What is breast augmentation (cosmetic breast enlargement) surgery? The breast are the most attractive and feminine trait of a woman’s personality. In breast augmentation surgery silicon breast implant placed behind the breast and chest wall muscles surgically. Benefits It Increase fullness and projection of your breasts Improve the balance of your figure Enhance your self-image and self-confidence What are the breast implants? The breast implants are available in many sizes and shapes. All the breast implants are made with Silicone envelope (bag). Many of them contain only Silicone gel. The Saline filled inflatable implant comes empty and after placing it in the body, is filled with saline. There are other double lumen implants that have silicone gel in the inner compartment and saline in the outer. What extent breast can be enlarged? Though there are limitations with regards to the extent the breast can be enlarged, most patients’ wishes and desires can be usually fulfilled. It is limited by the amount of skin available. Is there any side effect of breast augmentation surgery? As the implants are placed behind the breast tissue and the muscles, there are usually no problems in breast examination after enlargement. Also, there are no problems in breast feeding after this surgery. To-date, there is no recorded evidence of increased risk of breast cancer after silicone implant surgery. What about Surgical procedure? This surgery is performed under general anesthesia. The surgery takes approximately 2 to 3 hours. The patient usually goes home the same day or another day. An incision (cut), approximately two inch long is made just above the lower breast fold. A cavity is created behind the breast area/muscles. A satisfactory size implant is placed in the cavity and wounds are sutured in many layers. A snug dressing is applied and left in place for 5 to 6 days. The stitches are absorbable and no need of stitch removal. If there is excessive sagging of the breasts, breast tightening with uplift (mastopexy) could be done at the same time as breast enlargement. What happen after the surgery? There may be some discomfort during the first few days post-operatively. This will be similar to a muscle pain after strenuous physical activity. What is Post Operative Protocol? Wear a support bra for about 6 weeks until the swelling and bruising subsides. Avoid any straining, bending and lifting for a minimum of four weeks following the surgery. The scars from the incision will disappear over time. Women often return to non strenuous activity within two to three weeks of surgery and start returning slowly to their normal routine after four weeks of surgery.

Female genital rejuvenation procedures are mainly aimed for reshaping or reducing the external appearance of the vagina. It can boost self-esteem and enhance sexual life. Various factors contribute to your femininity, confidence and sexual life but one of the most important things is your private part, which is appearance of your genitalia. Why do you need labioplasty? In women asymmetric, large, or irregular genital labia (lips) can occur naturally or it may develop with age, childbirth, hormones, or even from sexual intercourse. In most women, the labia minora (inner genital "lips") are seen only when the legs are kept apart, however in some women, large labia minora are visible even when the legs are not separated, causing discomfort, embarrassment, self-consciousness, and distances in relationships. Enlarged labia may also be noticeable in tightly fitting clothes, and might cause discomfort during intercourse or bicycle riding. For these reasons, many women with asymmetric or large labia choose to make the labia smaller, more defined, and/or more symmetric through a procedure known as Labioplasty or labia majora/ minora reduction. How long the labioplasty surgery takes? Usually, this procedure takes between 1 to 2hours and is performed with local / regional anaesthesia. Some patients prefer even general anaesthesia. Do I need hospitalization? It can be done as day care procedure but sometimes a day stay can be offered if General anaesthesia is given. How is the postoperative period recovery? There will be mild swelling and discomfort that will settle in 1-2 weeks time. Oral medications will be prescribed for the same. The sutures will be absorbable so need to give further pain for stitch removal. The final result will be appreciated in around 2 months’ time once the oedema disappear completely. What are the complications of labioplasty? As these areas are more prone for infection, so patient are advised to maintain hygiene and cleaning of part regularly. This is a minor procedure and like any other wound there is slight chance of bleeding, infection.

Periorbital Rejuvination Periorbital rejuvenation is one of the most important areas of rejuvenation of the aging face these days. The eye area is important in contact between individuals, with eye-to-eye communication or eye to eye contact occurring in approximately 80% of all interactions. The orbital area conveys information on general health and impressions regarding individual health, fatigue, interest, and emotion. For many individuals with limited budgets or limited interest in facial rejuvenation, the eye area is the focus of facial rejuvenation surgery.

Diabetic Foot Evaluation NeuroScan -a non-invasive tools to detect neurological loss of sensation by vibration. It is an electronic tuning fork device mainly used for wide range of research, laboratory to identify the diabetic neuropathy. Its vibration strengthen operates tunning fork gradually increase the amplitude till the patient sense the vibrations. NeuroScan can be functioning with the integrated software with PC (Windows) and Android based devices Features: Digital 0 to 50 Volts indicator. Android supported Windows based PC software Custom set interpretation rules. Test key to cross check patient perception. No probe indicator alarm. Maximum 50 volts indicator alarm. Multiple operation mode (Plantar and Penile) software. Optional single or multipage report. Customized PDF report printing facility. Podoscan PodoScan is the most efficient and accurate way to access plantar pressure distribution system of both static and dynamic. It mainly enables precise and immediate evaluation conditions related to the diabetic foot, analysis of the depth to overlayered on the foot, analysis of the depth to overlayered on the foot impression. To fetch the mapping gray scale images to depth conversation. We made for graphical high resolution foot images. The dynamic foot plantar pressure distribution is the principle of resistance which gives the greater advantages in both foot adaptability and customization this implies to test repeatability, consistent Patient report, and more space storage patient reports for further treatment to patients. Features: Below are the features - Measure the plantar pressure distribution of static and dynamic pressure Footwear measurement report enabled Accurate color coding results, easy self tunning color schema according to user scanner Can be compatible with any PC scanner E-Mail and Simple report printing facility Customised PDF report for portability To minimize the time factor performing technical skills DICOM supported reporting Guidelines Diabetes is dangerous to your feet- a small cut can produce serious consequences. Diabetes may cause your nerve damage that takes away the feeling in your feet. Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist infection. Because of these problems, you may not notice a foreign object in your shoe. As a result, you could develop a blister or a sore. This could lead to an infection or a non-healing wound that could put your health at risk for an amputation. To avoid serious foot problems that could result in losing a toe, foot or leg, follow these guidelines. Inspect your feet daily. Check for cuts, blisters, redness, swelling, and nail problems. Use a magnifying hand mirror to look at the bottom of your feet. Call doctor if you notice anything. Bathe feet in lukewarm, never hot water. Keep your feet clean by washing them daily. Use only lukewarm water the temperature you would use on a newborn baby. Be gentle when bathing your feet. Wash them using a soft washcloth or even sponge you can use. Dry by blotting or patting and carefully dry between the toes. Moisturize your feet. Use a moisturizer daily to keep dry skin from itching or cracking. Cut nails carefully. Cut them straight across and file the edges. Don't cut nails too short, as this could lead to ingrown toenails. If you have concerns about your nails, consult your doctor. Wear clean, dry socks. Change them daily. Consider socks made specifically for patients living with diabetes. These socks have extra cushioning, do not have elastic tops, are higher than the ankle and are made from fibers that wick moisture away from the skin. Wear socks to bed. If your feet get cold at night, wear socks. Never use a heating pad or a hot water bottle. Ulcer Treatment People with diabetes develop foot ulcers because of neuropathy (sensory, motor, and autonomic deficits), ischaemia, or both. The initiating injury may be from acute mechanical or thermal trauma or from repetitively or continuously applied mechanical stress. Patients with clinically significant limb ischaemia should be assessed by a vascular surgeon to determine the need for angioplasty, stenting, or femorodistal bypass. When infection complicates a foot ulcer, the combination can be limb or life-threatening. Infection is defined clinically, but wound cultures reveal the causative pathogens. Tissue specimens are strongly preferred to wound swabs for wound cultures. Antimicrobial therapy should be guided by culture results, and should aim to cure the infection, not to heal the wound. Alleviation of the mechanical load on ulcers (off-loading) should always be a part of treatment. Neuropathic ulcers typically heal in 6 weeks with total contact casting, because it effectively relieves pressure at the ulcer site and enforces patient compliance. The success of other approaches to off-loading similarly depends on the patients' adherence to the effectiveness of pressure relief. Surgery to heal ulcers and prevent recurrence can include tenotomy, tendon lengthening, reconstruction, or removal of bony prominences. However, these procedures may give some complicated results like- secondary ulceration and other complications. Ulcer recurrence rates are high, but appropriate education for patients, the provision of posthealing footwear, and regular foot care can reduce rates of re-ulceration.

What is polydactyly? Polydactyly is a deformity in which the hand has one or more extra fingers in any of three places of the hand: on the small finger side most common (ulnar) on the thumb side, also called thumb duplication less common (radial) in the middle of the hand least common (central) What are the different forms of polydactyly? skin and soft tissue the simplest to remove skin, soft tissue and bone but no joint more challenging to remove/remodel skin, soft tissue and bone with joint (closer to a fully-formed finger most challenging to remove/remodel) Is this is a hereditary problem? Yes but some time it present non hereditary. What causes polydactyly? During normal embryonic development (while the baby is still in the womb), the hand initially forms in the shape of a paddle, and then at about the sixth or seventh week of gestation splits into separate fingers. Polydactyly results if there's an irregularity in this process: An extra finger forms when a single finger splits in two. How is polydactyly diagnosed? Polydactyly can be seen by ultrasound prenatally, and after birth by clinical examination. How is polydactyly treated, and at what age? The extra finger can be removed surgically, when the child is between 1 and 2 years old, young enough that he won't miss developmental milestones such as grasping (prehension), but late enough that he can tolerate anesthesia and surgery well. What are the Complications of surgery? Major complications after surgery are rare but often minor like scar formation, stiffness, instability, and late deformity. Most cosmetic or functional deformities can be addressed in later corrective surgery. What is the outcome of polydactyly surgery? Most of the young patients have full hand function and an improved appearance of the hand. It is possible that in a severe case, may need additional reconstructive surgery to recover full function and improve the hand's appearance.

Tendon repair is surgery done to treat a torn or otherwise damaged tendon. Tendons are the soft, band-like tissues that connect muscles to bone. When the muscles contract, the tendons pull the bones and cause the joints to move. When tendon damage occurs, movement may be seriously limited.

In more severe nerve injuries in which endoneurial tubes are disrupted, regenerating axons are no longer confined to their original sheaths. They may meander into surrounding tissue or into inappropriate endoneurial tubes, thus failing to reinnervate their proper end organs. Neurological recovery is compromised, generally to a degree proportional to the severity of the injury. Nerve Repair Your nerves transmit sensory (feelings of touch, pressure or temperature) and motor (movement of muscles) impulses to and from your brain. Damage to nerves may result in reduction or a complete loss of sensation, weakness and dry skin. When one of your nerves is cut or damaged, it will try to repair itself. The nerve fibres (axons) shrink back and ‘rest’ for about a month; then they begin to grow again. Axons will regenerate about 1mm per day. The extent to which your nerve will recover is variable, and it will always be incomplete. Recovery is improved if the cut nerve ends are brought together and repaired surgically. If your nerve ends are not brought together, the nerve fibres still attempt to grow and find the other end. However, often the result is a lump of nerve ends (a neuroma) that is tender to knocks or pressure and in some cases can be uncomfortable all the time. How long does my nerve take to regenerate? Regeneration time depends on how seriously your nerve was injured and the type of injury that you sustained. If your nerve is bruised or traumatized but is not cut, it should recover over 6-12 weeks. A nerve that is cut will grow at 1mm per day, after about a 4 week period of ‘rest’ following your injury. Some people notice continued improvement over many months. Sensory nerves are more resilient than motor nerves and can recover sensation months or years after injury. Motor nerves have a time limit for healing. The reason for this is a structure called the ‘motor endplate’, where the nerve joins into the muscle. If the motor endplate receives no nerve impulse for more than 18-24 months, it dies away and there is no longer any way that the muscle can be activated by the nerve. The muscle then whithers away. Thus surgical repair of motor nerves needs to happen within 12-18 months of the injury. Before sensation returns to the injured area, your limb is at risk of damage as it has no protective sensation. Please be careful of your hands or feet, especially around hot or sharp objects. Similarly, before the motor nerves recover your hand or limb may not be able to move normally or may develop abnormal postures. Hand therapy or physiotherapy will allow movement to be maintained while the nerve cells regenerate. How do I know the nerve is recovering? As your nerve recovers, the area the nerve supplies may feel quite unpleasant and tingly. This may be accompanied by an electric shock sensation at the level of the growing nerve fibres; the location of this sensation should move as the nerve heals and grows. Over time, these feelings subside and the area should begin to feel more normal. Will my nerve recover completely following surgery? Unfortunately, nerves never recover completely after they have been cut. The degree of your nerve’s recovery depends on a number of factors: Age: As with many other things in life, your body becomes less efficient at healing itself as it grows older. Mechanism of injury: Nerve damage from a cut has better chances of healing than damage from a crush. The time since the injury: The quicker your nerve heals, the better it will recover. The mechanism of repair: direct repair is best. Refer to surgical nerve repair options below. The type of nerve: Sensory nerves heal better than motor nerves. Associated injuries and whether there is tension across the repair. Sometimes the recovering nerve may be trapped within scar tissue. Recovery is significantly reduced if this happens. Options for nerve repair and nerve surgery Immediate nerve repair Direct nerve repair I use a microscope or magnifying glasses (loupes) to repair your cut nerve with sutures finer than a human hair. This type of nerve repair surgery has the best recovery rates. Whether or not I can perform direct nerve repair on your injured limb depends on the injury your nerve has suffered. Nerve grafting Sometimes I cannot directly repair your nerve ends, for example, if there is a piece of nerve missing or a delay in repair. With nerve grafting, I take a length of nerve from somewhere else in your body and place it as a graft. I perform this repair using a microscope, too. You will have a scar from the surgery and often a numb patch in the area I took the nerve graft from. Possible donor nerves include sensory nerves of skin of the forearm and leg. Having a numb patch on the side of your arm or foot is usually less bother than having a numb area on your hand. As with all procedures I perform, we will have an in-depth consultation about all aspects of the surgery and recovery, including possible donor nerves, risks etc. Later nerve surgery Nerve Freeing (Neurolysis) The nerve may have been repaired, and some recovery of function may have occurred, however scar tissue around the nerve causes tethering and discomfort when you move your hand. The scar tissue can also limit nerve cell regeneration. I can surgically release the scar tissue from around the nerve. Nerve grafting Your nerve may fail to recover due to a neuroma (link to the top of the page), or there is a persistent gap in the nerve. During the procedure, I cut back your nerve ends until I can see healthy ends, and I place a piece of nerve graft to facilitate normal re-growth of your nerve. The function (sensation and power) of your nerve is initially worse and then should gradually improve – it will be like beginning recovery all over again. Unfortunately, your hand’s function will never return to normal but should be improved with nerve grafting. The pain and discomfort you feel at the site of injury improves as recovery progresses. Nerve wrapping Sometimes a nerve is persistently tender. This is usually due to a neuroma. Wrapping a vein, fat or another substance around your nerve provides padding around the nerve and will make the area less sensitive. Nerve burying After a nerve is injured, sometimes painful neuromas develop in smaller nerves of your hand. They are usually in locations that are not suitable for nerve repair such as amputated fingers. I can cut away the neuroma and bury the nerve end deep in a muscle or bone. This prevents the nerve end from being knocked and should reduce the electric shock like pain. The area that the nerve supplied will be completely numb, and this is permanent. Possible complications after nerve repair and nerve surgery Minimal or no improvement Improvements of your symptoms may be minimal, or there may be no improvement at all. Bleeding This occasionally requires a return to theatre. Infection You will be given antibiotics at the beginning of your procedure and occasionally after your operation. Antibiotic use is carefully monitored to reduce antibiotic resistance. The signs of infection to look out for include increasing redness, swelling, pain and purulent discharge. Most wound infections will respond quickly to antibiotics. Very occasionally further surgery may be required to clean out a deeper infection. Infection can lead to delayed recovery and increased stiffness. Delayed wound healing This may require dressings from the district nurses. Scarring Can be improved with massage and moisturizing cream. Stiffness I may ask you see an expert hand therapist to provide you with a splint and complete a personalised regime of exercises to reduce stiffness. Please read more about the hand therapists that I work with. Complex regional pain syndrome Some people have hands that are very sensitive to surgery or trauma and become very painful, stiff and swollen following surgery. This is treated with special kinds of pain relief and physiotherapy. Read more about Complex Regional Pain Syndrome. Complications specific to nerve grafting You will be left with a scar and a numb area on your arm or leg where the donor nerve was taken from. In rare cases, a painful lump at the site of the donor nerve may develop requires further surgery. Please read more about Complications following Hand Surgery.