In today's society of body consciousness, much greater attention is directed to the size and shape of our bodies than ever before.

In an attempt therefore to control any bodily changes which may occur in this respect, we try to make use of exercise and diet to the best of our abilities. However certain areas of our body can become stubbornly resistant to any improvements.

In some individuals the localised deposits of fat in the abdominal region combined with muscle laxity can make any hopes of a "flat tummy" very difficult to achieve. In women this becomes all the more difficult if stretched and loose skin appears following pregnancy. The children are, of course, worth every inconvenience. Nonetheless this does not stop us from thinking whether or not anything can be done to improve this.

Alternatively there are individuals who may have lost a large amount of weight and subsequently find as a result that they have an "apron" of skin which hangs down in front of the abdomen. This occasionally can lead to problems of chafing and rashes appearing under this "apron".

Surgical procedures can selectively be employed to improve situations in which these problems arise. These operations however are not directed toward weight reduction, which is still primarily a dietary problem. In cases where improvements can't be made despite even the most diligent efforts, an abdominoplasty may be appropriate.

Abdominoplasty or "tummy tuck" as it is commonly known is an operation to tighten the muscles of the abdominal wall and to remove excess skin folds and fatty tissues from the middle and lower abdominal region.

There are a number of variations in techniques with this surgery. As such it can dramatically reduce the appearance of a protruding abdomen and lead to a flatter, firmer, tighter stomach and when liposuction is combined with this procedure, a thinner waistline can be achieved also. When abdominoplasty is combined with liposuction we call it lipoabdominoplasty.

Many times however the problem is basically confined to only localised fat in the abdominal region without any associated skin laxity or stretch marks. In these cases liposuction alone may be suitable. Other times, as mentioned liposuction can be performed in conjunction with one of the many variations of an abdominoplasty procedure.

Introduction and Indications:

Liposuction is a technique to remove unwanted deposits of fat from specific areas of the body including under the chin, the upper arms, the trunk, the abdomen, the buttock, the hips and thighs, the knees and occasionally the calves and ankles.

Liposuction is also called lipoplasty or liposculpture by plastic surgeons. This is not a substitute for weight reduction, but a method for removing localised deposits of fatty tissue that do not respond to either diet or exercise. Liposuction may be performed as a primary procedure for body contouring or may be combined with other surgical techniques such as a facelift, an abdominoplasty or thigh-lift. In these combined procedures the idea is that the excess loose skin and supporting structures are also tightened.

The best candidates for liposuction are individuals of relatively normal weight who have excess fat in a particular body area. Having firm elastic skin will result in a better final contour after liposuction.

Techniques:

There are different techniques to remove fat from underneath the skin. Basically, fat cells are broken down either by mechanical force or blasting with a laser or ultrasound energy probe or fat cells are liquefied by water jet.

Suction assisted liposuction (SAL) is performed by using a hollow metal rod known as a cannula that is inserted through a small skin incision and is passed back and forth through the area of fatty deposits. The cannula is attached to a vacuum pump which provides the suction needed to remove the fatty tissue.

Power assisted liposuction (PAL) is an advancement of suction assisted liposuction in which the cannula vibrates back and forth making the liposuction procedure faster and smoother. PAL also reduces tissue trauma, hence it reduces postoperative swelling, pain and bruising.

In Laser assisted liposuction - LAL (commonly known as Smart-lipo) the fat cells are blasted with a very thin laser wire (probe). The liquefied fat is removed from the area by lymphatic and venous circulation and gets metabolised in liver. If the volume of liposuction is large then it is removed by low suction assisted liposuction. It is a very effective treatment technique for small localised area of fat deposits.

Water Jet assisted liposuction (WAL) is another modern technique of removal of localised fat deposits. It also allows infiltration of large volume of diluted local anaesthetics solution with minimal discomfort. Therefore, we can perform your liposuction only under local anaesthesia even without sedation. The water jet (spray) breaks fat cells with minimal trauma. Hence postoperative swelling and bruising are reduced.

In some situations a special cannula may be used that emits ultrasonic energy to breakdown the fatty deposits. This technique is known as ultrasound assisted liposuction (UAL).

Radiofrequency assisted liposuction (RFAL). This is a new technique by which the fat cells are broken by regulated heat energy. The liquefied fat is then removed using either suction or power assisted liposuction, g\ether suction or power assisted liposuction g\techniques. The effect of thermal treatment to the fatty tissue as well as the structures directly underneath the skin helps the body to tighten its skin - hence the technique is also well known as BODY TITE.

All these modern techniques are designed to reduce tissue trauma hence minimises postoperative discomfort to you We use all the above modern techniques to suit your requirement.

Anaesthesia:

Liposuction may be performed under local or general anaesthesia. Tumescent liposuction techniques involve the infiltration of fluid containing diluted local anaesthetic and adrenalin (to help prevent bleeding) into areas of fatty deposits.

This technique can reduce discomfort at the time of surgery as well as reduce post-operative bruising. We always undertake tumescent liposuction. We prefer to perform your liposuction under local anaesthesia and if required and requested with sedation as a day case procedure. This helps us to encourage you to mobilise and return to your day today activities as early as possible.

Post-operative Care:

Pressure garments and lymphatic massage therapy are essential in the post-operative period to reduce swelling, bruising and pain. They also promote the healing and maturation of the small incision scars.

Life style quality and long term benefit of lipoplasty

Tendency to deposit fat in certain areas of the body is genetically influenced. People have different distributions of excess fat, however fat cannot be deposited if excess food is not eaten and the calories consumed do not exceed the calories needed for energy.

To obtain the best results for liposuction you must balance your activities and exercise level with your calorie intake. You must remember that any surgical result can be quickly undone by a failure to maintain appropriate diet and exercise regimes.

Patients should be physically healthy, psychologically stable and realistic in their expectations. Age is not usually a criterion, but older patients tend to have diminished skin elasticity and may not achieve as good a result as a younger patient.

Liposuction can enhance your appearance and your self-confidence but it may not change your looks to match your idealised concept, nor will it cause people to react differently to you. Before deciding on a liposuction procedure, think carefully about your expectations and discuss them with us fully at your consultation.

The four crucial elements in establishing a healthy, stable appearance are a change in lifestyle, good diet, appropriate exercise with the 'aid' of body contouring.

What is cellulite?

Cellulite is a term used to describe a specific look of fat in skin overlying certain areas of the body. As people age almost all develop some areas of cellulite. Cellulite is not a different type of skin but rather a specific look that reflects the architecture of the fat and skin in these areas. It is difficult condition to treat. Liposuction, pressure therapy and lymphatic massage therapy may help to treat cellulite with variable outcome.

What is skin contraction?

When a person loses weight through dieting and exercise the skin will usually contract gradually over the period of weight loss. This is the same as skin contracting after a pregnancy. However skin contraction is not always smooth. Many people who have undergone significant weight loss will often have stretch marks or loose skin. These changes can also occur with liposuction.

Immediately after liposuction the skin overlying the area where fat has been removed is loose but over the next several hours this area will swell significantly and the skin may actually stretch. This swelling slowly disappears over the next few weeks and the skin will usually contract as the swelling resolves.

Irregularities in the microscopic blood flow to the remaining fat cells can also result in further areas of fat atrophy. The larger the amount of fat removed the greater the amount of variation and skin irregularities.

As the body heals these irregularities will lessen. This process can be helped by massage, pressure garments and skin conditioning.

What treatment is best for me?

At your initial consultation we will evaluate your general health, identify the areas of fat deposits to be treated and assess the condition of your skin. We will explain fully the body contouring methods that may be most appropriate for you.

For instance it may be that a tummy tuck would be more effective or that a combination of liposuction techniques will achieve good results. It is important that you communicate in an open and honest way what your expectations are from having this procedure.

Be sure to mention any significant weight loss or gain that you have experienced and also remember that no detail in your past medical history is unimportant.

How should I prepare for surgery?

We will give you specific instructions on how to prepare before surgery. In the longer term we can advise you on eating, drinking and smoking and exercise regimes. It is important to get a degree of self-control and discipline before surgery.

It is important to avoid any aspirin or aspirin-containing products for at least two weeks before surgery. If you develop any kind of skin infection your procedure will have to be postponed. Your final result will depend as much on what you do before and after surgery, as what we do in the operating room.

Where will the surgery be performed?

We utilise several private hospitals for the procedure. It is usually performed on a day case basis for cost containment and convenience, but if large volumes of fat are removed then we would advise an overnight hospital stay so that we can closely monitor your progress.

What can I expect immediately after surgery?

You are likely having some fluid drainage from the incisions. You will be fitted with a snug elastic bandage or compression garment to wear over the treated area to help control swelling. You may need to wear this for up to four weeks to help your skin to shrink and fit its new contour. The compression garment can be changed three days after surgery, but a garment must be worn at all times (24 hours) for 2 weeks. After the initial 2 week period the garment must be worn at night for at least 2 additional weeks. The pain can be controlled with medication prescribed by the Hospital prior to your departure.

How long will it take before my new contour is final?

You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after 3 weeks when most of the swelling has subsided.

After 3 months any persistent mild swelling will resolve and the final contour will be apparent. If your expectations are realistic you will be pleased with the results. You may find that your clothes fit more comfortably and you are more at ease with your body image.

By eating a healthy diet and getting regular exercise you can maintain the benefit of liposuction permanently. There are two components of fat contributing to the shape of the abdomen. Liposuction can reduce the fat volume between skin and muscles but will not have any change in the volume of fat inside the peritoneal cavity which could be of significant amount.

Risks of liposuction surgery

Liposuction is one of the most commonly performed surgical procedures in the United Kingdom. Every surgical procedure involves a certain amount of risk but as with any elective surgery procedure it is important to weigh the risks against the potential benefits.

The vast majority of patients undergoing liposuction do not have any complications, however listed below are some descriptions of possible complications.

1. Bleeding

During or after surgery particularly if aspirin or anti-inflammatory medication has been taken seven days prior to surgery.

Using tumescent techniques and being sensible about the amount of fat removed in one treatment, blood transfusions have never been required by our Practice for our liposuction patients.

2. Infection

Infection is unusual after this type of surgery. We give antibiotics during the operation as a prophylaxis.

3. Scarring

Although good wound healing is expected after liposuction, abnormal scars may occur within the skin and deeper tissues. In rare cases abnormal scarring may result which may be unattractive or a different colour from the surrounding skin. In general the scars of liposuction are never a problem as they are so small.

4. Changes in skin sensation

A temporary decrease in skin sensation after liposuction may occur.

5. Skin discoloration/swelling

Skin discoloration (bruising) normally occurs following liposuction. In very rare situations, swelling and skin discoloration may persist for a long period of time. Permanent skin discoloration is rare.

6.Skin contour irregularities

Contour irregularities and depressions in the skin may occur after liposuction. Visible and palpable wrinkling of the skin can also occur. Additional treatments including surgery may be necessary to treat skin contour irregularities following liposuction.

7. Symmetry

It may not be possible to achieve symmetric body appearance from liposuction surgery. Factors such as skin tone, body features, bony prominences and muscle tone may contribute to normal asymmetry.

8. Seroma

Fluid accumulation infrequently occurs in the areas where liposuction has been performed. Additional treatments including aspiration of the fluid may be necessary.

9. Long term affects

Subsequent alterations in body contour may occur as the result of deposition of fat elsewhere, ageing, weight loss or gain, pregnancy or other circumstances.

10. Body fluid imbalance:

There is a possibility that large volumes of fluid containing diluted local anaesthetic and adrenalin that is injected into fatty deposits during surgery may contribute to fluid overload. We are conservative in the amount of fluid that is used as we do not undertake liposuction of large areas in one operative procedure. Your operation will be monitored constantly by the well trained team.

11. Pain

Chronic pain and discomfort following liposuction is rare but does sometimes occur, presumably due to scarring under the skin.

12. Deep vein thrombosis / pulmonary embolism/ fat embolism

This is a rare complication following liposuction. We encourage you to mobilise as early as possible in the early post-operative period.

13. Injury to deeper structures

Cases have been reported where injury to deeper structures such as intestines, lungs, spleen and liver have occurred during liposuction. These are very rare complications have never happened in our Practice.

15. Over and under correction

This is a rare situation. If it is a significant issue, then a revisional procedure is considered.

You should be aware that the larger the amount of fat removed, the more likely that some of the above complications may occur. It may be necessary to perform additional surgery from time to time to improve your results.

This may only be evident after about 6 months after surgery when most of the swelling has resolved. It is important to understand that the scarring underneath the skin should be allowed to mature and soften before any secondary procedure is undertaken.

Usually a minimum of one year is left before undertaking a secondary procedure.

Thigh lifts are done to remove excess skin from the thigh and buttock area. This sagging skin is usually caused by weight loss. The goal of the procedure is to improve the appearance of your thighs by removing the excess skin and fat from the involved area.

What does Thigh Lift Surgery Involve?

Thigh reduction removes excess skin and fat from both the inside and the outside of the upper thigh. The surgery leaves a noticeable scar that begins in the groin, traverses the inner thigh, runs under the crease of the buttock, and ends on the hip. Post-operative scars are always more visible on the body than on the face. An incision higher up on the body hides the scar with some clothing, but may remove less tissue.

Thigh reduction improves the body contour when seen through trousers or tight dresses, but the scars will be visible when shorts or bathing suits are worn. For this reason, suction lipectomy alone may be preferable as the scarring is less, but for this procedure to be successful, the skin must have the good elasticity.

How long does a Thigh Lift take?

This procedure takes about three hours and is done under general anaesthesia. Patients may spend their first night in an overnight care facility however some may go home the same day.

What can I expect from a Thigh Lift?

Your expectations need to be realistic. Most patients are pleased with the outcome and find they have smaller and firmer thighs, therefore in most cases giving a new-found confidence.

Recovery after a Thigh Lift Procedure.

What will happen in the recovery period?

Bruising and swelling are to be expected as well as a tight feeling in the thighs. Normally, your stitches will be removed within a week after surgery, though deeper sutures aren’t removed until 2 or 3 weeks later.

It is advised that you wear a compression support garment for few weeks to reduce swelling and you will need to take antibiotics to prevent infection. Most of the swelling will disappear after 3 weeks or so. You should avoid strenuous activity for at least 1 month.

What is the recovery time from Thigh Lift surgery?

Depending on the individual patient recovery times will vary. Most patients are able to go back to work 2 to 3 weeks after surgery and 4 to 5 post-operative check up visits to the practice are required.

Age and large weight loss can unfortunately lead to sagging tissue on the upper arm which shows as a bag of flesh on the lower side of the upper arm when the arm is extended outward (commonly known in the UK as Bingo Wings or Bat Wings).

This minor defect can be corrected by removing skin and subcutaneous tissue. At your consultation we will also discuss the possible option of laser-lipolysis as an alternative to arm lift surgery. This will depend upon your skin type and the extent of skin redundancy. The laser-lipolysis procedure in certain cases can remove excess fat and tighten the skin. It also has the added benefit of minimal scarring.

What does Arm Lift Surgery Involve?

Surgery is performed under general anaesthesia and the procedure takes 1 to 2 hours. Normally the patient is hospitalised for 1 to 2 days. Post-operative discomfort is minimal.

What can I expect from an Arm lift?

Your expectations need to be realistic. Most patients are pleased with the outcome and find they can wear the clothes they want, especially short sleeved tops. In most cases this procedure gives patients new-found confidence.

What will happen in the recovery period?

Bruising and swelling are to be expected as well as a tight feeling in the arms. It is also recommended to you wear a compression support garment for few weeks to reduce swelling and will need to take antibiotics to prevent infection. Most of the swelling will disappear after 3 weeks. You should avoid strenuous activity for 1 month.

What is the recovery time from Arm Lift surgery?

Depending on the individual patient recovery times will vary. Most patients are able to go back to work 2 to 3 weeks after surgery and 4 to 5 post-operative check up visits to the practice are required.

There is a significant amount of variation in size, shape as well as level of buttocks. This may have variable effect on body proportion and its beauty. There is a definite racial, familial and genetic link with body as well as buttocks contour.

Women from Afro-Caribbean origin are known to have larger and protuberant buttocks projection. The Arabic women from Middle East represent with a very unique body/buttocks proportion.

The size, shape and level of buttocks is a matter of personal preference which can be influenced by racial trends (black women may prefer large bums). Arabic men and women from the middle east may have predilection for wider and bigger hips, there may be geographical influences which could be compounded by famous celebrities like Jennifer Lopez creating a big wave of ’Brazilian Jelo bumps’ The concept of ‘Beauty from Behind’ is becoming more and more relevant because of increasing popularity of beach holidays and globalisation of cultural acceptance of wearing revealing clothes in day to day life. Hence, it is impossible to set up globally acceptable criteria for ‘Bootylicious’ beautiful buttocks.

There is no doubt that well-toned hour glass shape body with straight confident posture is always desirable. The pre requisite to achieve this comprises of regular muscle toning and maintaining normal body mass index by observing optimum diet and nutrition. Obesity and massive weight loss will adversely affect body/buttocks proportion. It is needless to say that as we mature in our age our buttocks are going to lose their tone and will continue to sag southwards. It is also very interesting that excessive deposition of fat and sagging of the adjoining areas e.g. Flanks (love handles) and outer aspect of the thighs (saddle bags) will distort the shape of the buttocks. This will make the buttocks appear ‘pseudo square’ rather than the desirable rounded shape. There are many misconceptions amongst the general population regarding aesthetics of the buttocks; this may lead to either ambiguous requests for a particular procedure or requesting completely inappropriate procedures.

There are following procedures to be considered for buttock contouring:

1) Liposuction into flanks to improve the definition of waistline, with a view of correcting love handles along with liposuction to the outer thighs for correction of saddlebags. This procedure is advisable for ‘pseudo square’ buttocks.

2) Buttock lift – this procedure is designed to remove redundant excess skin and lift the buttocks. This is quite a common procedure when there is sagging of buttocks following massive weight loss or because of ageing.

3) Buttock Augmentation – there are 3 methods of buttock enhancement, each method has its own advantages and limitations;

a) Fat Grafting - if a person has got excess fat in other areas of the body e.g. abdomen, flanks, outer and inner thighs then fat can be harvested from these areas and injected into the buttocks. There is always a possibility of variable degree of fat graft loss hence we need to be prepared for additional fat grafting procedures if required.

b) Buttock Enhancement can be done by using biodegradable synthetic material such as Macrolane. Macrolane is made up of hyaluronic acid. This product gets absorbed into human body over a period of 12-18 months. Hence one would require a top up injection every year. It is a procedure worth considering when a patient is in the process of making a long term definitive decision.

c) Buttock Enhancement can be done using silicone implants. This procedure is done by inserting implants either within the muscle or in front of the muscle through a cut made just above the crease between the two buttocks. This procedure is known to have more complications in comparison to breast enhancement using silicone implants. However it gives a more long lasting solution in comparison to other techniques.

During the initial consultation, we will discuss with you your concerns regarding buttock aesthetics. The examination consists of measurement, photographs, followed by detailed discussions of the options. This can also be helped to a certain extent by using the “morphing software“.

We would like to advise you to surf through the relevant sections on our website, including photo–gallery to allow you to develop a better insight into the procedures, our website address is www.vadodariaplasticsurgery.com. You may want to contact us by e-mail on info@vadodariaplasticsurgery.com or by giving us a call on 02089308663/02089303976.

Cosmetic tattooing is quite popular amongst the young population during their college and university stage of their lives. Most of the tattoos are permanent since the pigments injected are water insoluble and can stay into the deeper layers of the skin all throughout life. Many a times one would like to get a tattoo removed because of a variety of reasons such as :

The presence of a tattoo on an exposed part of the body can compromise job opportunities.

There are many types of treatments available for the removal of cosmetic tattoos :

1. Laser tattoo removal - only possible depending upon the colour of the pigments used for tattooing. This requires more than one treatment and the success rate varies.

2. Cosmetic tattoos can be surgically treated by:

• Removal (excision) and direct closure – if the dimension of the tattoo design is small and slim then the whole tattoo can be removed under local anaesthetics and the resultant defect can be closed directly. Mr Vadodaria uses dissolvable stitches hence they do not require removal. Please note that this procedure will leave behind a visible scar.

• Multi-Stage serial excision - If the design/dimensions of the tattoo are wide/big then it may not be possible to remove the tattoo completely in one stage. In such situations it can be dealt with by multi-stage serial excision of a tattoo. In such circumstances, a proportion of the tattoo is removed in such a way that the remaining defect can be closed directly using dissolving stitches. Once the wound has nicely healed, further excision can be undertaken as a second stage procedure. The interval may be between 6 weeks to 3 months. These kinds of stage operations are continued until the remaining tattoo is completely removed. Please note that there will be a permanent scar following this procedure and the scar can stretch depending upon the tension on the suture line. The scar can be camouflaged with water insoluble cosmetic foundation creams.

• Removal (excision) and Reconstruction with a skin graft - Many a times the dimension of the cosmetic tattoo and its anatomical location is too big and wide that it is not possible to remove such a tattoo even with multi-stage serial excision. In such cases the tattoo skin is completely removed and the defect is resurfaced with a skin graft. The skin graft looks like a patch of your own skin (like a pocket on a shirt).

For very big and wide tattoos, other kinds of plastic surgical techniques can be used in the form of tissue expansion and flap reconstruction.

Mr Vadodaria will discuss with you possibilities as well as his preferred option in a given situation.

Every woman is constructed slightly differently. It is not uncommon for a woman to feel dissatisfied with her labia minora (inner lips of the vagina), especially if they are particularly long.

In many cases women are just not happy with parts of their genitalia. This can be embarrassing, uncomfortable and can even lead to sexual dissatisfaction or difficulty. Women with exceptionally long or unequal lengths of the labia minora can have them aesthetically reshaped.

The procedure is usually under general anaesthetic however we do it under local anaesthetic at your request. The edge of the labia minora is carefully trimmed so that they no longer protrude. This could be also achieved by snipping out a 'V' shape wedge of tissue from labia minora. The remaining edges are carefully sewn back together taking care to obtain as natural a result as possible.

The aim of this procedure is to achieve symmetry of labia minora without any undue protrusion through the vaginal vault.