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Surgery Department

Surgery Department Chiang Mai

Surgery Department

1. Hair Transplant

        Baldness is hair loss, or absence of hair. It’s also called alopecia. Baldness is usually most noticeable on the scalp, but it can happen anywhere on the body where hair grows.
        And hair loss can occur for many reasons. Some of the more common causes include the following: aging, change in hormones, illness leading to shedding of hair (called telogen effluvium), family history of baldness, hair transplant in Chiangmai can help with hair problem.

What are hair transplant
        you can restore your hair, your self-esteem, and your self-confidence. The result of the procedure is totally natural and may be completely undetectable. But wait, choosing the right doctor with the right skill set is critical.
        Now, hair transplant physicians can work with different techniques to uproot and transplant large numbers of hair follicles called follicular units. There are two main techniques currently in use for hair transplantation. The FUE, Follicular Unit Extraction; and the FUT, Follicular Unit Transplantation techniques. They vary mainly in the manner hair follicles uprooted from the donor area.

Follicular Unit Extraction (FUE)
        In an FUE hair transplant procedure. each follicular unit is independently uprooted from the scalp with no strip of tissue being removed.
        Hair follicles will randomly uproot, decreasing hair density in the donor area that many say is hardly observable. This is the major distinction between FUE and  FUT procedure.

Generally, the hair transplant physician follows these steps to perform a FUT:
1. The donor area is mark and anesthetize.
2. The custom-built micro-removal instrument isolates individual follicular units. Note that the surrounding tissue is particularly unaffected. See figures below.
3. Follicular units removed with utmost care. The donor area will heal within a week. See figure below.
4. The recipient area is anesthetized. Then your physician will create small puncture sites to receive the grafts, positioning them in a predetermined pattern and density, and angling the punctures in a uniformed way so the hair pattern will appear realistic.
5. The donor’s hairs are put in. See figures below
6. The recipient area will heal within a week

Hair Transplant – Follicular Unit Transplantation (FUT)
        Follicular Unit Transplantation (FUT) is an approach where the hair transplanted from the permanent zone. The region in the back and sides of the scalp where the hair is more resistant against balding, to the bald or balding areas of the scalp.
        This can achieve by using naturally occurring clusters of 1, 2, 3, or 4 hairs, called follicular units. After the patient’s scalp anesthetized. The physician removes a strip of tissue from the donor area. 
        An area within the permanent zone, and, once extracted. The donor strip slivered into several independent follicular units by means of microscopic dissection techniques.

        As these follicular unit grafts readied, the physician makes a small incision in the scalp, called recipient sites, where the grafts are placed.
       The arrangement and positioning of these follicular unit grafts dictate the aesthetic qualities of a hair transplant. Therefore, an arrangement needs to decide on a case-by-case basis. And according to the patient’s history of hair loss and probability of future hair loss. For the simple reason that follicular unit transplants mimic the manner in which hair grows in nature. The results will appear absolutely natural and be indistinguishable from one’s original hair.

before for Hair Transplantation
1. No Alcohol and stop smoking
2. Make arrangements for someone to take you to and from the clinic because you have to take oral sedation in addition to local anesthetics.
3. Confirm your appointment
4. Consultation or pick up antiseptic shampoo and pre op antibiotics at the clinic
Clear the payment
5. If you color your hair on the regular basis, please do so a few days prior to surgery because you should not color your hair post operative at least 1 month
On surgery day
1. Wash your hair in the morning using given antiseptic shampoo at least 5 minutes (antiseptic hand wash can be substituted for Betadine scrub and Hibitane scrub)
2. Wear a button-down shirt and comfortable pants. You should also bring an adjustable baseball cap or scarf along with you.
3. Do not wear anything that will have to be pulled tightly over your head and for a few days after surgery.
4. No tight hats or caps.
5. You may have light breakfast, but do not drink tea and coffee
6. Take antibiotic 2 capsules after meal as doctor prescribed one hour before coming to clinic. If you are not prescribed, you may take it at the clinic.
7. Please report to the clinic on time.
8. Do not drive to the clinic on the day of surgery.
9. Do not bring valuable things with you to the clinic
10. You're required to have the blood test for anti HIV (rapid test from finger tip at the clinic) 
11. Due to our policy, we apology for our cancellation, We have to cancel all case of contagious patients.

After Hair Transplantation
1st Night:
        After hair transplantation operation you will have a bandage on your donor part and a hairband around your forehead to avoid the swelling on your face. You will see small scabs in recipient area and small red holes on the donor area that will heal within 15 days.

        You may feel some swelling, itching and mild pain for a couple of days after the hair transplant operation. These symptoms can be reduced with ice applications, emollient lotions or some symptomatic medicine recommended by the doctor.
        You should start post-op hair wash procedure; you might have the first hair wash in our clinic too.
        We will recommend you a shampoo and a lotion and describe you how to wash your hair for the next 15 days. Washing will help remove the scabs and help with the healing process.
DAY 5-7 Days
        Transplanted grafts will become stronger, and they won’t fall by touching. You should avoid scratching. 4-5 days after the operation, hair in the transplanted area will start to fall down and this will continue for 2-3 months. After that, new permanent hair will start to grow.
DAY 15-30
        Your appearance will become regular in 2-3 weeks; people wouldn’t understand that you had a hair transplantation operation.
Months 1-3
        Shock hair loss experienced in this period and then the transplanted hair starts to grow.
Months 4-6
        In 4th month re-growth rate will increase and within the 6th month, you will see half of the result and recognize some obvious changing.
Months 6-12
       Transplanted hair will continue to grow and become thicker.
Months 12-18
        In 12-18 Months you will see the final result of your hair transplant operation. You will get the look of more intensive, longer and thick hair. The final result will appear 12 to 15 month after the operation on the front area and 18 to 20 months on the crown area.

2. Chin Reduction Surgery

        Chin Reduction Surgery is a plastic surgery procedure that can refer to either chin reduction or chin augmentation. During a chin reduction surgery, the surgeon removes part of the bone tissue that makes up the chin to enhance the appearance of the lower jawline, neck, and chin area. The primary goal of this cosmetic surgical procedure is to reduce the projection of an overly-prominent chin, thereby helping to increase the patient’s facial appearance, self-esteem, and confidence.

Why to do chin reduction surgery?
        This procedure is a cosmetic surgery to reshape a chin on the bone that can perform on the lower jawline and chin area to improve proportions of the face to help more confidence.
- Advancement or moving the chin forward.
- Pushback or moving chin backward.
- Side to side, which can help a symmetric chin
- Making chin shorter, or longer

There are many types of chin reduction;
1. Chin Reduction with Mandible angle reduction.
2. Chin reduction without Mandible angle reduction.
3. Chin reduction with T osteotomy technique. Or V. line surgery

 Chin reduction with Mandible angle reduction
          Chin reduction with Mandible angle reduction is an aesthetic surgery procedure that can refer to chin, jaw angle and mandible reduction. During a chin reduction surgery, the surgeon will remove the part of the bone tissue that makes up the chin to enhance the balance and harmony appearance of the lower jawline, chin and neck. There are many techniques as follow:
1.1 Chin reduction by resecting the bone of chin angle, this procedure is available for in case has a small chin but concerns only the angle of chinbone. After the surgery, the patient will get the curved chin that they require
1.2 Chin reduction by resecting the bone from chin angle to the middle of the mandible, in case has the shape as a square and broad chin. They need to cut it longer, form a chinbone to middle of a mandibular for balancing a new lower jawline.  Mostly, chin reduction performs this technique. 
1.3 Chin reduction at the chin area by resecting a chinbone to be shorter, in case has long chin but not too much projecting chin. This procedure removes the lower chinbone out and shaving to be smaller and curved chin, and balancing a new lower jawline   
1.4 Chin reduction by resecting from side to side of angle jaw through mandible and chin, as a horse shoe reduction. This technique is used for wide jaw and broad chin to improve the lower part of the face to be more shorter and smaller lower jawline with a proportionately facial feature. 

Chin reduction without Mandible angle reduction
        Chin reduction alone is an aesthetic procedure, to slide the chin that is too short or too long chin, while the jaw and mandibular are nothing to do.  The surgeon uses a saw to cut a small vertical line for reference. Then they slide the bone forward or backward and attach screws and plate to ensure it stays in place. After chin forward or backward surgery may create the a step in the bone by bone shaving

1. Chin forward surgery
This procedure is a correction of a short chin by moving chinbone forward to make the short chin to look more natural.
2. Chin Backwards Surgery
This procedure is a correction of a long chin by moving chinbone backward to make the long chin to look smaller and more natural.
Chin Reduction by T-Osteotomy, V-Line surgery
        This procedure is provided for V shave face that is make balance between jaw and chin. For a short chin and wide face. Length and location of chin are adjusted for smaller face with a V- line. The surgeons will create the shorten chin and jawbone at the under ear to a smaller face with balance proportion.

How do you prepare for chin reduction surgery?
1. Stop smoking and consuming alcohol at least 2 weeks prior to the surgery date
2. Avoid aspirin and aspirin-containing medicines at least 1 week prior to the surgery date
3. Discontinue the use of anti-inflammatory drugs at least 1 week prior to the surgery date
4. Consult your doctor about usage of any other prescription medications leading up to the surgery date.

How do you after care for chin reduction surgery?
1. Eating liquid or soft- food.
2. Often keep clean in the mouth by mouth wash.
3. Avoid smoking.
4. Don’t over exercise within 1 month.
5. Often take a pain killer medicine to control pain.
6. You can normal back to school or work after surgery 2 weeks, the wound healing well within 4-8 week


        Rhinoplasty is surgery that changes the shape of the nose. The motivation for rhinoplasty may be to change the appearance of the nose, improve breathing or both.
        The upper portion of the structure of the nose is bone, and the lower portion is cartilage. Rhinoplasty can change bone, cartilage, skin or all three. Talk with your surgeon about whether rhinoplasty is appropriate for you and what it can achieve.
        When planning rhinoplasty, your surgeon will consider your other facial features, the skin on your nose and what you would like to change. If you're a candidate for surgery, your surgeon will develop a customized plan for you.

what to expect after rhinoplasty?
1. Take the antibiotics and pain medication only as prescribed by the office.
2. Do not take any aspirin or any anti-inflammatory compounds for 2 weeks before and 2 weeks after your surgery unless you first discuss it with your surgeon.
3. you should not smoke for at least 2 weeks prior to surgery and 2 weeks after surgery. Smoking and chewing tobacco inhibit your circulation and can significantly compromise your surgical outcome.
4. To minimize swelling, you may use cool, clean compresses or ice wrapped in a dry cloth. Apply these gently to your closed eyes four to six times a day for the first twenty four hours after surgery.
5. Sleep with the head elevated for the first week after surgery.
6. You should not blow your nose for two weeks after surgery as it can disrupt proper healing and cause bleeding. If you have to sneeze, sneeze with your mouth wide open as this will minimize any disturbance within the nose.
7. It is important to either avoid the sun or use a sunblock (SPF 15 or higher) for 6 months after rhinoplasty. Failure to do so may result in long term reddish discoloration of the skin of the nose. Patients undergoing only septoplasty have no increased risk of discoloration.
8. Usually, your surgeon will use dissolvable sutures inside the nose which will disappear on their own within a few weeks. Any external sutures should be kept clean and dry. If non-dissolvable sutures are used on external incisions, they should be removed within 5 to 7 days after surgery (at the time of splint removal).
9. You should do no vigorous exercise and should avoid any significant physical exertion, lifting or straining for a minimum of 3 weeks after your surgery, as this activity could disrupt your wound healing and cause bleeding. Plan on taking it easy. Although your nose will not feel painful while healing, it is still susceptible to injury. Be careful not to bump it or squeeze it.

4. Upper Blepharoplasty or Eyelid surgery

         Upper blepharoplasty or Eyelid surgery is a procedure that involves resection of redundant skin and/or musculature of the upper eyelid.
        Droopy eyelids are a major reason why some people consider eyelid surgery (blepharoplasty) to remove and tighten excess eyelid skin for a more alert, youthful appearance.
        Sometimes blepharoplasty also can improve your vision by providing a less obstructed field of view, once droopy eyelids are improved.
        Blepharoplasty can remove excess skin, muscle and sometimes fat from the upper or lower eyelids. In some cases, you might need only skin removed but not muscle — or you might need the procedure done on both upper and lower eyelids.
        An upper eyelid blepharoplasty (sometimes called an "eye lift") should not be confused with upper eyelid ptosis surgery, which is a procedure to raise the position of the upper eyelid margin by tightening the muscle and tendon that normally elevate it. Blepharoplasty surgery sometimes can elevate an upper eyelid margin slightly if the heaviness of the excessive skin actually is "weighing down" the upper eyelid, causing it to droop.

What Is Cosmetic Blepharoplasty?
        Cosmetic eyelid surgery is a surgical procedure that is not medically necessary and is performed solely to improve your appearance.
        Unfortunately, your upper and sometimes lower eyelids may become droopy or baggy as part of the aging process. Your eyebrows also may sag or droop as a part of the same process.
        The eyelid skin stretches, muscles weaken and fat pockets become more prominent as they bulge. This may be a hereditary condition that runs in your family.
        Cosmetically, such conditions may detract from the overall attractiveness of your eyes and face and cause a tired or older appearance.
        A number of different types of surgeons can perform cosmetic blepharoplasty.
       Ophthalmologists and oculoplastic surgeons (a surgical sub-specialty of ophthalmology) most commonly perform these types of procedures. However, general plastic surgeons, oral and maxillofacial surgeons, and ear, nose and throat surgeons also perform cosmetic eyelid surgery.

When Is Functional Blepharoplasty Needed?
        A functional blepharoplasty (in contrast to a cosmetic blepharoplasty) is eyelid surgery performed for medical reasons.
        In most cases, a functional eye lift is performed to remove loose skin from the upper eyelid if it droops low enough to impair your vision for driving or other visual tasks.
        Another functional problem is difficulty wearing glasses or contact lenses, whether from baggy upper or lower eyelids.

Other medical conditions that may require functional eyelid surgery include:
1. Irritation from excess folds of eyelid skin rubbing together.
2. Forehead discomfort from overused muscles that strain to lift sagging skin in the eyelid area.

Preparation for a Blepharoplasty Procedure
        You'll need to clarify with your doctor whether you'll be undergoing local or general anesthesia for your eyelid surgery.

        If you have local anesthesia, you will remain awake during the procedure, but the area around your eyes will be numbed with a drug administered through a needle. Local anesthesia can be enhanced with the use of systemic sedatives given either orally or intravenously.
        You may require general anesthesia if the blepharoplasty is more complicated or if you plan to undergo other cosmetic procedures at the same time.
        If you need general anesthesia, you will be given an intravenous (IV) injection that will put you to sleep for the duration of the procedure, which lasts from 20 minutes to two hours, depending on the complexity of the surgery and whether both upper and lower eyelids are involved.
        Prior to the day of the procedure and particularly if you'll be undergoing general anesthesia, you may be asked to take steps such as these:
        If your doctor advises this, stop taking any medication that can thin your blood and prevent it from clotting normally. This includes pain relievers such as aspirin and ibuprofen. You'll need to stop these medications one to two weeks beforehand, to reduce the possibility of excess bleeding during the procedure.
1. Eat only a light meal such as soup the evening before your surgery.
2. Do not eat or drink anything after midnight.
3. On the morning of your procedure, you should take essential medications — such as for blood pressure — with a small sip of water.
4. Do not wear makeup of any kind on the day of surgery.
5. Make sure someone is available to transport you home and watch after you during the first several hours after you are released following surgery.
6. Procedures typically are performed in a day clinic or at the doctor's office. Ordinarily you would not need an overnight hospital stay unless you plan to have several complex cosmetic procedures that day.

What are my post-operative instructions?
1. Have someone drive you home after surgery and help you at home for 1-2days.
2. Get plenty of rest.
3. Follow a balanced diet.
4. Constipation is a side effect of decreased activity, use of pain medicines, and dehydration. Be sure to walk, drink fluids regularly, and consider adding raw fruit to your diet.
5. Take pain medication as prescribed. Do not take aspirin or any products containing aspirin unless approved by your surgeon.
6. Do not drink alcohol, drive a car, or make important decisions when taking pain medications.
7. Even when not taking pain medications, no alcohol for 3 weeks as it causes fluid retention.
8. If you are taking vitamins with iron, resume these as tolerated.
9. Do not smoke or be around a smoker. This can be the most significant cause of serious healing issues.
10. Sleep with your head elevated 45 degrees for several days to minimizeswelling.

What should my activity level be?
1. Start walking as soon as possible - this helps to reduce swelling, lower the chance of  developing blood clots and/or pneumonia, and avoid constipation.
2. Do not drive until you are no longer taking any pain medications (narcotics).
3. Avoid activities that raise your blood pressure, including bending, lifting and rigorous sports.
4. Keep activities to a minimum for 3-5 days; avoid strenuous activities for 2-3 weeks.
5. Read or watch television after 2-3 days.
6. Return to work in 10-14 days.

How do I take care of my incision?
1. Avoid exposing scars to sun for at least 12 months.
2. Always use a strong sunblock, if sun exposure is unavoidable (SPF 30 or greater).
3. Keep steri-strips on. If steri-strips come off, you can replace them if provided with additional strips.
4. Keep incisions clean with soap and water and inspect daily for signs of infection.
5. Use cold saline compresses for the first 24 hours for comfort and to reduce swelling and bruising.
6. Generally, your hair can be shampooed anytime after surgery.
7. Wait at least 2 weeks before wearing contact lenses.
8. You will have sensitivity to sunlight, wind and other irritants for several weeks, so wear sunglasses and a special sunblock made for eyelids.