Breast implant replacement surgery requires a highly customized approach to achieve the most natural-looking results possible and to deliver the patient’s cosmetic goals, which she must be able to explain in detail.
Leading Inland Empire plastic surgeon Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate a patient who had saline implant deflation and thus required replacement.
The before photo shows the right breast looking deflated due to saline implant rupture. The after photo, meanwhile, shows the results of new silicone implants combined with internal lift.
The patient’s right breast appeared smaller than the other side due to saline implant leak. Also, she had moderate breast ptosis (sag) that could benefit from internal lift and implant pocket repair.
To remove both saline implants, Dr. Smiley created a small incision right at the lower border of the areola, which was the location of her previous scars.
Dr. Smiley says a good number of his primary and secondary breast augmentations are performed through the peri-areolar incision technique because the scar blends well into the dark-light skin junction.
When the right breast’s saline implant was extracted from its pocket, it was completely deflated. Dr. Smiley says that full deflation takes about four days, causing the affected breast to look smaller than the other side; however, the leak does not cause any harm since the filler material is saline, i.e., salt and water, which is naturally found in the body.
“The saline is simply absorbed by the body and excreted by the kidney,” the celebrity plastic surgeon says in one of the videos.
Both saline implants were replaced by silicone implants, which are filled with a more cohesive filler material. To ensure that they settle “more naturally,” Dr. Smiley performed internal lift and pocket repair.
Pocket repair was mainly performed by tightening its lateral side, allowing the silicone implant to settle to a more natural position and therefore giving the right amount of fullness along her mid cleavage and upper breast pole; this ancillary technique also prevents excessive lateral bulge (i.e., implant displacement).
During the actual implantation, Dr. Smiley used the Keller Funnel technique in which a cone-shaped disposable device was used to propel the silicone implant into the pocket with just one “squeeze.”
Aside from reducing the operative time, the Keller Funnel device is also known to minimize trauma around the wound. To further promote favorable scar—i.e., it is barely visible at the areola’s border—Dr. Smiley closed the incision in several layers without picking up the outermost layer of the skin.
Only the dermis, which is the deeper layer of the skin, was sutured to ensure that the most superficial layer would receive no or very little tension, which is the key to the most favorable scar possible.
It is important to note that the latest plastic surgery trends should not supersede patient safety and satisfaction. Therefore, the goal of any prudent plastic surgeon is to enhance one’s appearance based on her “realistic” goals and, of course, within the safe limit.
Dr. Tarick Smiley, who is the medical director of the renowned California Surgical Institute, has explained some of the latest plastic surgery trends in Beverly Hills.
Thanks to recent improvements in fat transfer—allowing most of the grafts to persist long term—buttock augmentation is now more commonly performed with the use of the most natural material available—i.e., the patient’s very own fat.
In 2016, board-certified plastic surgeons performed about 18,000 buttock augmentations via fat transfer, a 26 percent increase from the previous year. The growing popularity of this procedure, also dubbed as Brazilian butt lift, is attributed to curvy celebrities like Kim Kardashian, Jennifer Lopez, and Beyonce Knowles.
- Sayonara to the over-inflated breasts
In the past decade, a good number of breast augmentation patients sought for an over-inflated chest appearance (e.g., DD and E cup). But with more women today following a healthier and more active lifestyle, it is not surprising that they now gravitate towards smaller “improvements.”
With smaller breast implant sizes, the results generally appear more natural and proportionate. In addition, they do not interfere with the patient’s active lifestyle.
“Instead of simply augmenting the breasts, most patients today want something more, but subtle. They desire for a more natural appearance and so they are also focused on improving their breast shape. Therefore, implants are now typically combined with some type of breast lift,” says Dr. Smiley.
In the past, facelift received notoriety due to its unnatural effects—flat cheeks, lateral skin pleating, overly tight face, and weird brow position. However, things have changed when surgeons started recognizing that simultaneous procedures like fat transfer, neck lift, and eyelid lift can make a huge difference.
Dr. Smiley typically combines facelift with fat transfer—a method dubbed as three-dimensional facelift—to achieve a more natural, more youthful result.
To further achieve natural results, Dr. Smiley highlights the importance of the correct vector of pull. In his previous Snapchat video posts, he demonstrates how pulling the skin at a 45 degrees angle can restore the softness of the cheeks (as opposed to making them flat and gaunt) and provide impressive rejuvenating effects.
- Quick fix facial procedures
Some patients, particularly men, deter the idea of surgery and the ensuing recovery and so they resort to Botox, dermal fillers, and Kybella injection (i.e., double chin eliminator).
According to a survey conducted by the American Board of Plastic Surgery, about 7 million Botox injections, and 2.6 million dermal fillers were performed last year alone.
Simply put, one of the latest plastic surgery trends favor non- or minimally invasive methods.
Capsulectomy breast implant exchange is the best solution for capsular contracture, a complication in which a thick scar capsule forms around a prosthetics, as explained by leading Beverly Hills plastic surgeon Dr. Tarick Smiley on his recent Snapchat posts.
In a series of Snapchat videos, Dr. Smiley presented a patient whose right breast had capsular contracture, leading to the implant to ride higher; it also resulted in hardness of the breast tissue. The left breast, meanwhile, had no such problem although it appears pendulous.
To achieve good results from capsulectomy breast implant exchange, Dr. Smiley also performed areola reduction and wise breast lift technique.
After and before photos of a patient who have had revision breast augmentation to correct her capsular contracture
In the videos, the celebrity plastic surgeon is seen removing the entire scar capsule, which has encapsulated the implant.
“It is important to remove the entire capsule to prevent the problem from recurring. In primary breast augmentation, the capsular contracture rate is 4 percent, but in revision it goes up to 15 percent,” he said.
“However, removing the entire capsule and with the use of meticulous techniques, we can lower the capsular contracture rate to 4 percent,” he added.
Aside from lowering the risk of recurrence, Dr. Smiley said that removing the entire scar capsule also allows for smoother, more natural results from revision breast augmentation.
“The thick scar capsule squeezes the implant inside sometimes to the point that it becomes deformed, with some of its edges showing through the skin as bumps,” he said.
To further reduce the risk of capsular contracture recurrence, Dr. Smiley always irrigates the implant pocket with antibiotic solution, and only performs his surgeries in accredited surgical facilities.
“One of the main causes of capsular contracture is implant contamination at the time of surgery. However, this can be minimized since our accredited surgical facilities have air ventilation system designed to curb contamination. Also, they are fully equipped with sterilization devices,” he further explained.
Moreover, Dr. Smiley requires all his patients with smooth round implants to perform breast implant massage everyday to maintain the “thinness” and softness of the scar capsule, which naturally forms around any implanted device.
“Capsular contracture is made up of excess collagen fiber. We could prevent this from happening with daily breast implant massage in which the idea is to push the prosthesis into the outermost corners of its pocket,” he added.
Meanwhile, Dr. Smiley finished off the surgery by performing a breast lift, which corrected the patient’s pendulous breasts.
Abdominal revision liposuction poses some unique challenges. First and foremost, plastic surgeons often have to deal with skin irregularities caused by over-removal of fat, and the internal scar tissue from the previous surgery.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a Snapchat video showing a female patient who had botched liposuction that resulted in large dents below her navel, contour irregularity on the left flank, and less than optimal waistline.
The large dents and surface irregularities, according to Dr. Smiley, were primarily caused by over-liposuction or removing too much fat.
In the video, the celebrity plastic surgeon said a thin layer of fat must remain after surgery to ensure a smooth skin surface and to avoid a wide range of surgical stigmata.
To correct the ill effects of over-liposuction, Dr. Smiley performed fat transfer, which in essence is a reverse liposuction. After removing some fats along the flanks and waistline, instead of discarding them he injected them to smooth out the indentations.
To further achieve a smooth skin surface, Dr. Smiley released the scar tissue that was causing the skin to adhere to the muscle, which in turn also improved the contour of the left flank.
Moreover, he removed additional fat along the flanks to create a more hourglass silhouette (narrow waistline and wide hips).
Since revision abdominal liposuction is more complex than the initial surgery, Dr. Smiley always uses the tumescent technique combined with microcannula, or flexible hollowed tube with an outside diameter of less than 2-3 mm.
Tumescent liposuction involves injecting large amounts of tumescent fluids into the fatty area before the actual removal fat is performed. The idea is to make the fat cells swell up to pave way for a more precise, gentler extraction.
Furthermore, the tumescent fluids contain epinephrine that constricts the blood vessels and thus the amount of bleeding is reduced by up to 90 percent as compared to the “dry” or “no wetting solution” technique.
Precision is further improved with the use of microcannula during the actual extraction of fat, allowing the surgeon to remove excess fats in smaller bits, as opposed to larger chunks. For this reason, he avoids using large cannulas especially when doing some type of revision liposuction.
The female patient has presented Dr. Smiley her “wish pic” (Kylie Jenner’s voluptuous body). For this reason, he not just sculpted the four quadrants of the frontal abdomen and the flanks, but also the inner thigh and hips.
Overall, Dr. Smiley used 12 tiny liposuction incisions to meet the cosmetic goals of this particular patient; these are expected to fade into the background after 6-12 months.
The success of revision rhinoplasty surgery preparation will not just rely on the surgeon’s skills. Patient cooperation will also play a critical role on the final results and ultimately the satisfaction rate, according to the California Surgical Institute website.
The list below explains the “basics” of revision rhinoplasty surgery preparation. It is important to note that some patients may need to follow a set of highly specific instructions due to their unique anatomy or individual problem. For this reason, the safest route is to stick to the recommendations of one’s surgeon.
Minor contour irregularities and persistent fullness or swelling of the supratip (right above the tip) are best addressed after the skin has redraped completely to the new contour, which happens after 9-12 months. This “guideline” applies specifically to patients with markedly thick nasal skin, which is susceptible to prolonged swelling.
Waiting also allows the patients to be more objective on the results of their surgery and to ponder deeper on their cosmetic goals.
The idea is to have the most accurate assessment of the nose to achieve the most satisfying results possible. Nonetheless, certain deformities are best treated as soon as possible because of the zero possibility of improvement even after the passage of time.
Any medical condition that can interfere with healing must be controlled well in advance of the surgery. Healthy lifestyle and/or medications can help patients achieve their optimal health so they can handle the surgery.
- Avoid risk factors linked to increased bleeding, infection, and poor healing
Aspirin and other drugs and supplements with blood thinning properties must be discontinued 2-3 weeks before surgery and at least week afterward.
Tobacco and smoking cessation products (gum and patch) are also best avoided several weeks or even months ahead of the surgery because they are known to significantly increase the risk of skin necrosis and poor healing.
Doctors generally have preoperative information packet that explains what medications, supplements, drinks, and foods to avoid or at least limit their consumption. Furthermore, prudent patients should never hide or omit information regarding their drug use (including recreational drugs) to prevent complications and less than optimal results.
In the ideal scenario, lab screening, which is primarily blood work, is performed not later than 10 days prior to surgery to ensure that the patient is healthy enough for rhinoplasty and the ensuing recovery.
Revision rhinoplasty, also referred to as corrective or secondary nose job, deals with deformity of varying degree. In general, mild asymmetries such as small residual hump along the profile are best addressed after 6-18 months postop; the idea is to wait for all the residual swelling to subside.
Waiting is also ideal for patients with a markedly thick skin that makes them susceptible to protracted postop swelling in order to achieve a more favorable outcome, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Postponing revision rhinoplasty also ensures that the skin has fully shrink-wrapped to the new contour, and the patient becomes more “objective” in assessing the surgery’s results. Simply put, waiting prevents anyone from making hasty decision that could lead to more problems and frustrations.
However, there is no reason to wait when the issue involves gross deformities and abnormalities, especially when there is very little chance that they will improve even after all the swelling has dissipated. This is particularly true for twisted nose, collapsed appearance, and polly beak (the nose resembles a parrot’s beak due to its excessive convexity).
Function-related problems are also best addressed sooner than later to prevent further suffering.
In addition, patients with significant swelling caused by aggressive scar tissue inside the nose are best treated with steroid (Kenalog) injection as soon as possible, provided that the nasal framework is sturdy.
Steroid injection is commonly used in the supratip (right above the tip) to reduce persistent swelling, which is not uncommon in patients with thick nasal skin. However, the treatment should be used sparingly (i.e., highly diluted form and at intervals of 4-6 weeks) to minimize risk of skin depression, skin discoloration, and abnormal blood vessel formation.
In summary, the right or ideal timing for revision rhinoplasty will depend on many factors such as skin thickness, degree and type of abnormality or deformity, amount of postop swelling, stability of the framework, and presence of function-related problems. Simply put, the “usual” guideline of waiting 6-18 months is not always justified.