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4:1 REJUVENATION OF THE FACE

Most of us have desire to have tighter skin, smooth surface and absence of wrinkles and furrows on the face. By middle age, on the face and rest of the body aging changes start developing even though we do not want these changes. Furrows or creases start running from the nose to the mouth. These are sometimes uneven bilaterally. Sometimes wrinkles are also present. Deep furrows may have deep wrinkles in deeper part of the furrow. Extra fat and skin may also be present. If skin is pulled up, furrows and folds improve if the skin is in excess. Jaws are notching from the angle of mouth, furrows may turn down. Such furrows create appearance of more age and sad look.

Our face is continuously affected by aging process, environmental pollution, sunlight exposure, nutritional status, stress, hormonal level, cosmetics we use etc. So, patient himself / herself also plays role in maintenance of the youthfulness.

Beauty is skin deep as well as bone deep. Skin continuously undergoes reformation. Balance of this built up & destruction decides quality of beauty. So, everybody who undergoes cosmetic improvement procedure should try to understand all these points & expect accordingly. Results are always satisfying and help to recover softened appearance of the face and beauty of appearance. Face of young person is like triangle pointing downwards. Face of young person is like triangle pointing upwards or square shape.

4:2 FACE REJUVENATION BY NON-SURGICAL METHODS

Depending upon degree of changes, number of changes, extent of expectations of patient and budget of the patient, type of procedure is decided. It may be an injection of filler material (fat or bio compatible material like hyaluronic acid), implants (Gortex, soft form), Laser procedure (Non surgical or surgical /ablative) or incisional surgical procedure of the face lift. Every procedure has its own advantages & also limitations. Try to understand information of all these alternative procedure & then take the decision in consultation with your cosmetic surgeon or laser surgeon. If you are not able to decide, leave the decision making to your doctors.

Improvement of the face:

Face can be improved by improving the skin, by adding or removing fat under the skin, by changing the shape of bone underlying the skin & by strengthening the muscles on the face. Skin can be improved with laser rejuvenation. Excess fat in the face (Round face in fatty person) can be improved by removing excess fat thereby changing round shape of face (which is present in middle age) into triangular face (which is present in young person). Shape of face & jaw can be changed by adding or putting implants under the facial tissue. The thin & bony face can be converted into attractive face by adding fat under the skin. The muscle strength can be improved with ISOGIE treatment

Improving face Cosmo glow & face toning: -

The skin of the middle aged or old aged patient drops down. This skin becomes rough & less glowing. Black/blackish/brownish spots develop on the skin. Wrinkles develop on the face. Skin appears loose & less attractive. Such skin can be lifted up. It can be made smooth & glowing. The dark blackish/brownish spots can be treated with laser cosmo glow& laser toning treatment. This skin can appear more glowing & attractive. It is done by Q-switch Nd:YAG laser. Patient needs 4-10 sitting. Number of sittings depends on the number of problems on the face, general health conditions, associated diseases, life style, nutritional status etc. Some patient need maintenance sitting.

Maintenance of glow & tone of the face:

We take maintenance care of our vehicle regularly by visiting garage. Every active living thing needs maintenance care. So, also our skin & body needs maintenance care to maintain its beauty. So, everybody needs preventive laser cosmoglow treatment at regular interval. So, such preventive treatment reduces the need of cosmetic & bleaching. It also helps to avoid side effect of chemicals used on our skin. Take our guidance and treatment to look young for more years of life.

Face rejuvenation:

Contour threads:

Minimum detectability, no scar, no down time, less expense, more reliability. Natural look is to maintain. Improvement continues gradually. Results are less dramatic. Migration or extrusion off the thread can happen. Aesthetic surgery technique are becoming less traumatic, less invasive with less downtime.

FACE:

Aging of face:

As aging develops skin becomes thinner & less elastic and so it sags and wrinkles and folds develop. Midface area of face is affected by aging among most of the population. This is triangular area between inner and outer corners of eyes and corner of the mouth. The cheeks drift downward and begins to bulge. So, nasolabial fold accentuates and jowls develop. Demarcation line between lower eye lid and the cheeks gradually drifts down at lower level. So, entire area of eye appears bigger. Skin of eye lid becomes more lose and wrinkles increase. Fat bags become visible and start showing shadows beneath them.

4:3 FACE REJUVENATION BY SURGICAL METHODS

Shape of the various features of face:

Shape of the nose affects the overall balance and aesthetic appearance of the face. Contour of chin (e.g. weak chin, extra forward protrusion of the chin), angularity of jaw, narrow / broad jaw line, flat or extra elevated cheek bones should also be looked for and noted down. Some people have double chin which can also be removed. Chin implants improve the appearance of receding chin. Jaw line can be well defined by removal of neck fat.

Points of face examination:

Face has various problems like fat bags, wrinkles, swelling, junction of lower eyelid and cheek, dark circle, mellasma, excess wrinkles, drooping of upper eyelid around eye & on the eyelids etc.

Contour of cheek & lower eye lid:

In high contour check, there may be a problem of puffiness directly under the eyes. In low contours of cheek, there is hollow directly under the eyes. Dark circles below the eyes get worse after removal of fat in lower blepharoplasty.

So, also, the skin in this area will become thinner and wrinkle in lower eyelid will increase. Use of laser treatment along with lower eyelid blepharoplasty helps to reduce these complications. In arcus marginalis fat under the eyes is released and slide down into one hollow. It helps to smoothen one level contour of the face. So, tissue coating puffiness under the eyes go down to fill valley. If there is not much fat under the eyes, cheek lift is performed.

Face lift make appearance smooth and skin becomes more tight. But hollow look to the eye develops. In midface lift, (or malar lift), it is done through an incision immediately below the lashes of the lower eye lid. After healing it appears like crease line. In this procedure, the entire midfacial triangle of tissue is gently separated from the bone and lifted upwards. Excess fat in this area is used to fill in the lid/cheek, junction line. This last step avoids hollow eye look of post face lift. Thicker tissues are placed over the cheek bone and so cheek bone area enhances and nasolabial fold is softened. Lower eyelid becomes more softened and no fat bags appear. Preoperatively the appearance of this mid face lift results can be showed by placing finger on the cheek bone just below the corner of the eye. Then gently elevate skin tissue. 90% upwards and 10% backwards. This reduces nasolabial fold and fat bags. Eyelid will appear more smooth.

4.4 COSMETIC SURGERY OF THE NOSE / NOSE RESHAPING / RHINOPLASTY

Nowadays people like high bridge and slightly longer nose. It can be done in all types of noses where nose bridge is depressed. It is one of the most common cosmetic surgery. Nowadays, rhinoplasty operation is done quite frequently. It is often demanded by patient and results are encouraging. Although most of the patients improve satisfactorily, perfection is the goal that remains elusive. Purpose of seeing results of other patients is not to allow you to pick out the shape of the nose your want but rather to give you some idea what type of results are achieved after the surgery. Human experience of nose surgery is of 2000 years old. Correction of shape of nose also improves psychological tones and mental outlook.

Crooked nose:

Before after

Due to accidental trauma, dislocation of nasal bones from usual place occurs thereby shape of nose become less beautiful or ugly. Most of us are exposed to trauma of the face during childhood and it is neglected or remain uncorrected. Due to dislodged position of bone, the margins remain dislocated and unopposed. As body grows, such dislocated margins of the bones and cartilage also grow. There is no resistance by contact and so these may overgrow. Due to such overgrowth of bone air way in nose is blocked and the midline septum is deviated in all these case in ‘S’ shape fashion. Straightening such septum by surgery is called septoplasty. It improves the air way. But such improvement may not be enough due to deformed external shape. In septoplasty only midline septum is made straight but external shape remains deformed. Such deformation can be improved and nose can be made beautiful by a surgery called septorhinoplasty.

Before after

Nasal reshaping:

Nose reshaping surgery can dramatically improves shape of the imperfect nose, ugly nose, crooked nose, deviated nose, depressed bridge of nose, oversize nose etc. As one ages, the top of the nose becomes drooping & difficulty in breathing develops. Such tips can be elevated to improve the shape of the nose & breathing.

Why rhinoplasty:

Attractive nose influences the whole face and so it compensates for other less than perfect facial features. Due to ugly appearance of nose, person hates his picture. He avoids to take picture. Even if patient wants to take picture he / she goes to unfamiliar photographer who may be staying far off and cares that only picture should be taken from good side or at the angle which shows minimum defect.

Who needs rhinoplasty & septorhinoplasty ?

To improve function of nose (to reduce / improve air way in nose) and to make it more beautiful rhinoplasty surgical reconstruction of the nose. It corrects the birth defects and disfigurement. It can also remove unwanted extra tissue.

Rhinoplasty is done in various situation to increase size of the nose, to reduce extra size of the nose, to widen the narrow nose, to reduce extra length of the nose, to reduce extra bone in nose, to correct asymmetry of the nose, to elevate tip of the nose, to reduce broad tip of the nose into narrow pointed tip, to reduce length of alew, to improve angle of the nose with upper lip. If patient desires to improve his present unwanted shape or appearance of the nose rhinoplasty operation is performed.

Before after

After surgery, plaster cast is placed over nose which is removed after 12-15 days. When this cast is removed, one may see some smelling which subsides in due course. Patient should take care that nose should not be injured for few weeks. So, physical activity should be limited for initially three weeks. Eye glasses pressing nose should be avoided for 3 weeks.

Patient should choose better centre where only cosmetic surgeries are done. Nose is 3-dimensional structure which needs sufficient supporting structure. Do not do hurry to choose cheaper centres. Something that cheap can turn out to very costly later on. It can cost one’s life also.

Patient should keep realistic expectation about results of operation. There is stepwise expectation. Ugly appearance of nose can be made into good appearance. Nose having good appearance can be converted into beautiful nose. Thus, rhinoplasty operation is meant to improve the shape of the nose and not the perfection. If some patients achieve perfection of beauty, it is bonus for them. during healing of surgical wound, any healing reaction takes place which may sometimes be unpredictable. So, it is always better to keep expectation of low profile. Some patients have blockage in nostril. Such defect can also be corrected. Some patients have a problem of sinusitis or defect in lateral wall of the nose. It can also be corrected. This operation can be done along with other operations like cheek bone augmentation, chin augmentation, surgery of aging like facelift, eye lid surgery etc. Generally, this operation is done after the age of 17 years upto the age older age. But in case of breathing problems, or some significant reasons, it can be done earlier. It is basically operation modification of framework of the nose. Most of the incision is given from inside. If in some patients, due to peculiar problem of nose, surgery is done by external technique, the very small scar is seen on the columella which is invisible for others during sitting and standing position. After correction of bony defects, skin is redraped on the underlying structure. Every rhinoplasty surgery is individualized to that particular individual. Although in some case, fracture of nasal bone is done, it is not painful operation. There is swelling and bruising after surgery which reduces gradually. If only work on cartilage is required, then, these problems are very mild.

Before after

Procedure of Rhinoplasty:

When shape or size of nose is not in harmony with the rest of the face, rhinoplasty is done to modify size and sculpting the structures in nose to balance the face. There are two techniques- open rhinoplasty and closed rhinoplasty. Open rhinoplasty technique is time consuming technique and produces better symmetry. Structures are sutured directly under vision. The incision is hidden and inconspicuous. In case of wide nostril, small incisions are made at the base of the nostril to narrow this area of nose, after few months, scar is almost invisible. After surgery, pain is mild. Nose pack is kept for 24-48 hours. Ice pack may be applied over the face to relieve swelling. Cast is placed over the nose for 7-10 days. Avoid strenuous activities after 2 weeks. Some patients have thick or oily skin which masks the results of the surgery. One product may be suitable for some body skin may not be suitable for other person.

Before after

Every one’s skin responds differently and has different needs. Even very good shape of cosmetic appearance may not meet your need due to your over expectation. Depending on amount of surgical work done and thickness of the skin, it takes four months to achieve final shape. Some irregularities in contour resolve in due course. Occasionally a minor second procedure is done in patient who have gross deformity before surgery. Change is affected by thickness of the skin. Thinners skin over nose reflects better results. This surgery can be done after 14-15 years of age. In some cases, final results become appear out after about 6 months to one year.

Risk:

Some patients may have bleeding after surgery for few days. Few months after the surgery scarring of the wound may make mild change. Rarely one may develop nasal septal perforation but it is often harmless. Septo rhinoplasty not only improves the appearance of the nose and face but also improves the airway. Limitations: Nose is complicated organ and healing process develops certain changes due to fibrosis in the wound. So, there is limit to the ability of the surgeon to change the appearance of the nose.

4:5 LIP AUGMENTATION:

Lips:

Lips are visible sex organ. Distance of lip from the nose should be 18-20 mm & from chin to lower lip should be 36-40 mm. upper lips should projected more than lower lip. Ratio of lower lip to upper lip is 1.6:1. Due to wrinkling & resoption of fat changes develop in old age. In old age, projection of lip is reduced. Perioral wrinkles develop. Angle of mouth is depressed. Marionette lines develop. Augment fat with filler or fat. Do relaxation exercise of fat (IP), do resurfacing. Inject at 450 To the skin while injecting in lip. Stretch the lip, inject uniformly & slowly. Inject in buttress of the lower lip. Talker & smokers more likely to develop perioral wrinkles.

Volume of lips may be reduced due to aging or other factors. To enhance appearance of lips, lip augmentation is done by using fat injection, fillers, or putting implants. When filler hyaluronic acid (Perlane / restylane), collagen or alloderm or fat is used results tend to last for 6 months for one year. One may need repetition of treatment after certain gap of 6 to 12 months.

Lip augmentation (Permanent) in thin and flat lip:

Lips in young persons are smooth, wrinkle free and youthful. Due to aging, tissue in the lip degrades and lips become thinner and wrinkles increase on their surface. Smoking, excess talking and genetic factors also affect beauty of the lips and face.

Larger and full lips give younger look. In women, larger lips gives feminine and sensuous look of mid face. Due to gravity and aging in females’ upper lip becomes thinner, droopier and recessed. So, more space is created between the bottom of the nose and upper lip. It is very much undesirable. To overcome it , lip augmentation technique is used.

Lips can be made more prominent and beautiful by injecting natural material like fat. It needs repetition two to three times at the gap of 3-6 months. Synthetic implants like Gore tex, soft form, ultra soft, advent can also be used. This materials can be removed if necessary.

Excess skin is removed during face lift. Top portion of the epidermis is vaporized. Then, incision is made into each side of inner lip. The lasered skin is used into upper and lower lip. Excess skin can be preserved in freeze and used to augment lip years later. In patients who wants only fuller lip, dermis and muscle is removed from the scalp. As it is patients own tissue there is not allergic reaction.

Risks – Bleeding, uneven upper and lower lips, implant shifting or erupting through the skin. Unnatural shift and feeling for some period.

Lip augmentation requires larger V-Y incision inside the lips (which is not visible externally after the surgery). Results last longer. If artificial materials are used they may sometimes cause swelling.

4:6 LIP REDUCTION

Larger than usual lip is not acceptable. It creates insecurities or inferiority complex. During childhood classmates tease. Ethnically, in India, lower lip is larger than the upper lip. Lip reduction is minor and simple surgery. Rarely one may develop swelling after surgery which reduces gradually. During this healing period maintain patience. Candidate who wants to reduce lip should discuss with surgeon how much reduction he or she wants. One may ask about surgical procedures and any possible problem. In lip reduction surgery, excess tissue is reduced to appropriate size under local anaesthesia. Surgery takes about half an hour. Healing is complete within a week. Generally, surgery is done under local anaesthesia. Incision is made along the length of the lip inside the mouth. In children, one needs to wait until face is properly developed.

4:7 DIMPLE CREATION ON THE CHEEK OR CHIN

Nowadays more young females and even males request for creation of dimple on the cheek or chin. It is thought that dimple improves beauty. It brings good fortune and fertility. This operation is done under local anaesthesia. Tissue from underlying area is removed to develop a dimple. Patients may go home after some rest. Post operative suggestions:
Use ice pack for 2-3 days to prevent swelling. Take soft diet. Dimple will appear at rest and in animate position for about 2 months. Then it will be present during facial expressions. Complications are less. Very rarely the person may have persistent swelling, asymmetry abscess formation, nerve weakness etc. If necessary, revision surgery may be one to increase depth of dimple.

4.8 REDUCING FATNESS OF THE CHEEK

Thinner triangular appearance of face is often preferred because it gives more youthful look. Some individuals have round face or puffy face. They feel fullness of mid cheek which does not suits the face and beauty of the body. So, they have a desire to reduce this fullness in mid cheek area so that it will appear natural and more sculptured. This procedure is done under local anaesthesia or light general anaesthesia. Excess pad of fat is removed from inside. There is no visible scar on the face. This procedure can also be combined with face lift surgery. In this later face lift procedure, approach is through incision of face lift and so extra inner incision is saved. After some rest, patient can go to home. One can have shower or bath immediately. Stitches are removed on 4th or 5th day. There is minimal swelling, bruising and slight pain for some period. One can attend office work and social function the next day.

4:9 REDUCING PROMINENCE OF CHEEK BONES

Some patients have large, prominent cheek bones which are disturbing beauty of the individual. Prominent cheek bones (molar and zygomatic bones) can be reduced to small size and contoured of cheek bones can be improved. Surgery takes about two hours. There is no visible scar. Results are good and long lasting. Cheek becomes more rounded with less prominence of cheek bone. This surgery is generally done under general anaesthesia. A small incision is taken from inside the mouth. Excess cheek bone is reduced with the help of burrs or cutters. After surgery no dressing and drains are used. Postoperative swelling subsides within 2-4 days. Individual can go back on usual activities within 5-7 days. Moderate pain may be felt after surgery, which can be controlled by painkillers. Patient may feel numbness in cheek which improves.

4:10 FACIAL IMPLANT

Face defines the body. It helps in influencing the people. If any element of face is undergrown or smaller, it needs augmentation to make it more attractive. These provide balance to less defined face or further enhance an already existent structure of the face. If any element of face is too big, it requires reduction. To enhance shape of cheek, chin, nose, face implants (hetero-implants) are used. These implants are artificial. These substitute body tissues. In some of the patients, his/her own bone or cartilage (auto implants) is used instead of implants. To remove these auto implant additional surgery is required. Those patients’ whose body does not tolerate artificial implant, auto implants are used. Good candidate for face implant is a person who wants improvement in the look rather than perfection. He keeps realistic expectation and healthy look.

What are the risks of facial implant surgery?

Facial surgery is usually safe. Rarely implants may cause infection. Rarely some patients need removal of implants to cure infection. Sometime implants may become mobile or may shift from original place. In such case, one needs to correct the position of implant. In some patients bruises may develop for some period. Face implants are more safe and durable as compared to implants in breasts. Consultation: Doctors evaluate health and contours of the body including the face. Alternative methods of facial contouring are discussed. Patient is expected to tell frankly his expectations, any continued medical problem and medications. He should also reveal about his habits like smoking or tobacco chewing and alcohol consumption. If patient wants to undergo surgery complete physical check up is done.

Nasal implants:

To keep nasal implant, intra oral incision is given. Sometimes, small external incision is taken on columella. Pocket for implant placement is created. Then, small nasal splint is applied over the nose for seven to ten days. If stitches are given intraorally, do warm antiseptic gargles 4-6 times in a day. Take very soft food for about a week. One can brush the teeth but do carefully. After the surgery, the local areas will have swelling and discolouration and so it will appear worse for a week. Patient can take pain killer if pain is felt. Patient is asked to come for review after 5 days and then after 10 days since surgery. Avoid strenuous exercises to prevent displacement of implants. The implants give attractive new contour with minimum wound. The results are permanent.

4:11 CHEEK IMPLANTS

Before after

Making cheek bones more prominent by cheek implant: In childhood, individual has prominent cheek bones. As individual grows old his face changes. So he loses prominence of cheek bones. In such cases, cheek implant gives fullness to flat cheek bone. It adds to overall projection of the face. In some people due to loss of fat of the face, it appears ugly. Fat is lost along and under the cheek bones. It happens due to malnourishment. It may also develop in patients who are taking protease inhibitors for HIV problem. These persons have loose hanging skin in the middle part of the face, deep laugh lines on either side of raised prominent fold, sunken cheek pads. These persons show prominent and noticeable outlines of facial muscles and bones. Such problems can be overcome by filler material like collagen fat, dermatogen or grafts under the skin but the effects are not long lasting.

Subperiosteal implants:

To make face fuller in appearance and more balanced look, cheek implant is placed within the cheek. Thus, more harmonious balance with rest of the face can be created. Due to old age and weight loss or lack of weight gain face appear sunken and tired. To overcome this problem, cheek implants are used.

Putting custom made silicon like permanent material under subperiosteum is a good method. These custom designed implants adapt and mold to the facial shape and mouth movements. This surgery is often done under local anaesthesia unless patient asks for general anaesthesia. This surgery is done from inside of the mouth. Incision is given from inside of cheek at its junction with the upper gum. Skin and underlying soft tissue are separated from bone in cheek to create a pocket. Implant is placed in pocket and fixed. Incision is closed in layers. It takes thirty to sixty minutes. Patient can go home on the same day. Cheek implant surgery can be done with other cosmetic surgery on the face. After surgery bandage may be applied externally to minimize swelling and discomfort. Painkillers and antibiotics are advised. Numbness of the face develops temporarily. This procedure can be combined with eyelift, forehead lift, chin implants, neck liposuction or any other cosmetic procedure. Results are immediate, dramatic and permanent. Person can return to work quickly.

Recovery:

Pain is very minimum. Patient is discharged after few hours. Some swelling may be felt for 3-4 days. One can have shower on the next day. Patient can resume to all usual activities in 7 to 15 days. He may join his office work in 2-4 days. Patient gets very natural and younger appearance quickly and comfortably. Results are always permanent and provide better look. Improvement is about 90% and dramatic.

4:12 CHIN AUGMENTATION

Some people have sunken or smaller lower jaw. To strengthen jaw line and to restore youthful reshaped appearance of the face chin augmentation is performed. It provides more harmonious balance to face appearance. Chin augmentation can be done alone or in association with other procedures. It is often done along with rhinoplasty or face lift. Implants like solid silicone, bone or fat from patient’s body is used. This procedure can be combined with liposuction of fat from under the chin and the neck. Procedure requires about ½ hour and two hours. Patient can resume his work in a week.

Before after

When we look in mirror, we often focus our attention to nose, cheek, eyes, sagging jaws and wrinkles. We less often pay our attention to our chin. Although shape and size of chin plays an important role in beautifying our face we neglect it. Rounded chin or non-prominent chin steals beauty of the face. Size and prominence of chin may magnify or reduce the perceived beauty and size of the nose. Fleshy pad of fat of chin normally varies from 8 to 11 mm thick. So, from weak chin, face is transformed into more pleasing aesthetic shape. Doctor discusses with the individual about his/her expectation after surgery. One should speak out openly about one’s expectation from surgical augmentation. Doctor takes into account your 3-D facial dimensions and natural shape of the face. Then, doctor decides size of implant. Be free to speak with your doctor even after you discussion. It is done under local or light general anaesthesia. It takes one to two hours. Incision is given through mouth where lower gums and mucosa meet. Implant is placed in position and fixed with screw or thread. The same implant can be put externally by incision below and behind the chin. Such scar is invisible in our usual sitting and standing position. Stitches are removed after 5 days. Risk of infection increases as compared to chin implantation done from outside below the chin. But such risk can be reduced by following strict hygienic and antiseptic care. Results are immediate. Initially patient may feel that implant is too big at first glance, slowly with time the swelling will reduce and so chin will have less prominence.
After surgery, mild to moderate pain is felt which can be relieved by painkiller. Swelling and bruising develops locally which also reduces within 2-3 days. Some degree of numbness may rarely develop which disappears in due course of about four weeks. If you develop local increase in temperature or sudden swelling, redness, tenderness, sudden discoloration it indicates local infection or allergy. Contact your doctor urgently. Patient may return to work within 2 to 5 day. One should not do exercises for 2-3 weeks.

Complications:

These are rare. Haematoma may develop due to accumulation of the blood clot. Some damage to nerve may produce numbness. Hyperpigmentation may develop due to bruising. These entire problems are of temporary nature. Sometimes implant may shift causing asymmetry. Re do or removal of implant can also be done.

Results:

Silicon chin implants last for lifetime. Any properly fixed implant give long term symmetrical response. Bone resorption under the graft may take place with aging. Bone and fat implant may get absorbed after some period. Silicon implant may likely to displace in certain cases or may rarely be extruded. It can be replaced.

Before after

Alternative methods:

There are other methods of chin augmentation. But these are less preferred. One of them is genioplasty. It is more invasive. With the help of bone saw, a piece of bottom of the chin is trimmed off and slided forward and then fixed with titanium screws. It takes much more time to heal and pain lasts for longer period. Some surgeon may use injection of hydroxy apatite (HA) paste to increase prominence of chin gradually. Injection is repeated but prominence of chin is not upto expectation. Some surgeons use your cartilage from pinna to make chin prominent. Thus, body material of the same individual is used. So rate of acceptance is high. It saves cost of implant. Rate of infection is minimum. Use support wear in night, to alleviate tissue stress and to support healing tissue correctly.

Before after

4:13 FACELIFT (RHYTIDECTOMY)

Face lift improves sagging skin of the face, a slack jaw and loose skin of the neck. Men and women over 40 years of age seek for this surgery. Everybody of us grows older. Exposure to sunlight and presence of gravitational forces affects of tissue below the skin. Physical and mental stress of daily life affects the muscles and other tissue. Stress keeps them in tense condition. Aging and lack of physical exercise makes the tissue of face and neck more lax. Wrong diet and wrong habits accelerate signs of aging. Cover of tissue on the face (e.g. skin, muscles, and fat tend to thin out). So, face appears more old. Fat deposit below lower jaw increases.

Signs of aging appear on everybody’s face. No body can escape from changes of aging. So, as we grow old, all of us need some face procedure to look younger. Face lift reduces signs of aging like fine lines, wrinkles, deep creases, a jowl of jaw line etc.

Those who have slight wrinkles can be treated with fillers. Those who have moderately progressed wrinkle furrows can be treated partially with fillers and botox. These can also be treated by thread lift.

Those who have excess wrinkles and sagging of skin on their face and neck are candidates for facelift. Usually these candidates are between forty and sixty years of age. But this procedure can also be performed effectively even older age. In face lift signs of aging are corrected. Skin and underlying muscles are tightened. Excess fat is removed, face looks more young, fresh and enhanced.

These procedures cannot reverse aging and cannot stop aging but can reduce effects of aging. If person follows certain rules of health maintenance then process aging is slowed down.

Surgery of facelift set back the clock of aging by improving the most visible signs of aging by removal of excess fat tightening underlying tissue and redraping the skin of face and neck. All these causes lead to formation of deep creases between the nose and mouth. This crease is called nasolabial fold. Tissues of margin of the jaw near jawline develop laxity and jaw emerge. More folds and furrows are in between eyebrows, around the eye on the forehead. Fat deposition increases around the neck and mid part of the face and below the chin. It converts attractive triangular face into round face.

Upper part of incision is in hair line then it extends down in natural line in front of ear (to minimize visibility of scar), then this incision continues behind the ear lobe to the lower scalp.

Patient should provide his personal information like habits (tobacco consumption, smoking, alcohol), post surgeries, blood pressure, urine sugar, blood clotting problems, tendency of late wound healing, tendency of keloid or hypertrophic scar formation. Patient should show papers of medicines which are taken in past and which are still continued (e.g. aspirin). In face lift, excess fat is removed, underlying muscles are tightened and skin of face is redraped. Thus, skin of face becomes more firm and fresh. These results may last for about a decade or more. It depends on health status and maintenance care by individual.

Bad face lift:

Face lift can be detected when there are signs of ‘bad face lift’ like unnatural pull to the face that produces mask like appearance, if incision are not placed correctly and hair loss is along temporal hair lines area along the base of ear. Ear lobe ponting back of the neck instead of towards the chin.

Like any other surgery, cosmetic surgery complications may take place.

Every individual has his own unique facial features. So, results vary from person to person. Thus, face lift is an individualized procedure. Every procedure of the facelift is individualized. Surgeon evaluates change in the skin. Subcutaneous tissue, muscles and underlying bones.

Procedure:

The incisions of face lift are hidden behind the hairline or within the scalp, inside the ear and / or behind the ear. This helps in minimum scarring. The incision begins in temple area above the hairline just above the ear. This is extended downward in a natural hairline either in front of the ear or just inside the tragus cartilage at the front of the ear. This incision is further continued posteriorly around and behind the ear lobe superiorly. It is ended at the lower scalp. Skin is raised outwards to separate from fat and muscles below. Excess fat is removed. Underlying muscles and connective tissue layers are tightened and repositioned. Skin is pulled back to lift it and to tighten it. Excess part of the skin is removed. The incision is closed. Surgery takes 2-4 hours. Bandage is applied. Small tube may be kept as drain behind the ear to drain any accumulated blood. Patient is discharged after about 6 to 8 hours. If additional procedures are done, additional time is required. When neck lift work is to be done, incision may be made below and behind the chin.

Side effects:

There is temporary swelling, bruising, numbness and tenderness. Skin is felt dry and tight. Men need to shave behind ears due to repositioning of beard growing skin.

Risk:
Bleeding, infection, poor healing, scarring. Rarely facial nerve is affected.

Before after

Instruction:

Do not take tab of vitamin K and aspirin or other anticoagulant or hormone replacement therapy one week prior to surgery. Stop smoking and tobacco in any form few days before surgery. If you are taking medication for high blood pressure, heart problems, diabetes, ask about when to take doses one day before surgery and on the day of surgery. If you have received radiation therapy or chemotherapy, AIDs, autoimmune therapy or any other therapy, inform the surgeon about it. Get confirmed your appointment one day prior to surgery. Do not wear contact lenses, wear glasses. Do not keep any jewelry or any valuables in hospital. Do not eat 4-5 hours prior to surgery. Wash your face with antibacterial soap. Shampoo your hair with antibacterial shampoo. Remove all make-up. Males should shave. Do not apply any creams afterwards. No mascara / kajal should be applied. Remove all mascara from eye lashes and lid margin. This material may enter into the scar and cause permanent stain.

Investigations done before surgery: Blood tests as suggested. In case of elder person above 45 or persons having heart and lung problem, chest X-ray is done. Cardiac fitness remarks and ECG. If you have any of the following problems, please let surgeon know urgently. If you have fever exceeding 1000 F, bleeding or discharge from the incision, progressive increase in pain, repeated vomiting. After surgery: Apply cold clean compresses. Fill ice in thin plastic bag and then wrap it in dry cloth and apply 4-5 times in a day over the face to minimize swelling. Maximum bruising and swelling is felt on 2nd and 3rd day. After 7th days bruising start to go away. Use elastic garments for about a week. Then use these garments during night only for next week. Sleep with head elevated position for three weeks post operatively. Do not apply any thing on sutures other than prescribed by surgeon. Stitches are generally removed on 6th or 7th day. Sutures in hair line may be removed gradually. Avoid vigorous exercise for three weeks. Generally pain lasts for two days. If pain increases, promptly contact the surgeon. For about forty eight hours, bleeding or oozing is present from the wound. Brushing or combing of the hairs should be done carefully. Do not wash or rub or massage face till surgeon permits. Do not wear make up until your surgeon permits. Do not use contact lenses initially for 7-8 days after surgery. Do not eat or drink anything after meal. It may strain healing process. Avoid to twist neck initially till healing is complete.

For few weeks after surgery:-

Numbness develops around the ear lobes and neck for several weeks which reduces gradually. Tightness may be felt around the face and neck for few days. During mouth opening tightness may be felt. Small irregularities under the skin develop post operatively for some days which resolve in due course. Skin is felt stiff during healing. All these problems are reduced during healing. Cosmetic surgery changes the look of the person and helps to change feel of individual about oneself. Nowadays most of us have some facial flaws and signs of premature aging, which undermines self-confidence. Surgical procedures like double fold creations for Asians and various chemical peels, laser peels are used to improve skin. To improve aging effects on the cheek and lower eye lid (midface). It is performed by two approaches individually or combinely.

Risks and side effects:

It may be like any surgery. There is a risk of infection, haematoma formation, scarring, nerve damage, reaction to anaesthesia. Side effects like any surgery. There may be mild pain, bruising and numbness.

Types of face lifts:

Many times in addition to tight the skin of face, one needs to correct problems around the eye lids, at the corner of the mouth as in mid face lift and creases at the lip. So, various types of procedures of face lifts are available such as ‘S’ face like, SMAS face lift or submuscular aponeurotic system, the mini lift, smaller lower third face lift, SOOF (sub orcularis occuli face lift), temporal face lift, lateral brow lift, deep plane lift, subperiosteal face lift, neck lift (platysma lift) etc. SMAS (sub artificial) lift. In this procedure SMAS is lifted up and out or diagonally. This lift can be performed in conjunction with neck lift or platysma lift. SMAS layer is responsible for face movement e.g. smiling.

‘S’ lift:

This procedure is used to correct merely lower third of the face which include the jaw line, the jaws and the neck. In the procedure, upper part of face and eyes remains unaffected.

Mini lift:

It is later lift to overcome problem of nasolabial fold (i.e. a fold running by the side of nose to the angle of the mouth. Incision is given in front of the ear.

Mini lift with suspension suture: Sutures are anchored under the skin in muscles.

SOOF: (Suborbicularis oculi fat lift)-

To lift central third of the face, it is done. Area from the center of eye brow to the frown lines and area adjacent to nose and mouth are included in this procedure. The midfacial tissues at the deep layer (the periosteal layer) are lifted and repositioned allowing the sagging check to be lifted in vertical direction. Thus, smoothing the nasolabial fold. The volume of upper cheek is also enhanced.

Temporal face lift:

In temporal face lift, upper one third of the face is lifted. Eye brows are lifted up. Horizontal lines of forehead are removed. It may also help in correcting ptosis of upper eye lid. Deep plane lift: It is done at a deep plane than standard face lift. It can benefit the neck and jaw. Subperiosteal face lift: This procedure is used to lift the suborbital area as well as the midface area. Neck lift (Platysma lift): For more youthful neck platysma muscles are tightened along with removal of excess fat and hanging skin. It can be performed with face lift. Mid face lift: Middle part of the face is triangular area between two corners of eyes and the corner of mouth. Mid face lift may also be done with the help of endoscope.

Who should undergo face lift?
Those whose face and neck begins to sag, whose face shows wrinkles face.

4:14 BLEPHEROPLASTY:

Blepheroplasty changes and improves the look. The face appears more fresh and younger. Area around the eye becomes firmer. In blepheroplasty, excess fat, muscle and skin from upper and lower eyelid is removed. So, this surgery removes puffiness and bags under the eyes that make person look worn out, older and tired. It cannot alter fine lines, crowfeet, wrinkles and dark circles around the eyes. It cannot improve sagging of eyebrow. It does not correct sagging of eye brow It does not erase evidence of racial or ethnical features. This surgery is often done along with other procedures like face lift or brow lift. Every year, thousands of individuals choose to undergo blepheroplasty to improve the way they look. This surgery is done as single surgical procedure or it is done as combined procedure with eyebrow lift, face lift and skin resurfacing of face, forehead lift (to correct drooping brow, forehead lines and skin resulting to remove the fine lines in the eye area). These additional surgeries have complementary results and improve the results of procedures. During the presurgical consultation, surgeon will ask detail history concerning use of lenses, status of vision, tear production and desire of the surgery. He examines completely. Doctor notifies your age, skin type, ethnic background and degree of visual obstruction. Face skin and underlying bone is evaluated. Complete facial examination is done. Then, surgeon will tell you. Due to drooping eyelid face appears older and impairs vision.

Before after

Blepheroplasty is very individualized procedures Surgeon may explain about the type of anaesthesia, additional other procedures for complementary results, risks and costs etc. In order to make the scars as invisible as possible, surgeon marks incision lines in natural folds. Excess fat, muscle and loose skin are removed. Fine suture material is used. It is self-dissolving. It leaves the visible scar. If permanent stitches are given, these are removed on 4th and 5th days after surgery. In lower eyelid, blepheroplasty incision is made along with the eyelash line and smile creases of lower eyelid. In case of eyelid puffiness caused by excess fat, transconjunctival blepheroplasty is done. After surgery, some swelling and bruising occurs. Cold compresses and head elevation may be advised. One should avoid smoking before and after the surgery. One may need to clean eye area. Patient may feel sticky, dry and itchy.

After surgery:

Some patients feel slight numbness for few weeks or months. Due to swelling and bruises, face may not be felt attractive. As wound heals, face recovers from these changes within 2-3 weeks. Healing continues for a few months even though the wound has externally healed within a week. Till this time, patient should protect himself from strong sunlight and strenuous activities.

LASER BLEPHAROPLASTY:

CO2 LASER of 10600 nm can be used in incisional mode to treat droopy eyelids (dermato chalosis). These patients have redundant skin of eyelids, hypertrophied orbicularis muscle and herniated periorbital fat due to aging. So, patients appear more tired and older than they actually feel. Distance between eyelid margin and pupil is 2mm or less. To improve superior visual field upper blepharoplasty is done in some cases otherwise these patients may suffer from chronic tension headache due chronic brow hiking caused by hyperactivity of frontalis muscle. Some patients has blepharitis or dermatitis locally which improves by this surgery.

Before ------------------------------------------------------After

Patient of poorly controlled hypertension and patients on anticoagulants, non steroidal anti inflammatory drugs (NSAIDs) vitamin E and ginkobiloba should be temporarily avoided.

In patients with diplopia, thyroid related eye problem, myasthenia gravis, neuro ophthalmic problems are avoided. Time blepharoplasty caused by levator dehiscence, myasthenia gravis, third nerve palsy and Horner’s syndrome are not benefited by this surgery. Diplopia indicates orbitant and CNS pathology. Dry eye symptom may develop. Aggravation of dryness is often develop after blepharoplasty. So assess dry eye status, pupillary size, reaction to light, schirment test. Examine forehead for any furrowing and actinic damage. Note down vertical furrow in the glabellar area which indicates corrugator hyperactivity.

Examine eye brow for position, asymmetry, contour and fullness. Typically in male, eye brow rests just above the orbital rim and it is flat across its length. Female eye brow is higher above the orbital rim. Its arch is usually located at the junction of middle and lateral third of the eye. Normal value of distance of eye lid crease above the lid margin is 9-11 mm in female and 7-9 mm in Asians. Note down any asymmetry preoperatively and inform the patient. Note down epicanthal fold upper lid margin should rest 1-2mm below the superior limbus. In thyroid related orbitopathy due to upper lid retraction, lid margin lies above the superior limbus. If marginal reflex distance between pupil and upper lid is less than 2 mm. There is functional ptosis. It should be corrected to improve visual field.

Weight of upper lid sometimes pushes lid margin down causing pseuodoptosis. Blunted lid crease and low levator function indicates congenital ptosis. Lower lid margin should rest at inferior border of the limbus. In case of etropion due to lateral canthal dehiscence, lid laxity, thyroid related ophthalmopathy inferior scleral show is present. So, such patient has epiphora and corneal exposure. Note down herniation of each of the three lower lid fat pads. Also note down wrinkles and actinic changes. Note down area of atrophy along the malar ligament and inferior orbital rim that may not improve.

If malar area is flattened or orbit is shallow or axial myopia (near sighted patient with large globe) eye appears more prominent. In such cases, minimum tissue should be removed from eye lid to prevent ability of eyelid to close. Note down true proptosis due to thyroid and orbital problems. In some patients one eye may be inferior due to old fracture.

After surgery, due to higher plat form of surgery, it is easier to wear make up especially muscara, visual field increases, headache caused by brow hiking and blepharitis improves. In case of modest improvement, brow ptosis can be improved by removal of skin.

Q. What is blepheroplasty?

The excess skin and bulge on the eyelids or below lower eye lid make our appearance like tired and older face. Eyelid surgery (blepharoplasty) is a procedure to remove excess laxity and bulged part of eye lids.

Q. Who is suitable candidate for a blepheroplasty?

Ans: Person should be healthy, psychologically stable and should have realistic expectations. Those who have droopy and boggy eyelids at younger age can also undergo blepheroplasty. Usual age is 35 years or more.

Q. Who should undergo blepharoplasty?
People above 35 years of age prefer to undergo this surgery. But younger person having baggy or saggy eyelid also need to undergo this surgery.

Q. Are the marks of wound are visible after healing?
The incisions are made along the natural lines and marks of wounds are almost invisible.

Q. What are the risks?

Ans: Every surgery is associated with some uncertainty and risk. Individual vary greatly in their anatomy, physical reaction and recovery abilities. So, outcome is never completely predictable. If patients are carefully selected and if operating facilities are properly equipped, it is safe surgery.

Q. How are the results?

Ans: The aim of surgery is to improve outlook of face more alert and youthful. Results are long lasting and even permanent.

Fat melting blepharoplasty:

If patient needs to remove fat punches and if he is younger below 45 years of age then fat melting is done. They do not need skin to muscle tampering. Special problem is passed. Flash heats the fat and steams out its water content in 2-3 seconds and shrinks the punches. There is no scarring. Results are long lasting.
Due to aging and occasionally due to hereditary causes, muscles and ligaments around the eye’s weaken. Skin becomes increasingly loose and puffy.

Risks-

Temporary blurred or double vision, bleeding, infection, dry eyes, swelling at the corners of the eye lid, formation of white heads. Slight asymmetry may develop due to scarring. Some patients may have temporary difficulty in eye closure. Some may have problems of pulling down of the lower lid.

Results lasts for several years. Sometimes results are permanent.
Blepharoplasty does not correct crows feet and other wrinkles or eliminate dark circles.

It corrects obstruction in vision caused by eyelid.

4:15 MOUTH LIFT FOR AGING OF THE CORNERS OF MOUTH

Due to aging, corners of the mouth naturally turn down. So, one feels older. Patient appears tired. To lift the mouth, incision is given in red part of the lips. Excess skin is removed through the lip incision. So, the area around the mouth appears tighter, smoother and pleasing. Fat is injected to plump up the lips. LASER resurfacing or dermabrasion resurfacing is also done simultaneously. Only 25% fat persists and rest of it is absorbed. Simultaneous face lift gives the face more natural and less operated or tight look.

4:16 BROW LIFT & FOREHEAD LIFT

Hooded eyes or heavy brow is earliest sign & most noticeable sign of aging. Eye brows fall over their orbital bone rim (the eye socket). Eye brows can be raised above this bony rim.

To lift the eye brow and to smoothen the fore head, brow lift is done endoscopically. It can be done in patients who is undergoing blepheorplasty (eye lift) and rhytidectomy (face lift).

The distance from the base of the nose to the anterior hair line should be about 1/3rd of the length of the face. When fore head is more in height, it can be reduced, if fore head is low, to raise hair line, resect full thickness skin and scalp in mid portion of the skull from ear to ear straight across.

Patient has high degree of satisfaction and results are uniformly good.

Patient face feels numbness for few months which gradually fades away. Sensation rarely return to normal level. In some patients, bruising is more and black eye may develop for few days. Red eye may also develops rarely. Small areas of hair loss may develop which can be covered with hair grafts.

In between age of 40-60 years, aging effects become visible. People develop various wrinkles and furrows on the skin and drooping of skin in certain area also develop. Due to emotional stress in our life, expression of muscles cause furrows. Some people have inherited low, heavy eye brow or furrowed lines.

To correct the appearance of sadness, anger, unnecessary wrinkles / furrows on forehead, and drooping of eye brows forehead lift and brow lift is done. Many people do not like these above mentioned lines. The tissues and muscles which are responsible for furrows and drooping are removed or altered to make the fore head smooth. So, also, drooping eye brows are corrected in the same procedure. Incision is behind the hair line and so it is not seen after healing. It is done under local anaesthesia with sedation to make a patient drowsy. It can also be done under general anaesthesia if patient prefers so. Forehead lift can also be done with the help of endoscope. It requires very small incision.

Thus, procedure can be done along with face lift and upper blepharoplasty. This surgery can also be done in presence of baldness or who have undergone upper eye lid surgery.

Before surgery, hairs are tied with rubber band on either side of incision line. Hairs in front area of incision may be trimmed. Incision is made behind the baldness so that its scar will remain invisible. In case of some baldness, incision is made near hair line. Sometime mid scalp incision is preferred.

In endoscopic forehead lift four or five scalp incisions of size 1 ½ to 2 cm are taken. Through one incision endoscope is inserted and through another incision, instrument is inserted.

The muscle and tissue layer of forehead is completely lifted. The nerves and blood vessels are carefully protected. The lifted tissue is carefully secured into their higher position by sutures beneath the skin surface. These can also be temporarily fixed by screws. Scalp incision is closed in layers.

If only this procedure is done in the patient, he/she can walk comfortably in a day or two but he should plan to have easy activities for a week. If forehead lift is done with endoscope, then, he can return to work more earlier. A vigorous activities should be avoided for 10 days. Prolonged exposure to sun or heat should be avoided. Visible signs of surgery fades in about three weeks.

Most of patients are pleased with the results. Patient needs to take care to maintain good health so that signs of aging can be postponed.

4.17 FACIAL SCULPTING

In some persons, some structures of the face are out of proportion with the features of rest of the face. Features may be smaller or larger than body desire. So, face becomes harsh and unattractive appearance. Excess bone is present in chin area above the eyes in eye brow region. In females, such face appears masculine. In males, face appears equally hard and mean. Such bone can be sculpted away through small incision given within hair line or eye brow. For chin incision is given through mouth.

4.18 NECK LIFT

With increase in age, underlying muscle of the neck become weak and so these are not able to support neck effectively. Middle of neck may develop sunken appearance and excess skin sags to form ‘turkey wattle’. In neck lift, underlying neck muscles are tightened and make the muscles less prone for further sagging as age increases. So, youthful appearance of neck is restored. Neck lift may be performed in conjunction with face lift or neck liposuction. Note that liposuction of the neck tightens the skin of the neck but does not correct weakness of the neck muscles. Neck lift is done under local anaesthesia. Sedation is given to keep patient relaxed. In this procedure, small incision is made under the chin. Surgeon locates the edges of platysma muscles which runs down in neck. These edges are brought together and stitched in midline. Posterior part of this muscle is tightened and fixed by stitching at the back of the neck. Such fixation makes neck and jaw support stronger. Soft dressing is applied. Patient notices new contour in four to six weeks. Instructions: Apply cold compresses to reduce swelling. Pain, discomfort and swelling can be treated with medicine. Give rest to the head and neck for early healing.

Midline neck lift:

Younger patients having fat deposit in the middle or lateral neck with muscle laxity and muscle bonding and mild to moderate skin excess are selected. After liposuction, superficial muscle aponeurotic system muscles of the midline including patysma are tightened. Excess skin is removed. patients can resume to his activities in 1-2 weeks.

4:19 THREAD LIFT / BARB THREAD/ APTOS THREAD/ CONTOUR THREAD

These varieties of thread face lift procedures are less invasive & require less down time. So, those who want to undergo face lift surgery & if the aging effect is less, then, they can choose this surgery. Those who can not afford to have post operative rest can also choose these. This procedure has its own limitations. So, let doctor decide whether you should choose this procedure or not. Nowadays everybody is busy. Everybody wants to look as good as possible without requiring any need of rest and down time.

To support sagging skin, along with underlying muscle barb threads are used to recover effects of gravity. The barbs are fixed into the surrounding tissue. The excess skin shrinks in 3-6 weeks. So, new look is created. Due to barbs on contour threads force is applied uniformly. Hollow needle is passed through fatty layer of cheek bones. Toper ends of the thread is tied deeper and firmer internal structure in the face. The other end passes under the skin for about four inches. When needle is passed, barbs on the suture deposit themselves in droopy part of the face. Results last for 6 months to five years. Side effects like swelling, bruising are rare.

Brow lift-

one point should be static superficial is passed through subdermal plane and deeper one is passed through fascia.

No. 1 for lifting nasolabial fold
No.2 for lifting marionette line
No.3 for lifting jaw

Contour thread is passed in zigzag fashion. Do not go upto nasolabial fold but 1 cm away from it.

After proceding, ask the patient not to open mouth too widely. Take soft food. Do not massage the face for a week. Contour thread is unidirectional and apthous thread is birectional in each half. Contour thread is fixed at its upper end and if lifts. Apthous thread is suspending thread. In contour threading for lifting the skin, pull the lower end of the thread and then adjust the tissue over it. If there is dimpling mobilize tissue slowly to reduce it.
mid face lift is done for nasolabial fold and cheek.

Contour threads:

4:20 EAR PINNA SURGERY (OTOPLASTY)

Otoplasty for protruding ear / bigger ear pinnas: Ear surgery of pinna, surgery or otoplasty is done to change the appearance of pinna or ear. Here ear means external part of ear which participates in beauty of face and head. This surgical procedure improves person’s appearance dramatically. This surgery reshapes the ears, reduce their size and folds them back to the head. It also corrects any asymmetry in appearance.

Some people have protruding ears or some have extra large ear (bat ear). Due to such extra large ears, or protruding ears, child is frequently teased by others or adults feel awkward. When external ear pinna appears extra prominent or bigger or protruded forward, otoplasty is done to reduce its size and to make it more backwardly directed. Thus, to correct protruding ear this surgery is done.

The prominent pinna shows protruding ear. So, children or the individual may be teased upon as elephant ears or bat ears or any other bad names. So, these pinnas lead to pathological self-consciousness and poor adjustment with friends and school. So, it is always better to correct this deformity immediately after the age of six years. In adults some benefits are obtained. Treatment of choice is a surgery. It can be done once pinna or ear achieves adult size i.e. after age of 6 years. It can also be done in younger adult age. In younger patient this operation is done under general anesthesia. In adults it can be done under local anesthesia.

These ear pinnas can be pin back or can be reshaped or reduced in size or made more symmetrical. Thus, successful otoplasty, the pinna of the ears are given proportional size and shape. This surgery does not affect hearing capacity. Patient needs to be in good health and should have optimum or realistic expectation. In children, the benefits are more because cartilage is very pliable. So, shaping can be done easily and child gets psychological benefit in right age. Cartilage in adult age is firmer and so it is less moldable. To achieve symmetrical appearance, surgery of both ear pinnas is advised. Incision is given in natural crease just behind the pinna where it joins the head. Optimum amount of cartilage and skin is removed to achieve the right effect. In case of protruding ear (bat like ears), the part of cartilage is sculpted and bent back towards the head. Thus, ear becomes more natural looking and lie flatter against the head. Sometimes it may be necessary to trim and reshape the cartilage. The reshaped cartilage is stitched back with permanent statures to secure the cartilage. Sometimes only stitches are given to hold the cartilage in proper position. The technique of procedure varies according to defect of shape and position. Surgery may take one to three hours. After incision in the back of ear pinna, cartilage is sculpted and bent back towards the head. Occasionally, in case of bigsize pinna, bigger sized cartilage is removed. In scar of incision fade away slowly.
In case of one sided defect, surgery of both pinna may be suggested for a better balance. After surgery, soft dressing is applied patient should avoid to sleep on that side. This surgery is safe incision almost disappear after a year. Risks like any usual operation in some patients, swelling, bruising, bleeding, infection a scar and numbness feeling may develop. It is not always possible to get perfectly matching results. But all patients are happy with the results. Procedure may require 2-3 hours. Down time is 2-5 days. Patient recovers in 3 weeks. Mild pain may be felt during post operative period.