While cosmetic surgery will certainly improve your appearance and, in many cases, make you more youthful-looking than before, it is a self-delusion to believe - as many do - that cosmetic surgery can miraculously turn back the clock to the extent that a person who's 40 plus will look 21 again.

This is simply not possible, and your level of satisfaction with the results depends greatly on how realistic your expectations are. This cannot be emphasized too often.

Cosmetic surgery is not an exact science: in fact, it is a combination of a science and an art. Besides, the final results depend on a variety of factors, many of which are not entirely within the control of the surgeon or the patient. To give one example: the healing process varies from individual and is absolutely unpredictable. It depends on very many variables, including the area operated upon, the quality of tissue, the blood supply, the presence or absence of infection, the body's immune response to a foreign body such as an implant, the level of personal hygiene maintained, and so on.

For this reason, it is not possible to "guarantee results". What is possible, however, is to maximise the potential for good results, and in achieving this, your active involvement as a patient becomes very important. the regular use of prescribed medications, observance of the recommended precautions and hygiene measures, frequent follow-ups, a wholesome diet and a supportive environment - all these can make the vital difference between poor and high-quality results.

In skilled hands, cosmetic surgery very rarely produces serious complications. This is nevertheless, "surgery", and as such subject to a number of imponderables. Potential risks and complications can range from minor and expected after-effects such as swelling, bruising and discomfort to, more seriously (but also more infrequently), infection, implant rejection and anaesthesia complications.

Modern medicine is equipped to tackle most of these adverse fall-outs but you need to keep in mind that they do exist as possibilities. They are the "calculated risks" you undertake when you undergo any surgery. Do discuss them all with your surgeon in advance.

Any form of surgery leaves scars, and cosmetic surgery is no exception. Despite what you may have hard or read, all scars are permanent and cannot be erased. The cosmetic surgeon tries to make his incisions so that the scars are hidden in the natural creases and body-fold areas. In most cases, the scars fade gradually and become barely noticeable. Also, they can be camouflaged with concealer and other make-up.

The duration of the operation varies, depending on the procedure being undertaken and on the amount of surgery indicated for each patient, but normally it ranges between 40 minutes to 3.30 hours. A face lift, for instance, takes about 3.30 hours, breast implant surgery needs about an hour and a half for each breast, while breast reduction takes much longer - about 5 hours.

The time required for liposuction and lipo-transfer (auto-fat injection) is, again, variable, depending on the part of body involved. A double chin correction would take just 20 minutes, while liposuction around the hips, buttocks, thighs and tummy takes about 2 hours.

The hair from the eyebrows, eyelids and the head is not shaved off completely. But, for surgery done on other parts of the body, the hair on the concerned portion is completely shaved.

It depends on the surgeon's preference in terms of the procedures being undertaken as well as the individual patient. Although general anaesthesia is not normally require, the surgeon may opt for it in the case of an especially nervous patient.

Many surgeons prefer a combination of a light general anaesthesia and local anaesthesia, which appears to be most comfortable for the patient and allows a light level of oxygen to be maintained during the surgery.

Following a face-lift, bandages are applied to the head, chin and neck; they are changed 24 hours after the surgery, and the second set of bandages left on for 48 hours more.

Bandages are also definitely applied to areas like the breast, tummy, hips, thighs and buttocks, and the duration of each change of dressing varies according to the area concerned.

Bandages are applied for several reasons. One of them is to keep the operated area as immobile and as supported as possible. (This is also the reason that telephone line calls, visitors and physical movements must be kept to a minimum after the operations).

Bandages also help to prevent infection from external sources, as also injury/trauma.

The usual hospital stay is one day (and admission is generally on the day of the operation itself) because the surgery is in most cases superficial, not involving manipulation of any of the vital organs such as the kidneys, liver, intestine, pancreas or heart.

All the same, medicine is not an exact science. In unpredictable circumstances, a longer hospital stay may be required and you should be prepared to stay another night if the situation calls for it.

Irrespective of which procedure you may have undergone, you can expect bruising, pain, swelling and discolouration. Before you see the expected improvement, there is a period during which you will look quite battered and bruised and 'strange' to yourself. During this phase, when you're looking your worst, you may also experience at temporary period of mild emotional depression - especially if you've had facial/eyelid surgery. It is not easy to except looking bruised and swollen, particularly when you are natural expectation are to look forward to an improved appearance. This is quite normal and should not alarm you. Fortunately, this is a short-lived period as the improvement in appearance gradually become noticeable.

With a few expectations, nose, cheek and chin implants do not require any removal of the sutures. Eyelid surgery sutures are generally removed 3-4 days following the surgery. In the case of a face-lift, the stitches come out about a week after the surgery. If everything goes well, the sutures of breast surgery can be removed within a week or two.

Removing the sutures does not cause pain. It is advisable for you to stay in town for about a week to ten days following any cosmetic surgery.

Eye make-up can usually be applied three days after the sutures have been removed. This includes mascara, eye shadow and artificial eyelashes. Facial make-up can usually be applied about the tenth day.

It is important that all makeup be thoroughly removed, using an upward motion. Oil eye pads are recommended for the removal of eye make-up.

Gentle shampooing can be carried about five days after the surgery. The use of a hair dryer is restricted. Tinting and colouring can usually be done about three weeks after surgery.

A face and neck lift, when combined with eyelid surgery, actually retards the aging process. It continues, but at a slower rate. The skin will not "suddenly fall down". That is impossibility. How long the effect lasts varies from person to person, but generally it is between 5 to 10 years.

Some patients may never require another face-lift. Others may need one before five years. In still other cases, where there is marked aging of the neck, or excessive loose skin on the face, neck and jaw, it may be rarely necessary to perform a second face-lift within a year to achieve the maximum possible improvement.

Pouches under the eyes, once they are surgically removed, do not usually return. But, as the ageing process continues, the skin in this area also becomes loose and tends to hang; this may call for surgically tightening it up at a later stage.

In the case of implants (whether in the chin, cheek, nose or breast), once they are accepted by the body, the results are long lasting, virtually permanent.

These are common to all kinds of cosmetic surgery

Before surgery

• Fill all prescription and take the advised medications.
• Consult the doctor again should you have any remaining doubts or questions about the surgery.
• Arrange for transportation to and from the hospital on the day of the surgery.
• Avoid aspirin, aspirin-containing medications and alcoholic beverage for 7 days before and after surgery.

On the day of surgery

• Take nothing by mouth.
• Wear comfortable clothes; avoid panty hose. Also, please wear a bottom down shirt or sweater.
• Please arrive at the / clinic at least half an hour before the scheduled time of surgery; make allowances for traffic delays.
• Please shower and wash your hair on the morning of the surgery. Remove contact lenses, nail polish, jewellery and all makeup, while at home.
• Expect to be in the hospital or clinic for the better part of the day.

After the surgery

Along with general instruction:

• Once again, remember no alcohol or aspirin for seven days.
• Take your prescribed medications for seven days.
• Follow the diet recommended.
• Ensure you have complete bed rest on the evening of the surgery. Limit physical activity during the early postoperative period. Avoid quick movements, bending, straining, lifting and if possible sneezing. If you feel nausea, contact your surgeon immediately and you will be prescribed the necessary medicine.
• Post operative visits: You will be seen at the clinic at frequent intervals for the first few weeks. The exact timing of these visits will vary from one individual to another depending on the healing process.

Please make every attempt to keep these appointments since it is vitally important that the surgeon closely monitors your healing. If you live in a distant city, it is preferred that you stay in town for the first few days after surgery.

After the surgery

Along with the general instructions:

• Stay on a liquid to soft diet for three days after the surgery. Take your prescribed medications, including painkillers, if necessary.
• You may experience some swelling of the face, as also bruising on your neck and chest. This is normal and should disappear within two weeks.
• If you have pain that is not relieved by the prescribed medicines, or are oozing fluid through your bandages, please contact your surgeon immediately.
• You will be required to return the following day for a change of dressing.
• All stitches will probably be removed after 7-12 days.

After the surgery

Along with the general instructions:

• Apply ice-cold water compresses with gentle pressure (prepare a bowl filled with ice cubes and water and keep it by your bed. Use the gauze purchased the previous week: Squeeze out most of the water before applying the gauze compress). This should be done continuously on the day of the surgery, and on following day for one-hour four times a day.
• Apply the prescribed ointment along the stitches every 2 to 3 hours. Blurring of vision may result from the ointment. This is temporary and to be expected.
• Swelling (edema) of the eyelids and purplish discolouration will also occur and is to be expected.
• If you have excessive swelling, pain or bleeding, call on the hospital or the doctor immediately for instructions.
• The sutures will be removed in 3 to 5 days and you should be able to resume normal activities in 7 to 14 days.
• Do not use contact lenses for atleast 2 weeks following the surgery.

After the surgery

Along with the general instructions:

• Stay on a liquid to soft diet for 7 days after the surgery. Take you prescriptions and pain medication if necessary.
• You may experience some swelling of the face. This is normal and should disappear within 2 weeks.
• You may need to return the following day for a change of dressing (if advised by the doctor).

Special precautions

During the first 7 to 10 days after surgery:

• Avoid talking, chewing or unnecessary jaw movements.
• Take only liquids with the help of a straw.
• Ensure a continuous flow of cool air over the face to keep it as dry as possible.
• Use a LISTERINE mouth wash twice daily or as advised.
• Take the prescribed medicine regularly.
• Cut your nails short and wear hand gloves at night to avoid unconsciously scratching at your face in your sleep.

From the day after peeling to 24 weeks:

• Avoid exposure to direct sunlight and/or a running T. V. screen or sharp / bright electric light.
• Wash your face very gently and dab it dry with towel as shown to you by your doctor. Avoid rubbing it with the towel.
• Apply a protective layer of moisturising cream over your face at frequent intervals.

After the surgery

Along with the general instructions:

• Complete bed rest is advised for at least a day; after that you may be up and about.
• On your return home, drink plenty of fluids, particularly hot broths and mineral water. Take the prescribed medications as indicated.
• Showering and bathing are permitted after the dressing is removed, approximately one week after surgery.
• Start gentle fingertip massage (light kneading motions) on the operated area on the 10th postoperative day (10-20 minutes over each areas twice daily for 3 weeks).
• Exercise may be resumed on the 14th postoperative day. Bicycle-riding 10-20 minutes a days for three weeks is recommended. (If a stationary bicycle is used, do not use any resistance.)

After the surgery

Along with the general instructions:

Day 1 - 10

For the first 10 days the patient is regarded as totally convalescent, pursuing a program of relaxation with activities limited to reading and watching TV. If the patient has an infant or a child under the age of 3, it is imperative that she does not play an active part in their care and management for 10 days.

Day 11-20

Over for the next 10 days of convalescent, light activities like dusting and elementary cooking are permitted. Driving a car is not allowed for 2 weeks. Women who are in a physically undemanding occupation can return to work at the end of this period.

Day 21-35

Over for fourth and fifth week the patient should be gradually returning to her normal routine with the exception of lifting, stretching and athletic endeavours. At the end of 6 weeks, she can resume a normal life with the exception of athletics involving marked arm activities, e.g.: tennis, bowling, swimming and volleyball. Sexual activities involving the breast should be avoided for the same period of time (4-6 weeks).

Care of the wound

• The bra must be worn at all time for the first two weeks, even in the bath.
• The wound should be kept dry for the first 2 weeks. If any swelling, redness or extreme tenderness arises, contact your surgeon. Muscular pain and discomfort can be expected for a period of 2-3 weeks following surgery.