Before you look in the mirror and utter in your mind “Ah, I want to enhance my beauty…”, you have to know what beauty is. The concept of beauty varies from age to age, from one culture to another, from one civilization to the next and indeed from one individual to another. What is beautiful in States is not beautiful in Greece. And what is beautiful in Arab World is not beautiful in India.
So you have to consider your profile in respect to your ethnic origin (eg.Bengali) and also the understand the modern concept of a Bengali beauty. The first and foremost is a definition of normality. Leonardo da Vinci has been the pillar stone of this definition, when he described the proportions of human face and the body. As building of a house is dependant on its structural framework, so the definition of this normality has been the ground framework on which- individual, ethnic, socio-cultural variations are embalmed. Obviously the concept is a dynamic process, changing its colours and parameters with time, but the basic ground framework always remains the same. Though certain basic parameters have been laid down in the aesthetic framework of cosmetic surgery, yet it is the surgeon’s own perception of the patient. Sometimes the patient may desire, something which ‘she’ feels might look good, but the surgeon may perceive it otherwise. Unless the surgeon and the patient can meet on a common platform, it is best not to have cosmetic surgery.
Kolkata has a culture of its own and indeed stands uniquely as being the cultural capital of India. Indeed lots of beauties have emerged from this historic soil. To figure, where cosmetic surgery stands in Kolkata, one has to understand, what is beautiful in Kolkata?
In considering the facial profile as a whole, - we all know nasion, nasal base and chin must be in a straight line in the side view. This is the western concept. The grannies in Kolkata would hug a newly wed bride by her chin. So mild chin protrusion may be the concept of a Bengali beauty. “Beauty is in the eyes of the ‘beholded’”- if one organ is most important in a face, it is the eyes. Many a poets have written volumes on its beauty, many an artists have flown with its dream - even sculptors at Coomortooli will say this forms the mainstay of sculpting of Goddess Durga. Its disposition varies with the ethnic trait of the individual. The distance between two eyes is broad in an eastern Asian (Japanese, Chinese etc.), whereas it is narrow in European face. Bengali face is somewhere in-between.
After eyes, most people would view the nose. Where does the root of the nose originate? In a Greek it will probably be at the nasion. In an Anglo-Saxon, it is slightly lower down. In Bengalis it is usually further down. An even dorsal line would be the most aesthetic nose on the lateral profile. We all know African or Arabic Nose (especially males) have a broad nasal tip, British nasal tip is relatively thin - Bengali nose has a softer hue with slight supra-tip projection. When treating the nose to maintain the lateral profile, adequate proportion of the lips is important in relation to forehead and the chin.
Figure 1: Correctly Augmented Breast
Figure 2: Over-augmented Breast
Does Bengali beauty end with the face? What happens below that?
In Kolkata, the bra manufactures have no clue of what it means by a 32 or 36, ignoring the cup size in their nomenclature. Invariably ladies grow up with a wrong concept of their bra-size. The first and foremost is a philosophy, that there is a gradual droop of the breasts with age. The breast of an eighteen year girl and that of a fifty-five year old lady are not the same. This natural droop with age forms the aesthetic basis of performing breast surgery. On the lateral profile the line from collar bone to the nipple must be straight line, rather than an obvious convex curve. The breast projection is to be a balance with the profile of the individual, while performing an augmentation or reduction. This is to be balanced with shoulder distance, girth of the individual and the age of the patient and above-all the diameter of the buttocks.
In short, the individual seeking to enhance her beauty is unique. And perception of this uniqueness is the key issue, before jumping into cosmetic surgery.
I will try to give a scientific shape of this uniqueness - in defining the parameters of performing this art. They say no art grows without a vision; no discoveries are made without a dream- dream can materialize only when there is a perception. Some people ask us to show pictures of operations performed on others or computer imaging of the projected appearance. I have strong reservations:
- The picture of an individual subjecting herself to cosmetic surgery is entirely personal and not for public exhibition.
- Surgeon would show only his best works and leave out the average ones. The patient seeking surgery might not always get his best results.
- The picture shown is of another individual, whose uniqueness varies from that of the patient.
- Computer Graphics only can sell dreams, which in reality may never materialize and this results in dissatisfaction.
History of Cosmetic Surgery
The art of Plastic Surgery was practiced as early as 200 BC in ancient India where women’s noses, mutilated by their jealous husbands, were reconstructed using flaps of skin from the forehead. For thousands of years with the progressions of modern medicine, plastic surgery slowly evolved. Used to correct birth mutations or acquired deformities, plastic surgery was first found to be relevant in reconstructing bodies that
were wounded in wars. Following the American Civil War (1861-1865) and the introduction of anaesthesia and antiseptic techniques, the stage was set for the flowering of plastic surgery. By making surgery cleaner and less painful, it encouraged a great surge in less life-threatening operations. Probably the greatest step towards the recognition of plastic surgery as being a legitimate branch of surgery came in World War I, where actual “plastic surgery units” were opened in hospitals. These units were designed to treat combat veterans who had received extensive gunshot injuries and burns on the front.
The technologies continued to advance and there was an increased amount of studies published by doctors around the world. It was not until after World War II that the principles of cosmetic surgery were established. Cosmetic surgery, which is a branch of plastic surgery, was designed to improve and rejuvenate the appearance of an individual. Cosmetic surgery was developed to respond to a person’s need to change some aspect of their appearance, frequently one which has bothered them over the course of their lives. Advancements were soon made that made scars less visible, thus making cosmetic surgery less obvious in it patients.
Today’s cosmetic surgery has evolved considerably from when it took its birth in 1920’s from the prisons of San Quentin. Here the inmates were ordered cosmetic surgery to elevate their mental well being. This theory was substantiated by a Viennese Psychologist by the name of Alfred Adler who defined the conceptions of body image and the resultant “inferiority complex”, as a result of cosmetic unfulfilment.
It is a multidisciplinary approach between a plastic surgeon, cranio-maxillofacial surgeon, orthodontist, clinical psychologist, qualified beautician and dietician.
Broadly this can be divided into 3 groups:
- Facial Aesthetic Surgery
Facial Cosmetic Surgery is perhaps the most challenging aspect of Cosmetic Surgery. Firstly it is to do with the most exposed areas of the body. Secondly the results are easily noticeable by anyone. And thirdly it projects the personality of the individual.
Before anyone attempts Facial Cosmetic Surgery, one has to be familiar with the concepts of beauty, - its evolution with time. Also the surgeon must be familiar with the ethnic variations.
It is an art. An art that is mastered with experience. Every individual has got its own ethnic and genetic traits. The aim is to improve those traits without jeopardizing its originality. That is where the art and experience of the surgeon to know about individual comes in.
When the groom’s relatives see an individual first they glance at her face. Though make-up may cover up blemishes temporarily, yet for a permanent solution, cosmetic surgery is called for.
- Scar Revision :
Imagine an old man’s face. Any scar to be less visible must fall on these lines. If any scar crosses these lines it will be visible.
Scars are the body's reaction to healing skin. Unfortunately, when injuries occur, the size, shape, and location of wounds are unpredictable. Wounds heal by laying down scar tissue. Physicians are unable to consistently predict how a patient will heal for a given injury. Ethnic skin, such as Blacks, Hispanics, Asians, and patients of Mediterranean decent has a higher incidence of healing with hyper pigmentation. Caucasian skin tends to heal with hypo pigmentation. It is important after appropriate cleansing and wound care that a patient understands that a scar will continue to heal and look its best one to two years post injury. Most physicians would not recommend scar revision for a minimum of six months to one year after the injury/surgery. Besides the expertise of the surgeon, to limit scarring, other factors, such as size, location, shape, age of the patient, and healing ability play a role in the final result. Even with scar revision, which can be performed by several techniques, the resulting scar may be better, worse, or the same. Therefore, it is important that the patient and the physician revise scars that are cosmetically unacceptable and have a high probability of improvement. Scars play a role in appearance, but can limit movement of a joint, retard growth of a child, and may be painful, bleed or ulcerate. Scars that cause functional impairment are almost always revised. Non-surgical treatments of scars include sun avoidance, Vitamin E, steroid applications, steroid injections, or the use of silastic gel sheeting. It is the public's misperception that plastic surgeons operate without producing scars.
Unsightly facial scars and blemishes can very often be improved by well-planned and carefully executed surgery. It must be stressed that a cosmetic surgeon cannot make invisible scars. He can only make the scars as inconspicuous as possible. The aim of scar revision is to achieve a scar, which is fine, level, and even with the surrounding tissue and about the same colour as the adjacent skin. We do not want the scar to pull on the surrounding structures. The old unsightly scar has to be removed first. Any planned surgical incision heals in exactly the same manner as any other deliberate or accidental cut, i.e. it produces scar tissue, which is nature's method of healing. Once an incision is made and sutured the surgeon has little control over the healing process, a fact that must be appreciated by the patient. It is often not realised that a period of 6 to 18 months must elapse before the scar is mature; the stage where no further change or improvement will occur. Initially, any scar will be red and raised above the level of the surrounding skin and may often be hard in consistency. Gradually the redness and hardness lessen and resolve leaving a soft scar, which is level with and somewhat paler than the adjacent skin. For these reasons scar revision must not be undertaken too soon because adequate time must elapse to allow the original healing tissues to mature. When revising a scar on the face the surgeon attempts to get the best possible result by placing the new scars parallel to or actually in one of the normal crease lines of the face. This usually means that the direction and shape of the original scar has to be changed.
Although scar revision often requires surgical treatment, non-surgical treatment can be considered appropriately and sometimes considered first. Non-surgical options include: silicone sheeting, laser use, steroids, ultra-violet radiation, and permanent cosmetic camouflage. Excision of large scars or blemishes may require several operations over a period of time. It must also be mentioned that some areas of the body always produce noticeable scars, e.g. nose, chin, chest, shoulders, upper back and parts of the arms and legs. The patient is admitted on the morning of surgery. Most facial scars can be revised under local anaesthesia. Extensive scarring in adults and scars in children are best treated under general anaesthetic. Most scar revision procedures can be treated on a day-care basis, but some may require an overnight stay in the hospital. It is most unlikely that any scars can be removed completely, but the aim of the procedure is to make them less noticeable and perhaps easier to disguise with make-up. The goal in scar revision is improvement and not perfection. Patients who are unable to accept this should not have treatment.
With experience, the cosmetic surgeon can predict whether there will be scar improvement after surgery. The surgery usually involves an overnight stay and may involve surgical interference to sand papering (also known as dermabrasion) to laser resurfacing. In where surgery may not give significant better results a qualified beautician, who advises on Cosmetic Camouflage and Make Up, gives cosmetic camouflage.
Hypertrophic Scars are difficult to treat. In dark skin there is an increased possibility of forming hypertrophic scars and keloids. So also it is common with the redheads. Keloids are seen in all races, but are more common in darker-skinned individuals. Keloid scars are abnormal scars that grow beyond the boundaries of the injury. For example, a simple ear piercing may lead to a marble size keloid. Keloid scars are difficult to treat and are many times misdiagnosed by physicians and patients. Keep in mind, when a surgeon performs a cosmetic procedure, scars are placed in locations that are cosmetically acceptable, unlike traumatic wounds.
Normally scars do settle in a year to fifteen months time. If it tends to be prominent it is hypertrophic, if associated with itching it tends to be keloidal.
Acne Scars are deep pits on the face as a result of Acne Vulgaris (Pimples). This cannot be treated medically. Only surgical treatment is the curative solution. The best way to treat this is by dermabrasion or laser . Sometimes more than one sitting is essential.
Vitilgo (white patches) is a common problem and can be treated by dermabrasion and grafting or micropigmentation
- Nose Job
This is one of the most frequently requested types of cosmetic procedure. It is a surgical procedure, which reshapes and realigns the nose either to repair injury or to correct a deformity which may be hereditary. This is the main anatomical objective but it must be remembered that the benefits may extend way beyond this in terms of enhanced self-image, greater pose and confidence and improved performance. It is appropriate for males or females after the age of puberty. The nose is a very important facial feature.
Although this operation is anatomically straightforward, it requires the most meticulous of surgical skills, and the aesthetic anticipation and perception of an artist, in order to form a ‘new nose’ that will blend in and harmonize with the whole face, and give natural and individual results. Through rhinoplasty many problems can be reduced or corrected - long noses can be shortened, crooked noses straightened, bumps and hooks removed, wide noses can be narrowed, bulbous tips removed, nostrils made smaller, etc. It is important to realize that drastic changes to the nose are not desirable, for various reasons. For instance, the underlying bone structure may not permit it, or the potential result may not harmonize with other facial features, and therefore, would look unnatural. The surgeon ensures that any reshaping to the nose does not impair breathing function. A patient usually has an idea of the shape of nose desired, but this must be realistic and make allowances for the points mentioned and clearly the advice of the surgeon on these points must be followed. Results are limited by your anatomy and a nose matching someone else’s features may not match your own. It must be remembered that although surgical changes to the nose should be subtle the overall facial transformation thus effected can be very significant indeed.
There are risks associated with rhinoplasty, as with any surgery, but these are limited and complications rare. The greatest risk is that of a result undesirable to the patient. An understanding between the patient and the surgeon reached at consultation should reduce this. It is also possible for some asymmetry or contour irregularity to develop but this can usually be corrected later. Rhinoplasty involves the removal or alteration of nasal bone and cartilage. The skin subsequently adapts to the new bony arrangement of the nose. Surgery is usually performed internally, that is from inside of the nose, thus leaving no visible scarring, except under special circumstances. For instance, to alter nostril size, an incision may be required at the side creases of the nose where it meets the face, but these incisions normally heal very quickly and the scars become virtually invisible. The operation is performed under general anaesthesia. The procedure itself takes about an hour, or more, depending on its complexity. Three nights’ stay in the hospital is usually required. Major changes are apparent immediately, but your nose will continue to change to a certain degree for up to 2-3 months. Expect this and accept this. It usually takes six to nine months for all the subtler contour changes to take place. This process can not be hurried and nature must be allowed to take its course. It is a lengthy process and patience and understanding are required.
- Correction of Eyes
The eyes are perhaps our most important facial feature. They are our source of vision, but not only that - ‘the eyes are the mirror of the soul' and have the ability to show our feelings, and emotions, and to greatly influence overall facial expressions. One's eyes and surrounding tissues can also be regarded by the layperson as a barometer of the health of the individual.
- The direction of the lateral slant can be re-adjusted to give a more aesthetic look
- The aperture of the eyes can be narrowed or widened
- In widespread eyeballs, the orbits (the casing of the eyeball) can be moved inwards by craniofacial surgery.
- Eyebrows can be made, if they are missing or re-adjusted to required levels
- Protruding Ears
The most common of all operations on the ear is to "pin-back" protruding ears. The surgical name for this operation is Otoplasty, which can be performed quite effectively as early as the fifth or sixth year, as by that time the ear itself has already reached almost adult size, so that there will be little if any subsequent change. The operation involves the repositioning or otherwise altering of the flexible cartilage structures of the ear. There are many variations of this problem and each must be treated differently. Very simply, the surgical objectives are to reduce the protrusion and at the same time to provide a normal outline when the ear is viewed from the side. Surgical incisions are usually hidden behind the ear, where any remaining surface scars will not be visible. Occasionally external incisions are required, and these can be placed inconspicuously within the normal contours. Otoplasty is normally regarded as an overnight stay operation carried out under local or general anaesthesia. It should be noted however, that both ears are never exactly alike, even in the normal state, and that perfect symmetry is therefore not a reasonable expectation. In cases where significant differences occur, however, secondary treatment may be performed. As the skin has been lifted during the operation some collection of fluid or blood may well occur. This is guarded against by the special padded dressing that is applied following the operation, which must not be disturbed in any way. Minor adjustments in ear lobes may be desirable afterwards. The operation has no adverse effects upon the hearing mechanism, as it does not actually involve the inner ear structures of the organ itself. Finally, the otoplastic operation is generally most successful and most rewarding for the patient in terms or improved personal appearance, confidence and self-esteem.
- Cheek Enhancement
The height and projection of the cheekbones can be altered by the insertion of prosthetic implants, collagen injections, artecol injection and autologous fat implants or bony recontouring. Cheek implants can improve facial harmony by giving greater definition to the cheekbones. Cheek implants are silicone plastic shapes designed to rest on the patient's own cheekbones. These are usually inserted via a small incision inside the mouth. There is therefore no visible external scarring. Collagen injections can be used if a small increase is required. Unfortunately the body gradually absorbs collagen and top-up injections will be necessary at intervals. With autologous fat implants, the patient's own fat can be used to augment the cheek. The donor fat can be taken from the abdomen, thigh, neck, etc. and injected through a wide bore needle into the cheek area. This procedure is not permanent but seems to last longer than collagen. Post-operative problems are uncommon, but the following complications can occur. A full discussion with your consulting surgeon is advised.
Cheek implants can move out of position to give an asymmetrical appearance to the face. This is more likely to happen during the early post-operative phase. Infection can also occur in the post-operative period. The implant has to be removed and the infection effectively treated before re-insertion. Finally, cheek implants can produce a dramatic improvement in suitable cases and the result is permanent. Higher cheekbones tend to make people more photogenic. Collagen injections and fat transfer produce more subtle effects that slowly change back with time unless kept "topped-up". However artecol is a more permanent solution. .
- Improving Your Lips
Lips, no doubt enhance the beauty of the face. The contour of lips and its lining relates to the overall facial profile. Enhancement can be in the form of augmentation or reduction. Augmentation can be done by natural or artificial tissue taken from other parts of body.
- Natural: Body’s own tissue can be used to augment the lips.
- Artificial: Among the artificial tissue Gore-tex has been proved to be the most inert material. Gortex has been used for over 20 years in the body and is very well tolerated. Prior uses include using it in bypass surgery long before it was used for ski jackets and gloves.
As a circular thread, the Gore-tex is passed deep within the centre of the lips to plump up the shape. Swelling lasts for several days and there is little discomfort associated with the procedure. This is performed under general anaesthesia.
The sensation and the feel of the lips will be unaffected. Someone kissing you will not feel the gortex, however if you were to grasp your lip between your fingers you could identify the insert.
This procedure is a relatively simple way to achieve the desired end result. The change is very subtle and as in most cosmetic surgery appreciated very much by the patient.
- Improving Your Chin
The chin is an important facial feature, particularly so in evaluating one's profile. There are two distinct reasons for cosmetic surgery to the chin; the first is to rejuvenate a sagging chin and the second is to improve or correct a receding chin, thus enhancing the profile. We want the chin to harmonize with your facial features giving good definition and balance with your facial structure. The operation to rectify a loose or drooping chin is usually the lower facelift operation, described in the ' Facelift ' leaflet. The operation to rectify a receding chin can be by natural or artificial materials.
- Natural Material: Chin protrusion can be affected by making an incision from inside the mouth and moving the jaw bone forward and fixing it with titanium plates and screws.
- Artificial Material involves the insertion of a small silicone implant just in front of the jawbone. A receding chin is a common problem and may be associated with deformity of the nose. Minor degrees of 'receding' chin often become more noticeable with age. The implants have a subtle enhancing effect on the face and are rarely conspicuous yet very successful. The implants used to improve the chin are shaped to the required contour and are inserted through a small incision inside the mouth. The procedure therefore leaves very little, if any, scarring. The procedure is usually performed under general anaesthesia.
Finally, the improved shape of the chin and balance of the face, especially in profile, should be permanent once the wound around the implant has fully healed. The receding chin is a common condition and its treatment can be very satisfying allowing for marked facial balance.
- Torn earlobes
A common problem for women is torn earlobes. This occurs from wearing heavy earrings or earrings which are pulled upon, causing the tear. Torn earlobes can be easily repaired under local anaesthesia as a day case procedure. Sutures are removed in one week, and ears may be re-pierced in eight weeks. It is recommended to avoid heavy and large dangling earrings to prevent recurrence.
- Breast Surgery
The idea of the beauty has changed over ages, in different cultures and at various stages of civilisation, along with its individual perception. This is mainly related to facial aesthetics and body contour. Seldom is much talked about breast- except that it is ornamental in a female, as much as it is the first contact between a mother and a child after birth.
In breast it's ‘proportions to the body of the individual (i.e. height, structure, girth etc.) has to be considered, when visualising the outcome.
The first and foremost is a philosophy, that there is a gradual droop of the breasts with age. The breast of an eighteen-year girl and that of a fifty-five year old lady is not the same. This natural droop with age forms the aesthetic basis of performing breast surgery.
Aesthetic Surgery is an art and the success of the cosmetic surgeon lies in the fact that the profile is enhanced; yet nobody can recognize that the lady underwent cosmetic surgery. This is where the natural aesthetics of the breast should be taken into account. The other factor, while performing this surgical art- is not only the immediate result, but also its long-term aesthetics. Gravitational changes with aging do play an important role together with the intrinsic changes.
That the fashions of performing breast surgery are changing is reflected in our human beings’ eternal quest for a change due to our inherent dissatisfaction with what is present.
Breast is one of the organs, which give femininity to a female. As it is ornamental to the psychology of a female as well as to the male eye - to the child it is first rapport with the mother. Modern cosmetic surgery of the breast stems from two important horizons- the beauty of the virgin breast and the improvement of its cosmetic appearance after childbirth.
To understand breast surgery one has to be familiar with the psychosexual disposition of the individual; and indeed with the socio-economic taboos. To discuss anything about breast in Kolkata, even today, is a relative ‘shame’ - how can we talk about cosmetic surgery? As much as the nose or the eyes can enhance a feminine look the breast can add to the overall femininity of the individual. One must remember, like the eyes, the nose, the lips; - breast has an important profile in the psychosexual disposition of the female. As much as it is ornamental, it is the first essence of motherhood, where a newborn child establishes its first rapport with the mother. In short, it gives a lady her femininity.
Indeed big breasts do form a physical problem causing back, neck and shoulder pain, abrasion of skin by bra straps due to its sheer weight - needless to say the social ‘comments’ do distress the ladies. Breast reduction is one of the most popular operations performed in other parts of the world.
Small breasts seem to cause a severe psychological problem for a female in the development of her femininity. ”Sh! Sh! Thou shalt not discuss these issues” - mums would say, disregarding the psychological trauma the girl is going through. Yes this simple operation can change a girl’s life.
Modern Cosmetic Surgery aims at increasing or decreasing the size of breast and if necessary lifting it to the desired level aiming to counteract the effects of gravity and yet provide the best aesthetics. It is an art of making the 'body beautiful'.
Among breast surgery for the ‘brides would be’ few needs consideration.
- Breast Enlargement
It is a fact, unfortunately, that no amount of exercise, hormonal treatment, or creams will have any noticeable effect on the size of small breasts. There is no method, other than surgical correction using implants, that can increase the size and fullness of the breast, and thus augmentation mammoplasty has become a very popular method of enhancing the female form. This operation has been successful in this country and world-wide and has helped many women attain a better figure, which in turn has made an important psychological contribution to their feelings of femininity, confidence, general sense of well-being and happiness. Physical and psychological factors are closely linked in this area. Patients are very carefully assessed by the surgeon in order to assist patients in realising their expectations and to achieve a mutual understanding.
Breast augmentation can be performed at any age after the breasts are fully developed, but there are regulatory restrictions on the use of breast implants in women less than 18 years of age. There is no scientific evidence that breast augmentation increases the risk of breast cancer, autoimmune disease or any systemic illness, nor is there evidence that breast implants affect pregnancy or the ability to breast feed. In addition to the positive aesthetic outcomes of breast augmentation, data has shown that many patients enjoy substantial psychological benefits including enhanced self-esteem.
When analyzing this popular procedure the key issues that come to one’s mind is “What do we insert?” and “Where?”
Augmentation mammoplasty is suitable for women who perceive their breasts as being too small, either because they have never had full development of breast tissue or as a result of the loss of breast tissue that sometimes occurs after pregnancy and breast feeding. Small breasts may also be due to massive weight loss. If breast sagging accompanies small breast volume, a breast uplift operation, Mastopexy, may be required. Augmentation and Mastopexy can be performed together or separately. Post-mastectomy breast reconstruction is also performed to correct the deformity resulting from the removal of a breast, e.g. for cancer. Modern surgical techniques allow the aesthetic plastic surgeon to simulate a breast, and free the mastectomy patient from the need to wear an external prosthesis within the bra. This surgery does not usually alter breast function. Since the operation does not interfere with breast tissue, the possibility of breast feeding after pregnancy remains unaltered. It must be remembered that not all women can breast feed successfully anyway - the important point here being that the breast will function the same after treatment as before. There may be altered nipple sensation.
Augmentation Mammoplasty does not increase or decrease the chances of later developing breast cancer.
Augmentation mammoplasties involve the small breast being made larger by the insertion of a pre-formed "gelatine-like" material implant, into a pocket behind each breast, through a small incision. (This is not to be confused with silicone injections that are used.) The implant is placed either above or below the pectoralis muscle that covers the ribcage. The texture of the implant is very similar to the natural feel of the breast. The size of the implant can vary, according to the wishes of the patient and the advice of the surgeon. However, the size selected is based on the degree of stretch within the breast and the amount of breast tissue available to accommodate the implant. The patient’s general physique and stature must also be taken into account. There are now available to assess the desired size of implant. A natural looking result is the aim.
There are several variations to the above described technique. Different types of implant may be used. The location of the incision can be varied. It may be beneath the breast in the normal fold of skin, or in the armpit, or it may be in the areola, the pigmented area surrounding the nipple. These variations can be discussed in greater detail with your consultant. The main purpose of the procedure is to make the breasts as attractive as possible. There will be scars but these will be kept as small as possible, and either hidden, as stated above, beneath the nipple or under the creases of the breast or in the armpit. In either case they usually fade and become almost unnoticeable after a period of time. Some factors to be considered when making your choice of implants are the compatibility of implant materials with your body over time, the need to have a well read mammogram, and to be able to follow the implant over a long time. Implants are man-made and can wear out. Of course, the implants need to look and feel right. All breast implants utilize a silicone shell but the fillings differ. Silicone implants are gel-filled, saline implants are filled with salt water, the most
- Breast Reduction
Large breasts may be attractive to some male eye, but it causes enormous inconvenience to the victimized female. In addition to breast pain it also causes shoulder, neck and back pain. Getting the right cosmetic clothing (bra etc.) to turning from one side to the other or carrying out gymnastics, it is a nuisance to the person who develops this hypersensitivity of the oestrogen receptors during puberty. The social comments to the downward fixation of a male vision in a discourse - shatters the identity.
Reduction Mammoplasty is the name given to the surgical treatment designed to overcome a number of problems caused by excessively large and pendulous breasts. The breasts are naturally too large through the development of excessive breast tissue. This may have caused stretching and relaxation of the supporting breast ligaments that results in sagging and loss of the desired feminine outline. This condition can be as psychologically disturbing to a woman as extremely small breasts, causing feelings of self-consciousness and embarrassment. However, there are physical problems associated with excessively large breasts - breast discomfort, shoulder and neck pain and backache are prevalent. Participation in various athletic activities is limited. If the condition is left unchecked into later maturity it may affect the posture through strain and a possible curvature of the spine. Lesser problems, but very still very frustrating, relate to the need for special supportive undergarments, and difficulty in finding suitable clothing to fit in readily available sizes.
Successful treatment of this condition by means of surgery is not new, and has been practised for more than fifty years. The operation is designed to reduce, uplift and firm the breasts. It involves the reduction of breast volume, removal of the breast tissue and the restoration of a normal contour consistent with the patient's skeletal proportions to give a natural appearance. It also involves the repositioning of the nipple to a level consistent with the new breast shape. Results are very good.
With this operation the ability to breast feed is sometimes affected. Nipple sensitivity may be partially or completely lost depending on the treatment selected. Sometimes numbness occurs related to the scar areas. It is unlikely but there may be some asymmetry of the breasts, but it should be noted that no two breasts are identical, even in the normal state and that absolute perfect symmetry is not a reasonable expectation. It is rare but scars can sometimes widen, and may need revision at a later date.
The operation is performed under general anaesthetic and takes about two to three hours. It necessitates a three night’s stay in the hospital. As far as possible incisions are made in the fold under the breast or around the pigmented nipple area (the areola) in order to minimize scarring. However, there will be scars, even if they are hidden in natural contours but most will fade and improve with time. The position of these, together with any other questions you may have, should be fully discussed with your surgeon at consultation.
Finally, results of this operation are extremely successful and rewarding for patients. A typical comment afterwards is "If I had known how easy it was, I would have had it done earlier."
- Breast Uplift
Most women will experience varying degrees of breast sagging and loss of firmness at some stage in their lives. The cause may be a tendency that one inherits. It may be due to pregnancy, alternate weight gain and loss, or simply be part of the normal ageing process. The size of the breast in total volume may remain the same, but the firmness and erect position of youth are lost. The breasts have become pendulous, flattened and displaced to varying degrees, with loss of female contour.
Mastopexy is the surgical name for the operation that can restore the firmness of the breasts, and correct their position on the chest wall without increasing or decreasing their size. The operation involves a rearrangement of the soft tissues, shifting of the nipple position, and increasing firmness by tightening the skin covering. Position of the incisions can vary and this should be discussed with the surgeon. The incisions are intended to be as minimal and as concealed as possible. Nipple sensation usually returns to normal although there could be some numbness during the healing process. "Perfect" breasts are not a realistic expectation, but symmetry is the goal. The question of long term results with regard to scarring, nipple sensation, asymmetry and permanency of effect should be discussed with the surgeon.
The operation is performed under general anaesthesia and a three night’s stay in the hospital is required. Patients may return to work within one to two weeks.
Mastopexy is an excellent surgical procedure. It produces rejuvenated breasts, which is the anatomical objective, but it must be remembered that the benefits extend way beyond this in terms of enhanced self-image and self-confidence. It has helped many women return to more youthful and feminine contours and thus makes a significant contribution to feelings of femininity and a general sense of well-being.
- Male breasts or Gynaecomastia
Male Breasts or Gynaecomastia is males having breast tissue like that of females. It can be surgically corrected. Though liposuction has been tried, since breast is a fibro fatty glandular organ and liposuction only sucks the fat out, liposuction has been ineffective. Surgery is only the treatment of choice. The scars are around the nipple and rarely noticeable.
The operation is performed under general anaesthesia and hospital stay is four to five days. Patients have to wear pressure garments for six weeks.
- Unequal Breasts
Unequal breasts[i] may be due to an underdevelopment of one breast or over-development of the other. Basically the decision is of matching the two. Depending on the size the patient wants, one breast can be reduced or the other augmented, - in most cases, it is the combination of the two to give it the right size and aesthetic shape.
Usually the hypoplastic breast is often associated with a condition called tubular breast. Here not only is the breast hypoplastic, but also the base diameter is very narrow. Though there are some one stage operations to correct this primarily, the results are not very good. In these cases volumetric increase of the size would not give best aesthetic result. The aim is to increase the base diameter. This can be achieved by an expander-prosthesis as a Becker or expand the breast in the first instance and later insert the right sized prosthesis to balance the contra-lateral side
- Unequal Breasts
Though there is a theoretical possibility of accessory breasts developing anywhere on the milk ridge, in reality it is usually a single or a pair that is mostly found in the axilla. Sometimes it may be mistaken for a lymphangioma or even a part of the breast. Excision either open or endoscopic remains the only alternative.
- Inverted Nipple
Nipple has two important roles in a female. As much as it is sensory to the sexuality of the female, it is the vehicle of transport of the breast milk to the hungry infant. Inverted nipple interferes with breast feeding.
Correction can be achieved by non-operative or operative means.
Breast is an intensely personal organ of a lady - and there is a relationship of this femininity to her soul. So whenever a surgeon attempts to perform this surgery, let us remember that we are playing with her femininity - and surgery done in the wrong way, is a monstrous abuse of her femininity. Changes may come and go, fashions of performing breast surgery may change further in the next millennium, but the eternal philosophy of human psychology in relation to this organ will not change. Even before attempting to put a knife in it, one must always remember, they are delicate and must be dealt with expertise, professionalism, aesthetics and art.
- Body Contouring
Body contouring is a general term given to shaping of a body. Either excess body fat is removed or excess skin is got rid of. Sometimes areas are augmented to give that feminine contour. Where good food is readily available, where activity is minimal, where girth is not as important a factor, as labour to make fitting dress is so damn cheap, where voluptuousness is an attraction to the male eye - why bother about body contouring?
But alas! India is unique in many ways - more so in its individuality of dress. And this uniqueness exposes more the belly of a female than any other social dress. And this exposure makes the ladies conscious too! After childbirth this normal phenomenon of sagging belly perturbs them to run from one fitness centre to the other in vain for reducing this exposed laxity. Nothing works. Only abdominoplasty, be it open or endoscopic can help.
Liposuction has received a widespread publicity and the common myth is that it reduces weight. No - certainly it is not so. Liposuction cannot reduce weight. It improves the body contour. Liposucking more than three litres of fat can cause serious problems.
For generalized obesity in Apollo Gleneagles Hospital provides a combined team approach between the physician (for reducing weight with anti obesity drugs), dietician (for keeping the weight under control) and plastic surgeon (for body contouring).
Shaping a body is by means of getting rid of localized fat collection by liposuction.
Body Contouring consists of:
Liposuction is the removal of fatty tissue from localised problem areas using a surgical technique. It is a fairly recent method of fat reduction that is proving to be very successful, and extremely popular. It helps both men and women to improve the contours of their bodies, through a remarkable and yet relatively simple and safe surgical procedure. The process involves the insertion of a slender, hollow metal tube or cannula, through a small incision, and by repeated movements, fat globules are separated and removed by suction through this tube. Incisions are small and are concealed in a skin fold near the site to be reduced, thus scars are virtually undetectable. Usually only one small incision is needed for each specific area. The area treated is injected with various solutions prior to insertion of the cannula, in order to reduce bleeding and to assist breakdown and loosening of the fat globules.
Liposuction while improving the silhouette does not necessarily eliminate the subtle puckering of the skin called cellulite. Cellulite results from the pull of fibrous tissue that connects skin to underlying muscle. What we do see is a reduction in the degree of cellulite because new techniques tend to sever the attached fibres allowing the skin to bounce up and return to a more smooth appearance. This is actually a "bonus" that one gets from the procedure but without any guarantee.
Liposuction sculpts or recontours the body and it must be stressed that the aim is to alter the patient's shape, rather than his or her overall weight. It is certainly effective in the removal of unwanted bulges and in improving the silhouette, but it is not a method for the treatment of general obesity. Fat cells removed by liposuction are permanently removed. Fat can never regenerate in the specific area thus treated. However, by eating to excess one may still gain excess weight and fatty bulges in other areas.
Particular areas of the body that can be helped by liposuction are the hips, inner thighs, outer thighs (" saddle-bags" or " riding-breeches" ), the abdomen or stomach, the buttocks, the waist (" love-handles" problem in men) upper arms, knees, ankles, the over-developed male breast, the "dowagers hump" problem, and the double chin. Liposuction may be carried out in a number of areas at the same time or be combined with another procedure. For example, it may be done with a facelift where excess fat is present under the chin. The amount of fat removed is up to the surgeon but between one and three litres is considered safe.
The operation may be carried out under general anaesthesia. Operation time will depend on the number and extent of areas treated. The length of stay in hospital will also vary for the same reasons, from one night to two nights.
Pressure bandages/corset will need to be worn under clothing for up to six weeks.
- Tummy Tuck or Abdominoplasty
Tummy tuck is usually not advised before marriage
- Ancillary Procedures
There are several ancillary or "touch up" procedures which help in the enhancement of beauty. Each is used under special conditions. The judgment and experience of the surgeon will give you the answer to which procedure is suitable in your case.
Circumcision is excising an amount of the foreskin around the penis.
This procedure is performed on babies, children and adults, each for different reasons (Religion, complications or, indeed hygiene).
After the skin and mucosa is removed (wrongly named mucous membrane) we stitch around the skin and mucosa with self dissolving sutures.
The procedure is performed as day surgery and the patient is advised to avoid sexual excitement otherwise he may bleed.
- Mechanical Abrasions
Microdermabrasion is an office procedure that is considered a mild, mechanical peel. It improves the skin's texture by using a stream of crystals and suction to gently exfoliate the skin. Each session takes approximately thirty minutes. It is recommended to have bi-weekly sessions, followed by longer-term maintenance treatments.
Microdermabrasion reduces age spots, acne scars, surface imperfections, and sun damage. It can also be used on the neck, upper chest, and backs of hands. This treatment may be used on all skin types. There is no down time after this treatment; however, your skin may be slightly pink. You can return to work/school immediately following the treatment.
Microdermabrasion leaves your skin with a healthy glow.
Dermabrasion is a moderate to deep mechanical peel. It is the removal of the surface layer of skin with high-speed sanding. A rapidly rotating wheel or circular brush removes the upper layer of skin. It is most often used on deep acne scars as well as facial lines and wrinkles. It is not recommended for all skin types. A few days following dermabrasion your new skin emerges. Redness will fade over time. Dermabrasion is done in the hospital under general anaesthesia and you can return to work within one to two weeks. Makeup may be applied after healing is complete.
- Surgical Injectables
Some wrinkles are the result of overactive muscles. A popular treatment for this is Botox. Botox (a controlled toxin) is a paralyzing agent injected directly into the muscles to reduce muscle activity. Common places to inject include the horizontal forehead furrows, vertical lines between the eyebrows and "crow's feet" around the eyes. Botox is temporary (3-4 months). It is an OPD-based procedure that does not require anaesthesia and has little to no downtime.
Collagen is injectable filler made from cow protein and is used to fill or plump wrinkles or furrows. Popular places to inject include the lines between the eyebrows, lines between the nose and lips (nasolabial folds), lines to the side of the mouth, and lines around the lips. It is done as an in-office procedure, and does not require anaesthesia. Recovery is usually one day. Keep in mind; collagen is temporary (3-4 months), therefore, repeated treatments are needed. Also, a test dose is required for first time users to determine the possibility of an allergic reaction.
Fat taken from your own body is used as a soft tissue filler material. Since it is taken from your own body there is little possibility of an allergic reaction. Fat is taken from areas such as your abdomen, buttocks, or thighs using a small needle attached to a syringe. This is a day case procedure, where the fat is injected in multiple thin strands into the treatment area. It is a belief that autologous fat injections may be long lasting or even permanent. I have doubts. Keep in mind; your body will absorb some of the fat and therefore repeated injections of stored fat may be needed for optimal results.
Alloderm is soft tissue filler made from cadaver dermis. It comes in a sheet and is soaked in a salt -water solution prior to insertion. It can be used to enlarge lips, fill lines between the nose and lips, and in areas where soft tissue augmentation is needed. It is hard to predict the longevity of this product; however, it seems to have a long-lasting result. Unfortunately, there are some patients that absorb this material sooner than expected. The product is processed in such a way that infections from the donor or patient rejection are not a concern. Alloderm acts as a structural framework for the body and becomes an integral part of human soft tissue starting at two to three weeks.
Cymetra is injectable, soft tissue filler that consists of micronized Alloderm. Popular places to inject include the lines between the eyebrows, lines between the nose and lips (nasolabial folds), lines to the side of the mouth, and lines around the lips. As with Alloderm, this filler may have long-lasting results if used correctly. Unfortunately, multiple treatments are needed to obtain a long-lasting augmentation. As with Alloderm, some patients metabolize or absorb the Cymetra sooner than expected. Cymetra injections can be performed in the office simply with manufactured syringe preparations.
Porex is a non-absorbable, permanent facial implant made by Med Pore. The material is made of Porous Polyethylene. It is fabricated in various shapes and sizes. It is used in cheek augmentation; chin augmentation, and nasal re-profiling. Its main advantage is tissue adherence and lack of implant movement.
Gore-tex is a non-absorbable, permanent, soft tissue implant that is used in cheek, chin, lip, and nasoabial (nose-lip line) augmentation. It can be purchased in various shapes and sizes. This material is soft and flexible. The multi-strand Gore-tex product has been used successfully in nasolabial augmentation (with the benefit of not being able to feel the implant).
- Permanent Make Up
Cosmetic tattooing, permanent cosmetics, permanent makeup, permanent lip liner, permanent eyeliner, or even non surgical scar reduction treatment by micro pigmentation camouflaging. All of these refer to a means of applying pigmentation changes to a person’s skin for the purpose of permanent cosmetic changes or postoperative scar revision. Often these techniques are finding favour over traditional surgical revision. From the hectic lifestyles of today's workingwomen, to the postoperative patient desiring a scar reduction, micro pigmentation application is the choice of many people. It is effective and usually only takes several hours when applied by qualified beautician. Permanent lip liner can usually be performed in 2-3 hours. Wanting to avoid the rigors of daily makeup application, many women turn to permanent makeup application.
Permanent Lip Makeup: involves enhancement through several different approaches. Different than it existed 15 years ago, current micro pigmentation of the lips is not focused on lip lining, as it is on lip colouring. While defining lines can be enhanced, today's active women have the desire to have naturally defined lips without the need to put on lipstick all day long. Lip colouring is the placement of pigments throughout the entire lip. This process takes into account skin type, desired base colour, and current lip shape. The perceived fullness of lips can be greatly enhanced without the need for painful and temporary collagen injections. Lips have anaesthetic applied, either topically or through regional anaesthetic blocks administered by trained medical professionals. The procedure takes approximately two hours. The initial lip tone obtained immediately after pigment implantation will fade over 6-8 weeks. After this period of time a touch up to sharpen the desired colour can be performed.
Eye Brows: Shaping and defining: The face maintains it's aesthetics through symmetry. The eyebrows are a major factor in the perceived symmetry of a persons face. Unlike the eyebrows that were tattooed 15 years ago, today's beautician has been trained in the art of pigment application. Contingent on applicator selection and brush stroke, today’s beautician applies pigments in feathering strokes to mimic the appearance of hair. This provides the person with a more realistic brow, enhancing the natural features. Micro pigmentation of the eyebrows can be performed to replace eye brows that have lost their fullness due to age and hair loss, of to add defining tones to existing brows.
Eyeliner: Permanent eyeliner is applied by implanting pigments in the eyelid margin, right in the lash line. This frees you up from having to apply eyeliner every morning or when getting out of the pool. The procedure is meant to provide a fine lined look that enhances the aliveness of the eyes, without creating a heavy makeup look. Heavier makeup looks can then be applied when necessary with traditional cosmetics.
Scar Camouflage: Many burn scars and postoperative scars are now benefiting from micro pigmentation treatment. The procedure may take multiple visits, and 3-12 months to finish, but many scars that can't be surgically removed can be hidden with natural skin pigments. This can give the perception that the scar has been removed. Realistically, surgical scar removal never completely eliminates a scar. Surgical approaches simply modify or revise existing scar tissue. Micro pigmentation can augment surgical revision, providing the patient with a result closer to their desired outcome.
When considering the beauty in Bengal, because of its unique dress, which seems to cover most parts of the body elegantly- only exposed areas are left to the realms of cosmetic surgery. But the word ‘beauty’ is a variable entity. To understand it one must be familiar with what is normal. Normality is a human conception over time on a particular race.
I have tried to define cosmetic surgery parameters on a young would be bride in Bengal. Brazilian socio-cultural issues are different from the Middle East - more so different from Bengal. So it is obvious, concepts of beauty and cosmetic surgery parameters will be different Understanding this uniqueness in an unmarried female gives the artistic visualisation of the results to be.
They say no art grows without a vision, no discoveries are made without a dream - this treatise will give some idea of the fashion of cosmetic surgery in Kolkata.