Why is choosing the right surgeon the most important decision prior to going in for cosmetic surgery?
One may think that qualification is the only criterion – it may be one of the criteria but not the only one. The paramount criterion is the skill, experience of the surgeon and whether the practice is limited to cosmetic surgery alone. The first surgery is the one with the best possibility of a good outcome. Corrective surgeries or reoperations are very complicated for the average surgeon and therefore in these cases the choice becomes even more important. Go for a second opinion if you are not sure. Bad outcomes make the patient jaded and turned off towards surgery in general and particularly secondary procedures. Think smart, be smart and arrive at the right choice.
How should I select a surgeon?
It is important to establish a rapport with the surgeon since you place total confidence in that doctor's ability. Select a surgeon who compares alternatives, explains clearly what will be done for you and the rationale for the approach selected. Be sure he discusses convalescence and possible risks. Choose a surgeon who communicates and has a clear understanding of your desired result.
You should carefully evaluate the proposed surgery and the surgeon himself before proceeding. Insist on certain qualifications. Ask specific questions about the doctor's training. Has he fellowship training or specialized training in the procedures you want performed? A specialist does the same procedures far more often and therefore has greater experience and skill than most surgeons. Does the surgeon have aesthetic taste compatible with yours? Remember Cosmetic Surgery is an Art and Science. Does your surgeon have an Artistic Sense?
Why should I choose a surgery center?
A surgery center offers high quality in the nursing team, anesthesia and post-op care available. Having surgery in a surgery center gives you peace of mind that every detail has been checked and checked again. A surgery centre also has less patient traffic thus maintaining confidentiality and greater testability.
What should I know about anesthesia?
When necessary, twilight sleep or light general anesthesia is administered by a competent anesthesiologist. The level of anesthesia will vary with the needs of each patient. The type of anesthesia is clearly discussed at the time of consultation and is tailored to the patient's needs for surgery. The patient will remain in the recovery area until able to be discharged. Your friend or family member will have to drive you home after the operation.
What are the risks?
Although complications are possible, they are very rare. Most patients accept the risks after consideration. A full description of every possible complication is beyond the scope of this text, but risks specific to each procedure will be discussed in the appropriate section.
How long will my recovery be?
The period of recovery depends on the surgery performed. After surgery strenuous physical activities are limited. You can resume normal activities within a few days depending upon the surgical procedure. In some cases there will be temporary swelling, bruising and discomfort. The most common concern is an uncomfortable feeling, not pain. Pain is surprisingly minimal and easily controlled with medication. Mild analgesics are used in most cases, but stronger medication is given when necessary.
The surgeon will discuss your postoperative visits for removal of dressings and sutures. Special arrangements are made for patients who are from out of town and arrangements are usually available for patients who do not live in the area, or choose to spend a few days after surgery away from their families.
Care is taken to place the incision in the natural skin creases or skin folds along inconspicuous areas so they are not visible when the healing process is completed. The incision may be pink for several weeks postoperatively, but is easily camouflaged the day after suture removal. Complete maturation of the surgical area takes more than one year, though in most cases after one or two weeks, only the patient and physician can detect the surgical incision. Time is the single most important factor in the healing process.
How are fees determined?
In general cosmetic surgery is not covered by insurance. Insurance will only pay when the surgery is done for reconstruction of deformities caused by accidents or when surgery improves function which is impaired by a physical deformity such as a septal deviation in rhinoplasty (nasal surgery). If an insurance company is to be billed for the surgery, the doctor's office staff will usually submit the insurance claim forms and documents to your insurance company for payment.
Fees are generally determined based on each patient's needs. All fees cover post surgery visits. Fees are clearly explained to the patient at the time of the first consultation.
How much will the surgery cost and will I be able to afford it?
One of the most frequently asked questions when considering cosmetic surgery is "how much?"
Often, patients choose their surgeon on the basis of price. Cosmetic surgery is very affordable in India and costs are much lower when compared to the United States and other countries. However, since the success of your surgery is largely dependent on your choice of surgeon, cost should not be your main consideration for your decision to undergo cosmetic surgery in INDIA.
Your surgeon's skill can make all the difference between a good result and one which will require correction and additional expense. Thus, although it is understandable that price is one of the considerations in your choice of surgeon, it is important to remember that the main consideration should be your surgeon's professional qualifications and experience.
Why should I schedule an initial consultation?
At the time of your visit the extent of your surgery will be carefully discussed and an evaluation made. A consultation helps to clarify the patient's desires and the surgeon's plan. There is no standard operation which applies to the same patient. An operation will be designed during this consultation specifically for you and all of the details will be explained.
The most important goal of the consultation is to clearly communicate. Caution is advised in looking at before and after photos. These can often be misleading and may not reflect your particular needs.
In general, the consultation helps the patient understand what can be achieved. It helps the doctor understand the patient's desires and, most importantly, it gives the patient an opportunity to ask valuable questions and decide if surgery is right for them.
Why are pictures taken before and after surgery?
Pictures are taken prior to surgery to help plan the procedure. They are useful guides which the surgeon will use in planning and preparing for your procedure. In addition, postoperative photos are taken to enable you and the surgeon to evaluate the results of the procedure.
You will be asked to review and sign a form that clearly describes your desired operation. This informed consent is a legal document and your authorization allows the surgeon to perform the surgery.
Q : Are there different types of liposuction?A : Some offices use different names which mean the same thing. You may hear words such as "lipoplasty" "liposuction" or "suction lipectomy" - they all mean the same thing. Procedure can be eased by help of VAL, UAL and power liposuction.
Q : Can liposuction be used as a weight loss method?A :No, liposuction is used to get rid of isolated areas of fat which are diet and/or exercise resistant. Weight loss is achieved as the fat removed does have mass.
Q : Who is a good candidate for liposuction?A :No, liposuction is used to get rid of isolated areas of fat which are diet and/or exercise resistant. Weight loss is achieved as the fat removed does have mass.
Q : How long do I need to be off of work?A :It is suggested that you take off of work for 3-5 days after surgery but continue to avoid strenuous activity for one month after surgery.
Q : When can I get back to my normal routine?A : Each patient differs with recovery times. Also, the recovery time will vary depending on how much liposuction was performed. Most patients are able to return to work 2-7 days after surgery depending on the areas treated.
Q : When can I start exercising?A : The doctor will assess each patient and discuss returning to their exercise regimen. We highly recommend walking within the first couple of days - this helps with the swelling, constipation, etc. Depending on the areas treated, most patients are able to resume exercise 2-4 weeks after the procedure.
Q : Anything I can do to decrease the swelling?A : Most of our patients find that walking helps decrease the swelling after liposuction surgery.
Q : Will the fat return to the area that was treated?A : If after liposuction surgery one does not eat healthy and exercise regularly, the fat cells that remain in the treated area can swell. The fat cells that have been removed are gone forever. Liposuction is not meant to be used as a weight loss program.
Q : Can I do multiple areas at the same time?A : Yes. The doctor will discuss what procedures may be performed at the same time while still being safe. Many patients will opt to have liposuction and breast augmentation surgery OR liposuction and tummy tuck surgery at the same time. Combination surgeries can give dramatic results.
Q : Will I be wearing any special garments after the surgery?A : Yes. When you wake up after the procedure, a garment will be on the treated areas. This compressive garment is there to assist in the healing process and to decrease the amount of swelling. The doctor will discuss the amount of time you will need to wear the garment - depending on what areas are treated.
Q : How long do I need to be off of work?A : It is recommended that you take one week off from work after breast augmentation surgery and continue to avoid strenuous activity and heavy lifting for 4 weeks after the surgery. We also ask the patients to not drive for 2 weeks after the surgery.
Q : Who is too old to get a breast augmentation?A : Breast augmentation can be performed on 18 years old and older. You are NEVER too old to improve the appearance of your breasts.
Q : Should implants be placed under the muscle or over the muscle?A : Every patient's anatomy is different and therefore, the only way to know which procedure would give you the best cosmetic result is by having a certified cosmetic surgeon examine you and discuss your options.
Q : Is it necessary to wait until after having children before having breast augmentation surgery?A : No, it is a matter of choice for each woman. More than half of patients perform the surgery before having children and the majority of them have no problems breast feeding afterwards. The incisions used are small and the surgeon attempts to minimise the amount of disruption of the glands to the nipple/areola. The underlying breast implant does not harm the breast fed baby in any way.
Q : How do I decide what size to go?A : The size that a patient decides to achieve is a very personal decision. Many a time the patient wishes to achieve a "natural look" to simply improve the proportionality of the upper and lower body. Some patients, however, want a "round" look. For these patients a "natural look" is not a priority and they are not concerned if other people know that they have had a breast augmentation. In making this decision, it helps to discuss your goals with your surgeon. Pictures are often helpful as a form of communication between the patient and the surgeon. Often discussing "cup size" is useful but one must be careful since "cup size" depends on the manufacturer of the bra.
Q : Do breast implants interfere with mammography?A : Yes. Breast implants, regardless of their location in the sub-muscular or sub-glandular location, can interfere with mammography. Generally, the breast implants placed in the sub-muscular position tend to interfere with mammography less than those placed below breast tissue. Mammography centers are well accustomed to performing mammography on patients who have had breast implants (using displacement techniques).
Q : Can sensation of the nipple/areola be lost after breast augmentation surgery?A : Yes, a small percentage (1%) of patients have permanent nipple/areola sensation loss after breast augmentation surgery. Many patients have temporary loss or hyper-sensitivity of the nipple/areola complex. The surgeon takes great care during the operation to avoid injury to the nerve supply to the nipple/areola complex.
Q : How do I decide on the incision (approach) to be used during breast augmentation?A : Several approaches are available to perform the breast augmentation. These include the following: an incision under the areola, under the breast (just above the infra-mammary fold), and in the axilla (arm pit). The choice of incision is a decision made by the patient and the surgeon. In general, we try to use the incision which is best hidden and therefore less visible. Often this decision is made based on the patient's anatomy.
Q : How do I decide to go over or under the muscle with the breast implant?A : The decision to do a sub-muscular (under the muscle) or sub-glandular (under the breast tissue) breast augmentation is based on several factors. Some of these factors include the patient's preference and the patient's anatomy. Each type of augmentation has its pro's and con's. In general, however, all things being equal, I prefer to do sub-muscular breast augmentations. This type of augmentation is associated with less chance of seeing or feeling the breast implant. This operation is also associated with a decreased risk of breast implant hardening (encapsulation or scar tissue formation). Sub-muscular breast augmentation interferes with the performance of mammography less so than does sub-glandular breast augmentation.
On the other hand, sub-muscular breast augmentation is generally associated with more patient discomfort and a longer period of time to achieve the final cosmetic results compared to the sub-glandular breast augmentation. Weighing the pro's and con's of each type of augmentation, whenever possible, I prefer to perform a sub-muscular augmentation to achieve an end result with fewer complications and a better aesthetic result.
Q : What is capsular contracture?A : This is scar tissue that forms around the breast implants causing the breasts to harden. This hardening may be associated with tenderness and pain. This is the most common complication with breast augmentation. Sub-muscular breast augmentation helps to deter capsular contracture. Massage may be useful, especially for implants placed above the muscle. If severe capsular contracture occurs, it may be necessary to remove the scar tissue and replace the implant (preferably in a sub-muscular position).
Q : Who should perform my breast augmentation surgery?A : The physicians most qualified to perform breast augmentation surgeries are certified surgeons. It is important to get information regarding the surgeon's training. Can the surgeon perform this procedure in a major hospital in your city? What do other patients say about the surgeon's ability to communicate and his level of care post-operatively?
Q : What do the implants feel like?A : In general, implants feel firmer than your own breast tissue. Also, the appearance and feel of augmented breasts depends on how much breast tissue the patient had pre-operatively. In general, the more tissue the patient has pre-operatively, the more natural the look and feel post-operatively.
Q : What medications should I stop before surgery?A : It is recommended not to take any aspirin containing medication, ibuprofen containing medication or any herbs or weight loss medications for at least 2 weeks before surgery.
Q : How do I reduce nausea post-operatively?A : Unfortunately, nausea is a common problem after many surgical procedures. Many medications can be used intra-operatively in an attempt to reduce this problem. Post-operatively, nausea can be reduced by minimizing the use of narcotics and taking the medication with a small amount of food in the stomach. If nausea is not relieved by these measures, anti-nausea medication may be prescribed.
Q : How do I know if I need a breast lift?A : A breast lift (mastopexy) is an operation used to treat ptotic (sagging) breasts. A consultation with a well qualified surgeon can help answer this question for you. In general, evaluating the position of the nipple/areola complex in relation to the fold under the breast (infra-mammary fold) will help determine the need for lifting. Different types of breast lifting operations are available depending on the severity of the sagging. Reviewing pictures of patients with similar situations may be helpful in deciding how to proceed.
Q : What can I expect post-operatively?A : Unfortunately, most patients experience a moderate to significant discomfort post-operatively. This seems to be increased with sub-muscular breast augmentation compared to sub-glandular breast augmentation. Many patients are unable to sleep because they are not used to sleeping on their backs. Soreness of the back and neck may be related to this difficulty finding a comfortable position. Some patients choose to use 2 pillows and sleep in a reclined position.
Q : What is synmmastia?A : This is when the two breasts communicate in the midline (cleavage area). This may be done to "increase cleavage" by dividing the soft tissue or muscle fibers at the medial edges of the breast. This can be seen with implants placed over or under the muscle. It is a correctable problem.
Q : What is the difference between textured and smooth implants?A : Texturing refers to the surface of the breast implant. Textured implants have a rough surface in an attempt to prevent contracture formation (especially when the implants are placed above the muscle). This does not appear to be relevant in the sub-muscular position. Textured implants may be associated with rippling more than smooth implants.
Q : What is a "tubular breast"?A : Tubular breasts, otherwise known as constricted breasts, are associated with some breast tissue deficiency especially medially (around the cleavage area). The appearance of the breasts can vary greatly from a very severe deficiency of breast tissue to mild deficiency. Often times, the patient will have different size and shape between the right and left breast. This is a correctable condition. Often, implants can be used to improve the size, shape and symmetry of the breasts.
Q : How long will I have to wear the special bra?A : Normally, the bra will need to be worn for 2-4 weeks. There are reasons why the bra is important and following the surgeon's directions will give you the best possible results. Each patient is different and so the recovery will also be different.
Q : When can I start to exercise?A : Doctors do not recommend heavy weight lifting or strenuous exercise until 6 weeks after the procedure. Patients may walk and do leg exercises soon after the procedure.
Q : How long is the recovery?A : Every patient is different in their recovery. Most patients are able to resume the majority of their normal activities 4-6 weeks after the procedure.
Q : Do I have to do any special exercises to massage the implants?A : There will be exercises that the doctor and his office staff will review with you.
Q : Anything I can do to decrease the possibility of getting capsular contractures?A : By placing the breast implant under the muscle, the risk of getting capsular contracture will be decreased. We follow our patient's long term to diagnose encapsulation and there are now medications that may be used to combat this problem.
Q : Do these implants have warranties?A : Yes, these breast implants have life time warranties. The breast implant companies will cover the cost of the breast implants for life and may also supply a stipend to cover some of the cost associated with returning to surgery (anesthesia, surgery center, etc.) for 10 years after your primary procedure.
Q : Can I get silicone implants?A : At this time, there are special categories that a Cosmetic Surgery patient will need to fall into to be able to request silicone gel implants. We can discuss these criteria with you at the consultation if you are interested. The US FDA is assessing the possibility of allowing patients to use silicone gel implants but at this time, it is not FDA approved for all patients.
Q : I have friends from out of town/state who have gone to see Dr. Thomas, how can I schedule a surgery without coming in for a consultation if I live out of state?A : Our office has many patients coming from out of town/state to have their breast augmentation surgery performed. We can discuss the majority of what we need to via e-mail. Our office tries to work with your schedule so that the inconvenience is minimised.
Q : When do the stitches come out?A : The stitches are all inside but for the ends which usually come out 5-7 days after surgery.
Q : When can one shower after this procedure?A : After the stitches are removed, the patient is allowed to shower.
Q : If I have to have the surgery re-done later in life, will the incision be made in the same place as the original?A : Usually, yes. The incision would be made in the same area.
Q : Will I need expanders to achieve the size I want?A : Usually, expanders are not necessary.
Q : How many different sizes of implants do you take into the OR?A : I always have all breast implant sizes available in the OR.
Q : Do you make over-sized pockets?A : Pockets are slightly larger than the implants used. This will allow for some movement of the implants so as to resemble natural breasts as much as possible.
Q : If I develop a capsule and the implants have to be removed, will I be able to have them put back again?A : Most of the time, patients wish to have implants replaced after removal of capsules (capsulotomy).
Q : What guarantees are offered with the implants?A : Currently, the implants are warranted for life by the implant manufacturer.(may very)
Q : What is the best way for me to determine the size i.e. from where I am to where I want to be?A : Often, by looking at pictures, we can ascertain your goals of size and shape of breast desired.
Q : Will I be able to sleep on my stomach?A : In general, approximately 2-3 months after surgery, one is able to sleep on their stomach.
Q : Who prescribes the painkillers and can we collect them prior to surgery?A : All necessary prescriptions will be prescribed by the doctor several weeks prior to surgery (at the pre-op appointment).
Q : How does a person get rid of the constant "puffiness" under the eyes?A : A lower blepharoplasty (lower eyelid surgery) can get rid of the pockets of fat that can cause the puffiness.
Q : Is there any way to alleviate the heavy feeling of the eyes that make it difficult to hold the eyes open?A : Yes, upper eyelid surgery can alleviate the "heaviness" that people feel around their eyes when the excess skin of the eyelid weighs down on them.
Q : Where is the incision for eyelid surgery?A : The incision for upper eyelid surgery is hidden within the natural fold of the upper eyelid and extends slightly beyond the outside corner. For the lower eyelid, the incision is also hidden but below the lower eyelashes.
Q : How long do I need to take off from work after eyelid surgery?A : It is suggested that you take off 3-5 days from work after eyelid surgery but refrain from strenuous activity for up to one month after the surgery.
Q : How long do I need to be off of work?A :
Q : What is a good age to have a facelift?A : There is no specific age for having a facelift. The results of a facelift can be subtle or very dramatic depending on the patient's appearance before surgery.
Q : Are the incisions visible after facelift surgery?A : No, if done correctly, all of the incisions associated with facelift surgery can be hidden in normal creases / folds of the face or in the hairline.
Q : What is an endoscopic midface lift?A : Endoscopic or minimal- incision surgery is performed using a tiny fibreoptic lens inserted through small incisions placed in the temple and in the mouth.
Q : Is a midfece lift for me?A : The midfece lift procedure is particularly useful for patients with sagging cheeks, deeper nasal furrows, thinner lips and down-turned corners of the lips.
Q : What are the benefits of endoscopic facial surgery?A : The main benefits of endoscopic surgery include : no visible incisions, minimal scarring, less bleeding, no hair loss, minimal numbness and a much quicker recovery.
Q : What other cosmetic procedures can be performed endoscopically?A : Depending on the patient, browlifts, face lifts, neck lifts and breast augmentation can all be performed endoscopically. Dr. Thomas is particularly skilled at these procedures.
Q : How long do I need to be off of work?A :
Q : Is the hair transplant surgery painful?A : You may have heard that the process is very painful. But with the proper technique and use of anesthesia, it is not a painful process at all. Initially, the patient is given a sedative through an IV medication. This sedative puts the patient into a relaxed, "twilight zone" state to minimize any pain there might be from the subsequent injections. The tumescent technique is used for prolonging the anesthesia time. Most patients have informed me that the process was less painful than a routine trip to the dentist. In addition, the day after the hair transplant process. 50% of our patients do not require any pain killers at all. The only disadvantage to this "Twilight Zone" anesthesia is that the patient will not be able to drive on the day of the surgery. However, should the patient forego the "twilight zone" anesthesia and opt instead for a local anesthesia, he will be able to drive on that day.
Q : What steps should I take before the surgery?A : Pre-Operation Instructions
1. Maintain an adequate length of hair [atleast1"] on the back of your head. Your donor grafts will be removed from here. Stitched skin incision will not be visible from day one.
2. Two weeks before surgery
1. No Finpecia or Minoxidil.
2. No Aspirin or anti-inflammatory medications that contain Aspirin one week before surgery.
3. Stop smoking
3. One day before surgery
1. No alcohol.
2. Make arrangements for someone to take you to and from the clinic. Confirm your appointment.
3. Nothing by mouth from midnight.
4. On Surgery day
1. Wash your hair in the morning using your regular shampoo.
2. Brush teeth but don't swallow water.
Q : How will the surgery affect me when I return to work?A : For the first two days, there will be a bandage around the head. It will be removed on the second day. If you have the surgery done on the hairline, the small scabs will remain for seven to ten days. When the small scabs fall off after seven to ten days, the freshly implanted grafts will be pink, slightly shiny which is usually a similar color to the surrounding normal skin and is minimally obvious at first. After approximately two weeks, the areas where the grafts were transplanted are barely visible. Pre-existing hair around or adjacent to the transplanted grafts may shed, giving a thinner look, but will begin to grow back within a few months. This temporary thinning of pre-existing hair is called Telogen Effluvia. Unfortunately there is a time lag between this increased thinning of pre-existing hair and re-growth of transplanted hair, so do not be alarmed if this happens.
Q : How many sessions of surgery will I need?A : If you have a completely bald area, it may take two to three surgeries to cover. If you have an area partially covered with hair, it may take only one surgery to fill in the area. Our goal is to restore about twenty-five percent of the donor's original density in each surgery. After two surgeries, the density is about fifty percent which is often adequate coverage to satisfy the patient. The time between each session is usually four to six months in order to see how the hair is growing out and to provide more equal distribution. Correct evaluation &estimation is possible after personal consultation.
Q : How long does it take for the transplanted hair to grow out enough to fill in the balding area?A : Usually it takes three to four months for the hair to grow out, and after that it will grow about half an inch per month which is the same rate as the donor hair. Initial hair quality is usually very thin, softer in texture like baby hair and then it become coarser over time. Sometimes the initial hair is curlier which then straightens in about one year. The color of the initial hair may also be darker. It may be lightened by the sun later.
Q : How long will the transplanted hair continue to grow?A : The transplanted hair is the hair from the back of the head, so even though it is transplanted it will still have the same life span. Normally a hair follicle sheds every three to six years and then grows back from the same root. Thus, the transplanted hair continues the same life cycle.
Q : Can hair transplantation affect the rest of my hair?A : Hair roots are very tough and can tolerate surgery or any irritation to the scalp. We know this because we can see how difficult it is for people to remove unwanted hair. A hair can be plucked out hundreds of times and just keeps growing back. The actual physical trauma of cutting the scalp, then inserting the donor grafts, can cut the shafts and/or damage some hair follicles. But more significant is the interruption to the pre-existing hair's blood supply which is enough to cause the shedding of this pre-existing hair. It is temporary as most lost hair will grow back after a few months.
Q : What are the complications?A : There are some minor, temporary complications. Bleeding Some bleeding is normal and will stop with simple pressure. Persistent bleeding occurs in about one in a few hundred cases. Additional stitching is rarely required. Pain Pain is usually fairly minimal and lasts only a few days. 50% of our patients do not require any pain relievers, and the others take Tylenol - Paractmol for a few days. Numbness Some transient numbness is inevitable, and usually lasts from three to eighteen weeks. It is rarely bothersome or long-lasting. Itching Some itching commonly occurs. Shampooing the hair daily will help the discomfort. Swelling There is some swelling in nearly all cases. It affects the forehead and the area around the eyes and lasts two to five days, being maximal on the fourth day. We can prescribe you some medication to reduce the selling. Infection This happens in one in several thousand cases and is easily cured with antibiotics. We will provide you antibiotics prior and after the procedure to prevent it from happening . Scarring Keloid scarring occurs only in pre-disposed individuals and is quite rare. Cysts One or more cysts may occur in the recipient area when many mini-grafts have been inserted. They usually disappear by themselves after a few weeks or immediately with various simple treatments. They are not usually more than 2or 3 mm in diameter, i.e., the size of small pimples. Neuralgia When a medium-sized nerve, such as the occipital nerve, is either cut or bruised, patients can get numbness, tingling or "pins and needles" sensations, sometimes even shooting pains and hypersensitivity of skin in that part of the scalp Once in a while someone reports varying combinations of the above, usually lasting for one to four weeks. Very rarely have patients had neuralgia last a longer time period. Prolonged or severe symptoms are exceeding rare and virtually always disappear within a few months.
Q : Can fallen hairs or hairs from other body area or hairs from friend or relative be transplanted?A : No.
Q : Can hairs be transplanted in eyebrows, sideburns, beard or moustaches?A : Yes.