Latest Plastic Surgery Articles - Page 13

WHAT OUT OF TOWN BREAST AUGMENTATION PATIENTS SHOULD KNOW

 

If you can’t find a local breast augmentation surgeon that you’re comfortable with, it is not unreasonable to travel long distances for your surgery. Nevertheless, you must know certain precautions that will keep you safe and help you achieve the “best” result from this procedure.

Medical tourism is loosely defined as “traveling for more than five hours” to get a surgery. For this reason, instructions differ from patient to patient due to variables such as the type of procedure, length of travel, amount of pain and discomfort, just to name a few.

breast-augmentation-Los-Angeles

Photo Credit: Stockimages at FreeDigitalPhotos.net

Leading Los Angeles plastic surgery expert Dr. Tarick Smaili says he generally “prefers” or requires his out of town patients to stay within the vicinity three to 10 days so he can personally see their progress, adding that women who are not amenable to this arrangement should exercise extra precaution.

If you are travelling alone, you may want to have an overnight stay at a hospital or hire a private nurse to take care of your needs for at least a day or two.

In the first few days postop, it is not ideal to travel alone or drive your car since painkillers are known to cause lethargy and sleepiness, which can make it dangerous to perform tasks that involve high level of alertness.

Should you really need to travel by car a few days postop, a good alternative is to ask someone whom you trust to drive you home. However, it is important that you make regular stops (or every one or two hours) so you can take a short walk, stretch your legs, or just move around to keep your blood circulating.

Keep in mind that performing light exercise regularly plays a crucial role in preventing deep vein thrombosis or blood clots in legs, which is a risk after any type of surgery. This will also prevent weight gain, persistent swelling, and lethargy.

However, you may want to wait a little longer if you are going to travel by air. While each doctor has specific instructions, a good rule of thumb is to stay within the vicinity 10 to 14 days before you take a long flight.

When you arrive home, it is ideal to have a local doctor who can check on your progress, although you should still communicate with your breast augmentation surgeon on a regular basis.

While breast augmentation recovery is a “straightforward” experience, with pain easily managed by mild painkillers in the first few days, it remains important that you avoid sudden jerky movements of the arm, or anything that causes discomfort. Also, stay away from activities that can increase your heart rate and blood pressure in the first three weeks.

RHINOPLASTY SURGERY AND CARTILAGE GRAFTING

 

rhinoplasty surgery is not just about improving the outside appearance of the nose. An equally important motive is to preserve its structural integrity, which could be done with cartilage grafting, so the results can last a lifetime.

Cartilage is a flexible connective tissue that is found in the lower half of the nose. In rhinoplasty, it is harvested from areas of the body where it is plentiful (e.g., bowl of the ear, septum or wall between the nostrils, and rib) and then sculpted into a specific shape to achieve the patient’s cosmetic goals and to create a strong underlying structure as well.

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Rhinoplasty Los Angeles expert Dr. Tarick Smaili says the septal cartilage is the most preferred source because its quality is almost the same as the rest of the nasal cartilage. For this reason, it provides the most predictable results among other sources.

Another advantage of using one’s septal cartilage, he adds, is that no additional incision is used to collect it. Other sources, meanwhile, will require another cut just to retrieve them, although a good surgeon will make every effort to hide the scars.

For instance, using ear as the cartilage source requires a discrete incision behind it, without affecting its outside appearance and function.

If there is not enough septal cartilage inside the nose, which might be the case in revision rhinoplasty and patients requiring large augmentation, the ear cartilage is believed to be a good alternative.

Nevertheless, ear cartilage poses several challenges due to its curved shaped, limited amount, and less structural support compared with septal cartilage. As a result, using this material requires more technical skills to achieve impressive results, explains Dr. Smaili.

Another possible source is the rib, although many surgeons consider it as their last resort. While it is notable for its strength and abundance, compared with other sources it has a higher risk of resorption (dissolving), shifting, warping, and visibility under the skin.

But no matter where the cartilage grafts have been sourced, in the hands of a board-certified plastic surgeon who performs primary and secondary rhinoplasties on a regular basis impressive results can be still achieved, with very minimal risk.

In some cases, artificial implants might be a better option than the patient’s own tissue. However, this is only true for individuals whose cartilage quality or quantity is low, or they require larger augmentation just like in many cases of Asian rhinoplasty.

IS THIN NASAL SKIN AN ADVANTAGE IN RHINOPLASTY PROCEDURE?

 

The thickness and elasticity of nasal skin will have a large effect on the results of rhinoplasty surgery, or “nose job.” Other factors that also play a crucial role include the patient’s gender, ethnicity, facial features, and amount and quality of the bone and cartilage.

A rhinoplasty procedure reshapes, files, or removes a small portion of the nose’s underlying framework—the cartilage, which is a flexible connective tissue found in the lower half of the structure, and the bone, which comprises the upper half. Meanwhile, the skin is not touched.

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The overlying skin must be able to shrink down to the new framework, lest the results will appear amorphous or ill defined particularly at the tip.

The advantage of thin skin is that it can redrape better than thick skin due to its elastic nature. And for this reason, patients with this anatomy can tolerate more downsizing without having to worry too much about the risk of amorphous tip, explains leading Beverly Hills plastic surgeon Dr. Karan Dhir.

And due to the innate elasticity of thin skin, Dr. Dhir says it heals faster and experiences less bruising and swelling than thicker skin. Simply put, it leads to quicker social recovery, or about 10 to 14 days.

Meanwhile, patients whose nasal skin is markedly thick may have to wait a little longer before they look presentable in public.

And while full healing—i.e., the skin has “stabilized” or has redraped to the new contour—takes nine months to a year for patients with thin skin, complete recovery for someone with thick skin could take up to two years.

Due to persistent swelling experienced by ethnic patients who generally have thick nasal skin, it is not uncommon for their surgeons to recommend steroid injections especially into their supra tip (slightly above the actual tip or “end” of the nose) to eliminate or at least reduce the postop fullness.

Meanwhile, thin skin rarely requires the use of steroid injections, which must be used judiciously to avoid normal tissue atrophy (shrinkage). To prevent this type of problem, prudent surgeons typically dilute the drug and only use it during the first 3-6 months of rhinoplasty recovery.

However, thin skin has also its disadvantages. For instance, it could slightly increase the risk of minor revision to correct irregularities especially in the nasal bridge.

Any minor imperfection that is easily camouflaged by moderate or thick skin could show through thin skin.

WAYS TO DETERMINE IF BREAST LIFT IS WARRANTED

 

breast lift surgery tightens the tissue and its overlying skin to correct the drooping appearance. But to achieve a more rejuvenated contour and profile the nipple-areolar complex is repositioned higher or to an area where the breast projects the most.

The shape of breast lift scars primarily depends on four variables: 1.) amount of droop 2.) size of the breast 3.) patient’s goals and expectations 4.) and use of implants at the time of surgery.

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Some type of breast lift will be needed if the nipple area hangs more than an inch below the inframammary fold or breast crease, says renowned Beverly Hills plastic surgeon Dr. Tarick Smaili.

Aside from measuring the distance between the nipple and the inframammary fold, Dr. Smaili says it might also be helpful to conduct a pencil test in which a pencil is placed in the inframammary fold. If it remains in place most likely the patient will need a breast lift, or at least a good-fitting supportive bra.

Nevertheless, Dr. Smaili says only a consultation with a board-certified plastic surgeon who performs breast lift on a regular basis can actually determine if breast lift is warranted or other options might help.

During a physical exam, surgeons will measure the distance between nipple area and the inframammary crease, examine the skin elasticity along the power poles, and assess the most ideal scar pattern that will allow them to contour the breasts, explains Dr. Smaili.

If the droop is only minimal—i.e., the nipple is within or less than 1 inch below the inframammary fold—, Dr. Smaili says he typically recommends donut lift or Benelli mastopexy in which the scars are just around the edge        of the areola, or the pigmented part of skin.

But instead of actually lifting or tightening the breast tissue, a donut lift just repositions the nipple area higher above the inframammary fold, ideally creating 4.5-5 cm distance between these two “points,” explains Dr. Smaili.

Sometimes, donut lifts are performed simultaneously with breast implants which could deliver some lifting effect, or at least an illusion of it. But this combo procedure, he says, is only reserved for women who want to increase their cup size as well.

But for a moderate amount of droop, Dr. Smaili recommends lollipop lift in which there is an additional vertical scar between the areola and the inframammary crease. For the right candidates, the technique also has a narrowing effect, he adds.

However, women who require the most correction due to the significant droop and their large cup size, Dr. Smaili recommends the standard technique, which is also referred to as anchor lift because of the additional incision “inside” the inframammary fold.

HOW TO AVOID SKIN IRREGULARITIES AFTER LIPOSUCTION SURGERY

 

While liposuction surgery removes excess fat from under the skin, it is crucial to preserve some fatty tissue to prevent skin asymmetries, destruction of the natural curves, gaunt appearance, and other “stigmata.”

Leading Beverly Hills plastic surgeon Dr. Tarick Smaili shares his techniques that allow him to deliver smooth liposuction results.

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  • Proper patient selection

The success of any body contouring surgery largely depends on the patient’s anatomy. In liposuction, the right candidate should have good skin quality (no redundant or loose skin) and a stable weight to achieve pleasing results.

Meanwhile, skin irregularities are common among yoyo dieters, patients who ask for repeat procedures on the same area, and individuals with poor skin quality.

  • Avoid over-aggressive liposuction

There are several techniques to avoid inadvertent removal of too much fat. One effective way is to meticulously examine the patient in several positions—e.g., upright position (static and with muscle flexed), lying on one’s back or side, etc.

Proper position is more important at the time of surgery. A good rule of thumb is to avoid exaggerating the fat bulges—for instance, lying flat could amplify the saddlebags and upper arm rolls.

Other ways to minimize the risk of over-aggressive include the use of microcannulas which remove fats in small pieces rather than in big portions, and quick aspiration in one spot rather than treating it for too long.

If skin or contour irregularities occur at the end of surgery due to inadvertent over-liposuction, it is important to shift some of the fats around the over-treated area to correct the lumps or depressions.

But if contour irregularities are detected when the patient is no longer on the operating table, reverse liposuction or fat grafting can correct the problem. However, one must wait for after a minimum of six months from the initial surgery to achieve predictable results from revisions.

  • Preserve a layer of fat especially under the skin

Leaving at least 5 mm of fatty layer beneath the skin can minimize the risk of depression, lumps, and bumps. Failure to adhere to this guideline can lead to defects that are difficult to revise.

  • Use compression garments

These should fit snugly without causing pressure problems that could delay one’s recovery. The idea is that expelling the edema or excess fluids, which form within the cavities where the fat has been removed, can lead to faster recovery and smoother results.

Correct use of compression garments during the initial phase of liposuction recovery can also promote skin adhesion, further improving the surgery’s results.

GOING BACK TO WORK AFTER LIPOSUCTION SURGERY

 

Compared to other body contouring surgeries, liposuction results in a rather straightforward recovery that most patients can return to “quiet” work within two to five days. This has become possible due to the introduction of tumescent technique in which only local anesthesia is used.

In the past, liposuction surgery always required the use of general anesthesia, leading to prolonged recovery. Patients were also exposed to high surgical trauma because the fatty areas were not injected with tumescent fluids that could make them swell, paving way for gentler extraction.

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Photo credit: patrisyu at FreeDigitalPhotos.net

While today’s liposuction recovery is quick and less painful compared with previous techniques, the downtime still depends on the treated area, the patient’s nature of work, and their pain threshold.

Patients whose job is physically demanding may have to wait two to three weeks postop before they return to work. The idea is to avoid increased heart rate and blood pressure, which are tied to persistent swelling, late-onset bleeding, and other factors that might compromise their recovery.

Also, patients planning to undergo large-volume liposuction with multiple areas treated are advised to take a little more time off.

Although many patients are able to return to their work within a couple of days, leading Orange County plastic surgery expert Dr. Tarick Smaili says it makes sense to do just part time or reduce their work load to avoid “feeling wipe out at the end of the day” since it takes a while to regain their preoperative energy level.

Dr. Smaili also says that patients who try their best to stay relaxed tend to recover faster than those who constantly expose themselves to stress.

Meanwhile, the amount of pain in the first few days postop is manageable for most patients that mild painkillers are usually enough. The use of compression garments is also believed to provide some level of comfort by supporting the recovering tissue.

Compression garments can also help skin adherence, leading to smoother results.

Unless liposuction involves the face, swelling and bruising—which can take four to six weeks to dissipate—can be easily hidden under normal clothing.

While most patients are advised to avoid strenuous activities for a minimum of three weeks, during the initial healing stage it remains important that they perform light exercise such as walking to prevent weight gain, persistent swelling, and deep vein thrombosis in which blood clots form in legs.

MALE BREAST REDUCTION SCARS—ARE THEY VISIBLE?

 

In most cases, male breast reduction scars are limited around the border of the areola complex, which is the pigmented part of skin. As the patients move forward to their recovery, the “surgical marks” gradually fade until they become imperceptible.

With the use of incisions around the areola’s border (bottom half), doctors are able to remove the excess skin, breast tissue, and fat. However, some patients will need liposuction as well for an additional amount of contouring.

male-breast-reduction-scarsLiposuction scars—which are usually 2.5-inch diameter or less—are also discretely positioned within the border of the areola or very close to the armpit, so they are hard to detect even by the patients themselves.

Another common technique is to place a ¼ inch incision inside the armpit, allowing the surgeons to remove the excess tissue and fat. While the resulting scars are virtually undetectable, the approach is not enough for patients who have a significant amount of redundant skin.

Aside from discrete scar placement, it is also crucial to eliminate unnecessary tension on the skin surface to prevent the scars from stretching or becoming irregular. This is often done through proper wound closure and use of dissolvable internal sutures, which can also support the new contour.

To further promote favorable scarring, some doctors recommend the use of scar creams and/or silicone tapes at least three weeks postop. Others suggest massaging the incision site (clinically healed) in an attempt to break up the scar tissue while it still responds well to such manipulation.

All scar treatments must only start after the wound is fully closed and clinically healed to prevent causing harm to the incision site.

Despite all attempts to achieve favorable scars, some patients remain susceptible to keloids. Studies have linked darker complexion to increased risk of aggressive scarring and hyperpigmentation (or darkening of the incision site).

While scar revisions, laser treatments, and camouflage medical tattoo can improve the scars, these should only be done about a year after surgery. The idea is to wait for the scar to settle and mature—i.e., there is no redness and could have shrunk to its best appearance.

Performing the aforementioned treatments too soon could lead to unpredictable results.

It is also helpful to avoid sun exposure or to use sunscreen/protective clothing for at least a year because ultraviolet rays can affect healing and lead to darker scars or hyperpigmentation, explains leading Brea plastic surgery expert Dr. Tarick Smaili.

TUMMY TUCK TATTOO TO COVER UP SCARS

 

A tummy tuck surgery typically requires a hip-to-hip incision underneath the bikini area to hide the resulting scar. However, a small percentage of patients may have to accept a “surgical mark” positioned higher than ideal to achieve a near normal contour.

Tummy tuck scars are sometimes positioned higher than the bikini line particularly if there is a significant amount of redundant skin in the upper abdomen, which may occur after massive weight loss.

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Photo Credit: Marin at FreeDigitalPhotos.net

If the underwear does not hide the scar, tummy tuck tattoo is a great option to cover up the surgical stigmata. However, it is ideal to wait for at least a year to make sure that it has fully matured—i.e., has settled and achieved its “best” appearance—before camouflage tattooing or any type of scar revisions is attempted.

While the wound is clinically healed but the scar is still considered “immature,” about three weeks postop, some Beverly Hills plastic surgeons recommend silicone sheets or tapes that create a moist environment known to promote “favorable” scarring in which it appears flat and thin and blends well with the skin.

In addition, silicone sheets can hold the scar in place and minimize the tension on the skin, preventing it from becoming wide and uneven.

Scar massage wherein the goal is to break down the scar tissue by massaging it in a circular manner and/or stretching it can also improve its appearance.

To achieve optimal results, these “simple” scar treatments must be continued for at least six months.

While the aforementioned remedies—together with proper wound closure at the time of surgery—often result in fine scars one year postop, some patients are simply susceptible to aggressive scars. According to studies, younger age, infection during tummy tuck recovery, darker complexion, and history of keloids are risk factors.

If scars remain unattractive a year after tummy tuck that is when camouflage tattooing might be considered. This involves meticulous color mixing so the marks will blend well with the skin.

Camouflage tattoos typically require two sessions for longevity.

If the goal of medical tattooing is to make the scars look just like the surrounding skin, it only works on hypopigmented scars which appear lighter than the “normal” skin tissue. Meanwhile, patients with hyperpigmented or dark scars are not good candidates for the procedure.

Cover-up tattooing is another great option in which designs can range from a string of flowers or stars to abstract patterns on and around the scars.

IMPORTANT THINGS YOU SHOULD KNOW DURING TUMMY TUCK RECOVERY

 

For most patients complete tummy tuck recovery—i.e., getting back their preoperative energy level—takes six to eight weeks. It is important that during the initial healing stage they avoid activities that can pull on the abdominal stitches, lead to increased heart rate, and anything that can compromise their healing.

Upland plastic surgery expert Dr. Tarick Smaili explains the most important issues during tummy tuck recovery.

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  • Pain and discomfort

Pain pumps and oral painkillers are commonly used together during the initial healing stage, or first few days postop, allowing you to get the much needed sleep and rest. But after a week or two, it is ideal to start tapering the dose to avoid [excessive] lethargy, constipation, and straining at stool which might harm the muscle repair.

Also, a “little” pain is beneficial at this time because it tells you to take a rest if you are over-exerting yourself. To promote recovery, you should take things slow and avoid physical and emotional stress.

  • Activities

The first five to seven days postop, you should be flexed at the waist (even during sleep) to prevent pulling on your wound. At this period, you should also avoid physical activities, including walking unless it is goal-driven—i.e., going to the bathroom.

After about a week, you can sit and walk straight up and may gradually perform light activities such as walking. The idea is to keep your blood flowing without increasing your heart rate and blood pressure, promoting quicker recovery and reducing the risk of blood clotting.

While most patients can return to a “quiet” work two weeks postop, it remains important to avoid rigorous activities and heavy lifting for about a month or sometimes longer.

  • Hygiene

For about a week, you can only sponge bathe because the dressing and compression garments must not get wet or be removed. Take note that you must always be accompanied by someone when going to the bathroom at this time.

  • Recovery diet

While there is no strict diet plan, most surgeons recommend increasing your protein intake because it promotes healing. Of course, eating more fruits and veggies and avoiding empty calorie food can also speed up recovery and prevent weight gain during the time when your activities are restricted.

It is also important to increase your fluid intake to counteract the effects of painkillers such as constipation and lethargy, and to hydrate your skin which can promote good healing.

ARM LIFT PROCEDURE FOR THE AGING ARMS

 

An arm lift procedure, or brachioplasty, is a common surgery performed on massive weight loss (MWL) patients who develop a large amount of redundant skin in their upper arms.

However, a small percentage of arm lift patients ask for the procedure to correct the appearance of their aging upper arms that typically comprise of excess sagging skin, loose supportive tissue, and/or fat atrophy (shrinkage or disappearance).

arm-lift-procedure

Unlike MWL patients who require longer incisions (from elbow to the underarm) and more extensive approach, older patients who have maintained a healthy weight throughout their lives will require just a short incision hidden inside their armpit. This will allow them to wear sleeveless tops without having to worry about visible scars.

Nevertheless, the amount and location of the excess skin will dictate the incision pattern and length. Fortunately, the scars are generally positioned on the inside of the upper arm or within the natural skin creases of the armpit to hide them.

With the use of short incisions, doctors are able to remove a small amount of excess skin and tighten the underlying supportive tissue; the latter technique is important to eliminate the tension on the skin, allowing the wound to heal without spreading or becoming uneven.

Some older patients have significant fat atrophy, which also contributes to the saggy appearance. This problem is corrected by fat replacement or fat grafting in which their own fat—typically derived from their tummy and hips through liposuction—is used to reshape the upper arms.

Meanwhile, others have excess or localized fat deposit, which is best treated by minimal liposuction. To achieve smooth results, the entire circumference of the upper arm or at least 75 percent of it must be treated, and some fat layer must be preserved as well to prevent gaunt or overly muscular appearance.

Aside from the shorter arm lift scars, another advantage of performing it on older patients is their reduced susceptibility to aggressive scars—e.g., keloids and hypertrophic scars. However, it remains imperative to avoid sun exposure six months to a year after surgery to prevent hyperpigmentation in which the scars turn darker and more visible.

While sunscreen is helpful in preventing hyperpigmentation, experts from the California Surgical Institute recommend long sleeves or any protective clothing when going outdoors.

To further improve the postop results (i.e., to promote skin adhesions), most surgeons recommend the use of compression garments continuously for at least four weeks.

 

California Surgical Institute

9025 Wilshire Blvd, Suite 411, Beverly Hills, CA 90211

Brea: 910 E. Birch St, Suite 350, Brea, CA 92821

Upland: 930 W. Foothill Blvd. Upland, CA 91786

Riverside: 7120 Indiana Ave. Riverside, CA, 92506

By Phone: 866-372-3288

By Email: info@californiasurgicalinstitute.com

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