Rhinoplasty, or nose job in layman’s term, is either performed through an open or closed technique incision; this allows the surgeon to reshape the cartilaginous and bony framework of the nose to improve its “outside appearance.”
Renowned Los Angeles plastic surgeon Dr. Tarick Smiley says he prefers the closed technique in which the incisions are limited inside the nostril, thus reducing any risk of visible scar. The open rhinoplasty, meanwhile, cuts the columella or wall separating the two nostrils to lift the “roof” of the nose before reshaping the underlying framework.
The female patient receives the closed rhinoplasty technique known for its shorter recovery or social downtime.
“About 95 percent of my rhinoplasty is done through closed technique,” Dr. Smiley said in his recent posts on Snapchat that demonstrated two female patients who have had nose-reshaping surgery.
The celebrity plastic surgeon has explained the “core” benefits of closed rhinoplasty:
- More control and increased predictability over the final results
Some surgeons argue that the open technique provides more control over the final results due to the improved visibility since it allows them to raise the roof of the nose. However, Dr. Smiley says it comes with one major caveat: They do not see the “outside appearance” of the nose while they are reshaping the underlying framework.
Meanwhile, the closed rhinoplasty technique allows the surgeon to reshape the underlying framework and see and examine the outside appearance of the nose in “real time.”
“Just like you’re molding a piece of clay it is better to see it every time you do it step by step,” he explained in the videos.
Compared to the open technique, closed rhinoplasty causes less disruption and injury to the soft tissue, leading to less bruising, pain, and swelling, which in turn contributes to shorter recovery.
Contrary to popular belief, most patients are concerned about the “social downtime” than the pain (which in most cases is well controlled by medications). With closed technique, many patients can expect to look presentable after a week, versus 10-14 days when open rhinoplasty is performed.
With closed rhinoplasty, there is no external scar across the columella. It is important to note that open rhinoplasty often results in barely detectable scar, although a small percentage of patients have experienced less than optimal scar.
Male liposuction ab etching, a procedure purported to turn a keg-shaped belly into a six-pack, has been receiving both media hype and controversy. While this sounds great in theory, in reality the final result still boils down to the patient’s underlying anatomy.
The six-pack appearance is caused by well-developed abdominal muscle that shows through the skin. However, some men have thick superficial fat that conceals any muscular definition.
Photo Credit: patrisyu at FreeDigitalPhotos.net
Unlike the deeper visceral fat surrounding the abdominal organs that is linked to obesity, the distribution of superficial fat is mainly influenced by genes and thus some men despite adhering to the strictest exercise regimen and diet do not achieve the appearance of six-pack abs.
Fortunately, liposuction cannula—a hollowed steel tube attached to a vacuum pump—can remove the superficial fat. Hence, this body contouring surgery is reserved for normal weight patients who are committed to healthy lifestyle, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Even the standard liposuction technique may lead to the appearance of six-pack provided that the patient has well-developed muscles that are concealed by a thick layer of superficial fat.
During a standard liposuction technique, doctors remove fats deep within the subcutaneous tissue.
Meanwhile, there is one specific technique purported to deliver six-pack even in patients with poor muscle definition.
Ab etching liposuction, which has always been hounded by controversies, involves very superficial and aggressive fat removal. The idea is to eliminate fats in a way that several “grooves” are created in the process.
These “grooves” have their skin almost sticking down to the underlying muscle, which is believed to increase the risk of poor healing and skin scarring.
Some doctors also stay away from ab etching liposuction because of the “manufactured” or unnatural look due to the presence of contour irregularities.
Because of the difficulty of creating natural-looking results from ab etching technique, plastic surgeons typically prefer the standard liposuction and occasionally complement it with a very small amount of etching in the midline (above the navel).
Tummy tuck and waist size: Can this body contouring surgery result in a dramatic improvement in the size and contour of the patient’s abdomen?
Celebrity Beverly Hills plastic surgeon Dr. Tarick Smiley says the vast majority of tummy tuck patients can expect drastic narrowing of their waistline with the right combination of surgical maneuvers.
The patient is ecstatic after seeing the results of her tummy tuck.
(Note: The only tummy tuck patients who would experience limited contouring effects are those who have lost large amounts of weight but still remain overweight, and those with diabetes and other conditions that compromise their healing. Since the large apron-like skin causes pain and tissue breakdown, their doctors are more focused on improving their quality of life than refining their physique.)
Traditional tummy tuck uses a hip-to-hip incision to remove the excess skin from the lower abdomen; the skin above the navel is then pulled downward to close the wound in a way that the scar settles very low and is concealed beneath the underwear. However, this method alone is not enough to narrow the girth.
Prior to the creation of hip-to-hip scar, Dr. Smiley occasionally performs liposuction of the flanks to remove the excess fat. In his recent Snapchat post, he said this allows him to tighten and pull more skin centrally during tummy tuck, further contributing to the tapered waist appearance.
To further reduce the waist size and correct the barrel-shaped appearance of the abdomen, Dr. Smiley also incorporates tummy tuck with muscle repair.
Prior to pregnancy or large weight fluctuation, the pair of abdominal muscles is positioned immediately side-by-side right and runs below the sternum and above the pubic hairline.
However, the abdominal wall becomes separated due to the stretching of fascia layer (connective tissue) during pregnancy or large weight fluctuations. Hence, the once flat and athletic-looking abdomen is turned into something that resembles a “barrel.”
To correct the barrel-shaped abdomen, Dr. Smiley uses permanent sutures to bring the abdominal muscles closer to each other, back to their original configuration. He said that he prefers the “individual suturing technique” to the “running stitch” due to the former’s stronger support.
“The individual suturing technique means that each stitch is as strong as the next one,” Dr. Smiley said in his previous Snapchat post.
On average, patients can expect to lose 2-6 inches off their waist following tummy tuck surgery. Nonetheless, the celebrity plastic surgeon said that its long-term success still boils down to the patient’s commitment to healthy lifestyle—i.e., sustainable weight management.
Complete smoking cessation a few weeks leading up to plastic surgery has become a common practice to reduce risk of skin necrosis, pulmonary- and heart-related complications, and poor healing and scarring, according to the California Surgical Institute website.
However, a recent study published in Plastic and Reconstructive Surgery has found that many patients receiving smoking cessation instructions had kick the habit for good or at least smoked less frequently years after their surgery.
Photo Credit: WebMD
Researchers at the University of British Columbia, Vancouver have suggested that “surgeons who request pre-operative smoking cessation may influence patients’ long-term smoking status.”
The researchers enlisted 47 patients who responded to a 5-year follow-up survey, although five social smokers were later excluded to make sure that the study only involved “bona fide” daily smokers. Most respondents were women whose average age was 40.
Most respondents requested for tummy tuck, breast lift, and facelift.
In the follow-up survey, 25 percent of patients had quit smoking since their cosmetic surgery, while 40 percent said they smoked less. Most patients said the frequency of their cigarette use was reduced to a varying degree, citing their surgery as a strong motivation to live a healthier life.
The authors of the study have concluded that people were more likely to quit smoking or at least reduce their tobacco use when they were presented with “specific negative effects of smoking” rather than with “general health benefits of smoking cessation.”
In 2016, about 215,000 cosmetic plastic surgeries were performed in men, accounting for 13 percent of all aesthetic procedures; their popular requests included facelift, eyelid lift, and rhinoplasty (nose job), according to a survey released by the American Society of Plastic Surgeons.
Aside from gender-based beauty standards, men’s facial plastic surgery is different from women’s due to their underlying anatomy. For instance, their skin is more vascularized and thus more susceptible to bleeding and bruising compared to females.
Men’s facial plastic surgery requires a different approach than women’s.
Furthermore, any scar that may result from facial plastic surgery is more difficult for men to hide since they do not wear makeup, as most women do.
Another notable difference is the men’s tendency to ask for subtler results because unlike women, they are less likely to disclose their plastic surgery to other people probably due to “double standard” stigma.
Fortunately, achieving subtle and natural results from men’s facial plastic surgery is possible with correct surgical maneuvers and deep understanding of universal guidelines of facial proportion and masculine beauty.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley explains the three most commonly sought facial plastic surgeries of men and the core principles that help him deliver natural and gender-appropriate results.
Men are more prone to hair loss than women, making it more challenging to hide the scar. It is important to note that facelift typically uses incisions within or behind the hairline to hide the scar, which can be difficult in patients with receding hairline, unless a short-scar or mini lift is used.
Another issue with male facelift is the surgical stigmata—e.g., flat cheeks, overly pulled appearance, and hollowing of the lower lid. However, these can be avoided with the correct vector of pull.
Aging causes the vertical descent of the skin and other soft tissue; hence, the correct vector of pull should be oblique and not a “blunt” horizontal.
By lifting the skin at a 45-degree angle, several wonderful things happen: the jowling is reduced, the softness of the cheek fat pad is restored, and the face appears tighter but not too taut.
Another nuance of male facelift is the propensity of patients to ask their surgeons to maintain a few small wrinkles for a more realistic, natural result.
Men generally seek nose-reshaping surgery to reduce their hump and refine their tip without causing them to lose the masculinity of their face. Hence, great surgeons avoid over-resection of the tissue, which is also linked to increased risk of nasal collapse and other deformity.
The ideal nose is defined by universal beauty tenets instead of a highly rigid set of rules. The goal is to reshape the nose that will fit the face of the patients, respect their gender and ethnicity, and meet their aesthetic goals.
Several studies have attempted to describe what constitute an ideal male nose and these are some of their findings: It is “biologically” bigger than female’s possibly due to men’s increased muscle mass that requires more oxygen; it has a prominent dorsum or bridge; its tip has an angle of rotation around 90 degrees giving it a straighter profile (a slight upturned appearance is enough to feminize the face); and the overall profile appears strong instead of delicate.
Eyelid surgery eliminates the hooding of the upper lid and the under eye-bags. However, even the slightest error—i.e., removing just a few millimeters of fat or skin than intended—can lead to stigmata such as lid retraction, deep tear trough, and abrupt lower lid-cheek transition.
To deliver natural and gender-appropriate results, doctors ensure that after surgery the upper lid appears “heavier” and lower compared to women’s, and there is a smooth lower lid and cheek junction.
And to preserve smooth transition between the lower lid and cheek, eyelid surgery is now commonly performed together with fat injection.
Another issue with male eyelid surgery is the risk of scar. This can be avoided by placing the incision precisely at the skin fold of the upper lid, and very close to the lower lash line margin.
All efforts are made to ensure that the scar remains concealed because men do not wear makeup to hide surgical stigmata.