Dr.Dinesh Bhargava

Dr. Dinesh Bhargava,A New Image, Center for Aesthetic Surgery & Medicine

Pushpanjali Crosslay Hospital

Trends in Aesthetic Surgeryand a physician’s role




Dinesh BhargavaAesthetic Plastic surgeon , MS, FACS

Trends in Aesthetic Surgery and a physician’s role




Desire to look good and beautiful is not new.

What is beautiful ?• Education• Social customs• Social needs




• Plastic Surgery deals with surface deformities :– Congenital– Traumatic– Infectious– Malignancies– Degenerative




• Aesthetic Plastic Surgery primarily deals with surface changes that do not often cause or compromise function.

• Therefore are not medically necessary but improves the quality of life and life style.

• Main thrust is on aesthetics and good looks




• For this reason – Plastic surgeons need to be not only

physician but also skilled surgeon, a master craftsman but also a good listener.

– A prerequisite is not only hearing but listening as well.

– To fully understand the underlying emotions and then design a plan to help.




• I would like to share some of the stories from my 29 years of dealing with people.

– What the patients have said – What the patients mean– What can we do the help




• On breast reduction:– She was 65 year old when I saw her for

consideration of breast reduction . After she had healed she said

“ I can finally climb into my boat from the water. Only one complaint. Why did some one not tell me about this operation 30 years ago”




• On breast reduction – A young teenager who was shy and

recluse was brought in by her mother. She had a breast reduction and was very happy. After her wedding several years later she wrote“ Thank you for giving me my life back”




• Breast reduction




• On breast reduction:– A 45 year old came with back ache and

shoulder pain with macromastia. The reduction mammoplasty was done. She said

“ It is so nice to have the weight off your chest. I can do things that I did not think I will ever do again”




• Breast Reduction





Reduction in the size of the breast and aesthetically pleasing




• On breast reduction – Why some women delay mammography– Doing mammograms on large breasted

women is difficult – Fear of pain, from previous experience– Contributing to diminished compliance y– And could contribute to late diagnosis of

CA breast





Reduction in weight and a more youthful appearance




On Gynecomastia -“my son has become recluse and does not go out to play with his friends”- Doctor I cannot take off my clothes for fear of

being teased’- My ‘friends’ pinch me and physically hurt me.

- Gynecomastia is a common problem




Correction of gynecomastia by (UAL)Ultrasonic assisted liposuction and excision




• On breast reconstruction– Reconstruction will not change the

course of the disease but will enhance the quality of what ever life one does have.“ thanks for a new lease on life. Today I celebrate my 12th birthday and I feel whole”

Pam




• Breast reconstruction




• On prophylactic mastectomy and reconstruction

– “ I am so relieved that I don’t have to worry about cancer, knowing how my aunt, my mother and my sister had suffered from the disease”




• Breast Reconstruction

Bilateral prosthetic breast reconstruction




• On breast reconstruction:

– “ only if I knew that the reconstruction could be done my fear of mastectomy would be have much less.”




• TRAM flap reconstruction at the time of mastectomy




• On breast reconstruction in conservative breast surgery:

– is there a role of plastic surgeon in partial mastectomy / lumpectomy / breast conservation surgery ?

– I think so• Designing incisions, reconstructing the remaining

tissue.




• Restoring breast after segmental loss




• On breast augmentation

– ‘ thank you for helping to see the pretty me.”

– The confidence that these people exhibit is nothing short of a miracle.

– A metamorphosis into a new person.




• Breast Augmentation

A natural and pleasing outcome450 ml Saline Submuscular Prosthesis




• On abdominoplasty– 40 year old after abdominoplasty

shares her thoughts ‘ doctor you don’t know when last I took my clothes off in front of my husband’

– Unable to see beauty in the lax and drooping abdomen she could not share her thought with her husband. A very lonely place to be.




Lateral Tension Abdominoplasty

Dramatic change




• On abdominoplasty– A 55 year old who had an

abdominoplasty ‘ I think my back pain is so much improved”

– Postural changes with a large abdomen could lead to exaggeration of back pathology




• Lateral Tension Abdominoplasty

Lateral tension Abdominoplasty with UAL




• Lateral tension Abdominoplasty

As flat an abdomen you can get along with improvement in the contours of the hip and the torso in general




• On abdominoplasty

– A 40 year old having lost 40 lb. of weight looks in the mirror and wonders ‘ I have tried so hard to be and look healthy, when I see myself all I can see is this skin. Have all my efforts been in vain?”





Lateral tension Abdominoplasty in Men





Lateral Tension Abdominoplasty in menA flat abdomen with low placed incision




• On abdominoplasty– “my Caesarian scar healed terribly. See

this overhang?”– In reality, it was not about the scar at

all.





Lateral Tension AbdominoplastyA flat abdomen and improvement of contour





Two weeks after lateral tension abdominoplasty




• On Ultrasonic liposuction– ‘ I can’t find the jeans that fit me. My hips are

too big. I just want to be able to wear normal clothes”

– ‘ I work so hard to get in shape but these bulges don’t budge’

– Liposuction will correct hip and the lower abdominal deformity

– Ultrasonic Liposuction does this with minimal trauma to the tissue and quick recovery, a facility we offer at PCH only.




• Ultra sonic assisted liposuction (UAL)

• Subtle




• On liposuction

– ‘ all I want to do is to be able to get into shorts to play tennis’ a 65 year old lady asked me.

– liposuction was her answer. A rather simple technique for so much gain. ‘able to play tennis in shorts’




Ultra sonic assisted liposuction (UAL)




• Ultra sonic assisted liposuction (UAL)

Significant




• On facial aesthetics– ‘We need to get my daughter married’

Rhinoplasty. Just a word of caution. If we need the operation give yourself 9 months to a year worth of time to see the final results.

– Think of correction well in advance.




• Ultrasonic Assisted Liposuction

– Utilizing the unique ability of Ultrasonic energy to lyse fat cell selectively, this procedure offers quick recovery and early return to function.




Rhinoplasty




PreOp

PostOp

Rhinoplasty




• On otoplasty– “I have never been able to wear my hair

up.” I would rather hide than to acknowledge my real concerns.

– “ I am teased for my big ears” a child will not tell mothers but will refuse to go to school instead.




Otoplasty, change in personality

Observe the change in countenanceSubtle but undeniable.




Bilateral Otoplasty

PreOp

PostOp




PreOp

PostOp

Unilateral Otoplasty




• On skin, the great envelop– “ I don’t feel my age” when my image in

the mirror does not match my inner feelings.” • Medical aesthetics. Use of Botox, Tissue

fillers

– Use of heavy cosmetics to hide the blemishes and expression lines on the skin. • Skin care program, peels,

microdermabrasion and lasers




Tissue filler effect on the nasolabial region

Pre treatment Post treatment




• On hair, – some times too much

• Laser hair removal “ what a great relief from waxing and shaving”, a perfect choice of a working woman

• And some times men

– and at others times not enough• Follicular Hair transplant for baldness.




• Laser hair removal




• On facial rejuvenation– “ I feel tired in the evening and can

barely keep my eyes open” Blepharoplasty

– ‘Doctor why do I always look sad” drooping of the brow, the lids and the angle of the mouth. Brow and face lift

– ‘ I never had these neck bands” hyperactive platysma.




• Facial rejuvenation




Facelift




Upper lid blepharoplasty




Upper and lower lidblepharoplasty




Significance of computerSimulation

Real results




There are great benefits to aesthetic surgery

Upbeat

Self confidenceUndertake activities that one could not before.




How do we know this ?

Up trends in demandHappy surgery

Patients come for repeat procedures




• On changes in an individual – Personal desire– There is an increasing need generated

through the media– Personal awareness and social freedom– Demand of the competition to look

healthy and young and therefore rises in the priority ladder.




• So if it is really so great,

• Why don’t we see more aesthetic surgery than we do, you might ask.

• A very valid question, indeed and one that needs to addressed




• There is surely more aesthetic surgery than even 5 years ago– Not many people talk to about it. This

too is changing

• When done well you should not be able to identify a surgical result.




• On Psycho social issues– ‘What will people say” need of social

approval at least of those close to us, family, physician

– ‘I don’t want to talk to every one’ need for privacy and a listener

– ‘ my doctor said never to have it done’ Forces of valued opinion

– ‘It is vain”. force of tradition.




• On facilities and Surgeons– ‘the hospitals are in it for the money.”

long standing distrust of the hospitals– ‘I don’t know who to go to for help’. We

as surgeons don’t talk enough about our skills. • To our patients and to our physician

colleagues.




• On financial issues– “Can I afford it.” this is changing with

two family income and affluence. You might be surprised. Ask don’t assume

– Pricing is market driven* Remember that at no time should a

surgeon or a facility compromise safety or quality at the alter of economy




• A physician’s role– Be a listener, – identify correctable causes of concern– Know the corrective measures &

alternatives– Know your surgeon colleagues – Identify the qualified facilities.And refer




We are on a threshold of change




• A New Image

• We have just built a Center for aesthetic plastic surgery & Medicine at Pushpanjali Crosslay Hospital, dedicated to the care of those seeking aesthetic improvement.




I would like to take this opportunity to invite you all to come visit us.




Thank you




Contact: [email protected]: +91 120 4173700

Dr.Dinesh Bhargava

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