Latest Plastic Surgery Articles - Page 11

 

MALE BREAST REDUCTION THROUGH LIPOSUCTION

 

male breast reduction surgery aims to correct gynecomastia in which the excess skin and tissue leads to woman-like breasts. Doctors use incisions that are usually placed within the areola’s border and the inframammary fold in an attempt to hide the scars.

Meanwhile, male breast reduction through liposuction can only address “fake” or pseudo-gynecomastia in which the underlying mass is not breast tissue but fat.

male-breast-reduction-surgery

Surgeons are able to distinguish real from pseudo gynecomastia by making their patients lie flat on their back and then feeling if there is a firm mound of tissue around the areola complex with the use of their thumb and index finger.

If there is no palpable “disk” of tissue around the areola complex, it is a case of pseudo gynecomastia which responds well to liposuction-only procedure.

Male breast reduction via liposuction requires the insertion of a cannula, a thin stainless hollowed tube, through 2-4 small incisions that fade into imperceptible scars within a year, assuming the patients have no predisposition to aggressive scarring (e.g., keloids) and have avoided skin irritants and sun exposure for at least six months.

The cannula is moved back and forth to loosen the excess breast fat, which is then removed from the body by a vacuum pump.

The risk of visible scars is markedly low with a liposuction-alone procedure because the incisions are typically less than ¾ cm, and are placed within the breast crease, in or very near the armpit, and around the margin of areolar complex where it meets the “normal” skin.

Contrary to popular belief, liposuction of male breasts is not about removing the fats altogether. In fact, over-correction can lead to crater deformity in which the nipple “sinks” due to the absence of fat wall that is supposed to “support” the areola complex.

Due to the nature of fatty tissue found in the male breast—i.e., extremely fibrous and hard to work with—leading Beverly Hills plastic surgeon Dr. Tarick Smaili recommends tumescent liposuction in which large volumes of local anesthesia, epinephrine (to control bleeding), and saline are injected into the treated area to make it swollen and firm.

The tumescent fluids, he adds, paves way for more accuracy that the risk of over-correction is greatly minimized.

Meanwhile, postop swelling could hide the results for three weeks, although after this most patients will see some improvements. Final results, nonetheless, can take up to six months since it takes a while for the skin to redrape to the new contour.

LASER LIPOSUCTION VS. TRADITIONAL TECHNIQUE

 

Liposuction is a type of plastic surgery that breaks up and removes “unwanted” fat from various parts of the body such as the tummy, flanks, hips, thighs, and buttocks. But with the advances in technology, it has now become possible to contour smaller areas such as the chin and neck with this technique.

Laser liposuction is one technique suitable for contouring smaller areas. It requires the insertion of cannula (thin probe) that houses a laser to melt the fats prior to their extraction—i.e., with the use of drains/small incisions or vacuum pump.

laser-liposuction

The laser device is calibrated to target the fat cells only, however, burns could occur if too much heat builds up under the skin, although a skilled liposuction doctor knows how to avoid such risk.

On the other hand, tumescent liposuction is believed to be the gold standard [traditional] technique. It requires the injection of large volumes of local anesthesia, saline, and blood vessel-constricting epinephrine into the fatty area to make it swollen and firm.

Most liposuction procedures start off with the injection of tumescent fluids, although some surgeons prefer an “additional step” which could be in the form of laser, ultrasound, power-assisted, VASER, etc. But even as a stand-alone technique, tumescent lipo is notable for its accuracy.

With or without laser or any other additional step, liposuction recovery is fairly quick that most patients are back to work two to three days postop, although it remains important to avoid strenuous exercises for at least three weeks to prevent persistent swelling and bruising.

The length of recovery largely depends on the type of anesthetic use. Nowadays, general anesthesia is rarely used due to the introduction of tumescent fluids that contain lidocaine, which is a type of local anesthesia wherein its numbing effects can last 18-24 hours postop.

Despite being a newer technology, laser liposuction is often less expensive than the traditional technique due to the reason that it only targets a small area—e.g., chin, jowl, cheek, calf, ankle, and knee.

The tumescent lipo as a stand-alone technique, meanwhile, often involves a larger area such as the abdomen, flanks, thighs, male chest, bra rolls, and upper arm, thus explains the higher liposuction cost.

With different liposuction techniques and “technologies” all claiming to be the best, renowned Los Angeles plastic surgeon Dr. Tarick Smaili says the most important variable is the “operator” who must have the right board certifications, training, and experience.

BUTTOCK IMPLANTS—WHAT IS THE FINAL APPEARANCE?

 

Buttock implants do not rupture unlike some breast implants because they are made of a solid silicone material. For this reason butt augmentation is supposed to provide near permanent results, assuming that the patients will not experience infection, shifting, and other similar complications.

Buttock implant sizes are measured in cubic centimeter and can be custom-made if the patients ask for more augmentation. However, the more enlargement they ask the higher the risk of complications such as rippling, palpability, shifting, and unnatural appearance they have to accept.

buttock-implant-sizes

Anecdotal reports show that buttock implant sizes between 400 cc and 550 cc are enough to meet the goals and expectations of most patients without exposing them to increased risk of palpability and other stigmata of the surgery.

Aside from the size, buttock implants Los Angeles expert Dr. Tarick Smaili says the prostheses dimension should also reflect the underlying anatomies to achieve impressive results.

Going beyond the anatomical limits could lead to rippling especially around the implant’s edges, shifting, and nerve impingement, Dr. Smaili warns.

Dr. Smaili says most patients are too focused on the amount of augmentation that they almost forget about the final appearance, which includes the shape and projection.

Most buttock implants today are oval, which are suitable for patients with an elongated butt shape. However, this demographic may also benefit from a teardrop implant in which most of the volume is at the bottom portion.

Patients with a square-shaped butt, meanwhile, may benefit from round implants, which in essence are more like a flattened sphere and have less height than oval buttock implants.

Because of the way the implants are positioned—i.e., above the actual sitting area—they can only reshape and augment the upper half of the butt cheek.

On the other hand, fat grafting, or more commonly referred to as Brazilian butt lift, can reshape the entire “cheek” because the fats can be injected anywhere, including the hips if one likes to achieve a more hourglass appearance.

While buttock implants can only reshape the upper portion of the cheek, with the use of liposuction it is possible to contour the area around the buttocks—such as the back of the thigh, flanks, and midsection—to achieve a curvier figure.

Liposuction uses a few small incisions to remove the unwanted fat, which does not respond to further weight loss.

Any type of body contouring surgery is only suitable for patients who are near their ideal weight, which they maintain through superb diet and regular exercise.

BROW LIFT SURGERY AND ITS EFFECT ON FOREHEAD HEIGHT

 

brow lift surgery removes or softens the horizontal lines across the forehead, raises the sagging brows that may cover some part of the upper eyelids, and eliminates the “11” lines between the eyebrows.

Depending on the amount of excess skin, forehead height, hairline (or hair loss problem if there is any), and skin quality, the surgery may involve one continuous incision from ear to ear, or 2-5 shorter cuts behind the hairline.

brow-lift-surgery

Beverly Hills plastic surgeon Dr. Karan Dhir says the traditional brow lift called coronal technique can make the forehead look higher by increasing the space between the hairline and the eyebrows. This is an issue for someone whose preoperative forehead is already large.

During a coronal brow lift, an ear-to-ear incision behind the hairline is created to lift the saggy skin and deeper structures. But due to such “mechanism,” it is only ideal for patients without a high forehead and do not require specific or “spot” correction of their brows.

The distance between the incision and the brow gives a coronal lift less accuracy when it comes to brow elevation. Another potential risk is the bald patch, which happens if there is an excessive amount of trauma/injury to the hair follicles and their surrounding blood supply.

Due to the side effects of coronal brow lift, a growing number of plastic surgeons are becoming partial to the use of minimally invasive techniques in which shorter incisions behind the hairline are used instead of one straight cut.

One popular technique is called endoscopic brow lift in which 2-5 small incisions are created so that a fiber-optic camera (attached to a screen) allows the surgeons to view the deeper structures of the forehead.

Another less invasive approach is the lateral lift in which a small temporal incision on each side of the face is used to lift the lateral brow, resulting in an elegant, more rested appearance. Some experts believe that a good number of patients will benefit from this procedure because it is quite rare for anyone to need her/his entire brow to be lifted.

A lateral brow lift is particularly suitable for male patients whose brow is innately lower and appear “heavier” than women’s. For this demographic, aggressive lifting of the forehead skin can either lead to a quizzical look or effeminate appearance.

In general, minimally invasive brow lifts will not alter one’s hairline or lead to a higher forehead.

LIST OF LIPOSUCTION PREPARATION TIPS

 

As a type of body contouring surgery, liposuction removes “unwanted” fat using suction through a slender, blunt-tipped tube called cannula. While small round cuts in the skin are made to access the fatty tissue, within a year they will most likely fade into imperceptible white “dots.”

The success of liposuction depends on several factors, which include the surgeon’s skills, patient’s weight and health condition, skin quality, and motives and expectations.

liposuction-preparation-tips

Beverly Hills plastic surgeon Dr. Tarick Smaili shares his liposuction preparation tips that help his patients achieve impressive results and at the same time avoid complications.

  • Achieve your goal weight. The general rule of thumb is to be within 15-20 percent of your ideal weight before any body contouring surgery is attempted. Nevertheless, it remains important that you are able to keep it long term through regular exercise and superb diet.

Even after achieving your goal weight, sometimes it makes sense to wait for at least six months before you undergo a body contouring procedure to make sure that you will not experience weight fluctuations that will affect the surgery’s results.

  • Preparation for “good” blood. The general rule of thumb is to avoid blood thinners such as aspirin and ibuprofen for 10-14 days prior to surgery. The same rule also applies to a variety of nutritional and herbal supplements such as green tea, maidenhair tree, ginseng, and high-dose vitamin E.
  • Superb diet. Some surgeons recommend a low-sodium diet a week prior to surgery to minimize postop swelling and bruising, while others are more focused on increasing their patients’ fruit and vegetables intake.

Despite some differences in preoperative diet, the consensus is to eat a small amount of [lean] protein at each meal because it plays a crucial role in tissue repair.

  • Avoid smoking and alcohol for at least three weeks. Tobacco products are particularly deleterious to your healing as the nicotine leads to poor blood circulation and increased risk of infection and skin necrosis (death of tissue).

Alcohol, meanwhile, affects how your liver metabolizes medications and is known to increased postop bruising and cause longer recovery.

  • Prepare your skin. While there is no truly proven treatments which can change the inherent quality of skin, it remains helpful to avoid skin irritants (used in skin resurfacing treatments), sunbathing, and tanning booths at least three weeks prior to liposuction.
  • Organize your house. Purchasing your supplies (e.g., postop drugs, dressing, loose clothing, easy-to-prepare meal), cleaning your home, and making simple arrangements days prior to surgery can go a long way toward a comfortable recovery.

FACELIFT AFTER WEIGHT LOSS

 

It’s not uncommon for massive weight loss patients to have redundant skin in their face and neck, making them a good candidate for facelift. But because their skin tone is markedly poor, they might need a more extensive facial rejuvenation surgery than someone who is just experiencing the natural effects of aging.

Riverside plastic surgery expert Dr. Tarick Smaili says that facelift after weight loss deals with more jowling and neck skin laxity, thus most patients will need a longer incision from each side of the face that starts from the temple, behind the hairline, then runs around the ear’s contour and reaches the lower scalp or neck.

facelift-after-weight-loss

For an additional contouring, some massive weight loss patients may also require a small incision under the chin.

Aside from the skin, the underlying tissues and muscles are repositioned as well to create a strong support for the new contour, explains Dr. Smaili.

To further rejuvenate the facial contour, Dr. Smaili highlights the importance of redistributing, repositioning, or sculpting the fat from the neck and jowl.

Meanwhile, a recent study published in the Plastic and Reconstructive Surgery journal has suggested that massive weight loss patients generally have severe volume loss in the mid face and mouth area, which is further aggravated by decreased skin thickness.

For this demographic, the researchers have suggested an extensive form of facial fat grafting in which the patient’s own fat is used to correct the flat or hollowed cheeks and other gaunt areas. This technique can also soften the nasolabial folds, or more commonly referred to as laugh lines.

Dermal filler injections can also restore facial volume loss, although the results are slightly firmer than fat grafting due to their more cohesive consistency. However, this trait makes them ideal for correcting deep folds especially the laugh lines and the marionette creases, which laterally circumscribe the chin.

Regardless of the material used as a volumizer, Dr. Smaili emphasizes the importance of microinjections to create discrete layers that will serve as the new soft tissue structure. On the other hand, he warns that “dumping” alone it will lead to “pillow face appearance” and other “stigmata” of the surgery.

While some forms of plastic surgery after weight loss are covered by insurance, facelift is always considered as an elective or cosmetic procedure, so the patients will pay for it. According to surveys, its cost can range from $6,000 to up to $20,000 for a full rejuvenation surgery.

MALE FACELIFT PROCEDURES AND THE SUBTLE NUANCES

 

facelift surgery eliminates or softens the visible signs of aging in the face and neck with the use of hidden incisions placed behind the hairline and/or within the ear’s contour. However, a more important goal is to create results that respect the patient’s anatomy, motives and expectations, and gender.

Male facelift procedures face unique challenges because of issues involving the anatomy and the patient’s goals.

male-facelift-procedures

Men have thicker, more vascularized skin than women, which predisposes them to increased risk of bleeding and persistent bruising. For this reason, renowned Los Angeles plastic surgeons will avoid any unnecessary surgical trauma and may possibly consider “modified” or minimally invasive techniques.

Another anatomical difference is that men tend to have a less severe cause of jowling than women. And because they require less contouring in the area, the incisions typically just stop behind their ear.

On the other hand, patients who have jowling and neck sagging will need their incisions to be extended into the lower scalp or nape area. Nevertheless, the resulting scars remain well concealed within the hairline and “inside” the natural folds of skin.

Another challenge of male facelift surgery is the susceptibility of men from hair loss, making it trickier to hide the scars. But one compromise is to modify the incision pattern in which the scars are only around the ear’s contour, avoiding the temporal area (used in standard facelift technique) because there is no hairline to conceal the surgery’s “stigmata.”

However, a facelift technique that is limited to the ear’s contour will not provide the same rejuvenating effects as those delivered by the standard approach in which the scars start from the temple area, behind the hairline.

But despite the limited rejuvenating effects of minimally invasive facelifts, they are suitable for a good number of male patients because they tend to have a more conservative goal—i.e., to soften the deep wrinkles without actually eliminating them.

Some doctors will deliberately allow some wrinkles to preserve the masculine and “more mature” appearance. This is a way better option than rely on excessive skin pulling, which is tied to a wide range of cosmetic problems such as visible scars, overly tight look, and probably the worst, effeminate countenance.

In some cases, the only way to correct the overly tight appearance is to wait for the skin to relax again, which can take a couple of years.

Meanwhile, it is not uncommon for male facelift patients to ask for brow lift performed at the same time as their surgery. In this procedure, it is important to raise the brow conservatively to preserve the “heavy” masculine look.

MOST COMMONLY REQUESTED PLASTIC SURGERY FOR MEN

 

Surveys have shown that a good number of male patients cited stiff job competition as their main reason for getting a plastic surgery procedure. For the past several years, men accounted for 8-9 percent of all surgical enhancements performed in the US.

Los Angeles plastic surgeon Dr. Tarick Smaili explains the most commonly requested plastic surgery for men and the corresponding techniques to preserve their masculine appearance.
plastic-surgery-for-men

  1. Male breast reduction. This corrects a condition called gynecomastia in which the excess skin, tissue, and fat lead to the appearance of woman-like breasts.

Aside from removing the excess soft tissue, typically the procedure also involves reducing the nipple size to further achieve a more masculine contour. Meanwhile, failure to address an overlarge areola can lead to a disproportionate or “effeminate” appearance.

  1. Rhinoplasty. More commonly referred to as nose job, it should be able to produce results that respect the patient’s ethnicity, the rest of the facial features, and most importantly, his gender.

According to studies, the ideal angle between the upper lip and nasal tip for men is around 90 degrees, thus creating a straighter profile. For this reason, male rhinoplasty must avoid any procedure that may cause the tip to become more upturned, leading to a feminine look.

Nevertheless, some male rhinoplastic patients can tolerate a minimal droop and still look attractive and “manly” with such feature.

  1. Facelift. Compared to women, most male patients require less contouring in their jaw line since they tend to ask for subtle improvements.

Male facelifts and forehead lifts also tend to be more conservative because it is crucial to preserve the “heavy” brow look and the strong jaw. An overly tight appearance, meanwhile, can lead to feminine-looking brow, flat cheeks, “distorted” smile, and other telltale signs of surgery.

  1. Liposuction. In general, men have more fibrous fats and have bigger body-frame than women, so their surgery is more time-consuming, more challenging, and more expensive.

Liposuction only removes the excess “superficial” fat beneath the skin, and not the deeper visceral types that lead to obesity-related health condition. For this reason, men who are complaining about their “beer belly” are rarely considered as good candidates for the procedure.

  1. Eyelid surgery. There are some subtle nuances involved in male eyelid surgery. For instance, men tend to have thicker and more vascularized skin (increasing the risk of bleeding and more postop bruising), and shorter upper lid platform than women.

REVISION RHINOPLASTY FOR ASYMMETRIC NOSTRILS

 

In general a revision rhinoplasty, or secondary “nose job,” is more technically demanding than a primary procedure because the baseline of the nose has already been altered. The presence of scars further complicates things, making the skin thicker and harder to work with.

Because of the challenges of revision rhinoplasty, renowned Los Angeles plastic surgery expert Dr. Tarick Smaili emphasizes the importance of choosing the right doctor—i.e., someone who is board certified and has been doing the procedure on a regular basis that has given him an in-depth knowledge of the “roadblocks” ahead.

revision-rhinoplasty

One of the most common reasons for revision rhinoplasty is to correct the “noticeably” asymmetric nostrils, which not only result in unnatural appearance but possibly breathing problems.

Most cases of asymmetric nostrils are caused by over-aggressive removal of the cartilage, which provides the form and support. But with a structure whose stability has been compromised, various problems can arise immediately after surgery or at a later date.

The “universal” approach is to preserve the structural integrity of the nose, which is done through correct grafting techniques. A graft is any tissue taken from one area of the body—such as the bowl of the ear, septum or wall between the nostrils, a piece of rib or hip, etc.—and is then used to improve the appearance and function of the nose.

Aside from the repair of collumela or wall separating the nostrils, many patients with asymmetric nostrils following a nose job will also need the alar or the lateral surface of the external nose—i.e., the area that flares out forming the nostrils—to be restructured with grafts.

But for some patients, a more viable approach is to undergo a septoplasty, a nose surgery wherein the columella is straightened, thus eliminating the crooked appearance and breathing problems.

Another possible solution is to use spreader grafts, which are particularly helpful when there is a depression on the upper lateral cartilage, leading to one side of the tip to “dip” or the nostril to appear smaller than the other side.

Because revision rhinoplasty patients are already dealing with disappoints, it is more important than ever to use 3D computer imaging technology that allows a more open discussion between them and their plastic surgeons. According to studies, this tool can increase patient satisfaction rate because it paves way for better communications.

Meanwhile, recovery after a revision rhinoplasty generally takes longer than a primary nose job’s, with the residual [unnoticeable] swelling taking up to two years to fully dissipate.

NECK LIFT SURGERY PHOTOS—VARIABLES YOU SHOULD PAY CLOSE ATTENTION TO

 

A neck lift surgery is a highly customized procedure because aging differs from patient to patient. But typically, it removes the sagging skin and fat responsible for the jowling, tightens the platysma muscle that appears like vertical grooves, and eliminates the excess fat to correct the “double chin.”

For many patients, neck lift is also performed as a part of full facelift or other facial rejuvenation surgeries.

neck-lift-surgery-photos

Leading Beverly Hills plastic surgeon Dr. Karan Dhir says neck lift surgery photos will reveal a lot about a doctor’s artistic skills, which are important in any type of facial rejuvenation procedures.

The list below shows the variables that you should pay close attention to when examining a doctor’s neck lift “after” photos.

  • No visible scars. A neck lift typically uses incisions behind the ear or around its contour and sometimes another one under the chin for an additional amount of contouring.

Incisions are closed in several layers to eliminate any unnecessary tension from the skin, allowing the scars to heal and fade to the point that they are barely imperceptible within a year. Also, this technique can minimize the risk of scar migration and “pulled-on” or pixie ear deformity.

  • The neck contour must be smooth. To remove the appearance of vertical grooves in the center of the neck, the platysma muscle must be reshaped and tightened. Failure to address this problem defeats the purpose of achieving a rejuvenated look.
  • The skin must appear smooth. Under-correction lead to some residual excess skin, while over-correction can result in an overly tight appearance. A skilled surgeon knows how to strike the perfect balance between removing the excess skin and preserving the natural contour of the neck.
  • There should be no depression and other irregularities. While the excess fat contributes to jowling, it is crucial not to overdo the procedure lest it results in less than optimal contour.

Over-aggressive fat removal can also lead to platysma muscle becoming visible right after surgery or at a later date. For this reason, a good surgeon will only remove a conservative amount of fat to anticipate further facial volume loss, which happens due to advancing age.

  • The side burn should look “normal.” A traditional neck lift uses an incision that begins in the hairline at the level of the sideburn, which then continues around the ear.

Proper wound closure is important to prevent scar migration, disappearance or displacement of side burns, and other stigmata of surgery.

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