Sir Ganga Ram Hospital

Hello friends!

I am Dr. Anubhav Gupta. I am a consultant plastic surgeon at Sir Ganga Ram Hospital. Today I am going to talk with you about a very neglected problem faced by a lot of patient of ours and that is the diabetic foot ulcer. Now what happens usually is people who have diabetes are always prone to have some problem in their feet. It is because of microangiopathy and because of the high level of glucose which is constantly there so there is a culture medium in the blood which can cause a lot of injuries. So it is very important for them to take very good care of their feet.

I always recommend my patients from diabetes that they should look at their feet just like they look at their face everyday in the morning. So every day you have to see even if there is a small issue then you should not neglect it. You should approach a plastic surgeon or an aesthetic surgeon or any other surgeon who is taking care of the feet. Usually, these kinds of the patient require a multimodality approach. A plastic surgeon, a vascular surgeon and sometimes a paediatrics.

So it's a combined therapy. Multiple sessions are required but what is more important is to attack the problem at the very beginning, because if we don't attack the problem in the very beginning it can lead to catastrophic consequences. It may start with a small blackening of the toe and it can actually extend up to right above the knee also. So when we treat these patients aggressively and at an early stage we usually limit the damage caused by the diabetic neuropathy and as well as other infective focus. The point or the take the home message over here is that we should treat these patients aggressively and early and the patient should be made aware that these kinds of problem are not to be taken lightly. For more details, you can contact me on lybrate.

Thank you!

Hello friends,

I am Dr Anubhav Gupta and I am a consultant plastic surgeon at Sir Ganga Ram Hospital. Today we are going to talk about a topic, which usually we see all around us every day in there and out. That is the common household injury that is an injury which we sustain in our household, our kids sustain and everybody of us must or might have this kind of injuries during our lifetime. So, if we are to look broadly, what kind of injuries we sustain at home, you can say some of them are like called kitchen injuries, injuries which are sustained in the kitchen. What they can be, they can be a simple cut by a knife or finger coming into the grinder by a kid or even burns, by hot water spilling and sometimes the oil spilling off, so one is the cut injury and other is the burns. Now, cut injuries can be anywhere in our body, cut injuries are usually in the hand because we are working with the knife with our hands. So one thing which I am going to emphasize here is that, in any injury of the hand we should not take it lightly because our hand is a network of lot of tendons, nerves, ligaments and they are pretty superficial hairs, so any injury, suppose the injury is there in the wrist, it should always be evaluating because there is a lot of function of nerve which is going from here to here. So whenever you have an injury by a knife at home, you should always consult an expert preferably a plastic surgeon. So this is one kind of injury, many times our fingers can come into certain machine and there are cut off, so they if brought properly preserved in time can be put back and you should then there is cut part is there you should be preserved inside a clean cloth and should be put on the ice, not directly but inside a polythene then on ice you should rush to your nearby plastic surgeon and there is a possibility that the cut part can be put together by microvascular surgical technique, now this is one type of injury. The Other type of injury which is common sees the children hand and fingers come into bed boxes, doors this kind of injuries can also be evaluated and the treatment as early as possible. Then many times we slip and we fall, we have multiple injuries, we break a bone, there are wounds, many times kids running around hitting the bed and they have cut all over their face. So these injuries should also be if you want a less scar, if you want a better result you should consult your plastic surgeon. And if there is a hand injury which is not neglected something which is followed in the head we should not neglect. Even if you have slightest of a doubt for example if there is a vomiting, if there is a bleed from the nose or there is some sort of conversion or patient has gone as loss of consciousness, so you should consult a neurosurgeon also. So these are the kind of slip injuries, then sometimes there is a fall of heavy object or fall of things over you, they also should be evaluated. The other injuries if we have seen in children as zipper injuries to the penis that also should not be neglected and immediate action if the skin deep should be taken and whatever surgical intervention is required that should be done. All in all, it is always said that prevention is better than cure. So you should always be very careful when you are around at home and you should not let the kids roam around here and there and they should be supervised and so we can prevent these injuries.

Hello friends, I am Dr Abhinav Gupta, I am a consultant plastic and cosmetic surgery working at Sir Ganga Ram Hospital in New Delhi. Today I am going to talk about the very common topic and that is post massive weight loss body contouring. So what exactly is post massive weight loss firstly we need to understand that nowadays we are seeing a lot of people who are very obese and in fact, they are morbidly obese with a BMI (Body Mass Index) is more than 35. Now there are 2 ways in which patients lose weight, one is by a lot of exercise and dieting and the other way is bariatric surgery. So what we will see a trend of is, there are many patients who have lost a lot of weight for the period of one year, they come to us with lose, hanging skin from all over their body from their arms to the chest as well as abdomen as well as thighs and buttocks, which looks very bad. So they come to us for surgical corrections. So what we do exactly comes under the heading of pot massive weight loss body controlling. Now the next question which comes to our mind is what we do, there are multiple procedures which are required in these patients, they have lose skin of the arms, the chest, the abdomen as well as buttocks and the thighs. So we combine and try to do these surgeries in two sittings, in one surgery usually we do abdominoplasty, along with the thigh and buttock lift or a CBL or complete body lift. And in the 2nd sitting, we do chest with arms, usually, in the 1st sitting we prefer to do chest and arms and in a 2nd sitting, we do the abdomen and buttocks, many times in many patients we do this surgery in three sittings that depend from patient to patient. And another thing which comes to our mind after the surgery is recovery period. Usually, the recovery period for the abdominoplasty is 7 days to 10 days and wreaky plasty and chest surgery is 5 to 6 days and after the surgery is over, the patient is usually advised to wear pressure garments. So that the skin, whatever skin is that further come into shape. Usually, these patients are very gratified and very happy because all the extra skin is gone and this is a rewarding surgery for them.

Thank you.

Hello Friends, I am Dr Anubhav Gupta and I am consultant Plastic surgeon working at Sir Ganga Ram Hospital, today I am going to talk about hand surgery. Now hand surgery is a very vast felid which involves a lot of conditions like if you look at congenital since birth there are many kids who have absence of finger, absence of thumb, then there are many times the fingers are joined that condition called Syndactyly, then there are many time extra digits which is polydactyly. So these are the common conditions which are present in our hands at the time of birth. Then there are many conditions which are acquired like for example, there are injuries, common cuts in kitchen then finger getting into the washing machine simple cut by knife then road traffic accident wherein the part of the hand is cut from the body it is amputation and abrasions, avulsions, crushes, bruises. All these kind of injuries, loss of tissue, fracture all these comes into under the preview of hand surgery, then injury to nerve tendence. Then the third group is the burns, burns related when there are burns of the hand they cause contracture they cause the abnormal position of the joints with the inability of the person to do his works. These all category comes under the gament of hand surgery. Now, who is qualify to do hand surgery, with the basic training of at least and a person should be a qualified orthopaedic surgeon or a plastic surgeon which special interest and having worked in the field of hand surgery, such people are more qualified to do hand surgeries. I always tell that we should never take any injury to the hand lightly because there are very important vital structures which are moving under the skin. There are tendons and nerves lot of things which make this hand work. So even if thus a small it should always be super wise examined by an expert because even a small cut can cause injury to a vital structure leading to loss of function.

You can compare our hand to a crane, for example, the crane has a metallic part then there it has a lot of wires which act as pully, picking up the weight and it has a wires circuitry which is electricity which provides it. Similarly, if you look at our hand the bones soft tissues provide the framework of metal just like a crane and the pullies the tendons and the ligaments they are the pullies for lifting the weight and electric circuitry are the nerves. So, if we look at this analogue hand, works like a crane so any part of this complex system if it is injured then it is not working properly. Again another thing which we should understand it many times even after surgery the return to function depend a lot of things like Physiotherapy exercise what your surgeon tells you. It is like a machine if we don’t lose it, it will rust and it will not work. So we have to understand the complexity of the injury, the outcomes which are dependent or not only on the surgery but lot of other factors for example, the education of the person, if he is well educated there is always a chance the person will understand the mechanism how his hand works he will be able to get a better result as compare to the person, who doesn’t understand the importance of these systems.

Hello everyone, I am Dr Anubhav Gupta and I am a consultant Plastic and cosmetic surgeon working at Sir Ganga Ram Hospital, today I am talking about a procedure called Fat grafting or lyco injection. Now the first question which comes to our mind is who is the group of patients or who are the people who can on benefit from Fat grafting. There are many conditions, for example, we can broadly divide them into reconstructive and aesthetic conditions.

In reconstructive, in congenital i.e. since birth many children have an asymmetry of the face that is one part of the face is not as developed as the other part or condition called macrosomia. So in those conditions then there are certain females very rarely though who have a Poland Syndrome that is one side of the breast is not developed. So these are the conditions which present since birth, we can do fat grafting or we can correct those conditions.

Second is post-traumatic for example there is a fracture of the face leading to atrophy or loss of fat from there, there is some depression, some depression in any part of the body which can be corrected by fat grafting. Many times there is the asymmetry of the breast, small asymmetry of the breast which can also be corrected.

Now the cosmetic indication of Fat grafting is usually related to age-related changes. Wherein there is sagging of facial tissue, Fat grafting sometimes helps in that and there many times cosmetically patients have depressions in the hand people request for fat grafting. Similarly, even in genitalia people request for enhancing the size of genitalia and we can do that by fat grafting.

And the question which comes to our mind is what exactly is done in fat grafting, basically, fat grafting is a procedure in which we take fat by technique which we uses Coleman technique and we take fat from our body which has excess of it, for example, people have flap in their tummy or thighs and buttocks. We take that fat and we process it by the procedure by centrifuging it and once we process it and then we very find out we separate the very fine fat and by a technique of finely injecting we put it to areas where it is required. So this is briefly and a rough idea of what we do.

Then something about the cost usually it costs somewhere between 25 thousand to 60-70 thousand depending on the amount of fat which needs to be injected. Then another question which might come to our mind is are there is any side effect it is a routine procedure pretty safe, usual side effect the common one is there is sometimes bruising in the areas from where we do liposuction and take out the fat.

So what they usually settle down in 3 to 4 weeks and the next question which might come to us how soon the patient can go back to work again there is some amount of swelling usually stays for 5 to 7 days and the patient can resume work after 7 days to 10 days. Thank You.

Hello friends!

I’m Dr. Anubhav Gupta and I m a consultant plastic surgeon. Working at Sir Ganga Ram Hospital.

Today I’m going to talk about a very common condition which is the treatment and surgical treatment of age-related changes in the face or surgical facial rejuvenation. Now as we are all aware that as we grow old the changes in the skin like wrinkles, depression, and sagging of skin starts appearing. Many creams have been advised. Lots of people use creams but today I’m going to talk about surgical part which involves that. There are many surgical procedures which we can do which can actually make the skin tighter and make the person look younger. These procedures are like procedure like facelift, fat grafting, neck lift then forehead lift, brow lift then blepharoplasty. All these procedures are there is a combination of these procedures which use to may be knock out 10 to 15 years of age from a person age. Now the question which comes to us is what exactly are these procedures? Basically what happen as we grow old is that there are 2 or 3 changes which take place in skin of our face as well as underline tissues of our face. The skin becomes loose an d it starts sagging i.e. number one, then there is some redistribution of fat because of the laxity of various ligaments which are holding the fat so fat also start sagging. So these are the two major changes which take place. Now the premise of these procedures which we do is number one is we remove the excess skin e.g. if there is a loose skin we tighten the skin and we remove the excess skin which is common procedure called face-lifting. Now face-lift can be a conventional, full face lift, then there is a mid-face lift, there is a partial mini face lift so there are many types of face lifts are there. Then there are procedures like lags for lag skin there is a neck lift. Similarly lags forehead we have forehead lift and then we have eyelids for that we have blepharoplasty. So it is by a judicious understanding and choice. We decide which procedure to do in which patient. Now the next question which comes to our mind is how early can the patient go back to join his work? Usually when we do these procedures it takes 4-5 days for the swelling to subside and usually by 7 to 10 days the person can go back to resume his/her work. Finally if you were to ask me any tips for not letting us grow old and how can we prevent going old? Well from plastic surgeon point of view it’s very difficult to reverse the process because once it started you are aging and so there its going to happen the only thing that I feel and I strongly recommend is that sunlight is not good for your skin so direct sunlight exposure should be avoided. Then as the various naturopathies have described, plenty of water, wash your face number of times with mild soaps and drink plenty of fluids and seasonal fruits. These are the simple basic things if we do and avoiding sunlight can prevent damage to the skin.

Thank you!

Hello, everyone. I am Dr Anubhav Gupta and I am a plastic surgeon at Sir Gangaram Hospital.

Today I am going to answer few important questions related to the technique of Liposuction.

What is Liposuction?

Liposuction is a technique in which we inject medicated fluid in the body of a person and after then we take out the fat through suction from the body.

Is Liposuction safe?

Liposuction is a very safe procedure.

Who is a good candidate for Liposuction?

If people come to me for reducing their weight to 80-100 kgs, I refuse for Liposuction, as they are not suitable for this treatment. But people who have localized areas or difficult areas which they are not able to reduce that particular fat part inspite of following a proper diet and regular exercise, they are appropriate candidates. The generalised obesity people are not suitable for Liposuction. This treatment is suitable for such areas of the body which needs to be controlled and sculpted.

What is the duration of a treatment?

Liposuction depends on the number of areas we are treating. For example- Liposuction od abdominal area can be done in 3 hrs, Liposuction of thighs can be done in 1-2 hrs. Hence the treatment duration depends on the number of areas we are treating.

How long is the recovery period?

The recovery period of one area is about 24-48 hours. But if the Liposuction is done in 2-3 areas then you may suffer from pain for 2-3 days. There may occur some bruising which can last for 17-18 days.

Is there any risk or side effects?

If the Liposuction is done in a reputed Hospital through a well-experienced surgeon, then the risks are minimal. There are definitely certain minimal risks after any surgery, which is normal. Common side effect we see in patients after Liposuction is the collection of fluid which is called Seroma which is seen in less than 5% o our cases. apart from this, Bruising may occur for some period. But excluding these issues, it is quite safe if it is done by the well- an experienced or a well-trained surgeon in a controlled environment and in a healthy manner.

If you have any queries regarding Liposuction, You can contact me through Lybrate.

Thank you.

Hello friends, I am Dr Anubhav Gupta. I am a consultant of cosmetic and plastic surgeon. Today I am going to talk about a very common topic, that is Facial injuries. Now this is something which we see very common in our day to day life. Face is comprising of a lot of structures; the skin, there is the subcutaneous tissues, there are muscles, then there is bone underneath it. So when we talk about facial injuries, we can divide them broadly into two types:

•  One is the simple injuries and
• The complex facial injuries.

Now the simple injuries are the one, which we see like, our kids, they fall in the house, and they have cuts, and they have continuous lacerated wounds.

The complex facial injuries are seen when there are road traffic accidents, where there are deep cuts right up to the muscle and there are fractures of these bones.

So these are the common types of injuries related to face. Now the question which next comes to our mind is, what to do?

So in case of facial injuries, what is required to be to be done is, whenever such injuries happen, we need to apply some pressure on that, so that the bleeding stops. And if you are concerned about good scars and better looking sutured wounds, then you should consult a plastic surgeon to get it sutured. And in any case, it has to repaired, it has to be stitched. This is how the management of simple injuries is done.

But in case of complex injuries, they require advanced management, wherein not only a plastic surgeon but also a neurosurgeon and many other surgeons are involved because these injuries are usually not isolated injuries. They occur with head injuries also, and many times there are injuries to other parts of the body also. So it is better to take the patient to a better hospital. So in such injuries, what we usually do is, once the patient is stabilised, such injuries, for example a fractures, requires fixation.

Fixation means, is very similar to fracture of the hand or the limb, there is plating and screws and clamps and plasters and related things. The principles are similar for all these things also. So we use very fine, titanium plates for fractures.

The common fractured parts are the upper maxilla, or the lower maxilla or the mandible. The importance in such facial injuries, there are two priorities:-

•  One is , the patient should be able to eat, even after these injuries and fractures. Because once these bones are fractured, it becomes very difficult to eat so the main priority is that the patient should be able to eat even after these injuries.
• The second thing is, the lower part of the eye. So, there should be no problem in the vision, as well as the cosmetic outcome. So these bones are put back together anatomically by plating and fixation. So that the patient can lead a normal life, i.e, having a normal vision, and is able to eat properly.

So these are the principles required for practical fixation of complex facial injuries.

Now, to know more about these types of injuries you can get in touch with me on Lybrate. Thank You.

In today’s world, there are hardly few people who do not have a scar or a tattoo on their body. Basically, scars are marks which are left after any injury.

How can we prevent scars?

The most important thing is to take immediate treatment after having an injury to prevent scars, it is imperative or it is important even if it is a small scar or small injury. Even if we let it heal on its own, it usually will leave a bad mark. So it is always advisable to take some treatment, in case you have a cut, preferably with a plastic surgeon or any other trained person who can stitch these wounds in a manner which will leave a minimal scar.

The next question which comes to our mind is that, Is it possible to completely remove the scar or make the scars invisible?

Well, honestly, it is not possible. Every individual has his own way of healing, and in some patients, we have seen such good healing that the scars become hardly noticeable. Still by better techniques, by use of creams, lasers and other techniques, the scars can actually be made almost invisible.

Now I would like to discuss is Tattoos,

We, as plastic surgeons are concerned about making tattoos. But a lot of people approach us, to get their tattoo removed. There may be many reasons like social reasons like somebody gets selected in the Army or the police force where the tattoos are not allowed. So these patients come to us, and they ask what can be done for these tattoos. Basically, there are two modalities for managing a tattoo:

• One is a non-surgical or laser or by chemical peeling
• Surgical.

Laser treatment is more effective in removing scars rather than tattoos. It requires a number of sittings, usually 6 to 8 sittings or even more, as per the requirement. It makes the tattoo little hazy and little lighter after a certain period of time. There are however certain tattoos, which can be removed to a great extent but not completely.

Then the other technique is by surgical excision or surgical removal. Now this technique is useful for people, like, somebody comes to me and says, Sir I have my medical interview for Army after 20 days and I have a tattoo which is not allowed and I cannot go for laser, so the option that is available is surgical removal. If the scars are thin, like these names and all, they can be easily removed with leaving just a line, which with time becomes lighter. But if there are big scars, or big tattoos, which are broader, then many times we have to remove them and we need to put a graft also, a skin graft. So these are the two techniques, by suturing or by skin graft, wherein we can remove the scars and tattoos.

To know more about this, you can get in touch with me on Lybrate. Thank You.

Hello friends, I am Dr. Anubhav Gupta. I am a consultant of plastic and cosmetic surgeon. Today I am going to talk about breast surgery.

Breast surgery is a fast growing field, and a sub speciality of plastic and cosmetic surgery. Basically, breast surgery is a field that involves any surgery related to the breast, whether it is male or female. And basically, we can broadly divide breast surgery into two broad compartments.

• Aesthetic or cosmetic breast surgery
• Reconstructive breast surgery.

Reconstructive surgery is basically involving swelling, lumps in the breasts, then post-cancer, when the breast is removed in the cancer, and then the reconstruction, making the breast new, a new breast in a post cancer patient. These all come under reconstructive breast surgery.

But the field which is fast growing these days, is the Cosmetic breast surgery. In the cosmetic breast surgery, there are many surgeries.

In females, there is:

• Breast lift
• Breast augmentation. Augmentation means enhancing.
• Breast reduction

 These are the common surgeries. And in male, gynaecomastia surgery is coming up, and it is becoming more demanding these days. Males, young boys between 20 to 30 years are now the bigger number of patients coming to us and operating now, has increased manifolds in the past couple of years. Because people are now more aware. Now we have techniques which give very good aesthetic results. So this is about aesthetic breast surgery. And among this, one type of breast surgery, which is augmentation mammoplasty or enhancement is becoming very popular.

Females with small sized breasts come to us and we enhance the breasts by two basic techniques:

•  One is by implants
• The other is by fat grafting

In case of fat grafting, we take the fat of the patient itself, like, we take it from parts which are more bulgy like their abdomen or the buttocks and then we put it in the breast to enhance them. So that is also a popular surgery which is being done.

Then there is breast reduction. In many females, rather young females, there is an abnormally large growth of breasts tissue leading to embarrassment of these patients, pain in the neck and back, and they come to us for correction. So this is also possible now by the technique called breast reduction.

To conclude, breast surgery has now become a very safe and predictable surgery, with a reasonable good outcome.

And to know more about it, and to contact me, you can get in touch with me on Lybrate. Thank You.