The British tv personality, who has appeared topless on numerous tabloid newspapers, was quoted saying that her large implants seem out of proportion with her smaller body-frame.  In fact, she even admitted to “lifting her breasts” during body-building competitions because they hide the “first couple of rows of her abs.”

Meanwhile, Dr. Tarick Smaili, a cosmetic surgeon who did not treat Marsh, said that he is seeing more patients wanting to downside their breasts in order to achieve a more natural look.

“In general, very large breast implants lead to the heavy top look which often looks unnatural, especially if you have a small frame and limited chest width.  Surprisingly, this was a trend during the previous years although I am now seeing that many patients are opting to replace their implants with smaller ones to look natural,” Smaili said.

Another concern with extremely large breast implants, Smaili said, is that the patients are at higher risk of rippling, which is more of a problem if they have a limited amount of breast tissue and fats to cover the implant shell.

Citing the body-builder’s recent photo, Smaili said that her upper and medial cleavage has some visible rippling, which the doctor explained is caused by implants that are too large for her body.

Marsh is not the only celebrity who is shifting to the natural look.  In fact, Denise Richards and Pamela Anderson have been reported to undergo a revision breast augmentation to downsize their implants.

Another good example is Kate Hudson who has been reported to have plastic surgery in 2010 to receive small breast implants that no one would even be able to tell she have them if not for her previous videos and photos.

Going back to Marsh, she previously said that she was concerned if she had the controversial PIP breast implants which have been pulled out in the UK market and other countries after findings suggest the devices have a very high failure rate.

However, she did not mention if her decision to replace her breast implants with smaller ones has also something to do with the controversial PIP devices.

But aside from the natural wear and tear, breast implant replacement is also necessary if there is:

• Capsular contracture

Not all cases of capsular contracture need revision surgery particularly if there is no visible distortion and pain.  But if the symptoms are present, the only way to address the problem is through implant replacement.

The problem occurs when the surrounding scar tissue squeezes the implants, which in turn leads to pain and distorted shape of the breasts.

• Dissatisfaction with the breast size

One of the most common reasons why revision breast augmentation surgery is performed is dissatisfaction with the breast size.  Some women either think that they have gone too small or too large; for this reason, plastic surgeons advise their patients to spend some time thinking over the bust size they really want to achieve with the procedure.

Today, there are many ways for plastic surgeons to help their patients visualize the final result of breast implant surgery.  Some of the most common examples include rice test and 3D imaging technology.

• Bottoming out

Bottoming out occurs when the glandular tissue is too weak to support the weight of the breast implants, resulting to unusually low crease and sagging appearance.  This problem is often caused by implants that are too large for a patient’s body frame and amount of breast tissue and skin.

If bottoming out occurs, most plastic surgeons replace the implants with smaller ones; and to avoid its recurrence, they place the devices behind the muscles (instead above them) to provide better support and coverage.

• Drooping breasts

Breast implant surgery does not prevent sagging, a condition caused by weight fluctuations and natural aging.  If this problem occurs, a patient may seek to have a revision surgery in the form of breast lift complemented with implants.

• Implant displacement

This problem occurs when the implants settle unusually low or high, move sideways, or shift toward the center (resulting to a “uniboob”).  Displacement is often caused by breast pocket that is too large or wrong dissection of the pectoral muscles.

While many patients can enjoy the result of this plastic surgery procedure for a lifetime, about 5 to 12 percent of them may undergo a revision or secondary rhinoplasty due to several reasons such as unsatisfying result, natural changes in the nasal structure that are beyond the control of plastic surgeons, and certain complications such as breathing problems and asymmetrical appearance.

Patients should remember that revision rhinoplasty is usually more expensive and complex compared to the initial procedure since the cartilage and bones have already been reshaped while the tissue and skin already have some scarring which made them thicker and harder to work with.

Another consideration is that secondary plastic surgery in the nose involves more risks; for this reason, a person should really take time to choose a board-certified doctor who has an extensive experience in conducting this particular procedure and has a good record of satisfied patients.

For anyone considering this procedure, most plastic surgeons require to wait at least a year after the initial nose surgery so the swelling and bruising have completely subsided.  In this way, a person can also be sure that the aesthetic problem is not caused by such symptoms.

Because every patient needs a different correction, there are several rhinoplasty techniques nowadays such as bone and cartilage grafting, suturing procedures, dermal fat removal, and introduction of biocompatible implants.  However, most plastic surgeons prefer reshaping or filing the nasal cartilage and bones in order to change the structure; in this way, there is no risk of rejection because no synthetic implant is introduced.

But in case that there is not enough supply of nasal bones and cartilage, these can be grafted from the rib, pelvis, or behind the ear which is the most popular choice for majority of plastic surgery specialists.

However, this approach always requires a separate surgery aside from the rhinoplasty itself in order to collect bones or cartilage.  For this reason, some patients would rather choose to use implants to change the structure of their nose.

To date, most doctors recommend Gore-tex which is said to be one of the safest nasal implants due to its ability to allow tissues to grow inside its structure and become part of the nose.

According to plastic surgeons, revision breast implant is usually performed to correct aesthetic- and implant-related problems such as leak, bottoming out, and capsular contracture—a painful condition in which the scar tissue attaches itself to the shell, which then distorts the appearance of the breasts.

But still, most women who had a revision breast augmentation surgery were unsatisfied with the size of their breasts.  Some of them thought that they have gone too big or too small.

For women who want to further increase their breast size, most plastic surgeons consider the amount of breast skin and tissue, overall body frame (small- vs large-framed structure), and chest width in order to avoid the risks and complications related to having sizes that are too large for the body and tissue to accommodate.

It is important to note that petite women who usually have limited breast skin and tissue are at higher risk of developing complications—such as wrinkling, more post-operative pain, and bottoming out—compared to large-framed patients.

Meanwhile, most experts in plastic surgery believe that it is always easier to replace smaller implants with bigger ones than the other way around as long as there is enough skin and tissue that will cover the biocompatible materials.

In contrast, replacing the implants with smaller ones usually requires a more extensive surgery because the tissue and skin have been stretched.  For such reason, internal suturing or capsulorrhaphy will most likely be needed to tighten the capsule surrounding the implants and also “lift” the tissue and skin.

If needed, some doctors in cosmetic plastic surgery perform breast lift in conjunction with revision breast augmentation particularly for patients whose breast tissue and skin turned saggy due to aging, weight loss, physical effects of childbearing, and natural changes of the body.

In US plastic surgery, only the saline- and silicone-filled breast implants have received clearance from the Food and Drug Administration due to their high rate of tissue compatibility and relative safety to many patients.

For petite women who usually have limited breast tissue and skin, the silicone implant is usually a better option than the saline version since it has a lower risk of wrinkling, a problem which may happen if there is not enough tissue to cover the implant shell.

Aside from using the silicone implants, placing these biocompatible materials under the chest muscles will further reduce the risk of rippling and wrinkling for petite patients.  Meanwhile, most plastic surgeons believe that this implant placement is better than putting this above the tissue (even for large-framed individuals) as it creates a more natural result and prevents/corrects sagginess as more tissue and skin support the weight of the implants.

Despite the advantages of the silicone implant, some women still prefer to have the saline version so they can avoid the periodic MRI screening which is used to detect “silent leak.”  According to plastic surgery specialists, this requirement is only applicable for patients with silicone-filled implants because the cohesive gel filling may leak without any visible manifestations such as deflated breasts and asymmetrical appearance.

In case the saline implant breaks, the breasts will immediately appear deflated which will allow patients to seek a revision plastic surgery.

Some women have compared the feel of saline-filled implants to a water balloon while those with silicone said that their breast tissue feels natural to the touch.  For this reason, plastic surgeons believe that the silicone provides a slightly better result compared to the saline implants.

Both the saline- and silicone-filled implants come in round and teardrop shape which provide different results.  Round implants can make the upper poles of the breasts appear fuller while the teardrop shape simulates the natural curve of the bust.

Plastic surgeons generally recommend the round-shaped implants for women who want to have a prominent cleavage.  On the other hand, the teardrop version is ideal for those who want to achieve a more natural appearance and not the augmented, round look.

However, teardrop implants only come in a textured shell (and not smooth) to prevent these from flipping over and distorting the breast’s contour.

As with any plastic surgery, rhinoplasty involves certain risks and recovery.  For such reasons, patients are required to meet several requirements before they are considered as a good candidate for this procedure.

If the surgery is performed for cosmetic reasons, most plastic surgeons require their patients to be at least 14 years old or slightly older for males.  In this way, the nasal development has already stopped and may not affect the result of the procedure, thus reducing the chance of having a revision plastic surgery in the future.  However, this age limit may not apply if rhinoplasty is used to treat injuries, birth defects, and breathing difficulty.

Another important requirement for patients seeking cosmetic rhinoplasty is to be emotionally and psychologically stable.  In this way, they can set realistic expectations and goals that usually result to higher satisfaction rate.

Meanwhile, patients with mental disorder (manic depression, schizophrenia, etc.) and individuals who are experiencing emotional crisis are generally considered as a bad candidate for cosmetic rhinoplasty which are only ideal for well-rounded individuals.

Because nasal cocaine users usually have perforations in their nasal tissue and septum (the wall separating the two nostrils), most doctors consider them as a high-risk patient.  For this reason, they may not be allowed to have rhinoplasty especially if this is performed for aesthetic reason.

But in some instances, they may be allowed to have the procedure, although this should be always combined with septal perforation repair to fix the “holes.”  Plastic surgeons usually perform this additional surgery through the use of silicone button or flap of mucosal tissue.

According to plastic surgeons, patients with too many previous rhinoplasty are also not a good candidate for this procedure because they have significant scarring and thicker skin and tissue which are harder to work with.  In fact, revision nose-surgery is more complex, involves higher risk of complications, and more expensive compared to the initial procedure.

In a recent study, about 15 percent of rhinoplasty patients will need a revision surgery at some point in their lives.

If the rhinoplasty is performed for aesthetic reasons, doctors recommend patients to wait until they reach the age of 14 for females and slightly older for males to make sure that their nasal structure has stopped growing.  In this way, the result of the plastic surgery will most likely last a lifetime.

While nose surgery can be performed several times, patients should remember that revision plastic surgery is more challenging and involves more risk than the initial procedure since the scar tissue inside the nose makes the skin thicker and harder to work with.  For this reason, most surgeons require consultation and physical examination to determine the eligibility of patients for this procedure.

However, the age limitation is usually not applicable if rhinoplasty is performed for reconstructive purposes such as treating breathing problems, congenital defects, abnormal growth, and traumatic injuries.

In most cases, plastic surgeons alter the appearance of the nose by rearranging the nasal cartilage and bone without introducing synthetic materials such as silicone plastic and Medpore which involve rejection risk and other complications.  But in case that there is not enough supply of such tissues inside the nose, they may graft these in other parts of the body such as behind the ear, rib, and pelvis.

Cartilage and bone grafting is a favorable technique since there is no risk of rejection, although patients have to undergo another surgery to graft these tissues, which means additional risks and scarring.

For patients who want to avoid additional surgery, plastic surgeons will usually recommend Gore-tex which is said to be the safest synthetic material used in rhinoplasty surgery.  This is proven by a recent study showing that its rejection rate is only 1.9 percent, significantly lower compared to silicone plastic, Medpore, and other synthetic materials.

Aside from its safety, Gore-tex generally provides a natural appearance as its porous structure allows the tissue to grown inside, thus becoming part of the nose.  And because the biocompatible material is soft, it can be easily molded into the desired shape unlike Medpore and silicone plastic which are hard.

Aside from using implants (either natural or synthetic), rhinoplasty plastic surgery may also involve suturing techniques and dermal fat removal particularly if the nasal tip needs some alterations.

As with any plastic surgery, breast lift comes with risks such as unnecessary scarring, delayed healing, infection, and excessive bleeding.  For this reason, patients should be physically fit and have a normally functioning immune system.

Aside from being healthy, the right candidates for this plastic surgery should have realistic expectations and goals which will most likely determine if they are going to be satisfied with the result or not.  With this, plastic surgeons always conduct consultation and interview with their patients before proceeding with the operation.

During the consultation period, doctors will explain to their patients that the procedure will not significantly change the shape of the breasts and will not permanently make them firm.  For this reason, women should consider that they may need a revision plastic surgery at some point in their lives to contour the effects of aging.

For women who are considering having children in the future, some plastic surgeons may recommend that they postpone breast lift.  This is because pregnancy and breastfeeding may stretch and weaken the skin and tissue, thus affecting the result of the surgery.

To reduce the risk of infection, delayed healing, and skin necrosis (death of skin tissue), doctors require their patients to quit smoking several months before their operation and during their recovery.  According to several studies, the nicotine constricts the blood vessels which prevents the oxygen from effectively reaching the wound, as a result, smokers are more likely to experience delayed healing which may even lead to skin necrosis and unnecessary scarring.

Meanwhile, breast lift is traditionally performed using the anchor-shaped incision that resembles a nautical anchor—a circular cut around the areola, another one starting from the nipple down to the breast crease, and one more that covers the fold of the bust.

In general, this approach is recommended for women who have larger breasts with severe droopiness.

Because of the extensiveness of the anchor-shaped incision, this technique is usually not ideal for small- to medium-breasted women and those who with minimal to moderate sagginess.  For this reason, surgeons have developed modified breast lift procedures which usually require fewer incisions, less scarring, shorter downtime, and reduced risk of complications.

Patients should remember that implant manufacturers do not cover the cost of revision breast augmentation, although most of them generally provide lifetime guaranty for their products.

There are two ways to perform revision plastic surgery: through implant removal surgery for patients who no longer wants the material due to personal or medical concerns, and via breast implant replacement for women who want to correct their implant-related problems.

Most plastic surgeons believe that the most common reason why women ask for a revision breast implant surgery is being unsatisfied with the size (either going too small or too large).  With this consideration, it is very important for patients to take some time to think about the size they want to achieve without pushing their body’s limitations.

To help patients choose the right implant size, plastic surgeons usually perform “rice test” in which they put a certain amount of rice in a small sack which is then placed inside the unpadded bra.  The amount of rice is then reduced or increased until the patients are satisfied with the result.

Another common reason for revision breast augmentation surgery is due to implant displacement or “bottoming out,” a problem which happens when the material travels downward.  To avoid or correct this problem, most plastic surgeons put the implants under the chest muscle instead above it so that more tissue and skin can serve as a natural support and padding.

Aside from reducing the risk of implant displacement, putting the implants under the muscles has been said to lower the risk of capsular contracture (another common reason for revision plastic surgery) in which the tissue squeezes the implant resulting to a painful, hard, and distorted breast.

Some experts also believe that the under-the-muscle placement prevents the implants to have contact with the tissue wherein the bacteria, which may trigger capsular contracture, may contaminate the synthetic materials.  Another advantage of this implant placement is that it usually creates a natural appearance and not the round augmented look which commonly happens if the implant is placed above the muscle.

Implant deflation caused by rupture is another common reason for revision plastic surgery.  This problem can be easily corrected by removing the damaged implants and replacing these with a new one.

According to plastic surgeons, “bottoming out” is one of the most common reasons for revision breast implant.  This condition happens when the synthetic material travels south and results to unsightly, drooping breasts.

There are certain factors that can increase a patient’s risk to this complication, including over-dissection of the implant pocket during the initial surgery.  This pocket, in which the implant is placed, should be not be too big to the extent that the material can travel freely.

Bottoming out also happens if the implants are too big and heavy for the skin and breast tissue to accommodate.  With this consideration, plastic surgeons do not recommend larger sizes for petite women who usually have limited skin and tissue in their bust.

Some plastic surgery experts also attributed this complication with the use of above-the-muscle implant placement on thinner women or those who have limited skin and tissue.  To minimize such risk, the under-the-muscle placement is the most recommended so there will be more breast tissue and skin to support the implants and serve as a padding that will cover the synthetic materials.

Currently, there are different techniques to address implant bottoming out including the use of internal sutures to reduce the size of the breast pockets and push the implants to a higher place and reposition the areola in the center of the breast mound.  But instead of using sutures, some plastic surgeons use a flap of tissue derived from the inside of the pocket to reduce the capsule.

While the said approach can correct bottoming out, most doctors stay away from this since the stitches may cause additional scarring.

Fortunately, there is another option to treat this problem.  By using tissue substitutes such as Strattice and Alloderm, there will be a structural brace to hold the breasts up and support the implants.  This approach is ideal for patients who do not have enough tissue in their breasts.

Certain cases of bottoming out can be addressed by breast lift (or mastopexy) combined with skin removal along the breast crease.  And if the problem is also caused by implants that are too large, plastic surgery specialists will most likely replace them with a smaller size to prevent this complication from happening again.