Breast augmentation techniques vary from patient to patient because each one has unique underlying anatomies (i.e., soft tissue coverage and body frame) and cosmetic goals from the surgery.
Nonetheless, a recent survey published by journal Plastic and Reconstructive Surgery shows that certain techniques and breast implant designs are favored by many board-certified plastic surgeons.
The survey was based on the answers of more than 1,000 board-certified plastic surgeons who were asked to fill out an electronic questionnaire.
The survey has shown general agreement in several breast augmentation techniques, which are explained below:
* The inframammary fold incision site is the most preferred entry point. Aside from the precise visibility that minimizes risk of asymmetry, its popularity is also linked to favorable scars as they are hidden within the natural fold of skin.
A good number of patients also need their breast crease to be slightly readjusted, which makes the inframammary fold technique an ideal choice for many.
* The submuscular technique is the most recommended implant placement. Proponents suggest that positioning the implants behind the thick layer of muscle is one effective way to minimize palpable rippling, scar capsule formation (capsular contracture), and unnatural contour.
Meanwhile, placing the implants above the muscle—so only the breast tissue and skin cover and support them—has become a less popular choice because of the increased risk of rippling, especially in small-breasted and thin women.
* Silicone breast implants are the most popular choice. They provide a more natural result and feel than saline implants because of their cohesive filler material, making them an ideal choice for women with little breast tissue to begin with.
Silicone implants that come in smooth surface and round shape (or more like a flattened sphere) are believed to further make the result look and feel natural.
Meanwhile, teardrop implants, which always have a rough or textured outer shell to prevent rotation, are less popular because of the increased risk of palpable rippling and asymmetry if they flip over.
In addition, the most popular breast implant size range is between 300 and 350 cc, as suggested by the survey.
* Recent technologies. Despite the growing popularity of 3D imaging technologies in plastic surgery that allow patients to preview their possible results, they are not commonly used by breast augmentation surgeons.
Also, the respondents do not routinely use fat grafting, either as an adjunct procedure of breast implant surgery or as a stand-alone augmentation technique.
Liposuction procedure removes the excess fat underneath the skin with the use of suction. Nonetheless, it is not a weight loss surgery since it is too risky to remove the deeper visceral fat, which only responds to “real” weight loss—regular exercise and healthy diet.
According to a recent report published by the Plastic and Reconstructive Surgery journal, the safe amount of fat to remove during liposuction is determined by the patient’s body mass index or BMI.
While the perceived safe volume during liposuction surgery is up for debate, with current guidelines suggesting that no more than 5 liters of fat should be removed per treatment, the study has shown that people with higher BMIs who had a greater liposuction volume experienced a lower complication rate.
Patients with lower BMIs who had a greater liposuction volume, meanwhile, experienced an increased risk of complication arising from seromas or collections of fluids beneath the skin.
Nevertheless, patients who had large-volume liposuction—or removing more than 5 liters of fat in one surgical setting—had the highest complication rate: 3.7 vs. 1.1 percent.
The study analyzed data of around 4,500 patients who had liposuction in which the overall complication rate was 1.5 percent, with no death reported. Meanwhile, the average amount of removed fat was approximately 2 liters.
Aside from the amount of removed fat relative to the patient’s BMI, liposuction risks are also tied to concomitant procedures (breast augmentation, tummy tuck, body lift, etc.), length of surgery, and overall health of the patients, as suggested by the researchers.
Celebrity LA plastic surgeon Dr. Tarick Smaili, who is not part of the study, also suggests that liposuction risks are also higher among smokers because the nicotine found in tobacco products constricts the blood vessels, thus retarding wound healing and leading to poor oxygen circulation.
Other risk factors include hypertension and medical conditions that can affect healing, use of blood-thinners, malnourishment/undernourishment, and excessive surgical trauma due to unrelated procedures performed at the same time as liposuction, he further explains.
The number of men having plastic surgery is on the rise, with a recent survey showing that they accounted for 13 percent of all cosmetic surgical enhancements, or about 205,000, last year alone.
The survey, which was conducted by the American Society of Plastic Surgeons, has shown that rhinoplasty or nose surgery, eyelid surgery, and facelift were included on the top five list of the most commonly performed procedures in men.
Celebrity LA plastic surgeon Dr. Tarick Smaili says the growing popularity of male plastic surgeries, particularly those aiming to create a more youthful and more balanced face, is due to the declining stigma on surgical enhancements.
Another contributing factor, according to a recent survey, is the growing job insecurity. In an attempt to look more competitive and youthful, male patients are commonly citing this reason for having cosmetic plastic surgery.
But since there are certain aesthetic characteristics that typify the masculine face—including “heavier” and lower brow, more horizontally-oriented forehead, thinner lips, and bigger nose compared with women’s—Dr. Smaili says facial plastic surgery should always take into consideration one’s gender, in addition to other factors such as the rest of the facial features, ethnicity, and motives and expectations.
When treating male patients who want to have a more youthful visage through facelift, Dr. Smaili warns that excessive tension on the skin can lead to fake results, or worse, a more feminine appearance.
While too much tension on the skin has detrimental effects on both genders, over-correction is particularly detrimental to men because it not only feminizes the face, but also leads to unnatural side burns, hairline, and ear (pixie ear deformity or “stuck-on” appearance).
Compared to women, male facelift generally requires a more conservative jaw line contouring to preserve their masculine appearance. Some “seasoned” plastic surgeons even retain a few wrinkles to create a somewhat mature, but still attractive male face.
By being on a conservative side, the leading LA plastic surgeon says it is easier to achieve more natural results and avoid the dreaded windswept and perennially surprised appearance.
In brow lift surgery, Dr. Smaili says being conservative is also beneficial to men. The idea is to create a more horizontally-oriented, “heavier” brow to preserve the masculine appearance.
A more curved, arched brow, on the other hand, only works for female brow lift surgery.
There is also a stark difference between male rhinoplasty and female nose surgery. According to a recent study, an attractive male nose is a bit bigger and wider, and has an angle of rotation close to 90 degrees to give it a stronger, straighter tip.
On the other hand, creating a more upturned nose has a feminizing effect which must be avoided when performing a male rhinoplasty, explains Dr. Smaili.
Statistics show that pre-wedding cosmetic procedures and plastic surgeries are on the rise, thanks to the growing use of social media and photo-sharing sites that is forcing many people to look good online. But there is one question that needs to be answered: Is it a good idea?
Leading Inland Empire plastic surgery expert Dr. Tarick Smaili says there is no “strict” answer since several variables should be taken into account beforehand, such as the patient’s motives and expectations, emotional and psychological health, medical condition, and even her wedding day.
A 2012 survey conducted by the American Academy of Facial Plastic and Reconstructive Surgery has shown that the most popular pre-wedding cosmetic procedures were medical-grade chemical peels, dermal fillers, and Botox injections.
Dr. Smaili says it is not surprising that most brides- and grooms-to-be choose non-surgical treatments because these have no or very little downtime, although it remains ideal to have them at least two to three weeks before the “D-day” to make sure the residual swelling, redness, and bruising have enough time to subside.
The popularity of these non-surgical facial rejuvenation procedures, particularly Botox injections and dermal fillers, as a pre-wedding “gift” just reflects a recent survey showing that Americans are getting married later, thus early signs of aging such as fine wrinkles and loss of facial volume or fat—which might show in wedding photos—are common concerns of brides and grooms.
Chemical peels are also popular among brides-to-be as they can erase or at least minimize skin imperfections such as freckles and sunspots.
But some brides and grooms do not shy away from “real” plastic surgery. According to a recent survey, rhinoplasty, or more commonly referred to as nose job, eyelid surgery, breast augmentation, and facelift are the most commonly requested pre-wedding surgical enhancements.
Dr. Smaili warns that any surgical procedure should be performed at least three to six months ahead lest the subsequent postop symptoms such as swelling and bruising could attract unwanted attention during the “event.” This is particularly true for facial plastic surgeries such as rhinoplasty and facelift.
But even body contouring such as tummy tuck and breast augmentation requires a minimum of four months of recovery, Dr. Smaili warns.
Rushing one’s recovery could also result in elevated blood pressure and heart rate, which Dr. Smaili says is linked to poor wound healing, higher risk of hematoma or pooling of clotted blood within the tissue, and other complications that could prevent the patient to achieve optimal results from her surgery.
More than one-third of US adults are obese, which is defined as excessively high body fat percentage. To determine overweight and obesity ranges, doctors use the patient’s weight and height to calculate his body mass index (BMI), with 30 and higher considered obese.
And with the looming obesity problem in the US, the number of patients seeking weight loss surgeries, also referred to as bariatric procedures, is increasing as well. But this also leads to a subsequent trend—more people asking for body lift such as tummy tuck, arm lift, breast lift, thigh lift, and lower body lift.
According to data released by the American Society of Plastic Surgeons website, last year body lift after weight loss grew at its fastest rate since 2009, when this organization began tracking procedures specifically performed on massive weight loss patients.
Tummy tuck surgery, which removes the apron-like skin in the midsection using a hip-to-hip incision, remained the most commonly performed body lift after weight loss, with around 17,260 patients receiving the procedure, a 4 percent increase from the previous year.
While the redundant skin affects several body regions, most MWL patients work first on their midsection where the hanging extra tissue is particularly problematic as it leads to poor hygiene, skin ulcers, non-healing irritation, foul odor, and functional problems.
Functional problems are not uncommon following dramatic weight loss because the ensuing redundant skin (especially in the midsection and inner thigh) makes it uncomfortable or difficult to perform daily activities and exercise.
The second most popular procedure performed on MWL patients during the same period was breast lift in which the saggy breast tissue and skin is lifted and reshaped to achieve a perkier appearance. Oftentimes it is combined with reduction mammoplasty or “downsizing” of breast to prevent drooping recurrence and/or to achieve a more balanced figure.
More than 12,050 breast lift surgeries were performed in 2014, according to the survey.
But thigh lift and arm lift surgeries had their highest single-year growth during a five-year period, both up 9 percent.
Dr. Tarick Smaili, a Los Angeles plastic surgeon, says the most commonly mentioned benefits of body lift after weight loss are usually cosmetic-related, although it has been well documented that improvement in quality of life and body image is also possible after body contouring performed on MWL patients.
According to a 2013 study, tummy tuck may lead to long-term weight loss for MWL patients possibly due to increased satiety as the procedure typically involves removal of some abdominal fat, which is believed to control appetite.
Male bodybuilders with abnormal breast enlargement might benefit from a body contouring procedure called gynecomastia surgery but only after medical conditions such as hormonal problem have been ruled out.
According to a study published by Plastic and Reconstructive Surgery medical journal, gynecomastia surgery performed on bodybuilders results in high patient satisfaction, although in general they require a different surgical approach from “ordinary” patients.
The study involved more than 1,000 male bodybuilders whose age ranged from 18 to 51, with about 15 percent of them have joined professional bodybuilding competitions.
Prior to surgery, all patients were free of diseases such as tumors and kidney failure that might cause male breast enlargement. Meanwhile, some took steroids or supplements containing hormones during their younger years that resulted in gynecomastia (which more often than not a temporary condition) that become a permanent problem.
The author of the study has concluded that high patient satisfaction among bodybuilders would require a different approach and special attention to prevent bleeding, which is an issue because a well-developed chest muscle is highly vascularized.
Another consideration is that bodybuilders, compared to ordinary patients, have higher expectations and goals from their surgery.
The study, which claimed that most respondents were extremely satisfied with the results, also looked into the most ideal techniques to prevent increased bleeding, poor cosmetic outcome, and recurrence of gynecomastia.
Aside from using a 1-inch incision to reduce the risk of increased bleeding and poor scarring, the plastic surgeon who conducted the study said that removing all the glandular breast tissue could prevent gynecomastia from recurring.
Another factor contributing to the success of gynecomastia surgery, according to study, is the “right” preparation to minimize increased bleeding and poor scarring. For instance, blood-thinners, supplements known to affect healing (e.g., fish oil, vitamin E, green tea, ginseng, and gingko biloba), and steroids must be avoided months before the procedure.
Meanwhile, the study has shown that complications after gynecomastia surgery were either uncommon or just minor. About 6 percent of the patients experienced hematoma or accumulation of blood within the surgical site.
However, most of the complications reported by patients are less likely to occur with the right preoperative and postoperative care such as avoiding steroids and other supplements/medications known to affect healing, stopping all rigorous activities while the body has not yet fully recovered from the surgical trauma, and performing only light exercise such as walking during recovery.