Latest Plastic Surgery Articles

TOP 5 WAYS TO PREPARE FOR MOMMY MAKEOVER SURGERY

 

Mommy makeover surgery by definition is a body contouring procedure in which the goal is to reverse the effects of pregnancy. Perhaps the most common examples include tummy tuck, abdominal liposuction, and breast enhancement.

Aside from selecting a qualified surgeon, mommy makeover Beverly Hills expert Dr. Tarick Smaili says preparations will also play a crucial role in the success of your surgery.

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Image courtesy of KEKO64 at FreeDigitalPhotos.net

These are the top five ways to prepare for mommy makeover surgery, as suggested by Dr. Smaili.

1. Nutrition. The goal is to nourish the body well in advance of the surgery to promote good healing. The general rule of thumb is to eat more fresh fruits and vegetables, whole grains, and lean meat or plant-based protein, and stay away from empty calories and highly processed foods.

Because the typical American diet lacks “diversity,” it is not uncommon for surgeons to recommend multivitamin, iron, and protein supplementations.

2. Weight. Your weight must be within normal range (or at least within 10-15 lbs. of your weight goal) that you can maintain long term, allowing you to achieve optimal results from tummy tuck or any type of mommy makeover surgery.

However, a month or two before the surgery you should not lose a significant amount of weight, which can lead to malnutrition and eventually poor healing after your mommy makeover.

3. Recover from childbirth. It is important that you have fully recovered from the trauma of childbirth before any body contouring surgery is attempted. While the general rule of thumb is to wait at least six months after giving birth, you may want to further postpone your mommy makeover if you choose to breastfeed your baby.

Keep in mind that breastfeeding involves the release of hormones, which can affect the elasticity of your skin.

4. Emotional health. Most patients focus on their physical health without realizing that they should also mentally and emotionally prepare themselves prior to the surgery, which involves temporary symptoms such as pain, swelling, and bruising. For this reason, postop blues are not uncommon during recovery.

Aside from taking care of your emotional health, you must also build a support system who will be there throughout your “journey.”

5. House preparation. Do all the house chores and buy all the “recovery period” supplies that you will need before your mommy makeover to avoid being stressed out during the healing phase in which your sole responsibility is to take care of your wellbeing.

Also, arrange an in-house care for at least three days postop. 

FACIAL IMPLANTS—COULD THEY PROVIDE NATURAL RESULTS?

 

Facial implants such as those used to correct the near absent chin, weak jaw, and gaunt cheeks are supposed to provide results that feel and look natural. But for this to be possible, renowned Beverly Hills plastic surgeon Dr. Karan Dhir says the patient’s underlying anatomies should always be taken into account.

Dr. Dhir says a surgeon’s facial implants before and after photos can reveal a lot about his artistic skills, or lack thereof. Not only should they appear natural, they must also rejuvenate the face and improve facial symmetry based on the patient’s gender and aesthetic goals.

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Chin implants

Chin implants can provide natural results if they are customized based on the patient’s underlying anatomies. For most people, these are used to improve the chin’s profile rather than increase the height of their face.

These implants, which are usually made of solid silicone, must be attached to the bone so they will act and feel like its extension. Also, they should not move or migrate for them to appear natural that no ordinary observer can tell if a patient has had the surgery.

Cheek implants

They should be fastened to the cheekbone so they will not move and will feel like its extension. However, during the initial healing stage they might appear slightly palpable until a scar tissue forms around them and prevents them from moving.

Aside from sculpting the cheek implants so they can fit into the underlying anatomies, it is equally important to take into account any slight asymmetry of the face.

Most cheek implants today are made of semi-firm silicone that blends well with the cheekbone if they are positioned correctly. However, some plastic surgeons remain partial to dermal fillers and fat grafting, which are both injected into the cheeks.

Proponents of fat grafting and dermal filler injections believe that they provide a more natural outcome than cheek implants because they are as soft as the surrounding tissue. But one downside is that their results do not last as long as the silicone implants’.

Jaw implants

These are commonly used in men whose near absent jaw makes them look effeminate, although some women can also benefit from these implants if they are bothered by their overly narrow, long face.

To achieve natural results, jaw implants must be resized and reshaped based on the underlying anatomies and in a way that they will widen the angle of the jawline, thus improving the facial balance.

MALE BREAST REDUCTION SURGERY—WHY YOUR WEIGHT MATTERS

 

Male breast reduction surgery is supposed to provide a near permanent result. However, this is only possible with proper patient selection in which his health, weight, motives and expectations, and lifestyle are all taken into account.

Dr. Tarick Smaili, a renowned Upland plastic surgery expert, explains the reasons why your weight matters prior to male breast reduction or any type of body contouring procedure.

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  1. Predictable results. Take note that overweight and obese patients are poor candidates for this surgery because there is a good chance that shedding the extra is enough to correct their enlarge breasts.

Also, being near one’s ideal weight can help his doctor make proper assessment, thus reducing the risk of over- or under-correction.

Aside from correcting the enlargement, the surgery must also provide results that look natural rather than “operated-on.” For this reason, it is important to maintain some fat and skin to prevent the hollowed look and unfavorable scarring.

  1. Lower risk of complication. One recent study published in Plastic and Reconstructive Surgery journal has suggested that obese patients who had plastic surgery were 35 percent more likely than normal weight individuals to have emergency visit or hospital admission within 30 days after their operation.

Experts suggest that the increased complication risk is due to obese patients’ predisposition to high blood pressure, diabetes, heart problem, and other medical conditions that can compromise their healing.

Also, adipose or fat tissue has been found to be poorly vascularized—i.e., low blood supply—that makes obese patients susceptible to infection, delayed healing, and poor scarring.

  1. Less medical expenses. Being near your ideal weight prior to surgery means less hospital admission or emergency visit due to postop complications. This means a lot if you are paying out of pocket for the procedure.

Also, remember that most insurance companies rarely cover the cost of complications associated with [elective] plastic surgery.

  1. Results can last a lifetime. Once the excess soft tissue has been removed, there is a very small chance that breast enlargement will recur. Nevertheless, it is only true for normal weight patients who are able to keep the extra pounds at bay through long-term weight management.

On the other hand, anyone who is experiencing yoyo weight is not a good candidate for any type of body contouring surgery because the real underlying problem is not the redundant skin or excess breast tissue and fat, but his inability to keep a healthy weight long term.

PREPARATIONS FOR PLASTIC SURGERY AFTER WEIGHT LOSS

 

The success of plastic surgery after weight loss is determined by several factors such as patient selection, surgical planning, doctor’s skills and qualifications, postop care, and long-term weight management through healthy lifestyle choices.

The preparations also play a crucial role in its long-term success, as suggested by Riverside plastic surgery expert Dr. Tarick Smaili.

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Dr. Smaili explains the basic ways to prepare for body contouring surgery after weight loss, which typically involves combining two or more procedures (e.g., tummy tuck and thigh lift) to achieve a near normal appearance or to address non-healing irritations caused by the redundant skin.

  1. Reach your ideal weight first. After reaching your ideal body weight, it remains helpful to wait at least six months to ensure that you can sustain your lifestyle long-term, meaning no yoyo dieting and “unbearable” exercise routine.
  1. Make sure you are not suffering from nutritional deficiencies. It is not uncommon for massive weight loss patients to have anemia and other similar conditions due to the sudden change in their diet and calorie intake, level of physical activities, and other aspects of their lifestyle.

Prior to surgery, most MWL patients are instructed to take vitamin supplements, change their diet (daily protein intake should be at least 50-70 grams), and work with nutritionists and behaviorists to prepare them not just physically but also emotionally and psychologically.

  1. Stop smoking. If you are a smoker and/or using smoking cessation products such as “the patch” and nicotine gum, avoid them for at least four to six weeks to reduce the risk of complications such as skin necrosis (death of skin tissue), poor healing, unfavorable scarring, and less-than-optimal results.
  1. Establish a reliable support network. In the first few days of your recovery, you will need someone to help you with your basic needs and allow you to focus on your healing rather than stress over your daily responsibilities such as house chores and childcare.
  1. Make the necessary preparation. Take note that you will need at least a three-week off, or sometimes even longer if your surgery is quite extensive. For this reason, it might be ideal to clean your house, buy your medical supplies and easy-to-prepare meals, do the laundry, etc. days before your operation.

BODY SCULPTING SURGERY COST—WHAT ARE THE VARIABLES?

 

Body sculpting surgery is a broad term used to describe any procedure that improves the contour of the body—e.g., arm lift, tummy tuck, lower body lift, breast enhancement, and thigh lift.

The aforementioned procedures are also commonly used as a plastic surgery after weight loss in which the goal is to remove the redundant skin, stubborn fat rolls, and tissue laxity with the use of incisions beneath the bikini area and within the natural skin folds so the scars remain hidden.

plastic-surgery-after-weight-loss

Dr. Tarick Smaili, one of the leading Beverly Hills plastic surgeons, explains the variables affecting the body sculpting surgery cost.

  1. Type of procedure. “Isolated” procedures such as tummy tuck, upper arm lift, and breast-related surgery typically cost between $6,000 and $9,000, while full body lift or multiple procedures can range from $15,000 to $30,000, depending on the extensiveness of the “makeover.”

Despite the hefty fee, several studies have shown that plastic surgery after weight loss help patients stick to their healthier lifestyle to maintain their new contour.

Nowadays, insurance companies are becoming more and more restrictive that plastic surgery after weight loss is rarely covered, even though it can improve the patient’s quality of life.

As of this writing, only the panniculectomy is labeled as a reconstructive surgery and thus covered by health insurance. This involves removing just the apron-like skin in the abdominal area, without tightening the deeper muscle that also contributes to the saggy appearance.

  1. Location. The demand for plastic surgery in metropolitan regions is higher compared to less populated areas, thus city dwellers may have to pay premium. It all boils down to the supply and demand.

However, renowned doctors (e.g., Beverly Hills plastic surgeons) typically choose to practice their craft in large cities so it is not uncommon for patients from “more remote” areas to travel long distances for surgical enhancements.

  1. Hospital versus accredited outpatient surgery center. While a hospital privilege shows that a certain plastic surgeon has been thoroughly screened, having one’s procedure in an ambulatory surgical facility can slightly lower the overall cost.

Aside from the lower fees, outpatient surgery centers might also reduce the risk of contamination because they do not handle infectious diseases unlike most hospitals.

  1. Doctor’s fee. Plastic surgeons with impressive qualifications, good reputation, and extensive experience generally demand higher fees than someone who is still new in his craft.

Nevertheless, it is not uncommon for non-specialists (i.e., doctors practicing plastic surgery despite the lack of certifications and training) to ask for hefty fees to create an illusion of “exclusivity.” For this reason, a prudent patient should always conduct a thorough background check.

GOING BACK TO WORK AFTER BREAST AUGMENTATION SURGERY

 

Breast augmentation recovery has several definitions: complete disappearance of pain and discomfort, return to physical activities and social routine, breast implants settling into their final position, scar maturity, and skin redraping to the new contour.

For most patients, the pain after breast augmentation surgery is mild to moderate that oral painkillers are only needed in the first few days. In fact, some women have been able to return to their “quiet” work just three days postop, although it remains imperative to avoid strenuous activities for at least three weeks.

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On average, patients are able go back to work a week after surgery if their tasks are not physically demanding. For this reason, women whose jobs require them to move around or carry heavy things may have to wait for another week or two to avoid persistent swelling and other untoward side effects.

Leading breast enhancement surgery expert Dr. Tarick Smaili says avoiding or at least minimizing physical and emotional stress can help the body recover faster from the surgical trauma. For this reason, it is not uncommon for patients to work part-time until their preoperative energy level goes back, a process that can take three to four weeks.

While pain can easily dissipate, lethargy might persist for several weeks because it takes time for the body to heal from any surgery, so some patients may find themselves going to bed earlier than their normal routine because they can easily tire out, explains Dr. Smaili.

But the postop lethargy is not a reason to remain in bed for too long as prolonged immobility after any type of surgery can lead to increased risk of blood clotting in the legs, persistent swelling, chronic fatigue, weight gain, and delayed recovery. As a result, Dr. Smaili instructs all his patients to take a short, gentle walk several times a day to promote good circulation of blood.

The residual swelling also takes time to dissipate, although about a month most of the symptom will be gone. For this reason, the leading Beverly Hills plastic surgeon recommends his patients to buy just a few cotton bras (without underwire) because the breast size and shape will change over the course of their recovery.

In addition, the breast implants will take up to six months to settle into their final position and the skin to fully redrape to the new contour, making it ideal to purchase just a few bras to anticipate minute to moderate changes during the entire healing process, explains Dr. Smaili.


GOING BACK TO WORK AFTER FACELIFT SURGERY

 

The real challenge in facelift recovery is not the pain since it usually lasts just a day or two (and is easily managed by mild painkillers), but the interruption of social activities. The general rule of thumb is to take at least a two-week off to wait for most of the swelling and bruising to subside to a significant degree.

While some patients had successfully returned work on the seventh to tenth day after surgery, at this stage there might be some noticeable symptoms, although scarves, large sunglasses, and camouflage make-up could be of help. For this reason, many choose to wait at least two weeks if they are trying to be discrete.

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Patients with desk job can return work about a week postop if they don’t mind unsolicited questions and inquiries from their co-workers. However, they may want to wait a little longer if they are assigned to physically demanding tasks.

Dr. Tarick Smaili, one of the leading Brea plastic surgery experts, says patients who are less active during facelift recovery are less likely to experience persistent bruising and swelling. The idea, he adds, is to keep the heart rate and blood pressure within the “relax level” in the first three weeks.

But Dr. Smaili warns that prolonged immobility and bed rest should be avoided as well because it can lead to persistent swelling and delayed healing, so he recommends short walks several times a day to promote good blood circulation that can prevent the aforementioned complications.

Because “uncontrolled” stress could delay one’s recovery, some patients choose to work part time for a while, then resume their usual routine after they get their preoperative energy level back, which can take four to six months. Meanwhile, anecdotal reports show that people who are physically active prior to their surgery recover faster than individuals whose lifestyle is less active.

Aside from waiting for most of the swelling and dark bruises to dissipate, patients who are trying to be discrete may consider getting a drastic hairstyle beforehand. Doing so might also be ideal because it can take a minimum of six weeks before they can dye or cut their hair.

Overall healing—i.e., skin redraping to the new contour and looking more relaxed than overly tight—can take up to six months. For this reason, in the first few weeks it is not uncommon to look “overdone,” explains the leading Brea plastic surgery expert.

THINGS I WISH I KNEW BEFORE MY FACELIFT SURGERY

 

For a successful facelift surgery to be possible, it should involve strict patient selection and surgical planning by a qualified surgeon who has a deep understanding of the aging process and the limits of the underlying anatomies as well.

It has been a year after my facelift surgery and I have no regrets doing the procedure, which has softened my deep wrinkles and contoured my jowl. Now, I look more rejuvenated and happier after my doctor removed the “angry appearance” caused by the loose skin and fat atrophy (shrinkage of facial volume).

facelift-recovery

While my plastic surgeon has explained to me all the details of my surgery and facelift recovery, I was still caught off guard with the amount of swelling, bruising, and postop blues.

These are the things I wish I knew before my facelift surgery.

  1. Know how to relax. I have always hated downtime, which is inevitable for anyone planning to undergo a plastic surgery procedure. Take note when I say “downtime” it means no house chores (including the simplest tasks) and work-related undertakings (even answering emails) for at least a week.

During the most crucial time of your recovery, your only focus should be about your wellbeing. Remember that the more relaxed you are, the more efficient your body is able to recover from a surgical trauma.

  1. There is no shame to ask for help. For at least a week, have a close friend, family member, or nurse to take care of your basic needs. Simply put, let someone pamper you to avoid the stress of your [usual] daily responsibilities at home.
  1. It’s okay to be afraid of mirror. While my surgeon explained to me that the swelling and bruising would conceal my results initially, I was not expecting that my face would have bruises literally everywhere. In fact, seeing my reflection for the first time after surgery scared the hell out of me.
  1. Controlling swelling is the key to quick “social” healing. The postop pain was not really the issue during my facelift recovery, but the interruption of my social activities was the hardest part for me. For this reason, I strictly followed my doctor’s instructions to control this symptom—e.g., head elevation, low-sodium diet, cold compress, rest and sleep, etc.

In my experience, most of the swelling was gone about a week, although it took another week for me to look “socially presentable.”

  1. Camouflage make-up and fashion accessories are helpful. Some cosmetics are specifically formulated to hide bruising and swelling caused by facial plastic surgery, although ask your surgeon first before using them. You don’t want to irritate your incisions, which could lead to unfavorable facelift scars.

Aside from camouflage make-up, large sunglasses and scarves can also help you hide the postop symptoms.

DO’S AND DON’TS OF TUMMY TUCK RECOVERY

 

Tummy tuck procedure creates a flatter, more toned abdomen. Aside from removing the apron-like skin, it is also important to tighten the loose muscle or fascia and reposition the navel so it will look proportionate to the hips and waistline, thus creating a more natural result.

Due to the use of hip-to-hip incision in the lower abdomen, tummy tuck recovery is filled with “challenges” although studies after studies have shown that it has one of the highest patient satisfaction rates. In fact, one survey has suggested that it may encourage massive weight loss patients to stick to a healthy lifestyle to maintain their new contour.

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Meanwhile, the list shows the do’s and don’ts of tummy tuck recovery, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smaili.

  • Do accept the prolonged downtime. It is best to prepare for at least a four-week recovery, despite promises made by some doctors that it could be shorter.

On average, patients are able to return to their desk job two weeks after surgery, although it might be helpful to work part-time temporarily to avoid undue stress that may compromise their healing.

  • Be emotionally prepared. Most patients focus all their effort to prepare themselves physically, almost forgetting about the emotional aspect involved in tummy tuck recovery.

Due to the pain and lethargy, postop blues are not uncommon after tummy tuck surgery. For this reason, family support is more important than ever.

  • Do accept help. The main focus of tummy tuck patients should be their recovery, thus household chores, childcare, and life’s daily responsibilities should take a back seat for a while. But for this possible, there must be at least one capable adult who will perform all these tasks, including the patient’s basic needs in the first few days postop.
  • Don’t remain in bed. Prolonged immobility not only increases the risk of blood clots in the legs (deep vein thrombosis), but can also lead to poor healing, weight gain, persistent swelling, lethargy, and other untoward side effects. The general rule of thumb is to take a few short walks a day to promote good blood circulation.
  • Don’t expect a skinny appearance in an instant. The swelling can take several weeks to dissipate, so a prudent patient should not expect to jump into a pair of overly tight jeans any time soon.
  • Don’t hesitate to communicate with a plastic surgeon. A patient should express her concerns (e.g., tummy tuck scars that remain obvious, mood swings and depression, signs of complications, etc.) to her doctor no matter how trivial they might appear.

TRAVELING FOR PLASTIC SURGERY—TIPS TO HAVE A PLEASANT EXPERIENCE

 

Traveling for plastic surgery has its own benefits especially if there is a valid reason—e.g., you want the expertise of a reputable surgeon who happens to live far away from your place.

But if you travel for plastic surgery solely to avail a low-cost service, it might prevent you to look at the “bigger picture.” Take note that your primary goal is to find a qualified plastic surgeon who knows how to avoid the complications and give you results that look natural.

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Dr. Tarick Smaili, one of the leading Orange County plastic surgery experts, shares his tips on how to have a pleasant experience when traveling for plastic surgery.

  • Lots of planning and communication. While it is true that the distance is an issue, good rapport and open communication with your plastic surgeon can offset such challenge.

The general rule of thumb is to find someone you feel comfortable with and confident in his technical and artistic skills. For this reason, you may want to visit his websites and check his before-and-after photos online to assess his level of professionalism and “core values” that can help him deliver impressive results.

  • Someone to help you during the initial healing stage. It is a bonus if you have family or friends living within the vicinity. You need a support group to pick you up after surgery and take care of your basic needs during the most crucial phase of your recovery, i.e., a day or two after the operation.
  • Postpone travel for five to seven days after plastic surgery involving the body (e.g., breast augmentation and tummy tuck), or longer if your operation involves the face (e.g., facelift and rhinoplasty/nose job).

The idea is to avoid prolonged immobility—i.e., sitting for hours during a flight—because it can predispose you to risk of blood clotting or deep vein thrombosis in the legs that can travel up to the lungs and lead to more serious complications such as pulmonary embolism.

  • Don’t combine plastic surgery and vacation. Despite the proliferation of surgical vacation package, cosmetic surgery should be treated as a major surgery that involves a “quiet time” to recuperate. Thus you should plan your tropical holiday at a different time.
  • Collect all your medical records before leaving. For example, you should document the type of breast implants used during breast augmentation, the surgical technique, the attending surgeon’s name, the facilities, etc. Such info will help your local doctor in case that you have postop concerns at home.

DO’S AND DON’TS OF COSMETIC PLASTIC SURGERY

 

Cosmetic plastic surgery such as breast augmentation, facelift, and liposuction is always considered a major surgery, meaning it is a decision you shouldn’t take lightly. Not only it involves some downtime, but also risk of complications especially if you are not careful in selecting your surgeon.

Dr. Tarick Smaili, a renowned Inland Empire plastic surgery expert, shares the do’s and don’ts of cosmetic plastic surgery.

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List of Do’s

  1. Find a doctor and be extra choosey. Confirm if he is a bona fide plastic surgeon, i.e., certified by the American Board of Plastic Surgery and other reputable plastic surgery affiliates.

Other ways you can conduct a background check: look at his before-and-after photos, confirm that he has a hospital privilege, talk to his previous patients, verify that his facility is accredited, and search him online.

  1. Know thyself. Know the real reasons why you want to have the surgery despite the downtime and potential complications. If your motivations are based on pleasing other people, most likely you will never be happy no matter how successful the postop results are.
  1. Be realistic. Understand that no plastic surgery can give you perfection, only improvement because your underlying anatomy has a large effect on the final results.

List of Don’ts

  1. Don’t be stingy. Focusing too much on the plastic surgery cost will prevent you from selecting the right plastic surgeon. Take note that your main goal is to find a qualified doctor who is worth every penny you are going to spend.
  1. Don’t rush into it. Plastic surgery is something that you should think over and over. If there is any doubt, you have to stop for a while and listen to what your “heart” really tells you. This is a decision that may affect your life and your self-esteem and body image.
  1. Don’t think that an improved appearance will improve your relationship. Some people think that enhancing their look will change the way others will treat them, their exes will take them back, or worse, their new look will be the “end all be all” of their quest to happiness.
  1. Don’t have it if you are experiencing a major life’s event. Cosmetic plastic surgery is only reserved for emotionally and psychologically stable candidates who understand the ramifications of their decision. There is no room for impulsive behavior when it comes to surgical enhancement because the results tend to be lifetime or near permanent.

 

HOW TO SPEED UP EYELID SURGERY RECOVERY

 

The length of your eyelid surgery recovery, or to be specific, the moment when you look socially presentable, may take about a week. However, you may still need to use camouflage make-up or large sunglasses to cover the bruises and swelling around the eyes.

Dr. Karan Dhir, one of the leading Beverly Hills plastic surgeons, believes that certain steps can help speed up your recovery and avoid the inconvenience of persistent bruising and swelling.

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For a “quick” recovery, the general rule of thumb is to minimize eyelid motion in the first two to three days. Ideally, you should try to relax and listen to your favorite music, and avoid watching TV, reading books, and using computer because these activities will force the lids to open and close more frequently, which can increase postop bruising.

Aside from taking things slow, another way to speed up your recovery is to follow a strict diet—i.e., very little salt, lean protein, and more vegetables and fruits. Salty and fatty foods, meanwhile, can aggravate the swelling and possibly impede with your healing.

Some herbal and vitamin supplements are also known to aggravate bruising such as green tea, ginseng, and fish oil, although some doctors suggest that taking a small dose of arnica montana and bromelain can control postop symptoms and lead to quicker recovery.

While the effectiveness of arnica and bromelain is still up for debate, most Beverly Hills plastic surgeons agree that head elevation in the first 48-72 hours can do wonders. The idea is to help the swelling caused by the excess fluids to go down by relying on the gravity’s effect.

Cold compress is also believed to control swelling, although you should not put ice directly on your bare skin to prevent cold burns and blisters. For this reason, some doctors prefer using washcloth slightly moistened in ice water, a technique that eliminates the risk of frostbite.

But since time is the best treatment, a month after surgery there is no difference between a patient who did head elevation and cold compress versus someone who skipped these postop care.

And lastly, it is important that you avoid heavy lifting, bending over from the waist, and doing strenuous activities for at least three weeks because doing so can elevate your blood pressure and eventually lead to bleeding and poor healing. Just to be on the safe side, ask for your doctor’s approval before returning to your normal routine.

HOW LONG IS THE SOCIAL RECOVERY AFTER FACIAL PLASTIC SURGERY

 

Facial plastic surgery such as facelift, rhinoplasty (nose job), fat grafting, brow lift, and eyelid lift involves postop bruising and swelling that may prevent anyone to join social activities for a couple of weeks.

Take note that healing from such procedures takes many forms—e.g., social recovery, physical recuperation, and return of normal sensation.

facial-plastic-surgery

For many patients, the hardest part of the recovery is not really the postop discomfort, which can be easily controlled by painkillers, but the interruption in their social activities.

The list below explains the length of social recovery after a specific type of facial plastic surgery and what kind of postop symptoms one should expect during the initial healing phase:

  • Facelift. Five to seven days after surgery, the swelling and bruising will rapidly improve that most patients can return to their social activities by eight day, although usually with the “assistance” of camouflage make-up and/or fashion accessories such as sunglasses and scarves.
  • Rhinoplasty. The postop bruises are the most apparent around the eyes and will take a week to subside to a significant degree. However, social recovery greatly varies from patient to patient, with some people able to look “more acceptable” within a week, while others have to wait for two to three weeks especially if they have a thick nasal skin.
  • Fat grafting. This involves injecting a small amount of fat into the area that needs more volume, leading to mild swelling and bruising that can last for seven days, although some patients may have to wait for another week to appear “socially presentable.”
  • Eyelid surgery. This involves a rather straightforward recovery with the use of very fine incisions made within the natural upper eyelid crease and close to the lower lash margin. For this reason, most patients can have “dinner with friends” after about five days, although big sunglasses remain helpful to hide any residual swelling and bruising, and to protect the scars from harsh elements.
  • Brow lift.   With endoscope or small camera probe, the procedure will only need several small incisions that can lead to about a week of social recovery; however, the initial healing phase could take longer with the standard technique in which one continuous incision from ear to ear, behind the hairline, is used.

WHAT HAPPENS TO THE INTERNAL SUTURES IN TUMMY TUCK SURGERY?

 

Tummy tuck surgery, or abdominoplasty, not just involves skin removal to create a flatter, more toned abdomen. For many patients, they will also require muscle tightening to achieve a smoother contour, as suggested by leading LA plastic surgeon Dr. Tarick Smaili.

Massive weight loss patients and mothers who have developed splayed muscle due to previous pregnancies often need muscle tightening or repair. While this additional procedure contributes to most of the pain and discomfort, and possibly longer recovery, most patients consider its benefits worth it.

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To tighten the splayed muscles, doctors either use permanent internal stitches or slow-dissolving absorbable sutures.

Nowadays, absorbable sutures are becoming popular because they are believed to cause less problems compared to permanent nylon stiches that tend to create small tears in the muscle over time.

Dissolvable sutures work by holding the muscles in place until scar tissue forms or the healing process permanently “secures” them. For most patients it takes about six weeks for the muscles to heal together.

While permanent sutures can still provide good results in the hands of skilled surgeons—since their knots are tight and strong and are relatively easy to handle—they might cause problems such as chronic irritation and infections.

The aforementioned complications rarely occur in absorbable sutures because there is no foreign material that stays longer after the surgery. Nevertheless, using them requires great care to prevent knots breaking or becoming loose.

Some surgeons only choose one type of sutures, while others “vary” their choice depending on the underlying anatomies and the patient’s cosmetic goals and expectations.

Other plastic surgeons also use mesh in addition to one or two layers of sutures to further create a stronger support. According to previous studies, the additional “scaffolding” is suitable for massive weight loss patients.

The use of several layers of closure is important to remove or at least minimize the tension on the skin, thus promoting “good” scarring—i.e., thin, flat, and faded scars.

By removing most of the tension on the skin, the wound can heal more efficiently and the scars are less likely to spread, become uneven, or migrate higher (thus becoming more visible), explains Dr. Smaili.

Aside from avoiding external sutures when doing the surgery, many surgeons these days are also using steri-strips and/or silicone tapes. The idea is to further eliminate tension on the skin to promote favorable tummy tuck scars.

GUIDE TO ACHIEVE SMOOTH TUMMY TUCK RESULTS

 

One of the goals of tummy tuck surgery, or abdominoplasty, is to deliver smooth skin—i.e., no hanging and redundant skin, bulges from incorrect wound closure or residual fats, or thick scars.

Impressive results from the surgery also preserve the natural valleys and shapes of the abdomen. For instance, the flanks or contours on the sides should appear smooth, and the area between the rib cage and pubis should have no fat rolls or any sign of asymmetry.

tummy-tuck-scarsLeading Beverly Hills plastic surgeon Dr. Tarick Smaili says smooth results are achieved by removing just the right amount of excess skin. Too little and the hanging appearance will remain, and too much the abdomen will look overly tight and fake.

The amount and location of redundant skin will dictate the tummy tuck scars and their pattern, although Dr. Smaili says the general rule of thumb is to position them beneath the bikini area so they remain discreet.

Most patients are suitable for the standard tummy tuck in which a U-shaped or relatively straighter scar from hip to hip is used, while massive weight loss patients may have to accept a longer scar that reaches their flanks for an additional amount of contouring.

Dr. Smaili says it is crucial to examine the quantity and quality of skin, which will dictate the scar pattern and length. Failure to acknowledge this anatomy—such as using shorter incisions despite the apparent need for a large correction—will lead to skin asymmetries, destruction of the abdominal contour, weird-looking navel and other “stigmata” of surgery, and poor healing.

Aside from the condition of skin, the leading Beverly Hills plastic surgeon highlights the importance of examining the abdominal fat, which may contribute to the appearance of lower pooch, muffin tops, and unsightly rolls. For this reason, he occasionally combines tummy tuck surgery with liposuction.

But if one requires large-volume liposuction, Dr. Smaili suggests staging the procedure to limit the surgical trauma, minimize the risk of complication, and achieve a more predictable result (liposuction first then followed by tummy tuck weeks or months afterward).

Nevertheless, over-correction or aggressive liposuction of the flanks and the quadrants of the abdomen is counterproductive especially if the goal is to achieve smooth results, Dr. Smaili warns.

And lastly, it is important to repair or tighten the muscles (with the use of internal sutures) that have become separated due to massive weight loss or pregnancy, he adds.

BREAST REDUCTION INSURANCE REQUIREMENTS

 

For some women, breast reduction is not a cosmetic plastic surgery, but rather a medically necessary procedure to address their neck and back pain, postural problem, non-healing skin irritation along the inframammary crease, and other symptoms of disproportionately large breasts.

While this procedure is usually covered by insurance, the requirements are becoming more and more restrictive. Nevertheless, a board-certified plastic surgeon who regularly performs the surgery can help you get pre-approval as he is familiar with the “process.”

breast-reduction-insurance-requirements

Los Angeles plastic surgeon Dr. Tarick Smailisays breast reduction insurance requirementsdiffer from issuer to issuer, and state to state. Nevertheless, they have common “denominators” such as:

  1. Extreme downsizing. The problem with this requirement is that some patients might be forced to get too much reduction just to satisfy their insurance issuer, leading to breasts that are too small for their liking.

However, even some reductions may relieve symptoms such as back and neck pain, rounded shoulder, and headaches. This is particularly true of petite women whose breasts are too large in proportion to their body.

  1. Proportion of the breast size to the body. This requirement is less restrictive as it allows smaller reductions because the patient’s height and weight are taken into account.
  1. Strict numbers. A growing number of health insurance issuers are becoming stricter when it comes to breast reduction coverage that some will only pay if the weight of the removed soft tissue is at least 500 grams per breast. This could pose a problem in small-framed women with overlarge cup size.
  1. Medical evidence. The more medical evidence a patient is able to present, the higher the chance of pre-approval. The general rule of thumb is to secure letters and recommendations from experts—such as board-certified plastic surgeon, chiropractor, internist, and orthopedic surgeon—attesting that the surgery can relieve one’s physical symptoms.
  1. Alternative non-surgical treatments. It is not uncommon for health insurance issuers to require policyholders to have tried weight loss and physical therapy first; however, this is a “tricky” requirement since women with overlarge breasts find it hard, if not too painful, to perform even the easiest exercise.

Nevertheless, it remains helpful to be near one’s normal weight prior to breast reduction or any type of body contouring procedure because it is easier to predict the results, particularly the proportion of the breast to the body frame.

Despite the challenges of securing insurance pre-approval, Dr. Smaili says a patient can always demand an appeal if the first request is denied.


 

FACELIFT AFTER PHOTOS—WHY THEY PLAY A CRUCIAL ROLE IN SURGEON SELECTION

 

Facelift surgery is not just about lifting the skin and soft tissue of the face; a more important goal is to deliver results that look natural, with no “stigmata” or visible signs of the procedure.

Aside from your surgeon’s credentials—such as his board certifications, plastic surgery affiliations, training, and relevant experience—you should also scrutinize his facelift before and after photos, which will reveal a lot about his artistic skills.

facelift-before-and-after-photos

Most surgeons’ who maintain a website also make some of their before and after photos accessible online.

Leading Los Angeles plastic surgeon Dr. Karan Dhir explains the variables that you should look into when gauging the “after” facelift photos.

  1. There should be no visible scars. The incisions used in any facelift procedure are within the ear’s contour and/or behind the hairline to hide the scars, although excessive tension on the skin and incorrect direction of pull could lead to scar migration.
  1. The hairline and side burn should look normal. They should maintain their preoperative appearance before the surgery is considered a success.

Meanwhile, the disappearance or distortion of side bun and lack of hairline “continuity” are telltale signs of the surgery that must be avoided at all cost. Should they appear, you may need to undergo hair transplantation, scar excision surgery, or skin flap rotation.

  1. The ears in the after photos should maintain their original position and appearance. Pixie ear deformity is arguably one of the most blatant signs of surgery since it appears “pulled” inferiorly.

To correct the pixie ear deformity, the earlobe must be released from the lateral cheek and then reattached in a higher position; it is equally important to use a layered wound closure to eliminate or at least reduce the tension on the skin.

In addition, the ears in the after photos should have no excessive fullness in front of the ear canal, which is generally caused by under-correcting the loose, excess skin.

  1. The overall result should look balanced. A good facelift should also include the neck to achieve a more rejuvenating effect; failure to address the signs of aging in the lower third of the face will make them appear more obvious.

While facelift does not completely eliminate all the signs of aging, the postop appearance of the jaw line and neck area should appear smoother and tighter than the “before” photos.

  1. The result should look smooth, not overly tight. Nowadays, skin-only lifts are rarely used because they can lead to “surprised” or windswept appearance, flat cheeks, distorted hairline, and slanted eyes.

CHOOSING A PLASTIC SURGEON FOR BREAST AUGMENTATION PROCEDURE

 

Contrary to popular belief, the goal of breast augmentation procedure is not just about creating a bigger cup size, but more importantly, to deliver results that look and feel natural.

Good results from the procedure is only possible in the hands of a qualified plastic surgeon, or to be more specific, a board-certified doctor who regularly performs the surgery and has impressive breast augmentation pictures.

breast-augmentation-pictures

(Note: The general rule of thumb is to choose a member of the American Board of Plastic Surgery, which is recognized by the American Board of Medical Specialties. Meanwhile, there is no recognized certifying board with “cosmetic” or “aesthetic” surgery in its name.

You can visit ABPS website or its online database to check if a surgeon is a member of this reputable certifying board.)

All plastic surgeons have before-and-after photos to showcase their artistic skills and also help their future patients make an informed decision, as suggested by Beverly Hills plastic surgery Dr. Tarick Smaili.

Take a look at the breast contour of the “after” photos. They should appear like a teardrop, with most of the volume in the lower poles while the upper cleavage must look concave rather than globular—unless there is a specific instruction from the patient who wants exaggerated fullness in the area.

A slight lateral bulge is also deemed attractive as it contributes to the hourglass figure, although remember that one’s underlying anatomies also affect the final appearance, says Dr. Smaili.

You should also look at the distance between the lower edge of the areola and the inframammary fold, which primarily depends on the breast size although for the “average” women it is normally 5-6 cm. But in general, the bigger the cup, the greater the gap tends to be.

Once you are confident with a doctor’s qualifications, you may schedule a consultation with him. This will allow you to assess his “principles” and surgical approach that will help you achieve your desired results from breast augmentation procedure; it is equally important that you are comfortable with that provider.

During consultation, ask for the chance to talk to some of your surgeon’s patients who have undergone the procedure. This is also an opportunity to prepare yourself emotionally and psychologically during the initial healing stage when pain, lethargy, bruising, and swelling will contribute to your “postop blues.”

BREASTS TOO HIGH AFTER BREAST AUGMENTATION SURGERY

 

It is not uncommon for the breasts to appear too high on the chest wall after breast augmentation surgery, although they are supposed to “drop” or “settle” in three to six months, resulting in a more natural appearance.

Take note that it takes time for the breast skin and soft tissue to adjust to the new contour, thus high-riding implants are not uncommon during the initial breast augmentation recovery. Meanwhile, the postop swelling further aggravates the appearance of “excessive” upper cleavage.

breast-augmentation-recovery

While high-riding implants are not uncommon during the initial healing stage, leading Los Angeles plastic surgeon Dr. Tarick Smaili instructs his patients to perform regular massage, or medically referred to as implant displacement exercise, to accelerate the “settling.”

Breast implant massage is also known to maintain the natural softness of the breast tissue and internal scar tissue that forms around the device, explains Dr. Smaili.

Other postop solutions for high-riding breast implants include compression garments and upper pole bands, although Dr. Smaili says time remains the best “treatment.”

Remember that the aforementioned solutions will only accelerate the settling of the implants, and any high-riding appearance that remains “stubborn” after four to six weeks will always need a revision breast augmentation, warns the leading Los Angeles plastic surgeon.

To prevent excessive fullness in the upper breast pole, Dr. Smaili highlights the importance of correct implant pocket dissection. One way to do this is to perform the surgery while the patient is sitting up, a technique that allows any surgeon to correctly assess the breast size, projection, and contour.

To further create natural-looking results, Dr. Smaili says that some patients may require their inframammary crease to be lowered; the idea is to position the implants approximately at the center of the breast mound, behind the nipple area.

Also, the additional distance between the inframammary fold and nipple area might also create some lifting effect, further contributing to the perkier, more youthful appearance.

In addition, using the correct breast implant base diameter (side to side dimension) and size also plays a crucial role in simulating the natural projection and shape. The general rule of thumb is to respect and acknowledge the existing measurement of the breasts.

Meanwhile, an implant whose base and profile goes beyond the existing dimension of the breast can lead to “over-projection” and excessive upper breast pole fullness. Other possible results include palpability, rippling especially along the sides, and globular/unnatural shape.

FACELIFT REVISION SURGERY FOR HAIRLINE AND EAR DEFORMITIES

 

The reasons for facelift revision surgery vary from patient to patient. Others want to regain the impressive results of the initial procedure that they lost due to continued aging, while some need correction of hairline and ear deformities due to a poorly executed surgery.

Facelift surgeries often use an incision that starts in the hairline at the temple, which continues around the ear; however, there are “shorter versions” that lead to shorter scars. The idea is to hide them behind or within the hair-bearing scalp, and inside the natural creases of skin.

facelift ear scars

Aggressive or incorrect direction of pull is one of the causes of unnatural temporal hairline, loss of side burn and hair behind the ear, and bald patches around the incisions. While some hairstyles could camouflage them, most patients will want to correct these telltale signs of surgery.

The aforementioned problems are typically treated with hair transplantation in which hair follicles from the back of the scalp are moved to the area that needs correction or “coverage.” But to achieve impressive results and avoid the doll’s hair appearance, it is crucial to group the hair in smaller units.

Other possible methods to correct the distortion or loss of side burn and temporal hairline include scar excision surgery and skin flap rotation, with the latter being more suitable for patients who need their hairline “continuity” to be restored.

Regardless of the approach being used, it is a sacrosanct rule to use a tensionless, layered wound closure, as suggested by Beverly Hills plastic surgery expert Dr. Tarick Smaili.

Another reason for facelift revision surgery is to correct ear deformities—e.g., excess skin or too much fullness in front of the ear, pixie ear or “pulled appearance,” and visible facelift ear scars.

Fullness in front of the ear is usually corrected with a minor procedure (under local anesthesia) in which a small portion of skin is removed in front of the ear canal.

A pixie ear deformity, meanwhile, is best addressed by releasing the earlobe from the cheek skin then reattaching it in a higher position. It is also crucial to close the tension with no or very little tension on the skin to prevent the ears from stretching inferiorly.

And for the facelift ear scars that appear visible—i.e., they migrate outside the contour of the ears—treatments such as scar excision, steroid injection, silicone tapes, and topical creams could improve their appearance.

FACELIFT FOR JOWLS

 

Facelift for jowls comes in several incision patterns because aging differs from patient to patient; further complicating things is that each of them has a different underlying anatomy. The general rule of thumb is to customize the surgery to achieve impressive, natural-looking results.

Jowls might be caused by several factors such as redundant skin, excess fat, soft tissue or fat atrophy (receding or disappearing), or cheek fat that has sagged to a significant degree. For some patients their jowling is caused by two or more variables, thus careful analysis must be done to achieve good results.

facelift-for-jowls

For most patients their jowl can be addressed by a SMAS facelift procedure in which the connective tissue below the skin is reshaped and tightened, creating strong framework and results that can last longer than a skin-only lift.

The length and position of incision greatly varies, although the general rule of thumb is to place it behind the hairline and/or “inside the ear,” or specifically within the natural skin creases. The idea is to hide the scars that no one can detect them even at a conversational distance.

SMAS facelifts not only reshape and tighten the jaw line, but also correct the appearance of nasolabial folds, or more commonly referred to as “laugh lines,” as it can elevate the corners of the mouth.

Another benefit of going deeper is the “favorable” scarring—i.e., fine flat scars that are barely imperceptible. Because most of the tension is on the SMAS layer, which carries the skin, the wound can heal without the unnecessary pull.

Skin-only facelifts, meanwhile, are often criticized for their thicker, wider scars because the skin receives most of the tension. Another downside is the short-lived results because the deeper structure of the face has not been tightened and reshaped.

Aside from loose skin, fat or facial volume loss might also contribute to the appearance of jowling, with the deep laugh lines further aggravating the aged look. In this situation, volumizers such as dermal fillers or fat grafting can be of great help.

The idea of combining SMAS facelift and volumizers is to address facial aging in a 3D approach, thus creating a more natural and more rejuvenated appearance without having to worry about the windswept or perennially surprised look.

Meanwhile, some patients can benefit from a minimal facial liposuction to correct the appearance of jowl, although the soft tissue must be tightened as well if they appear hanging. Nevertheless, it is crucial to preserve some fat to avoid the jaw line from appearing skeletonized.


 

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.


 

WEIGHT LOSS SURGERY INSURANCE

 

During a weight loss surgery, or bariatric procedure, doctors make some changes to their patients’ stomach and/or small intestine in an attempt to improve their satiety. For the right candidates, studies have suggested the surgery can significantly improve their health, mobility, and overall quality of life.

Weight loss surgery insurance has become more accessible for obese patients after the passage of the Affordable Care Act (Obamacare) in which issuers from 23 states are required to cover the procedure’s cost for all Individual, Family, and Small Group Plans.

weight-loss-surgery-insurance

Nevertheless, some insurance companies exclude weight loss surgery from their plans, while others have very stringent requirements that would make it next to impossible to receive pre-approval.

But to allay some concern, take note that many patients have successfully gain insurance approval after appealing the initial decision of their issuers and presenting additional evidence suggesting that their weight loss surgery is the only long-term, viable solution for their life-threatening weight-related health problems.

Aside from medical documentation, it is not uncommon for health insurance issuers to require their policyholders to have tried medically supervised weight loss options (which have failed) before coverage becomes even possible.

To increase your chance of pre-approval, ask your surgeon to contact your insurance company since his office will be very familiar with the requirements and the entire approval process. He can also send them letters of recommendations and complete documentation—such as diet and medical records, and previous attempts to lose weight—stating that your bariatric surgery is “medically” warranted.

Another viable option is to check your policy, including the “fine print,” and then contact your insurance company to ask for additional details.

Aside from your surgeon’s recommendation letter, other experts such as your nutritionist, dietician, and behaviorist’s “endorsement” verifying the medical necessity of your weight loss surgery insurance can also help build your case, increasing your chance of getting approved.

While many health insurance issuers now cover the cost of bariatric surgery, this is not the same with plastic surgery after weight loss, which is generally categorized as an elective procedure. Nevertheless, patients may resort to other financing options such as bank loans, regular credit cards, medical credit cards, home equity loans, unsecured medical loans, and doctor’s payment plans.

It has been well documented that plastic surgery after weight loss such as tummy tuck and lower body lift can serve as a strong motivation for post-bariatric patients to maintain a health, stable weight long-term.

FULL FACELIFT VS. MINI LIFT

 

Facelift surgery comes in several techniques and terminologies, which differ from surgeon-to-surgeon. Nevertheless, good results are only achieved by customizing the surgery based on the patients’ cosmetic goals and their underlying anatomies such as skin quality and bone structure.

A standard facelift primarily targets the sagging cheeks, jowling, and turkey neck appearance. It has no effect on the upper third of the face, which requires a different procedure called forehead lift. Meanwhile, combining these two surgeries or other techniques that aim to rejuvenate the entire face, or at least most of its area, is called full facelift.

facelift-surgery-procedure

On the other hand, a mini lift procedure is a very broad term that may describe a mid facelift, lower facelift, brow lift, forehead lift, or short-scar lift. But despite the confusing terminologies, it is generally used in patients with early features of facial aging or “isolated” problems such as sagging cheeks, jowling, neck bands, or laugh lines (nasolabila folds).

Also, a mini lift typically uses shorter incisions than a standard or full facelift wherein the scar lies behind the hairline near the temple and then goes around the ear, specifically within its natural skin creases to hide any telltale sign of the surgery.

In mini lift, a scar is typically hidden just behind the ear or around it.

While a mini lift procedure can deliver impressive results, it is only suitable for patients who have maintained a good amount of skin elasticity, with just mild changes in the lower third of their face, specifically the jaw line and neck area.

Performing mini lift surgeries on individuals who have more noticeable signs of facial aging is like under-correcting the problems. In worst case scenario, it leads to unfavorable scarring or skin asymmetries, which are telltale signs of plastic surgery. Simply put, proper patient selection is crucial to achieve impressive results from any type of facial rejuvenation surgery.

Regardless of the facelift technique used at the time of surgery, it is always crucial to go deeper into the facial structures to achieve more rejuvenating effects and longer lasting results. The idea is to lift the SMAS, which is a layer of skin where the soft tissue and muscle are attached, and not just the skin alone.

A skin-only lift, while it provides immediate rejuvenating effects and shorter facelift recovery, almost always leads to short-lived results because the skin will eventually sag due to the “weak” or loose SMAS that has not been reinforced.

BLEPHAROPLASTY FOR HOODED EYES

 

Eyelid surgery, or blepharoplasty for hooded eyes, is a highly customized procedure because the underlying cause of the problem is different from patient to patient. Other factors that are taken into account include a person’s cosmetic goals and anatomies, as explained by leading Beverly Hills plastic surgeon Dr. Tarick Smaili.

One of the most common causes of the hooded appearance is the excess skin in the upper eyelid, which happens with advancing age, although sometimes genetics could also play a role.

blepharoplasty-for-hooded-eyes

Skin resection via incision within the natural eyelid fold (to hide the scars), with or without fat removal, is usually enough to correct the aforementioned problem. However, it is crucial not to over-do the procedure to avoid skin retraction, unnatural appearance, and unfavorable scarring.

It is equally important to preserve some fats in the upper lid area to simulate the “youthful plumpness” of the face. Over-aggressive fat removal, meanwhile, can lead to a skeletonized appearance of the eye socket, Dr. Smaili warns.

Another possible cause is the descent of the lateral eyebrows that is better addressed by a brow lift, which is way different from the primary goal of eyelid surgery.

Most brow lift surgeries just address the lateral aspect of the eyebrow because the medial part rarely sags to a significant degree to the point that it requires some lifting. The idea is to raise just the “outer half” of the brow to show more of the eyelid platform.

The third cause of a hooded eyes appearance is eyelid ptosis in which the levator muscle becomes weak to the point that it can no longer support the skin and other structures of the lid. This underlying problem requires a more complex approach than a skin-only resection.

Patients with ptosis need their levator muscle to be tightened, which could be done with the use of strands to raise the lids (they are positioned between the eyelid and eyebrow). While this technique can correct the underlying problem, it is not uncommon for patients to experience temporary incomplete blink and dryness of the eye.

With time, patients should be able to close their eyes fully, although in the initial healing stage they will have to frequently lubricate their eyes with drops and/or ointment to prevent them from drying out.

Sometimes, plastic surgery insurance is possible if the excess upper eyelid skin or muscular ptosis is affecting a patient’s vision. But proper documentations, e.g., photos, clinical exams results, visual field tests, and specialist’s recommendations are needed for pre-approval.

LIPOSUCTION SAFETY GUIDELINES—WHAT IS THE SAFE AMOUNT OF REMOVED FAT?

 

Liposuction procedure removes the excess fat underneath the skin with the use of suction. Nonetheless, it is not a weight loss surgery since it is too risky to remove the deeper visceral fat, which only responds to “real” weight loss—regular exercise and healthy diet.

According to a recent report published by the Plastic and Reconstructive Surgery journal, the safe amount of fat to remove during liposuction is determined by the patient’s body mass index or BMI.

liposuction-procedure

While the perceived safe volume during liposuction surgery is up for debate, with current guidelines suggesting that no more than 5 liters of fat should be removed per treatment, the study has shown that people with higher BMIs who had a greater liposuction volume experienced a lower complication rate.

Patients with lower BMIs who had a greater liposuction volume, meanwhile, experienced an increased risk of complication arising from seromas or collections of fluids beneath the skin.

Nevertheless, patients who had large-volume liposuction—or removing more than 5 liters of fat in one surgical setting—had the highest complication rate: 3.7 vs. 1.1 percent.

The study analyzed data of around 4,500 patients who had liposuction in which the overall complication rate was 1.5 percent, with no death reported. Meanwhile, the average amount of removed fat was approximately 2 liters.

Aside from the amount of removed fat relative to the patient’s BMI, liposuction risks are also tied to concomitant procedures (breast augmentation, tummy tuck, body lift, etc.), length of surgery, and overall health of the patients, as suggested by the researchers.

Celebrity LA plastic surgeon Dr. Tarick Smaili, who is not part of the study, also suggests that liposuction risks are also higher among smokers because the nicotine found in tobacco products constricts the blood vessels, thus retarding wound healing and leading to poor oxygen circulation.

Other risk factors include hypertension and medical conditions that can affect healing, use of blood-thinners, malnourishment/undernourishment, and excessive surgical trauma due to unrelated procedures performed at the same time as liposuction, he further explains.

RECOVERY AFTER BREAST IMPLANTS WITH LIFT

 

Breast implants with lift can accomplish two goals in one surgical setting—raise the drooping breasts and create more fullness, especially in the upper pole that has the tendency to appear deflated with advancing age. For the right patients, this is a cost-effective approach because they will only have to pay for one facility and anesthesia fee.

Contrary to popular belief, breast implants with lift in general does not lead to longer recovery than breast lift- or augmentation-alone procedure.

breast-lift-with-implants

Leading Los Angeles plastic surgeon Dr. Tarick Smaili says the combo procedure favors women who need mild to moderate correction of their sagging breasts, while individuals with a significant amount of drooping may have to stage their surgeries to achieve a more predictable result.

Ideally, the surgery should involve the use of smaller breast implant sizes to prevent pulling on the wound used during the concomitant breast lift. And by choosing a more conservative augmentation, the patient can also expect a more straightforward healing.

Overlarge breast implants, meanwhile, are tied to longer, more painful recovery because they can pull on the wound and stretch the skin, which over time could lead to a wide array of cosmetic problems such as rippling, palpability, implant displacement or shifting, and bottomed-out appearance.

Breast implants that are too large for the pre-existing tissue can also lead to accelerated aging of the breast and sagging, thereby defeating the purpose of breast lift surgery, warns Dr. Smaili.

With proper patient selection and judicious surgical approach, most patients are back on their feet seven to ten days after surgery, although they should wait for another two to three weeks before they can resume their rigorous exercise routine and other physically demanding tasks.

In the first few days of surgery, Dr. Smaili says it is normal to experience swelling, bruising, soreness, stiffness, and mild to moderate pain in the chest region—symptoms that can be controlled by painkillers, muscle relaxants, and rest.

These symptoms are supposed to subside as the patient moves forward to her recovery, thus any increasing pain and persistent swelling should be reported immediately because these might be a sign of infection or healing problem, says the celebrity Los Angeles plastic surgeon.

Numbness or hypersensitivity of the nipples or certain areas of the breast is also a common part of recovery. This will resolve over time, although some patients may experience tingling sensation for several weeks caused by the nerves starting to “awaken.”


 

TOP 5 REASONS WHY KELLER FUNNEL BREAST AUGMENTATION IS GOOD FOR YOU

 

Since the introduction of Keller Funnel in 2009, the device has received nothing but praises from breast augmentation surgeons because it can significantly reduce the risk of breast implantcontamination, which leads to other benefits.

The Keller Funnel resembles an icing bag whose internal surface has an oily coating that paves way for a quick and efficient implantation, explains one of the leading breast augmentation surgeons Dr. Tarick Smaili. Right after opening the silicone implant from its sterile package, it is poured inside the device which is then squeezed a couple of times to propel the implant into the pocket.

breast-augmentation-keller-funnel

These are the top five reasons why Keller Funnel breast augmentation is good for you:

  1. It prevents the implants from touching the skin.

The cone-shaped device allows the transfer of breast implant into the pocket without allowing it to touch the skin around the incision site, which is known to harbor bacteria that could lead to shell contamination and infection.

The narrower end of the cone is positioned about 1 cm into the center of the breast pocket before it is squeezed several times to propel the implant into its proper place.

According to studies, compared to finger-push implantation the use of Keller Funnel can reduce the risk of bacterial contamination by up to 200 percent.

  1. The technique lowers the revision rate.

With no implant contamination or “deep” infection, the risk of capsular contracture or tissue hardening can be minimized as well. The theory is that a low-grade infection triggers the body to “over-react” and produce a copious amount of collagen around the implant, eventually leading to visible deformity and pain.

  1. Shorter incision is possible.

The main appeal of saline implants, which are filled with sterile salt water once inside the pocket, is the use of smaller incisions, about 1.4 inches or sometimes even shorter. Nevertheless, their results are not as natural as the silicone implants, which are always prefilled by their manufacturers.

With finger-push method silicone implants require an incision usually longer than 2 inches, but with Keller Funnel device they can be introduced into the pocket through the same opening as required by saline implants, leading to a shorter and less conspicuous scar.

  1. It can significantly reduce the amount of force.

Excessive force applied to any portion of the implant could affect its long-term stability (i.e., more prone to rupture), which is often unavoidable with the use of finger-push method.

But with Keller Funnel, the force is efficiently redistributed around the implant shell at the time of insertion. As a result, the stability of the prosthesis is relatively unaffected after surgery.

  1. This breast augmentation technique can reduce tissue trauma.

The insertion of silicone implant with Keller Funnel on average only takes 10 seconds, which reduces surgical trauma and at the same time shortens the surgery by 10 to 20 minutes, as suggested by several studies.

BREAST APPEARANCE AFTER MASTOPEXY

 

Mastopexy, or more commonly referred to as breast lift surgery, is reserved for women with breast ptosis (sagging) wherein their nipple-areola complex falls within or far below their inframammary fold.

The inframammary fold is where the breast meets the chest and is most apparent in women with larger and/or saggy breasts.

breast-lift-surgery

Using strategically placed incisions, this type of surgery can tighten the loose tissue and skin and at the same time reposition the low-lying nipple area near the center of breast mound.

To help you better understand the surgery’s effects and determine whether your aesthetic goals are achievable, the list below describes the breast appearance after mastopexy:

* The original position of your inframammary fold will remain the same.

While mastopexy can raise the drooping nipple-areola complex to further create a “perkier” appearance, take note that it does reposition your inframammary crease. Simply put, the surgery cannot change your breast height.

* It can only reshape the mid to lower half of the breast.

Breast lift uses incisions within the lower half of the breast mound (e.g., around the nipple area, vertically from the areola down to the crease, and/or inside the inframammary fold), so it has no effect on the shape and appearance of the upper cleavage. Thus, if you have a deflated-looking upper breast pole, it will remain the same after surgery unless you will ask for small implants to achieve some fullness in the area.

* Scar is always a tradeoff.

Any time the skin is cut or injured, scar will always develop. However, it is supposed to heal and fade drastically within a year and is hidden even if you are wearing a low-cut top.

To encourage the scars to fade and heal well—and prevent them from becoming thick and noticeable—it is important to minimize the tension on the skin and work deeper into the layers of the breast to support to the new contour rather than use skin-only lift techniques.

With proper surgical techniques and post-op care that may include the use of scar treatments, for the vast majority of patients breast lift scars are barely noticeable.

* The nipple is repositioned higher.

In a youthful breast, the nipple lies in the center of the “mound.” However, it should not be too high lest it will lead to a very unnatural result that could appear worse as the soft tissue continues to age and respond to gravity.

* Your breast size will remain the same.

If you have overlarge, droopy breasts, the best approach is to combine mastopexy with reduction mammaplasty—or more commonly referred to as breast reduction surgery—to prevent or at least postpone re-drooping. And for most patients, the “combo” procedure also results in a more balanced appearance.

5 WAYS FOR TIP RHINOPLASTY TO DELIVER NATURAL RESULTS

 

One of the most common goals of rhinoplasty surgery is to improve the appearance of the nasal tip of patients. But as with any plastic surgery, its quintessential aim is to create results that look natural rather than “operated.”

Dr. Karan Dhir, a leading facial plastic surgeon based in California, says there are five essential ways for tip rhinoplasty to deliver natural results and at the same time prevent or at least minimize the risk of complications.

tip-rhinoplasty-surgery
1.  All the components of the nose must be taken into consideration.

If you are unhappy with the appearance of your nasal tip, more often than not your only focus is the area. But take note that most tip rhinoplasty patients require several of their nasal components such as the nostril, bridge, and/or radix or “root” of the nose to be enhanced as well to achieve a more balanced, natural result.

2.  Your gender determines the ideal nasal tip angle.

Studies have suggested that for female, the ideal angle between the nasal tip and upper lip is between 104 and 108 degrees, which results in a slightly upturned nose. The general rule of thumb is that an angle at least greater than 90 degrees can lead to a more feminine, attractive face.

On the other hand, the ideal nasal tip angle for men is near 90 degrees, leading to a straighter nasal profile than women.

3.  Your skin quality determines the “viable” amount of correction in rhinoplasty surgery.

The amount of tip refinement, according to Dr. Dhir, also depends on your skin thickness and its overall quality. The goal is to reshape the nose in a way that the skin can effectively redrape to its new contour rather than look amorphous or ill-defined.

Younger individuals, women, and Caucasians in general have a thinner skin (than “seniors,” men, and ethnic patients) that redrapes better than thicker skin.

4.  The ideal tip projection for most patients is 0.55-0.60.

Nasal tip projection deals with how far the tip of the nose protrudes from the face, which is measured through a method called Goode.

In Goode method, a line is drawn starting from the bridge to the tip, and another one is created from the base of the nostril to the tip again (imagine a half triangle). Conventional wisdom suggests that a ratio of 0.55-0.60 is the ideal tip projection for most patients.

5.  Your facial width determines the ideal nasal width.

Draw imaginary lines that divide your face into five equal vertical columns. Your nose, which lies at the center, should fall [almost] exactly within the central fifth to be considered ideal, including the outer margin of the nostril.

But remember that ethnic patients can tolerate a slightly wider look but still maintain an attractive-looking nose.

WHAT IS SUB-PECTORAL BREAST AUGMENTATION TECHNIQUE?

 

A good breast augmentation result must simulate the appearance of unoperated breasts—and that means no implant rippling, they are soft to the touch, and have a teardrop shape in which most of the volume is in the lower poles.

Contrary to popular belief, natural results are not only achievable through the use of the “right” breast implant size and style. Breast enhancement expert Dr. Tarick Smaili says that surgical techniques, particularly the implant placement, can also play an important role in delivering good cosmetic outcome.

subpectoral-breast-implant-placement

There are two basic ways to position the implants relative to the muscle: unders or sub-pectoral (also called submuscular), and oversor subglandular.

For many patients, Dr. Smaili says that the sub-pectoral breast implant placement in which the prosthesis lies underneath the thick layer of muscle is a more suitable choice than subglandular technique or overs.

In this technique, the upper two-thirds of the implant is covered by pec muscle, thereby preventing or at least minimizing the risk of rippling and palpability. But because the lower third of the prosthesis is only covered by the soft natural tissue, the technique allows the breast to appear teardrop in shape.

While most breast augmentation patients can benefit from the sub-pectoral approach, Dr. Smaili says that it is particularly favorable to thin and small-breasted women who have little “coverage.”

For patients with little natural tissue, rippling and palpability are more likely to occur with the use of subglandular in which the implants lie above the pec muscle. To achieve good results from this surgical technique, one has to have an adequate amount of glandular tissue and fat.

Aside from cosmetic benefits, the sub-pectoral implant placement could also minimize the risk of capsular contracture or tissue hardening, explains the renowned plastic surgeon.

Studies have suggested that capsular contracture is often caused by low-grade infection or contamination of the implant at the time of surgery. But with sub-pectoral, the muscle can serve as a barrier that prevents the prosthesis from making contact with the tissue that is known to harbor bacteria.

In terms of allowing the breast to age “gracefully,” the sub-pectoral implant placement is often considered a better option than subglandular because the muscle also acts as a “sling” that supports the implants. According to Dr. Smaili, the technique specifically reduces the risk of bottoming out in which the prostheses “go down south” due to tissue laxity and gravity.

But one potential issue with sub-pectoral is breast animation, which happens when the implant is slightly pushed by the muscle each time it is being flexed. Nevertheless, this is a tradeoff if one has little tissue and does not want visible rippling, which of course is more problematic.

COULD BREAST IMPLANTS SIMULATE THE NATURAL BREAST SHAPE?

 

There is more to breast implants than augmenting a small bust size. First and foremost, they are supposed to provide results that look natural in terms of appearance and shape that a common observer will not be able to tell if you have had the surgery.

While the term natural-looking results can be interpreted in many ways, depending on the personal views of patients, in essence the breast shape should resemble a teardrop in which the lower aspect has less fullness, while the lower bottom has most of the volume, explains leading plastic surgeon Dr. Tarick Smaili.

breast-implant-natural-shape

With decades of experience, Dr. Smaili explains his techniques that help him simulate the natural breast shape with the use of breast implants:

* The inferior origin of the breast must be adequately released.

The goal of this technique is to prevent the implants from riding up too high, leading to a globular look or exaggerated fullness in the upper aspect of the breast. To simulate the natural shape, it is important for the prosthesis to drop a bit so the lower bottom will have most of the volume.

* The submuscular breast implant placement is often the most ideal choice.

Aside from minimizing the risk of rippling and palpability because the technique allows the thick layer of muscle to cover the upper portion of the implants, it is also notable for delivering natural breast shape.

And because the lower bottom of the implant is only covered by fascia, which is a strong connective tissue that serves as an “internal bra,” it allows the prosthesis to take on a teardrop shape.

* Use round implants with the right profile or projection.

Once inside the breast pocket, round and teardrop/anatomical implants adopt the same shape because of the effects of gravity—i.e., pulling most of the filler material to the bottom of the shell.

But the advantage of round implants over anatomical implants is that they eliminate the risk of deformity caused by “flipping over” since all their sides are symmetric.

To provide natural results, round implants must have the right amount of projection, which is determined by your underlying anatomies. The general rule of thumb is that only a small to moderate upper fullness in the upper breast poles must be allowed to simulate the teardrop appearance.

Using a conservative implant size (or within the limits of your chest and breast measurement)—rather than overlarge ones—can further help you achieve a more natural breast shape and a result that looks proportionate to your body frame.


 

HOW SKIN QUALITY AFFECTS LIPOSUCTION RESULTS

 

Liposuction surgery or lipoplasty removes the excess superficial fat, which lies just underneath the skin, through several small incisions that can heal and fade well without causing visible scar. But as with any body contouring surgery, it is not a substitute for weight loss and healthy lifestyle.

Aside from the patient’s weight, her skin quality—particularly when it comes to its elasticity and firmness—also affects the liposuction result.

skin-quality-liposuction-results

A skin with a “decent” amount of elasticity, which is commonly found in younger patients who have maintained a healthy weight throughout their lives, can redrape better to the new contour than loose skin. Nevertheless, “older” individuals could a still expect good cosmetic results after surgery.

Meanwhile, patients with noticeably poor skin elasticity could develop some visible wrinkling. For this reason, liposuction is occasionally followed by certain procedures such as Thermage in which the goal is to “heat” the skin and/or break up the cellulites.

Most patients below the age of 40 have a decent amount of skin elasticity, which allows it to contract during the healing phase and leads to a smooth result. However, the “process” of redraping could take up to six months.

Nowadays, the most commonly treated area is the abdomen because it has the tendency to carry excess superficial fat even among thin people. It is important to note that abdominal liposuction could only deliver good results if the patient has maintained good skin quality and has no splayed muscle caused by pregnancy.

If there is a significant amount of loose skin and splayed muscle, which might be caused by pregnancy and massive weight fluctuation, a tummy tuck is a far better option than liposuction.

However, plastic surgeons have noticed that the lower aspect of the abdomen can redrape better than its upper region after a liposuction surgery, a characteristic that is attributed to the presence of a membrane called scarp fascia.

Simply put, liposuction of the lower abdomen tends to provide a smoother result than surgery involving the upper abdomen.

Nowadays, liposuction uses a thinner cannula that can easily fit into smaller incisions—about the size of a small grain of rice. This is the main reason why most scars fade and heal efficiently even without the use of sutures, although dark-skinned patients might have to wait a little longer than fair-skinned individuals for their scars to become less noticeable.

Also, patients with a darker complexion might experience skin discoloration (hyper- or hypo-pigmentation) after liposuction surgery. To avoid or at least minimize such risk, the use of microcannula that requires a very small incision is important, as well as positioning the scar in “discreet” areas—e.g., underneath the bikini line and within the natural folds of skin.

TECHNIQUES TO DELIVER MORE NATURAL RESULTS WITH SALINE BREAST IMPLANTS

 

About three-quarters of breast augmentation patients today are choosing silicone implants over saline implants because the former can deliver better cosmetic results even in patients with little “coverage.”

While both breast implants are made of an outer silicone shell, their main difference is the filler material that moves and “behaves” distinctly from each other.

saline-breast-implants

Saline implants are inflated at the time of surgery with a predetermined amount of sterile saltwater solution, while silicone implants are always prefilled with a viscous type of medical-grade silicone gel.

The main appeal of saline implants is that they do not pose any risk of gel leak and its side-effects such as pain and tissue inflammation (in the event of rupture) because the saltwater solution is easily and quickly absorbed by the surrounding tissue.

Because asymptomatic or “silent” leak is not a concern with saline implants, regular MRI exam—which might be too expensive for some patients—is not a requirement, unlike with the use of silicone implants in which the procedure is part of their “maintenance.”

To compensate for the “sloshing effect” of saline implants, certain techniques and appropriate implant design and size are used to deliver more natural results.

The first step to deliver natural results with breast implants, no matter what kind of filler material they are using, is to choose a conservative size based on the patient’s chest/breast measurement (vertically and horizontally) and the amount of her existing soft tissue.

By going conservative, the soft tissue is more palpable than the implants, leading to a softer and more natural result.

Smaller saline implants, or at least not larger than 350 cc, can also reduce the likelihood of visible rippling.

Patients who are opting for saline implants also fare better with a submuscular technique wherein the prostheses are placed underneath the thick layer of pec muscle, which provides additional coverage. While it results in more post-op pain and longer recovery, the “cosmetic” benefits still far outweigh the “temporary” drawbacks.

Using the right implant profile or forward projection can also help saline implants deliver results that look and feel more natural. The rule of thumb is that women with a narrower chest are best suited for implants whose base is equally small, while patients with a wider frame need a design that complements their anatomy.

And for patients whose breast tissue is saggy, while their upper cleavage looks deflated, breast implant with mastopexy (or more commonly referred to as breast lift) is the only surgical approach that could provide them good aesthetic results.

IS LIGHTHEADEDNESS COMMON AFTER LIPOSUCTION?

 

Recovery after liposuction surgery differs from patient to patient; some individuals are able to return to their work within two to three days, while others require a longer work off to give the swelling and bruising enough time to dissipate.

Meanwhile, it is not uncommon to experience lightheadedness after liposuction, which is caused by several factors. But in most cases, the “feeling” will only last about a day as the body flushes out the anesthetics and other excess fluids.

lightheadedness-liposuction

Aside from the surgical trauma and anesthetics, the lightheadedness might be also caused by decompression of the lower extremities after removing the compression garments.

While the temporary “fainting episode” does not pose serious threat, certain steps to prevent fall injuries and inconvenience remain important.

Anecdotal reports show that lightheadedness is common after urinating the morning following the surgery. For this reason, the usual advice is to stand up slowly and carefully after using the toilet.

Just to be on the safe side, some patients may also ask a capable adult to accompany them in the bathroom.

In case the patient starts to feel dizzy or lightheaded, the best thing to do is to sit down or lie down immediately on the floor until the feeling subsides to prevent fall injuries.

Because decompression could lead to lightheadedness, compression garments must be removed slowly if the patient is going to take a shower, preferably with another person’s assistance. Some doctors also believe that eating a small amount of food before taking off the garment could also prevent fainting episodes.

Eating small amounts of food every couple of hours could prevent hypoglycemia or low blood sugar, which is another cause of dizziness. It is important to note that the body needs glucose to have enough energy to perform its normal functions.

While the most common sign of hypoglycemia is hunger, patients should also look out for irritability, racing pulse, shakiness, confusion, and headaches.

It is important to note that while lightheadedness is normal within a day or two after a liposuction surgery, the patient is supposed to feel better as her body heals from the surgical trauma and anesthetic. For this reason, any persistent postoperative symptoms such as dizziness, swelling and bruising that are not improving must be immediately informed to a doctor.

PLASTIC SURGERY CONCERN—HOW TO AVOID SCAR MIGRATION?

 

Every time the skin is injured or cut, the body releases collagen to repair the wound—a process that can lead to the appearance of scars. This is something any plastic surgery patient should consider before going under the knife.

However, a good plastic surgeon will make every effort to hide or make the scar less noticeable by placing the incisions within the natural folds of skin, underneath the bikini region, and/or area where scar tissue is less likely to form.

scar-migration-plastic-surgery

But scar migration remains a real concern with any plastic surgery, especially when it comes to facelift, breast enhancement surgery, tummy tuck, and body lift.

Leading Los Angeles plastic surgeon Dr. Tarick Smaili says that one way to avoid or at least minimize the risk of scar migration is to take most of the tension off the skin; this is often done by using deep internal sutures to create a stronger “support” to the new contour.

For instance, instead of lifting the facial skin alone during a facelift surgery, doctors today also re-sculpt and tighten the subdermal fat and muscle. While this technique leads to longer swelling and recovery, its results are way better than a skin-only lift which is criticized for its higher risk of wide scarring and short-lived results.

In tummy tuck surgery wherein scar migration is particularly problematic, the hip-to-hip incision positioned underneath the bikini region is supposed to remain low so the patient will have no “issue” wearing a two-piece swimwear.

To prevent the tummy tuck incision to ride up too hide, the renowned Los Angeles plastic surgeon highlights the importance of removing or at least minimizing the tension on the superficial layers of the closure. This technique not only encourages the scar to remain thin and inconspicuous but also leads to accelerated healing.

Aside from too much tension on the superficial layers of the wound, scar migration is also caused by excessive excision of skin during facelift and tummy tuck and other forms of body lift such as arm lift, breast lift, panniculectomy, and thigh lift.

Nevertheless, the right amount of skin excision remains important when dealing with massive weight loss patients suffering from redundant skin whose primary goal is to achieve a near normal appearance.

In the case of breast augmentation surgery in which the inframammary crease (or natural breast fold) is the most commonly used incision site, the risk of scar migration could be avoided by using a conservative implant size, which is determined on the amount of existing skin and other soft tissue.

The problem with using overlarge breast implants is that the scar may migrate too high or too low because they can overstretch the skin and tissue.

STEROID INJECTION FOR PLASTIC SURGERY SCAR

 

Any time the skin is cut or injured, a specific type of growth cell called fibroblast produces collagen, which in turn leads to the appearance of scar. Nevertheless, LA plastic surgeons will make every effort to place the incisions within the natural folds of skin or in an area where they will appear inconspicuous.

A “good” scar is supposed to appear flat, thin, and “faded,” which is possible through the use of suturing techniques wherein the skin receives no or very little tension.

steroid-injection-for-plastic-surgery-scars

But despite all the best efforts, some plastic surgery patients are simply prone to scar tissue or more appropriately called as keloids and hypertrophic scars, which both appear raised and discolored. According to studies, dark-skinned individuals are more vulnerable to heavy scarring than fair-skinned people.

While keloids go beyond the original incision area, hypertrophic scars just remain within the injured site.

Steroid injection, specifically Kenalog, is one of the most common scar treatments used after plastic surgery. It works by breaking up the bond between collagen tissue, thereby shrinking the scars.

Despite the relatively high success rate of steroid or Kenalog injection, only a qualified practitioner should perform the treatment because its incorrect use could lead to depression and thinning of the skin. As a result, most doctors start with a low dose and they usually wait six to eight weeks before another session is performed, but only if there is a need to.

While it is possible to inject higher doses of steroid, once the skin depression occurs it is difficult, if not impossible, to correct.

The success of steroid injection also depends on the scar’s age. Conventional wisdom suggests waiting at least three months after plastic surgery so the swelling can resolve on its own. During this period, silicone sheet or tape can be used to prevent or minimize the formation of scar tissue within the dermis.

Meanwhile, Kenalog injection is particularly helpful in minimizing the swelling after rhinoplasty or nose surgery, which is most apparent in the tip area. This has also been found to prevent the formation of scar tissue especially among ethnic patients who are prone to keloids.

The treatment can also help minimize the appearance of post-surgical scars in patients who had facelift, breast reduction, mastopexy, gynecomastia surgery, body lift for after massive weight loss, and breast augmentation.


 

THIN NASAL SKIN IN RHINOPLASTY—IS IT AN ADVANTAGE?

 

Rhinoplasty, or more commonly referred to as nose job, is not just about improving the outside appearance of the nose. “Goals” that are equally important include delivering results that look proportionate to the rest of the facial features, and preserving breathing functions by maintaining the underlying structural integrity.

The underlying anatomies of the nose, especially the skin thickness or lack thereof, affect the postop result and dictate the “ideal” surgical approach as well, as suggested by leading Beverly Hills plastic surgeon Dr. Karan Dhir.

Dr. Dhir says one of the advantages of thin skin, which is commonly found in Caucasian patients, is that it heals at a much faster rate than thick nasal skin, a common trait of ethnic patients—e.g., Hispanics, Africans, and Asians.

rhinoplasty-thin-skin

Simply put, rhinoplasty recovery for thin-skinned patients is shorter than those with thick nasal skin.

Thin skin also experiences less swelling at the nasal tip than thick skin. In fact, some ethnic rhinoplasty patients have to wait for up to two years to see the final result because of the persistent swelling, although most patients will already look presentable in public by the second week after their surgery, the celebrity plastic surgeon says.

Another advantage of thin skin is that it allows for a high degree of refinement due to its ability to redrape or shrink-wrap well to the new contour. Nevertheless, Dr. Dhir says the same trait could also pose some challenges since even the tiniest irregularities may be visible underneath the skin.

Asymmetries showing through thin skin are more common in patients whose nasal cartilage—which is the main framework of the lower two-thirds of the nose—is notably “strong.” This is manifested by a tip cartilage outline that is visible through the nasal skin.

For patients who have very thin skin and strong prominent cartilage underneath, Dr. Dhir may recommend soft tissue thickener such as acellular dermal matrix (Alloderm) or fascia to hide minute asymmetry and achieve smoother results from rhinoplasty.

Compared with thick skin, it is easier for thin skin to redrape to the new contour, thus more amount of alteration or refinement is generally possible. However, the renowned Beverly Hills plastic surgeon warns that over-resection must be still avoided because it leads to unnatural appearance, breathing problems, and collapsed nostrils or pinched tip.

Over-resection does provide little to no benefits, both long and short term, for rhinoplasty patients. This is particularly true for thick-skinned individuals who are prone to amorphous appearance after removing too much or incorrect manipulation of cartilage.

HOW SKILLED RHINOPLASTY SURGEONS PREVENT BREATHING DISTURBANCES POSTOP

 

Rhinoplasty, or cosmetic nose surgery, is not just about improving the outside appearance of the nose. An equally important goal is to preserve normal breathing functions, which is possible with proper patient selection, honest communication between a surgeon and his patient, and careful planning.

Proper patient selection is the first step to achieve desirable results. Aside from being physically fit, the right candidate for rhinoplasty or any elective plastic surgery should have realistic motives and expectations. For this reason, a prudent surgeon will turn down patients seeking secondary or tertiary procedure even their result is attractive by normal standard just because it does not conform to their unrealistic goals.

before-and-after-rhinoplasty-photos

Patients who have had several rhinoplastiesgenerally have a significant amount of scarring or skin contracture that is further aggravated by another surgery. Aside from higher risk of breathing disturbances, it is expected that the degree of cosmetic improvement would be limited, making another procedure no longer ideal.

Correct surgical planning also plays a crucial role in the prevention of postop complications such as breathing problem and unnatural appearance or deformity. Inland Empire plastic surgery expert Dr. Tarick Smaili says over-resection of the nasal cartilage is one of the most common causes of breathing disturbances.

Over-resection of the cartilage, which is the main structure supporting the lower two-thirds of the nose, is often the tool of “over-enthusiastic, inexperienced” surgeons whose only goal is to deliver the cosmetic goals of their patients without considering the architectural integrity of the nose.

In some cases, over-resection of the cartilage delivers the desired outcome short term, only to result in deformity (twisted nose, collapsed nostrils, droopy tip, etc.) and/or breathing problems later down the road because the structural integrity has been compromised.

Over-resection commonly occurs in reduction rhinoplasty in which the goal is to create a nose that looks proportionate to the rest of the facial features. To avoid a wide range of complications, it is important not to remove too much cartilage and to always take into consideration the changes that could occur due to natural aging of the face.

Reduction rhinoplasty should address bumps on the bridge, droopy tip, and/or excessively flared nostrils without affecting the architectural integrity of the nose.

Rhinoplasty is believed to be one of the most difficult plastic surgeries due to the involved anatomies and how they limit the amount of improvement. Further complicating things is the expectations of patients and doctors that are not always corresponding.

FACIAL FAT GRAFTING AND FACELIFT

 

Facial rejuvenation surgery or facelift is not just about pulling the loose skin in an attempt to smooth out the appearance of wrinkles, jowling, and sagging tissue. Leading Los Angeles plastic surgeon Dr. Tarick Smaili treats it as a three-dimensional concept in which the lost of volume or fat must always be taken into account.

Facial fat grafting is often performed simultaneously with facelift. The goal is to correct the gaunt appearance due to volume or fat loss, a common problem of patients who are on the thin side, explains Dr. Smaili.

facelift-surgery-with-fat-grafing

Oftentimes, facelift is performed first then followed by facial fat grafting, although under one surgical setting to minimize the cost. However, proponents of one-stage procedure believe the grafts should be only injected into the areas not undermined by facelift to prevent shifting and other unpredictable effects.

For this reason, Dr. Smaili may recommend a two-stage procedure for patients who need a more extensive form of facelift in which more loose skin is reshaped and/or removed. The goal, he explains, is to achieve a more predictable result since the second surgery is attempted only after recovery from the initial procedure is complete.

Nevertheless, there is no current study suggesting the cosmetic advantage of fat grating at the time of facelift or at a later date.

While dermal fillers such as Restylane and Juvederm can also correct the skeletonized or gaunt appearance caused by aging, Dr. Smaili says that fat grafting makes it easier to achieve natural results because it feels and behaves just like the surrounding tissue. Nevertheless, it involves a rather more complex procedure in which gentle liposuction, purification method, and re-injection are performed.

Structural facial fat grafting is usually performed to restore the fat or volume in the cheek, jawline, and around the eye, although it can also soften the marionette lines (creases that run downwards from the corners of the mouth) and nasolabial folds (laugh lines).

However, Dr. Smaili says some surgeons prefer the use of dermal fillers to fat grafting when the primary aim is to smooth out deep creases like the nasolabial folds and marionette lines because these biodegradable, non-reactive materials are believed to have a more cohesive nature that makes them effective in softening facial wrinkles.

Since dermal fillers are readily available materials, they are generally less expensive than fat grafting, although not in the long run as they need to be repeated every four months to two years.

Fat grafting, meanwhile, provides a longer lasting result if the grafts are able to access or form new blood supply needed for their survival, explains Dr. Smaili.

BREAST IMPLANT INFECTION—SHOULD I BE CONCERNED?

 

While infection after breast implant surgery could have some devastating effects, with modern surgical techniques the complication is a rare occurrence. For this reason, leading Beverly Hills plastic surgeon Dr. Tarick Smaili highlights the importance of choosing a board-certified breast augmentation surgeon.

Infection after breast augmentation surgery should be avoided, or if it were to occur, treated immediately because it is linked to capsular contracture or hardening/thickening of the scar capsule around a synthetic prosthesis.

breast-implant-infection

Bacterial infection immediately after surgery often results in tenderness, persistent swelling, drainage/pus, and redness. Treatment often involves antibiotics. Take note that you must finish taking the prescribed course of these drugs to avoid reinfection caused by the surviving bacteria or the growth of antibiotic-resistant germs.

The theory is that implant contamination at the time of surgery is the most common cause of infection and its subsequent complications such as capsular contracture. To minimize such risk, the leading Beverly Hills plastic surgeon will make every effort to promote absolute sterility—this usually includes the use of “no touch” technique.

In “no touch” technique, the sterile implant packaging is only opened prior to insertion. A cone-shaped device called Keller Funnel is then used to propel the implant towards the breast pocket, without actually touching the prosthesis.

To further minimize the infection risk, Dr. Smaili says many breast augmentation surgeons these days are using antibiotic irrigation to bathe the implants, pocket, and wound.

Meanwhile, one postop factor linked to infection is seroma or formation of excess fluids within the tissue. To prevent or treat this complication, some surgeons put surgical drains at the end of the incision site. This practice is more common in revisions wherein there is a perceived higher risk of fluid buildup.

Aspiration is another way to address large seromas, which is commonly performed via ultrasound-guided technique to prevent puncturing the implant shell, while small seromas, meanwhile, tend to disappear on their own without treatments, explains Dr. Smaili.

In some occasions, breast implant infection occurs years after the surgery, which is often manifested by capsular contracture (pain and hardening of the breasts). In severe cases, implant removal is always necessary, with many surgeons recommending waiting at least six months before “replacements” are used to avoid the recurrence of infection.

Some doctors recommend taking antibiotics prior to any dental procedure in an attempt to minimize risk of breast implant infection. However, there is no scientific or clinical study proving its usefulness.

ARM LIFT RECOVERY—WHAT YOU NEED TO KNOW

 

Arm lift surgery, or brachioplasty, is a body contouring procedure to remove the hanging excess skin and fat. The supportive tissue called fascia is contoured and tightened as well to further improve the upper arm, which has sagged due to weight fluctuations and/or aging.

Arm lift recovery depends on how long the incisions are and whether ancillary procedures have been performed—such as liposuction in which the excess fat is removed through the use of a hollowed stainless steel probe called cannula. However, anecdotal reports show that most patients are able to return to [light] work within three to seven days.

arm-lift-recovery

To make sure that you are healing properly, your plastic surgeon will require routine check ups. If he used removable sutures to close your wound at the time of surgery, these will be removed within a week or two.

As with any type of plastic surgery, after arm lift you should expect some swelling and bruising, which will subside to a significant degree by two weeks. However, a wound that appears not to be improving and inflammation that remains persistent might be signs of infection that must be addressed immediately to avoid unsatisfactory scarring and poor cosmetic results.

Your surgeon will inform you about the telltale signs of infection such as fever (38 degree Celsius or above), persistent redness and swelling within the incision site, increasing pain, and drainage/pus in the affected area.

To minimize bruising and swelling, compression garments are typically worn during arm lift recovery. These are also known to encourage healing by preventing seroma or excess fluids within the recovering tissue, and improve the postop result to some degree by helping the skin to shrink-wrap around the new contour.

The use of compression garments differs from surgeon to surgeon, although Los Angeles plastic surgery experts typically recommend four to six weeks of regular use. Take note that they should not cause discomfort, numbness, or skin changes, which are signs that they impede with normal blood circulation.

Within two to six weeks of surgery, you should avoid excessive arm movement and heavy lifting to promote good healing. You should also keep a normal heart rate and blood pressure to prevent increased bleeding, persistent swelling, and other complications that could impede with normal healing.

Nevertheless, it is important that you avoid prolonged immobility because it could lead to weight gain, more swelling, and lethargy. A good rule of thumb is to take short walks several times a day to improve blood circulation, which is also known to minimize risk of blood clot or deep vein thrombosis in the legs and to promote healing.


 

BLOOD CLOT RISK AFTER SKIN TIGHTENING IN PLASTIC SURGERY

 

Skin tightening in plastic surgery is a common procedure performed on seniors (facelift), massive weight loss patients (body lift), and women who want to reverse the effects of pregnancy (tummy tuck and breast lift).

Any type of elective plastic surgery is only reserved for healthy patients with the right motives and expectations. Meanwhile, individuals with medical condition that could predispose them to higher risk of healing problems and poor cosmetic results are almost always considered as poor candidates.

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Blood clot formation or deep vein thrombosis (DVT) that commonly affects the legs is one of the risks associated with skin tightening surgery. Nevertheless, the possibility is greatly reduced if the operation is performed on healthy patients who avoid the “known” risk factors and perform the necessary preparations.

Dr. Tarick Smaili, one of the leading Orange County plastic surgery experts, says the first step to minimize blood clot risk is to avoid tobacco, second-hand smoke, and smoking cessation products such as nicotine gum and patch at least one month before and after surgery.

The association between smoking and blood clot has been well documented, making smokers poor candidates for any type of plastic surgery. Studies have already shown that compared with non-smokers, smokers have a higher incidence of poor healing and “unnecessary” scarring after breast surgery and facelift, explains Dr. Smaili.

Aside from nicotine and other toxic constituents of smoking, the use of contraceptives and hormone replacements is also linked to higher risk of DVT. For this reason, they must be discontinued for at least three weeks prior to surgery.

Another risk factor for DVT is a sedentary lifestyle, so the renowned Orange County plastic surgery expert recommends light exercise or walking after surgery. The idea, he explains, is to pump blood through the leg veins, preventing not just blood clotting but also persistent swelling and bruising.

Prolonged immobility, meanwhile, could significantly increase the risk of DVT, thereby immediate long travel and bed rest are an absolute contraindication after an elective plastic surgery.

With any type of elective plastic surgery, especially if it involves skin tightening, overweight and obese individuals are poor candidates because of the increased risk of healing problem, wound dehiscence, and DVT because of the pressure in the veins of their legs and pelvis.

Aside from obese patients, skin tightening plastic surgery is also not for individuals with blood-clotting disorder, cardiovascular disease, cancer, and inflamammatory bowel disease because of the increased risk of DVT and other types of complications.

PATIENT SELECTION IN LIPOSUCTION SURGERY

 

The primary aim of liposuction surgery is not to remove all the fat in the treated area, which could even lead to gaunt appearance and skin asymmetry. Instead, the procedure almost always leaves some layer of fat to preserve the natural contours and “valleys” of the body, which is particularly important when treating female patients.

The success of liposuction surgery, as with any body sculpting procedure, is only possible with proper patient selection.

liposuction-surgery-patient-selection

The list below, shared by leading body sculpting expert Dr. Tarick Smaili, explains the proper way to select patients.

*  Normal weight. For the sake of accuracy, plastic surgeons use body mass index, or BMI, to figure out if a patient is at a healthy weight for his or her height. Generally, the higher the number, the more body fat a person has.

Liposuction only works on localized subcutaneous fat, which is underneath the skin and is responsible for the appearance of fat rolls and unsightly bulges. Meanwhile it is surgically difficult, if not impossible, to remove the deeper, obesity-related visceral fat that only responds to real weight loss.

Obese patients are poor candidates for any type of elective surgery—not just body contouring but also facial procedures such as facelift—because of the increased risk of skin necrosis (death of tissue), infection, and wound dehiscence.

*  Healthy individuals. Medical conditions that could prevent a person to heal properly, or could expose him or her to undue risk, is a poor candidate for liposuction or any type of elective plastic surgery. For example, blood-related disorder, diabetes, cancer, heart disease, and autoimmune deficiency can increase the risk of complications.

Also, patients who are taking drugs known to increase bleeding (e.g., anticoagulants, aspirin, and non-steroidal anti-inflamammatory drugs) are at higher risk of complication unless they will discontinue these medications at least two to three weeks prior to the operation.

*  Motives and expectations. The ideal candidates for liposuction should have realistic expectations. First and foremost, it only removes just a small amount of localized fat, thus the preoperative weight and dress size will likely remain the same after surgery.

Liposuction is also not a substitute for “real” weight loss, making regular exercise and healthy diet more important than ever after surgery.

*  Good skin tone. While old age is not an absolute contraindication to liposuction, it is known to decrease the capability to redrape to the new contour. Nevertheless, surveys have suggested that many patients past their prime have reported high satisfaction rate with their more streamlined appearance.

As long as the patient has realistic goals and expectations, liposuction could deliver a satisfying result.

USE OF ANTIBIOTICS IN BREAST AUGMENTATION SURGERY

 

While the use of antibiotics is common in breast augmentation surgery, there are many different opinions on what type and how long they should be utilized. Nevertheless, the primary aim is to prevent infection that is tied to a wide range of subsequent complications such as poor wound healing, capsular contracture, and cosmetic results that are less than optimal.

Antibiotic is a medicine that prevents the growth of microorganism. Nevertheless, it remains important to perform breast augmentation at a fully accredited surgical setting or hospital, avoid or at least minimize contact of the implant shell with the skin at the time of surgery, and practice good hygiene postop to further minimize risk of infection and its subsequent complications.

antibiotics-breast-augmentation

Some Los Angeles plastic surgery experts recommend antibiotics hours before the actual surgery, while surgeons feel that these should only be given within five to seven days of operation.

However, it has become a common practice to use antibiotic solution to bathe the breast implants, wound, and implant pocket at the time of surgery. The idea is to make everything sterile before and during implantation to minimize risk of infection and capsular contracture in which a copious amount of scar tissue forms around an artificial prosthesis.

Despite the growing popularity of implant and pocket irrigation, a study conducted between 2011 and 2012 involving 55 patients has shown no significant difference in the capsular contracture rate between a surgeon who used the procedure (3.7 percent) and someone one who did not (3.6 percent).

The researchers have concluded that breast implant and pocket irrigation with the use of antibiotics may not have an impact on the incidence or severity of capsular contracture when the surgery is performed at a fully accredited surgical facility using high-quality medical techniques.

When oral antibiotics are prescribed, it is important to finish the entire course and follow the dosage recommended by surgeon. If the treatment is stop early, the bacteria that have not been killed could restart an infection and lead to more serious complications.

Aside from antibiotics, surgical methods such as Keller Funnel could further minimize risk of implant contamination and infection. This involves the use of a cone-shape device that propels an implant towards the breast pocket without actually touching the prosthesis, thus it is sometimes referred to as “no touch technique.”

Some experts also feel that breast augmentation performed at an accredited outpatient facility could minimize risk of implant contamination because it does not handle infectious diseases like most hospitals.

MINIMIZE HEMATOMA RISK AFTER FACELIFT SURGERY

 

Hematoma is the most common complication after facelift surgery. In this condition, a pool of blood forms under the skin, causing persistent swelling, discoloration, and other untoward side effects.

If left untreated, large hematomas can coagulate and become a solid lump underneath the skin (leading to poor wound healing and “unnecessary” scarring), while small hematomas often heal on their own without the need for aspiration or surgical removal. A physical examination after facelift will determine the right course of action.

hematoma-after-facelift-surgery

Many variables that contribute to hematoma can be controlled, making appropriate preparation, surgical techniques, and postop care indispensable to minimize one’s risk. Nevertheless, some factors are beyond the control of doctors and patients—For instance, male gender is known as a predisposing cause that about 8 percent of men experience this problem, as suggested by one study.

The hematoma rate in female patients, meanwhile, is 1-3 percent. They are less likely to experience this problem because their facial skin is less vascularized than men especially around the beard area.

Another factor associated with increased risk of hematoma is the use of blood-thinners such as aspirin, non-steroidal anti-inflammatory drugs, anticoagulants, and antiplatelet medications. For this reason, it is a common guideline to avoid them at least three weeks before surgery, or sometimes longer.

Some herbal supplements that can be easily bought over the counter have the same thinning effect on blood. The most common examples include ginkgo biloba, green tea, milk thistle, ginseng, and horse chestnut.

Tobacco products, smoking cessation treatments, and alcohol also have detrimental effects on blood clot formation, leading not just to increased risk of hematoma but also to a wide range of short- and long-term complications such as poor scarring, skin necrosis, and cosmetic results that are less than optimal.

To further avoid or minimize risk of hematoma and its subsequent complications, a normal blood pressure must be maintained before and after surgery. According to a study involving 229 facelift patients, those with uncontrolled hypertension were more likely to experience the problem compared with individuals whose blood pressure was well under control.

Because hypertension is an age-related medical condition, which is not uncommon in facelift patients who are typically aged 50 and above, many plastic surgeons choose to work with their patients’ general physician or specialist to make the elective surgery reasonably safe.

Postoperative factors such as rigorous activities, nausea/vomiting, coughing, and even stress are also known to increase hematoma risk. For this reason, it is a sacrosanct rule to maintain a normal blood pressure and heart rate during the initial healing stage to avoid the pooling of blood underneath the skin.

BREAST AUGMENTATION VIA PERIAREOLAR INCISION AND RISK OF MILK DUCT INJURY

 

Breast augmentation via periareolar incision technique involves making a small U-shaped opening within the border of the nipple-areola complex. It usually results in well-concealed scars, particularly when the wound has been meticulously closed with sutures that minimize tension on the skin.

One of the most common concerns with the technique is the risk of milk duct injury, which plays a crucial role in breastfeeding and sensation. For this reason, many surgeons will always prefer other incision sites such as the inframammary fold and armpit unless there is an indication for breast lift.

breast-implants

Because breast lift always involves incisions around the areola, it becomes an ideal incision site if breast implant surgery is performed simultaneously, thus preventing additional scars.

While the milk ducts are mostly concentrated around the nipple-areola complex, during periareolar breast augmentation not all of them will be transected or injured. On average, there are 13 to 25 breast ducts found in the female breast, thereby increasing the likelihood of successful breastfeeding in the future even after this technique.

Nevertheless, many surgeons prefer to “err on the safe side” by using the inframammary fold, armpit, or even navel incision instead because of the perceived lower risk of nerve injuries and sensation-related problems.

Some doctors also argue that breast augmentation via periareolar incision leads to higher risk of capsular contracture compared to other techniques, making other sites a more viable option.

Capsular contracture, or the formation of copious amount of scar tissue around an implant (not just breast implant but also artificial heart valves and facial implants), is often linked to low-grade bacteria and implant contamination at the time of surgery. It is believed that the nipple-areola complex contains a high number of staph bacteria, predisposing the patients to such risk.

Many surgeons in Los Angeles plastic surgery believe that the risk of milk duct injury is more closely associated with the implant size, suggesting that larger augmentation leads to higher risk of nerve impingement, breastfeeding difficult in the future, longer recovery, and more postop pain and discomfort.

Breast implants that are too large for the underlying anatomy to handle also result in a wide range of short- and long-term complications such as visible rippling, more palpability, bottomed-out appearance, chronic breast pain, and implant displacement.

To further minimize risk of milk duct damage, many surgeons recommend the use of submuscular technique in which the implants are positioned underneath the muscle rather than above this thick layer, leading to less disruption to the anatomies that play a crucial role in breastfeeding.

NARROWER WAIST VIA PLASTIC SURGERY

 

Since time immemorial, a narrow waist is a much-coveted feature on women, particularly if it is complemented by wider hips.  According to several studies, a waist-to-hip ratio of 0.7 or at least near this number generally signifies good health and female fertility, thus there seems a biological reason why men are attracted to females with an hourglass figure.

In an attempt to narrow the waist and create a more hourglass figure, some women ask for plastic surgery—particularly with a tummy tuck and liposuction.

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If the “thick” waist is primarily caused by excess fat—or particularly the superficial fat found underneath the skin—liposuction alone is enough to create a drastic, long-lasting result.  It involves just a few small incisions the size of a grain of rice where a suction probe or cannula is fit inside and then pulled back and forth to dislodge and remove the fatty tissues.

But as with any body sculpting surgeryliposuction is only reserved for patients who are closed to their ideal weight.  First and foremost, surgical removal of the deeper, obesity-related visceral fat, which covers the organs in the abdominal cavity, is deemed to be too risky.

Visceral fat only responds to weight loss, which is only possible through regular exercise and healthy diet.  In contrast, superficial fat can be surgically removed because it sits just underneath the skin.

For many patients whose goal is to achieve a narrower waist through liposuction, the flanks must also be treated to further contour the midsection.

However, a large waist that is mainly caused by muscle separation due to pregnancy and/or massive weight gain will not respond to liposuction.  Instead, tummy tuck is the only appropriate “tool” because it often uses a hip-to-hip incision to remove the hanging tissue and tighten the splayed abdominal muscle.

In some cases, liposuction and tummy tuck are performed at the same time to further recreate the hourglass shape.

While these two procedures have their narrowing effect, it is important to note that the overall improvements are still largely affected by the underlying anatomies, i.e., muscle and other soft tissue, and pelvis.

Meanwhile, rib removal in an attempt to narrow the waist is rarely performed in the US because of the risks since the ribs are necessary to protect the internal organs from trauma.

The controversial procedure involves the removal of the 11th and 12th ribs, with their rear portion left behind to at least maintain some of their functional purpose.

COULD PLASTIC SURGERY CREATE AN IDEAL SHAPE OF THE FACE?

 

Several studies have suggested that beauty can be defined by some innate characteristics that go beyond race and skin color.  For instance, scientists have found that high facial symmetry (or the balance between the right and left side of the face), waist-to-hip ratio of 0.70 and babyish features among females, clear skin, and lustrous hair are found to be physically attractive by most people regardless of their economic, social, and racial background.

It is important to note that the intrinsic purpose of facial plastic surgery is not to create an “ideal” shape (since there is no such thing lest people would all look homogenous) but rather to improve the balance and harmony of the face.

chin

Meanwhile, there are ways to alter or at least improve the shape of the face, including jaw reduction, facial implants (chin, jaw, and cheek implants), cheekbone reduction, dermal fillers, and fat transfer.

People with an almost absent chin, weak jaw, or sunken cheek are best served with facial implants that are supposed to last a lifetime.  Usually, they are made of silastic or hard silicone material that is compatible with human tissue, thus the risk of allergic reaction is fairly small.

Chin and jaw implants are particularly popular among men with recessed chin and weak jaw, which almost disappears from the neck, since the features make them look effeminate.

By contrast, female patients tend to ask for cheek implants to correct the deflated-looking cheek area caused by aging, or to achieve the much-coveted patrician look.

Meanwhile, injectable dermal fillers such as hyaluronic acid and fat transfer may be a better option if a patient only needs “minute” improvement or do not want to undergo facial implant surgery which involves a longer downtime.

While some patients need “augmentation” to achieve their goals, others want “reduction” for a more balanced feature.

Jaw reduction requires cutting off a small portion of the mandible, while chin reduction involves shaving off some of the bone in the area.  In the US, these procedures are not as popular as in many Asian countries in which a small ant-shaped face has become the epitome of female beauty.

While most US board-certified plastic surgeons would agree that jaw and chin reductions are only reserved for extreme cases of facial asymmetry, in South Korea, China, and Japan, the procedures are gaining popularity despite the higher risk of nerve damage, permanent numbness, and functional problems.

Cheek reduction is also becoming a popular procedure in some Asian countries where a V-shaped face is much preferred over a rounded face.

AUGMENTATION RHINOPLASTY OR NOSE-RESHAPING SURGERY

 

Augmentation rhinoplasty is just one of the many techniques in nose-reshaping surgery.  As its name suggests, its goal is to increase the nasal projection and possibly create a more defined bridge and/or tip.

In the US, augmentation rhinoplasty has almost become synonymous with Asian rhinoplasty because the Oriental nose often exhibits a lower nasal bridge, less tip projection, rounder nostrils, and wider base in relation to the height.

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Rhinoplasty surgeon Dr. Karan Dhir said that most Asian patients ask for more bridge and tip projection, although not to the point that their racial features are compromised.  For this reason, the technique is also dubbed as ethnic rhinoplasty, even though it is a general term used to describe any nose surgery performed on non-Caucasian patients.

Meanwhile, nostril reduction is rarely performed on Asian rhinoplasty because propping up the tip is often enough to minimize the appearance of nostril flare.

Augmenting the nose comes in a wide range of techniques.  Some patients only need their nasal bone and cartilage to be manipulated, removed, and/or reshaped to achieve good results, while others need a more complex approach.

Because Asians have a thicker nasal skin, they can tolerate solid silicone and other synthetic implants better than Caucasians, meaning there is a lower risk of implant protrusion.  Nevertheless, there is always a possibility that the body might reject the implants.

Instead of using solid silicone implant which is criticized for its relatively high complication rate, some plastic surgeons prefer the use of polytetrafluoroethylene or PTFE (example of brand name: Gore-Tex) with its low rejection rate—only 1.9 percent as suggested by a previous study.

The low complication and high success rate of PTFE is attributed to the fact that it is made of a porous material that allows the patient’s own tissue to flourish inside.

Aside from Asians, augmentation rhinoplasty also appeals to patients with a flat nose commonly seen among boxers and professional fighters due to the constant blows and injuries they sustain from their professions.

In general, these patients need additional framework in their bridge to correct the flat appearance and possibly address the breathing difficulty.  While it is often possible to achieve good improvements in severe cases of nasal collapse, one must not expect perfect symmetry due to the underlying factors.

To further achieve good results, some patients may also need skin grafts during their augmentation rhinoplasty, Dr. Dhir added.

WHY BODY FAT PERCENTAGE MATTERS ON PLASTIC SURGERY PATIENTS

 

A growing number of medical experts are backing proposals to use body fat percentage as an indicator of obesity rather than the traditional body mass index or BMI.  Once it becomes a “mainstream standard,” the criteria used to filter out “bad candidates” from “good “candidates” in plastic surgery will likely also change.

One recent study titled, “Percentage Body Fat as a Risk Factor for Surgical Complications,” has suggested that obese patients—based on body fat ratio—are at higher risk of developing complications following surgery.

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The study involved 438 patients aged between 18 and 64 who had elective surgery (e.g., general, aesthetic, and orthopedic) whose body fat percentage was measured using a technique called bioelectrical impedance analysis.

Obese patients were identified as those having body fat levels greater or equal to 31 percent in women, while 25 percent in men.  Fifty-two individuals meanwhile had experienced complications.

Patients who fell under the category of obese experienced higher rate of complications after their surgery compared to those considered as non-obese (14.1 versus 6.8 percent).  However, there was no significant difference in terms of post-op risk when BMI was instead used to identify obese individuals (14.9 versus 10.2 percent).

While the study did not divulge the reason behind the higher complication rate experienced by obese patients, separate studies have shed some light to issue.  For instance, some experts believe that the high levels of deeper visceral fat—which is linked to obesity—prevent it to efficiently access the blood supply where the nutrient-rich blood flows.

Another study involving breast reduction patients who were 200 pounds overweight has shown that they faced a higher risk of delayed recovery and healing problems (e.g., infection and skin necrosis) than normal-weight patients.

Aside from higher risk of complications after surgery, patients with high body fat percentage may not enjoy predictable results.  For instance, liposuctionwherein the excess superficial fat sitting just underneath the skin is suctioned out—is ineffective in removing the deeper visceral fat that covers the abdominal organs.

In fact, the consensus among medical experts is that any attempt to surgically remove the deeper visceral fat is downright risky.  Thus anyone who wants to shed the extra pounds has to follow healthier lifestyle choices—or as a last resort—to have a bariatric surgery.

And because people with a high body fat ratio are also at risk of significant weight fluctuations, any attempt to surgically contour the body will only provide short-lived results.  While theoretically most procedures can be repeated more than twice, it will only lead to higher risk of skin asymmetry and scarring.

LONG-LASTING EFFECTS OF RHINOPLASTY

 

While many rhinoplasty patients enjoy a [near] permanent result, it is important to mention that the revision rate as suggested by medical literature is about 10 percent.  Simply put, for every 10 individuals who had the surgery, one of them would need a secondary procedure at some point in his life.

There are many reasons why a revision rhinoplasty is needed: to correct aesthetic concerns that remain after the initial surgery, asymmetric appearance, functional problems, and “unpredictable” growth.

rhinoplasty

But for the vast majority of patients, the result of rhinoplasty can last a lifetime that a secondary surgery is often unnecessary, said board-certified facial surgeon Dr. Karan Dhir.

Nevertheless, it is important to mention that rhinoplasty does not stop the natural aging of the nose, the same way as a facelift surgery cannot prevent the process of facial aging.

As people age, the renowned surgeon said that the nasal skin will change the same way as the rest of the body does, which may lead longer or drooping appearance of the nose.  But overall, it is hard to tell the exact effect of aging on one’s nose—either unoperated or operated—because each person will age differently from one another.

However, anecdotal reports claim that in some cases rhinoplasty does slow the aging process particularly if the grafts are used to define and support the nasal tip, an area that may be prone to drooping as people age.

Nonetheless, there are also some rhinoplasty patients who may notice a slight amount of narrowing after hitting the age of 50 as the grafts used to support their nose could be absorbed minutely.  Fortunately enough, in most cases a revision surgery is not necessary.

Meanwhile, there are possible ways to minimize the likelihood of needing a revision surgery in the future.  The best advice is to only consult a board certified rhinoplasty surgeon with a minimum of five-year experience.

Rhinoplasty is arguably the most challenging elective plastic surgery in which even the slightest alteration of the nose in terms of its projection can have a drastic impact on one’s appearance.  To execute this procedure successfully, a doctor should both have artistic skills and surgical dexterity.

Another way to potentially make the surgery’s result long lasting is to have it only when the nasal development is complete.  For girls, it usually occurs at the age of 15 to 16, while for boys it happens one to two years later.

Any attempt to alter the nose younger than intended meanwhile could significantly increase the likelihood of a revision surgery at some point in one’s life.

WHAT FACELIFT CAN AND CAN’T DO

 

With the aging Baby Boomer in the US, it is not surprising that facelift has been one of the most commonly performed surgical enhancements over the past several years.  According to a survey released by the American Society of Plastic Surgeons, in 2012 alone about 126,000 patients had the procedure.

Despite the growing popularity of facelift, which has become a common household term, there are still many misconceptions about it.  To better help you understand the procedure, leading plastic surgeon Dr. Tarick Smaili has provided a list of things it can and cannot do.

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What Facelift Can Do:

*  It can target the saggy mid-face, an area that fits inside an “imaginary” inverted triangle starting from the lower eyelids to the chin.

*  Deep lines below the lower eyelids caused by skin laxity.

*  The procedure can target the nasolabial folds or the deep creases along the nose that extend to the corners of the mouth, which are caused by repetitive facial movement and tissue laxity that comes with age.

*  Facelift can reposition the displaced fat pad particularly in the cheek area.

*  The surgery can also correct the muscle laxity in the lower thirds of the face, leading to an appearance of jowls and double chin.

What Facelift Can’t Do:

*  It cannot remove the drooping skin in the upper eyelids.

*  The procedure is not designed to remove the furrows across the forehead and the low-lying or asymmetric brows.

*  The surgery cannot address the hanging skin in the neck area, unless the incision that goes around the ear will be modified to reach the lower scalp.

*  It can’t address loss of facial fat that commonly affects the temples, tear troughs, and lips.

*  Facelift cannot address the drooping nose, which is also associated with facial aging.

Conclusion:

One effective way to achieve a more dramatic and longer-lasting result is to involve not just the skin but also the deeper muscles.  While this approach leads to longer recovery and more post-op pain than the skin-only lift, the overall aesthetic outcome far outweighs such tradeoffs.

To achieve the most desired appearance, you may also need some procedures that are often used to complement the result of facelift—examples include eyelid lift, brow or forehead lift, fat graft, dermal fillers, chemical peels, etc.

Fat graft is particularly helpful in further improving the result of facelift by plumping up the sunken facial region using the patient’s own fat usually derived from the tummy and hip area.

BREAST IMPLANT PATIENTS’ DILEMMA—COULD BREASTFEEDING CAUSE SAGGING?

 

One of the most common concerns of breast implant patients is the drooping or bottomed-out appearance, which according to popular belief, is primarily caused by breastfeeding.

But such concern has no bearing as suggested by one study presented at the annual meeting of the American Society of Plastic Surgeons.  According to its finding, all the “potential physical changes” of the breasts are solely determined by pregnancy.

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The study titled “The Effect of Breastfeeding on Breast Ptosis Following Augmentation Mammaplasty” involved women with implants who breastfed (57) and those who did not (62); the vertical measurement of their breast was measured before getting pregnant and a year after pregnancy or after weaning their babies.

The researchers found out that all patients had experienced a certain degree of breast changes, although not everyone had developed a serious case of drooping appearance.  Overall, there was no difference between those who breastfed and those who did not.

Simply put, with or without breastfeeding the breasts will likely change to a certain degree after childbirth.  This finding both applies to the natural breasts and augmented breasts.

With this finding, the researchers are hoping to encourage all women, whether they have breast implants or not, to breastfeed their babies since it provides countless of benefits including lower risk of childhood obesity, higher metabolic rate for mothers (helping them to shed the dreaded “baby fat”), and better resistant to diseases and infection for children compared to those who were given formula milk.

If one really wants to rule out pregnancy-induced sagging, the best advice is to postpone breast augmentation surgery until she is done having children.

However, pregnant women with augmented or natural breasts can still take proactive steps to at least limit the effects of pregnancy, if not avoid the saggy appearance.  Fortunately, such goal is easy as long as they are equipped with the right kind of information.

Maintaining a normal weight throughout pregnancy is arguably the most important step to limit its detrimental effects on the breast appearance.  Meanwhile, the “ideal” weight gain depends on a woman’s weight prior to her conception and also her height.

In general, women whose weight is at “healthy” or normal range (between BMI of 18.5 and 24.9 as suggested by experts) should only gain 25 and 35 pounds during the first trimester and then 1 pound every week throughout the pregnancy.

And because breast enlargement in preparation for milk production is a common occurrence, pregnant women should make sure to buy a new set of larger bras that provide additional support—they usually come with wider straps and better-fitting band.

TANGIBLE BENEFITS OF GYNECOMASTIA SURGERY

 

While gynecomastia surgery is a body contouring procedure in which the overlarge male breasts are reduced through the use of incisions, its benefits are often far beyond cosmetics; this is particularly true among patients who have been taunted and teased because of their unusual breast size.

As more and more people become aware of male breast reduction surgery, it has been one of the most commonly performed plastic surgeries over the past several years.  In 2012 alone, about 20,700 underwent the procedure (many of them were under the age of 18) performed by US board-certified plastic surgeons.

Male-Breast-Reduction-06

One recent study has suggested that even the mildest form of male enlargement, whose primary cause is yet to be determined by experts, is enough to have a detrimental impact on one’s body image and self-esteem.

The study involved boys with breast enlargement who scored lower in terms of body image, mental health, and social functioning compared with their peers of the same age and gender who were unaffected by the condition.

Another surprising finding was that boys with the condition were more likely to exhibit eating disorder, which could be their way to cope with emotional and psychological stress of being taunted.

Some plastic surgeons have suggested that eating disorder may also be attributed to the goal of some boys and even adult men to gain more weight in an attempt to hide their distinctly large breasts.

But despite the negative impact of male breast enlargement as suggested by many experts, it is surprising that health insurance rarely covers the cost of surgery to correct this problem.  In contrast, female breast reduction is now often covered particularly if the condition leads to poor posture, chronic back and shoulder pain, rounded shoulders, etc.

Meanwhile, the good thing about gynecomastia surgery is that its results tend to last a lifetime as long as the patients are able to maintain their ideal weight throughout their lives.  Nevertheless, a few may need revisions in the future in the event that enlargement does recur.

The surgery is performed by literally removing some of the excess skin, tissue, and/or fat, while still making sure that the breast’s natural contour is preserved.  For better results, some patients may require nipple repositioning and/or liposuction to further remove the excess fat.

THE ADVANTAGE OF OTOPLASTY OR EAR-PINNING TO YOUNGER PATIENTS

 

Otoplasty, or more commonly referred to as ear-pinning surgery, has been the most commonly performed plastic surgery over the past several years performed on patients below 18.  In fact, it accounted for about 45 percent of all surgical enhancements sought by minors in 2012, one survey has suggested.

While ear surgery can be performed on a healthy patient regardless of his age, double board-certified facial plastic surgeon Dr. Karan Dhir recommends having the procedure at a young age due to some notable benefits.

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First and foremost, children’s cartilage is more flexible and easier to work with compared to adults’, thus they achieve better aesthetic results in general.  However, there are still other factors that can affect the final outcome, and these include the underlying anatomy (length of the ear) and the surgeon’s skills.

By the age of five or six, the ear’s development is complete that otoplasty could already be attempted.

Aside from achieving optimal results, having the surgery at a young age could also curb potential psychological trauma from teasing and name-calling, which have detrimental emotional ramifications on bullied individuals that could last into adulthood as suggested by several studies.

Some experts even suggest otoplasty on children before they begin their education, while others believe that it should only be attempted when they are asking for the procedure themselves or at least confiding to their parents that they are bothered by taunting.

Meanwhile, it is important for parents to explain to their children the ramifications of otoplasty—not just its aesthetic benefits but also the recovery.

In an attempt to hide the scars, the incisions are placed behind the ear that will allow the surgeons to manipulate the cartilage underneath and ultimately reshape the ears and/or bring them closer to the head.  Because each individual has a different anatomy, otoplasty comes in various techniques to achieve the most desired result.

Dr. Dhir said that otoplasty typically lasts one to two hours and is deemed as a “simple” procedure since most patients can resume normal activities, of course excluding physically-demanding tasks, within days of the surgery.

PERFECT TIME TO HAVE A MOMMY MAKEOVER SURGERY

 

Plastic surgeons have coined the term mommy makeover surgery to describe any procedure that aims to reverse the effects of pregnancy—or at least minimize the physical changes it has brought on.

Basically, a mommy makeover procedure is a type of body contouring in which the saggy skin and sometimes even the deeper muscle (just like in the case of tummy tuck) are removed, tightened, and/or reshaped.

tummy_tuck_patient_photos

Any attempt to surgically improve the body’s contour demands a perfect timing, which is determined by many factors.  However, having a normal weight that has stabilized for at least six to eight months is crucial to make sure the results can last for decades or even a lifetime.

Tummy tuck is arguably the most popular mommy makeover surgery as it deals with the abdomen, which is the area significantly affected by pregnancy.  While it can effectively tighten the loose muscle and excise the hanging skin, it should only be attempted once the body has fully recovered from childbirth and hormonal fluctuations.

It is important to note that if a woman chooses to breastfeed, her hormones will remain higher than normal even months after giving birth.  This leads to skin and tissue unable to shrink back or at least regain some of their former firmness, thus a longer waiting period is important.

Breast lift is another popular mommy makeover surgery, which is often complemented by implants to help mothers regain the lost fullness in their upper poles.

But before any breast enhancement surgery is attempted, it is a sacrosanct rule to make sure that milk production has completely stopped lest it would significantly increase the risk of infection and poor wound healing—complications which can be minimized with proper planning.

Meanwhile, all types of mommy makeover surgery require long-term maintenance, i.e., making sure one is able to maintain a stable weight throughout her life through a well-balanced diet, regular exercise, and an overall healthy lifestyle.

Aside from having a stable weight maintained through healthy lifestyle choices, another way to keep the results of surgery long lasting is to only have it if one completely rules out pregnancy in the future, which could affect, if not reverse, the results.

If any of the surgical prerequisites is absent, the consensus is to postpone the surgery.  Simply put, each factor determines the perfect or ideal timing to have a mommy makeover procedure to achieve the best aesthetic result possible


 

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.

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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.


 

IS FORTY-SOMETHING TOO YOUNG FOR FACELIFT SURGERY?

 

The primary aim of facelift surgery is to minimize the signs of aging in the face and neck, particularly the fat that has fallen, jowls, deep creases below the lower eyelids and between the corners of the mouth and nose, and sagging in the mid face.

In a 2011 survey released by the American Society of Plastic Surgeons, patients aged 55 years and older accounted for more than 65 percent of all facelift surgery.  On the other hand, the procedure is not so common among people in their 40s with the belief that they are too young for this invasive procedure.

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But is 40 really too young for facelift?

Dr. Tarick Smaili, one of the leading Los Angeles plastic surgeons, believe that age per se does not determine if one is a bad or good candidate for the procedure.  In fact, he recommends it to younger patients who have already developed sagging skin and deep creases.

“Some people are prone to facial aging.  Some are caused by genetic factors while others develop sagging skin after massive weight loss.  It is not really necessary to wait until you reach your 50 or 60 to have a facelift.”

The world-renowned surgeon added that “early intervention” may be even more beneficial to some patients as those in their 40s tend to have a skin that is more elastic compared to older people, thus they could achieve a better result.

Another advantage of doing facelift surgery “earlier” than usual is that the patients could keep the procedure a secret as the transformation is only subtle.

On the other hand, older patients who receive facelift will most likely be asked about the reason for their visible transformation and the fact that their friends and family have already seen the severity of their sagging and facial creases.

But full facelift may be too invasive for forty-something, so plastic surgeons would most likely recommend “isolated” techniques like mid facelift, which targets the area around the nose and corners of the mouth, and the lower eyelids.  This procedure is particularly ideal for younger patients who only need cheek elevation, while their neck and chin area do not require lifting.

If needed, a mid facelift is performed in conjunction with eyelid surgery and lower facelift, helping patients achieve a more youthful appearance.  Meanwhile, non-surgical procedures such as laser skin resurfacing, medical-grade chemical peel, and dermal fillers could further improve the surgery’s result.

RECOVERY AFTER MALE BREAST REDUCTION SURGERY

 

Male breast reduction surgery is performed on men who have overlarge breasts due to excess tissue, redundant skin, and/or superficial fat.  Meanwhile, the length of recovery depends on many factors such as the surgical technique and amount of correction.

Male-Breast-Reduction-011Also, healing varies from patient to patient; in general, younger men recover faster than older ones, i.e., 55 years and above.

The surgery comes in many techniques, depending on the type of correction a person needs.  Oftentimes, male breast reduction involves skin excisions to remove the excess tissue and fat, although others can benefit from liposuction-only procedure as long as the “enlargement” is primarily caused by fat and they have elastic skin.

And for some patients, they can benefit more with skin excision plus liposuction for further contouring, leading body contouring surgeon Dr. Tarick Smaili said.

With liposuction-alone surgery, patients can resume most of their normal activities just after three days.  This is because the procedure only involves the use of round incisions as small as a grain of rice where doctors remove the excess fat with a cannula, which is a slender steel probe attached to a vacuum pump.

But the traditional way to perform male breast reduction requires skin and tissue removal, thus it uses long incisions that are usually positioned within the natural breast crease and around the edges of areola.

Because of skin excisions, pain and discomfort is a normal part of recovery.  Most patients will need painkillers for three to four days to help them cope with the post-op symptoms.

Most doctors require their patients to take at least a week off from work to get enough rest and sleep during the most crucial period of their recovery.  While it is important to stay away from heavy lifting and strenuous exercises for a week or two, taking short gentle walks several times a day is highly encouraged because it improves healing and blood flow.

Walking and other light exercises can also reduce risk of blood clotting in the legs that may travel up to the lungs.

To support the new contour and protect the incision site, most patients are instructed to wear compression garments for at least three weeks.  And with continuous use, some doctors feel that it may improve the result to some degree as the skin heals closer to the body.

While the incisions may appear completely healed, it is not uncommon to have some minor skin irregularities or “bumps” that can persist for up to three weeks.  But as with any post-op symptoms, they are supposed to subside as the body heals itself.

COMMON RESULTS AFTER BREAST REDUCTION SURGERY

 

Breast reduction surgery, while it reduces the breast weight and volume, is also commonly used to address physical symptoms linked to macromastia or overdevelopment of the breasts such as neck pain, postural problems, inability or difficulty to jog or engage in sports, back pain, and rounded shoulders.

Studies and surveys have suggested that breast reduction surgery provides the highest patient satisfaction rate because oftentimes the benefits are far beyond cosmetics.

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To better understand the benefits and other ramifications of the surgery, the California Surgical Institute has provided a list of results most patients should expect:

  • Compared with other body sculpting procedures, breast reduction involves a more straightforward recovery as it does not require the muscle to be manipulated and the breasts tend to be less prone to surgery-related pains.  For this reason, patients can resume most of their activities within a week or two.
  • Physical symptoms caused by overlarge breasts are immediately resolved because they are now smaller and lighter that the patients can perform activities and exercises with much ease and comfort.
  • All surgeries will leave permanent scars, although in breast reduction a good plastic surgeon will make every effort to make them less visible, i.e., placing the incisions within the natural fold of skin and around the edges of areola.  And to promote good healing and avoid ugly wide scars, they also minimize the tension in the skin through various techniques.
  • In terms of body image and self-esteem, studies after studies have shown the positive impact of breast reduction due to a more balanced figure.
  • Some patients experience reduced sensation or complete numbness in their nipples and/or breast mound (making it hard or even impossible to breastfeed in the future) that may or may not improve over time.  If one finds this risk unacceptable, breast reduction surgery should not be attempted.
  • Patients who are experiencing difficulty or inability to perform certain activities will find much ease when exercising, making it easier for them to maintain a healthy, stable weight over the long term.
  • With smaller and lighter breasts, they are less prone to the effects of gravity that contribute to the saggy appearance.  The surgery itself also creates a lifting effect because the internal structure of the breast is reshaped and the nipple-areola complex is repositioned to a higher, more youthful appearance.

BREAST REDUCTION SURGERY—DOES IT CREATE A LIFTING EFFECT?

 

As its name suggests, breast reduction or reduction mammoplasty reduces the breast volume through tissue and fat removal.  Aside from creating a smaller size, the surgery is also performed to address physical symptoms caused by macromastia, manifested by overlarge breasts, such as back pain, rounded shoulder, and poor body posture.

While the primary goal of reduction mammoplasty is to make the breasts smaller, body sculpting expert Dr. Tarick Smaili said the surgery—because its incisions are the same with breast lift—can also create a lifting effect.  A properly executed procedure, he added, also includes repositioning and reshaping of the areola complex or the pigmented part of skin.

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The standard technique, also called the anchor-shaped reduction because of its incision pattern, provides plastic surgeons the most control over the final breast size and appearance.  It uses a vertical incision between the nipple and inframammary fold, a horizontal cut within the natural crease, and another one around the edges of areola complex.

A less invasive technique called the vertical or lollipop reduction, which removes the horizontal incision across the natural fold, can also effectively reduce the breast size and at the same create a lifting and narrowing effect, making this particularly ideal for improving a markedly wide breast.

While a “true” breast reduction always involves skin excision and tissue removal, some doctors attempt to reduce the breast size with liposuction alone, a procedure that eliminates the fat through the use of a slender steel probe attached to a vacuum pump.  For a vast majority of patients, the approach will not provide them the desired result and may even lead to a saggy appearance.

In essence, liposuction does not create any lifting effect because it does not reshape the ligaments or tighten the skin.  But for a few carefully selected younger patients, the procedure can reduce the breast size and make it lighter, which could help the skin shrink to a certain degree.

While breast reduction creates a lifting effect [almost] the same way as the breast lift surgery because they share the same incision techniques, the latter does not reduce the breast volume and only aims to correct the saggy appearance.

Aside from the “weakened” breast ligaments and stretched skin, the saggy appearance is also caused by the excessive weight.  For this reason, some breast lift patients can benefit more if their doctors will also make their breasts smaller and less prone to the effects of gravity.

FACELIFT YEARS AFTER WEIGHT LOSS SURGERY

 

Facelift surgery or rhytidectomy is commonly performed to minimize the appearance of wrinkles, gaunt areas, and other signs of aging.  However, some massive weight loss patients may also need the procedure to address skin laxity and other forms of deformities after shedding large amounts of excess weight.

With one-third of US adults considered obese, the number of weight loss or bariatric surgery patients has been steadily increasing over the past several years.

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While weight loss surgery can decrease the risk of obesity-related illnesses and even death, almost all patients will experience deformity at a varying degree.  In fact, it is not uncommon to develop hanging, loose skin in the tummy area that even reaches the pubic region, causing tissue breakdown, non-healing irritation, and foul odor.

However, the face and neck area are also not spared from the effects of massive weight loss, leading plastic surgeon Dr. Tarick Smaili said.

The right timing is important to enjoy the full benefits of post-bariatric facelift surgery.  While most patients are able to shed most of the excess weight between eight and 12 months, the general rule is to wait at least one to two years after weight loss surgery to make sure the weight has already stabilized.

Aside from waiting until the weigh has stabilized, Dr. Smaili said it is also important to make sure that prior to facelift, the patients are no longer malnourished from the sudden change in their diet and lifestyle.

Because each patient has a different anatomy and “problem” area, a good doctor will examine the skin quality, wrinkles and fat pad to come up with an individualized technique, which can help achieve the best result possible.

For massive weight loss patients, their facelift is often complemented by neck lift to achieve a more balanced result.  In general, the goal is to refine the jowls, eliminate or reduce the appearance of wrinkles and saggy skin, and raise the displaced cheek pads.

Incisions are always needed to reshape the skin and underlying tissue, but to hide the scars they are typically positioned in front of and behind the ears, extending behind the hairline.

Compared to traditional facelift, the renowned plastic surgeon has noticed that post-bariatric facelift typically involves more skin removal to correct the deformity caused by dramatic weight loss.

Despite the facial “deformity” caused by excess skin after significant weight loss, all facelift surgeries are considered cosmetic procedures so health insurers do not pay for their cost.

WHY FUG IS THE GOLD STANDARD IN SURGICAL HAIR RESTORATION

 

Surgical hair restoration or hair transplant, while it comes in two basic techniques, always involve transferring bald-resistant hair follicles from the back and side of the scalp to the crown and front hairline.

Over the past 10 years, the follicular unit graft or FUG has been the gold standard practice despite the growing popularity and media hype surrounding a relatively new technique called the follicular unit extraction or FUE.

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In FUG, doctors collect a strip of scalp behind the head before they dissect each hair follicle one at a time under a microscope.  The graft is then planted into tiny incisions in the balding spots or areas that need coverage.

On the other hand, the relatively new technique FUE involves the use of a small round puncher to harvest hair grafts one at a time and plant them into the areas where hair is thinning out.

Proponents of FUE always highlight the technique’s ability to harvest hair grafts without creating long incisions, which can lead to scar, at the back of the scalp.  While there is some truth behind it, there are still notable advantages that make FUG still the gold standard approach.

Despite the use of long incisions to collect a strip of scalp, a well-executed FUG leads to a very thin scar, about 1-2mm wide, that is easily covered by the surrounding hair. Simply put, visible scarring is rarely a problem.

In terms of better coverage and higher survival rate of hair grafts, the FUG is superior over FUE, 90-95 percent vs. 75-80 percent.

The higher graft survival rate in FUG is attributed to its shorter time procedure, meaning the hair follicles are less exposed to the “elements.”  Meanwhile, in the FUE the grafts are outside the body for a longer period of time, leading to a lower regrowth rate.

The amount of coverage in FUG is also superior because it allows doctors to collect as many as 3,000 grafts, versus 500 grafts in FUE.

Because FUE is more time consuming and it often involves multiple procedures to achieve the desired result, its cost can be 50 percent higher than FUG which is a much simpler and more effective hair transplant technique.

But even with a well-executed FUG, patients should also do their part to further increase the graft survival rate and avoid the wide scar in the donor site; this typically involves proper care and washing of the hair to remove scabs, and avoiding strenuous activities and heavy lifting for at least two weeks after surgery.

LARA FLYNN BOYLE RUMORED TO HAVE PLASTIC SURGERY

 

Tabloid writers and showbiz bloggers are all saying that Lara Flynn Boyle, who starred in Men in Black 2 and Wayne’s World,” had received facelift surgery and dermal fillers that resulted in a pillow-face appearance.

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Last week, the 43-year-old actress was photographed shopping with her mother in Los Angeles.  The pictures showed her face, lips, and neck “unusually” swollen, which some people claimed to be the works of excessive injection of dermal fillers.

Celebrity news website TMZ has reported it contacted Boyle’s friends to confirm the “alleged” plastic surgery but they all said the actress “looked fantastic” and did not divulge more information about her.

Rumors about Boyle’s alleged plastic surgery have been circulating the Internet over the past several years due to her seemingly changing appearance.  But despite the allegations, the actress has never publicly denied or admitted any surgical enhancement.

Meanwhile, over the past years Boyle has been touted as one of the worst celebrity plastic surgeries, getting the same public derision Melanie Griffith, Meg Ryan, and Madonna have been receiving.

Boyle seems have managed to remain “cool” and “mum” despite years of harsh criticisms that have started in the late 90s when bashers said she was too thin and “appeared to have starved herself” that she was a poor role model for young children.

FACIAL PLASTIC SURGERY—COULD I HAVE MULTIPLE PROCEDURES IN ONE DAY?

 

Facial plastic surgeries such as faceliftrhinoplasty (nose job), cheek or chin implant, and fat graft are performed on patients who want to reduce the signs of aging and/or create a more balanced appearance.

The most notable benefit of having multiple procedures all performed in one day is the lower surgical cost than getting them separately since you only have to pay for one surgical facility and anesthesia fee.  The convenience of one post-op recovery is another advantage with this approach.

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In spite of the obvious benefits of “combo procedures,” double board certified Dr. Karan Dhir said safety is the main issue rather than the number of surgeries performed in one day.

The consensus among board certified plastic surgeons, according to Dr. Dhir, is to perform cosmetic or elective surgeries under five to six hours in an attempt to avoid or at least reduce the likelihood of developing complications such as increased bleeding, high surgical trauma, and general anesthesia-related risks.

Meanwhile, it is not uncommon for plastic surgeons to further limit the operative time when dealing with older patients, i.e., 55 years and above, and individuals who have certain medical conditions that may increase the risk of complications.

If your combo procedures will take a lot of time, take note that a good surgeon will most likely recommend performing them separately in an attempt to minimize the risk.

You also have to consider that certain facial procedures cannot be done at the same time because doing so could lead to “unpredictable” results, cosmetically poor outcome, and delayed healing.  For instance, many surgeons feel that a full facelift surgery should not be combined with an immediate fat graft because the “added volume” might move.

However, mini or “isolated” facelifts may be combined with fat graft as long as it is used in uncompromised areas—the skin and underlying facial muscle are not lifted and reshaped.

Some mini facelift patients may also undergo rhinoplasty at the same time as their surgery if they want to correct their “aging” nose manifested by the drooping tip and/or more pronounced humps in the nasal bridge.

Whether you decide to have multiple procedures performed all at the same time or have them separately, the number one rule is to only consult a board certified surgeon who specializes in facial plastic surgery; stay away from non-specialists as they accounted for the majority of botched cosmetic procedures.

SAFETY OF ABDOMINAL LIPOSUCTION SURGERY

 

The abdomen is the most commonly treated liposuction area because it is where the fat “rolls” and “bulges” tend to accumulate even in healthy, normal weight individuals who exercise regularly and eat a balanced diet.

Body sculpting expert Dr. Tarick Smaili said the abdominal liposuction is “reasonably” safe as long as the patients are carefully selected and the procedure is performed by a board certified surgeon.

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A good surgeon, Dr. Smaili said, should be able to know the risk factors in an attempt to make the abdominal liposuction safer and help patients achieve a cosmetically pleasing result.

To better understand the procedure, particularly in terms of safety, the world-renowned plastic surgeon has explained the risk factors in abdominal liposuction, and ways to minimize the likelihood of developing a complication:

*  Abdominal hernia or muscle separation increases the risk of accidental penetration of the liposuction cannula into the intestine or liver in the abdominal cavity.  For this reason, a good doctor will not attempt the procedure unless the condition is repaired.

In most cases, an abdominal hernia repair is a simple procedure performed under local anesthesia.  A CT scan can help doctors diagnose the condition prior to a liposuction surgery.

*  While the risk of accidentally penetrating the abdominal cavity is very small with liposuction, another surgery performed inside the abdomen may result in unnecessary risks.  Simply put, performing abdominal liposuction-alone is the best way to make the surgery safer.

*  The standard liposuction technique, which injects a tumescent solution into the fatty area, has allowed plastic surgeons to perform the procedure under local anesthesia, which is safer than general anesthesia.

But some doctors use general anesthesia, particularly if liposuction is performed simultaneously with other procedures such as tummy tuck, or if it involved multiple areas of the body.  However, this approach may be counterintuitive if the goal is to minimize the risk of complications.

*  While a secondary abdominal liposuction can still provide good results, each time the procedure is repeated the more difficult it becomes due to the presence of internal scar tissue within the remaining superficial fat.  For this reason, a good patient should stick to a healthier lifestyle after surgery to preserve its result.

*  Over-liposuction, or removing more than 3-4 liters of body fat in one session, is generally avoided by good surgeons because of the “unnecessary” risks.  Just to be on safe side, they prefer two or more separate procedures performed months apart to minimize the surgical trauma and bleeding.

NEW BREAST IMPLANTS COME WITH MICROCHIPS

 

A new brand of silicone breast implants will be equipped with a radio frequency microchip that can help patients and doctors access crucial information about the device, including its serial number, implant size, manufacturer’s name, and other related data.

To activate and “read” the microchips of the silicone implants, which are marketed by Florida-based Establishment Labs, doctors need to use a handheld device that will release radio waves.

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In a press release, Establishment Labs said the new product, which they call Motiva Implant Matrix Ergonomix, will soon become available in 28 European countries.  Meanwhile, the company is currently seeking approvals from health regulators in Asia, South America, and Middle East to sell their silicone breast implants.

The company’s CEO, Juan Jose Chacon-Quiros, said in a statement that the microchip-equipped silicone implants aim to “give women the power of verification and control” throughout the life of the devices.

The official added that his company “is currently in talks with the biggest clinics” in Europe to further improve the safety of patients who choose to undergo breast augmentation or reconstructive surgery with the use of breast implants.

Meanwhile, currently available breast implants in the US come with a “device identification card,” which the patients must keep in a secure place so they can show it to their doctors in case they need a revision surgery or other procedures.

Experts suggest the new technology will provide an additional safety measure after health scares involving French-made breast implants that were found to contain industrial-grade silicone gel filler used for making mattresses.

According to the most recent report, about 300,000 women in Europe and South American were affected by the health scare, although some experts have suggested it could be higher since the substandard PIP breast implants were “repackaged” and sold under different names.

Health authorities have been recommending routine removal of PIP implants due to their high failure rate.


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.

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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.

liposuction-surgery

  • 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.

liposuction-surgery-going-back-to-work

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.

tummy-tuck-tattoo

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.

tummy-tuck-recovery

  • 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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