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.”
Blepharoplasty with fat transfer is a modern approach in eyelid surgery that ensures natural and youthful results. It diverges from the antiquated technique in which the main focus is to remove the excess skin and fat with little regard to age-related volume loss.
The antiquated technique may cause skeletonized eye socket appearance especially along the lower eyelid. This is particularly true when the fat is entirely removed, leaving no “carpeting” beneath the skin to promote smooth results.
To prevent creating or aggravating the hollowed lower eyelid, Dr. Tarick Smiley of the California Surgical Institute says he often incorporates blepharoplasty with fat transfer. The idea is to create a smooth transition between the lid and cheek, which is one of the key elements of a youthful face.
In Dr. Smiley’s recent Snapchat post, he has shown a female patient who has had upper and lower blepharoplasty with fat transfer.
The patient’s upper blepharoplasty was performed to eliminate the hooding of the lid; this was done with incisions made precisely at the existing skin fold to hide the resulting scar. Only a very small amount of skin was removed to preserve the function or “normal blink” and to allow for proper wound closure, which is the key to optimal hidden scars.
While some doctors extend the incision into the crow’s feet, Dr. Smiley keeps it within the natural skin fold of the upper lid to ensure that the scar will remain hidden.
The patient’s lower blepharoplasty surgery, on the other hand, was performed with an incision placed very close to the lower lash line so her eyelashes can hide the resulting scar. The area has a markedly thin skin, which allows the scar to fade better into the background.
Meanwhile, the antiquated technique removes the entire fat in an attempt to remove the under eye-bags; however, this causes hollowness right after surgery or years down the road, as soft tissue volume decreases with aging.
There are several ways to prevent the appearance of hollowed lower eyelid, with fat transfer being the most popular option, says Dr. Smiley.
Other patients can benefit from the repositioning of their superficial fat (fat beneath the skin; this is different from the deeper “bulging” fat that often requires removal), specifically laying it over the upper cheekbone to maintain a smooth lid-cheek junction. Fat grafting or injecting can further fine-tune the results.
Rhinoplasty for ethnic nose has one primary goal: improve the nose in a way that it will remain consistent with the patient’s ethnicity and facial features. Meanwhile, any attempt to reshape it using a set of highly restrictive beauty ideals will lead to unnatural results.
Dr. Tarick Smiley, who is the medical director of the California Surgical Institute, says the success of rhinoplasty, or nose job in layman’s term, boils down to acknowledging the great variations of beauty as well as respecting the patient’s underlying anatomies, ethnicity, gender, and aesthetic goals.
The vast majority of successful rhinoplasty for ethnic noses performed on women delivers “finesse” results. On the other hand, over-narrowing of the tip, over-augmentation of the bridge or dorsum, and over-tapering of the nostrils almost always lead to ethnically inconsistent results.
“Finesse” rhinoplasty generally means creating a result that is a more refined version of the original nose.
Respecting the patient’s ethnicity and underlying anatomies also entails the use of conservative surgical maneuvers, meaning the surgeon avoids over-resection of the tissue. In a way, this preserves the structural integrity of the nose and thus it is less susceptible to aging, deformity, and contour irregularity.
Before and after photos of ethnic rhinoplastic patient
One good example are patients of Middle Eastern and Indian descent who typically require dorsal hump reduction, a rhinoplastic technique in which the excessive fullness along the bridge is corrected by removing a piece of bone and cartilage, which is often re-used to improve the structural integrity of the tip.
In many cases, ethnic rhinoplasty deals with a tip that has weak support, causing it to droop and the nose to appear oddly elongated.
Reinforcing the tip has some auspicious effects on the femininity of the face. According to studies, the ideal female nose has an angle of tip rotation between 95 and 110 degrees, resulting in a slightly upturned appearance.
Again, raising the tip should be done in a conservative, finesse manner lest an error of just a few millimeters can lead to unusually short nose and excessive visibility of the nostrils, a deformity colloquially called as “Miss Piggy” in reference to the popular Muppet character.
The slightly upturned tip might be further enhanced with the small suptratip break, a slight indentation along the bridge just above the nasal tip. However, this “subtle” feature is avoided like a plague in male rhinoplasty due to its feminizing effects.
And lastly, female rhinoplasty for ethnic nose should take into account the patient’s aesthetic goals—which are largely influenced by social and cultural ideals of beauty—down to the last detail.
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.
It is important to note that plastic surgeon experience directly correlates to the cosmetic results following liposuction or any other forms of body contouring surgery.
While education and formal training are the foundations of good plastic surgeons, experience allows them to further hone their eyes for detail. It is important to note that body contouring surgery is a combination of art and science.
Although beauty is not confined by strict definition or mathematical equation, most scientists, visual artists, plastic surgeons, and even “ordinary observers” know it when they see it. Hence, experts have come up with standards in an attempt to define attractiveness.
Dr. Tarick Smiley, who is the medical director of California Surgical Institute, explains how plastic surgeon experience affects the results of liposuction, a body contouring surgery in which the unwanted fat is removed with a slender steel probe called cannula.
- “Feeling” the surgical site
Contrary to popular belief, great liposuction surgeons do not rely mainly on their eyes during surgery, but more on “feeling” the treated site, as explained by Dr. Smiley on his recent Snapchat video post.
“While I move the cannula back and forth with my right hand, my left hand feels the skin, allowing me to decide if I need to stop or continue what I’m doing. It is critical to leave behind a layer of fat afterwards, as opposed to removing it entirely, to ensure a smooth skin surface,” he said.
Dr. Smiley, who has performed more than 9,000 liposuctions, said that board certified plastic surgeons with extensive experience have a notably low complication rate.
Inexperienced and unqualified surgeons, meanwhile, may commit a serious mistake of removing too much fat and causing excessive injury on the skin. Aside from surface irregularities, being too aggressive results in tissue necrosis (death of tissue) and poor scarring (liposuction is supposed to result in nearly invisible scar).
The consensus is to choose a board certified plastic surgeon who performs liposuction almost every week, or someone who conducts over a hundred surgeries every year.
Major revisions after liposuction (due to surface irregularities) can be serious that sometimes that it is better to leave the area alone than risk having a more severe problem. Hence, Dr. Smiley believes that the surgery must be performed correctly the first time.
Despite best effort, minor revisions may be sometimes necessary to further improve the initial results after liposuction. Nonetheless, a major “overhaul” is not to be expected if the surgery is performed by a qualified, reputable plastic surgeon, Dr. Smiley has explained.