7.1 Liposuction:

Liposuction is used as adjunct to health life style. Those who are ready to make changes in their diet and ready to exercise are good candidate for liposuction. These have 96% chances of decreasing in clothing size and 15 times more likely to be happy with results and long term outcomes. In United States of America & Europe, liposuction is the most popular and accepted cosmetic surgery. In USA, 5 lac people undergo this surgery every year.

Dr. Jafery Klien dermatologist from America standardized the procedure of liposuction.

It is done between 18-50 years of age upto 5 Kg overweight. Stubborn pockets of fats are dealt with. Patient must have realistic approach.

To alter size of muscle:

If muscle needs to be made larger, with the help of exercise do 10-12 repetition so that you can no longer lift it. If you want to shrink muscle, choose a weight you can no longer lift by 4 th or 5 th repetition. To slim and strengthen the muscle (e.g. muscle of legs) use lighter weights that you can no longer lift by 20 th repetition. Carry out aerobic activity like fast walk, stationery cycling, running or jogging and push ups.

Fat is usual component of tissue below the skin. Its thickness varies at various sites of the body and so it gives attractive contour to body. Pattern of fat distribution differ among the races, ages and sexes. Although total number of fat cells remain same in adult life, fat cell increase in size when person gains weight and becomes smaller when person loses weight. Women have more fat than men. Women fat cells are disproportionately more in areas of buttocks, upper thighs, hips. In men, even distribution of fat cells is observed in the trunk. Due to excess fat in body, extra fat accumulates in certain areas of the body.

Thus, in liposuction, unevenly distributed fat cells are removed permanently to change contour of the body.

When diet, exercises and medical treatment fails to reduce fat, liposuction method is used to remove fat permanently. It is safe, effective method of removing excess fat.

In process of liposuction, visible bulge of fat can be reduced with the help of vacuum suction like process to create attractive smooth body contour. Liposuction gives good cosmetic results in properly selected area and fulfills patient's realistic expectations. It provides permanent lasting results. It is financially affordable. Liposuction can be done with tumescent fluid injection and ultrasound assisted method/superwet technique/ power assisted technique. Liposuction permanently removes fat cells but overeating may not prevent weight gain because remaining fat cells in other areas still can store fat. Some people have fat inside the abdomen which cannot be treated by liposuction. Liposuction is done in skin of areas like abdomen, buttocks, neck, hips, thighs, flanks, back, waist, upper arms, chest and calves. It does not require hospital stay of more than 8-10 hours.

Patient should have reasonable expectation about results stable weight, and having good health. He should exercise regularly. Patients of mild fat, moderate fat accumulation are selected. Skin tone should be of good quality. Localized area of fat deposition are ideal for liposuction. Liposuction is not weight loss programme.

Consultation:

During consultation, patient should tell about all past and present health and medical problems. Show current and past records of treatment. Let doctor know which drugs including vitamins you are taking. Tell everything about your personal habits like consuming tobacco product and alcohol. Patient is assessed for locations of fat deposits, skin tone, skin infection, other body health problems and possible underlying hernias, redundant skin. Such redundant skin may be present in areas of tummy, trunk, breast, face, thigh and arms. Doctor assess whether it is fat or extra tissue.

Many patients often feel overwhelmed by number of options and techniques available today. They also get confused and are unable to take right decision. So, always take the help of your cosmetic surgeon.

Follow specific instruction given to you before coming for surgery.

Liposuction procedure takes half hour to three hours depending upon size of area, extent of fat deposition and number of sites to be sucked. In some patients additional other procedures is done simultaneously. For medical records, photographs of that part are taken. Sedation is given. IV fluids are given to maintain hydration. Antibiotics are also given. Your body vital parameter is monitored with equipments.

Tumescent liposuction:

Before the procedure you may be given sedation to feel calm and relaxed.

The area is anaesthetized by injecting local anaesthetic solution like xylocaine or lidocaine with adrenaline. Xylocaine anaesthetize the local area and adrenaline acts as vasoconstrictor to prevent bleeding. It makes area blanched, swollen, firm or tumesced. The expanded fat compartment allows the liposuction canulas to travel smoothly beneath the skin for liposuction.

Then, through very small incision of 2 to 4 mm in length infusion canula is passed. Through this, cannula dilute local anaesthetic solution is delievered into the fat tissue to make it 'plumped'up or 'tumesced'. After twenty minutes liposuction canula is passed through the previously made tiny incision to suck the fat. This canula has a round tip and multiple holes near its tip. At the other end of the canula, hose is attached. It is connected to suction vessel and vacuum machine or aspirator. Canula is advanced repeatedly and withdrawn in the area to be treated to suck fat. Fat accumulate in the affected bottle. The area takes new shape after removal of fat. If you wish you may be able to see fat exit through the tube.

After completion of the procedure compression garments are worn over treated areas.

Liposuction of belly:

Flatter tummy has lot of fat. This fat does not easily get reduced after dieting or exercise. So, this area is most commonly requested to be freed by liposuction. Some persons have more fat in upper part of abdomen while some have more fat in lower part of abdomen.

This procedure is done under local anaesthesia. Less commonly it is done under general anaesthesia. After anaesthetizing abdominal wall with tumescent solution. Very small incisions are given at certain multiple points to suck out the fat from all direction in such a way that most even results are obtained.

Dressing is applied. Special garments are worn for mild compression. After this procedure, patient can get up and walk. Recovery is quick. Generally, patients can start his work in 3 to 4 days. He is allowed to move to prevent increase in discomfort. Tylenol is advised to reduce discomfort for initial 48 hours drainage continues but it lessens after first 24 hours.

In some cases, localized subcutaneous fat collection is present which can be reduced easily with liposuction procedure. In some patients bulge of fat is more in lower half of abdomen. In some cases, abdominoplasty or tummytuck is done in same sitting or after some period. When it is done after some period, due to previously done liposuction is much smaller comfortable and safer.

In some cases, swelling develops near belt line which makes it difficult to bend at waist for few days. If bending is avoided discomfort is not felt. Lumpiness at some places may be felt for few days. After 3 weeks, patient experiences reduction in size.

Liposuction of the waist- love handles

Fatty deposits in waist are called love handles. In some women, at the waist area, excess fat is deposited and it appears straight line like appearance. Like abdominal fat these are not easy to get rid of with diet or exercise. Liposuction in this area helps to create more pleasing hour glass shape to this area.

Flat rim waist line:

It can be done with endoscope. If patient has lost some weight (5-10 Kg) by exercise, then, key-hole mini tummy tuck is done to create flat trim waist line with endoscope.

Liposuction of buttock area:

Fat accumulate in lower most part of buttock. When fat accumulates in extra area between the buttock and the back of the thigh. Some refer it as 'banana roll'. These problems can be easily treated with modern smaller liposuction canulas.

Liposuction of the hips:

Excess fat in the hips broadens the lower waist. So, clothes do not fit easily. This is easily treated with liposuction.

Liposuction of outer thighs:

Upper part of thigh is often associated with mismatched and follow lower part. It may be called, "Saddle bags or "riding breeches". The fat in this area also does not reduce effectively with diet and exercise. Results are better if fat is deposited in buttock. At the same sitting, hip areas are also treated by liposuction. So, clothes dramatically fit well and so patients feel well.

Liposuction of inner thighs:

The deposit in inner thighs often causes chafing and rubbing and so restrict free mobility of the patient. Liposuction is removes this fat partially.

Leg fat:

Leg fat is difficult and it is difficult to treat. Fat distribution on legs and ankles is genetically predetermined. Those women, who have such fat finds it displeasing and disproportionate. The fat is relatively displeasing and superficial. So, sub dermal vascular plexus easily gets injured.

Aggressive liposuction is avoided in legs and ankle.

After liposuction:

After liposuction, the body contour improves but two-third of patients feel fear of recurrence. i.e. whether bulges would come back. So, they have stress or confusion in mind at conscious or subconscious level. Some of them may even avoid to wear sleeveless dress or may feel embarrassed to do so. It takes sometime to change attitude, thoughts, self-image and behaviour.

Instruction after liposuction:

Take rest for 2-3 days to prevent excessive swelling and possible bleeding. After liposuction, one may apply ice packs to suctioned areas for the first 48 hours.

For 24-48 hours, wounds may ooze. So, protect bedclothes with cosmetic sheath.

Painkillers are prescribed to relieve pain. Take more fluids for 7-10 days. After 72 hours after surgery, bandages are removed.

Compression garment should be worn for 24 hours a day for the first week. In next two weeks, it should be worn for 12-18 hours everyday.

Use sunscreen (SPF fair 15 or higher) to protect the skin from sunburn.

Puncture marks slowly shrink and disappear by six weeks. One may use prescribed antimarks to reduce the marks.

Swelling reduces gradually. It reduces completely after 4-6 months. First change/ reduction of size and shape is noticed one to two weeks after surgery. So, initially during first 10 days clothes are felt tight.

One can go to work, drive and travel after one week. Walking can be resumed after a week gradually. Swimming and exercises can be resumed after three weeks.

Massage of local area may be started after 10 days.

Keep expectation realistic. Unrealistic expectations of patients lead to complications of unhappy patient. So, both doctor and patient should discuss fully before the surgery.

Complications:

Excessive liposuction:

It can be avoided by avoiding removal of excess fat on same day by avoiding other surgical procedure in the same sitting and by avoiding liposuction of excessive area of the body in the same sitting.

Common but minor complications:

Superficial of the skin discoloration, temporary bruising, haematomas, seromas, local skin necrosis, fainting, numbness may be observed in some patients. Some of the patients may feel giddy or have syncope (fainting), on the next day in morning. These can be tackled effectively.

Rare but severe complications:

These are anaesthetic complications, thrombus in the legs, overhydration, injury in deeper organ, excess blood loss, hypothermia, allergy of drug, infection, nerve damage, aspiration pneumonia, cardiac problems, hypoxia etc.

Drugs that prevent blood clotting:

Certain drugs interfere process of blood coagulation and so these should be avoided e.g. aspirin, ibuprofen, warfarin. Drugs like vitamin E, some herbal remedies, red wine etc. prolong bleeding process. Avoid all these drugs.

Risk of local anaesthetic drug:

Xylocaine or lidocaine is safe if it is used upto 50 mg/Kg bodyweight. So, if this limit is followed, its cardiac toxicity can be avoided.

Risk of general anaesthesia:

Modern techniques of general anaesthesia are streamlined. So, these complications have been reduced drastically. It is made more safe by performing single procedure at a time by avoiding excess liposuction and rarely patient may have inherited sensitivity to anaesthetic drug. Sometimes anaesthetic drug may cause over effects.

Vomiting may cause aspiration of the stomach contents. Rarely respiratory depression may be treated.

Like any other medical procedure, there are some risk of infection, bleeding, swelling, reaction to drugs, ripplings, dimplings etc.

Contraindications: (Following patients are not chosen for liposuction)

1. Patient with prominent medical problems like uncontrolled diabetes

2. Patient who have unrealistic expectations

Before getting admitted for surgery, patients should note following instructions:

1. Avoid any make up including mascara
2. Take medicine regularly
3. Report right time for admission
4. Be with empty stomach for 5-6 hours
5. Do not keep any valuable with you during period of admission in hospital
6. You may bring own CD to play in OT.

Postoperative instructions:

Take full rest for few hours.

Fainting :

Fainting may be felt immediately after surgery or after standing up too quickly or after removing decompression garments or at sight of blood or after urination. If one feels sensation of fainting, immediately sit down or lie down for 2-3 minutes. When one wants to remove compression garments first remove out compression. Outer compression garment and then after 10 minutes, remove second compression garment. Pass urine in sitting position. Do not stand suddenly and immediately after passing urine. Take your own time to pass urine and take interval of 2-3 minutes to stand up after passing urine.

Take medicine as per prescribed schedule:

One needs to change absorbent pads after 24 to 48 hours. When there is large amount of drainage use protective absorbent tower on your bed or furniture to protect underlying sheet from staining.

Avoid applying ice packs or heating pad to the skin. Do not seal incision sites with band-aids. Let them be open. Do not use go for swimming for at least 7 days.

Postoperative complaints:

Nausea: Some patients feel nausea due to effect of local /general anaesthesia, stress causing hyperacidity, antibiotics and certain sedatives.

Fever: Due to body's reaction to operative trauma some patient develops slight fever for first and twenty-four hours. Swallowing and pain. Due to surgery, inflammation develops and so pain, swallowing. Some redness develops for first twenty eight hours which subside later on.

Avoid certain painkillers:

Avoid painkillers like aspirin and ibuprofen for first forty-eight hours as it suppresses immune response to infection by impairing function of whole blood cells and promotes bleeding by impairing function of platelets in blood. If you develop dramatic increase in pain, report to your surgeon immediately.

Bruising and itching:

Some patients have a tendency to develop more bruising. Due to inflammation, these patients develop bruising. Normal healing process underlying skin may cause itching, which can be controlled by antihistaminics.

Seroma:

Seroma is a collection of fluid from the blood accumulated at the site of liposuction.

Thrombophlebitis:

Thrombus means blood clot. When blood clot causes inflammation of the vein, it is called as thrombophlebitis.

Toxic shock syndrome:

During surgery, bacteria may enter in the wound. These bacteria may release toxin which leads to development of this syndrome.

Frequently asked questions:

What is ultrasound assisted liposuction (UAL)

When ultrasonic probe is used to remove fat by suction it is called as ultrasonic assisted liposuction.

Why fat deposits feeling hard to budge persists in spite of proper dieting and exercise?

This is due to hormonal changes in woman caused by pregnancies, menopause or hormone replacement therapy. Many women have genetic predispositon. If exercise and dieting does not help, one may undergo liposuction method of liposuction.

I am in adult age but still I have double chin. Why? What can I do?

Double chin develops due to fat deposition. Such deposition may be due to overweight, hereditary cause or aging. Liposuction produces remarkable reduction of double chin.

I have failed to reduce fat around waist? Please advise me.

Nobody likes 'bear belly'. Liposuction gives predictable results when dieting and exercise fail. In men, fat is more in 'love handle area', the abdomen and occasionally chest. New techniques like ultrasonic and power canula used in our set up produces better results. Removal of fat cells by liposuction helps.

Goal of liposuction is to expose muscularity in men and to create sensuous curves in females.

Who should undergo liposuction?

Any person who has excess fat or who has local fat deposition or who is candidate for traditional liposuction is also a candidate for liposuction. This technique can be used over area of abdominal wall, face, neck, arms, thighs, carries, ankles, waist etc.

What is done during liposuction?

Under anaesthesia, tumescent fluid is injected through small puncture holes of size 2-3 mm are created to suck fat. Injected fluid is sucked along with fat. Replacement fluid is given through vein. After the procedure, area is compressed with tight dressing and compressive garment. Patient is discharged on the same day.

How much fat can be removed?

Amount of fat removal varies from case to case and need in the patient. 60 to 70% of local fat below the skin can be removed. If more fat is removed, then, there will be rippling and dimple formation. Skin will hang. In one sitting, 1 to 5 Kg of fat may be removed safely. Depending upon number of sites from which fat is to be removed, one requires number of sittings. These number of sittings can be decided.

These fat cells which are removed do not grow later on.

Why compression garment is required?

To reduce swelling and to help the skin for shrinking to new body frame, compression garment is used. Compression garment also helps to prevent bleeding and to reduce swelling.

How excess skin will look like after liposuction?

In liposuction, cells are sucked through cannulas by passing in subcutaneous plane in multiple direction. So, it allows to preserve fibrous connections between the skin and body. These fibrous connections help to contract the skin. But dimples, ripples and stretch marks remain unchanged.

Whether effect of liposuction or fat removal is permanent?

After age of puberty, when we gain weight the number of fat cells does not increase but the cells enlarge in size. When we remove fat in liposuction, these sucked fat cells no longer remain behind and so there is no enlargement. So, effects are permanent. After liposuction, if you do not control weight, by proper diet and exercise fat cells in other part of body may increase in size and may create body out of balance.

So, liposuction is not just removing the fat but it is 3D fat reduction or artistic liposculpture of the body to maintain natural shape of the body and to make it fit for wearing proper clothing. Areas like the abdomen, flanks and under the bra area is treated to make proper borders of the waist i.e. to achieve narrow waist.

Is liposuction is helpful to lose weight?

Liposuction is effective procedure to make uneven proportions of fatty body in to proportions.

So, weight loss is not main aim of liposuction but it is resultant effect. Thus, it improves relative proportion of fat deposition. If after liposuction, an individual will control weight by dieting and exercise the weight will not increase and shape will maintained. If the individual does not control weight by diet and exercise the fat will be deposited in other areas.

When will I see results of liposuction?

An individual easily feels that the fat has been removed when he or she touches the area. During healing there is reaction as swelling and some tumescent anaesthetic solution still remain for several days. So, improvement of liposuction remains hidden for several weeks. After about 4 weeks patient realizes that he/she needs new clothes which can fit proper and also find that it is easy to wear clothes which had not fit for a long time. Improvement continues for six months. Patient achieves enormous satisfaction and he/she is more ease with own body.

How the effect of liposuction is permanent?

After liposuction, there is scarring in sub dermal area and permanent decrease in number of fat cells. So, effect of liposuction is permanent. The body's tendency to store fat in old favourable area no longer continues. If patient does not control diet, he/she will gain weight but it will go to new areas and not in former troublesome areas.

If liposuction a safe procedure?

Liposuction done under local anaesthesia is safe procedure. When liposuction is done under general anaethesia inherent risk of general anaesthesia is involved and not risk of liposuction. When liposuction is done under local anaesthesia there are no life threatening complications.

Bariatric surgery:

The person who has a body mass index of 40 or more, bariatric surgery is done to reduce weight. So, one may lose 50 to 100 Kg. After huge weight loss, excess skin hangs from neck, arms, chest, legs and abdomen. Such person then needs body lifting or body contouring.

Pannus:

Pannus is a huge mass of loose skin hangs from stomach. Such form of skin affects the body movement, exercise, activities, fitting of usual clothes and skin health problems.

7 :2 Tummy tuck:

Those people who are in good physical shape but find their abdomen still possessing excess skin and fat. Tummy tuck helps them. So, protruding appearance of abdomen is reduced. It appears more flat and tight.

When there is excessive loose skin, excessive stretch marks and laxity or spreading of abdominal rectus muscle (often due to pregnancy) tummy tuck is advised.

Liposuction of fat in abdominal wall instead of tummy tuck:

It is much safer than tummy tuck. First do liposuction of upper abdominal wall and then wait for two months. Most of the patients are pleased with results of the first stage.

Flatter tummy has lot of fat. This fat does not easily get reduced after dieting or exercise. So, this area is most commonly requested to be freed by liposuction. In some cases, localized subcutaneous fat collection is present which can be reduced easily with liposuction procedure. Some persons have more fat in upper part of abdomen while some have more fat in lower part of abdomen.

This procedure is done under local anaesthesia. Less commonly it is done under general anaesthesia. After anaesthetizing abdominal wall with tumescent solution, very small incisions are given at certain multiple points to suck out the fat from all direction in such a way that most even results are obtained.

Dressing is applied. Special garments are worn for mild compression. After this procedure, patient can get up and walk. Recovery is quick. Generally, patients can start his work in 3 to 4 days. He is allowed to move to prevent increase in discomfort. Tylenol is advised to reduce discomfort for initial 48 hours drainage continues but it lessens after first 24 hours.

In some patients bulge of fat is more in lower half of abdomen. In such cases, abdominoplasty or tummytuck is done in same sitting or after some period. When it is done after some period, due to previously done liposuction. This procedure is much smaller, comfortable and safer.

In some cases, swelling develops near belt line which makes it difficult to bend at waist for few days. If bending is avoided discomfort is not felt. Lumpiness at some places may be felt for few days. After 3 weeks, patient experiences reduction in size.

Abdominoplasty:

To reduce dramatically protruding appearance of abdominal wall in which excess skin and fat from middle and lower part of the abdominal wall are removed. It is commonly known as 'tummy tuck.' So, best confident men or women who have relatively good shape of body but are bothered by large fat deposit and loose abdominal wall. Women who have undergone pregnancies and has stretched abdominal muscles may tend to have tummy tuck. In older patients who have loss of skin elasticity and obesity may chose to undergo abdominoplasty.

Who should wait before going for abdominoplasty?

Those who want to lose lot of weight should wait till weight is sufficiently reduced. Those who plan for pregnancy should wait till delivery or end of lactational period. Abdominoplasty enhances your appearance and self confidence.

Tumescent liposuction:

In tumescent liposuction, layers of fat are injected with large amount of anaesthetic liquid before liposuction is performed. It makes area blanched swollen, firm or tumesced. The expanded fat compartment allows the liposuction canulas to travel smoothly beneath the skin for liposuction.

Results:

Patient perceives the difference after surgery. More results are seen after 3 weeks. Final contouring can be appreciated after 3 months. Most of the patients are pleased with new contour. Those, who continue to take maintenance care like balanced diet, exercise, have lasting results.

Mini tummy tucks:

In fatty person, to remove fat and to reduce fold and bulges from the fold under the breast, down to pubic area, from hip, hip folds, flanks and love handles. Liposuction is done. It produces thin and uniform layer of fat over the area of the entire abdomen and the flanks.

In this procedure, a horizontal incision is given just above the pubic hair line in proper crease. Skin is carefully lifted. The underlying muscles are tightened surgically to flatten the abdomen. Slick and lax tissue developed due to pregnancy is removed. The navel (umbilicus) is detached from underlying muscle and layer and lowered down by about 1 ½ to 2 cm. excess skin is removed. Skin incision is then sutured. Preoperative horizontal umbilicus made vertical (more youthful looking). With the help of liposuction, groove is created in midline to etch in the abdomen. Man's pubis is elevated. Exercise can be resumed after 3-4 weeks. Healing & remodeling under the skin continues for about six months. Thus, smooth and flat, graceful athletic contour can be developed in the abdomen.

Buttock surgery:

Some have over sized buttocks. If an individual wants more youthful appearance of buttock region, procedure like buttock enlargement, buttock reduction and buttock lift can be done. Some patients have sagging loose and flabby buttock.

Buttock enlargement:

To produce higher and rounder buttock and to lift sagging of the buttocks, this surgery is done. It can be done by injecting fat into gluteus muscle and into fat space. Another way is under anaesthesia, put silicon buttock implants beneath the muscle through 4 inch incision. This procedure can be done along with other cosmetic procedure.

After surgery dressing, light compression garments are used for a few weeks. Pain is maintained and lasts for 3-4 days. Small swelling may develop which disappears soon. Rest is advised for 3 to 7 days.

Buttock reduction:

Under tumescent anaesthesia, liposuction is done as explained earlier.

One should follow precautions mentioned for liposuction. There are no stitches. If liposuction is done optimally. If procedure is overdone it produces sagging of buttock.

Buttock lift:

Incision is given to take out loose and excess skin. Thus, tissues are made tight. Incision is hidden in crease of the buttocks or can be kept hidden under the belt line across the lower back just above the buttocks. Stitches are removed after a week.

Occasionally, buttock lift can also be done by fat injection into gluteus muscle to make sagging area round and to lift the sagging area. In some patients both of these procedures are done simultaneously.

After the procedure, drains are kept for 2-4 days. Dressings and light compression garments are used for few days. Pain, swelling and bruising is minimum. Some grogginess is present for about a week.

These procedures can be combined with other cosmetic surgical procedures.

Thus, more proportionate, balanced and beautiful contour of the buttocks is achieved. Results are long lasting. Appearance of new look is natural and presentable. An individual becomes more confident and comfortable in tight garments.

Mesotherapy:

Mesotheragy is a medicine is injected into mesoderm layer of the skin to break down cellulite.

7: 3 BEAUTY STRATEGIES FOR NEW MOTHERS AND OTHER WOMEN:

Women:

When modern women think of health, she is concerned with stress but many of them are also concerned for sleep and weight loss. 75 % women want to lose weight but many of them cannot do it due to lack of cutting down junk food and tasty food. 25 % do not get enough time to sleep.

Regaining shape after child birth:

Child birth stretches stomach muscles and make the skin loose and hanging around the waist. Many women carry extra pounds after pregnancy and child birth. Medicine taken in childhood and during pregnancy makes its marks on body. Stresses of life, responsibilities and negligence creates dark circles and bags under the eyes. Breasts become stretched and distorted, stomach bulges, more fat deposits on hips. Thighs become more thick. The muscles of belly gets stretched during pregnancy which later cannot be filled by diet and exercise alone. Breast reduce after period of breast feeding and they develop stretch marks and hanging shape. Due to increase in weight, the kids and relatives may also lose respect for us. So, most of the women want to be perfect. So, they try to go to parlour for performation in other area. They make themselves less out going less confident and frumpy. Most of women want their shape back so that they can return to world of work more confidently and self assured. So, we start respect to ourselves.

Six months after last delivery, body settles down. Due to hormonal changes, mother may develop skin tags on the neck and chest, darkened moles, scars and freckles. Mellasma deepens in colour: There is increased hair growth on the upper thighs and upper arms. These changes often resolve on their own. One may consider liposuction and breast reshaping (reduction or lift augmentation).

Mother as well as perfect in appearance:

So to match youthful appearance, they perceive attractive person in oneself. Women undergo tummytuck (to tighten abdomen wall), breast lift (to lift and reshape the breasts), eye lids surgery (to erase bags below the eyes, liposuction of her thighs and waist (to remove the unwanted deposits) remove unnecessary wrinkles of body, stain on face and teeth etc. Such person stands up more straight, smiles more and feels frequently better, more confident, more outgoing with high self esteem.

When you meet cosmetic surgeon, do not be afraid to ask question no matter how trivial it may be. Generally doctor answers honestly and thoroughly. Let the doctor know about your motivations and expectation. He will tell you various available alternatives. He will not pressurize you for any particular procedure. He will tell risks of the procedures and variations in outcome. Note the fact that due to personal variations, healing problems in different individuals results never match cent percent with ideal. Everybody is unique in him / her. Everybody has his own body structure, anatomy, health status, healing tendencies etc. So, an individual cannot achieve someone's else's surgical results in spite of having same cosmetic surgeon. The more knowledge one has, the less fearful and more tolerable recovery will be.

Following procedures are used for after care:

1. Abdominoplasty (tummytuck)
2. Breast reduction
3. Breast lift (by non surgical way or in some cases by surgical way)
4. Brow lift (with or without face lift)
5. Face lift
6. Extensive liposuction
7. Above mentioned multiple procedures done simultaneously

Any of the following procedure if done does not require after care.

1. liposuction (small to moderate amount)
2. rhinoplasty (surgery to improve shape of the nose)
3. breast augmentation
4. otoplasty (ear pinning)
5. blepharoplasty (eye lid surgery)
6. breast lift (mastopexy)
7. cheek /chin augmentation

Miracle diet:
There is nothing like miracle diet. So, stop looking for miracle diet. Avoid simple sugar and refined carbohydrates. It affects the aging of the skin.
After child bearing age, there are many future years to enjoy and wear fashionable clothes and to wear bikini.

7:4 Autogenous tissue transfer (ATT):

Patients own natural tissue is transferred to the area when fullness is needed. It can be filled in frown lines, smile lines and marionette lines and wrinkles. It is also used for lip augmentation. Incision is given on each side of wrinkle and ATT tissue is filled to soften the wrinkles.

7:5 IMPLANTS

Pectoral implants:

If one cannot achieve the chest size of one's desire or to improve muscular appearance of the chest pectoral implants are used. If a person wants prominent muscular appearance of chest with more roundedness pectoralis implants can be put. This procedure also corrects asymmetry or unevenness from one side to the other. This procedure is done under general anaesthesia. In armpit 2" long incision is given at higher level. Space is created between the two chest wall muscles called pectoralis major and pectoralis minor. The soft silicon implant of suitable shape and size is placed in this pocket. Later on wound is closed in layer. No drains are kept. Surgery takes about two hours. Patient can be discharged from hospital on the same day. This procedure can be done along with other surgical procedure.

After surgery, compressive dressing and garments are put up. Some pain may last for 2-3 days. Swelling disappear after 3 days. Bruising is minimal. Patient can resume light activities in 3-4 days and can do full work in 4 to 6 weeks. This procedure improves enlarged full bodied muscular chest appearance. Thus, it produces balanced, beautiful and well-proportional contour. Results show natural appearance. Result lasts for lifetime.

Buttock implants:

Like breast, buttocks are areas of arousal. Buttock implants provide more pleasing appearance. Some women have lack of definition in buttock area. These women are benefited by enhancing their appearance, boosting their self esteem and self confidence. During liposuction procedures, fat grafting is placed in buttock area for augmentation. Implants are placed under general anaesthesia. It takes 2-3 hours. Patient recovers in 3 to 6 weeks. 1-2 weeks down time is required.

7:6 CELLULITE

Cellulite:

Cellulite on thigh gives 'cottage cheese thigh' appearance. Deep massage on affected area helps to reduce cellulite. This procedure is called as endermoligie in which rollers gives deep massage to the fibrous tissue and fat and gentle suction procedure lifts the skin and mobilize deep tissue. Thus trapped tissue and compressed fat is made lose. Thereby easing blood circulation. This is minimally invasive procedure.

Those who have just recently undergone liposuction get more benefit of about treatment. Sessions are relatively short and performed once a week for several weeks. Above procedure does not need anaesthesia. No down time and recovery time is required. Procedure needs 30 -60 minutes.

Many women have bump and dimpled area. Localized cellulite is often called as saddle-bags and it may also be present in thin women. These are located on thighs and buttocks. Exercise and diet may help to some extent. Due to body dysmorphic disorder, person may feel too much craze for cosmetic.

Person becomes fanatically obsessed with supposed bodily defect that nobody else can see. They endlessly check mirrors, comb and recomb their hairs and use tremendous layers of the make up. Such persons should consult psychiatrist.