Latest Plastic Surgery Articles - Page 5

 

A GOOD FACELIFT DOES NOT RESULT IN BALD PATCHES

 

Facelift surgery is not just about tightening the skin and deeper facial structure to rejuvenate one’s appearance. An equally important goal is to eliminate or at least hide any telltale sign of the procedure through proper scar placement, correct direction of pull, adjunct procedures, etc.

Facelift generally uses incisions behind the hairline that may extend in front, behind, or around the ear, specifically within the natural skin creases to hide the scars.

facelift-procedure-scars

Around the incisions, temporary hair loss/fall may occur as the hair follicles go into a hibernation phase. For the vast majority of patients this will resolve on its own, although they could “accelerate” the healing process by using topical treatment such as Rogaine.

The general rule of thumb is to wait three months to see if there is any hair regrowth around the facelift scars.

Nonetheless, permanent bald patches do occur after a facelift procedure, particularly if there is an excessive damage to the hair follicles or due to incorrect wound closure. To prevent this complication, the general rule of thumb is to eliminate tension on the wound.

A technique called trichophytic closure is particularly helpful in preventing hair loss or bald patches following a facelift procedure. It involves suturing the overlapping edges of the wound, and removing a small piece of skin at an oblique angle (on one side of the wound), before the adjacent flaps are brought together to close the incisions.

With this wound closure, a piece of scalp tissue lies beneath the other, allowing the hair follicles from both flaps to grow and conceal the facelift scars. This technique is also helpful in hair transplant surgery.

To further eliminate any telltale sign of facelift, such as frontal hairline distortion or weird-looking sideburns, the direction and amount of pull should also be taken into account. The idea is to eliminate or at least minimize tension on the skin by contouring the SMAS (deeper facial structures) and not just the skin alone.

Should permanent bald patches occur after facelift, hair transplant surgery is the only permanent solution. This involves collecting hair follicles from the back of the scalp, grouping them together, and implanting them into the area that requires some coverage.

Most Los Angeles plastic surgery experts suggest waiting at least a year before considering hair transplant since hair regrowth is possible with time, or the patient could find hairstyle options that may hide their small bald spots.

RHINOPLASTY RECOVERY—WHY SKIN THICKNESS IS AN ISSUE

 

During a rhinoplasty surgery, the skin is raised off to reveal the nose’s bony-cartilaginous framework which is reshaped, filed, reduced, or altered to achieve the patient’s cosmetic desire. However, the procedure does not change the amount or quality of skin, which must be able to shrink-wrap onto the new contour to achieve good results.

Los Angeles plastic surgeon Dr. Tarick Smaili says that skin thickness largely determines the amount of changes the nose can handle, and the length of rhinoplasty recovery as well.

ethnic-rhinoplasty-surgery

During the initial healing stage, which could take a few weeks or months, a patient will not see any “real definition” since it takes time for the skin to redrape to the newly altered framework. Postop swelling of the skin and soft tissue further conceals the surgery’s results.

A thick, oily nasal skin, which is commonly found among ethnic rhinoplasty patients, is less flexible than thinner skin, thus it contributes to longer recovery. According to studies, this feature can lead to residual postop swelling that can take up to two years to fully dissipate.

Thin skin, meanwhile, can redrape quicker and better than thicker skin and is less susceptible to postop swelling and bruising, which in turn leads to shorter recovery.

Because ethnic rhinoplasty patients are prone to persistent swelling, which could be replaced by scar tissue known to result in less than optimal results especially in the nasal tip, many surgeons use steroid (kenalog) injections after their surgery.

Steroid injections are particularly helpful in and around the supra-tip, or the upper nasal tip area, where most of the postop swelling persists. Aside from creating smooth results, the treatment can also accelerate rhinoplasty recovery, as suggested by Dr. Smaili.

These injections are also commonly used after a revision rhinoplasty, which involves more postop swelling than a primary nose surgery. However, some doctors recommend oral steroids as a precautionary measure especially in patients with a strong history of scar tissue formation.

Despite the challenges pose by thick nasal skin, the upside is that it is more efficient in “hiding” any residual asymmetry in the nose’s underlying framework. A thin skin, meanwhile, is less forgiving that even a mild irregularity could easily show.

Nevertheless, thick skin requires a strong [altered] framework to prevent amorphous appearance, nostril collapse, and other telltale signs of plastic surgery. And in doing so, the bulky skin in the nasal tip can also receive some tension, leading to a more refined, narrower look.

BRACHIOPLASTY MINIMAL INCISION FOR MILD BAT WING ARM APPEARANCE

 

Brachioplasty, or upper arm lift surgery, typically involves an incision that stretches from the elbow up to the underarm, sometimes even extending to the chest area for massive weight loss (MWL) patients who need the most correction. Aside from eliminating the “bat wing” appearance, a good result should also appear natural and smooth.

However, a technique called brachioplasty minimal incision is more suitable for patients who need less correction, or to be exact, those with little loose and redundant skin.

brachioplasty-minimal-incision

This minimally invasive approach results in a shorter scar, usually just within the armpit area, allowing the patient to wear sleeveless tops without having to worry about the visible scars. Nevertheless, it should not be attempted on someone who needs more correction due to risk of poor contour, skin asymmetries, and (ironically) unfavorable scarring.

While brachioplasty with minimal incision can provide an impressive outcome for the right candidates, it is occasionally performed in conjunction with liposuction in which the excess fat is removed through a stainless steel tube called cannula.

The adjunct procedure does not result in visible scars because it uses a few incisions that are less than ¾ of an inch, which further shrink and fade as the patient moves forward to her recovery.

But to achieve good results from liposuction as a concomitant procedure of upper arm lift surgery, the entire circumference or at least 75 percent of it should be treated. The idea is to create a smooth transition between the upper and lower arm through judicious fat removal.

However, it remains imperative to leave some fat layer to preserve the natural appearance of the upper arms and avoid the overly muscular look; this is particularly important among female patients who need to maintain the femininity and “smoothness” of their arms.

Regardless of the incision pattern, it is important to close the wound in several layers in an attempt to remove or at least minimize the tension on the wound, thus preventing it from becoming thick, wide, and raised. Proper suturing techniques also prevent wound breakdown and poor healing.

To further promote “favorable” scarring, it is not uncommon among plastic surgeons to recommend steri-strips and/or silicone tapes, which hold the wound in place and provide a gentle compression to inhibit keloid or hypertrophic scar formation.

Meanwhile, the average arm lift cost is $4,000-$5,000, although minimally invasive techniques are slightly less expensive than a full or standard method.

CHIN AUGMENTATION FOR MALE PATIENTS

 

Chin augmentation surgery through the use of implant is one of the most commonly requested facial rejuvenation procedures of men, which have different goals from women, as suggested by celebrity Beverly Hills plastic surgeon Dr. Karan Dhir.

Chin implant is reshaped in a way to correct the near absent or “weak” chin, which has an effeminizing effect. While dermal filler injection could also enhance this area, the use of implants is suitable for patients who need more correction and want a more permanent solution.

chin-augmentation-surgery

In essence, chin implant improves the profile of the chin that almost disappears from the neck; it does not elongate one’s face, which might require a different, more extensive facial contouring procedure.

Studies have suggested that a lot of rhinoplasty (nose job) male patients benefit from a concomitant chin augmentation. The idea is to improve the shape and profile of the nose, chin, and neck in a way that the aesthetic proportion of the face is enhanced.

For male rhinoplastic patients with recessed chin, their more refined nose could make their lower face appear weaker in comparison, thus aggravating the discrepancy and facial imbalance, explains Dr. Dhir.

Nowadays, chin implants are made from a variety of materials, although solid silicone is the most popular because of its biocompatibility and good track record for patient safety. If positioned and attached onto the bone correctly, the results are supposed to last a lifetime.

Nevertheless, impressive results are only possible if the chin implants are highly customized based on the patient’s facial structure and shape, and his “cosmetic” motives and expectations as well. The idea is to use an implant size and shape that is within the confines of the underlying anatomy.

Chin augmentation via implant is often performed under local anesthesia with sedation, although patients could also elect to have their surgery under general anesthesia.

The implant is introduced via a small incision under the chin or inside the mouth, behind the lower lip. Regardless of the entry point, the “process” is not supposed to result in visible scars or any telltale sign of plastic surgery.

For most patients, the surgery takes less than an hour, although it has become a common practice to combine it with other rejuvenating procedures such as facelift, rhinoplasty, dermal fillers, fat graft, etc., which can lead to a longer operating time. With a combo surgery, Dr. Dhir says the patient can avoid a second procedure and healing period.

3 ANATOMICAL FACTORS THAT HELP YOU ACHIEVE GOOD RESULTS FROM MINI TUMMY TUCK

 

A full or standard tummy tuck surgery can significantly improve the abdominal contour by removing the redundant skin and tightening the deeper muscular structure. However, some patients are turned off by the appearance of a long scar, which typically runs from hip to hip, across the lower abdomen.

For patients who need “less correction,” a mini tummy tuck is a good alternative. It uses a shorter scar below the navel, which is about the size or slightly longer than a C-section scar.

mini-tummy-tuck-scar

If there is an existing C-section scar, leading Los Angeles plastic surgeon Dr. Tarick Smaili says a cost-effective approach is to utilize it during a mini tummy tuck surgery to avoid additional scarring.

Aside from the “usual” requirements—e.g., being physically fit and near one’s ideal weight, non-smoker, and with realistic goals—you must also meet the three anatomical factors that can help you achieve impressive results from a mini tummy tuck.

  1. The excess skin is isolated to the area below your navel.

Due to the limited length of a mini tummy tuck scar, it has no or very little effect on your upper abdomen. For this reason, the procedure is only suitable for patients with just a small amount of excess skin limited to their lower abdominal area.

Take note that forcing this on someone who has too much redundant skin can lead to asymmetric, unnatural contour, particularly fat rolls and hanging skin tissue in the upper abdomen.

  1. Relatively good skin tone

If you have maintained a healthy weight throughout your life, most likely you will have a better skin tone compared to individuals who have resorted to “yoyo weight” lifestyle. Nevertheless, pregnancy could lead to some loose skin that is generally limited to your lower abdomen.

Having a decent amount of skin elasticity can also help your skin to shrink-wrap after a minor abdominal liposuction, which is often used as an adjunct procedure of mini tummy tucks.

  1. Minimal muscle laxity

Mini tummy tuck recovery is shorter than a standard technique’s because of the limited incision. However, the tradeoff is the limited amount of muscle repair, which is not enough for massive weight loss patients.

Due to the limited incision, the abdominal muscle is not as accessible as doing repair in full tummy tuck in which the skin is raised more extensively, as explained by the celebrity Los Angeles plastic surgeon.

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