Thin Cheek

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Vaibhav Shah

Thin face.      (Buccal fat removal)

Buccal fat pad reduction (also called Bichat’s fat pad) is a common cosmetic facial surgery procedure that is performed to slim the cheeks or face.  Notice I refer to this as buccal fat pad reduction and not buccal fat removal.  I never recommend removing all the fat.  More about that later.

The buccal fat pads (buccal refers to the Latin word Bucca meaning cheek) are walnut sized fat deposits deep in the cheeks.  These fat masses are located in the cheek between the nostril and corner of the mouth.  Their function is to assist nursing in infants or to provide a smooth gliding plane for the jaw muscles.  It is the large buccal fat pads that give infants and young children the cheeks that grandma likes to pinch.  It is also the atrophy of these areas that cause the gaunt faces of anorexia, HIV or starvation.

 Some patients have a very full and round face, in part from large buccal fat pads.  The buccal fat pad is a large unit with mass in the temple region, the cheek region and the pterygoid region (back of the upper jaw).  There is no indication to remove the entire buccal fat pad and it is the cheek region that is most frequently reduced.  I always warn about total removal as it will slim the face, but a decade later can lead to a very gaunt and unhealthy appearance.  Remember, you have to live with your face the rest of your live and all fat is not “bad fat”.

I most commonly see patients requesting buccal fat reduction that have chubby cheeks in relation to the rest of their face and body.  It is frequently hereditary.  Although you occasionally hear about liposuction of the buccal fat pads, I don’t ever do this for several reasons.  Number one, these pads have heavy fibrous capsules that do not lend themselves to common liposuction.  More importantly, facial nerve branches, the anterior facial vein and parotid duct are frequently in close approximation to these fat pads and could be injured producing facial paralysis or severe bleeding.  For this reason, I always perform a magnification assisted precision surgical reduction of the fat pads.  It is not an area for imprecise technique and it is important for patients to select a surgeon with lots of experience and expertise in facial surgery.

The fat is located by making several small incisions on the inside of the cheek.  The surgeon then locates the buccal extension of the fat pad which is generally very plentiful and protrudes into the mouth .  The amount of fat to be removed is determined and the fat pad is removed using a laser or radiowave device.  This is important as it seals the blood vessels and prevents bleeding which can be problematic in that area.  After the fat is removed the small incisions are closed with dissolving sutures

  

PROCECURE IS INTRAORAL. NO EXTERNAL SCAR . .. . 

Surgeons

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Vaibhav Shah

What types of doctors perform cosmetic surgery?

A: There are many qualified doctors from various specialties that perform cosmetic surgery. Plastic Surgery, Dermatology, Oral and Maxillofacial Surgery, ENT, Facial Plastic Surgery, Ophthalmology and other types of surgeons perform cosmetic procedures. Some specialties can mislead the public by indicating that their particular are of practice is the most qualified to perform cosmetic surgery. Again, all the specialties mentioned above have contributed significant advancements to the field of cosmetic surgery. There are excellent doctors all over the world in all the above specialized fields who have the experience and patient results to support their qualifications. Although any doctor can legally perform cosmetic facial surgery, it is not the degree that is the qualification. You would not let your pediatrician or psychiatrist perform a facelift even though they are a medical doctor. It is the training of the doctor. For instance, Dermatologists have added much progress to cosmetic surgery with the development of tumescent liposuction and lasers. Oral and maxillofacial surgeons pioneered and developed many head and neck cosmetic procedures as did ENT doctors. Ophthalmologists have defined the anatomy and techniques for many cosmetic eye procedures. To say that these doctors are not qualified is simply untrue.

Why to Select Maxillo-fACIAL Surgeon for Facial Cosmetic Surgery?????

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 Vaibhav Shah

                           Oral and Maxillofacial Surgeons are able to provide their patients with a wide range of facial cosmetic services to meet their evolving needs.  They have been leaders in the facial reconstruction of the osseous (bone) and soft tissue (skin, muscles, and cartilage) structures of the face.  Facial cosmetic surgery services provided by Oral and Maxillofacial Surgeons have always addressed physical imperfections resulting from birth defects, facial trauma, disease, and aging.  Oral and Maxillofacial Surgeons have the ability to carry out the entire spectrum of facial cosmetic surgery, from skin care and non-surgical enhancements to minimally invasive as well as full surgical rejuvenation of the face and associated structures.

                            In recent years, there has been an increased emphasis on cosmetic procedures to restore a patient’s youthful appearance.  Today, people have busy and active lifestyles and they have the desire to stay looking young with minimal down time and low risk.  Oral and Maxillofacial Surgeons utilize proven techniques to restore each patient’s youthful appearance and minimize the progression of the aging process.

                           Over the past few years, there have been a multitude of advances in facial surgical techniques.  As a result, Oral and Maxillofacial Surgeons are able to employ cosmetic procedures using local and/or intravenous anaesthesia, often in an office setting with same-day surgery.  Oral and Maxillofacial Surgeons are able to combine their extensive facial surgical  training with their dental expertise to uniquely provide  comprehensive treatment of congenital diseases, injuries, tumours, and deformities of the face and jaws. This extensive knowledge enables them to incorporate a patient’s desired result in cosmetic surgery with the necessary balance of creating harmony between facial aesthetics and facial function.

                           Cosmetic surgical procedures available by Oral and Maxillofacial Surgeons may include:

·         Rhinoplasty (nasal reconstruction)

·           Genioplasty (chin surgery)

·         Facial Implants (including chin implants and cheekbone implants)

·         Otoplasty (cosmetic ear surgery)

·         Liposuction  (of the face and neck)

·         Blepharoplasty (eyelid surgery/orbital surgery)

·         Brow lift, Mid-cheek, and Mid-face lifts

·         Rhytidectomy (facelift)

·       Skin Care and Skin Resurfacing (i.e. skin products, chemical peels, dermabrasion, non-ablative, and ablative laser treatments)

·         Botox, Dermal fillers, Fat transfer

·         Lip Enhancement

·         Hair Transplant

·         Eyelash Growth Enhancement (treatment of hypotrichosis)

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Orthognathic

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Vaibhav Shah

Orthognathic surgery (Jaw correction surgery)

Orthognathic surgery (Greek “orthos” means straight and “gnathos” means jaw) is a single or double jaw surgery which is performed to reposition the jaws. During orthognathic surgery a correct jaw alignment and occlusion, as well as, facial harmony is achieved. When the jaws are moved forwards or backwards, up or down, or rotated, the facial soft tissue in the chin, cheeks, lips and tip of the nose move accordingly. Therefore, once the jaws are correctly positioned a harmony between the facial features is acquired which results in a beautiful profile.

Nose Surgery

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Vaibhav Shah

Nose Surgery

                             Rhiniophyma is a skin condition that causes disfiguring growth and thickening of the nose. If left untreated, rhinophyma can grow very large. Treatment involves reducing the abnormal tissue with radiowave surgery and/or CO2 laser. The procedure is performed with IV sedation and the nose will be pink for several weeks.

            

Filler “rhinoplasty”

Although not a true surgical procedure, many patients have subtle nasal deformities that can be masqueraded or camouflaged with injectable fillers.  By filling a depression on the top of the nose, the nasal bridge can look smoother because the hump is lessened.

LASER

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Vaibhav Shah

Laser skin resurfacing (carbon dioxide laser)

Laser skin resurfacing is a procedure that can take decades of aging off the face in a matter of minutes. Although chemical face peels are reliable for sun damage and fine wrinkles, the laser can address much deeper wrinkles, acne scars and other complexion problems. Ideal laser patients are those without extreme skin sagging, but with wrinkles and sun or age spots. Laser skin resurfacing can be done on patients with lax skin, although these patients may benefit from face-lift or other cosmetic procedures at the same time. Laser skin resurfacing is still the gold standard for wrinkle improvement and to date no technology has surpassed laser skin resurfacing. The recovery is one to two weeks, but don’t be fooled by “light” lasers claiming huge results with minimal downtime. It is a myth! If you want to improve 40-50 years of aging, ten days is not an unreasonable recovery.

Hair Transplant

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Vaibhav Shah

Hair Transplant

What are the causes and treatment for Hair Loss?

Hair loss can result from heredity, stress, fungal or bacterial infection, affected liver or thyroid, crash dieting, dandruff, iron, calcium and vitamin deficiencies, systemic disease or side effect of prolonged medicines. These causes can be investigated and treated with suitable medicines. Hair loss that does not respond to treatment and has progressed beyond grade three requires replacement with new growing hair, which is done by hair transplant.

What is Hair weaving, Hair bonding, Hair fusion etc?Hair weaving is tying a wig on the head with silk thread knots. Hair bonding is holding the wig with clips and hair fusion is sticking a light weight nylon wig with a double sided sticking tape. These are all temporary methods. Prolonged use causes bad hygiene, pull out of the anchoring hair and excoriation of skin. These methods are not done by doctors.

What is Hair transplant?

Hair transplant is a one day procedure which gives permanent replacement of lost hair with new hair roots that grow. These can be cut, shampooed and treated like your own hair. Repeated visits to the clinic are not required.

How hair transplant corrects baldness?

Baldness is a progressive disorder. Hair on the front and top of the head is lost because it is hormone dependent. Hair on the sides and lower back does not have hormone receptors. This hair is retained till the age of 60 – 70yrs. Plastic surgeons transfer the persons own hair roots from the long lasting area to the bald area. Latest Follicular micro grafting ( FUT ), FOX technique and Body Hair Transplant

What are punches, single hair grafts and the latest FUT?

Use of punches and single hair grafts are now outdated. Hair grows in natural units of 1,2 or 3 hairs. These natural units are maintained in the latest follicular micrografting technique. This gives a robust, hair growth. If these units are separated and implanted as single hair they give poor growth. Follicular unit grafts avoid, clumpy appearance of punches and the thin look of single hair.

Do you have to be completely bald for a hair transplant?

Follicular micro grafts can be used in – between thinning hair in men and women for adding density. Our team covers most areas in single sitting. 1000 – 2000 grafts can be done at one time, going to a maximum of 3000.

Can you make less number of grafts look fuller?

Special interdigitated placing is used to make lesser number of grafts look fuller.

What happens to the area from where the grafts are taken?

The area from where the grafts are taken is closed so that no bald patch is seen.

How are the grafts placed and when do they grow?

The micro grafts are paced in the bald area with injection needle pricks to make sure there is minimal scarring. The grafts start growing with the next hair cycle at 3 – 4 months and keep on growing thereafter.

How long does the operation take? Do we have to remain admitted?

The surgery is done under local anesthesia. It takes 6 – 8 hours. Patient is discharged on the same evening and advised rest for 3 – 6 days. Follow up for suture removal is required at 12 – days. Suture-less FOX technique and transplant of body hair is available for suitable patients.

What can be done for old pluggy grafts or flaps?

Correction of old pluggy looking grafts or low straight line hair flaps can be done by recycling the punches and redraping the flaps.

What other hair loss can be replaced with FUT?

Restoration of eyebrows, eyelashes, burn areas, scars, beard, moustache, cleft lip Hanson’s patients, pseudopelade, and Folliculitis Decalvans is best done with follicular micro grafting.

Filler

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Vaibhav Shah

DERMAL FILLER

New Injectable Fillers

A virtual revolution is going on with the development of fillers. Many different products have been used safely and effectively for many years in Europe, Canada, and Australia. These fillers have been passing FDA scrutiny and many have been cleared for use in the India. Each coming year will bring the introduction of new fillers.

What Filler is the Best?

There is no easy answer for this question as each filler has different advantages and disadvantages. Contemporary cosmetic surgeons use multiple fillers to assist the various problems associated with facial aging. It is rare that any contemporary surgeon uses only a single filler. In reality it is important to separate the marketing and media hype from the true clinical science of injectable facial fillers. It seems that each time a new filler is FDA approved, it is hyped as “the best and longest lasting filler in history”, that is until the next month when the next filler comes out. In reality, they are all good for specific indications. Sometimes they are like “Coke” and Pepsi” in that they are made of the same ingredients and do the same thing. Some patients or doctors simply like one better than the other.

All doctors and patients want fillers to last long. As filler science progresses the longevity of fillers is increasing. Although we want things to last long, sometimes it is a good thing that they go away. What looks good or is in style today may not look good or be in style in 5 years. Due to this, fillers that will eventually be absorbed by the body may be preferable.

The contemporary cosmetic surgeon is somewhat of a “filler bartender” and has multiple filler choices specially tailored for specific applications.

Facelift

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Vaibhav Shah

                     FACE-LIFT

                        Facelift surgery is probably the best-known cosmetic facial procedure and is the absolute gold standard for lower face and neck rejuvenation. Although there are many new technologies that supposedly address skin and neck tightening, none of these can come close to the improvement and longevity of traditional facelift surgery.

                      Facelift surgery was developed and refined over a century ago and has undergone many changes. The facelift that your parents may have had is not the same as today’s contemporary techniques. A generation ago, a facelift had an average hospital stay of 3-4 days. With the recent advances in instruments, technology and anesthesia, facelift surgery has never been easier or more affordable.

                   

                         Another difference in today’s facelift patient is the age. Today’s patients do not want to wait until they look old to have cosmetic surgery. They want to stay younger looking all their life. In the past, most patients waited until their sixth decade and underwent a big operation with an extended recovery. Today’s patients opt to have smaller procedures along the way and avoid the overhaul their parents had. Performing smaller cosmetic procedures along the way may require the patient to have them again later in life, but again, they will avoid looking aged.

                            If it sounds too good it probably is! Don’t be fooled by any technology that reports facelift type results without surgery. This includes Thermage, Fraxel. Ulthera and Thread Lifts. This is not to say that these therapies do not do anything, but they cannot hold a candle to the improvement and longevity of contemporary facelift surgery. We routinely see patients in our office that were treated somewhere else with a “new miracle technology” to tighten their face and neck and are embarrassed and frustrated that they wasted enough money to have paid for a real facelift. If any doctor reports significant results from a non-surgical procedure, demand to see 20 STANDARDIZED before and after pictures at least 1 year after the procedure. Also make sure they are pictures of actual patients taken by this doctor and not company pictures. If someone can show you results like this, then the procedure may be worth consideration. So far we have never seen any technology meet this challenge. We see many disgruntled patients every month who wasted their hard earned money on a promise that sounded too good to be true.

Chin Surgery

Vaibhav Shah

Chin Surgery (Genioplasty)

What is Chin Surgery (Genioplasty)?

Chin surgery or genioplasty is more commonly known as chin repositioning. This surgical procedure is done to correct receding chins, chin misalignment or chin excess.

How is the Procedure Performed?

Reshaping the chin can be accomplished either by using chin implants cost in India https://www.drvaibhavshahclinic.com/cost-of-chin-implant-in-india/or by repositioning the bone supporting the chin. There are many types of implants available, manufactured from a variety of materials, including silicone or other substances. There is no available evidence to suspect that silicone implants cause any disease. Your surgeon will consult with you, and discuss recommendations for the type of implant to use.

During the procedure, an incision inside the lower lip or under the chin. The chin bone is repositioned or an implant is placed through this incision

Cheek Implant

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Vaibhav Shah

Cheek Implant

                             In the past, cosmetic surgeons concentrated on making patients look tighter, not necessarily younger. Contemporary cosmetic surgeons appreciate the importance of volume in facial aging and rejuvenation. Today’s surgeons utilize many options including injectable fillers, fat transfer, lifting procedures and midface (cheek) implants to restore volume. Cheek implants have numerous advantages over other methods of restoring midface volume.  Fillers and fat will dissolve over time.  Fat and permanent fillers will droop over time, worsening the problem and cheek or midface lifting procedures will sag over time.  Cheek implants are fixed to the cheek bones with tiny micro screws, so they will always remain in place and not droop.  This makes them the only three dimensional method of cheek rejuvenation that is permanent and won’t move.  Perhaps the biggest advantage is that if the patient does not like them, they can be removed in 5 minutes! There are not many options that are both permanent and reversible.  When considering the available options for midface rejuvenation (fillers, fat, lifting procedures and implants) nothing rivals the versatility of silicone cheek implants. One thing that has never ceased to amaze me is how many surgeons will perform cosmetic facial rejuvenation on the upper face and lower face and completely ignore the midface.  A volumized midface is the hallmark of youthfulness and contemporary cosmetic facial surgeons realize this fact and address this important area.

BOTOX

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Vaibhav Shah

BOTOX

What is Botox?

Botox is a weakened form of Botulinum toxin. It works by weakening the muscles that control facial expressions. Botox can be an extremely effective treatment for wrinkles in the upper third of the face, including the forehead, between the eyes, and around the eyes in the "crows feet" areas. Botox is the only form of botulinum toxin currently approved by the FDA for cosmetic purposes.

Who is a Good Candidate for Botox?

Candidates must be in good health, have no active diseases or serious, pre-existing medical conditions, and must have realistic expectations of the outcome of the surgery. In general, the best candidates for Botox are individuals with mild wrinkling of the face. During the initial consultation, your physician will determine if you are a good candidate for Botox or if an alternative cosmetic technique will yield better results.

How are the Botox Injections Performed?

Using a very tiny needle, small amounts of Botox are injected into the muscles to be paralyzed. Depending on the areas being treated, 5 to 15 needle pricks (or more) may be required. Discomfort is minimal and lasts only a few seconds. This paralysis is temporary, and re-injection is necessary within three to ten months.

Attractive Face

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Vaibhav Shah

ATTRACTIVE FACE

                           Every day we meet and speak to new people. What determines our perception, whether the face of a new man or a woman you have just come across is attractive or not? Probably it would be difficult to find two non-relative persons with exact faces on earth, but it is considerably easier to find people, who have similar eyes, cheeks, nose, lips, or chin. Why does one face created from the same “details” look more attractive than the other? Is facial attractiveness determined by the beauty of several separate facial parts? Or probably we can say that it is determined by the harmony rather than beauty of individual facial parts?

                             Scientists have been on the way in seeking an answer to this question for years trying to find which part of the face is playing the greatest role in the attractiveness of the face, and surgeons – trying to “attack” those parts, thus hoping to make the face more attractive by changing particular features. Do we look at the eyes, at the smile, the symmetry of the face or at the combination of several features like nose, cheeks, eyebrows or eyes when assessing facial attractiveness?

                              It is stated that the distance between eyes, facial width and height, mouth size, cheek position, eye colour and shape, make a fair influence for the attractiveness of the face. Features of mature face, such as protruding cheeks, rectangular jaw and large chin are associated with the attractiveness of the masculine face. In contrary, feminine face is considered to be more attractive if it is enriched with infantile features: long distance between eyes, small chin, and wide smile. Furthermore, a face is considered even more attractive if all parts are symmetric and all regions are of average size. For the face of an ideal shape, hairstyle has no great influence, but once well fitted it can make a non-ideal face look more attractive.

                             A great influence on the attractiveness of the face is exerted by the crowding of teeth or spaces between them. Anterior teeth, once correctly aligned, may influence facial attractiveness more than interrelation between jaws. However, lip projection, which largely depends on the relationship of jaws, makes the greatest influence on the attractiveness of the face.

Aging

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Vaibhav Shah

What is Aging (old looks)

                                 There are few certain things in life, and aging is one of them.  All things age and although some say that “age is only important in wine and cheese”, we know better.  Humans have been searching for the fountain of youth since recorded history and mankind has gone through some pretty crazy phases in the name of trying to stay young. There is no doubt that your average man or woman wants to look as young as they can for their age.

                             

                             Of all areas, the midface is one of the largest contributors to facial aging.  The youthful midface is all about volume and plumpness.  Young people have full and volumized midfaces and this is one reason they look young.  In youth, we have the proper amount of fat in the correct places.  As we age, we lose fat in the cheeks and gain it in the jowls.  This loss of midfacial volume produces an aged, gaunt and hollow midface because the cheeks become the jowls!  So as we age, you can say we go from a grape to a raisin.

                           When we are young, our midface is naturally volumized and our lower face and neck are tight.  A youthful facial outline looks like an upside down egg.  With natural aging changes, we lose the midface volume and our lower face and neck becomes full.  This produces a facial outline that resembles a right side up egg. Some may say egg foo  young and egg foo old! Midfacial aging and volume loss is treated with cheek implants , injectable fillers , fat transfer and lifting procedures.