Showbiz bloggers have come up with the term pillow face to describe celebrities with too much dermal fillers, which of course leads to the unnatural appearance. However, volumizers such as Restylane and Sculptra are not supposed to result in “plastic surgery look” as long as they are used in the right location and correct amount.

Dr. Karan Dhir, a celebrity Beverly Hills plastic surgeon who specializes in facial rejuvenation procedures, explains the techniques on how to maximize the effects of dermal fillers without resulting in chipmunk cheeks or pillow face.


*  It is not just about filling the hollowed area. One of the most common mistakes of inexperienced doctors is to “fill lines” and inject large amounts of dermal fillers without even bothering to reshape the treated area. This over-aggressive approach results in duck lips, chipmunk cheeks, and overall swollen appearance.

Dr. Dhir highlights the importance of contouring the face in a way that it looks natural and rejuvenated. For instance, lip injection can provide good results if the surgeon maintains the “bow” appearance.

*  Take the conservative route. Instead of dumping large amounts of dermal fillers, it is not uncommon for prudent doctors to perform two or more treatments performed several weeks apart. The idea is to wait for the patients to get used to their appearance and assess if there is a need for additional injections.

By avoiding the overfilled appearance, prudent doctors are able to preserve the natural shape of the eyes, cheeks, lips, and mouth area.

*  Understand that each dermal filler may have different effects. Sculptra is ideal for correcting the hollowed temples, jaw line, and cheeks because of its smooth consistency, leading to a more natural look and feel. Radiesse, meanwhile, is believed to be more suitable for deep lines and smaller facial depression due to its thicker consistency.

*  Correct depth of injection. While the superficial placement of fillers can correct the gaunt appearance, doing so could weigh down the skin, leading to the saggy appearance. For this reason, some patients also need additional support to achieve good results from dermal fillers.

Deeper filler placement is usually important in cheek augmentation via dermal fillers because it is ideal to create some support and lifting effect. But for this to be possible, the volumizer should be stiff enough or has the right consistency.

Proper angle and depth of injection not only provides natural results, but also prevents lumpiness, migration, and other telltale signs of dermal fillers.

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Bridalplasty is a term coined to describe cosmetic plastic surgeries that are performed before the wedding day.  While some people may think that brides having these procedures are going overboard, this is surprisingly a growing trend in the US.

Just recently, Good Morning America has reported that liposuction and breast lift are just some of the popular pre-wedding day surgeries for brides who want to look ravishing in their most special moment.

However, non-invasive procedures such as Botox injection, soft tissue fillers, and laser skin resurfacing are also popular among brides-to-be.  The advantage of such treatments is that they no longer have to allot some time for their recovery, which is the tradeoff in cosmetic plastic surgery.

Los Angeles plastic surgeon Dr. Tarick Smaili believes that bridalplasty will continue its popularity for the next coming years.  Nonetheless, he said that the patient asking for such procedure should be doing this for the right reasons.

“Cosmetic surgeries, which are elective procedures, should only be given to physically and emotionally healthy patients who want to improve the way they look.  By contrast, those who want to change their appearance just because someone else told them to do so are bad candidates from the very beginning,” Smaili said.

Smaili said that most brides-to-be who are asking for cosmetic plastic surgery view it as a good way to start their married life.

While there is nothing wrong with such belief, the leading cosmetic surgeon has warned people that plastic surgery is not a “quick fix to everything and every physical flaw.”

“A good example is liposuction, a procedure that can permanently remove the excess fats in your abdomen, hips, or any problem area.  However, it doesn’t automatically mean that you will not gain weight.  Yes, its result is permanent—unless you will manage your weight through regular exercise and of course healthy diet,” Smaili said.

Meanwhile, the plastic surgeon highlighted the importance of allotting enough time to rest during recovery.  It simply means that patients have to undergo a cosmetic surgery well in advance of their wedding day to avoid the stress and other factors that may compromise their healing.

“Just to be on the safe side, a patient should ask her doctor on how long it will take before she can resume her daily activities.  The rule of thumb is quite simple, never rush your recovery as it may increase the risk of complications,” he added.

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With the advances in US plastic surgery, patients can now use their own fats derived from their abdomen (or other areas where fatty deposits accumulate) to fill in the hollowed areas in the face such as the cheeks, temples, and lips.  But since plastic surgeons have recently developed ways to increase the survival rate of the grafted fats, it has now become possible to use this procedure to augment larger body parts such as the breasts and buttocks.

As people age, they lose a significant amount of fats in their face that leads to a tired, old appearance.  During the previous years, the loss of facial volume was only treated with soft-tissue fillers which are relatively safe, although some patients may develop allergic reaction.

Meanwhile, this is not a concern in using fat transfer since no synthetic material is introduced in the body.  For this reason, many patients are choosing this treatment over alternative fat injections such as Radiesse, Juvederm, Restylane, and Sculptra.

However, fat transfer is not just about collecting fatty tissues and then transferring these to another body part.  To increase the survival rate of the fats, plastic surgeons perform purification method in which they separate and remove the blood, tissues, and other impurities.

By employing the proper purification treatment, doctors can increase the survival rate of the fats to 65 to 85 percent which means the result can be long lasting (or even permanent) and also noticeable.

After removing the impurities, the fats are injected to a new area at a varying level in order to encourage better absorption and achieve a more symmetrical and natural appearance.

The good thing about this procedure is that patients enjoy two benefits: they can remove the excess fats from their abdomen and areas where these accumulate, and they can augment the parts which need to be more prominent such as the buttocks, cheeks, and breasts.

For treating larger areas such as buttocks and breasts, patients should have enough fats especially in their abdomen to achieve a drastic change in size.  With this consideration, thin or petite individuals may not have the same noticeable result compared to those with a good amount of fatty tissues in their body.

In case that fat transfer is not ideal or even impossible to perform, patients may choose biocompatible implants to augment and/or improve their breasts, buttocks, chest, cheeks, calves, and other deflated-looking areas which are supposed to be prominent.

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Facelift surgery is a cosmetic procedure that aims to remove the signs of aging which include excess skin, hollowed areas, deep facial lines and wrinkles, downturned lips, and sagging eyebrows.  To date, the plastic surgery comes in different, highly individualized techniques to create the most natural result.

As with any plastic surgery, facelift requires recovery that will largely depend on the number and depth of the incisions used, and a person’s healing ability.  For this reason, individuals suffering from serious health conditions such as diabetes, excretory disorder, heart problem, delayed healing, and high blood pressure are typically considered as a bad candidate for the said procedure.

While facelift provides a satisfying result to the right patients, they should realize that this plastic surgery procedure will not change their fundamental appearance and will not stop the aging process, although it can make them look five to 10 years younger.  In general, the surgical approach provides a more dramatic outcome compared to non-invasive procedures such as botox injection, facial fillers, and laser treatment.

If needed, plastic surgeons recommend non-surgical procedures to complement facelift surgery.  Examples of these treatments include chemical peels to improve the skin texture; botox to relax the muscles and prevent wrinkles due to excessive facial movements; facial fillers or volumizers to plump up the skin and “fill in” the small crevices and hollowed areas of the face; and laser treatments to treat photo damage manifested by sun spots, freckles, and other discolorations.

Because every person has a varying degree of skin sagginess and has different locations of lines and wrinkles, plastic surgeons have developed several “isolated” techniques to remove the effects of aging.  And by specifically targeting the “problem area,” there is almost no risk of having a “windswept appearance” caused by overcorrection.

For patients aged 30 to 50, the most popular “isolated” facelift technique targets the mid face, the first area to manifest the signs of aging.  Through this approach, plastic surgeons can remove the mouth-and-nose lines, correct the downturned lips, eliminate the under-eye bags, and lift the sagging cheeks through shorter incisions made discreetly behind the hairline, along the lower lash line, or inside the mouth.

These are the other examples of “isolated” facelift surgeries: brow or forehead lift, neck lift, lower facelift, and eyelid lift.  These procedures may be combined together to create the most desired result.

However, it is important to note that most minimally invasive facelift techniques, especially if performed as a stand alone procedure, are not ideal for patients 50 years and older who will benefit more with a complete facelift.

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In US plastic surgery, buttock enhancement is increasingly becoming a popular cosmetic procedure particularly on women who have “underdeveloped” buttocks and want to achieve a more feminine figure.

There are two ways to perform buttock enhancement surgery: through the use of butt implants made of a solid silicone material, and via fat grafting in which plastic surgeons use a patient’s own fats and transfer these to her buttocks.

For patients who want to significantly increase their butt size, the most recommended approach is buttock implant surgery which is typically performed as an outpatient procedure.  In this surgery, plastic surgeons create incisions in the buttock crease or in the area where the cheek meets the back of the thigh; through these incisions, they can create a pocket where they can place the synthetic materials.  (See picture below.)

To reduce the risk of shifting and rupture caused by a patient’s own weight, plastic surgeons place the implants above the “sitting area.”  With this, only the upper poles of the buttocks can appear fuller and not the lower region.

Meanwhile, the implants can be placed either above or under the muscles, although most doctors in LA plastic surgery prefer placing the biocompatible materials below the muscles so that more tissues and skin can serve as a “natural” padding.  However, patients should expect that this implant placement involves longer recovery and more post-operative pain and discomfort.

Patients can expect swelling, pain, and discomfort during the first few days of their recovery.  But after a week or so, most of them can perform “light” activities and return to their work, although full recovery may take three months or even longer.

While butt implants are safe and effective to a significant number of patients, these synthetic materials still involve potential risks such as adverse immune reaction.  With this concern, some people prefer fat grafting over buttock implant surgery, albeit that this approach does not significantly increase the butt size.

Doctors in LA plastic surgery perform butt augmentation through fat grafting by collecting fats to the abdomen, thigh, back, arm, or area where the fatty deposits tend to accumulate.  After this, the collected fats will undergo a purification method to remove impurities such as tissues and blood.

If the purification method is done properly, the transferred fats can have a survivability rate of more than 50 percent (or even higher) and they can last a lifetime or at least for several decades.

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There are countless of facial rejuvenation procedures such as facelift surgery, botox injection, dermal fillers, laser skin resurfacing, chemical peels, and microdermabrasion.  It is important to note that the best approach will depend on the severity or mildness of the sagging, wrinkles, hollowed appearance, sun damage, and other signs of aging.

Nowadays, botox injection and facelift surgery are the most commonly performed facial rejuvenation procedures in the US.  But to fully enjoy the benefits of these treatments, certain factors must be considered, including the goals and expectations of patients.

For patients aged 60 years and older, traditional facelift surgery is often the best treatment to remove the deep facial lines, excessive sagging, hollowness especially in the cheek area, and widespread wrinkles.  But more often than not, this procedure involves extensive and deeper incisions which can lead to prolonged recovery and more risk of complications such as nerve damage, scarring, and excessive bleeding.

Because of the risks associated with facelift surgery, a patient should only consult with a board-certified plastic surgeon specializing in this field.

But with the advances in plastic surgery, facelift is no longer an exclusive procedure for patients aged 60 years and above as doctors have developed less invasive approach to treat individuals with minimal sagging and wrinkles.  For instance, mid-facelift involves a few shorter excisions often hidden behind the hairline (near the temple) and/or along the nasolabial fold which is the line between the mouth and nose.

However, some patients may still find the mid-facelift surgery too invasive for their minimal sagging.  With this consideration, botox injection is a great alternative in which they will not experience recovery and risk of scarring, nerve damage, and other surgery-related complications.

Botox works by preventing the underlying muscle from contracting, preventing the formation of facial lines.  But still, not all types of wrinkles respond to this treatment, particularly those which are caused by gravity and sun damage.

For the first day or two, it is not uncommon to experience bruising and mild headaches which will resolve on their own.  In general, the treatment is safe for a significant number of patients although allergic reactions and temporary nerve paralysis may still happen.

To minimize the risk of nerve paralysis, a patient should never lie down immediately after the procedure or rub the injected site to prevent botox from migrating beyond the treated areas.

Unlike facelift surgery, botox injection does not involve recovery which means that a patient can immediately resume her normal activities.  However, one downside is that the result only lasts four to six months and should be repeated if one wishes to maintain a youthful appearance.

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