Emerging Trends In Acne Scar Management

 

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On an average 80% of Indian population suffers from acne between the age group of 12 to 28 yrs of age. Almost 50% of these patients have acne scars later in life which serve as a terrible reminder of this disease.
What Causes Acne scars:
Everyone who has acne does not scar to the same extent. Reasons of scarring are multi-factorial and there is no single identifiable cause.
1) Scars develop whenever there is dermal injury which is 0.56+/- 0.03 mm
2) People who tend to pick or squeeze their acne blemishes are more likely to scar
3) Delayed treatment of Acne resulting in more infection and increase breakouts also contributes to scarring
Types Of Acne scars:
All acne scars are not the same and each type requires a different treatment.
1) Consist of pigmentation like brown patches in darker skin or red patches in lighter skin tones
2) Depressions such as ice pick, rolling, and box varieties of scars
Best time to treat acne scars is there when there are no breakouts.
Treatment Of Acne Scars:
There are many treatment options today but there is no one size fits all approach as each scar is different. This is where a Plastic Surgeon who has good experience in various types of scarring and expertise in their various treatment modalities is required.
Treatment has to be individualised depending on the type of scarring, downtime required, frequency of treatment, cost and finally the most important factor the potential of the treatment to improve the condition.
1) Brown patches:
Topical bleaching cream with Vit.C application. It may require 4 to 6 sittings spaced 14 days to 21 days apart. This is a low cost treatment with minimal downtime.
Chemical peels: They are more aggressive form of treatment and vary from medium to superficial depth. They require more downtime and additional precautions from sun in a tropical country like India.
2) Red or Hyperaemic patches:
These are managed by giving oral and topical antibiotics which reduces the inflammation. Lasers can be used in cases where increased vascularity is a cause secondary to rosacea. Lasers increase the cost and the downtime in the treatment.
3) Scars with depression like ice pick scars:
These scars are the most difficult to improve and may require a combination of procedures to achieve significant levels of improvement. Various surgical methods as described below can be used.

Current Trends In Management of Depressed Acne Scars:
1)Micro needling: This is the technique in vogue these days. It involves multiple punctures in the scarred skin with the help of a Dermaroller or Dermapen. After this various various types of medications or solutions like PRP can be applied over the treated area. This treatment may require 4 to 5 sessions every 14 days. In my experience this has shown promising results when done properly in combination with the proper solutions.
2) Dermabrasion: This is a time tested procedure which gives the best results in experienced hands. This procedure is entirely operator dependent and requires the maximum downtime. This involves buffing down the scarred skin upto the entire depth of the pit scar. Quality of the dermabrader, protecting the surrounding normal skin followed by proper after care in the form of sun protection creams and other medications gives the optimum results.
3) Laser Resurfacing: This is the fad nowadays .With ever evolving technological advances there various types of lasers available for clinical use . They vary from superficial to deep or more aggressive lasers. More aggressive the laser, more the downtime required and less number of sessions are required. However, availability and cost are major limiting factors in the treatment. CO2 lasers with fraxel technology are quite effective for skin resurfacing.
4) Others: Punch excision, subcision, fillers and chemical peels are older methods used as indicated.

Dr. Arunesh Gupta is a renowned Plastic And Cosmetic Surgeon based in Mumbai,India. He has trained in Plastic, Reconstructive and Cosmetic Surgery in India and U.S.A.
Dr. Arunesh Gupta has published extensively in Plastic Surgery Journals, written book chapters, and has presented his work nationally and internationally at Plastic Surgery scientific meetings. He is also actively involved in organizing continuing medical education and workshops for the benefit of other doctors and medical students.
His areas of interest are
1. Cosmetic Surgery of face, breast and body
2. Microvascular Surgery for Onco-reconstruction
3. Stem cell therapy for Hair and Facial rejuvenation
4. Cosmetic Gynecology
For any queries regarding Cosmetic Surgery
contact Dr.Gupta :
Email : aruneshgupta@gmail.com
Whatsapp : +91-9594066503
Website: http://www.piaaesthetics.com/

 

Vampire Facial: Separating Science from Fiction

In these times of Instagram and Facebook where looks are everything ,it is not a surprise that people like to remain young forever like mythical  ‘Vampires ‘.  Actually Vampire facial/Dracula facial made popular by the celebrities  is an hour long cosmetic procedure to fill in fine facial wrinkles or plump up the cheeks . Scientifically speaking it’s the injection of platelet rich plasma(PRP) prepared from the individual’s own blood by centrifuging it and injected in the dermal layer of the skin so as to provide a more youthful appearance. Platelet rich plasma (PRP) is concentrated blood plasma that contains approximately 3 to 5 times the number of platelets found in normal circulating blood. It also contains platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), transforming growth factor (TGF) and other bioactive proteins. PRP along with it’s growth factors stimulate new collagen production that rejuvenates the skin.If PRP is combined with other fillers such as Juvederm then it is termed as the “Vampire facelift”.

Benefits of PRP therapy are that the results achieved are natural looking and subtle without the use of foreign substance and no allergic reaction. PRP therapy can also be used in the under eye areas where fillers can’t be injected or if the patient doesn’t desire artificial fillers.While the results of PRP can vary depending on the complexity, most people notice immediate improvements in the texture, coloration, and volume of their skin. It can take up to seven weeks after the procedure to see the full benefits. Regarding what procedure to be done, how many sessions to be undergone is best decided on an individual case basis in consultation with your Cosmetic/Plastic Surgeon.

Dr. Arunesh Gupta is a renowned Plastic And Cosmetic Surgeon based in Mumbai,India. He has trained in Plastic, Reconstructive and Cosmetic Surgery in India and U.S.A.

Dr. Arunesh Gupta has published extensively in Plastic Surgery Journals, written book chapters, and has presented his work nationally and internationally at Plastic Surgery scientific meetings. He is also actively involved in organizing continuing medical education and workshops for the benefit of other doctors and medical students.

His areas of interest are
  1. Cosmetic Surgery of face, breast and body
  2. Microvascular Surgery for Onco-reconstruction
  3. Stem cell therapy for Hair and Facial rejuvenation
  4. Cosmetic Gynecology

For any queries regarding Cosmetic Surgery , contact Dr.Gupta on his email : aruneshgupta@gmail.com or Whatsapp on +91-9594066503.

 

 

Is Bra Size The Right Way To Decide On Your Breast Implant ?

Most of the breast augmentation patients coming in for a consultation have the demand that i want THIS BRA SIZE. However this is an inaccurate way of measuring breast augmentation. Most of the bra brands have different cup sizes and there is no standardization of bra sizes. It is a variable which can not be measured in any way. So when a patient talks about her bra size it just gives the Plastic Surgeon a vague idea of her expectations. It should be made very clear to the patients exact cup size and bra size can not be guaranteed. Choosing the correct breast implant is a very exacting science which is determined by mainly patient factors and the type of implant to be used.

Patient variables which affect the implant size are  skin thickness, chest wall size , body frame of the patient etc. Implant factors like gel viscosity, gel-type, implant shape, projection and capacity are to be considered. Plastic Surgeon’s job is to educate the patient with what is possible,what fits their body, what fits their frame and emphasize that aim is to achieve natural results. When your friends see you the impression should be that have perfect breasts—NOT a great Plastic Surgeon.

Dr. Arunesh Gupta is a renowned Plastic And Cosmetic Surgeon based in Mumbai,India. He has trained in Plastic, Reconstructive and Cosmetic Surgery in India and U.S.A.

Dr. Arunesh Gupta has published extensively in Plastic Surgery Journals, written book chapters, and has presented his work nationally and internationally at Plastic Surgery scientific meetings. He is also actively involved in organizing continuing medical education and workshops for the benefit of other doctors and medical students.

His areas of interest are
  1. Cosmetic Surgery of face, breast and body
  2. Microvascular Surgery for Onco-reconstruction
  3. Stem cell therapy for Hair and Facial rejuvenation
  4. Cosmetic Gynecology

For any queries regarding Cosmetic Surgery , contact Dr.Gupta on his email : aruneshgupta@gmail.com or Whatsapp on +91-9594066503.

Tummy Tuck : Choosing The Right Tuck

Having a Tyre of fat around your waist? Probably it is time you consulted your Plastic Surgeon for solutions. By now you have tried everything dieting, exercise but stubborn belly fat around your waist refuses to budge. Losing weight elsewhere on your body only made the matters worse because the belly now is more pronounced. The skin on your stomach is loose, sagging, and you can grab a handful of excess skin. Added to all this in females who have multiple pregnancies their might be separated abdominal muscles which worsen the problem making tummy tuck a necessity.

Often considered a procedure for the rich and famous, tummy tucks (also known as abdominoplasties) are a common procedure now with almost 4 fold increase in the last decade and is now the third most commonly performed plastic surgery procedure.

Abdominoplasty is a surgical procedure that focuses on removing the excess skin and fat around the waist and tightening the underlying abdominal muscles. It is important to understand that a abdominoplasty is not meant to help you lose weight. Healthy lifestyle has to be maintained after surgery to get long term results out of the surgery. Depending on the type of tummy tuck performed, a combination of excess skin removal, liposuction, and abdominal muscle tightening can be used to give the stomach a flatter, toned, and firmer appearance.

Which Tummy tuck to choose: This decision is made in consultation with your Plastic Surgeon depending on the various criteria.

  • Traditional tummy tucks: Most commonly performed type and here scar extends between the hips
  • Mini tummy tucks (partial abdominoplasties): For patients within 10 percent of their ideal body weight and there are alterations only to the part of the abdomen that is below the umblicus.
  • Endoscopic tummy tuck
  • Extended tummy tucks: Removal of ‘love handles’ as well as the removal of fat and excess skin from tummy. Extension of the scars is behind the hips and below the panty line so it will not be visible, even when one is wearing low-rise clothing.
  • Circumferential tummy tucks: Type of body lift done in patients who have undergone bariatric surgery. The scars for this type of procedure are circumferentially around the waist.

 

tummy tuck blob pic

Abdominoplasty is always done best by detailed discussion between the expert Plastic Surgeon and the patient. It is individually tailored according to the needs and desire of the patient. When deciding to have a tummy tuck choosing the right plastic surgeon is of paramount importance.

Dr. Arunesh Gupta is a renowned Plastic And Cosmetic Surgeon based in Mumbai,India. He has trained in Plastic, Reconstructive and Cosmetic Surgery in India and U.S.A.

Dr. Arunesh Gupta has published extensively in Plastic Surgery Journals, written book chapters, and has presented his work nationally and internationally at Plastic Surgery scientific meetings. He is also actively involved in organizing continuing medical education and workshops for the benefit of other doctors and medical students.

His areas of interest are
  1. Cosmetic Surgery of face, breast and body
  2. Microvascular Surgery for Onco-reconstruction
  3. Stem cell therapy for Hair and Facial rejuvenation
  4. Cosmetic Gynecology

For any queries regarding Cosmetic Surgery , contact Dr.Gupta on his email : aruneshgupta@gmail.com or Whatsapp on +91-9594066503.

 

Fat Grafting: Putting fat in the right places

Volume loss in the face occurs as part of the natural aging process and with massive weight loss. Facial volume loss is usually more noteworthy around the eyes, cheeks and jawline. Facial wrinkles including laugh lines, smile lines and crow’s-feet, as well as acne scars and lips can also benefit from a fat grafting procedure.

Fat grafting involves two steps. First is harvesting  fat from one’s own body generally abdomen or thighs and second is to inject it into regions of the face that have started to lose fat, appearing creased and sunken. Since very minimal amounts of fat are removed for facial fat grafting, this procedure is not like liposuction and the whole procedure is performed under local anesthesia. Using small, 20 gauge cannulas, the fat is injected as little droplets throughout the areas of the face that need restoration.

Why Fat grafting and not artificial fillers:  As fat is from your own body (autologus), there is no chance of allergic reaction that is associated with adding a foreign substance, such as dermal fillers, to your body. Fat grafting provides a more permanent correction than temporary fillers as these absorb over a period of 3 months and require to be repeated. Another added advantage of fat is that it contains Stem cells (ADSC) which help the skin texture and tone and make the facial skin appear more radiant.

For a versatile Plastic Surgeon, the face is a region through which their patient’s lives are expressed. Fat grafting is an artistic Plastic surgery procedure that rejuvenates the face. It requires a combination of dexterity, talent and artistry. Skilled Plastic Surgeon’ use the face as a canvas and through fat grafting sculpts the facial features that make you look more youthful and energetic.

 

fat-injection

Bursting Age Myths

Myth: Inherited Genes are responsible for how you age

Truth: In some cases, it is true but for the most people aging happens, due to the way they live means lifestyle. Our aging process is affected by the environment, by the food we eat and habits (like exercise, smoking). Sun exposure along with excessive eating is a major cause of fast aging. Unfortunately excessive eating is becoming a common problem in our society. Watch what goes into your mouth.

Myth: Complementing our diet with supplements will slow the aging process

Truth: There is scientific evidence that the omega-3 fats EPA and DHA in fish oil are powerful anti-inflammatory agents and may reduce age-related cellular damage. This can be taken as diet by eating 2-3 fish per week or taken as tablets. Multivitamins which have Vit.B3 as a component are good for skin. Less compelling evidence is there for Coenzyme Q as well as Chondroitin taken for prevention of joint aches. The latest trend is Resveratrol, the active metabolite of red wine proposed to be capable of increasing lifespan, but studies are still inconclusive. All supplementation should be considered after consulting your Plastic Surgeon.

Myth: As age progresses, it’s the drooping skin of the face and neck that makes us look older.

Truth: The hanging skin worsens the look, but more than that, it’s the loss of facial fat, especially around the eyes and cheeks that make us look older beginning as early as age 30. Latest studies have shown these fat compartments on the face and help us in determining how and where to add fat to make you look young and more natural longer.

Myth: Conventional anti-aging cream will keep you looking younger longer.

Reality: This is not true however newer serums which are based on stem cells and other growth producing factors in these can really make a difference in the earlier signs of aging like fine wrinkles. With long-term use, it can improve smooth the skin and remove age spots. The other immensely important anti-aging prophylactic is a sunscreen with both UVB and UVA protection. Sunscren with a SPF of over 30 is ideal for Indian skin. The combined usage of these will make a big difference in how fast your skin shows visible signs of aging.

Real (Duchenne) Smile vs Fake Smile

Want to know the smile you received was true or fake? There is a simple test for it. True smile also known as Duchenne smile is smiling with both your mouth and eyes. It is a real and spontaneous smile if there is wrinkling at the corners of the eyes and a slight squint in them.

It is named after French neurologist Guillaume Duchenne who worked in mid-19th century on the physiology of facial expressions.  As part of a series of experiments which involved stimulating the facial muscles of test subjects with electrical currents Duchenne discovered that two specific facial muscles have to work together in order to produce a genuine smile, namely: the zygomatic major muscle and the orbicularis oculi muscle.

He described 2 different types of smile. True smile or Duchenne smile reflecting a positive affect is due to contraction of zygomatic major muscle which raises the angle of mouth and the orbicularis oculi muscle causing the wrinkling around the eyes. Fake smile (Flight attendant smile or social smile) involves just the contraction of zygomatic major muscle which raises the angle of mouth.

duchenne-smile

Social Smile                                                 Duchenne Smile

Smile like other human expressions must be taken in context with the social situation. People posing for social media photos with their pouts and things are unlikely to be real. But after all said and done smile is the best accessory you can ever wear.