Posts by California Surgical Institute


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.

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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.

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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.

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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.

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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.

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

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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.

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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.

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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.

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