✩ American Academy of Otolaryngology Head and Neck Surgery

✩ American Academy of Facial Plastics and Reconstructive Surgery

✩ American Rhinology Society

DOWNLOAD DR. KHETARPAL'S C.V. HERE

Candidates for brow lift surgery typically have deep horizontal creases across their forehead, frown lines between their eyebrows or across their nose, and/or sagging eyebrows, leaving them with a tired or sad appearance. Individuals seeking a brow lift often feel that they do not look as young as they feel.

The best candidates for blepharoplasty are those individuals who meet the following conditions:

-Are in good overall health

-Do not smoke

-Do not have any serious eye conditions

-Have healthy facial tissue and muscle

-If you have loose, sagging skin or puffy bags around your eyes, this procedure can help reduce these unwanted effects and leave the eyes looking young and fresh.

It is important for patients to have realistic expectations before undergoing a blepharoplasty procedure in order to be satisfied with their results. While the procedure can enhance your appearance and may improve self-confidence as a result, it cannot alter your entire appearance or change the structure of your face.

✩ American Academy of Otolaryngology Head and Neck Surgery

✩ American Academy of Facial Plastics and Reconstructive Surgery

✩ American Rhinology Society

DOWNLOAD DR. KHETARPAL'S C.V. HERE

The best candidates for rhytidectomy:

-Wish to improve one or more of the signs of aging indicated above

-Are men or women whose faces have begun to sag, but whose skin still has some elasticity

-Are generally healthy

-Do not smoke

-Have realistic expectations

-Are considering a facelift for personal reasons, not because someone else is pressuring them to do so

During your consultation, your doctor will discuss whether a facelift is right for you.

If a patient is experiencing problems with hearing, balance, dizziness, vertigo, ear infections, ringing in the ears, pain or discharge in the ears or a plugged up sensation, it is advisable to see an Otolaryngologist.. The doctor/specialist will diagnose each patient individually and work with him or her until the problem is resolved.

✩ American Academy of Otolaryngology Head and Neck Surgery

✩ American Academy of Facial Plastics and Reconstructive Surgery

✩ American Rhinology Society

DOWNLOAD DR. KHETARPAL'S C.V. HERE

No.

Balloon Sinuplasty is indicated for chronic rhinosinusitis and headaches or nasal/sinus congestion as it relates to chronic sinusitis.

Everyday, skin cells die and new ones form to replace them in a process controlled by DNA. Skin cancer can form when this process does not work properly because of damage to DNA. New cells may form when they are not needed or older cells may not die. This can cause a growth of tissue known as a tumor. DNA damage is often a result of ultraviolet (UV) radiation from sunlight or tanning lamps. Since skin cancer can sometimes affect areas not exposed to the sun, heredity may also be a factor.

Certain factors, such as fair skin, moles, a weakened immune system and age, can also increase the risk of skin cancer.

You can schedule an appointment two ways:

-Use this link to request a time and one of our associates will reply within 24 hours

-Call us at 832.356.7377

The blepharoplasty procedure is performed under local anesthesia with sedation. General anesthesia may be used for anxious or nervous patients. Patients may choose to have this procedure on their upper or lower eyelids, or both. Depending on these choices, the procedure can take anywhere from 45 minutes to 2 hours.

If the upper eyelid is being treated, an incision is made along the natural crease of the eyelid. Once the incision is made, the surgeon may reposition fat deposits, tighten muscles and tissue or remove excess skin in order to leave the eye looking younger and refreshed. For the lower eyelid, an incision is made just below the lash line in order for excess skin to be removed.

After the procedure is performed, the incisions are closed with sutures and usually wrapped in gauze to allow the area to heal.

If you are unable to keep an appointment, we ask that you kindly provide us with at least 48 hours notice. This courtesy, on your part, will make it possible to give your appointment to another patient.

Facelifts are typically outpatient procedures and may be performed in an office-based facility, surgery center or hospital. Patients may have a choice of IV sedation or general anesthesia. The procedure takes about two hours.

The way a facelift is performed varies depending on the surgeon, the patient’s facial structure, and the extent of correction desired. The three most common incision techniques are:

Traditional facelift – The “full” facelift for rejuvenating the face, jowls and neck, including fat sculpting, lifting and repositioning of muscle and deeper tissues, and skin trimming and redraping. The incision begins at the temples and travels down to the front of the ear, around the earlobe, and behind the ear to the lower scalp at the hairline. Sometimes, another incision is made under the chin.

Limited-incision facelift – For limited rejuvenation around the eyes and mouth, including nasolabial folds and other deep creases. Short incisions are made at the temples and around the ear, and possibly in the lower eyelids and/or under the upper lip as well.

Neck lift – A neck lift concentrates on jowls, loose skin on the neck, and fat under the chin. The incision is made around the ear lobe and behind the ear to the lower scalp.

In all three methods, incisions are closed with stitches or tissue glue. Scars are hidden in the hairline and natural contours of the face.

Restylane is an FDA-approved dermal filler made of hyaluronic acid that restores volume to the skin, lifting and smoothing out wrinkles and other fine lines. This procedure is most commonly used to treat the glabellar lines, between the forehead and the nasolabial folds. It can also be used to add volume and shape to the lips.

Since Restylane is made from a natural substance found in the body, no pre-testing is required. Restylane produces results that last for several months through its unique ability to bind with water and remain in the skin. The results of this procedure are visible right away, and can last for several months, depending on the condition of the individual patient’s skin.

There are many health hazards that could come along with nose and sinus problems. These problems could affect breathing, sleeping, smell and or physical appearance. There are many different treatments for these conditions that range from simple exercises up to surgeries that need to be done in a medical facility.

✩ Research Fellowships, Massachusetts Eye and Ear Infirmary and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

✩ Clinical Fellow in Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA

✩ Research Associate, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA

Skin cancer can often be identified as a new or changed growth on the skin that may often occur on the scalp, face, lips, ears, neck, chest, arms, hands or legs. The appearance of the growth depends on the type of cancer, but can appear as:

- Pearly or waxy bump

- Flesh-colored or brown scar-like lesion

- Firm, red nodule

- Crusted, flat lesion

- Large brown spot with darker speckles

- Mole that changes shape or color

-Shiny, firm bumps

✩ Research Fellowships, Massachusetts Eye and Ear Infirmary and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

✩ Clinical Fellow in Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA

✩ Research Associate, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA

During your brow lift consultation, your plastic surgeon will perform a physical examination, review your medical history, and discuss your desired goals from this procedure. He or she will evaluate the thickness, texture and elasticity of your facial skin, the structure of your facial bones and skin, the overall appearance of your eyebrows and eyelids, and the position of your eyebrows. Your plastic surgeon will use this information to determine the most appropriate surgical approach, which will be explained to you in great detail.

Simply because it is a very elegant way of opening the sinuses right in the office instead of performing surgery in the operating room under general anesthesia.

Also because there is minimal bleeding, less scarring and minimal down time after balloon sinuplasty. Furthermore, chronic rhinosinusitis is a very common condition and almost 37 million or so Americans suffer from chronic rhinosinusitis. Chronic rhinosinusitis affects quality of life.

✩ Research Fellowships, Massachusetts Eye and Ear Infirmary and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

✩ Clinical Fellow in Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA

✩ Research Associate, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA

Our data has shown that dust mite, pollens, molds and cockroaches besides cat and dog dander are the most common allergens. Pollens may come from weeds such as ragweed or from trees such as mesquite, pine, cedar or from local grasses such as Johnson or Bermuda grass. Most individuals are allergic to more than one antigen.

After the lower eyelid blepharoplasty procedure, your doctor may recommend applying lubricating drops or ointment and cold compresses to aid in the healing process and minimize side effects such as:

-Swelling

-Bruising

-Irritation

-Dry eyes

The eyes may be wrapped in gauze after the procedure as well. Patients can usually return to work within a few days, but should avoid exercise and strenuous activities for at least two weeks. Stitches are usually removed three or four days after the procedure. Swelling and other side effects usually subside within two weeks after surgery. Contact lenses and eye make-up may not be worn for two weeks after surgery. The doctor will give specific instructions on how to care for the eyes post-procedure.

Traditionally, brow lift surgery involved a large incision across the top of the forehead. Advancements in technology have led to the endoscopic technique, in which three to five small incisions are made across the forehead behind the hairline. These shorter incisions allow for a shorter recovery time when compared to the traditional brow lift technique. During your consultation, your plastic surgeon will explain the exact approach he or she will use for your brow lift procedure.

Balloon Sinuplasty can be used to open the sinuses which contain polyps but generally additional use of shavers or other instruments in the office is necessary to remove the polyps, especially in the ethmoid sinuses.

After your rhytidectomy, your doctor will wrap the incisions in bandages and may place drainage tubes in the area. The tubes will be taken out the next day, when your hair will be carefully washed. If surgical clips are used to hold the incisions closed, they will be removed one week after the facelift along with your stitches.

At first, you may experience swelling, numbness, bruising, and a feeling of tightness or tension in the face and neck. Your face may look uneven or distorted, and your facial muscles may feel stiff. Most of these usually resolve within 3-6 weeks, and sensation typically returns to normal within a few months. Scars become less red, raised, lumpy or itchy in time.

Many patients return to work by the third week. Camouflage cosmetics can be used to minimize the appearance of bruising.

You should be gentle with your skin and hair as you recover. Men may need to shave behind the neck and ears where areas of beard-growing skin have moved.

If it's an accute situation, please call 9-1-1 or visit your local emergency room.

Our office provides on-call service for emergencies, 24 hours-a-day, 7 days-a-week. Contact us at and the doctor on call will be contacted immediately.

Dr Khetarpal is well trained in facial plastic surgery and enjoys doing rhinoplasties, facelifts and blepharoplasties. Rhinoplasty or nose reconstruction whether cosmetic or reconstructive, is one of the most challenging plastic surgery procedures.

Obtaining good results requires a working knowledge of the complex anatomy and relationships within the nasal framework and that of nasal function. He has performed both primary and revision rhinoplasties with good success. He generally prefers to make the nose look natural after surgery instead of “an operated nose” look. He also performs cleft lip repairs.

It is important to see your doctor if you notice any skin changes. Early detection is valuable in successfully treating skin cancer. Regular full body screening is recommended as well. A biopsy is performed to properly diagnose suspected cancerous growths.

Just like balloon angioplasty opens up the clots in the heart blood vessels, balloon catheters when used in the sinuses, open the small sinus openings called ostia. By opening the ostia and making them larger without pulling or cutting tissue, they reduce the risk of scarring and minimize bleeding.

Once the sinuses are open, they generally drain better and therefore infections, if and when they do occur, clear more readily. It is also hoped that balloon sinuplasty will restore the mucus lining back to normal.

Patients that smoke are advised to stop smoking several weeks before brow lift surgery to improve post-operative healing. Be sure to advise your plastic surgeon of all medications and supplements you are currently taking, as some of them may have to be temporarily stopped before the procedure. Patients undergoing brow lift on an outpatient basis will need a friend or relative to drive them home afterwards, and to remain with them for the first night.

Results of a blepharoplasty procedure are visible as swelling and bruising, but will subside and continue to improve for up to a year after surgery. This procedure is designed to produce long-lasting results. While surgery cannot prevent your eyes from aging, most patients are satisfied with their results and do not seek repeat procedures.

The scars from the blepharoplasty procedure are usually well-concealed and will fade with time until they are virtually unnoticeable. The incision is hidden in the crease of the eyelid in an upper blepharoplasty, and just below the lashes in a lower blepharoplasty.

Results of a facelift do not last forever. You may want to have another procedure in five or ten years. But in another sense, the effects are permanent; years later, your face will continue to look better than if you had never had a facelift.

Why should you choose Dr. Khetarpal?

Dr. Khetarpal is one of a limited number of sinus surgeons across the country performing comprehensive sinus surgery in the office while also introducing the use of image guided endoscopic sinus surgery in the office. Dr. Khetarpal has performed complex endoscopic sinus surgeries for more than 15 years without any nasal packing. Dr. Khetarpal is a perfectionist, whether he is performing sinus surgery, balloon sinuplasty, sleep apnea surgery, blepharoplasty, facelift or rhinoplasty.

He is currently involved in research projects trying to identify causes of chronic sinusitis and devising newer treatments. He has a Western Institutional Review Board approval for performing research on chronic sinusitis, allergic fungal sinusitis, nasal polyps and allergic rhinitis as well as on data collection and clinical research on these patients and on measuring outcomes of treatment. Dr. Khetarpal completed his residency training in Syracuse, New York and has extensive clinical and research experience at Massachusetts Eye and Ear Infirmary, Brigham and Women’s Hospital and Harvard Medical School in Boston. In addition to his interest in sinus disease and allergies, Dr. Khetarpal is Board certified in Sleep Medicine and also has a tremendous interest in rhinoplasty and facial plastic surgery. He also brings his scholarship and research skills in improving treatments for chronic sinus disease and polyps as well as allergic fungal sinusitis. He believes that some of the solutions come from thinking outside the box.

Dr. Khetarpal had spent many years in the Rio Grande Valley treating the underserved patients with severe sinus conditions and significant Ear, Nose and Head and Neck and thyroid disease. He is currently publishing his experience with allergic rhinitis in chronic sinus disease as well as his experience with fungal sinus disease and recurrent sinusitis. Some of his video presentations have become public on www.youtube.com under the name of “thesinuscenter” or can be seen as embedded videos on this site.

DOWNLOAD DR. KHETARPAL'S C.V. HERE

When a person is having problems with their throat some conditions could speech, singing, eating, swallowing, and digestion. ENT specialists can diagnose, manage, and treat these problems.

Why should you choose Dr. Khetarpal?

Dr. Khetarpal is one of a limited number of sinus surgeons across the country performing comprehensive sinus surgery in the office while also introducing the use of image guided endoscopic sinus surgery in the office. Dr. Khetarpal has performed complex endoscopic sinus surgeries for more than 15 years without any nasal packing. Dr. Khetarpal is a perfectionist, whether he is performing sinus surgery, balloon sinuplasty, sleep apnea surgery, blepharoplasty, facelift or rhinoplasty.

He is currently involved in research projects trying to identify causes of chronic sinusitis and devising newer treatments. He has a Western Institutional Review Board approval for performing research on chronic sinusitis, allergic fungal sinusitis, nasal polyps and allergic rhinitis as well as on data collection and clinical research on these patients and on measuring outcomes of treatment. Dr. Khetarpal completed his residency training in Syracuse, New York and has extensive clinical and research experience at Massachusetts Eye and Ear Infirmary, Brigham and Women’s Hospital and Harvard Medical School in Boston. In addition to his interest in sinus disease and allergies, Dr. Khetarpal is Board certified in Sleep Medicine and also has a tremendous interest in rhinoplasty and facial plastic surgery. He also brings his scholarship and research skills in improving treatments for chronic sinus disease and polyps as well as allergic fungal sinusitis. He believes that some of the solutions come from thinking outside the box.

Dr. Khetarpal had spent many years in the Rio Grande Valley treating the underserved patients with severe sinus conditions and significant Ear, Nose and Head and Neck and thyroid disease. He is currently publishing his experience with allergic rhinitis in chronic sinus disease as well as his experience with fungal sinus disease and recurrent sinusitis. Some of his video presentations have become public on www.youtube.com under the name of “thesinuscenter” or can be seen as embedded videos on this site.

DOWNLOAD DR. KHETARPAL'S C.V. HERE

Sculptra is an injectable filler that restores facial fat lost by the effects of lipoatrophy, including sunken cheeks, hollow eyes and other indentations. This filler is injected below the surface of the skin in the areas of fat loss. The Sculptra injection consists of an alpha hydroxyl acid called poly-L-lactic acid, or PLLA.

This product is safe, synthetic, biocompatible, biodegradable and long-lasting. No pre-testing is required for Sculptra treatments.

The results of Sculptra will appear gradually after the injection, with most patients able to achieve their desired results after just one treatment session. The length of the results can vary from patient to patient, but often last for up to two years.

Most medical insurance plans will not usually cover cosmetic procedures. Our office is able to assist you with a financing program for elective medical procedures. Patients may be pre-approved for financing with a low-interest monthly payment plan. Our office manager would be pleased to provide you with further details.

In addition, we also accept the following credit cards:

JUVÉDERM Injectable Gel is a safe, effective gel that restores volume to the skin and smoothes away moderate to severe facial wrinkles and folds. JUVÉDERM is the first FDA-approved dermal filler proven safe and effective for persons of color. The JUVÉDERM gel is made of hyaluronic acid with a smooth consistency, allowing for easy injections and instant, natural-looking results. There is no pre-testing needed for this procedure.

Topical or injectable anesthesia may be used during this procedure to numb the treatment area and minimize any potential discomfort. The results of this procedure are available right away and can usually last for up to a year, the longest results available from any hyaluronic acid product.

ENT specialists have experience in treating and managing diseases, tumors, trauma, and abnormalities of the head, neck, and face. Ear, nose and throat specialists can perform cosmetic and reconstructive surgery in these areas while also managing problems with the nerves in the head and neck that control sight, smelling, hearing, etc.

Typically balloon sinuplasty is used for the frontal (forehead) and maxillary (cheek) sinuses and also the sphenoid sinuses (sinuses in the back).

Possible complications of facelift include: bleeding, infection, bruising, uneven swelling or discoloration, allergic reaction to the anesthesia, skin blistering (usually only seen in smokers), and temporary or permanent loss of sensation in the face. Your doctor will discuss the risks and benefits of a facelift with you before your surgery.

Brow lift surgery usually takes about one to two hours to perform, and may take place at a hospital, an office-based surgical suite, or an ambulatory center. Either general anesthesia or intravenous sedation will be used for this procedure; your plastic surgeon will choose the best option for you. Depending on the surgical technique used, an incision or series of small incisions are made across the forehead.

Then, the tissue and muscle underneath the skin are moved or repositioned as necessary. At the end of the procedure, the incisions are closed with sutures, screws, adhesives, or surgical tape, and you will be moved to a recovery area for observation.

Why should you choose Dr. Khetarpal?

Dr. Khetarpal is one of a limited number of sinus surgeons across the country performing comprehensive sinus surgery in the office while also introducing the use of image guided endoscopic sinus surgery in the office. Dr. Khetarpal has performed complex endoscopic sinus surgeries for more than 15 years without any nasal packing. Dr. Khetarpal is a perfectionist, whether he is performing sinus surgery, balloon sinuplasty, sleep apnea surgery, blepharoplasty, facelift or rhinoplasty.

He is currently involved in research projects trying to identify causes of chronic sinusitis and devising newer treatments. He has a Western Institutional Review Board approval for performing research on chronic sinusitis, allergic fungal sinusitis, nasal polyps and allergic rhinitis as well as on data collection and clinical research on these patients and on measuring outcomes of treatment. Dr. Khetarpal completed his residency training in Syracuse, New York and has extensive clinical and research experience at Massachusetts Eye and Ear Infirmary, Brigham and Women’s Hospital and Harvard Medical School in Boston. In addition to his interest in sinus disease and allergies, Dr. Khetarpal is Board certified in Sleep Medicine and also has a tremendous interest in rhinoplasty and facial plastic surgery. He also brings his scholarship and research skills in improving treatments for chronic sinus disease and polyps as well as allergic fungal sinusitis. He believes that some of the solutions come from thinking outside the box.

Dr. Khetarpal had spent many years in the Rio Grande Valley treating the underserved patients with severe sinus conditions and significant Ear, Nose and Head and Neck and thyroid disease. He is currently publishing his experience with allergic rhinitis in chronic sinus disease as well as his experience with fungal sinus disease and recurrent sinusitis. Some of his video presentations have become public on www.youtube.com under the name of “thesinuscenter” or can be seen as embedded videos on this site.

DOWNLOAD DR. KHETARPAL'S C.V. HERE

Treatment for skin cancer depends on the type, size and location of the tumor. Most options remove the entire growth and are usually effective. Removal procedures are usually simple and require only a local anesthetic in an outpatient setting. Some of the treatment options for skin cancer include:

- Freezing – also known as cryosurgery, kills tissue by freezing them with liquid nitrogen

- – the abnormal tissue, as well as some surrounding healthy tissue, is cut out of the skin

- – destroys cancerous growths with little damage to surrounding tissue and few side effects

- – removes larger skin growths layer by layer until no abnormal cells remain to prevent damage to healthy skin

- – uses drugs to kill cancer, may be applied through creams or lotions for top layer tumors

Other treatment options are also available, including new methods that are currently being studied.

Although most treatment for skin cancer is successful, new tumors can still form. It is important to practice preventive measures and see your doctor on a regular basis. You can also perform self skin checks to spot any changes as soon as possible.

An allergy is an unusual response of the body to an environment agent. The development of allergies can depend on many different factors, some of which include: genetics, environmental interactions, degree of exposure to the particular allergen and duration of exposure. Some allergies are even caused by unknown factors. A variety of tests can be done to figure out allergies that are affecting day to day life. Some options for different treatment plans include: Immunotherapy and Allergy drops.

If you are wondering if an ear, nose and throat doctor could help you, contact us today.

In our office, balloon sinuplasty is performed either under local anesthesia with or without sedation or with IV anesthesia. Dr Khetarpal is now using a procedure called PIVA Balloon Sinuplasty or painless IV anesthesia balloon sinuplasty for maximum comfort during this in office procedure.

After laying the patient down on a office chair, local anesthesia is injected in the nose to numb the mucus lining. IV anesthesia or sedation may be given prior to that and a laryngeal mask airway placed. Once this is accomplished, the procedure is begun. The catheters are passed into the sinuses and the balloons expanded to open them.

The time for surgery depends on the number of sinuses that need to be opened. In some patients, I will use a shaver to remove bone and unhealthy mucosa or polyps from the ethmoid sinus. When a shaver is used in conjunction with a balloon procedure the procedure is called a hybrid procedure. Correction of a deviated nasal septum may also be performed at the same time if necessary.

Most patients return home the same day as their brow lift, although an overnight stay may be necessary for some. Swelling may be pronounced for the first day or two after surgery, although most swelling goes away within two weeks. To prevent post-operative bleeding, you should refrain from bending or heavy lifting for the first few days after your brow lift. It may take up to six months for all swelling to fully subside and for all scars to fade.

Otolaryngologists are also trained in Plastic surgery of the face including rhinoplasty, ear reshaping, eyelid cosmetic surgery, neck lift and facelifts besides injecting botox and fillers in the face and neck in addition to removing skin cancers and reconstructing the defects. They also perform reconstruction and repair to trauma to the facial soft tissue and bones.

Depending on your pre-surgical appearance and your goals, the results of your brow lift may either be subtle or dramatic. Within a few weeks after surgery, your results should be noticeable. To maintain the results of your brow lift, it is important that you use sunscreen when spending time in the sun and refrain from smoking.

This depends on the number of sinuses that need to be expanded by balloon sinuplasty and if ethmoid sinuses also need surgery. Generally the procedure can be completed in less than an hour or so even with the most extensive disease. For milder disease, the procedure generally takes less than 30 minutes.

Dr. Khetarpal has been performing balloon sinuplasty in Mcallen since the middle part of the last decade soon after it was first released for use. He was among the initial group of surgeons to be trained in its usage. However, he did not bring the technology into the office until he was confident that it was ready for prime time and to be able to access and open the sinuses reliably.

Today he is at the forefront in the movement for performing endoscopic sinus surgery with balloon sinuplasty in the office. At this time very few physicians in the country are doing this with image guidance. Over the years, Dr Khetarpal has performed some very complex sinus surgeries of the sinuses and skull base.

Brow lift surgery is a relatively safe procedure; however, most procedures carry a slight risk of complications. Although they rarely occur, these risks may include adverse reactions to anesthesia, injury to facial tissue, and hematoma (accumulation of blood under the skin). You can minimize the occurrence of complications by choosing a board-certified plastic surgeon for your brow lift.

Dr. Khetarpal has obtained a Western Institutional Review Board Review approval to assess the outcomes of balloon sinuplasty in patients with chronic sinusitis with and without polyps, as well as in those with sinus headaches.

He is in a very select group of physicians to do so. In addition to this, he is exploring different medications for their use in patients with polyps after expanding the sinuses with a balloon procedure. He is also at the forefront of using image guidance in the office along with balloon sinuplasty.