating small and thin basal cell carcinomas when surgery isn’t an option.

Photodynamic therapy:

  • Photodynamic therapy combines photosensitizing drugs and light to treat superficial skin cancers.
  • During photodynamic therapy, a liquid drug that makes the cancer cells sensitive to light is applied to the skin. Later, a light that destroys the skin cancer cells is shined on the area.

Treatment for cancer that spreads:

Targeted drug therapy:

  • Targeted drug treatments focus on specific weaknesses present within cancer cells, by blocking these weaknesses, targeted drug treatments can cause cancer cells to die.
  • Targeted therapy drugs for basal cell carcinoma block molecular signals that enable the cancers to continue growing. They might be considered after other treatments or when other treatments aren’t possible.

Chemotherapy:

  • Chemotherapy uses powerful drugs to kill cancer cells. It might be an option when other treatments haven’t helped.

How are they Managed:

Generally, when a skin lesion that looks suspicious, a biopsy is performed, which is a small sample of the lesion and send to the laboratory for analysis. The results might take a week. A definitive plan can then be made with regards to modality of treatment required.

What are the causes?

  • Sun exposure
  • Sun tanning booths
  • Immunosuppression
  • Exposure to high levels of radiation
  • Chronic heat exposure to heat
  • Previously traumatized skin e.g previous burns
  • Exposure to chemicals e.g arsenic, soot, hydrocarbons

 

What are the different modalities if treatment?

  • Medical treatment, usually employed for premalignant lesions or small low grade tumours
  • Alternative treatment: cryotherapy, coagulation and curettage, Laser etc. are also employed for the basal cell carcinoma, premalignant lesions and lesions located on cosmetically sensitive areas.
  • Surgical excision is done for Melanoma, high grade Squamous cell carcinomas and Basal cell carcinomas and recurring lesions.

What are moles and skin tags:

Moles:

  • Moles are skin growths made up of cells that produce colour (pigment). A mole can appear anywhere on the skin, alone or in groups. Most people get a few moles during their first 20 years of life. They are usually brown in colour but can be blue, black, or flesh-coloured. Most moles are harmless and don’t cause pain or other symptoms unless you rub them or they bump against something.

Skin tags: 

  • Skin tags are small, soft pieces of skin that stick out on a thin stem. They most often appear on the neck, armpits, upper trunk, and body folds. The cause of skin tags is not known. They are harmless.

Why remove a mole or skin tag?

  • Most moles and skin tags don’t require treatment. But sometimes people want to remove them for cosmetic reasons or because they cause discomfort when they rub against clothing or get caught in jewelry.

How do doctors remove moles and skin tags (these procedures usually leave no scars or marks)?

Cutting it off:

  • Skin tags may be snipped off with a scalpel or surgical scissors, some moles can be “shaved” off flush with the skin.
  • Other moles may have cells that go underneath the skin, so your doctor might make a deeper cut to remove the entire mole and prevent it from growing back, this cut may require stitches.

Freezing with liquid nitrogen:

  • Your doctor will swab or spray a small amount of super-cold liquid nitrogen on the mole or skin tag.
  • You might have a small blister where the mole or skin tag was, but it will heal on its own.

Burning it off:

  • An electric current passes through a wire that becomes hot and is used to burn off the upper layers of the skin. You may need more than one treatment to remove a mole.
  • Skin tags are removed by burning through the narrow stem that attaches them to the skin, the heat helps prevent bleeding.

What is a haemangioma of the skin?

A ‘haemangioma’ (Greek for blood-vessel-growth) of Infancy is a benign (not cancerous) overgrowth of blood vessel cells that is self-limiting (will stop growing without treatment).

What do haemangiomas of Infancy look like?

The majority affect the face, but any part of the skin or other organ can be involved. The appearance changes rapidly during early life. A small red mark or swelling may be visible at birth or develop during the first weeks of life. This may increase in size usually most quickly over the first 3 months. Further change is usually slower and gradual for up to twelve months. Usually the haemangioma subsequently shrinks in size for up to 10 years (‘regression’). However, some haemangiomas don’t grow much at all and some do not shrink.       

How is a haemangioma of infancy of the skin diagnosed?

The diagnosis can be made by the appearance of the haemangioma and the history of rapid growth followed by slow regression. Sometimes scans will be organised to help confirm the diagnosis or to get further information about the extent of the haemangioma. For deeper or less typical lesions, a biopsy (skin or tissue sample) may be required to confirm the diagnosis.

Treatment can consist of one or a combination of the following:

  • A topical solution or gel applied directly to the haemangioma
  • Medicines (orally by mouth or by injection)
  • Laser therapy
  • Surgery for haemangiomas that are still growing topical or oral treatments are most often used
  • Drugs called beta-blockers shrink blood vessels and can be used as a topical treatment or as an oral medicine:
  • Timolol can be applied as a solution or gel to the haemangioma. It has been proven to be safe and effective, especially for more superficial lesions
  • Propranolol given by mouth is now the first choice to treat haemangiomas at important anatomical sites such as around the eyes or mouth. Almost all haemangiomas respond to propranolol. Treatment usually lasts for 6 to 12 months.
  • An ulcerating haemangioma needs additional treatment with non-adherent dressings and pain relief. Laser therapy can be useful to treat ulcerated lesions. Antibiotic ointment or medicine may also be required to manage infection.
  • After the haemangioma has stopped shrinking, surgical removal of excess tissue or laser treatment of remaining redness can sometimes be useful. The Pulsed Dye Laser is most commonly used. It produces a beam of specially formed light that reacts with the red colour in blood and penetrates to about 1.2mm into the skin. In adults, usually no anaesthetic is required. 
  • Cover-up makeup can be useful to cover skin discolouration.

Tattoo removal is a procedure done to try to remove an unwanted tattoo. Tattoo ink is placed beneath the top layer of the skin. That makes tattoo removal more complicated — and expensive — than the original tattoo application.

Why its done?

  • You might consider tattoo removal if you regret a tattoo or you’re unhappy with the appearance of your tattoo.
  • Perhaps the tattoo has faded or blurred, or you decide that the tattoo doesn’t fit your current image.
  • Tattoo removal might also be important if you develop an allergic reaction to the tattoo or other complications, such as an infection.

Common techniques for tattoo removal:

Laser surgery:

  • Q-switched lasers — which release energy in a single, powerful pulse — are often the treatment of choice for tattoo removal. A special type of laser — called a Q-switched Nd:YAG — might be used on darker skin to avoid changing the skin’s pigment permanently.
  • Before laser treatment, the skin is numbed with an injection of a local anesthetic. Then a powerful pulse of energy is applied to the tattoo to heat and shatter the tattoo ink.
  • Multicolored tattoos might need treatment with various lasers and different wavelengths.
  • After the procedure, you might notice swelling and possibly blistering or bleeding. Antibacterial ointment can help promote healing. You’ll likely need repeated sessions to lighten the tattoo, and it might not be possible to completely erase the tattoo.
  • Surgical Removal
  • During surgical removal, the skin is numbed with an injection of a local anesthetic.
  • The tattoo is removed with a scalpel, and the edges of skin are stitched back together. After the procedure, antibacterial ointment helps promote healing.
  • Surgical tattoo removal is effective — but it leaves a scar and might be practical only for small tattoos.
  • Dermabrasion
  • During dermabrasion, the tattooed area is typically chilled until numb.
  • Then the tattooed skin is sanded down to deeper levels with a high-speed rotary device that has an abrasive wheel or brush, this allows the tattoo ink to leach out of the skin.
  • The affected area feels sore and raw for several days after the procedure.
  • Recovery can take up to two to three weeks. 

Results:

Tattoos are meant to be permanent, and complete tattoo removal is difficult. Some degree of scarring or skin color variation is likely to remain, regardless of the specific method of tattoo removal.

 

Breasts

Breast augmentation is a procedure done to make small breasts larger, correct volume loss associated with post breast feeding and age-related deflation. Implants can also be used to correct birth deformities and for breast reconstruction.

How are the implants inserted?

  • The most common way is by cutting a very small incision under the breast.
  • Other incisions that can be used are; on the edge of the areolar, from your axilla and from the belly button.

    Where is the implant placed?

An implant can be placed:

  • Under the breast tissue (sub-glandular)
  • Under the muscle (sub-pectoral)
  • or Most popular would be an interphase between the two (dual plane)

    Which implant filler is most commonly used?

  • Most common type is silicone, which gives the breast a more natural feel to touch and is associated with less chance of rippling and deflation as compared to saline filled implants

    What are the advantages of having a breast augmentation?

  • Enhances self-confidence and self-image
  • Improved cleavage
  • Enhances your figure

Big female breasts/ Macromastia are defined as disproportionally enlarged, sagging breasts where more than 500g (macromastia) or or > 1000g (gigantomastia) is expected to be excised from each breast.

What are the benefits of having a breast reduction?

  • Improvement posture (kyphosis)
  • Improves back pain related to heavy breasts
  • Can improve quality of sleep and breathing due to reduction of the weight from the chest area
  • Improves neck pain and shoulder strap notching related to Bra straps
  • Improvement of infra-mammary skin excoriation / intertrigo.
  • Has been shown to improve self-esteem, especially of adolescents.
  • Easier to find well-fitting clothes and brassieres
  • Improves physical activity, as in some patients, enlarged breasts can cause restrictions in physical activities and sports
  • Can improve neuropathic pain caused compression of the brachial plexus by Bra straps

A mastopexy is commonly known as a breast lift. This is a surgical procedure performed by a plastic surgeon to change the shape of your breasts. During a breast lift, excess skin is removed, and breast tissue is reshaped to raise the breasts.

What are the advantages of having a breast lift?

  • You might choose to have a breast lift if your breasts sag or your nipples point downward.
  • A breast lift might also boost your self-image and self-confidence.
  • A breast lift won’t significantly change the size of your breasts, however, a breast lift can be done in combination with breast augmentation or breast reduction.
  • A breast lift can reduce sagging and raise the position of the nipples and the darker area surrounding the nipples (areolae). The size of the areolae can also be reduced during the procedure to keep them in proportion to the newly shaped breasts.

Why it is done?

As you get older, your breasts change — losing elasticity and firmness. There are many causes for these kinds of breast changes, including:

  • Pregnancy:
    • During pregnancy, the ligaments that support your breasts might stretch as your breasts get fuller and heavier.
    • This stretching might contribute to sagging breasts after pregnancy — whether or not you breast-feed your baby.
  • Weight fluctuations:
    • Changes in your weight can cause your breast skin to stretch and lose elasticity.
  • Gravity:
    • Over time, gravity causes ligaments in the breasts to stretch and sag.

A breast augmentation combined with breast lift (mastopexy) can help women achieve breasts that appear fuller, rounder, perkier, and more youthful. The processes is performed simultaneously to position the nipples of the patient in a more youthful, centralized location. An implant adds volume to the breast, particularly its upper pole, when a breast lift alone may not be enough to meet a woman’s aesthetic goals.

How is it performed?

  • Incisions are made, including one around the areola (the pigmented circle surrounding the nipple) and a vertical one from the low part of the areola to the base of the breast and this removes excess skin. 
  • Implants are placed through these same incisions and are typically positioned under the pectoral chest muscle.
  • As in a standard breast augmentation, implants may be silicone or saline.

Majority of patients when undergoing a mastectomy, the nipple and areola are removed. Therefore, many patients choose to undergo nipple reconstruction surgery. 

Surgery Methods:

Several approaches can be used in the reconstruction of your nipple, depending on the condition of your new breast tissue and your surgeon’s preferences.

Skin Flap:

  • Small flaps of skin from your reconstructed breast are folded and sutured together to build a mound that becomes the nipple.
  • The skin is manipulated to give the nipple an elevated appearance compared to the breast mound.
  • Additional skin, fat, or synthetic fillers are sometimes used to make the nipple more erect.

Skin Graft:

  • If there isn’t enough tissue to create a nipple from the new breast, your surgeon may use a skin graft.
  • Grafts are usually taken from the abdomen, thigh, the crease of the buttocks, or the groin where legs and torso meet.

Autologous graft / Nipple Sharing:

  • If the nipple on your unaffected breast is large enough, a portion of it may be grafted onto your new breast. 

Medical tattooing:

  • Tattooing is widely used to recreate a natural-looking areola and nipple.
  • Skin grafts may also be used in addition to the tattoo procedure.
  • Women who want to avoid additional surgeries may choose to have only a tattoo.
  • It’s important to note that in this situation the nipple will not be elevated.

 Breast reconstruction:

  • The goal of breast reconstruction is to reform or reshape the breast after mastectomy or lumpectomy.
  • A mastectomy is a surgical procedure that removes the entire breast, usually including the nipple and areola, in order to treat or prevent breast cancer.
  • A lumpectomy is the removal of a piece of the breast where there is a smaller tumor.
  • While many factors determine what kind of breast reconstruction surgery would best suit an individual, there are two main types of breast reconstruction surgery: 
  • Implants or prosthetic involves surgery using silicone or saline implants.
    Autologous or skin flap surgery is a method where tissue from another area of the body is used
  • In some cases, a combination of both techniques may be used to reconstruct the breast more naturally.

Gynaecomastia (Man boobs) is an enlargement of male breast tissue to a point where it becomes noticeable. Medically its defined as the presence of palpable sub-area gland and duct tissue are bigger then 2 cm.

Who gets it?

Gynaecomastia is common and is thought to be present in at least a third of men in their lifetime.

 What does a gynaecomastia surgery involve?

There are two options depending on the type of excess tissue you have:

  • Liposuction:
    • Liposuction is performed if you have excess breast fat.
    • Liposuction for treating gynecomastia is typically performed using local or general anaesthetic.
    • The process involves a small incision on each side of your chest, the edge of your areola or within your armpit.
    • Through these incisions your cosmetic surgeon will insert a thin tube to loosen the excess fat and remove it using a high-power vacuum and sculpt a new more natural chest contour.
  • Male breast reduction:
    • A male breast reduction is performed if your breast gland tissue is in excess.
    • Male breast reduction surgery is usually carried out under general anaesthetic.
    • The process involves making a cut around your nipple that allows your surgeon to remove the tissue.
    • Cuts may be extended and your nipples re-positioned if you have a lot of tissue to remove.
    • The procedure will typically take 90 minutes.
    • The cosmetic surgeon will take care to place incisions so that the resulting scars are as inconspicuous as possible.

Liposuction and breast reduction surgery can be performed at the same time if you have an excess of both fatty and glandular tissue.

The befits of gynaecomastia:

  • The benefits of gynaecomastia surgery are that it will restore a naturally masculine appearance to your chest. 
  • With a firmer, flatter and better shaped chest, men often feel more confident with increased self-esteem and are able to wear more fitted tops and reveal their chests when they want.
  • Gynaecomastia surgery is typically a short procedure with a quick recovery and virtually invisible scars.

Fat injection, also known as fat transfer or fat grafting, is a procedure that improves the body’s contours and proportion by removing fat from one or more areas and injecting the fat into another area to add volume and reshape specific areas of the body. Common areas that are treated with fat injection include the face, buttocks, breasts and to reconstruct contour problems in any area of the body after weight loss, accidents or previous surgery.

What is the process?

  • Fat injection is invasive surgery that aims to improve the body’s contours by adding volume and reshaping specific areas of the body.
  • Fat is removed by liposuction from one area of the body and injected into another area to add volume and reshape that area.
  • Depending on the amount required and number of areas that require treatment, repeated treatments may be necessary.

Nipple inversion, which can also be called nipple retraction or invaginated nipple, is a condition where the nipple is either flat or is pulled in towards the breast. It is a very common condition that occurs in around 1 out of 10 men and women.
It is often due to the milk ducts in the nipple being too short. These short milk ducts pull the nipple in, therefore not allowing it to protrude out naturally. This happens gradually and is often present since puberty since this is when the majority of breast changes occur. It can be present in one or both nipples.

Procedure:

  • An inverted nipple correction aims to correct the nipple so that it projects out in a natural way.
  • To achieve this, your surgeon will either stretch the short milk ducts or cut them.
  • This releases the tension that is pulling the nipple in, therefore allowing it to protrude out again.

Incisions:

  • A small incision is made at the base of the nipple to gain access to the milk ducts that are pulling the nipple inwards.
  • The different techniques will depend on the severity of the nipple inversion, and include the following:
    • Mild to moderate nipple inversion:
      • In patients with mild to moderate nipple inversion, the surgeon can “stretch” the short milk ducts, therefore pulling the nipple outwards.
      • The surgeon will lift the nipple and areola from the breast, stretching them and then suturing the nipples into their new position.
      • As this method only stretches the milk ducts and does not cut them, it should not affect your ability to breastfeed.
    • Severe nipple Inversion:
      • The surgeon may choose to cut, or divide, the milk ducts.
      • When the surgeon cuts the milk ducts, it releases the tension that is pulling the nipple inwards.
      • Since the milk ducts are cut, this technique will affect your ability to breastfeed (you may lose the ability to breastfeed entirely).
      • There is however, a much lower risk of nipple inversion recurrence.
      • After your surgeon stretches or cuts the milk ducts, they will use stitches to secure the nipple in its new projected position.

Advantages:

  • Having a nipple correction can help boost self-esteem in patients, particularly when they are in intimate situations.

Body Contouring

A buttock lift is a cosmetic surgical procedure that improves the appearance of the buttocks. 

Procedure: 

  • It may be done as part of a tummy tuck (belt lipectomy) or lower body lift to contour the buttocks, groin, thighs and abdomen.
  • A buttock lift alone will not add any volume to the buttocks, but sometimes, a buttock lift is combined with an augmentation procedure to alter the shape or size of the buttocks with implants or fat grafts.
  • During a buttock lift, excess skin and fat are removed from the buttocks, the remaining skin is then re-positioned to create a more toned look.

Advantages: 

  • These factors can cause your buttocks, as well as other parts of your body, to sag:
    • Having lost a significant amount of weight and your weight has been stable for at least six to 12 months
    • If you are overweight and haven’t been able to lose a significant amount of weight through physical activity and changes in your diet
    • If you want to dramatically improve the appearance of your buttocks to boost your self esteem  
    • If your skin won’t contract after liposuction due to poor elasticity related to ageing a buttocks lift  will improve the appearance
    • As you get older, your skin changes and becomes looser. 

A body lift will improve the appearance of the patients body through:  

  • A body lift can help remove overall excess skin, fat and may improve cellulite — especially after losing more than 100 pounds.
  • This procedure helps reshape the upper or lower body.
  • This often requires several surgeries performed in stages over time
  • An upper lift focuses on the breasts, arms and back.
  • A lower body lift treats the stomach, buttocks, hips and thighs.
  • A body lift also can treat your face and chin. It may require liposuction as well.

Thighplasty (thigh lift) is a procedure to tighten and improve the overall appearance of thighs. Candidates for this procedure have loss of skin elasticity in the thigh or have thighs with a saggy, dimpled or flabby appearance which improves dramatically if the loose skin is lifted. A thigh lift can reduce sagging in the inner or outer thigh. It is often a procedure performed on patients who have lost a great deal of weight.

Surgical Procedure:

  • For a thigh lift, the surgeon will mark the thighs before surgery while the patient is standing.
  • In all types of thigh lifts, the incision is sutured shut with deep sutures to ensure that there is no sagging after the incisions heal.
  • The scar from the surgery is hidden in the groin crease, beneath the bikini line.
  • During the procedure, drains are put in place that allow excess fluid to drain after surgery, the drains are usually removed after several days.
  • If the outer thigh is to be targeted, a thigh lift sometimes includes lifting the entire thigh and buttock (circumferential lower body lift).
  • This procedure requires longer incisions than thighplasty, but surgeons at Cedars-Sinai’s Center for Plastic and Reconstructive Surgery are expert at ensuring the most effective results possible.
  • If there is an excessive amount of fatty tissue, a liposuction may be performed before a thigh lift.

Types of thigh lifts include inner thigh lift, bilateral thigh lift and medial thigh lift:

  • An inner thigh lift:
    • This procedure focuses on the inner thigh. 
    • An incision is made at the top of the leg, about where the lower edge of a bikini bottom or underwear would be.
    • A small amount of skin is removed and then the remaining skin is pulled up, which tightens the skin along both sides of the leg.
    • This procedure is often done after someone has lost a great deal of weight.
  • A medial thigh lift:
    • Skin and fat on the upper part of the inner thigh are tightened.
    • An incision is made from the groin back to the crease of the buttock.
    • The skin is then lifted and excess fat and skin removed to improve the appearance of the upper, inner thigh. 

A buttock lift is a cosmetic surgical procedure that improves the appearance of the buttocks. It may be done as part of a tummy tuck (belt lipectomy) or lower body lift to contour the buttocks, groin, thighs and abdomen.

Procedure: 

  • A buttock lift alone won’t add any volume to the buttocks, but sometimes, a buttock lift is combined with an augmentation procedure to alter the shape or size of the buttocks with implants or fat grafts.
  • During a buttock lift, excess skin and fat are removed from the buttocks. The remaining skin is then re-positioned to create a more toned look.

Why it’s done?

  • As you get older, your skin changes and becomes looser. 
  • A buttock lift is typically done in combination with other body contouring procedures. You might consider a buttock lift if you:
  • If you have lost a significant amount of weight and your weight has been stable for at least six to 12 months
  • If you are overweight and haven’t been able to lose a significant amount of weight through physical activity and changes in your diet
    Have a normal weight, but want a dramatic improvement in the appearance of your lower body
  • If your skin won’t contract after liposuction due to poor elasticity related to aging.

A brachioplasty is an arm lift that removes excess skin and reshapes the upper part of the arm. (As with the thigh lift, you may need liposuction as well.)

Liposuction, or simply lipo, is a type of fat removal procedure used in plastic surgery. The procedure may be performed under general, regional, or local anesthesia. It then involves using a cannula and negative pressure to suck out fat. It is believed to work best on people with a normal weight and good skin elasticity.

Procedure:

  • Power assisted Liposuction:
    • PAL uses an up and down, vibrating-like motion of the cannula to acquire greater fat removal.
    • When compared to simple suction-assisted liposuction, PAL requires less energy for the surgeon to operate while also resulting in greater fat removal.
    • It is commonly used for difficult, secondary, scarred areas, and when harvesting large volumes of fat for transfers to other areas.
  • Ultrasound assisted:
    • This process is associated with cases of tissue damage, usually from excessive exposure to ultrasound energy.
    • UAL devices address this problem by using pulsed energy delivery and a specialized probe that allows physicians to safely remove excess fat.
    • UAL is beneficial in liposuction of areas that are more difficult to remove fat, that include treatment of gynecomastia, or areas where secondary liposuction is being performed.

We believe in our clients being the best versions of themselves and we offer surgical and non surgical procedures to achieve those physical goals

Prof N Chauke-Malinga
Rhinoplasty Specialist