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EECP Therapy - Non Surgical Heart Disease Therapy

EECP Therapy - Non Surgical Heart Disease Therapy
No Knifes, No Needles, No Surgery, No pain, Heart Disease Therapy

Friday, September 2, 2011


Many years ago, when writers wrote about a world where machines would assist humans in daily life, it was called science fiction. As the years went by, and technology advanced, so many things that were fiction turned into fact. As recent as twenty years ago, cardiac operations were a big deal, a ‘serious’ operation, and you would not have believed it if someone had told you machines would be doing the job much better in a few years.

But this is now true, and H.G.Wells is probably saying ‘I told you so’. One of the latest approaches to cardiac surgery involves a recent innovation that uses robotic instrumentation to allow cardiothoracic surgeons to operate through a smaller opening for a minimally invasive surgery. It’s called the da Vinci Surgical System. 

For many heart patients, when medication and catheter-based treatments do not relieve the symptoms, surgery may be the only option for treatment. But just hearing about the procedures of traditional or open heart surgeries can make even the most stout-hearted among us to feel queasy. “First, your chest is cut open, then your breastbone is cracked open, then we reach in to your chest cavity…” you get the picture.

Thankfully, there have been major advances in surgical technology, which now brings to us minimally invasive surgery and unmanned surgery. Initially, the purpose of having a machine perform surgery was to facilitate remotely performed surgery in battlefields and other remote environments. But it was soon clear that the telesurgical robot was more useful for minimally invasive on-site surgery.

Robots as surgeons
Robotic surgery and research on this has been going on for some time. In 1988, the PROBOT was used to perform prostatic surgery. The ROBODOC was introduced in 1992 to ensure precise fittings in the thigh bone for hip replacement surgeries. These were the forefathers of the da Vinci Surgical System.

The da Vinci Surgical System provides surgeons and patients with the most effective, least invasive treatment alternative for even the most complex procedures, such as mitral valve repair. The best news for the patient who takes this option is that this process offers the potential for a better clinical outcome. Patients who choose this surgery have shorter recovery times than those who have open heart surgery.

How the da Vinci system works
In this process, instead of cutting open the chest, and parting the breastbone, a small working incision and three to five small incisions (ports) are made in the spaces between the ribs. The incisions are about the size of a fingertip. The surgical instruments (attached to the robotic arms) and one tiny camera are inserted through these ports. Motion sensors are attached to the robotic “wrist,” so the surgeon can control the movement and placement of the surgical instruments to perform the procedure.
The spirits of the sci-fi writers and scientific visionaries need to put the brakes on their celebrations though – the da Vinci still needs a surgeon to be in control of the robot. The system is an extremely sophisticated tool that enables the surgeon to perform the surgery with greater precision and control as well as minimal invasion on the body.

Apart from the advantage that the body does not need to take a severe trauma for the procedure, the da Vinci system also gives surgeons the option of performing the surgery on a ‘beating heart,’ in which case the patient is not placed on the heart-lung bypass machine (this is called“off-pump” surgery).

The Process
During the Robotic cardiac surgery procedure, the surgeon sits in a console to the left of the da Vinci console. The robotic arms are directly above the patient, and function as an extension of the surgeon’s hands, directed through the controls in the console.
A tiny camera attached to a robotic arm gives the surgeon a very detailed, 3D view of the operating space inside the chest. The robotic arms are very agile, and so the surgeon gets a greater range of motion than is possible with hand-manipulated moves in standard procedures.

Benefits of Minimally Invasive Surgery

  • Quicker return to normal activities: Rather than waiting several weeks to heal, patients can return to work or other activities much more quickly–usually within 10 days.
  • Shorter hospital stay:  Time spent in the hospital can sometimes be reduced by as much at 50 percent, compared to traditional procedures.
  • No splitting of the breastbone (“cracking the chest”): Keeping the breastbone intact reduces the chance for post-surgical complications and infection.
  • Smaller incisions: Depending upon the case, the operation may be performed through four to five fingertip-size incisions or through a 3- to 5-inch incision at the side of the chest. Traditional open-heart procedures demand a longer incision down the center of the chest.
  • Much less pain: Decreased destruction to tissue and muscle results in less pain. Tylenol or aspirin are usually enough to manage pain after some procedures.
  • Elimination of the heart-lung bypass machine: In most cases, avoiding the bypass machine decreases the risks for neurological complications and stroke.
  • Minimal blood loss and less need for transfusion
  • A reduced risk of infection
  • Small scarring: Instead of a long chest scar, only a few tiny scars or a small, 3- to 5-inch scar remains.

Robotic heart surgery in India
Doctors at the Chettinad Health City, Chennai have successfully performed a rare robotic heart surgery on a 23- year-old patient. Dr. R. Ravi Kumar, the Director of the Institute of Cardiovascular Disease at the hospital, said that the robotically assisted procedure involved replacing both the mitral and the aortal valve simultaneously. Although the procedure is quite new in India, Dr. Ravi Kumar was positive about the system being used for a variety of procedures.
Just like for any successful surgery, minimally invasive procedures also need well qualified, trained hands. Since the procedure is very different from operating through a large chest incision, it requires doctors to be trained in a different manner. Even highly experienced surgeons must devote dozens of hours to learning how to use the techniques and equipment for minimally invasive surgery.

There are already several surgeons in India who are well trained in robotic surgery. Since the procedure has only advantages to offer, it is sure to be increasingly in demand in the future. Remember to research as well as discuss all of your surgical options with your doctor if you need surgery.

A healthier YOU in just one WEEK

Contrary to what you might believe, getting healthier with each passing week can be easier and cheaper than you think. Drinking more water, doing some exercises and breathing properly can make a lot of difference. Try these simple but very crucial practices to ease your way into the good health zone.

Drink more Water   The human body is 75% water and a human brain is 85% water. This liquid is one of the key elements that ensure that our metabolic processes are going smoothly – think of the body as a vehicle that needs all of the lubricants at optimum levels. Even a mild instance of dehydration slows down the body’s metabolism by 3%! The lack of water is the single biggest contributor to daytime fatigue. So the biggest and easiest single step you could take to making yourself healthier is to consume more water. Research shows that almost 75% of people are chronically dehydrated. And almost 37% have such weak thirst perception that it is mistaken for hunger. Could you be one of them?

We have all heard the 8-12 glasses a day mantra. It is important to remember that this is the amount that the body absolutely MUST have for good functioning. For optimum replenishment, it is ideal to have 2-3 liters every day. This will ensure that all your cells are well hydrated. If you are not used to drinking these amounts, you will need to consciously enforce this on yourself for about three days. After that, your body’s natural thirst indicators will begin functioning again, and you will automatically feel thirstier.

How to do it: When you wake up in the morning, measure out 12 glasses of water, and pour it into a glass bottle or jug. (Avoid using plastics wherever possible). Make sure that you drink this water throughout the day. This way, you will be reminded of the amount of water you are drinking. Try drinking one glass of water every hour. Increase the amount to 2 or 3 litres steadily over the course of the week.

Breathe with awareness

Your breath is what keeps you alive -Oxygen is the most important nutrient that the human body needs. A few minutes of oxygen deprivation could kill you. Our breath is also the primary medium of toxin elimination. Close to 70% of toxin elimination happens through exhalation. Little wonder that pranayama practitioners usually enjoy better health than others! All of us breathe automatically, and do not use even half of our lung capacity. What results is that our bodies are forced to function on far lesser oxygen than it needs. Oxygen purifies the bloodstream, and is a major source of the energy that we utilize to stay alive. If you observe your own breathing, you may be surprised at how shallow and irregular your breath is. A lot of us even hold our breaths for long periods of time without noticing it!

Apart from throwing out toxins, breathing well can improve energy production, lower blood pressure, reduce stress, and strengthen the immune system.  In fact, there are a lot of studies being done which show that the lack of oxygen could be a major cause for heart disease, stroke and cancer. It is of utmost importance that people with sedentary jobs breathe better – this can make all the difference in their metabolism, immunity and even sleep.

How to do it: First of all practice breathing correctly. When you inhale, your stomach should inflate like a balloon – this is how you know that the air is filling even the lower part of your lungs, utilizing your breathing apparatus fully. Most of us push the air into the top part of our chest – moving the shoulders or upper chest as we inhale. This limits oxygen intake. Every time you take a bathroom break, take a few seconds to place your hands on your stomach and inhale, pushing your stomach out. It should take you just a few tries, or ask anyone who practices yoga to help you figure it out.

Every time you have a glass of water, every time you sit down to eat something, or if you are watching TV and a commercial comes on – remind yourself that it is time to breathe correctly. Relax your shoulders, straighten the small of your back and focus your attention on your breath. Breathe easily, gently with long breaths into your stomach. Exhale gently. Repeat at least 5-10 times. Make it a point to do this as often as you can.

Exercise Most of us know that exercise is important to burn off extra calories, but its benefits in maintaining good blood circulation and working your heart and lungs make it an essential part of keeping your body healthy. 
How to do it: Decide what you can incorporate into your schedule, and DO IT! Make sure you move your body every day – walk to the neighborhood store for the groceries, take the stairs instead of the lift (if you’re not going too far up), go for an evening or even late night walk, put on your favorite songs and dance, do some simple flexes or stretches every time you are talking on the cell phone.

Eat Dinner early  Our digestive system starts winding down when the sun sets. This means that the later you eat, the more strain you are placing on your system. Most of us make it worse by eating just before we hit the bed. This means that we have lots of food in our system and a body that is asleep before it is digested – making for poor digestion and toxin accumulation. Worst of all, this practice forces our body to focus most of its energy on digesting the food, when it should actually be using the time we sleep to repair, heal and energize our complete system. This is why we wake up sluggish and lethargic most of the time.

How to do it: Eat your dinner before 8.00 p.m. Don’t worry about getting hungry later. Go to sleep only by 10 or 10.30 p.m. If you feel hungry at bed time, drink a glass of water or have some fruit. It may take you about three or four days to hold to this routine, but if you persevere, the benefits that you feel will help you to make this a welcome, even effortless shift in your nightly routine.


Studies show that the human body is basically herbivorous in nature, and functions better on an alkaline diet of primarily vegetables. When we consume non vegetarian food on a constant basis, our blood becomes more acidic than alkaline, setting up the scene for illnesses and diseases to thrive.  Decreasing non-vegetarian foods also means decreasing the toxin burden on your internal organs, especially the kidneys.Toxins from a vegetarian diet are fewer and easier to expel. Overall, vegetarians enjoy better health and have lesser chances of suffering from cancer, high blood pressure and heart problems.

How to do it: A good way of improving your health is to decide that you will consume only vegetarian food on certain days of the week. This can provide radical benefits to your digestive system, sleep patterns and immunity. You can add the number of vegetarian days in the coming weeks, depending on how you feel about it.

It would be ideal to incorporate all of the things listed above into your routine, but it is important not to overwhelm yourself with change. Decide for yourself what it is you will focus on this week, stick to it and then add more things to it, if that is what works for you. The key lies in figuring out how these practices can be incorporated into your life, and also in having the perseverance to stick with a change for a few days. It is always the first few days that seem hard – this is the window period where you are resisting change from the old routine. After that, any practice that is good for your body will be welcomed by your system, and will be easy to stick to. 

A candid chat with Padmashri Dr. Marthanda Pillai

By Reba Paul
I waited among very patient patients outside Dr. A. Marthanda Pillai’s consulting room. The recent recipient of the Padma Shri award, who lives in Trivadrum and heads the team at Ananthapuri Hospitals and Research Institute, had a packed waiting room. I wondered what it would be like to meet a Padma Shri recipient- would I need to be extra polite and respectful? Surely a man who was respected for the huge amount of medical service given freely to thousands poor patients, wouldn’t be too hard to talk to. Inside the doctor’s room, behind a large table sat a bespectacled man in his early seventies, wearing an army style bristle- brush moustache. Just as I started wondering whether I should be nervous, a polite smile appeared. Clad in a simple brown shirt, sleeves rolled up to the elbows – Dr.Pillai looked like the kind of doctor who was ready to get into action at the shortest notice. Exactly how I would want my neurosurgeon to be if I needed one

Dr Marthanda Pillai (Former Head Neurology Department. Govt. Medical College-Thiruvananthapuram, Presently Chairman & Managing Director, Ananthapuri Hospitals & Research Institute, Thiruvananthapuram) graduated from Medical College Trivandrum and then went on to CMC Vellore to specialize in Neurology, after which he practiced there until 1978. He joined the Medical College service in the department of Neurosurgery after this, following which he worked at Kottayam for some time. Later on he went to England for a few years of further specialization and training, and returned to Medical College. Dr. Pillai was awarded the Padma Shri award in 2011 in recognition of his work in the field of neurosurgery and his service in performing brain and spinal operations for poor patients free of cost. When Dr. Pillai served in the government Health Service he oversaw the improvement of the neurosurgical services, taking it to one of the best at the national level.

H.C: “Going to CMC – was that a part of your initial plan?
“CMC was the foremost centre in the field of neurosurgery at that time and had the first center established under Dr.Jacob Chandy. Being there has greatly impacted who I am as a doctor and my career. It was more a place of worship than a hospital – there was that kind of a reverent attitude… and everyone was committed, service minded. Their day started at 7 o’clock, and went on till 11 or 12 at night, depending upon the workload. Absolute dedication and service – that’s what I saw there. My Professor was Prof.Mathai, who was a role model – his attitude and concern towards the patient, his work culture, punctuality, and meticulousness- were all inspiring to me. Seeing and being with senior doctors who were like this has really influenced my attitude towards this profession.

H.C: Has studying abroad played a part in shaping your career?
“Yes. That too has influenced my thought process, work culture etc. It was more or less similar to what I was seeing at CMC Vellore – their commitment to the patient. For instance, if a doctor is the MO of the Casualty, they just don’t pack up and leave after duty hours. After duty hours, they come back to the ward to check on the patient and see if their diagnosis in the causality was the right one, and would also follow up on the patient until discharged.   Another thing would be -  an approach of critical thinking about the patients as well as the medical approach taken – that was always there.

H.C: Would you say that this kind of an approach is lacking in our practice of medicine here, in Kerala?Could be, but there are various reasons for that – one is that we are not tuned to that sort of a situation. When we look at modern medicine, most of the diseases, particularly neurological diseases as we know them now, were all described by doctors in the West. They are the ones who documented and began studying it in the current manner and  form. We are more bookish – if something is put down on paper, we do not look any further than that. They are not like that – their thought goes beyond what is in the book. They don’t accept the status quo – there is a scientific curiosity to know more about things. That is why they constantly try to find out newer medicines, or define new scientific processes.
But they have much lesser patients than a doctor here has – so there is more time to pursue research and experiment. Also, over here, this profession is a way of making a living. This is our only means of security. In the UK, they do not have to worry about social security. On another angle, they also do not have the concept of amassing wealth for their future generations like we do here. All of these social factors count in how our attitude is formed. Things are different here – there is competition, it’s a mad race for existence and survival. So for many of the people, the time you spend on the real profession becomes much lesser.

H.C: So it was very important that you could have this experience?
Yes. It is very important to have this exposure.  Especially after you pass a certain stage in your profession, it is always good to look at the approach of professionals in other places.  For example in Vellore, which is considered one of the best teaching centers, we used to have postings in other medical institutions – in Madras or Bangalore or Karnataka… you would visit four other centers. The purpose was to understand that one situation or problem could be approached in different ways – you would see different people approaching similar situations with different perspectives. We lack this element in our teaching programs here. In my case, you can say that I got the opportunity by chance.

H.C: So would you say these are certain things that should change in the way our system works now?
You know, one very good thing about how the system works in the West is that right from the undergraduate level, there is a teacher to gauge the aptitude and skills of the student, and effort is taken to develop these skills. And ultimately the student will choose a profession for which he has more skills. It is not so over here – most of the time the parents decide that the child should go for MBBS. And there are many students who stop their course midway, especially in the private professional course sector. That is because without considering the child’s aptitude, the ambition of the parent is directly planted onto the child.
Of course the system is changing, but you can’t keep taking a lot of time to do this…even after so many years of realizing this is a problem, we are still ‘thinking’ about how and where to bring about change. We should be taking a little more of an active approach. I think the human resources department is focusing on this now.

H.C: Why is the human brain such a challenging topic to you?
Looking at it as an organ in your body – no other organ can match it , in terms of its physiological function. It constitutes only about 2% of your body mass, but almost 15% of the blood pumped out of the heart reaches the brain for its proper functioning. About 20-25% of the oxygen that we breathe is supplied to the brain. So you can understand how active the brain is. If we look at the functions- unlike other tissues like skin or the lining of our stomach etc. which looks like rows of bricks one on top of the other, the brain cells are very different. The actual cell body of a brain cell will be in one place but its process may be in a portion of the brain that is distant from it. One cell may have about 50,000 connections with another cell or its processes. So the brain is a group of cells that has such an intricate network – around 2 billion cells are in the brain. This cannot be duplicated by any computer – 2 billion cells with 50,000 interconnections!
This has its own advantages and disadvantages. Once the brain is damaged, it is almost impossible to reestablish all of these 50,000 connection between cells. That’s why recovery is more difficult in cases of injury to the brain as compared to other organs. But the brain is adequately protected, unlike any other organ – it’s the only one with a hard bone covering. Now, even this has its advantages and disadvantages – a tumor growing in the brain has no place to expand whereas a tumor in any other organ has space to expand. So in the brain even a slight increase in volume produces quite a lot of ill health or is life threatening.  Also in the case of infection – all other places in the body have their own defense mechanisms to fight against infections; the brain has much lesser capacity for this.

H.C: Is aging a part of the brain function?
Technically speaking, the reason that a person ages and dies, is due to the gradual decrease in brain function. In the first two years of your life, your brain grows by 200%. This is sustained for many years – up to 30-35 years. After this, even in people who are in the best of health, the brain slowly starts degenerating. When your brain starts failing, then every other organ slowly starts failing. This degeneration depends on how much of your brain you use. In all of us the capacity utility of the brain is hardly 2-20%. There are areas of the brain that are literally dispensable, simply because we are not using the whole brain. When you use a part of your body, there is a corresponding blood flow to a certain part of the brain. So leading an active life, using your brain and its thinking and processing capacities, engaging your mind - these are all things that will help keep the brain active and healthy.

H.C: What’s your opinion of the quality of the medical profession in India now? Are we moving in the right direction?
We cannot make a flat statement about that. The younger generation is more intelligent – that is evolution. So that process is going on, they are much more intelligent, versatile, and resilient. But the existing social order, the circumstances that exist, the lack of ideal people to look up to… these are all things that need to be addressed if the profession is to evolve in a good manner. When children are in their teens, having a role model is essential. We do not have good role models for our children to be inspired by. All we have is a distorted perception of life that is acquired through TV or other popular media. Many of them find their own way through trial and error. If there is anything wrong with the younger generation, the social order or the system is to blame. So if we correct the system, things will be better.
H.C: Are there ways in which the medical establishment can function in a much better way, so that the people are benefited more?
The evolution of the health delivery in our state is quite ideal –and over time, things are definitely improving. When a need comes, an adequate change comes. Availability of an efficient medical service at an affordable cost – is not available in many states of even other advanced countries. Even in a place like the USA, almost 40% of people who need medical care may not be in a position to receive it. Here, we have a combination of public and private sectors and other national institutes to ensure that everyone who needs medical attention gets it. So we can say that our system is a better system by any standard. We have to remember however, that quality improvement always comes when there is a demand for it and when you are vigilant. In Kerala we have a population who is health conscious and are also very demanding that they want the best.  This kind of a watchdog role is being taken by the public so there is a constant automatic improvement happening in the system.
Almost all areas of our state are receiving good health care through the private or government sector – even remote areas. Of course there is commercialization, and corruption does exist to an extent. But the positive aspect is that we are improving, we are giving better health care, at an affordable cost. So generally, the direction that it is going in is alright.

H.C: What is your opinion of the condition of the auxiliary services that we have right now?
A lot of improvements are actually happening in these areas. Earlier, the ambulance was used only to transport a dead body. It was just a vehicle with a driver. It’s not like that anymore. We have well equipped ambulances, with well qualified professionals. But this should be cost effective. The number of ambulances should be increased on the basis of utility. If you have 100 ambulances, which are not being utilized, then that is a waste of resources. The number of trained people also should be increased in accordance with the need. This can go a long way in givingtimely help to patients. For example, if a patient has a heart attack, an ambulance goes to pick him up, the accompanying  healthcare professional should be able to thrombolize the patient– which is same thing to be done for a stroke. This will shorten the time taken for the patient to get adequate attention, and can improve his chances of survival and recovery. For a stroke, if you can thrombolize within four hours, it can go a long way to dissolve the clot and prevent further complications.

H.C: What is your take on many patients going in for alternative treatments following a stroke and other such neurological conditions to facilitate and aid recovery?
The scope of an alternate system is limited. If you have a genuine disease, modern medicine is the one thing that can give you maximum relief; I have no doubt about that. People with psychological and psychosomatic disorders – for example, a patient complaining of back pain and repeated scans do not show anything wrong – such patients might get solace from alternate systems. For any real diagnosed disease, modern medicine is the only science that can give good relief. Ayurveda, in particular is effective for chronic illnesses, like stomach upsets or dermatological conditions. And the massages and other things are a substitute for physiotherapy. But even this needs a word of caution – a patient who suffers from neck pain should not go for Ayurvedic treatment without proper investigation – or it could do more harm. Especially in cases of disc prolapsed or bone disease; if proper diagnosis is not done initially, in many cases, massage can make things worse.

H.C: So what would be your advice for a stroke patient – many are conflicted about what to do next.
For a stroke, you have to always go back to the reasons that caused it and continue to treat it. Diabetes, cholesterol and lifestyle habits- all these are contributing factors. And a patient who gets a stroke is likely to get many more strokes over time. So lifestyle and dietary changes, exercise - these are the things to be strictly followed. And adding physiotherapy for recovery is scientific- if these things are followed, there is nothing more to be gained from any other alternate system. I don’t mean to belittle any other systems, but the scope of what they can do is the same as what the patient can achieve with these changes. There are, however, a large number of patients that do go for alternatives like naturopathy etc. Most of these are related to psychological symptoms.  The main things to remember is that rather than emphasizing on the curative aspect, we should be focusing on prevention of disease. Curative aspects are always taking great strides forward, but these are all expensive, so we should be looking to prevent disease….
and many are lifestyle related.

If you had not become a doctor, what profession would you choose to be in?
(chuckles)I would have been an engineer. You see, in neurosurgery, instrumentation and the mechanical aspect is very much there – the surgery is very dependent on tools and other equipment. This is something very interesting to me- the mechanical aspect of the brain.

H.C: What was your response to the prestigious award that you received recently?
Of course, there is a satisfaction that what you are doing is being recognized…but basically it gives you much more responsibility. Because once you get this kind of recognition you have to live up to it and keep improving your performance.

H.C: Finally, what would be your advice to someone of the younger generation who wishes to be an effective doctor?
First thing is, if you have an aptitude for it, go for this profession. This is a field that requires a high level of social commitment. You have to practice medicine with religiosity. It’s just like a prayer in a place of worship, and if you do that, then the rest of the things will follow automatically.


Cosmetic Dimples

Article by Parvathy Nambidi (The Health Cafe' - September 2011)

Don’t despair if you were born without a dimple- now you can get one!
Preity Zinta, Shah Rukh Khan, Deepika Padukone…Angelina Jolie, Jennifer Garner…not to forget Marc Anthony, Ben Affleck, Jim Carrey… and these are just the ultra famous ones. What do these stars have in common you say? Why, dimples of course!
For years, dimples have been seen as a little touch of something special that enhances beauty. Could it be that a little break in the symmetry of a face adds to its beauty, or is it simply that a cute little dip in the cheek or a strong cleft in a masculine chin possesses a power all of its own, making the beholder wish they had one too…?
Whatever the reason may be, dimples are widely considered to add an extra something to an already pretty face. Anatomically speaking, a dimple is an abnormal attachment of the smile muscle (zygomaticus) to the cheek skin, which pulls that part of the cheek when smiling. Since dimples are genetic, most folks who did not descend from families blessed to have a ‘dimple’ gene popping through, have resigned themselves to adoring their favorite dimpled celebrities, with no hope of having one of their own.
But wait! Here’s good news from the world of cosmetic surgery. If a dimple is what you are dying to have, just get to a cosmetic surgeon, and walk out with one on your cheek! The dimple fabrication procedure has recently been making the rounds on beauty forums, consumer sites and on TV shows. Since this is done under local anesthesia as a day care procedure, its demand is steadily increasing. Dr. Hari Menon, Cosmetic Surgeon at Lakeshore Hospital, Cochin says, “Dimple creation surgery is a straight forward procedure performed as a day care cosmetic surgery”. What’s more, there are no visible scars afterwards since only a small incision is made on the inside of the cheek.

How is a dimple surgically created?
The surgeon simply creates a connection between the muscle and the skin in the area selected. If you would like to have a dimple on your cheek, all you need to do is check into the hospital as an outpatient, and have the procedure done in the clinic, under local anesthesia in less than 45 minutes. You will be awake and comfortable during the entire process.
During the procedure, a punch biopsy instrument is placed against the inner cheek which cuts through the mucosa, submucosal fat, and cheek muscle. A circular core composed of these tissues is removed, leaving the skin intact, which will create a shallow cylindrical-shaped defect under the skin.

This ‘defect’ is then closed by placing an absorbable suture through the cheek muscle on one side of the hollowed out area, then through the dermis layer of the skin and finally through the cheek muscle on the outer cheek. A surgical knot is tied, which in turn will result in the person having a dimple in the cheek, even without smiling. In a week or two, the suture is absorbed and the skin will flatten out. The internal scarring which takes place will connect the muscle to the skin, creating a dimple when one smiles.

Dr. Menon adds, “It is a relatively safe surgery when performed by an experienced cosmetic surgeon”. The actual procedure takes about 20 minutes and you can go home right away after the procedure. Excessive facial animation or exercise is usually advised to reduce the swelling that may follow the procedure. For a more prominent dimple, a bigger punch biopsy will be used. This procedure can be performed on any kind of cheek, although it is easier to do it on a face that is not too chubby. For several weeks, a visible, static dimple will be seen whether you smile or not. This slowly converts to a dynamic dimple over time which will appear only when one smiles.

Individuals with severe medical problems that require additional treatment and investigation or have bleeding disorders, will not qualify for this procedure. Dr. Hari Menon says that most inquiries into the procedure have come from women. For many, after a lifetime or envying others with dimples, or wanting to look a little like their favorite celebrity – this is finally a chance  to make one of their dreams come true. 

In India this procedure is available at:
    The Apollo Hospitals
    at Bangalore, Chennai,
    Hyderabad, Delhi and Goa.
   Fortis Hospital, Delhi.
   Artemis Hospital, Gurgaon.
   Max Devki Devi Heart
    and Vascular hospital, Delhi.
   BGS Global Hospital,
    Bangalore and Hyderabad.
   Lakeshore Hospital,
    Kochi, Kerala.