Plastic Surgery


Eyelid surgery scars are supposed to be invisible or undetectable even by the patients themselves. The key is to position them correctly, use meticulous wound closure, and care for them so they can blend well with the skin once they are fully healed, which happens around six months.

 

For upper eyelid scars, they are made in the actual eyelid crease for optimal concealment. The lower eyelid incisions, meanwhile, are positioned inside the eyelid (when the goal is to remove the under-eye bags caused by excess fatty tissue alone) or very close to the eyelash line (when there is also loose skin that needs to be excised).

 

eyelid surgery scars

 

Most surgeons agree that it is much easier to conceal the upper eyelid scars because of the naturally occurring skin crease where they are positioned.

 

On the other hand, lower eyelids are believed to be trickier. The goal is to place the incisions adjacent to the eyelashes—not a few millimeters below them—to ensure optimal concealment. To do this, the surgeon must hold a pointed scalpel blade in a somewhat oblique position so he can place the scar very close to the eyelashes.

 

To further promote “favorable” eyelid surgery scars, Brea plastic surgery expert Dr. Tarick Smiley says it is critical to remove just the right amount of fat and skin. He warns that over-correction can lead to eyelid retraction in which the scars become more visible.

 

Aside from poor and obvious scars, all efforts are made to avoid over-correction and eyelid retraction because they also result in dry eye syndrome and irritation, explains Dr. Smiley.

 

Furthermore, wound closure can make or break the surgery. The goal is to close the incisions in which there is no or very little tension on the skin, allowing the scars to heal and fade better. Some doctors argue that absorbable sutures are better then removable stitches, although this “issue” is still up for debate.

 

Proponents of absorbable sutures (they are typically gone about a week) suggest that they do not leave a mark, while some doctors prefer removable stitches (they are removed 5-7 days) since they feel that if the sutures dissolve too early it may lead to wound breakdown.

 

With proper surgical execution and postop care, eyelid scars are almost always undetectable since the eyelid skin (which is very thin compared to other skin in the body) is highly resilient to “thick” or poor scars.

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Plastic surgery photos, i.e., the surgeon’s before-and-after pictures of his previous patients—can reveal his quality of work, experience, and personal style. Nevertheless, this is just one of the many aspects a prudent patient should look into; board certifications, education, training, and reputation should also carry the most weight when selecting a doctor.

 

It is important to note that plastic surgery photos can shed light on the critical factors stated below:

 

plastic surgery photos

 

  • The surgeon’s experience

 

Experience plays a critical role in the success of plastic surgery, allowing the surgeons to identify anatomical challenges and work around them to achieve good aesthetic results and to avoid or at least minimize risk of complications.

 

It may be safe to surmise that surgeons with thousands of before-and-after photos of previous patients (who all have had the same plastic surgery procedure) can produce better results than doctors with just a few pictures to show due to their limited experience.

 

The consensus is to choose a board-certified plastic surgeon who performs the sought procedure on a regular basis for a minimum of five years. However, the requirements are generally stricter in rhinoplasty (nose job), reconstructive breast surgery, and revision/corrective surgery because these are noted for their technical difficulty.

 

  • The surgeon’s personal style

 

While a good surgeon will always ask for his patient’s input, his personal style will still show to a certain degree. For instance, leading Brea plastic surgery expert Dr. Tarick Smiley’s “core value” when doing ethnic rhinoplasty is to maintain his patients’ racial traits when improving the appearance of their nose.

 

  • The “focus” of the surgeon’s practice

 

Plastic surgery is a very broad medical practice; hence, a doctor who produces impressive results from breast augmentation may not be able to replicate the same outcome if he attempts rhinoplasty.

 

Even rhinoplasty can fall into several different categories. For instance, revision or corrective nose surgeries are technically more demanding than primary operations that they are considered as a “niche” practice.

 

Some surgeons also focus their practice or at least mostly cater to a small subset of patients with similar pre-existing condition. For this reason, a patient seeking breast reconstruction-augmentation after mastectomy may want to see more “before” photos with the same condition, allowing her to visualize her possible results and to settle for more realistic goals and expectations.

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The resulting arm lift scars are the most common concern of patients who have a “bat wing” appearance, which is often the result of massive weight loss and/or aging. However, a good plastic surgeon will make every effort to hide any sign of the surgery.

Dr. Tarick Smaili, one of the leading Inland Empire plastic surgery experts, explains the guidelines on promoting favorable arm lift scars.

arm lift scars

before-and-after photos of patients who had arm lift surgery

* Proper patient selection. The patient must have no healing problem or medical condition that could lead to increased risk of infection or poor healing, which is linked to “aggressive” scars that appear thick and raised.

* Proper placement of incision. Most patients will need an incision starting from the armpit down to the elbow. While it is highly preferred to position the scar in the inner arm so it remains hidden, sometimes it might be better to place it more posteriorly to remove more redundant skin.

Simply put, sometimes a more visible scar placement is necessary if you think that having a more natural-looking result is a good tradeoff.

Aside from discreet placement of scar, it is also crucial to close the wound in several layers to minimize tension on the skin, which in turn can promote favorable scarring.

* Use of steri-strips and compression garments after surgery. In the first 2-3 weeks the wound only has 60-70 percent of the normal skin’s strength, which makes it a crucial period. To prevent wound breakdown and poor healing, it is important to minimize skin tension.

* Laser treatments. Fractional laser resurfacing and pulsed dye laser have been known to flatten raised scars (keloids and hypertrophic scars) and address post-inflammatory redness. But to achieve good results, you will need at least 3-4 treatments.

* Sun protection. The general rule of thumb is to avoid UV rays for 6-12 months postop to prevent hyper-pigmentation in which the scars become dark due to excessive production of melanin.

But if you cannot avoid the sun altogether, at least try to wear sunscreen with high SPF, use an umbrella, and wear long sleeves to protect your scars from UV rays, which can pass through clouds.

*Use silicone tapes. They are generally used in the first three months postop. Not only they can hydrate the skin, but can also prevent excessive collagen formation, which is responsible for the appearance of scar tissue.

Proponents suggest that silicone tapes are most effective when used as long as tolerated.

*Massage your “immature” scars, which are less than three months old. The idea is to break down the scar tissue while it is still responsive to “manipulation.”

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Several variables will determine the ideal neck lift procedure. Nevertheless, it remains imperative to place the scars behind the ears (specifically within the natural skin folds) and/or beneath the chin to hide the surgical stigmata.

Dr. Karan Dhir, one of the leading Beverly Hills plastic surgery experts, has provided simple explanations of the different techniques used in neck lift.

neck-lift-procedure

before-and-after photos of a neck lift patient

  • Standard technique. In general, it aims to correct the turkey wattle appearance by making around 3 cm incision beneath the chin (and possibly behind the ear if there is some excess skin as well). The idea is to access the muscle called platysma, which is responsible for the sagging neck.

Because the goal is to achieve a smooth right angle under the chin, many patients will need their muscles to be sutured across the midline in what doctors refer to as a “corset approach.”

But for a few patients, cutting or removing some muscle might be indicated to achieve good results from neck lift.

  • Skin lift. To remove the excess skin, incisions behind the ears are also needed. Nevertheless, it remains important to tighten and reposition the underlying structure such as the deep muscle and superficial fat to achieve long-lasting results and prevent tension on the wound, which is known to cause poor scarring.

In general, a skin-only lift is not practical because without reshaping the deeper structures the skin will only relax and sag over time.

  • As a stand-alone procedure it is rarely performed in older patients because they generally have poor skin elasticity. To achieve good contour, platysma muscle tightening and skin excision are commonly used as well.

Through a small incision beneath the chin (and sometimes behind the ears), doctors are able to correct the double chin appearance. However, it is imperative to leave some fat to cover and hide the underlying muscle.

With over-liposuction, the muscle might show, leading to unnatural results and/or more aged appearance. For this reason, most surgeons will only remove a conservative amount of fat to anticipate further tissue atrophy (or volume loss) caused by aging.

Special Note:

A good number of neck lift patients can benefit from facelift that is performed simultaneously with their surgery. The idea is to achieve a smooth transition between the mid face and neck area, leading to a more rejuvenated countenance.

Other common ancillary procedures include Botox injection, dermal fillers, fat grafting, rhinoplasty (nose job), and chin augmentation via implants.

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Tummy tuck after weight loss requires a more extensive use of incision to remove the redundant skin and fat rolls. Instead of the usual-hip-to-hip scar in the lower abdomen, the horizontal cut may extend to the flank area to give doctors more amount of control.

Dr. Tarick Smaili, one of the leading Orange County plastic surgery experts, says tummy tuck for massive weight loss (MWL) patients may also require liposuction to remove the “stubborn” fat which also contributes to their deformity.

tummy-tuck-after-weight-loss

While a typical liposuction involves removing just a small amount of fat for “spot contouring,” Dr. Smaili says MWL patients often require debulking in which large volume of fat is aspirated to achieve an impressive or at least a near normal appearance following their weight loss journey.

Large volume liposuction, which is often defined as removal of at least 5 liters of fat, can have a dramatic effect although the caveat is the increased risk of surgical trauma and its subsequent complications. For this reason, doctors take extra precautions to minimize such risks, explains the renowned plastic surgeon.

Dr. Smaili says it has become a common practice to combine liposuction and tummy tuck under one surgical setting, although for MWL patients who generally require the most amount of correction, they may have to stage the procedures to achieve a more predictable outcome and to minimize risks.

Dr. Smaili explains the two main issues when liposuction and tummy after weight loss are performed simultaneously.

  • Longer operative time. Ideally, elective plastic surgeries are performed under six hours to minimize the amount of surgical trauma and reduce the risk of deep vein thrombosis (DVT) and bleeding.

A good surgeon will make every effort to minimize the risk of DVT or blood clot in legs, which if left untreated can travel to the lungs and cause pulmonary embolism and other serious complications.

  • Increased risk of blood supply injury. To prevent healing problems and other complications, the liposuction cannula or suction probe must work far away from the tummy tuck scar. However, this might pose a challenge since MWL patients require a flank-to-flank incision.

While it is possible to perform liposuction at the same time as tummy tuck, some MWL patients may have to stage their surgeries, particularly those who need the most amount of correction.

Should the surgeon elect to combine liposuction and tummy tuck under one surgical setting, he may not remove fat as much as he would typically do.

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Breast reduction surgery is not just about downsizing. For many patients, the procedure also provides relief from postural problem, chronic back and neck pain, rounded shoulders, bra strap grooving, systemic discomfort, and restriction of physical activities.

As with any plastic surgery procedure, breast reduction is perceived to be 25 percent science and 75 percent art. For this reason, one of the qualifications you must look for in a surgeon is his visual talent, which you can assess by looking at his before and after photos.

breast-reduction-before-and-after-photos

Brea plastic surgery expert Dr. Tarick Smaili shares his tips on how to examine breast reduction before and after photos, and what variables you should pay close attention to.

  • Position of the nipple-areolar complex

While breast reduction and breast lift have different goals, they are commonly combined because they share the same incision pattern. For this reason, the low-lying nipple areolar complex is repositioned to achieve a more balanced appearance.

The nipple area is expected to be at least 4-5 cm above the natural breast crease, although this “guideline” can be slightly adjusted depending on the “cup” size.

However, inexperienced doctors might reposition the nipple area too high that it shows when a patient wears a low-cut bikini top. This botched result is generally difficult to correct because of the resulting scars.

Meanwhile, it is not uncommon to reduce the areola size at the time of surgery so it will look proportionate to the smaller breast.

  • Ideal projection

The 45:55 ratio between the upper pole to lower pole, with the nipple-areolar complex being the demarcation, “is the basis for design” in breast enhancement surgeries.

While breast reduction is often performed as a reconstructive plastic surgery since the goal is to improve the patient’s quality of life, it still makes sense to pay attention to the breast appearance.

  • Scars

Every time the skin is cut or injured, scars will always form. However, a good surgeon will make every effort to promote “favorable” scarring—i.e., it appears fine, flat, and faded.

To minimize the appearance of scars, Dr. Smaili says he closes the wound in several layers in an attempt to remove the tension from the skin, thus promoting healing. This technique, he adds, can also prevent scars from migrating and becoming thick.

  • Breast symmetry

The after photos should reveal breasts that are highly symmetric not just in size but also in shape and profile. A slight lateral bulge is also deemed attractive because it contributes to the hourglass figure.

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