Plastic Surgery Science


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.”

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Male ethnic rhinoplasty is a broad term used to describe nose-reshaping surgery performed in men of ethnic descent. It is important to note that even within the same ethnicity variations do exist in terms of nasal anatomy, facial features, and aesthetic goals.

 

Hence, leading Los Angeles plastic surgeon Dr. Tarick Smiley says successful nose surgeries are highly customized procedure, respecting the “starting” anatomy of the nose, the unique facial features of each patient, his aesthetic goals (which are partly influenced by his culture), and even his body-frame and height.

 

male ethnic rhinoplasty

 

While the ideal male nose is not defined by highly restrictive standards, the renowned facial plastic surgeon says there are definite philosophies and universal aesthetic guidelines that help doctors achieve more attractive and natural results from rhinoplasty.

 

  • The attractive male nose has a strong appearance.

 

Several aesthetic variables that determine a strong, attractive male nose include a slight hump or fullness along the dorsum (bridge), an angle of tip rotation between 90-95 degrees, and a bigger size compared to women (of the same height).

 

The tip rotation, or the angle between the upper lip and nasal tip, is one of the most critical aspects of male rhinoplasty. It should appear straight or sometimes even slightly droopy to look gender appropriate; in no way it should be over-rotated since even the slightest upturned appearance can make the results look delicate and feminine.

 

  • The patient’s face should be taken into account.

 

A good number of male ethnic rhinoplasty surgeries are performed to reduce the width and/or height of the nose, making it more proportionate to the face. However, over-reduction is avoided like a plague because a male nose is naturally bigger than a female nose.

 

  • His height and body frame will partly determine the ideal nose size and appearance.

 

In general, a taller, more muscular male may benefit from a stronger and more elevated bridge and a longer nose than a shorter, leaner man.

 

  • Consideration of some shared anatomies and features.

 

Respecting the patient’s anatomy is one of the keys to preserve natural-looking, long-lasting results. While “strict” generalization does not give justice to the wide variations of ethnic male noses, it is important to note that they have some shared traits such as thicker nasal skin, more bulbous tip (compared with Caucasians), and less supportive cartilage.

 

Markedly thick skin does not show all the details of rhinoplasty, although they are more forgiving compared to very thin skin which can show even the smallest contour irregularity.

 

Patients with markedly thick skin should not have their tissue over-resected because the overlying skin may not drape well especially around the tip, leading to its amorphous appearance.

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It may come as a surprise that rhinoplasty, or nose job in layman’s term, could make someone look younger, an effect more commonly attributed to neck lift and facelift surgery.

 

An aging nose has some archetypal traits: more prominent hump along the dorsum or bridge, and drooping tip, which contributes to the elongated appearance.

 

rhinoplasty

When these before-and-after photos were posted on Dr. Smiley’s Instagram account, some followers pointed out the youthful effects of the surgery on her face.

 

Aging causes the skin to lose its elasticity and the cartilaginous framework of the nose to weaken, leading to the drooping nasal tip, which could create an illusion of a more acute nasolabial angle and a longer looking nose.

 

Sometimes, the aged-related drooping of the tip causes breathing difficulty and abnormal airflow, which are considered medical conditions and thus some insurance may agree to cover the cost of rhinoplasty surgery.

 

Leading Los Angeles plastic surgeon Dr. Tarick Smiley, who has performed over 3,000 rhinoplasties as of this writing, says the “inadvertent rejuvenating effects” of the surgery can be achieved when the drooping tip is de-rotated.

 

However, the amount of de-rotation should take into account the patient’s ethnicity, gender, nasal anatomies, and cosmetic goals, he says.

 

For instance, women of short stature in general can have more angle of tip rotation (i.e., angle between the tip and upper lip) with studies suggesting that they can tolerate up to 110 degrees angle.

 

The ideal angle of rotation of the nasal tip for men, meanwhile, is close to 90 degrees giving it a stronger, straighter profile. The upturned appearance is avoided like a plague during male rhinoplasty due to its feminizing effects.

 

De-rotating the tip entails improving its structural integrity; hence, Dr. Smiley often uses the patient’s own cartilage derived from the nose itself or the back of the ear to raise it a bit. The use of “living tissue” eliminates the myriad of risks associated with artificial implants.

 

Shaving down the prominent dorsal hump can also result in a younger, more feminine appearance. Nonetheless, it might be ideal to preserve some minimal fullness along the bridge when dealing with male patients to ensure a more natural and masculine result.

 

A 2012 study published by Archives of Facial Plastic Surgery has shown that patients who have had rhinoplasty looked 1.5 years younger on average compared with their “before” photos.

 

The researchers enlisted 53 rhinoplastic patients aged between 15 and 61 (35 was the average age) who were photographed before and one year after surgery; 50 “ordinary observers” were then asked to rate their appearance based on the perceived youthfulness.

 

The study noted that the rejuvenating effects were more evident for older patients than younger ones, although regardless of age, individuals who had dorsal hump reduction and greater nasal tip de-rotation appeared to lose more years than other patients.

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Fat transfer buttock augmentation has made butt implants a passé due to its more natural results and notable safety, provided that it is performed by a board-certified plastic surgeon with “relevant” experience.

 

Dr. Tarick Smiley, a Beverly Hills plastic surgeon who conducts an average of three butt augmentations via fat every week, says the “holistic contouring effects of the surgery can be attributed to liposuction” wherein unwanted fats from two or more areas of the body are collected and transferred.

 

fat transfer buttock augmentation

 

The lower back, flanks, anterior abdomen, and bra rolls are common donor sites, as they typically carry excess fat. Furthermore, carving out the waistline is one of the key elements to improve the female waist to hip ratio, which is perceived to be one of the markers of beauty.

 

Across all cultures, there is a strong preference for female bodies with WHR of 0.7 or at least close to his proportion. This means that the hip circumference is 30 percent thicker than the waist.

 

After collecting sufficient amounts of fats, these are washed and sorted; all biomaterials such as the red blood cells and the anesthetic/tumescent fluids are discarded prior to fat injection.

 

In Dr. Smiley’s recent videos posted on Snapchat, he said that he only uses “good healthy fats rich in stem cells” to achieve permanent results from fat transfer buttock augmentation, which is colloquially called as Brazilian butt lift.

 

Aside from the quality of fat, the surgeon said the longevity and overall success of the surgery also rely on meticulous injection.

 

“Fat injection must be must be done in a honeycomb fashion, meaning the fats are injected into a larger surface area,” he explained.

 

When fats are injected in a way that they resemble tiny compartments within the soft tissue, somewhat resembling a honeycomb, blood vessels can form and bring the much needed oxygen and nutrients. Without this process, the fats eventually die and are resorbed just after a few weeks or months of injection.

 

Because permanent result is one of the goals of buttock augmentation via fats, all efforts are made to promote blood vessel ingrowth.

 

The honeycomb injection technique not just ensures long-lasting results, but also softer and better contour because it replicates the natural layered distribution of fats. Furthermore, it prevents fat embolism in which fats enter the blood vessels and interfere with the functions of critical organs like the heart and lungs.

 

But even with honeycomb injection technique and proper collection and purification of fats, Dr. Smiley said that about 30 percent of the fat volume is resorbed within a year, while 70 percent is expected to persist long term.

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While the surgeon’s skill sets and qualifications will largely determine the success of liposuction—a body contouring surgery that breaks up and removes “unwanted” fat—the techniques and equipment will also have their influence.

 

Dr. Tarick Smiley, a leading Los Angeles plastic surgeon, has recently posted a video on Snapchat to demonstrate one of his liposuction machines imported from Germany.

 

liposuction machine

Dr. Smiley says the Moller liposuction machine can perform “liposuction, lipo-filling, and infiltration all at the same time,” hence the operative time is shortened and thus may contribute to improved patient safety.

 

Hence, the liposuction machine is ideal for Brazilian buttock lift (BBL) in which large volumes of fat are suctioned out of the body, purified, and re-injected through a process called lipo-filling.

 

Nowadays, lipo-filling—also referred to as fat injection or structural fat grafting—is an established technique that can be applied to various plastic surgery procedures including BBL, three-dimensional facelift, cheek augmentation, and breast surgery (cosmetic and reconstructive).

 

Because BBL typically requires “aggressive” or large volume liposuction, one of the most pressing issues is the increased bleeding. During fat extraction, the cannula (straw-like device) inadvertently removes some blood.

 

Large blood loss can result in longer recovery, more fluid imbalance, and higher risk of complications; therefore all efforts are made to minimize the amount of bleeding. For this reason, Dr. Smiley uses another equipment called Cell Saver.

 

Cell Saver is a liposuction machine that can process the fluids, collect the red blood cells, and re-infuse them into the patient while the surgeon is doing liposuction. This piece of equipment is also used in hospitals to control bleeding, which is a risk when an operation takes too long (more than 6 six hours).

 

To further reduce the amount of bleeding, prior to liposuction Dr. Smiley infiltrates the fatty area with tumescent fluids, which are infused with several drugs that include epinephrine.

 

The renowned plastic surgeon says that epinephrine works by constricting the blood vessels, ultimately reducing the amount of blood loss by up to 90 percent compared to the dry liposuction, which is now a passé technique as it entails prolonged recovery and increased risk of skin asymmetry.

 

(Note: Dry liposuction means the fatty area is not infiltrated with tumescent fluids or any wetting solution before the fat is removed with cannula.)

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Safety in plastic surgery should be the main duty of your surgeon. Hence, you must practice due diligence when selecting your doctor, a decision that you should base on his qualifications instead of cheap cost or large discount. Remember, reputable and qualified surgeons will not join the “price war” just to lure patients.

 

Furthermore, any surgery that is priced way too low generally means there are some compromises. Take note that the cost not just boils down to your surgeon’s fee, but also to other expenses related to anesthesia, staff (including anesthesiologist), surgical facility, lab test, just to name a few.

 

safety in plastic surgery

Photo Credit: American Society of Plastic Surgeons website

Leading Los Angeles plastic surgeon Dr. Tarick Smiley shares his tips on how to identify a surgeon who prioritizes safety in plastic surgery.

 

• The surgeon is a bona fide plastic surgeon. The general rule of thumb is to choose someone who is a member of the American Board of Plastic Surgery, giving you an assurance that he has passed rigorous background check and oral and written exam, which he must take every 10 years.

 

• Prudent and ethical plastic surgeons carefully select their staff. Furthermore, they only employ a certified anesthesiologist whose job is not just to administer anesthesia (and thus results in a pain-free procedure), but to also observe the patient’s vital signs such as blood pressure, oxygen level, and heart rate during surgery.

 

• They only perform surgeries in an accredited ambulatory facility. This means that the “surgical setting” has passed rigorous inspections conducted by several certifying agencies (or health authorities). All board certified plastic surgeons are mandated to operate only in an accredited surgical facility.

 

• Reputable surgeons know how to say no. They always require lab screening and lengthy consultation to identify if you’re healthy for the surgery and its ensuing recovery. Should you have any chronic medical condition, or have unrealistic expectations that you’re just setting yourself up for disappointment, a decent doctor will not operate on you.

 

• Reputable plastic surgeons exhibit good bedside manner (they listen to your input) and will make every effort to build good rapport. In doing so, their patients tend to be more honest and more cooperative and committed especially during recovery.

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