Rhinoplasty/Nose Job

Posted on December 3, 2010 by admin

The nose is a prominent facial feature that never goes unnoticed. In fact, the nose is the most central feature of the face, which contributes to facial symmetry. When someone’s nose looks only slightly disproportionate compared to their other features it can affect their self image, ultimately damaging self-esteem. The size and shape of a person’s nose has the greatest impact on their appearance. This is why a minor alteration of the nose can dramatically improve facial balance and harmony.

Rhinoplasty is the most commonly requested surgical procedure in America. However, Rhinoplasty is also one of the more complex operations performed in plastic surgery. Many plastic surgeons describe Rhinoplasty as an art form in itself because of the numerous different technical procedures that can be done to the nose. It is not only cosmetic nose surgeries that patients ask for, but also functional abnormalities exist. Patients often request simultanteous correction. These abnormalities causing problems in breathing include a deviated septum or restricted nasal valves with reduced air passages.
The nose is comprised of many areas that typically require different procedures. In addition, it is important to remember that no two noses are alike. This is also critical for the surgeon to keep in mind when designing a specific operation for each nose that meets the needs of each individual patient.
Technique behind achieving consistent looking results in Rhinoplasty procedures is for the surgeon to have a strong three-dimensional perception of not only the nose, but the patient’s overall facial structure as well. A nose that is proportional with the rest of the features creates an even and more balanced appearance to the face.
Aesthetic surgery of the nose involves the following factors: nose size, width, and profile, over and under projection of the nose, nasal tip shape (hooked, bulbous, drooping, or pointed upward), oversized flared nostrils, nasal asymmetry, and limitations or advantages of skin type. Other considerations that require simultaneous evaluation are functional problems such as a deviated nasal septum or a collapse of the nasal valvular cartilage structures.
In teens, surgery of the nose is best performed when facial growth is completed. This begins at around age 15 for girls, and the latter part of age 15 and 16 for boys.Rhinoplasty can be performed with a local or general anesthetic, and always under the strict supervision of a Board Certified Anesthesiologist. The length of time required to perform primary Rhinoplasty is usually between 1 ½ to 2 hours. For Revision Rhinoplasty, 2 ½ – 4 hours is common.
All incisions are made inside the nose. However, in the exceptional cases where the sides of the nostrils are wide, they require reduction in width where parts of the nostril can be removed and this approach generally requires an alar incision which leaves only a fine scar that is hidden along the nostril base and is usually completely inconspicuous upon healing. A small  inconspicuous incision on the columella may be required in certain cases.
Following surgery, soft packing is placed inside each nostril and is removed one day after surgery. A small comfortable splint is then worn for 5 to 6 days to protect the nose and ensure rapid healing. The splint is not placed to retain the shape of the nose, but is merely used for protection and to minimize post-op swelling. The patient is up and about the day after surgery, and within a few days, can perform most sedentary tasks. Typically, the majority of patients who undergo Rhinoplasty have only minor discomfort or stuffiness with minimal bruising and swelling during the first few days after surgery.
Proper follow-up care is an essential part of this operation. Following the procedure, the patient’s recovery process is usually observed and directed for 6 to 12 months to ensure that healing continues correctly. While this might seem lengthy, it is necessary for the successful outcome of the procedure.

Posted in Uncategorized | Leave a comment

Botox : newer indications

Posted on November 9, 2010 by admin

What Is Botox?

Botox® (onabotulinumtoxinA, previously known as botulinum toxin type A) is a prescription injection that is approved to:

  1. Temporarily improve the appearance of wrinkles between the eyebrows (frown lines)
  2. Relieve neck pain and abnormal head position associated with cervical dystonia (a certain kind of muscle spasms of the head and neck)
  3. Treat severe underarm sweating that has not responded to other treatments
  4. Treat eyelid twitching or spasms (known medically as blepharospasm)
  5. Treat misaligned eyes, such as crossed eyes (known medically as strabismus)
  6. Prevent chronic migraines
  7. Treat upper limb spasticity.

How Does Botox Work?

Botox is a toxin produced by Clostridium botulinum bacteria. The drug works by decreasing nerve signals to muscles, which helps them to relax. Botox enters nerve cells and inhibits the release of acetylcholine, a chemical that transmits signals from nerve to nerve. The actions of the drug are not permanent, and the muscle will eventually recover and return to its previous state.

For severe sweating, Botox works similarly, blocking the release of acetylcholine from the nerve cells that stimulate the sweat glands.

Effects of Botox

Studies have evaluated Botox to treat frown lines between the eyebrows. In studies, up to 82 percent of people who received injections saw significant improvement one week afterwards, compared to just 9 percent who had received placebo injections (which did not contain any active ingredient). This effect lasted for at least 60 days, after which time the effects appear to gradually decrease. At 120 days after the injections, 39 percent of people who received Botox still saw improvement.

For cervical dystonia (muscle spasms of the head and neck), studies showed that botox injections help relieve neck pain and abnormal head positioning, compared to placebo injections (which contain no active ingredient). In most people, the beneficial effects were gone after about three months.

Studies of Botox for severe underarm sweating showed that up to 86 percent of people who received injections decreased their sweat production by 50 percent or more, compared to up to 45 percent of people receiving placebo injections (with no active ingredient). The beneficial effects lasted an average of 200 days.

Studies have also shown that Botox can improve eyelid twitching or spasms (blepharospasm) and misaligned eyes (strabismus) caused by abnormal muscle contractions

When and How to Take It

General considerations for when and how to take Botox include the following:

  • The drug comes in injectable form. It is injected directly into the muscles that are causing the problems. When treating severe sweating, Botox is injected directly into the underarm.
  • When treating misaligned eyes (strabismus), special techniques, sometimes using the electrical signals from the muscles, must be used to make sure that the injections are given in the right place.
  • Your healthcare provider may choose to use an anesthetic cream to numb your skin before the injection, but this is not necessary. If you are worried about pain, be sure to ask your healthcare provider about using an anesthetic cream.
  • The effects of Botox are not permanent. You will need to receive injections periodically in order to maintain the effects.
  • For the medication to work properly, it must be taken as prescribed.

Dosing Information

The dose of Botox your healthcare provider recommends will vary, depending on a number of factors, including:

  • The condition being treated
  • How you respond to Botox
  • Other medical conditions you may have
  • Other medications you may be taking.

As always, do not adjust your dose unless your healthcare provider specifically instructs you to do so.

Side Effects of Botox

As with any medicine, side effects are possible with Botox. However, not everyone who receives injections will experience side effects. In fact, most people tolerate it quite well. If side effects do occur, in most cases, they are minor and either require no treatment or can easily be treated by you or your healthcare provider. Serious side effects are less common.

Common side effects include but are not limited to:

  • Droopy eyelids
  • Difficulty swallowing
  • Vertical misalignment of the eye (vertical deviation)
  • Upper respiratory infection (such as the common cold)
  • Neck pain
  • Headache .

Drug Interactions With Botox

Botox can interact with a number of other medications .

What Should I Tell My Healthcare Provider Before Using Botox?

Talk with your healthcare provider prior to receiving injections if you have:

Also, let your healthcare provider know if you are:

Make sure to tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

What If I Take an Overdose?

People who receive too much Botox may experience the following symptoms:

  • Muscle paralysis
  • General weakness.

If you happen to overdose, seek immediate medical attention.

How Should Botox Be Stored?

The medication should be stored in the refrigerator at your healthcare provider’s office. It comes as a dry powder that must be mixed with saline. After it is mixed, Botox should be used within four hours.

Available Strengths

Botox comes in the following vial sizes:

  • Botox 50-unit single-use vials, containing 50 units of the drug
  • Botox 100-unit single-use vials, containing 100 units of the drug
  • Botox 200-unit single-use vials, containing 200 units of the drug.

There are two forms: regular Botox and Botox Cosmetic. There is no difference between the two, except Botox Cosmetic is approved to treat wrinkles, while regular Botox is approved for the other uses. Botox Cosmetic comes in 50- and 100-unit vials, while regular Botox comes in 100- and 200-unit vials.

Is There a Generic Version of Botox?

Currently, no generic versions of Botox are licensed for sale

An Introduction to Botox Side Effects

As with any medicine, side effects are possible with Botox® however, not everyone who takes the drug will experience side effects. In fact, most people tolerate it quite well. If Botox side effects do occur, in most cases, they are minor and either require no treatment or are easily treated by you or your healthcare provider.

Common Side Effects of Botox

Botox has been studied thoroughly in clinical trials. In these studies, the side effects that occur in a group of people taking the drug are documented and are then compared to side effects that occur in another group of people not taking the medicine. This way, it is possible to see what side effects occur, how often they appear, and how they compare to the group not taking the medicine.

In studies of Botox for cosmetic use (to improve the appearance of lines between the eyebrows), common side effects included:

  • Droopy eyelids — in up to 3 percent of people
  • Nausea — up to 3 percent
  • Muscle weakness — up to 2 percent
  • Facial pain — up to 2 percent
  • Indigestion or heartburn– up to 1 percent
  • Tooth problems — up to 1 percent
  • Hypertension  – up to 1 percent.

In studies of Botox for treating medical conditions rather than for cosmetic purposes, the following common Botox side effects were reported:

  • Droopy eyelids — in up to 20.8 percent of people
  • Difficulty swallowing — up to 19 percent
  • Vertical misalignment of the eye (vertical deviation) — up to 16.9 percent
  • Upper respiratory infection (such as the common cold) — up to 12 percent
  • Neck pain — up to 11 percent
  • Headache — up to 11 percent.

Other common side effects (occurring in 2 to 10 percent of people) included:

  • Cough
  • Flu-like symptoms, such as a fever and chills
  • Back pain
  • Runny or stuffy nose
  • Dizziness
  • Soreness at the injection site
  • Weakness
  • Dry mouth
  • Drowsiness
  • Bleeding at the injection site
  • Infection
  • Sore throat
  • Anxiety
  • Bronchitis
  • High blood pressure (hypertension)
  • Nausea
  • Fatigue.

Serious Botox Side Effects

Some side effects with Botox, while occurring infrequently, are potentially serious and should be reported to your healthcare provider right away. These include but are not limited to:

  • Signs of spreading of the toxin effect (a condition known as botulism), such as:
  • Muscle weakness all over the body
  • Double vision
  • Blurred vision
  • Droopy eyelids
  • Voice changes
  • Speech problems
  • Loss of bladder control
  • Difficulty breathing
  • Difficulty swallowing
  • Signs of an allergic reaction, such as:
  • An unexplained rash
  • Hives
  • Itching
  • Swelling of the mouth or throat
  • Wheezing
  • Difficulty breathing.

Final Thoughts on Botox Side Effects

You may experience some or none of the side effects of Botox listed in this article. Unfortunately, it can be difficult to tell if any particular side effect (such as nausea) is caused by Botox or by other factors.

Therefore, make sure to let your healthcare provider know if you develop any side effects while taking the drug. Also, let your healthcare provider know if you develop something that “just does not seem right.” While it may not be a Botox side effect, your healthcare provider will be able to diagnose and treat the problem.

What Is Botox Used For?

Botox® (onabotulinumtoxinA, previously known as botulinum toxin type A) is a prescription medication approved for several different uses. Although the drug is well known for its ability to improve the appearance of facial lines, it is also approved for treating severe sweating and a few muscle spasm conditions.

The generic name for Botox was changed from “botulinum type A” to “onabotulinumtoxinA” to help prevent confusion and mix-ups between Botox and other similar botulinum type A products.

Using Botox for Facial Lines

Botox is approved to temporarily reduce the appearance of “frown lines” between the eyebrows in people 65 years old or younger. It is not approved for older individuals, as studies have suggested that the drug is less effective in this age group. The beneficial effects of Botox for frown lines between the eyebrows last about three to four months. In order to maintain the effects, you will need to receive Botox injections periodically.

Botox Indicated for Head and Neck Spasms

Botox is also approved to treat cervical dystonia, a condition that involves unusual muscle spasms or contractions in the head or neck. Frequently, cervical dystonia causes an abnormal head position (often twisted to one side), abnormal head or neck movements, and neck pain. Botox can help decrease the severity of the abnormal head position and can help relieve neck pain. Although the drug will usually cause some improvement immediately, the full effects usually take about six weeks to develop and last for about three months.

Botox Uses for Eye Problems

Sometimes, abnormal muscle spasms or contractions can affect the eye, causing eyelid twitches (known as blepharospasm) or misaligned eyes (known as strabismus).  Botox is approved for treating these conditions in people 12 years of age and older.

Using Botox for Severe Sweating

Sweating is a normal and necessary way for the body to cool itself. However, some people sweat more than is necessary. This is known medically as hyperhydrosis. While severe sweating may be caused by certain medications or medical conditions, it can also occur for no apparent reason (this is known as primary hyperhydrosis). Botox is approved to treat primary hyperhydrosis of the underarm that has not responded adequately to antiperspirants.

Using Botox for Chronic Migraines

Botox is approved for preventing chronic migraines in adults. This is defined as 15 or more migraines per month, with each migraine lasting four hours a day or more. Botox is not approved for treating less frequent migraines.

Each treatment session requires many injections (typically 31), and the treatment sessions should be repeated. For chronic migraine sufferers, the results may be well worth it.

Using Botox for Upper Limb Spasticity

Botox is approved for treating upper limb spasticity (muscle stiffness) in adults in the elbows, wrists, and fingers. This type of spasticity can occur due to several different causes, such as a stroke, spinal cord injury, brain injury, multiple sclerosis, or cerebral palsy. Upper limb spasticity can be painful and disfiguring, and can interfere with a person’s daily life.

How Does Botox Work?

Botox is a toxin produced by Clostridium botulinum bacteria. The drug works by decreasing nerve signals that are sent to muscles, which causes the muscles to relax. Botox enters nerve cells and inhibits the release of acetylcholine, a chemical that transmits signals from nerve to nerve. The actions of the drug are not permanent, and the muscle will eventually recover and return to its previous state.

For severe sweating, Botox works similarly, blocking the release of acetylcholine from the nerve cells that stimulate the sweat glands.

Botox Uses in Children

Botox is approved to treat eye twitching or misaligned eyes in children as young as 12 years old. It is also approved to treat head and neck spasms (cervical dystonia) or severe sweating in children as young as 16 years old. Botox is not approved for treating facial lines in children. Talk to your child’s healthcare provider about the benefits and risks of using the drug in children.

Off-Label Botox Uses

On occasion, your healthcare provider may recommend Botox for something other than the conditions discussed in this article. This is called an “off-label” use. At this time, off-label Botox uses include:

  • Cosmetic uses other than for frown lines between the eyebrows
  • Achalasia (a condition involving difficulty swallowing)
  • Drooling
  • Muscle spasms in children with cerebral palsy
  • Neurogenic bladder (bladder disorders caused by nerve problems)
  • Congenital muscular torticollis (CMT).

Botox Dosage

Various factors affect a person’s Botox dosage, including the response to the drug, the condition being treated, and if other medical conditions are present. The drug comes in injectable form, and special techniques are often used to ensure that Botox is being injected into the correct site. In addition, the effects are temporary — you will need to receive a Botox dosage periodically to maintain the desired results.

Botox Dosage for Misaligned Eyes

The recommended dose of Botox for misaligned eyes (known medically as strabismus) is Botox 0.05 to 0.15 mL per muscle. Special techniques must be used to ensure injection into the proper site. Often, this is done with a special needle that measures electrical signals from the muscle. Your healthcare provider may give you anesthetic eyedrops a few minutes before your injection.

Botox Dosage for Severe Sweating

For treating severe underarm sweating, the standard recommended dose is 50 units of Botox per underarm, given in several small injections. Before the injections, your healthcare provider may do a painless procedure that stains the area of increased sweating in order to target the therapy to the appropriate area.

Botox Dosage for Chronic Migraines

For preventing chronic migraine headaches, the standard recommended dose is 155 units of Botox, given in 31 small injections in specific muscles of the face, head, and neck. Treatment should be repeated every 12 weeks.

Botox Dosage for Upper Limb Spasticity

For treating upper limb spasticity, the recommended Botox dosage is highly variable, ranging from 75 to 360 units per treatment session. The dosage will depend on the size and number of muscles, the severity of the spasticity, whether or not you have muscle weakness, and how you have responded to Botox in the past. Treatment sessions can be repeated as soon as the effects wear off (but no sooner than every 12 weeks).

General Information on Dosing With Botox

Considerations for people taking Botox include the following:

  • The medication comes in injectable form. It is delivered directly into the muscles that are causing the problems. When treating severe sweating, Botox is injected directly into the underarm.
  • When treating misaligned eyes (strabismus), special techniques, sometimes using the electrical signals from the muscles, must be used to make sure that the injections are given in the right place.
  • Your healthcare provider may choose to use an anesthetic cream to numb your skin, but this is not necessary. If you are worried about pain, be sure to ask your healthcare provider about using an anesthetic cream.
  • The effects of Botox are not permanent. You will need to receive injections periodically in order to maintain the drug’s effects.
  • For the medication to work properly, it must be taken as prescribed.
  • If you are unsure about anything related to your Botox dosage, please talk to your doctor, nurse, or pharmacist.

Botox Drug Interactions

If certain medications are combined with Botox, drug interaction may occur. These interactions can increase your risk of side effects, increase the effectiveness of Botox, and have other interactions that are currently unknown. Aminoglycoside antibiotics and neuromuscular-blocking medications are just two of the medicines that are known to cause Botox drug interactions.

Botox Warnings and Precautions

Prior to taking Botox, warnings and precautions for the drug should be reviewed with your healthcare provider. This includes telling him or her if you have a history of heart disease or neuromuscular disease, as well as if you have an infection near the injection site. Botox warnings and precautions also extend to people who are allergic to any components of the drug and women who are pregnant or nursing.

Botox Warnings and Precautions

Botox Overdose

In most cases, a Botox overdose will cause general weakness and muscle paralysis. It may also cause difficulty with swallowing. The severity of the overdose effects will depend on how much Botox was taken and if it was combined with food, alcohol, or other medications. Treatment for a Botox overdose typically includes administering an antitoxin and treating the symptoms that occur as a result of the overdose.

Botox and Pregnancy

In animal studies on pregnancy and Botox, the drug caused low fetal birth weight, delayed bone development, and miscarriages. However, when pregnant women have been exposed to the botulinum toxin through food poisoning or accidental ingestion, no ill effects were seen in the fetus.

Final Thoughts

If you are pregnant, it is always a good idea to ask your healthcare provider before taking any medication. You and your healthcare provider can consider the possible risks and benefits of using Botox in your particular situation, as well as any other treatment alternatives.

Botox and Breastfeeding

Because there haven’t been any studies done on Botox and breastfeeding, the manufacturer recommends that the drug not be used in nursing women. The effects Botox may have on an infant are unclear, but it is unlikely to pass through breast milk in amounts significant enough to cause problems. If you are taking Botox and breastfeeding is something you are considering, discuss the issue with your healthcare provider.

Generic Botox

Generic Botox is currently not available because the laws surrounding the manufacture of generic biologic medications do not allow it. These laws will likely be changed in the future, although whether these medications will be less expensive than the brand-name equivalents is not clear. If it does become available, generic Botox will probably be used for the same cosmetic and medical reasons as the brand-name version.

Botox Alternatives

Before turning to Botox, alternatives to the drug are often considered. This includes things such as chemical peels; dermabrasion; other injection treatments; and wrinkle creams, lotions, and serums. Each one of these alternatives has its advantages and disadvantages; some work as well as Botox injections, and others are only a short-term fix. These alternatives can also have side effects, such as redness or minor pain.

Posted in Uncategorized | 7 Comments

How I landed being a Plastic Surgeon

Posted on November 1, 2010 by admin

As a child I remember I used to have dreams in which people used to come walking to one end of a platform and climb it and suddenly become numb and on the platform they used to be sculpted into better bodies as per their choices and by the time they used to reach the other end of the platform they were TRANSFORMED…………..!
Never did I know my profession would be so similar to what I used to dream. I got inspired to become a doctor, partially by my parents, partially by seeing a doctor couple who used to be our tenants and to a great extent because I had my first degree relatives whose lives had been/had not been salvaged by doctors. Those childhood thoughts and circumstances kept on motivating me to become a doctor, then a specialist, then a superspecialist, a medical teacher, consultant plastic surgeon…….. and am still happy when I am able to deliver happiness in form of health and beauty.

Once I had achieved these milestones, next step was to push my-selves further into what is most difficult to achieve making “happy people happier….!!!!” and alas! I jumped into cosmetic surgery. In first few months I spent learning cosmetic surgery the ethics behind it seemed a paradox for the ‘doctor’ in me. Why should I be treating people who are not ill when we have countless numbers of sick patients in the world? Still as I had spent lot of time and money to learn cosmetic surgery I kept on doing it. Once I started seeing my patients who had been operated few weeks earlier, I realized the change in their morale; their spirits were higher, and not just that they started leading happier lives………….!!!! My conscious was satisfied when i realized that I was doing what a responsible doctor needs to do: alleviate misery and unhappiness by practising medicine.

Am still into core Plastic Surgery along with Cosmetic Surgical practice till I have another milestone in vision or some childhood dreams hit me again :) .

Posted in Uncategorized | Tagged , | 2 Comments

Hello world!

Posted on July 12, 2010 by admin

Welcome to WordPress. This is your first post. Edit or delete it, then start blogging!

Posted in Uncategorized | 1 Comment