Patients who have had rhinoplasty, or nose job in layman’s term, were rated higher in terms of facial attractiveness and perceived health and success, as suggested by a web-based survey published by JAMA Facial Plastic Surgery.
Rhinoplasty, also referred to as nose-reshaping surgery, was the third most commonly requested cosmetic plastic surgery in 2016, with more than 223,000 procedures performed, according to a survey conducted by the American Society of Plastic Surgeons.
Before-and-after photo that depicts great outcome. (Photo Credit: Dr. Tarick Smiley)
The study, which was conducted by researchers at Johns Hopkins University, Baltimore, involved 473 ordinary observers who were asked to rate before-and-after photos of 13 rhinoplastic patients. To prevent confirmation bias, the respondents were shown only one photo of the same patient.
Most of the respondents were women, Caucasians, and four-year college graduates.
The survey has shown the rhinoplasty effects or “after photos” of patients were rated higher in terms of average attractiveness, average perceived success, and average perceived health.
Despite auspicious results, the authors of the survey have pointed out some limitations because of the small number of respondents and patients. Furthermore, it did not include the patients’ self-perceived changes and satisfaction.
Also, the patients only represented optimal outcomes, which could be the main reason for higher scores in perceived attractiveness, health, and success. Simply put, the after photos did not reflect the wide spectrum of nose surgery results.
However, the survey’s authors said the findings could “help improve physician-patient discussion by providing a reference for an optimal outcome.”
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley, who was not part of the study, said creating an attractive nose with surgery boils down to how natural it looks.
“We have to create a nose that looks like the patient was born with it. Thus, factors such as gender, ethnicity, facial features, age, and even body frame are all taken into account to deliver results that look both natural and attractive,” says Dr. Smiley.
Some patients require a two-staged male chest reduction surgery, meaning liposuction and tissue excision are performed concurrently to achieve the best results possible.
Dr. Tarick Smiley, an Inland Empire plastic surgery expert, has recently demonstrated the “combo” technique on his Snapchat.
Dr. Tarick Smiley removes the excess breast tissue that will not come out with a liposuction-alone approach.
He first started the surgery by infiltrating each breast with tumescent fluids, which provided numbing effect and caused the fat cells to expand, paving way for quicker and more accurate removal via cannula (slender steel tube attached to a vacuum pump).
Afterwards, he created a small puncture wound on each side of the chest, precisely at the edge of the lower areola to conceal any resulting scar. This incision allowed him to remove the excess fat that was mainly behind the nipple area.
However, the patient’s male breast enlargement, or medically referred to as gynecomastia, not only stemmed from the excess fat, but also from the extra tissue, which a liposuction-alone approach could not address.
“The extra glandular or breast tissue is too thick and dense. It will not come out with a liposuction cannula,” says Dr. Smiley.
Hence, after liposuction Dr. Smiley proceeded to excision-based surgery with a creation of a curved incision that was also positioned at the lower border of the areola. Using surgical scissors and other special instruments, he was able to separate the excess tissue from the skin and eventually removed it.
By removing the excess breast tissue, he further eliminated the “roundedness” or fullness of the breast as well as the prominent submammary fold.
Meanwhile, the recovery following a two-staged male chest reduction is about a week. After this period, most patients can return to work although it remains prudent to avoid heavy lifting and strenuous exercise for another 2-3 weeks to eliminate the risk of persistent swelling, bleeding, and healing problems.
The postop pain is typically minimal that most patients will only need over-the-counter pain medications such as Tylenol. However, it is the swelling that takes longer time to dissipate (up to six months).
Arm lift, or medically referred to as brachioplasty, removes the excess skin caused by weight loss or age-induced soft tissue laxity. Leading Los Angeles plastic surgeon Dr. Tarick Smiley says the incision length and pattern will depend on how much tissue needs to be removed.
The short incision arm lift technique is reserved for patients whose excess skin is limited to the top of the upper arm, i.e., near the armpit, while the standard armpit-to-elbow incision is suitable for people who need the most amount of correction.
The short incision technique results in a scar that is within the armpit fold.
During a short incision technique, also referred to as mini arm lift, doctors create a crescent-shaped incision in the armpit area and so the resulting scar is completely concealed by the natural skin fold.
After removing the excess skin responsible for the appearance of “bat-wing arm,” the incision is closed in deeper layers to ensure that the skin receives no or very little tension, which in turn promotes the best scar possible and reduces the risk of wound healing problems.
Dr. Smiley says it is not uncommon to perform a concomitant liposuction to further achieve a smooth contour. The goal is to remove just the right amount of excess fat so the entire upper arm has no unusual fullness or bulge that detracts from the slender appearance.
Nonetheless, over-aggressive liposuction can “harm” the appearance of female arms. When too much fat is removed, surface irregularities and unnatural contour may ensue; these cosmetic problems are remarkably hard to correct during a revision surgery (fat grafting).
While a slender arm is the most sought after look, a slight convexity along the posterior surface of the “top of the arm bone” down to the elbow is ideal in order to preserve the appearance of a feminine arm.
Whether or not liposuction is performed, short incision arm lift generally takes two weeks of recovery. After this period, most patients can slowly resume their normal activities and may begin their scar management therapies, which may include silicone sheets, scar creams, and massage.
Sculptra for buttocks is a minimally invasive procedure that uses an FDA-approved injectable material that triggers more collagen production, resulting in up to fourfold increase in soft tissue volume.
Dr. Tarick Smiley, a prominent Los Angeles plastic surgeon, says the right candidate for Sculptra injection is determined by the underlying anatomies, cosmetic goals, and “acceptable tradeoffs.”
Dr. Smiley says lots of Sculptra vials are needed during buttock enhancement to achieve the desired outcome.
* Patients who do not have enough fat to undergo fat transfer buttock augmentation, or more commonly referred to as Brazilian buttock lift, is a good candidate for Sculptra.
Nonetheless, most surgeons would first still consider fat transfer before they would recommend Sculptra or any other filler material because fat provides near permanent results for almost the same price.
Dr. Smiley says that Sculptra’s results can only last an average of 3-4 years.
* Patients who can’t or don’t want surgery. Fat transfer to the buttocks often requires large volume liposuction or multiple donor sites to achieve the desired results. While this concomitant surgery results in a more holistic improvement of the physique, this entails 2-3 weeks of recovery.
Sculptra for buttocks, meanwhile, is performed under local anesthesia because it does not involve liposuction. Thus, most patients can return home about an hour after their procedure.
* Patients who want subtle to moderate improvement might be a good candidate for Sculptra injection. The amount of augmentation is quite conservative, although most can expect a rounder backside; this is particularly true when the surgeon focus on the lateral buttock, which anatomically speaking is the hips.
Meanwhile, fat transfer remains the best approach if one desires for bigger augmentation and more pronounced curves. Fortunately, the concomitant liposuction in the lower back and flanks makes these goals easier to achieve.
* The ideal candidate should understand that unlike fat transfer in which the results are near permanent (12-15 years), Sculptra is resorbed after 3-4 years and so it requires a more regular touch-up if one likes to maintain the curvier appearance of her buttocks.
Ultherapy or facelift for facial rejuvenation? While both can rejuvenate the face by reducing skin laxity, they work quite differently and so the ideal approach will depend on the patient’s underlying anatomy, amount of correction required, and aesthetic goals.
Ultherapy is an FDA-approved non-invasive treatment that tightens not just the skin but also the deeper soft tissue. Just like facelift, it also reaches the SMAS plane (fat, tissue, and muscle) by releasing ultrasound designed to bypass the skin in order to reach the deeper layers.
Photo credit: Ultherapy website
The ultrasound triggers more collagen production, leading to tighter skin. Nowadays, it is most commonly used to tighten the jawline, peri-orbital area (around the eyes and brows), neck, and décolletage (chest region that is visible when one is wearing a low neckline dress/top).
Most patients will only need one treatment, although a few may require a touch-up to achieve their desired results. Meanwhile, this 1-1.5 hour treatment provides rejuvenating effects that last 18-24 months.
One of the selling points of Ultherapy is the little to no downtime, a far outcry from the 1-2 weeks social recovery required by facelift surgery.
But as with any non-invasive facial rejuvenation treatment, Ultherapy only suits patients who require less amount of correction and thus it is commonly performed in people 50 years and younger.
For patients who require more correction, i.e., they are usually 55 years and older, the standard facelift still provides the best and most predictable results, says renowned Orange County plastic surgery expert Dr. Tarick Smiley.
During facelift, the SMAS plane, which is beneath the skin, is elevated and tightened to create more chiseled jawline, smoother neck, and fuller cheeks/mid face. In addition, a small amount of excess skin is removed with the use of incision made behind the hairline that runs around the ear’s curvature for optimal scar concealment.
One caveat of facelift is the social recovery that often takes a week or two. Furthermore, it is only reserved for patients who are physically fit and have no healing problems.
The results of SMAS facelift, according to anecdotal reports, can last an average of 10-12 years. This is particularly true for patients with good skin elasticity and will receive touch-ups, which may be in the form of Ultherapy, fillers, medical-grade chemical peels, or a combination of them.