Over the past several years, plastic surgeons have been using a biological mesh that serves as an internal bra to hold the breast shape and maintain its “perky” appearance long term. However, some experts say that due to its flat or two-dimensional shape, its contouring effects on a curved surface such as the breast could be limited.
To rectify the inherent problem of flat-surfaced biological mesh, one company has released a three-dimensional scaffold called GalaShape. Unlike its earlier design, this new breast lift technique has a curved surface with a rim that closely resembles a bra cup, which can be easily wrapped around the breast and fixed to the tissue.
Photo Credit: galateasurgical.com
According to the company website, GalaShape is a biological mesh made of poly-4-hydroxybutyrate that triggers minimal inflammatory response. Thus, once positioned beneath the breast it triggers the body to create more collagen or scar tissue, which will hold the new contour of the breast.
It takes between 12-18 months before the biological mesh is completely absorbed by the body, leaving just the internal scar tissue to support the perky appearance of the breast long term.
The use of biological mesh, or any type of scaffolding or internal bra, is sometimes referred to as scarless breast lift technique because it only entails one incision that fades into the background—i.e., precisely at the border of the areola.
Despite the invisible scar, leading Los Angeles plastic surgeon Dr. Tarick Smiley says that scarless breast lift only works in patients with mild to moderate sag, which means that the areolar complex has not drooped way below the breast fold.
Should the areolar complex sag below the breast crease, Dr. Smiley says the traditional breast lift remains the best approach. This involves incisions around the areola, which then go down the midline and across the base of the breast, resulting in an inverted-T scar.
The traditional breast lift relies on soft tissue rearrangement to improve breast projection and shape. When done properly, most surgeons would agree that the use of additional materials like biological mesh is unnecessary.
Cankle liposuction, which is an almost exclusive procedure for women, corrects the appearance of “chubby” ankles. The goal is to create a more tapered and slender appearance of the lower leg, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
The ankle is an eminently challenging liposuction area because it is replete with blood vessels and nerves. Hence, all efforts are made to minimize bleeding and risk of nerve damage with the use of gentle techniques and tumescent fluids.
Photo Credit: David Castillo Dominici at FreeDigitalPhotos.net
Dr. Smiley says he injects tumescent fluids into the liposuction area to constrict the blood vessels and thus minimizes bleeding and nerve injury. This technique also promotes gentler fat removal because the solution also causes the fatty cells to expand, making them easier to remove with microcannula.
The use of microcannula, a liposuction hollowed tube attached to a vacuum pump, can further minimize surgical trauma as well as the amount of postop bruising and swelling. And since the ankle is considered a tough area and there is not a lot of fat, it becomes more important than ever to use this device.
Large cannulas (they have thicker outside diameter), meanwhile, are best avoided during cankle liposuction because they remove fats in bigger chunks and thus may result in higher risk of nerve injuries and over-correction.
To ensure smooth and proportionate results, some patients also require liposuction of their calves.
Because of gravity, the lower leg experiences longer and more pronounced swelling than any other parts of the body. Hence, a many surgeon recommends the use of compression hose for longer periods, sometimes for up to six months.
(Ordinarily, liposuction elsewhere entails 3-4 months of complete healing and skin retraction. But with ankle and/or calf, patients may have to wait a bit longer.)
To further control swelling and ultimately promote healing, rigorous activities are best avoided for six weeks. Leg elevation, good hydration, and superb diet (avoid salty and fatty foods known to aggravate swelling) are also known to control postop inflammation.
When patients ask about the long term effects of breast lift, oftentimes they refer to the longevity of the shape. While many surgeons would say that it would probably last between 10-15 years, the truth is there is no definite answer due to the large number of variables.
The quality of skin, weight, sun exposure, diet, exercise, pregnancy, use of bra, and smoking and other lifestyle factors will have an influence on how long the breast contour and “perkiness” would hold. And while no surgery can stop aging, patients who have had breast lift in general will experience progressive sag that is significantly slower than someone who did not get the procedure done.
While aging and pregnancy contribute to breast ptosis (sag), leading Beverly Hills plastic surgeon Dr. Tarick Smiley says lifestyle factors also play a critical role in its appearance.
Dr. Smiley says that controlling lifestyle factors that have a detrimental effect on skin elasticity remains important after surgery.
Cigarette smoking reduces dermal collagen and skin tone, leading to breast ptosis. One previous study involving pairs of twins has clearly established its deleterious effects on skin elasticity.
Large weight fluctuations lead to breast volume deflation or involution, which can accelerate breast sag. Hence, the ideal candidate for any body contouring surgery should be committed to a healthy lifestyle, which they can adhere to long term. Diet pills and diet fads, meanwhile, are nothing but a palliative or temporary solution.
- Exercise and healthy diet
Combined with superb diet, exercise is the key to healthy weight and ultimately perkier and more youthful breasts. Of course, this only applies to women who make sure that they always wear a good fitting supportive bra.
Aside from smoking, UV rays also destroy the dermal collagen that gives the skin its youthful tone and elasticity. A good rule of thumb is to minimize sun exposure and use sunscreen regularly.
Facial fat transfer results should look smooth and natural and thus it entails a “perfect marriage” of art and science. While it is often combined with facelift or some type of facial rejuvenation surgery, it can also serve as a stand-alone procedure to improve the overall contour of the face.
Dr. Tarick Smiley, an eminent Beverly Hills-based plastic surgeon, has explained the three core guidelines that help him deliver smooth and natural fat transfer results.
This young patient has hollowed temple, which Dr. Smiley improves with fat transfer and ultimately the overall contour of her face.
- Harvest the right kind of fat.
In Dr. Smiley’s recent Snapchat post, he has explained that the abdomen and flanks are the two most ideal donor sites as their fat is more liquescent and thus provides smoother results. The back area, meanwhile, is best avoided because of its highly fibrous fat that may lead to bumps and other surface irregularities when injected into the face.
- Purify the fat prior to injection.
All the biomaterials (e.g., blood and oil) except from fat are removed prior to injection; this is mainly done with the use of centrifuge that separates fluids based on weight. This paves way for smoother results and long-term survival of fat grafts, Dr. Smiley explained.
With proper handling and injection, fat transfer results are near permanent (12-15 years).
- Perform meticulous injection.
Dr. Smiley said the purified fat is injected below the skin-and-fat layer and above the muscle. This provides not just smooth and natural results, but also prevents risk of nerve damage and other complications.
To further minimize risk of nerve damage, facial fat transfer uses a blunt needle during the injection process.
To further ensure smooth fat transfer results, injection is done through micro-droplet technique in which less than 0.1 cc of purified fat is inoculated one at a time into the tissue. This creates a honeycomb arrangement and thus allows tissue integration and blood supply ingrowth needed by the grafts’ long-term survival.
Hump reduction rhinoplasty is a nose-reshaping surgery that corrects the excessive fullness along the bridge whose upper third is made up of bone while the remaining two-thirds is composed of cartilage (firm but slightly flexible tissue).
While the surgery may seem like a straightforward procedure, the truth is that it goes beyond rasping the excess bone and trimming some cartilage.
Dr. Tarick Smiley, one of the leading Los Angeles plastic surgeons, shares the core principles of hump reduction rhinoplasty that allow him to deliver natural and permanent results.
- The deep radix must be addressed.
Occasionally, the fullness of the bridge is exacerbated by the deep radix, which is the root or origin of the nose from the forehead. Hence, some patients require this area to be filled in with soft tissue graft or cartilage to create smoother transition and balanced results.
Removing the excess cartilage does eliminate the hump, although this alone may result in open roof deformity, which is a visible gap. To prevent this surgical stigmata, a chisel-like device is used to cut the bone, allowing it to be narrowed and repositioned later on.
- Identify the most ideal amount of reduction.
Several variables determine how much reduction can provide the most natural and “stable” results; these include the nasal skin (particularly its shrinkage), facial features, gender, ethnicity, and even body frame (i.e., a bigger nose looks generally attractive in tall muscular men).
Over-aggressive reduction, especially in men, can result in unnatural appearance, disproportionately small nose (in relation to the face), and increased risk of nasal collapse and deformity.
- Closed rhinoplasty offers a unique advantage.
There are two basic methods to perform rhinoplasty: closed and open. The closed technique refers to placing all the incisions along the inner lining of the nostrils, while the open technique includes cutting the columella (wall of tissue between the nostrils) so the “roof” of the nose can be lifted, thereby giving more visibility during surgery.
While the open technique provides improved visibility, Dr. Smiley said closed rhinoplasty paves way for more predictable results.
“Because the columella and the roof of the nose remain intact during closed rhinoplasty, we see the outside appearance as we change the underlying framework step-by-step,” Dr. Smiley said in his previous Snapchat post.
Hump reduction rhinoplasty entails trimming the excess cartilage that is responsible for the “fullness.” But instead of throwing this away, in many circumstances it can be reshaped and later on used to reinforce the new contour of the nose, especially its tip, giving it a more refined appearance.