Plastic Surgery Science

Rhinoplasty bleeding is often minimal provided that the surgeon uses meticulous techniques, which can also lead to shorter social recovery (no outward signs of the surgery), and natural results that can last a lifetime, according to California Surgical Institute website.


Rhinoplasty, or nose job in layman’s term, typically results in 1-2 weeks social downtime, which is closely linked to the amount of postop bruising and swelling.


rhinoplasty bleeding

The list below shows the “core principles” in minimizing the amount of rhinoplasty bleeding.


  • The patients should be in their optimal health.


Hypertension, blood disorder, and other chronic medical conditions can lead to increased bleeding. Hence, rhinoplasty or any other elective plastic surgeries require all patients to pass a rigorous lab screening.


While some of these conditions can be controlled through medications or healthier lifestyle, it is important to note that some factors are not within the patient or surgeon’s control. For instance, older individuals often have more fragile blood vessels than younger ones and so they may experience more bleeding and postop bruising.


  • Preparation


All drugs and supplements with blood thinning properties are discontinued for at least 2-3 weeks before surgery and about a week afterwards to prevent bleeding and excessive postop bruising. The same rule may also apply to smoking and alcohol.


However, some doctors recommend Arnica montana (homeopathic remedy) and some “special” diet known to promote healing.


  • Use of drugs known to constrict the blood vessels


The use of local anesthesia combined with epinephrine—a drug that results in the constriction of blood vessels and thus reduces the amount of bleeding—is known to promote healing.


Decongestants like Afrin may also minimize the amount of bleeding by constricting the blood vessels.


  • Keep blood pressure low at the time of surgery


Board-certified plastic surgeons only work with board-certified anesthesiologists to ensure patient safety.


Qualified anesthesiologists know that keeping the patient’s blood pressure low during surgery under general anesthesia can reduce bleeding. Also, one of their tasks is to monitor the patient’s vital signs to prevent serious complications.


  • Avoid certain activities during the initial healing stage


Sneezing and blowing one’s nose should be avoided for 2-4 weeks because doing so can trigger bleeding.


It is important to note that despite best efforts, some patients remain susceptible to bleeding and thus they are required to use nasal packing while they recover.

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There is a lot of misconception surrounding breast implant longevity, with some patients thinking that it should be replaced every ten years. However, implant removal, with or without replacement, must only be done when there is some type of implant- or breast-related problem.


Perhaps the “10-year replacement” misconception stems from longitudinal studies suggesting that one out of five breast augmentation patients with silicone implants would need revision surgery.


However, revisions are only warranted when there are implant-related problems such as leak and malposition, or breast-related issues such as sagging appearance and capsular contracture.


Simply put, there is no point of replacing a “functioning,” stable breast implant.


Capsular contracture, according to studies, is one of the most common reasons for revision surgery. This happens when the scar capsule around the implant, which is the body’s natural response when it comes into contact with a syntethic material, becomes too copious and stiff.


Most cases of capsular contracture happen immediately after surgery or a few months afterward, which may affect one or both breasts. Many surgeons suggest that implant contamination at the time of surgery or low-grade infection during the healing stage are the most likely cause of the complication.


breast implant longevity


Nonetheless, capsular contracture may happen years after surgery, although with daily breast massage, or more aptly called implant displacement exercise, this could be prevented or at least minimized, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.


The goal of breast massage is to maintain the malleability and “thinness” of the scar capsule, ultimately preventing capsular contracture, says Dr. Smiley who has performed thousands of breast augmentation surgeries (primary, revision, and reconstructive type).


While 20 percent of patients with silicone breast implants would need removal/revision surgery within a 10-year period, it is important to note that the studies involving their longevity were conducted before the introduction of the latest silicone implants.


In 2013, the fifth generation silicone implants, also referred to as gummy bear implants, were approved by the US Food and Drugs.


Gummy bear implants are notable for their durability thanks to their highly cohesive filler material that even after cutting their shell in half, no leak will occur. Hence, it is perceived that they have longer lifespan compared to saline and fourth generation silicone implants.

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A good surgeon will make every effort to eliminate or at least control risk factors associated with deep vein thrombosis or DVT in plastic surgery. This serious complication occurs when blood clots form in deep veins in legs, pelvis, or arms.


All surgeries carry some risk of DVT, although there are several ways to reduce its chances of developing, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.


dvt in plastic surgery

Photo Credit: Shutterstock

The celebrity plastic surgeon explains the preparations, surgical techniques, and postop care that can reduce DVT in plastic surgery.


  • Strict patient selection


Plastic surgery is only reserved for patients who have achieved their optimal health through superb diet, regular exercise, and healthy lifestyle choices. For this reason, Dr. Smiley requires comprehensive lab test and blood work to rule out medical conditions linked to higher risk of DVT or any other types of complication.


It is important to note that obesity and blood disorder are linked to higher risk of DVT.


  • Avoid smoking


There is a strong link between smoking and increased risk of DVT in plastic surgery. A good rule of thumb is to avoid tobacco and smoking cessation products (patch and gum) for a minimum of three weeks prior to surgery and the entire duration of recovery (1-4 weeks). However, it remains ideal to quit the habit for good as the bulk of risk is perceived to be at three months postop, as suggested by recent studies.


  • Safety protocols during surgery


Surgical guidelines known to reduce risk of DVT include limiting the operative time (less than 5-6 hours); and using sequential compression device (stocking-like device that “massages” the limbs to promote good blood circulation in the area).


  • Light exercise after surgery


Instead of bed rest or prolonged immobility, which could increase the risk of DVT, light exercise such as taking short walks throughout the day is highly recommended. Moving around is also ideal to control the amount of postop swelling, which further minimizes the risk of blood clot formation.


  • Use of medical-grade compression stockings


They are known to control the amount of swelling, which in turn reduces risk of DVT.

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Plastic surgery and stem cells technology are two medical fields that are progressively becoming intertwined.   Over the past several years, there have been exciting developments that could help improve the lives of people with cosmetic deformities and terminal and congenital diseases.


However, plastic surgery and stem cells technology is still in the infancy stage and up to this point experts are still deciding how and when to apply this method in clinical practice.


plastic surgery and stem cells

Photo Credit: Advanced Cell Technology via AP

Stem cells, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley, are noted for their capability to turn into another type of cell, thus their application in cosmetic and reconstructive plastic surgery is almost infinite once their “core nature” and “power” have been harnessed and deeply understood.


In Dr. Smiley’s recent Snapchat video post, he has explained the impact of stem cells on the results of Brazilian butt lift, which in essence is buttock augmentation via fat transfer. In this procedure, excess fats are collected from two or more donor sites through liposuction, which are later purified and re-injected into the patient’s backside.


Because the procedure does not entail the use of artificial prosthesis, such as the case of butt implant surgery, it is perceived to be safer and more natural looking.


After collecting the fats from the donor sites, Dr. Smiley said it is of critical importance to purify them, i.e., remove the blood and other unnecessary materials. The goal, he further explained, is to get the healthiest fats that can survive long term once transferred to the buttocks.


Purified fats are loaded with stem cells, which he said “can promote high survival rate.” Nonetheless, he slightly “over-corrects” the re-injection process because some of the transferred fats will not survive despite best efforts.


“My goal is to achieve a survival rate of at least 70 percent. For this reason, during the initial weeks or months the patients may notice that their backside is swollen or slightly bigger for their liking. However, the long-term results are almost always satisfying,” Dr. Smiley said.


“The 70 percent that survives in the first 3-6 months will persist long term,” he added.

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Otoplasty long term results are possible with the right surgical techniques. In this procedure, the surgeon corrects the appearance of ears that stick out too much from the face.


Otoplasty is sometimes referred to as ear pinning surgery as it reduces its “sticking out” appearance. But the truth is, the procedure is highly technical and must be customized based on the patient’s underlying anatomies.


otoplasty long term results


Dr. Tarick Smiley, a celebrity Beverly Hills plastic surgeon, has recently posted a Snapchat video to demonstrate how to achieve long-term and natural-looking results from otoplasty.


In the video, the surgeon placed an incision behind the ear, specifically within the natural fold of skin for optimal scar concealment. This would allow him to remove the excess cartilage that was causing the conchal or bowl of the ear to stick out significantly from the side of the face.


After removing the excess cartilage, he pinned the ear closer to the face with the use of sutures.


One of the most common mistakes of inexperienced surgeons, Dr. Smiley says, is that they stitch the ears closer to the face without removing the excess cartilage. The problem with this technique, he further explains, is that the cartilaginous framework has a “strong memory,” hence the results are usually temporary.


The male patient shown in the video had his ears not just significantly sticking out from his face; there was also visible asymmetry as the right ear protruded more than the other.


To create a more symmetric result, Dr. Smiley removed a larger piece of cartilage in the right ear.


To further produce a more symmetric appearance, the surgeon ensured that the lower aspect of the ear (i.e., earlobe) would protrude 1 ½ cm while the upper aspect would jut 1 cm from the face. Using a measuring stick, he also made sure that both the right and left ears would almost have the same projection.


Dr. Smiley says that the goal of otoplasty is to pin it closer to the head; it does not change the actual size of the ear bowl.

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Dermal fillers or fat transfer: Which one provides better results?


These two treatments (both are injected into the soft tissue) are also referred to as volumizers as they replace facial volume loss that results in nasolabial folds (laugh lines), flat cheeks, deep tear trough, and thinning lips.


dermal fillers or fat transfer

Photo Credit: Ambro at

In order to answer which one provides better results, dermal fillers or fat transfer, several factors are taken into account such as the treatment site, cosmetic goals, and use of ancillary procedures such as facelift, if there is any.


Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that despite of the more natural effects of fat transfer, under certain circumstances the use of dermal fillers might be a better option.


For instance, the thinning lips are best treated by dermal fillers, particularly hyaluronic acid-based products like Restylane. Because the “site” constantly moves (while eating, speaking, yawning, etc.), the fat grafts may not settle properly or gain their new blood supply to become a permanent fixture.


And since the effects of dermal fillers are just temporary, usually 4-6 months, they are ideal for patients who want to see first the effects of volumizers before resorting to more permanent treatments like fat transfer or even facial implants.


Nonetheless, most patients with facial volume loss are good candidates for fat transfer in which a small amount of fats, not more than a few teaspoons, is collected from the donor sites, usually the tummy and hips, says Dr. Smiley.


The celebrity plastic surgeon even treats fat transfer as an integral part of facelift surgery. With a multifaceted approach in which the sagging skin and gaunt appearance are treated simultaneously, he believes that the results look more natural and are more “stable.”


“Stable” results mean that the face is less susceptible to the effects of continuous aging. Dr. Smiley warns that failure to address the loss of volume in the lower eyelid could lead to an abrupt transition between the lid and upper cheek, which can present itself right after surgery or years down the road.


Fat transfer and facelift are best performed simultaneously so the patient will only experience recovery once, he explains.


Because the results of fat transfer are near permanent (studies have suggested that on average they can last 8-10 years), in the long run they are cheaper than having regular dermal fillers injections.

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