P.D. Hinduja Hospital and Medical Research Centre, celebrated as Mumbai's foremost healthcare hub, is synonymous with excellence. Acknowledged as the city's best hospital, it hosts a stellar plastic surgery department, home to the best plastic and cosmetic surgeons in Mumbai.

1. FACIAL REJUVENATION
PUSHING BACK THE YEARS AND
TURNING BACK THE CLOCK
DR. MILIND S WAGH
Senior Consultant, Plastic and Cosmetic Surgery
Edition Date: 31st July, 2023
KHAR
From facial rejuvenation to body contouring, plastic surgery has emerged
as a solution for individuals seeking to redefine their physical appearance
and boost their self-confidence. In this edition, we delve into the various
procedures, insights and advancements in the field of plastic surgery.
VOLUME 5
Human beings are social beings and we all live in constant interaction with each other. When we cannot meet each
other face to face, we attempt to do so virtually on online digital platforms, on phone, on computers, so that we can
continue to visually interact and feel the “human touch”. Whether real or virtual, contact with each other means that
our appearance is looked at.
In fact, our first impressions of each other are often formed in that first visual contact by how we appear……how often
have we heard from friends, acquaintances and even people we have just met- “you look tired, are you ok?” or “you
seem to have aged since I last saw you” or “you look older than your age”, or luckily sometimes “wow, you are looking
younger every time I see you” or “ Oh my, you are really looking refreshed and glowing”.
The importance of our facial appearance not only matters in our casual personal interactions with each other, but it
has also been shown scientifically that it has a profound causal effect on the professional front as well. People are
invariably attracted, impressed and comfortable with someone who looks refreshed, younger and energetic.
PLASTIC SURGERY EDITION

2. 2
If there is any certainty about anything in our lives, it is
the ageing process. From soon after birth, the process
of ageing begins and inexorably it moves forward,
albeit slowly as we grow from infancy to childhood and
teenage to adulthood. At that time in our lives, we look
pleasing to the eye - youthful, attractive and raring to
go. The skin tone is perfectly taut and elastic, the
texture is smooth and glowing, the features are sharp.
The Ageing process is natural and inevitable, BUT it is
also related to everything that happens in our lives,
with our physical and mental health, the stresses and
strains on the body as well as the tensions and anxie-
ties on the mind. It is also related to our physical activi-
ties, our nutritional status and how we take care of
ourselves. It is also often genetic, and some people
appear prematurely older than they are and on the
other hand others seem younger than their actual age.
Whatever is the cause, this process gains pace after
the 30s while we are busy in our personal and profes-
sional lives with various external stresses and internal
pressures that start to take their toll. The changes are
gradually now visible in our face and bodies – the early
forehead wrinkle and crease, the appearance of frown
lines when animated, the plumping of the face and the
loss of definition of the jawline as we put on weight.
As we arrive in our 40s, the ageing process now
accelerates as the skin elasticity and tone slowly
decreases and the underlying support structures start
to lose their tightness. The forehead creases are
deeper, the frown lines visible even at rest, the
eyebrow arch is flatter than before, there may be loose
skin in the upper eyelids and early fat bags may appear
in the lower eyelid, smile lines have now become folds,
the high cheeks seem to have descended, early jowls
appear along the jawline and the previously taut and
smooth neck shows horizontal lines.
As we voyage into the 50s and the hair greys and
becomes thinner, so does the face continue to age.
The facial and neck skin is now quite lax; the forehead
advertises our experience and often the hidden stress
in our lives. The brow is now nearly flat and descended,
the eyelids themselves give a tired appearance to the
face as upper eyelid folds are seen and there is laxity of
the lower eyelids with either more prominent fat bulges
or hollowing or dark circles and worry troughs on the
inner side. The smile folds are now heavier, the cheek
prominence looks flatter and descended, the jawline
has now lost all sharpness and appears continuous
with the neck, there are fine wrinkles around the lips,
there is excess fat under the chin, loose neck skin and
vertical “grandparent” bands in the front of the neck. As
we reach retirement age, this process is getting faster
and faster and we really do not like how we look – tired,
stressed and AGED.
Medical science and surgical techniques are today at
the point where there are many means of retarding the
process of ageing to make a person look rejuvenated
and younger than his/her age. Some are non-invasive
or semi-invasive and some invasive. In general, the rule
of thumb is that more invasive and direct the means,
the more extensive the procedure, the longer lasting
will be the results.
It is a natural process and one that is unstoppable.
But can something be done about it? Is it possible
to reverse the process and remain perennially
young, attractive and refreshed?
AGE:
35
AGE:
45
AGE:
55
Can we stop the process ageing?
NO, we cannot, but can we slow
it down and retard it?
Yes, we can.

3. 3
Non-surgical Options
The non-invasive modalities include use of cosmeceu-
ticals on the skin in the form of cream programs and
peels of various types and combinations which either
exfoliate the skin surface cells and allow for fresh new
cells to form giving the skin a fresh glow or those that
promote formation of new collagen (neocollagenesis)
in the skin dermis to firm up and tighten the skin to
improve inherent elasticity. It is important to
understand that being non-invasive, these products
are aimed more at the younger age group in their late
30s and early 40s with early ageing changes. Their
effect is very temporary and does not last long, the
timeline being in weeks to just a couple of months.
Obviously, the benefit is on the skin surface in terms of
improvement of texture and tone, rather than on the
deeper structures that support the skin.
A plethora of such products are now available in the
market, some effective, others not so much and yet
others not at all. There is a very aggressive and often
in-your-face (no pun intended) marketing done by the
cosmeceutical companies, with advertisements galore
to sell these products because it is a billion-dollar
industry.
The opinion and advice of a qualified, trained Plastic
and Aesthetic surgeon is then the critical difference
between spending your money, time and effort
worthlessly or selecting products which will allow you to
actually benefit from these treatments.
Energy Based Devices
The semi-invasive modalities include energy-based
devices such as Lasers, Radio Frequency, Pulsed light
or mechanical devices such as Microneedles and
Dermabraders as well as Neurotoxin Injections and
Commercial Fillers. Also included in this group are
procedures such as surgical barbed and cog threads.
They are all office procedures that do not involve
admission of the patient to hospital.
The energy-based devices work on the principle of
using high focused light and heat energy, aimed with
precision and at different depths of penetration on the
skin surface, the collagen in the dermis and the tissue
immediately under the skin. They work not only on skin
resurfacing by clearing the senescent or old cells in the
epidermis but also by encouraging precise micro-scar-
ring within the skin to tighten the collagen scaffold
framework as well as encourage neocollagen forma-
tion to rejuvenate the skin envelope. The dermabrading
and microneedling procedures do the same but by
mechanical means.
Neurotoxins and Fillers
Neurotoxins, colloquially known to everyone as Botox
(which is a popular brand name), work by paralysing
selective muscle groups in the face, particular in the
forehead (frown and worry lines) and around the eyelids
(crows’ feet). When we express our emotions and our
face animate constantly and throughout life, the
muscle groups attached to the skin cause wrinkles and
creases to appear on the overlying skin. Initially these
lines are dynamic, meaning they appear only when we
animate but with time, they become static and visible
even at rest. Botox works on dynamic skin creases by
relaxing and paralysing muscle fibres temporarily
thereby causing the lines to disappear and the skin to
appear smooth till the effect of the neurotoxin on the
muscles slowly reverses over 4-6 months. The
neurotoxin injection can then be repeated to achieve
the same effect again.

4. 4
Commercial fillers are basically products made of collagen or hyaluronic acid, both of which are natural components
of our own skin. Early ageing changes cause deflation of the soft tissues by reduction of the fat under the skin. This
gives parts of the face a hollowed or gaunt appearance. Filler help by either rehydrating and rejuvenating the skin or
volumizing the tissue under the skin restoring shape and contours and providing a subtle lift to structures which have
descended. Different types of fillers are now available with different chemical structures and qualities to achieve this
effect. The effect of fillers once again is for a period of a few months to a couple of years so they are most effective for
early changes of ageing in patients in their 40s. They are also done as an office procedure.
Semi-Invasive Options
Going one step further are semi-invasive minor surgical methods such as the use of commercially available barbed and
cog threads. They are less invasive because they do not involve long incisions or complex dissections of the tissues
and can be done as an office procedure. They are inserted under the skin from a higher level on the face (in a location
behind the hairline) or side of the neck to a lower level towards the midline along the vector or direction in which the
descent of tissues in facial ageing takes place. They have hook like barbs on them or cone like cogs which engage in
the tissues under the skin getting a hold in them. They are then pulled along the vector to cause an effect of LIFT of the
tissues and anchored at the higher point from where they were inserted. The presence of the threads also causes a
foreign body reaction in the tissues and limited scarring under the skin to provide a subtle Lifting effect. Their
mechanical strength is however obviously poor as they are simply threads and therefore the effect is only subtle to
moderate and cannot last for more than a couple of years. They are also not very effective in older patients in their 50s
and 60s with advanced signs of ageing.

5. 5
Surgical Options - Face-Lift
The GOLD STANDARD in facial rejuvenation procedures is the formal surgical FACE-LIFT. Since it directly addresses
the soft tissues which are involved in facial ageing and repositions and anchors them back into their youthful location
as well as lifts and tightens the overlying skin, the longevity and durability of the procedure is assured for MANY YEARS,
usually between 8-10 years for patients in their late 40s and 50s and at least 5-7 years for patients in their 60s and 70s.
In the past, the drawbacks to surgical facelifts used to be the long incisions on the face and neck (though hidden in
natural creases), the extensive meticulous dissection of the supporting structures which have descended, so as to
reposition them, and the relatively long post-operative recovery period of a few weeks. However, as surgical
techniques have continuously improved, the incisions necessary in most cases are limited, the dissection also quite
precise and refined and the recovery period limited to only a couple of weeks. The improvement in appearance,
possible with modern techniques is remarkable and very clearly visible with patients often looking a decade or more
younger after surgery, their faces youthful, refreshed and rejuvenated, their features sharp and well defined
once again.
Autologous Fat Grafting – Using your own Body Fat
Since ageing also often involves loss of facial fat and deflation, replacement of this lost volume also restores the
youthful shape and contours. What better tissue to use than one’s own fat? It is in abundance; it is safe and it is the
ideal tissue with both volumizing as well as remarkable rejuvenative properties. The science of Autologous (your own)
fat transfer has transformed Facial rejuvenation and represents not only a cutting-edge technique of this era but also
the exciting future. It is now routinely used in facial rejuvenation along with other techniques including facelifts.
In summary, with the entire spectrum of procedures and techniques available to us today, it is now possible to provide
a plethora of safe as well as transformative options to our patients to benefit and turn back the clock, push back the
years and give them a refreshed youthful and revitalized appearance to their faces.
The most reliable and valuable resource to get genuine, accurate and up-to-date information about Cosmetic Surgery
procedures and treatments is a trained qualified Plastic Surgeon. It is always wise to ascertain the qualifications and
experience of your Plastic surgeon before you undertake any cosmetic surgery procedure.
Traditional Face lift dissection Limited Modern Face lift dissection

6. TUMMY - TUCK
(ABDOMINOPLASTY)
DR. VARUN DIXIT
Consultant, Plastic Surgery
6
Tummy-tuck is a surgery devised to achieve a
smoother, flatter and better contoured abdomen,
flanks and lower back. We commonly come across
patients who have lost all the excess weight but are still
frustrated by the poor abdominal shape and loose skin.
If there is significant skin laxity with stretch marks then
no amount of exercise, massages or other therapies
will appreciably tighten the skin.
Patients with excess fat and/or skin on the tummy,
flanks and lower back regions due to weight gain or loss
and especially in women, following pregnancy will
immensely benefit from tummy-tuck surgery.
Patients considering tummy-tuck should meet the
following criteria:
• Should be an adult, with stabilized weight (if you
plan to lose more weight, then it would be better to
schedule the surgery after you have achieved that)
• Healthy with adequate control over any existing
medical condition
• Female patients should preferably have completed
family; subsequent pregnancy is possible but may
generate fat gain and loose skin once again.
• Non-smoker
• Committed to a healthy lifestyle
• With realistic goals and positive frame of mind
What does the surgery involve?
Tummy-tuck surgery should be performed in a
well-equipped hospital. It is performed under either
general or spinal anaesthesia. The areas to be
addressed along with the planned incisions will be
marked by the operating surgeon before the surgery. It
is advisable to contour the lower torso
circumferentially for better contour results i.e. 3D
contouring.
The first step of a standard tummy-tuck involves
liposuction of the lower back and flanks to reduce the
bulky love-handles and to improve the waistline
contours. The patient is then turned to perform
liposuction on the flanks and upper abdomen to reduce
the bulk in these areas. Liposuction also frees up the
upper abdominal skin so that it may be better
tightened.
A lower abdominal skin incision is taken and the lower
abdominal skin and fat is raised off the muscle layers,
so that this may be subsequently excised. The
umbilicus (navel) is dissected and left attached to the
muscle layer for refashioning. Any muscle weakness in
the form of divarication of recti or abdominal hernia are
then tightened or repaired adequately. Next, the lower
abdominal skin and fat layer is excised so that skin with
stretch marks below the navel are reliably removed.
The remaining skin is pulled down, tightened and
stitched to the lower incision with dissolvable sutures.
The umbilicus is refashioned and stitched to the
abdominal skin through a new opening to achieve
improved navel contour. Dressings and a well-fitting
compression garment are applied.
Depending on the extent of bulkiness and loose skin,
there are variations of tummy-tuck that may be
employed to achieve better results:
• Mini-Tummy-tuck – Patients with minimal loose skin
in the lower abdomen and the upper abdominal
skin is firm and tight.
• Standard Tummy-tuck – described above
• Extended Tummy-tuck – Patients with loose skin
extending to the flanks will require a longer incision
till the flanks.
• Circumferential Tummy-tuck – Patients with
significant skin laxity in the lower back as well,
require a circumferential procedure to improve
abdominal contours.

7. 7
What to expect post-operatively?
Patients are routinely admitted to the hospital for 2-3
nights after a standard tummy-tuck. Patients are
prescribed antibiotics, pain killers, etc. for the first
7-10 days.
Patients are recommended:
• To keep a pillow or cushion under their knees while
lying down, this helps to ease the tension on the
suture line and helps better healing.
• To walk around in the room or at home to improve
circulation.
• To regularly wear the compression garment for the
first 4-6 weeks.
• To take things easy for the first 10-14 days till the
dressings are on. Change of dressing will be done
every 3-5 days.
• To avoid strenuous activities for 4 weeks.
Patients may resume normal shower and non-strenu-
ous activities after 10-14 days. Exercise and other
activities can be resumed after 4-6 weeks, depending
on the extent of surgery and muscle repair performed.
Patients can experience the improved contours almost
immediately. However, the swelling, bruises etc take
some time to settle. Therefore, the contour results are
generally evident by 3-6 months after the surgery. The
scar which is initially very evident will also settle with
time and can be aided by suitable scar creams advised
by the surgeon. However, the scar may take 6 months
to a year to lighten, soften and settle down.
Tummy-tuck is an extremely gratifying body contouring
procedure. Apart from achieving flatter, smoother
abdominal contours, it improves waistline definition,
removes significant amounts of visible stretch marks,
tightens the abdominal muscles, refashions the navel
and also repairs abdominal hernias, if any. The scar
settles down over time and is located low down on the
abdomen and is not visible with most day to day
garments as well as most swim wears.
Possible incision locations,
Including a vertical incision
if necessary
Abdominal muscles are
exposed
Muscles are surgically
tightened using sutures
Skin is pulled down and
excess skin and fat are
removed
Incision is sutured and
navel is repositioned to a
normal level

8. AUTOLOGOUS FAT
TRANSPLANT
DR. VIRAJ TAMBWEKAR
Consultant, Plastic and Cosmetic Surgery
8
Touted as liquid gold for its enormous potential and
diverse applications, autologous fat transplantation is
fast changing the scenario in the field of not only
aesthetic surgery, but plastic surgery as well. Let us
take this opportunity to learn more about the facts and
details and understand if it lives up to the hype.
Adipose cells or fat cells have a constant number in our
body. As we gain or lose weight, the size of the cells
alters, resulting in visible changes in the contour of the
body. Research shows that these fat cells contain a
population of regenerative cells (stem cells) that can
restore vitality in ageing and damaged tissues.
A small portion of the injected fat (10-30%) might be
absorbed by the body in the initial few months after
surgery; however, the fat that survives will last a
lifetime. Significant gain or loss in weight will affect the
transferred fat correspondingly.
The process involves three stages. The first one is
liposuction, wherein the fat is harvested from the body
of the individual in the operation theatre. This could be
from the abdomen, thighs or back, depending on the
body habitus and patients’ desire. This fat is
immediately purified using a certain process that
removes oil, excess fluid, blood, and damaged cells.
This “pure” fat is now injected into the desired areas
using special cannulae (blunt tubes) with utmost care.
Depending on the amount of fat to be transplanted, this
could be done as an out-patient/ day care procedure
under local anaesthesia with or without sedation or
after admission under general anaesthesia.
The fat obtained by this method can be used for three
main purposes:
a. Filling – the fat is placed in volume depleted areas
of the body to give a filling effect. Since the trans-
planted fat derives its blood supply from the native
tissues, multiple sittings may be needed if the fat
quantity planned is large. Common areas are
• Breast – for augmentation in size and to fill contour
defects following previous surgery
• Buttocks – for augmentation in size and to fill
contour defects following previous surgery
• Face - As a replacement for artificial fillers in lips,
cheeks, nasolabial lines, tear trough, temples
b. Rejuvenation – Further processing of fat yields
micro-fat and nano-fat which can help in
• Improving texture and replacing volume in ageing
hands
• To enhance hair growth
• To reduce fine lines, improve skin texture and maybe
even pigmentation over face.
c. Regenerate – the stem cell component helps to
treat chronic non healing ulcers and radiation
damaged skin, long standing scars and depressed
scars.
So, what are the advantages of this procedure? Since it
is a minimally invasive procedure utilising fat from one’s
own body, done in the sterile environment of an
operation theatre, chances of infection, rejection and
allergic reactions are minimised. Also, it avoids the
need of synthetic filler material and the need for
repetitive injections. The use in breast and buttocks
can forego the need for silicone implants and their
associated sequalae and complications. Like with like
replacement gives natural and longer lasting results.
Indeed, autologous fat transplantation does hold
promise for a variety of conditions and will be a game
changer in the near future!!

9. UNCOVERING THE POTENTIAL
OF PLASTIC SURGERY:
APPLICATIONS, ADVANCES, AND IMPACTS
DR. SHIVPRASAD DATE
Consultant, Plastic Cosmetic and Reconstructive Surgery
9
Plastic surgery, a medical specialty focused on
enhancing or reconstructing the physical appearance
of individuals, has evolved significantly over the years.
People in today’s world are more health conscious and
are aware of the different medical specialties. Yet,
there seems to be a limited knowledge regarding
plastic surgery and its spectrum, not only among the
general public but also among medical professionals.
The word plastic is derived from the Greek word
‘plastikos’ meaning “to mold or give form.” Plastic
surgery is a unique super specialty that defies patient
age group, is not restricted to an organ system or
anatomic area, and is based on principles rather than
specific procedures. The basic principle encompasses
the restoration, reconstruction, or alteration of the
human body tissue so as to improve its form
(appearance), function or both.
Initially associated with the treatment of wartime
injuries, the scope of plastic surgery has expanded to
encompass a wide range of applications, including
reconstructive procedures, restorative interventions,
functional as well as cosmetic improvements. One
needs to understand the diverse scope of plastic
surgery and the impact it has on individuals and society
as a whole.
Plastic surgery has experienced remarkable
advancements due to technological innovations,
medical research, and surgical techniques. The use of
minimally invasive procedures, lasers and microscopes
has revolutionized the field, reducing scarring,
minimizing recovery time, and enhancing surgical
precision. Additionally, advancements in materials,
such as bioengineered tissues, 3D printing, and
synthetic implants, have opened new avenues for
reconstructive and restorative procedures. These
advancements continue to shape the scope of plastic
surgery, making it a dynamic and rapidly evolving
discipline.
Plastic surgery is generally divided into cosmetic
(or aesthetic) surgery and reconstructive surgery.
Disproportionate media coverage ensures that public
attention remains focussed mainly on the higher-
profile cosmetic procedures. Procedures like breast
augmentation, liposuction, hair transplant, rhinoplasty,
facelifts, abdominoplasty (tummy tucks) as well as
interventions like botox / fillers aim to improve
aesthetic features and enhance self-confidence.
Cosmetic surgery helps individuals achieve their
desired appearance, addressing concerns related to
body image, aging, or congenital abnormalities.
Reconstructive surgery focuses on restoring function
and appearance for individuals who have experienced
trauma, disease, or congenital deformities. It
encompasses a wide spectrum of procedures like hand
surgery, cancer reconstruction surgery, restoration
and rehabilitation of burn victims, cleft lip and palate
repair, and post trauma limb reconstruction. All these
comprise an important component of plastic surgery
and a brief overview of some procedures is indeed
warranted.
Plastic surgeons specializing in hand surgery address
various conditions, including congenital hand
deformities, nerve injuries/ entrapment conditions and
traumatic bone injuries. Hand surgery aims to restore
hand function, alleviate pain, and enhance dexterity,
enabling patients to perform daily activities and
improving their overall quality of life.
Craniofacial surgery involves the treatment of
congenital structural abnormalities of head and face,
such as cleft lip and palate, congenital external ear
deformities craniosynostosis (mis-shaped skull bones),
and facial deformities. By utilizing a multidisciplinary
approach, plastic surgeons collaborate with neurosur-
geons, radiologists, orthodontists, and speech thera-
pists to provide comprehensive care, improving both
aesthetic appearance and functional outcomes.

10. 10
Having a deep understanding of wound healing, plastic
surgeons play a lead role in the treatment of all type of
wounds including diabetic foot wounds, pressure ulcer
(bed sores), neuropathic and rheumatologic ulcers. A
close collaboration with diabetologists, physicians,
interventional radiologists as well as supportive
specialists like orthotist and physiotherapists ensures
optimal outcomes for the patient.
Cancer reconstructive surgery, also known as
oncologic reconstruction involves reconstructing or
repairing defects resulting from the removal of
cancerous tumors or the structures affected by
radiation therapy, chemotherapy, or other cancer
treatments. This type of surgery can be performed on
various parts of the body, including the breast, head
and neck, limbs, and the pelvic region. Majority of the
procedures involves transfer of tissue from normal
areas to affected sites along with microsurgery
techniques to reattach blood vessels and nerves.
Breast reconstruction aims to rebuild the breast
mound and restore symmetry to the breasts typically
following mastectomy (surgical removal of the breast).
This may involve the use of implants, tissue expanders,
or autologous tissue (flap) reconstruction, which uses
the patient's own tissue, such as from the abdomen,
back, or buttocks. Head and neck reconstruction
focuses on restoring the functional and aesthetic
aspects of the face, jaw, throat, and neck after cancer
treatment.
To summarise, the scope of plastic surgery extends far
beyond its early association with burns and war
injuries. Plastic surgeon’s expertise in complex tissue
manipulation and wound healing contributes to
advancements in regenerative medicine and tissue
engineering. With advancements in technology,
surgical techniques, and materials, plastic surgery has
become a dynamic discipline addressing a wide range
of conditions. From cosmetic alterations to
reconstructive interventions and functional
improvements, plastic surgery profoundly elevates
self-esteem, body image, and overall confidence of an
individual ushering a sense of normalcy. The ability to
resolve complex problems helps plastic surgeons to
empower individuals to participate fully in social
activities, pursue career opportunities, and enjoy
interpersonal relationships without fear of judgment or
discrimination.
Plastic surgery continues to shape lives and contribute
to advancements in medical science, making it an
indispensable field within the realm of modern
healthcare.

11. GYNECOMASTIA
DR. RAJAN GARACH
Consultant, Plastic and Cosmetic Surgery
11
Male breasts, man boobs or moobs are a few names for
what is medically called Gynecomastia. A social stigma
and a point of ridicule for men right from teenage years
up until old age. It is described as enlargement of male
breast.
The male breast is made up of gland tissue,
surrounding fibrous tissue and fat, just like females. An
increase in any of these tissues or a combination of
them can lead to gynecomastia.
During normal development of a male, imbalance
between male hormones (testosterone) and female
hormones (estradiol) occur at three distinct phases.
• At birth, an increased level of circulating maternal
estrogens leads to a transient gynecomastia. After
birth, the levels decrease, the gynecomastia
resolves, and treatment is rarely necessary.
• Gynecomastia is said to occur in almost two-thirds
of adolescent boys during puberty. The adolescent
gynecomastia also resolves in majority of cases.
• As men age, they show a decline in levels of
testosterone and the incidence rises again.
Besides these instances:
• several drugs (recreational and medicinal)
• systemic illnesses (liver and kidney)
• certain cancers
• hormonal disturbances also lead to gynecomastia
• In most cases, the cause cannot be found and is
known as idiopathic
Since 1% of all breast cancers occur in males, this will
be looked for, if your examining surgeon feels so.
A grading system has been suggested, depending on
the size and skin excess:
Grade 1: small enlargement, no skin excess
Grade 2a: moderate enlargement, no skin excess
Grade 2b: moderate enlargement with extra skin
Grade 3: marked enlargement with extra skin
A thorough history, physical examination and review of
medications along with laboratory evaluation are
integral aspects of assessment of a gynecomastia
patient. If your surgeon feels that the gynecomastia is
idiopathic, long standing or causing distress, surgery is
the gold standard for management. All grades require
excision of the gland with minimal or extensive
liposuction of the surrounding fat as deemed
necessary. This approach minimises the recurrence
due to increase in gland size. Occasionally, grades 2b
and 3 may require some skin removal which can be
planned simultaneously or as a secondary procedure or
few months after the first surgery. Non-surgical
methods fail to provide the same level of satisfaction
and longevity when compared to surgery.
The use of a pressure garment after surgery helps in
skin tightening, avoiding complications and reduces
swelling.
Thus we see that the common issue of gynecomastia
can be easily managed as a day-care surgery by your
plastic surgeon, which provides life changing results!!
NORMAL MALE BREAST GYNECOMASTIA

12. HIGH DEFINITION
LIPOSUCTION
DR. AAMOD RAO
Consultant, Plastic Surgery
12
Liposuction continues to be one of the most popular
cosmetic surgeries in the world. Even during a
pandemic year, more than 210,000 liposuction
procedures were performed, making it the fourth most
popular procedure of 2020, according to the American
Society of Plastic Surgeons. Non-invasive fat-burning
treatments, like EmSculpt and CoolSculpt, are also still
incredibly popular, but despite the leaps in technology,
no device rivals the efficacy or the results of good,
old-fashioned liposuction. That is, except for the
next-gen lipo: High Definition Liposuction.
High Definition Liposuction (HDL) is a cosmetic
surgery procedure that is designed to create a more
sculpted and toned appearance in targeted areas of
the body. HDL is also known as VASER High Definition
Liposuction, as it typically involves the use of VASER
liposuction technology to remove excess fat and
contour the remaining tissue to create a defined,
athletic appearance. It is also called six pack abs
surgery. In this article, we will explore what HDL is, how
it works and the benefits of the procedure.
What is High Definition Liposuction?
High Definition Liposuction is a cosmetic surgery
procedure that is designed to sculpt and contour
specific areas of the body, creating a more defined and
toned appearance. The procedure involves the use of
advanced liposuction techniques, typically including
VASER or LASER technology, to remove excess fat and
contour the remaining tissue to create the appearance
of well-defined muscles.
The procedure is typically performed under general
anesthesia, and involves making small incisions in the
targeted areas. Through these incisions, the surgeon
will use VASER or LASER liposuction technology to
break up and liquefy the fat cells, making them easier
to remove. The surgeon will then use specialized
techniques to sculpt the remaining tissue and
create the desired muscle definition.
Can anyone get High Definition Liposuction?
First things first: an ideal candidate is a healthy
adult usually within 5-6 kgs of their goal weight, or
with a BMI of 28 or below, to consider the procedure.
But hi-def or not, "no form of liposuction is really
ideal for weight reduction or massive volume
reduction”.
Surprisingly, the limited candidate pool rarely
disqualifies someone due to fat, but rather whether
their skin has a rubber band snap-back quality. "You
really want the skin to kind of shrink, wrap down
around the areas you've treated. Otherwise, the
sudden volume loss will just result in hanging,
excess skin, which defeats the entire purpose. ”
What are the areas of the body we can
sculpt?
Hyper-chiseled abs, precisely cut deltoids and other
areas boasting superhero muscles are the most
convincing benefit of High Definition Liposuction
procedure, especially for pockets of fat many of us
struggle with toning. The most popular areas for
both sexes are abdomen and flanks.
Then the second or the third most popular spot for
women is likely the back, and for men, it's the chest.
Arms and inner thighs, which are probably four or
five on the list.
How Does High Definition Liposuction Work?
High Definition Liposuction is performed by a
board-certified plastic surgeon who has experience

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in body contouring procedures. The procedure
typically takes between one and four hours to
complete, depending on the extent of the work
required.
Before the procedure, the surgeon will work with the
patient to determine the desired outcome of the
surgery. The surgeon will also conduct a physical
examination to assess the patient's overall health and
determine if they are a good candidate for the
procedure.
During the procedure, the surgeon will make small
incisions in the targeted areas and use VASER
liposuction technology to break up and liquefy the fat
cells. The surgeon will then use specialized techniques
to sculpt the remaining tissue and create the desired
muscle definition. The incisions are then closed with
sutures, and the patient is sent to the recovery room to
rest and recover.
Benefits of High Definition Liposuction
The primary benefit of High Definition Liposuction is
the ability to achieve a more defined, sculpted appear-
ance in specific areas of the body. For individuals who
have struggled to achieve a toned and athletic-looking
physique through diet and exercise alone, the
procedure can provide a solution. Achieving those six
pack abs without the use of dangerous fat burners or
anabolic steroids is the main advantage.
Additionally, High Definition Liposuction can help to
improve self-confidence and body image. When
individuals feel more confident in their appearance,
they may be more likely to engage in activities that they
previously avoided due to self-consciousness.
Risks of High Definition Liposuction
As with any surgical procedure, there are risks
associated with High Definition Liposuction. Some of
the potential risks and complications include bleeding,
infection, scarring, uneven results, and anesthesia
risks.
It is important for patients to fully understand the
potential risks and complications of the procedure
before undergoing surgery. Patients should also be
aware that the results of the surgery are not guaran-
teed and that there is a possibility that the desired
outcome may not be achieved.
Recovery Process
Following High Definition Liposuction, patients can
expect to experience some discomfort and swelling in
the treated areas. The surgeon will provide instructions
for post-operative care, including wearing
compression garments to help reduce swelling and
promote healing.
Most patients are able to return to work and normal
activities within one to two weeks after the procedure.
However, strenuous exercise and heavy lifting should
be avoided for several weeks to allow the body to heal
properly. It is important for patients to follow the
surgeon's post-operative instructions closely to ensure
a smooth and successful recovery.
Final Thoughts
High Definition Liposuction is a cosmetic surgery
procedure that can help individuals achieve a more
sculpted look without the use of substances like fat
burners eg: clenbutrol which is harmful to the body.
The results last for a long time and are aesthetically
pleasing.

14. 14
COSMETIC ASPECT OF
RECONSTRUCTIVE SURGERY
DR. PARAG VIBHAKAR
Consultant, Plastic Cosmetic and Reconstructive Surgery
In today’s day and age, patients having deformities due to accidents / cancer / burn, birth defects are increasingly
demanding functional as well as cosmetic results. RECONSTRUCTIVE surgeons today are providing cutting-edge
surgeries to deliver the results that give patients a shot at near normal life, following extensive trauma or mutilating
facial / oral / breast / limb cancer surgeries.
Today reconstructive surgeons can re-create entire upper or lower jaw bones, facial structures lost to accident or
cancer. Large chunks of tissues including skin bones and muscles can be moved from one part of body to replace
another part using special technique called microvascular surgery giving hope to millions of patients. Even advanced
breast and facial cancers are now treatable as plastic surgeons are able to close large wounds in the body.
Many patients with badly mangled limb injuries are able to regain good function in their limbs which once upon a time
would have been amputated.
Reconstructive and plastic surgeons have the distinction of playing pivotal roles in many complex surgeries of other
specialties that are challenging or complicated due to their unique ability to manipulate living tissues of body.

15. 15
PREBIOTIC, PROBIOTIC AND
POSTBIOTIC SUPPLEMENTS
MS. CHAITALI RANE
Clinical Dietician
Prebiotics was described as “a non-digestible food
ingredient that beneficially affects the host by
selectively stimulating the growth and/or activity of
one or a limited number of bacteria in the colon, and
thus improving host health”.
Probiotics are live micro-organisms that are
intended to have health benefits when consumed or
applied to the body.
Postbiotics are functional bioactive compounds,
generated in a matrix during fermentation, which
may be used to promote health.
• Prebiotics are non-digestible fibres responsible
for the modulation of gut microbiome and
increased production of small chain fatty acids to
regulate appetite as well as metabolism.
Supplements like Chicory Root Powder, Jerusalem
Artichoke, Asparagus, Leeks, Artichokes and
Psyllium Husk are available and widely suggested.
• Probiotics are responsible for restoration
of the immune system. Supplements
like Lactobacillus rhamnosus GG
have shown to reduce duration and
severity of diarrhoea in children
and adult.
Bifidobacterium lactis which is
activated in the large intestine
reduces Constipation, Irritable
Bowel Syndrome and
Inflammatory Bowel Disease.
Streptococcus thermophiles used in the production
of yogurt, improve lactose digestion and reduce risk
of diarrhoea.
• Postbiotics are responsible to interact with
immune cells and to reduce inflammation in the
body.
Supplements like yogurt, sauerkraut, pickled
vegetables, and kombucha are produced by various
bacterial and fungal species.
Side effects :
Overdose of supplements or over the counter usage
of such supplements may create side effects or
reactions including gastric complaints however this
area requires detailed study and trials for exact
conclusions.

16. 16
PUBLIC INTERACTION
SESSIONS
Health Talk for the members
of Khar Gymkhana
Health Camp Activity for the members
of Rotary West Coast (Mumbai)
NEW THERAPIES IN MEDICINE
Interaction and doubts were resolved post session
DR. RAJESH JARIA - Consultant, Internal Medicine
WOMEN’S WELLNESS THROUGH THE AGES
Interaction and doubts were resolved post session
ASTHMA REVERSIBLE?
Interaction and doubts were resolved post session
DR. KINJAL MODI - Consultant, Pulmonology

17. CONGRATULATIONS
NURSES DAY CELEBRATION
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LAUNCH OF GERIATRIC ONCO
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18. 18
SPECIALTY CLINICS
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Look for the
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The
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P. D. Hinduja Hospital, Khar presents
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The Prostate Cancer Clinic Team:
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The entire team coordination is excellent all nurses are well trained n wonderful... I forgot that assistant
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during his short stay. My father was in room no 205B, The staff and the doctors were all very friendly and
helpful. Thank you for great experience during our visit. Grateful and appreciate each and every staff i have
had interacted with.
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- Rajat Lamba
One of the best experiences we ever had. And have been to other hospitals. The way they took care of us is
incredible. I will miss some names but a few I must mention who were exceptional!!! Thank you guys n gals!
Thank u Hinduja!!!
Room 1012
Dr. Nilen Shah • Dr. Manan Shah • Dr Pheba & Dr Preeti -Physiotherapist • Nurse Meena, Jincy
Maushi - Sangeeta • Dr. Pallavi • Dr. Roshini - anastheologist
- Khristina Jacob
I cannot reiterate enough how much Dr Shashank Shah and team have helped me to change my life. I was
extremely obese with all the lifestyle diseases like pre-diabetes, sleep apnea, PCOD, Hypertension. I thank
God for leading me to him and the whole team who helped me immensely. Through the surgery I have lost
about 45 kilos currently and consistently losing weight even now. The team including Radhika, Anagha and
Amrutha have supported me in the planning stages as well as the diet and medication throughout this one year.
19 April 2022 will remain the most memorable day in my life. God bless you all.
20

21. "Breathing Easy: Understanding and Managing Asthma on World Asthma Day 2023", read the blog
here: https://bit.ly/3HwYrFe Reviewed by Dr. Kinjal Modi, Consultant Pulmonologist, (MBBS,
MD (Mum.), DNB, FCCP (USA), EDARM (EUROPE), PGDHHM, PGDLMS, LLB) at #HindujaKhar
"10 ways to keep your Kidneys healthy", read the blog here: http://bit.ly/40lew8E
Reviewed by Dr. Neha Punatar, Consultant - Nephrology at #HindujaKhar
"The Role of Heart Valves in Maintaining Cardiovascular Health", read our latest blog here:
https://bit.ly/3K0jmSN Reviewed by Dr. Haresh Mehta, Consultant - Interventional Cardiology at
#HindujaKhar
"Understanding cancer a little better", read our latest blog here: https://bit.ly/41QGnib
Reviewed by Dr. (Prof). Vijay Patil, Consultant - Medical Oncology at #HindujaKha
READ OUR BLOGS
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22. CONTEST ALERT!
Answer 3 simple questions
& win exciting prizes
Email the correct answers along with your name
and contact number to
info.khar@hindujahospital.com
by 31st July, 2023 and win exciting prizes.
A. Dhanvantri
B. Dr. Fernando Ortiz-Monasterio
C. Sushruta
D. Dr. Karoon Agrawal
Who is considered as the "Father of Plastic Surgery"?
2
Brow lift is a type of plastic surgery
done to lift only the eyebrows.
A) True B) False
3
What is the origin of the word "plastic" in plastic surgery?
1
A. Synthetic reconstruction
B. Greek word "plastikos" meaning to mold
C. Use of plastic in changing appearance of a person
Previous Contest Winners
Congratulations!
DR. AMRUTA PAWAR

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