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Hi everyone… back after a long break.

I have often been asked that the blog dealing with the issues it does, has not yet touched upon an issue that every one of us tries to cope with at some point in our lives. You may ask what issue that is……. It is the issue of weight management.

I know each and everyone of us (including me) at some point in our lives are fighting the “battle of the bulge”, hence I thought of putting down a few of my thoughts on the same from a personal point of view and from a health professional’s point of view.

Another reason for this delay in writing about this could be fact that notwithstanding the “magical guaranteed weight loss” adverts that I’m sure everybody has seen, this is a difficult issue deal with. Let me be a party pooper here by saying emphatically…there are no and I mean NO SHORT CUTS.

So let us see why this is such a big problem and what are some of the factors that play a role in weight gain. I would call it weight gain rather than obesity because the term obesity does not include overweight people by definition.

This brings us the fundamental question, when would one be called normal / overweight/ obese or morbidly obese? This classification is based on BMI or Body Mass Index, which is basically a product of a person’s bodyweight divided by a person’s height. A BMI of 18-25 is normal, 25-28 over weight, 28-35 obese and above 35 morbidly obese.

You can calculate your BMI using this online link

Why does one gain weight? This is a question the answer to which each and everyone wants to know, because if we know the answer to this, very easily we can avoid the causes thereby avoiding weight gain.

Sounds pretty simple, doesn’t it?? Sadly it isn’t that simple.

But to take a common analogy that I give to my patients’ weight gain is like a bank balance, there are only to ways to increase your bank balance (weight) either you earn more (increased intake) or spend less (decreased output).

But sadly I’m sure all of us agree it’s easier to gain weight (except for the lucky few who have genetics on their side), than increase your bank balance. Now once we have the grass root level basic fundamental cause of weight gain let us examine a few reasons as to why and how it actually happens.

I’m sure we all have read enough and more about all this in all kinds of forums and media, let me just recapitulate a few of the reasons which most of us commonly face. I’m specifically not going too much into the technical details and trying to give you the gist of things. Secondly, I’m not touching upon certain medical conditions for weight gain, which I will briefly discuss during the course of the blog entry.

INCREASED INTAKE / WRONG INTAKE / IMPROPER INTAKE

As you can see from the heading, it is not only increased intake but also the intake of wrong kinds of food and improper intake, which also contributes to weight gain.

1.Over eating: Though most of us tend not to agree to it, it is often the most common cause for weight gain. Every time you have that extra spoonful, it adds up in the long run. It is said that after a meal one should feel that he can have a little more…. that, is the time one should stop. But more often than not, we stop when we feel full and that is already too much.

2. Fast food: Fast food is fast to make and convenient to eat can be eaten on the move but more often than not is full of fats/cheese & salt.
Anyone who has read science in school knows that fat has more calories (9Kcals/gm) as compared to protein (4Kcals/gm) or carbohydrates (4Kcals/gm). So, the more fats you eat the more calories you are putting in. Carbohydrates are easy to absorb and after your basic energy requirements are met, are converted to fat for storage.

Chips – a favorite amongst most is another common cause. An old saying for them, which holds very true, is “ A minute on your lips & a lifetime on your hips”, hence avoid them.
Increased salt intake causes more water retention in the body and hence is also an important factor for weight gain.

3.Improper timing: The time of a meal also is an important factor. Food should be eaten at least 2 hours before one goes to bed to allow digestion to occur properly. So, siesta’s after a heavy lunch or eating just before going to bed are not such good ideas after all.
There is research also to suggest that, the later in the night one eats, the more chances are that all that food is being converted to fat. So, having “ a midnight snack or munchies” is again not such a great idea.

4.Alcohol: Alcohol has often been blamed for gaining weight but the gain in weight is more related to the increased snacking, which goes along with consumption of alcohol.

5.Fizzy Drinks: These are aerated drinks with empty calories, which are of no use and add up to the over all “Bank Balance of Calories”. Instead, substitute it with fresh fruits or fresh lime, which is much healthier but of course try and avoid excess salt or sugar in them.

DECREASED OUTPUT:

This is now turning out to be an important part of the whole weight gain process, especially so in youngsters and children.

1.Sedentary lifestyles: Now with the comfort levels increasing, activity has reduced. We use the lifts instead of stairs, vacuum cleaners instead of brooms, cars instead of walking, etc. The amount of calories burnt per day is decreasing with more mental activity than physical.
Some amount of physical activity is needed daily to keep the Basal metabolic rate higher so that you can burn more calories. Of course though ideal, considering family and work pressures, it is understandable that a regular gymming schedule is not always possible.
But, one can incorporate small things into the daily schedule to increase the output like taking the stairs instead of the lift, walking to the nearby store instead of driving, morning or evening walks, etc which do not take up too much of your time but help in spending those calories.

2. Children especially should have some regular physical activity in their daily schedule or we are going to be waking up to a generation of overweight youngsters. It is already happening in the west and is a major health hazard. We can see it happening around us in India too.

Real games instead of Video Games, fruits instead of chips or pizza & fruit juices instead of a fizzy drink should be the mantra for the kids.

MEDICAL CONDITIONS FOR WEIGHT GAIN:

There are a few medical conditions that can be a cause for weight gain. These are usually hormonal imbalances. The most common being:

1.Hypothyroidism: Here there is a decreased secretion of “Thyroid Hormone” which is responsible to maintain the Basal Metabolic Rate and hence there is a tendency towards weight gain. This is a treatable condition and after proper tests to find out the hormonal levels, replacement of the hormones causes a reduction in weight.

2. PCOD: Poly Cystic Ovarian Disease or PCOD is another condition associated with weight gain. Here again the hormonal imbalances cause weight gain and the weight gain in turn worsens the PCOD. Medical & surgical options are available for treatment of this condition. A curious thing seen here is that weight reduction helps with the gyneacological condition with normalization of hormones.

3. Adrenal Hormonal Imbalance: This also can cause weight gain because of water retention.

WEIGHT GAIN & DIETING

A lot has been written n said about dieting and weight loss. Every other person is an expert in some sort of a diet. But a recent study has brought the proper perspective, as I have been saying for quite some time now, its not what kind of a diet you follow but the total intake versus the total output.

So whether it’s a low carb diet, a low fat diet or an only protein diet, it doesn’t really matter. What matters is,the total amount of calories going in.

Crash Dieting is a not a way to loose weight at all. You might loose weight initially but you are loosing muscle bulk and replacing it with fat. And most of the food that one eats gets converted to fat directly because of the body’s survival mechanisms. Secondly, with crash dieting there is a tendency to alternate binging with crash dieting and this doesn’t help.

So, what one needs is a proper balanced diet according to the work he or she does, which has all the necessary nutrients.

TREATMENT OPTIONS

I’m sure all of us have heard or read quite a bit on the treatment options. I’m not going to discuss exercise, lifestyle modification and diet control which are essential to all treatments as an adjunct.
For the ease of understanding, I will divide the treatment options according to the BMI.

BMI of 25-28(30) – Overweight Category:

This is the category for which we have the most number of options.

1. Isometric Exercise/ Non Surgical Body Contouring – This is an option where in, with the help of targeted muscle stimulation & Infra red waves, isolated areas of the body are treated to achieve targeted contouring and inch loss. Here the patient comes in twice or thrice a week to the center, where the machine does the work for them and helps to achieve targeted contouring.

Very good for people in whom muscle laxity is a cause for bad body contour especially in the tummy area. Also very good immediately post pregnancy to help reduce the flab and tighten the muscles which have become loose post pregnancy and child birth

2. Ultrasonic Lipolysis: This involves breaking down the fat cells directly with the use of a non-invasive ultrasonic wave. The patient comes in once a month for the treatment, which lasts 45 mins to an hour. The released fat has to be reabsorbed and excreted by the body. It works well for small isolated areas like the saddlebags, lower tummy. This doesn’t work for large areas.

3. Injection Lipolysis or MESOTHERAPY: This involves giving multiple injections in the target areas to help dissolve fat in that area. The injection is usually of a derivative of Soya protein, which helps the cell membranes of the fat cells to break down and release the fat into the body. This is absorbed by the body and excreted.

It requires injections maybe once a month for 4 or 5 times. It works well if given properly and for small areas like the double chin or the saddlebags. Contrary to what people might claim it is not for large areas. Complications in the form or small injections abscess or collections of liquefied fat, which may require drainage, are occasionally seen.

4. LASER Lipolysis: This is a minimally invasive procedure which involves insertion of a small LASER probe in the affected area help break down the fat cells in the track of the probe thereby releasing fat into the body which is reabsorbed and excreted. This is also an office procedure and requires multiple sittings maybe a month apart.

Works well again for isolated areas like double chin, cheek fat, saddlebags, arms, etc. Large volume Lipolysis again is technically possible to a certain extent but not practical. The patient does need to use pressure garments, should have the patience to wait for the results for a few months and of course undergo multiple sittings.

5. Liposuction: This is a surgical procedure where a cannula is inserted under the skin by small 1-1.5 cm incisions in hidden areas to suck out the fat. This again is a procedure for body contouring. Though one does loose weight, he will loose more in inches

There are various techniques like the mechanical, ultrasonic, VASER, power assisted. All these are different methods of suction depending on the type of probe used to breakdown the fat cells.

As regards to the technique there is also the tumescent technique which is the preferred technique nowadays and basically involves infiltrating large volumes of saline along with some drugs to help minimize bleeding and trauma to other structures in the vicinity.

Liposuction can also be classified according to the volumes to be removed. Small, moderate or mega liposuctions. Small volume suction can be done under local anaesthesia. Moderate volumes can be done under local anaesthesia with sedation or general anaesthesia depending on the patient’s comfort level. Mega liposuctions require anaesthesia, hospitalizations and in some rare instances blood transfusions.

Internationally, the accepted volumes of fat that can be safely sucked out at one sitting is @ 8% of body weight in men and @ 9-10% of body weight in women. This is because of the fact that men tend to have an equal amount of fat inside the abdomen, whereas in women most of the fat is extra abdominal and also the fat that men have more fibrous fatty deposits. Hence, women are good candidates for liposuction.

Problems after liposuction are because of the swelling. Here as the fat is physically being sucked out, the effects are noticed immediately, but in a few days swelling sets in and takes around a month before significant changes can be felt. This also depends on the areas targeted and the amount removed. Full healing takes around 3-4 months and during this period the patient needs to wear a pressure garment to help the skin shrink. Some amount of unevenness maybe present which gradually settles with time and massages.

Rarely in smokers, there maybe areas of skin necrosis. Sometimes especially with large volume liposuctions, there maybe some collection of fluid called seroma’s which might require drainage.

BMI of 30-35 – Obese Category:

This category is the so-called “Grey Zone” of weight loss treatments. As these patients are not yet candidates for a Bariatric procedure and the procedures for the overweight category cannot fully help in treating these patients. But increasingly we are seeing patients in this category.

In these patients it has to be a combination of procedures and sometimes multiple sittings are needed to get the desired changes.

More often than not we do large volume liposuction in such cases, maybe one or two sittings with a gap of 6 months in between combined with a proper diet and exercise schedule. The procedure of Liposuction has already been discussed.

BMI of 35 and more – Morbidly obese Category:

These patients have other metabolic problems along with the fact that they are overweight. These are candidates for Bariatric procedures that are procedures aimed at reducing the intake drastically (Gastric banding or Sleeve gastrectomy) or reducing absorption of food (Gastric & Duodenal bypass procedures).

These are major surgeries and have to be done in specialized centers and involve a multidisciplinary approach with the involvement of plastic surgeon, gastroenterologist, psychiatrist, dietician, physical therapists, anesthetists, etc. This itself is a topic by itself.

The aim of this blog was to try and bring things into perspective for a person looking at weight loss or to just get in shape. Ultimately, “ a Stitch in time does save Nine”! So the earlier we wake up to the fact that weight is becoming a problem to all of us, the better it is. If not to reduce, at least try and modify our lifestyle and being about some changes in how we do things, it might help prevent the problem from becoming worse, where a much more drastic and major procedure might be required.

As you must have seen in the course of the blog that, this is not a simple topic and I have not even scraped the surface of the problem. But, the aim is to try and simplify things so one can understand what are the little things we can do to bring about a bigger change.

Whatever said and done, all the procedures are only an adjunct to lifestyle modification to get the full benefits in the long run. Change in dietary habits, maintaining a negative intake output balance, increasing physical activity will all go a long way in helping one keep fit and stay healthy.

So let us bring about the change… by being the change!!!!

So here’s to a new, fit, healthy, better looking you..!!!

Dr.Surindher
www.cosmesisindia.com

“A Mummy Makeover!”

Sounds trendy doesn’t it???

Well not really, it’s new packaging of the procedures already being done, as we shall discover in the process of this blog and the next.

Why the mom makeover at all?

The woman being the one to create life, goes through many changes physically during the process of pregnancy, giving birth & nursing the child. In a way, it is a sacrifice she makes to create and bring forth a new life.

But, the question still remains, why the makeover at all. What are the changes that occur which need to be corrected.

Doc, I just saw myself in the mirror today and I was shocked, as I couldn’t recognize the person I saw in the mirror. It was definitely not me..!!!

This is a common complaint women come to us with. During their pregnancy, the mother and everyone around are concentrating on the eating, weight and the unborn child’s well being. After birth it is again the child who is the center of attention, after that till the child starts going to play school, the mother is totally neglecting herself. Then one fine day when she has a little free time from kids and family, she looks at herself and cannot recognize the person in the mirror.

It is not intentional, that this happens. It’s just how things are prioritized in life. I’m not saying that we do not need to give attention to the child during that period. Just that, a little bit of attention to the mother during the pregnancy, childbirth and post birth period, will go a long way in her not having to feel that way a few years down the line.

So what exactly am I talking about here?

To simplify the understanding of what needs to be done, let me first start by enumerating and discussing few of the issues that form the basis of the problems to be corrected in a Mum Makeover.

1. The Tummy: The abdomen, especially the lower abdomen is the area which bears the most insult during pregnancy. Because of the growing womb, the skin is stretched, the muscles are stretched, and there is collection of fat because of the weight gain. Post childbirth, the skin stays loose, has lot of stretch marks, there is a prominent bulge in the lower abdomen because of the loose muscles. All these are compounded by lack of physical activity concentrated to the specific area. Also, with more women now going in for cesarean sections, the lack of activity in that area get further delayed.
2. The Hips: This area is genetically programmed to carry more fat in a woman (the pear shape). More so during pregnancy and post pregnancy. This is genetically the reserve, which the woman accumulates during pregnancy. Combined with less physical activity in the immediate post partum period, tends to get worse.
3. The Breasts: The breasts also bear equal brunt of the pregnancy and post delivery period. During pregnancy and lactation there is development of the milk glands to produce milk for the newborn and hence as they develop they replace the fat that is present in the breast. Once the period of breast-feeding is over, the glands get back to their pre pregnancy state, but the lost fat doesn’t come back and that is the reason for the breast looking empty and sagging. Also because of the stretch marks on the skin of the breast, the skin doesn’t shrink back to the reduced volume giving it the appearance.
4. The Vagina: Post childbirth, the vaginal canal is stretched and like any muscle that is stretched a lot, it needs toning to bring it back to its normal size and tone. In fact in the west this has been used as a punch line to ask people to go in for caesarean sections… “ Have your child the C sec way and keep your passage the honeymoon way”. But that is not required, the vaginal passage was physiologically meant to stretch and contract. But a few things have to be kept in mind, as we will discuss later on in this blog.
5. The Face: Post pregnancy and childbirth many women tend to have pigmented patches on their faces called “ Melasma” which just persists even after childbirth. This occurs due to hormonal changes during pregnancy. Also some patients might have a double chin or a more rounded face as part of the generalized weight gain seen during this period.

Now that we know what are the few changes, which occur during the period starting from getting pregnant to one realizing that their whole body image has changed, is there something we can do to reduce these insults if not prevent them altogether?

The good news is YES…!!! There are things, which one can do during pregnancy and in the immediate period following childbirth to help prevent or at least reduce the changes that are occurring in the body.

Pregnancy Care:

The whole aim of the “pregnancy care” concept is to help the mother to be to take care of her body by doing small things to prevent future problems. The main problem during pregnancy is the weight gain and the increasing abdominal girth. When this rapid weight and circumference gain is more than what a person’s skin can tolerate, the dermis which is the supporting layer of the skin ruptures leading to stretch marks. So to prevent stretch marks the best thing that one can do it just spend 10 minutes each in the morning and night out of 24 hours to do a little something to help keep the skin supple to prevent stretch marks. The areas to be concentrated on are the abdomen (more so the lower abdomen), the breasts, the buttocks and the thighs.

The best way to keep the skin supple is to moisturize it. It could be with the help of oils or body lotions. Just take 10 minutes out of your daily schedule to gently massage the areas with a body oil or body lotion. This when done over the period of the pregnancy will make the skin supple and allow it to stretch easily as the mother gains weight and the abdomen gains circumference. This is true for the breast as well as other areas as mentioned before.

This simple step can prevent a lot of the problems later on. Also the second trimester is the most important period to do this because in the last trimester the weight gain and the circumference gain is very rapid and doing it then will not give the skin sufficient time to become soft and supple enough to stretch.

Post Child Birth:

Post delivery the single most important thing a mother can do to help her regain her figure and push her tummy back is the same thing that our grand mothers used to advice. That is the use of a binder or as the grand mothers would advice tying a sari around the abdomen tightly.

This helps in two ways, firstly it is pushing the skin back to its normal position and allowing it to shrink as it normally should and secondly it is also pulling the muscles together to the normal position they should be in. Hence, this when done properly for the next few months will greatly help in one getting back to the pre pregnancy state. Of course if the stretch marks are too bad then the shrinkage might not be to the extent that is desired for, as the skin is like a rubber band broken at multiple places, but even then the muscle toning itself is enough reason for one to use the binder.

This can be done for patients who have undergone C-Sec’s too. After the initial week or two of the healing time for the wound, the binder will help as mentioned above.

The other things that the mother can do are to continue the oil massages to the body and to get into some sort of regular physical activity. Be it morning walks or evening walks or treadmill, etc. I know there would be lot of women shaking their heads n saying… “ What does he know.. He’s not a woman! How do we find time for it? ” But for that, ladies.. let me just say one thing… “Its not easy agreed but if you do it.. it will benefit you. You are preventing a surgical procedure and getting back to how you were and not letting things get out of hand…!” So you work out the math!

As far as the vagina goes, the easiest way to help tone the pelvic musculature to get back to what it was is to do some basic exercises called Kegel’s Exercises. The aim of these exercises is to strengthen and fortify the muscle tone of the muscles of the pelvic floor which in turn. It basically involves contracting your pelvic muscles and keeping them contracted for a period of time and doing this in cycles all through the day. The best part of this exercise is that it can be done anywhere and anytime and doesn’t need any equipment.

So now that we know what are the few things one can do to prevent things from getting out of hand and one finally landing up in the so called “ Clutches” of the “Cosmetic Surgeon”, I hope more and more to be mothers will take better care of themselves to prevent or reduce these problems.

As, I will be dealing with the specific surgical management of these problems and the actual “Mom Makeover”, I think this blog should have been titled…” Tips to prevent a Mom Makeover”.

Happy reading…

Dr.Surindher

Hi all…..

Today, I’m gonna be talking about a relatively new topic ( at least in the general public’s mind) especially in the Indian scenario. I have been getting many queries and emails regarding this, but the common factor in all those being the fact that very little is know about it and there seems to be a lot of confusion regarding the same.

The topic is “Cosmetic Gynaecology”.

Though the procedures that come under this heading have been performed for quite a few years now, the term seems to be recently coined. It basically involves correcting cosmetic problems related to the female genitalia. The procedures which come under this are:

1. Labioplasty ( Reducing size of the lips)

2. Hymenoplasty

3. Vaginoplasty or Vaginal Rejuvenation ( Tightening of the vagina)

4. G spot amplification

These procedures can be done together or separately or in various combinations depending on the need of the patient. Sometimes certain other urological or gynaecological procedures maybe be combined if there is a associated medical problem.

Let us briefly discuss each of these procedures separately.

1.Labioplasty:

This refers to the procedure by which the labia ( lips) minora most commonly or sometimes both the majora and minora are reduced surgically if they are too long. Many women are bothered about it as they know how it was and they feel it is not the same as time progresses and they feel uncomfortable about it. In normal course the labia minora are smaller and hidden within the labia majora as in the younger age groups. So, this is an attempt to bring it back to the way it was.

It is a relatively simple procedure which can be done under local anaesthesia or regional anaesthesia and the patient can go home the same day.

Some times this maybe be accompanied by fat grafting of the labia majora to increase their volume & give them a more youthful look.

2.Hymenoplasty:

This refers to a procedure of recreating the Hymen. Not very commonly a part of the combination of procedures. It involves recreating the thin layer of skin at the vaginal opening to give it an impression of being virginal. Though the fact remains that the hymen can rupture because of many reason other than intercourse. But it is done more for personal and religious beliefs than for medical reasons.

The procedure involves recreating the hymen with the help of tissues in and around the vagina. It is a relatively simple procedure and the patient can go home the same day. The stitches dissolve on their own in a week or 10 days.

3.Vaginoplasty or Vaginal Rejuvenation:

Classically vaginoplasty refers to recreating the vagina in patients with a congenital absence. But here in context of cosmetic gynaecology, it refers to tightening the vagina. Because of child birth and repeated intercourse and lack of exercise the pelvic muscles surrounding the vagina become loose. This may sometimes cause problems during intercourse because of the lack of proper grip for both the partners.

Vaginal tightening can be done with the help of LASER’s where the light from the LASER tighten’s the mucosa and some part of the underlying muscle. This is a good option if the patient has a decent muscle tone. The other procedure is to surgically tighten the muscles outside the vagina. The procedure is done from within the vagina and the stitches dissolve on their own. The patient can go home the same day or the day after.

This is usually combined with a labioplasty and fat grafting of the labia. The patient can resume normal sexual activity in three to four weeks time. There is an increase in sensations and pleasure during intercourse for both partners.

There are some pelvic exercises which all women can do to naturally tighten their pelvic muscles and delay the need for such a procedure. Some centers also have equipment which will help tighten and strengthen the pelvic muscles.

4.“G Spot” Amplification:

This is a relatively new addition to the procedures. The “G Spot” or The Gräfenberg spot, is a female erogenous zone, which when stimulated leads to high levels of sexual arousal and powerful orgasms.

Though anatomically the “G spot” has not be identified as a distinct physical entity some studies and anecdotal evidences from different women have shown a very sensitive and thickened area in the anterior wall of the vagina. Some studies done also showed this thickening when the women is sexually aroused. Women claimed the experience of a “deeper” orgasm when their her G-spot was stimulated.

Despite professional and scientific criticism and skepticism in general by the public, the G-spot, as a concept, has been widely accepted. Even in India judging by the mails, the awareness has definitely increased.

“G Spot” amplification is an extension of the same concept. As stimulation of the “G spot” is supposed to give greater arousal to the woman, the procedure involves identifying the spot and increasing the size by an injection. It is a relatively safe and simple procedure done as an office procedure. The injection lasts for 6-8 months and can give enhanced pleasure during intercourse by increasing the size of the “G spot” during that time.

But in some cases the results may not be up to the mark because of the difficulty of finding the “G spot”. The injection can be repeated as and when the effect wears off and the woman feels she wants the extra help to get aroused.

The awareness of these procedures and the inquiry regarding the same has increased over the past few years as woman are becoming more aware of their bodies and their own needs. Though there will always be controversies regarding the procedures, like for all other cosmetic procedures the options are there for people who want to get it.

As one of my patient’s said… “Doc…I know it’s not a necessary procedure… but , Its nice to know we have options !!!!!”

I HATE my cones…!!! I was surprised when I heard that from a patient of mine. “Cones?? I asked…”

“Yeah…. these…” she answered, pointing out to the sides of her hip. Well that was the first time I heard someone refer to them by that name.

The area she was talking about is an area which has had different names,the most common unflattering ones being “saddlebags” and “riding breeches”.

This refers to the hips, upper outer thighs and buttocks that are disproportionately large relative to the rest of the body.

A woman’s hips are an overt sign of her fertility and sexuality. Ask your friends, and they’ll probably agree that the hips should be part of that classic hourglass figure that women constantly seek. However, there’s a big kink in that goal. Most women are genetically programmed to store fat in their hips and outer thighs… the “pear shape” as compared to the “apple shape “ of a man.

As men and women pursue more idealized body proportions, they usually find that they cannot rid themselves of their saddlebags with diet and exercise alone. The reason for this is that the shape and size of our hips is largely determined by our genetic makeup. There’s nothing to be ashamed of. The fat in the hips and thighs are highly resistant to diet and exercise. Even women with small frames can have a large lower body that is simply too full to be proportionate. In other words, fat deposits on the sides of the legs tend to be the last fat to go.

Many patients do ask me why they have it, in spite of having a good exercise regime. Various reasons apart from genetics. Its the area where you first put on fat and the area where you loose it last. Secondly its situated above an area which has a tendon rather than active muscle, which makes it all the more difficult to get rid of by exercise alone.

Many women are experience frustration when large thighs and/or saddlebags force you to buy clothing with different sized tops and bottoms and many of them try to squeeze into their clothes and have the saddle bags sticking out more prominently rather than going in.

Though it’s an unfortunate situation, it’s not beyond fixing.

What are the options one may ask?

1. Exercise: Lie on your side, head waist and legs in straight line, suck your tummy in and raise your leg straight up from the hips without bending your knees. Repeat this for 10 times and repeat the cycle 3-5 times according to your comfort level. Breathe out while raising the leg and breathe in while lowering it. Repeat on the opposite side too.
2. Injection Lipolysis: This is a good area to be treated with Injection Lipolysis if that is the only problem. Multiple small injections of the lipolytic solution are injected in the area. The dissolved fat has to be absorbed by the body and eliminated. The injections are repeated every 3-4 weeks for about 4-5 times.
3. Liposuction: Offers a one time and immediate solution to the problem. The procedure involves inserting a small canulla though a 0.7-1cm incision and suck out the fat and contour the area in proportion to the hips. Post operatively a pressure garment is necessary for the next few weeks to help the skin mold to the new shape of the hips.
4. Lipo Contouring: Sometimes it may be required to inject fat into the in between segment between the two bulges to give it a more proper contour which is call “ Lipo Contouring”. Post operatively a pressure garment is necessary for the next few weeks to help the skin mold to the new shape of the hips.

It is therefore no surprise that saddlebag liposuction is the most requested type of liposuction. Since the area is mainly meant for fat storage, a liposuction operation to remove your saddlebags can completely alter your waistline. You could have a smooth hourglass figure without those bulges if you combine a hip and outer thigh liposuction together. That’s because the fat in your hips and thighs doesn’t grow back. Once you’ve got the right curves, your new body shape will not revert.

After a successful saddlebag liposuction, you’ll be able to fit into jeans, dresses, and skirts in a way you’ve never imagine before. Your entire body will feel more complete and you’ll have a big boost in confidence.

So ladies, do not fret, its not a major problem. It can be treated. But, if you opt for surgery then make sure you go to the proper trained surgeons and not to untrained people claiming different things.

Dr.Surindher

www.cosmesisindia.com

Hi all…

Welcome back to my blog.

This is in continuum with my previous blog regarding the program related to Cosmetic surgery. Now, in this blog, let us address the issue of cosmetic surgery as related to the “regular Joe or regular Jane” if I may.

With my first hand interaction with the people opting for cosmetic surgery , operating on them and then following them up, I would really like to put to rest a few common notions that are doing the rounds and which were also highlighted in the program.

1. Not on impulse: Contrary to what one may believe, none of my patients to date has come to me asking for a procedure just as a dare or that they just woke up one morning and said..” Hmm what can I do different today.. OK!!! let me get a nose job!!” Most if not all of them have had it in the back of their mind to do something about it and they would have thought about it many many times even before picking up the phone to call for an appointment. This is true even for the west but more so in our country..

2. For others: It’s usually said that one was forced to get something done by the husband, wife , mother in law, friend, so on and so forth. From what I have seen the actual percentage of people actually forced is minuscule. Most of such instances are only the final call that brought them to my office which could be the husband or the wife. On inquiring more, its seen that it was something they themselves had been thinking about for quite a while. And as a rule I DO NOT operate on a patient who comes seeking a correction for someone else.

3. Only for Narcissistic People: I sincerely feel that everyone first has to love themselves before they can love others. If one feels good about oneself then the whole outlook to life changes. There is nothing wrong in trying to look good. One might argue that its whats inside that counts… Never judge a book by its cover..!!! But talking honestly, who has the time nowadays to really see inside? STOP..Read this carefully… I’m not saying what’s inside doesn’t count… what I am saying is that, in today’s fast paced life no one has the time to really see inside. It’s like choosing amongst the so many books lying on the book shelf. How does one pick up a book to read what is inside??? Yes… it’s by looking at the cover. Once the cover has caught your attention then it’s easier to find out what’s inside. Of course, if the content is worthless then anyway doesn’t matter cover or no cover. Similarly beauty plays an equally important part in our daily lives to bring people closer to one to get to know the qualities one possesses.

4. Only for women: A totally wrong statement. Nowadays we have more men coming in for cosmetic procedures than ever before. Previously we used operate on 1 male for every 10 females. Nowadays we operate on 5-6 men for every 5 women. In many cases the wives come with their husbands. Yes the “ Metro sexual Male “ has arrived.

So , it would be very wrong to judge anyone without knowing their reasons for doing anything. And it cannot be an easy decision to take, be it for a female or a male. Unlike the west where mostly the decision to do a certain procedure is only limited to him or his immediate spouse here the whole family and relatives have a say. People who have had surgery done and have reduced wouldn’t want anyone to know that it was because of the surgery. They would rather talk about how they starved themselves and put themselves through a fitness regimen in spite of their busy busy schedules. That shows that the acceptance levels are still low. But anyway after a few days everything is forgotten and people move onto the next best thing to criticize.

It’s sad that we criticize any effort anyone makes to look good, but at the same time if you look at the matrimonial columns and the glitzy advertisements, one can see the hypocrisy existing in our society.

But, the heartening fact is that( notwithstanding the so called “moral brigade”) at least in the general population there is more tolerance to the way people are reacting to what others do. Isn’t it what democracy is all about? Accepting people for what they are and allowing them to do what they feel right without injuring or hurting others. But, then again its digressing from the topic of this blog.

So to put it in perspective, whether one likes it or not, this is a branch of medicine that is here to stay and grow. And medically speaking it has improved how we treat reconstructions. Reconstructive surgery down the ages was always more concentrated on function rather than aesthetics. But now the trend is changing to make reconstruction aesthetic along with being functional too, which is a welcome change be it in a child with a cleft lip or a man with a crushed hand.

Controversy regarding whether it is good or bad will be on for a long time to come. As a person involved in providing the service I would put in as a procedure which gives best results for those in whom it is indicated and for people with realistic expectations with good awareness of the pro’s / con’s and options.

As long as the complications do not outweigh the risks involved I wouldn’t mind doing them, which again brings us to the “ RISK BENEFIT RATIO” which is not as skewed in favor of a procedure in celebrities as compared to a common man. So awareness is the key, knowing all your options is the key and of course knowing whom to go to for the said procedures.

So for anyone out there contemplating a procedure, go meet someone qualified to do your procedure, do your due diligence in finding out all you can about the procedure.

Once you have done that, do your own Risk Benefit Ratio analysis. It will help you take an educated decision about your procedure. And trust your doctor and share all your doubts with him/her and make that educated decision.

And remember it “HAS” to be “YOUR” decision ,,, not your husband’s/ wife’s/ relative’s / friend’s or doctor’s decision.

‘m sure everyone has a point of view on this and would really appreciate comments.

Dr.Surindher

Hi all…

Sorry for the long break…!

Day before yesterday I was watching a programme on a news channel dedicated to Bollywood stars undergoing cosmetic surgery to improve their looks.

The issue was that is it a good thing and also if they should do it. Second part of the programme was discussing about the fact that men and women ( regular people) are going in for cosmetic procedures more now than in the past. Let me also divide the issue into two parts.

The issue reminds me of one of my earlier posts….

Cosmetic surgery a Taboo??

So taking off from there after seeing the programme I though I could pen down a few of my views on the topic….Open to comments of course!!

I personally feel that there is no need to make such a big issue about it. The first thing that we need to realise is the fact that we cannot equate them to the regular joe’s and jane’s. A cosmetic procedure for most of these people might be something that they do to further their respective careers apart from the fact that it might be something they did want to do even otherwise. This is a facts that we know when we interact with the people from the “glamour industry”.

They have to look good to stay in the business its a plain and simple fact. We could be all judgemental and talk about the cliche’s like ” Inner beauty is what matters! / If you have talent it will take you places..” and all that.. But, fact of the matter is that though you cannot judge a book by the cover a good cover definitely makes people reach out to it to at least read a little to find out whether the contents are good enough. Secondly if they were not without talent they would not survive anyway not by looks alone but good looks can definitely compliment talent.

Would any of us complain if Sachin bought a new bat to help him score better?? I don’t think we would . So why complain when bollywood stars are getting cosmetic surgery done on themselves to help their careers? Yes, it is not as simple as buying a new bat& hence that brings us to the so called ” Risk benefit ratio”.

The ” Rish Benefit Ratio”  is a factor which will help decide whether to go ahead with the proposed procedure for that particular individual. I’m sure all plastic surgeon use this in their own ways to assess the need to do any procedure or anyone.

The Risk Benefit Ratio is used to see if the benefits in doing a particular procedure on the said individual is worth the risk to make it justifiable to that individual. In the case of someone in the “glamour industry” the risk/benefit ratio balance shifts and hence the benefits make the risks worth it which is why people opt for it.

Sometimes the people from the glamour industry are better patients from regular patients. This is because once educated about it they are more open minded to accept the risk and the scars than most of the regular patients who want the best results but totally without the risks. As I always say.. its true for anything in life.. ” No Pain No Gain”.

But then , we have people like ” Micheal Jackson”. The host of the show called him the poster boy ” for Cosmetic Surgery”. I would say that he is a poster boy for “Whom not to do cosmetic Surgery On”. In normal circumstances we see about 10% of patients who come in with unreasonable demands but in the segment of people coming in from the glamour industry the percentage maybe as high as 30%. These are patients with unreasonable demands or requests and these are the patients who ultimately end up with problems.

I have people telling me that why this issue is important is because of the fact that people in general can be influenced and they might try to emulate their stars.. But with all due respect to these critics, getting cosmetic surgery done is not as easy as maybe picking up and lighting a cigarette. Its a much more serious and longer process and involves many more people. I think we as doctors too believe and practice ethical medicine where the risk benefit ratio is brought into the picture to help educate the patient and help him / her make and educated decision regarding the same.

Secondly I think by saying this the critics are not giving the general population its due credit. Am sure the public at large is much more mature and discerning.The percentage of people who would blindly follow anything that a star does is very small.

I’m not here to justify anything. Its just that there is no need to make such a big fuss about who’s bust is becoming bigger or lips are becoming fuller, as long as they are not hurting anyone else. I think we have that freedom in our country.. at least when I last checked.

So , without being hypocritical, everyone wants to look better and feel good. If you don’t believe me just open today’s paper and check out the matrimonial columns or check out the social networking sites or fashion and clothing wear and the cosmetics sales. Everyone wants to look the part so to speak.

I have restricted myself in this post to only to the issue about cosmetic surgery and glamour industry. I will talk about the regular people in my next blog to take this discussion further.

I’m sure everyone has a point of view on this and would really appreciate comments.

SkinCare
Skin is the largest organ of the body, it forms the protective covering over our body and bears the brunt of all that we do and all that we consume. So, care of this protective covering is as essential as taking care of your cholesterol or your blood pressure though the ill effects of not doing so, are not fatal.
The condition of the skin also reflects about the general health of a person. When a person is happy and healthy you find people commenting on how glowing they look and similarly a person who is sick, they can be seen to have dry dull lifeless skin.
Basically, there is not much that it asks you to do for it and most of the time it looks after itself. Even in the ancient times all major civilizations have had their own methods of skin care, which have been written down in their texts. But going down to it, the basics have always remained the same.
But firstly we have to understand the different skin types. Normal skin is clear, soft, supple, uniformly textured & pigmented, neither too oily nor too dry. Normal skin is not too sensitive to climate, cosmetics or the body’s own internal environmentDry skin is dull, feels tight on washing, even with the mildest of soaps flakes, scales and chaps easily. Oily Skin feels relaxed and supple,but thicker,looks shiny and is much more prone to outbreaks of spots. Mature Skin is leathery and has wrinkles and folds, loss of elasticity.
Understanding the factors which damage or affect the skin will go a long way in understanding the care which has to be taken.
External factors most important of which is the sun, which causes photodamage to the skin because of UV rays and the next being pollution and dust. Apart from these, are air conditioning which causes dehydration of the skin, smoking , stress, late hours, etc all of which harm the skin.
Internal factors like diet which forms the major form of insult, not enough intake of water, minerals, vitamins and taking too much of junk food and alcohol. All these damage the skin or inhibit its reparative capacity, hence there is no time for the skin to recover from one insult before another is added.
Skin care can be divided into generalized care and then local care.
Generalized care- being in the form of eating healthy, drinking plenty of water at least 3 liters a day, eating plenty of green vegetables and fresh fruits, which have antioxidants. Avoiding smoking goes a long way in getting healthy skin because, apart from the fact that smoke harms the skin it also produces constriction of small blood vessels in the skin. Vitamin C is very good for the skin as it is important for regeneration as well as the fact that it is the most natural sun block one can get which acts from within the body.
Local care- basically consists of cleansing, toning and moisturizing.
Cleansing and toning - Wash the face with a mild unperfumed soap, lather briefly and rinse thoroughly. Because soap is an alkaline substance, washing will temporarily raise the ph of the skin, which is normally slightly acidic . Most skins have an inbuilt ability to readjust the balance within 20 minutes of washing, though sensitive skin types take longer. If the skin is oily, citrus based toning lotions or astringent can be used after cleansing.
If the skin feels dry and tight after washing, try using a super fatted soap that incorporates emollients such as lanolin or mineral oil into the soap base. Other causes of dryness are over washing, incomplete rinsing, hard water (calcium and magnesium salts in the water combine with the soap to form a drying scum on the skin) or sensitivity. In case of very dry skin try a cream cleanser.

Moisturizing - Moisturizing cream is used for dry skin and lotion for oily skin. All moisturizers can be made to work more effectively by dampening the skin first

The use of exfoliating agents to peel the epidermis & superficial dermis dates back to ancient Egypt. Sour milk baths were used by ancient Egyptians to soothe the skin. This helps by removing the dead cells which are clogging the new skin giving you a new glow to the skin. It can be either mechanical or using various agents commercially available in the market. This need not be done everyday.

Sun Protection- Dark skinned people have natural pigment which acts as protection but even then sun block will help prevent damage to the skin as has been proven by studies. Sun block or sunscreen with an SPF(sun protection factor) 20 to 30 should be used, unless you are planning to go to the beach or swimming when a higher SPF would be useful. The sun screen should be ideally applied at least 15 minutes before one goes out into the sun and should be reapplied every 3 hours.
Some people might say that they are in cold climates or if cloud cover is present, you don’t need sun protection. the statement is False, UV damage can occur even other wise and reflected sunlight is enough to cause damage so using sun screen will go a long way in protecting your skin.
Taking care of your skin will go a long way in keeping it healthy and preventing the inevitable signs of aging from creeping in on you suddenly. Yes, turning back the clock or rather keeping it at the same hour for a longer time is possible to a certain extent naturally, by some simple measures.
So take that few minutes out from your daily routine and pamper the largest organ of your body.

Is the above statement true??? Why is Cosmetic Surgery still on the “taboo” list in INDIA?
Is undergoing a cosmetic procedure a bad thing?? I think not. If that were the case then the insurance companies would not be excluding cosmetic procedures from their purview. It goes to show that even the medical insurers are aware of the fact that if given a chance many of their clients would be willing to undergo a cosmetic procedure.

A few years back there was an article in a leading magazine written by a socialite about “ the Great Indian cover up!” It referred to the common dress in India, the salwaar kameez, which worked well in concealing a lot and also worked well in covering up a lot of excess baggage, only to be revealed after marriage.

Well, as more and more people, especially women are coming out to work or party and the attire changing from the traditional salwaar to a more corporate one and trousers, jeans or even our traditional Indian sari in a new look becoming the norm, the Indian woman is being uncovered.
Now, people want to look good in their new roles be it as officers or corporate employees or even as young mothers, let alone celebrities in the limelight like, actors or models. Also, it is no more a bastion of the fairer sex, so to speak.

Even the “ metro sexual “ male of today is bothered about his appearance, be it a paunch, a receding hairline or a crooked nose. Keeping fit, being healthy and looking good is the “ new mantra” of the young and not so young generation equally. This can be seen by the tremendous increase in the number of procedures performed on men in the last few years.

Does cosmetic surgery really have an impact on person undergoing the procedure?? Sure it does. Ask the teenager who wears a cap so his scar doesn’t show, the lady who wears a baggy dress to cover her love handles or post pregnancy stretch marks or an adolescent boy who doesn’t go swimming at school because his friends tease him about the little excess breast tissue he has. In some cases the psychological impact is huge and very palpable.
Let us examine a bit more closely the enigma called “Cosmetic Surgery”. Yes, it is not necessary like maybe a cardiac bypass or an appendicectomy, but it sure helps the person it is intended for.

An ideal cosmetic procedure is one, which tries to correct the problem but, preserving the attributes, which make the person the individual, he or she is.
But, care has to be taken from the patient’s point of view to the fact that they understand the procedure, they are realistic about the expectations and risks of surgery and of course are motivated by their own desire

Is cosmetic surgery associated with any risks? Yes, as any other surgical procedure a cosmetic procedure has its share of risks, which any plastic surgeon operating on a patient will always explain. But, the risks are not always appreciated because the procedure is not “a necessity”. This is the reason why a complication, which may be accepted elsewhere, is not accepted in a cosmetic procedure. But, these instances are rare.

The problem if any is not because of cosmetic surgery per se’ but more because of it not being done properly and not being done by qualified personnel.
With so many “Cosmetic centers” burgeoning all over the place, people tend to be enamoured by the so called “ guaranteed results” which is shown in block letters and miss out on the “ results may vary from person to person” which is in small letters in one small corner of the advertisement.

Hence being well aware and educated of the procedure is the first step before you actually go ahead with the procedures. There is enough and more information available on the World Wide Web about all these procedures, which will help you know, about the risks, problems and results.

So, cosmetic procedures like any other surgical procedure require proper personnel to perform it, along with all the proper pre and peri operative care. It also requires co-operation of the person undergoing the procedure in terms of regular follow-ups care as advised by the surgeon and undergoing minor inconvenience in the form of quitting smoking or alcohol or fatty / junk food.

Also, the candidates must be sure of the credentials of the surgeon and most importantly should be willing to follow orders and willing to tolerate unavoidable inconveniences like healing time, time for the swelling to come down, avoiding exposure to direct sunlight and refrain from smoking, etc.

Cosmetic surgery is no more only for the rich and famous and is here to stay, with more and more people going in for that nose correction, tummy tuck, breast augmentation or liposuction.
Combined with proper nutrition and exercise, an aesthetic procedure may help you look good, feel better about the way you look and improve your overall self-image. It is not a fly by night operation and is definitely not a miracle solution as nothing in this world is.

Cosmetic surgery is coming out of the “ taboo” list as can be seen from the fact that China hosted the first ever “Ms.Plastic Surgery Contest”!!!!
There is no need for it to remain an enigma!!!

Dr.Surindher
www.cosmesisindia.com

I think every one who visits my blog is going to have this thought at the back of his or her mind.

True, why is there a need for this blog. In fact, even I didn’t think that it was necessary until it was suggested to me by a patient of mine. The blogs that I hope to put here under this heading are in a way to create awareness regarding cosmetic surgery and its present status in India. Also aim to provide necessary information for anyone and everyone who is contemplating a change.

India is not only seeing an economic change but also change in lifestyles and thinking. People are becoming more open to all ideas be it political or personal. I see a change also in the number of people becoming more aware and concious of their body image and looking for ways to improve it. This can be achieved by various means ,of which cosmetic and plastic surgery is one.

But along with the need to have themselves subjected to these procedures, I haven’t seen an equal increase in the awareness about these procedures or their antecedent risks , limitations , indications and contraindications.

Towards the same aim , I put up two websites with the necessary details of the procedures, their risks, limitations , etc. Also started writing in magazines and news health supplements. But still I recieve numerous responses on my website with vague details and strange requests. And all these from educated people, which suggests that awareness on these is very low. These are people from all walks of life like housewives to models, from youngsters to aged people, from engineers to shopkeepers and an equal or more number of men asking for such procedures.

Hence with this blog site I hope to provide information, clear doubts, increase awareness and provide a platform where in people can get more aware of these procedures and not necessarily be afraid of them. But also be educated about the ” FACTS’ so that they can make and educated decision to the procedure they want.

Hence with the changing trends in India may be with more people opting for such procedures there is also an increased awareness about them and also awareness as to who are the people who are qualified to do the procedures….

Dr.Surindher