The rhinoplasty preparation tips aim to help patients achieve their optimal health and ultimately the best results possible from the surgery. It is important to note that aside from the surgeon’s skills and experience, healing can also influence the long-term outcome.
Experts at the California Surgical Institute explain the “basics” of rhinoplasty preparation tips.
A balanced diet mainly consists of lean protein (about 15-25 percent of the total calorie intake), fresh fruits and vegetables, and “healthy” carbs. Meanwhile, avoid or at least limit the amounts of processed carbs (white pasta and bread), foods and beverages laden with too much sugar, and salty foods.
Some doctors recommend multivitamins a few weeks or months leading up to the surgery. However, a prudent patient should not take any supplement without their surgeons’ approval because a gamut of remedies are known to interact with anesthesia and painkillers or may increase the risk of bleeding and poor healing.
Supplements known to increase bleeding and other complications (e.g., ginseng, fish oil, green tea, ginkgo biloba, kava kava, and garlic) are best avoided 2-3 weeks before and after surgery.
- Discontinue all tobacco and smoking cessation products
While the general rule of thumb is to avoid these products for a minimum of three weeks, some doctors require a longer cessation period to ensure the patient’s full commitment. It is important to note that one stick is enough to compromise healing and even the long-term results of the surgery.
Most patients will need at least a week of “social recovery” (before they look presentable in public), although it still makes sense to plan for at least a two-week off just to err on the safe side. Furthermore, in the first ten days postop their focus should be on their recovery alone; hence, it s highly ideal that they assign house/pet/child care to someone else.
- Make the house “recovery-proof”
All surgeons will provide their patients a list of things they must purchase, prepare, or arrange weeks or days ahead of their surgery. Typically they include painkillers, button-down shirts, large pillows or recliner (it is ideal to keep one’s head elevated to keep swelling to a minimum), soft foods, and sources for entertainment (magazines, books, movies, etc.).
For some patients the residual bruising especially around the eyes might take longer to dissipate. Camouflage makeup can help conceal these bruises.
The appearance of breast lift cleavage is one of the most pressing concerns of patients. While the surgery to some extent can provide additional upper pole fullness, the real issue is how long the “effect” can last.
It is important to note that breast lift primarily reshapes the lower pole of the breast, which is the area between the nipple and the submammary fold. Basically, it repositions the low-lying, downward pointing areola and tightens the breast tissue of the lower pole with the use of internal sutures.
In standard technique, the resulting scars go around the areola’s border, vertically between the nipple area and the submammary fold, and parallel to the breast crease; hence, it resembles an inverted T or anchor, according to the California Surgical Institute website.
As a stand-alone procedure, the improvement in breast lift cleavage appearance is very minimal—i.e., the upper pole has a concave appearance while the lower pole has most of the volume. Simply put, the overall breast shape resembles a teardrop.
But a good number of breast lift patients want more fullness in the upper pole, which can be accomplished with a simultaneous breast augmentation via round implants, which in essence are like a flattened sphere. High profile implants are particularly ideal for women seeking fuller-looking upper cleavage because they “stick out” more from the chest wall.
It is important to use implants that reflect the underlying anatomies, particularly the breast and chest dimension, to prevent inadvertent implant displacement (going “south”), rippling, and palpability.
Meanwhile, implants that are too big for the anatomical dimension can spell disaster because patients seeking breast lift surgery have poor skin quality to begin with. For this reason, surgeons not just reshape the skin, which cannot support the new contour over time, but also the actual tissue by using internal sutures.
However, some women do not like the idea of using synthetic implants. For these patients, fat grafting or injection to their upper breast pole can be a good alternative. (Note: About 100 cc of purified fats are often enough to achieve fuller looking upper cleavage.)
Another possible alternative to implants is auto-augmentation technique in which some of the tissue in the lower breast pole is rotated and lifted higher with internal sutures to create additional fullness in the upper pole. This method only works for women with ample amount of breast tissue.
While repositioning the lower pole tissue, it remains attached to its blood supply (stalk) to prevent healing problems.
Low profile breast implants offer the least amount of projection relative to their wide base; hence, they are generally ideal for women with wider chest wall, according to the California Surgical Institute website.
Other types of implant profile include high, ultra high, and moderate, giving patients more control over the final outcome of their breast augmentation surgery. In the past, moderate profile implants were the only thing available.
Image Credit: Allergan-Natrelle website
Moderate profile implants have outward projection that is predetermined by their base diameter and so they are viewed as the “standard profile.”
In essence, the implant’s profile will largely determine the appearance of the breast when viewed from the side.
Low profile breast implants tend to give a softer, flatter breast as they push the nipple area out from the chest wall. High profile implants, meanwhile, provide a more outward rounded appearance as they offer more projection.
Furthermore, low profile implants tend to create a wider and “bubble-like” appearance, which may reflect the anatomy of patients with a wider body frame, leading to a natural and proportionate result.
When wide-framed women use high profile implants, they may end up with breasts that appear too pointy (which are far from looking natural) because the implants do not occupy enough horizontal space.
While the patient’s goal is taken into account when choosing the “ideal” breast implant profile, the underlying anatomy can have more bearing on the issue. The goal is to pick the “design” that reflects the patient’s anatomical features, particularly relating to chest and breast dimension and the amount of soft tissue.
By respecting the patient’s underlying anatomies, it becomes much easier to achieve natural-looking and proportionate results. In addition, it prevents or at least reduces the risk of complications such as inadvertent implant displacement (sagging or bottoming out, uniboob, and excessive lateral bulge), palpability, and rippling.
Aside from the implant profile, another critical aspect is the filler material (silicone gel versus saline). In general, patients with thin frame or low body fat percentage are more suitable for silicone implants to compensate for their lack of soft tissue coverage.
Saline implants, meanwhile, may not provide the most natural outcome in patients with little soft tissue because of increased palpability and rippling.
Teardrop breast implants—also referred to as anatomical, shaped, or contoured implants—have more volume at the bottom so when viewed from the front they appear oval. In profile view, however, they look somewhat conical.
Round implants, meanwhile, are similar to a flattened sphere (as opposed to a ball) that when placed on top of a table their shape is like an M&M candy. But when placed in a vertical fashion inside their breast pocket, the effects of gravity will turn them into a teardrop as most of their filler will settle to the bottom of the shell. This has already been demonstrated by breast exams.
Photo Credit: Allergan-Natrelle website
Simply put, the teardrop breast implants offer no real advantage in terms of giving a more natural shape. In fact, they may not look natural when the patient is lying down since they maintain their teardrop shape, whereas round implants spread to the side when the body is in supine position.
Because of the asymmetric dimension of the teardrop breast implants, they cannot afford to rotate inside their pocket lest the breast will appear distorted. For this reason, they require a more meticulous pocket creation compared to what round implants entail to prevent them from flipping, according to the California Surgical Institute website.
On the other hand, round implants can afford to rotate inside their pocket without causing visible distortion because of their symmetric dimension. Hence, they are generally the preferred choice in cosmetic breast augmentation surgery.
Just like round implants, teardrop implants are also available in different filler materials, from saline, standard silicone gel, to highly cohesive gel; their profile or forward projection also comes in different degrees, from full height to low height. This allows the patients to further “customize” the results based on their aesthetic goals.
All efforts are made to prevent the teardrop implants from flipping, which requires a revision surgery to put them into the correct position. Aside from a highly precise pocket dissection, their textured or rough shell can further minimize the risk of rotation.
The textured shell promotes tissue adhesion, although this “design” can also increase the risk of traction rippling and palpability, problems afflicting most thin and small-breasted patients.
Patients who are deemed high risk for rippling and palpability are the best candidates for smooth round silicone implants because their filler material (silicone gel) closely resembles that of the breast tissue and fat.
Capsular contracture breast implant treatment may come in non-surgical methods such as antibiotics and breast massage, or surgical procedures like capsulectomy in which the thick scar capsule is removed entirely.
Capsular contracture is believed to stem from chronic inflammation, which triggers the body to “over-react” and produce copious amounts of scar tissue around an implant. It is important to note that scar capsule normally forms around any synthetic device, although it is ought to remain thin and flexible.
The truth is, scar capsule formation is an auspicious natural process ensuring that the implant will not migrate. It only becomes problematic when it turns into a thick scar to the point that it results in breast deformity and pain.
While there is a gamut of capsular contracture breast implant treatment these days, prevention still remains the best route. A good rule of thumb is to avoid implant contamination and excessive bleeding at the time of surgery, and prevent infection during the initial healing stage (first few weeks postop).
Should capsular contracture occur, which in early stages is manifested by some firmness of the tissue although the breast shape still appears natural, non-surgical treatments such as breast implant massage and oral medications such as antibiotics and Accolate might be enough to prevent its progression or even allow it to regress.
Dr. Tarick Smiley, MD, who is the medical director of the California Surgical Institute, suggests breast implant massage to prevent and treat first-stage capsular contracture. Its goal is to push the implants into the outermost corners of their pockets so the scar capsule will remain thin and malleable.
The celebrity plastic surgeon is a staunch advocate of breast implant massage that he suggests it to all patients with smooth round implants, encouraging them to perform it everyday for a few minutes for the rest of the prosthesis’ life.
Meanwhile, high dose of vitamin E, oral antibiotics, and Accolate (and other similar asthma medications) are also believed to improve capsular contracture. However, there has been a debate on their effectiveness, with studies having conflicting findings.
Accolate and some asthma medications are sometimes used “off label.” Proponents suggest that capsular contracture happens due to the body’s “over-reaction,” which also occurs during asthma attacks. However, some clinical studies suggest they have very limited effect on scar capsule contracture, while some research findings indicate they are more effective in preventing recurrence after a revision surgery has already been performed.
Capsulectomy is the most effective capsular contracture breast implant treatment, although it involves major surgery to remove the scar capsule and replace the implants with new ones. Studies have shown that it has the lowest recurrence rate among all techniques.
A less invasive form of surgery called open capsulotomy is another option, although its recurrence rate is not as impressive as the capsulectomy. In this procedure, the scar capsule is cut into pieces usually with the use of an electrocautery device, and the implants are usually not replaced.