Closed rhinoplasty dorsal hump reduction involves meticulous techniques in order to create natural-looking results—i.e., the patient’s new nose looks as if he or she was born with it.
Recently, Inland Empire plastic surgery expert Dr. Tarick Smiley has shown images on Snapchat depicting this surgical technique performed on a female patient with nasal aesthetic issues that included prominent dorsal bump, droopy tip, and “nostrils that were showing too much.”
The patient’s rhinoplasty, or colloquially referred to as nose job, was performed via closed technique in which all the incisions were made inside the nostrils, precisely along their inner lining. Not only it resulted in well-concealed scars, she also mentioned a “relatively easy recovery due to minimal pain, swelling, and bruising.”
Dr. Smiley was able to create a “nicer and flatter” dorsal (nasal bridge) by removing the excess bone and cartilage. (Note: The upper one-third of the nose is composed of bone, while the remainder is comprised of cartilaginous framework, which makes it malleable but nonetheless firm.)
A piece of cartilage was then cut/reshaped so it could provide a strong tip support, ensuring that the results are stable (can resist or postpone aging and other changes). The same technique has also corrected the drooping tip appearance.
In general, a drooping tip, which also elongates the nose, detracts from the feminine face. According to several studies, attractive female noses have an angle of tip rotation that is between 95 and 110 degrees, giving it a slightly upturned appearance.
On the other hand, men can tolerate a slightly droopy tip without affecting their facial balance and level of attractiveness.
Elevating the patient’s droopy and bulbous tip has also made it appear more refined and narrower, and the nostrils have invariably improved as well.
Dr. Smiley says the ideal nose is not strictly defined by specific looks or rigid beauty tenets. The goal is to reshape the nose in a way that it complements the patient’s facial features, gender, ethnicity, age, and even height/body frame.
However, certain mathematical ratios that determine the ideal facial proportions do exist that can help plastic surgeons create natural results from rhinoplasty. For instance, for most people the ideal breadth of the nose is equal to the distance between the eyes.
Also, the length of the nose is ideally similar to the vertical height of the chin.
Closed rhinoplasty is a technique used in nose-reshaping surgery in which all the incisions are made inside the nostrils, specifically along their inner lining, and thus allows the surgeon to access the bony and cartilaginous framework of the nose.
Unlike open rhinoplasty that uses external incision to cut the columella or wall of tissue between the nostrils, the closed technique eliminates the risk of visible scar.
All the incisions are made inside the nostrils; hence, closed rhinoplasty technique eliminates any visible scar.
Inland Empire plastic surgery expert Dr. Tarick Smiley says about 95 percent of his surgeries is performed via closed technique due to its number of benefits such as shorter social recovery, greater control over the final results, and less bleeding and scarring.
Meanwhile, he says the remaining 5 percent of his rhinoplastic patients need the open technique, which he generally reserves for individuals who require highly complex changes to their noses as it allows for better exposure of the nasal framework.
One of the most notable closed rhinoplasty benefits is the reduced bleeding and surgical trauma, which promotes quicker social recovery thanks to little amount of bruising and swelling. In fact, many patients have claimed they were able to go out in public within a week postop.
Since there is no incision across the columella, the blood supply to the skin is not disrupted. This results in less swelling and bruising and quicker healing compared with the open technique.
Contrary to popular belief, closed rhinoplasty does not make it harder to visualize the nose in its natural state. Dr. Smiley says the technique even allows him to see the “outside appearance of the nose” while concurrently “reshaping the underlying framework step-by-step.”
In open rhinoplasty, meanwhile, the skin is lifted and so the “outside” of the nose is not in its most natural state while the surgeon is reshaping its underlying framework, says Dr. Smiley in his previous Snapchat video.
“When you’re molding a piece of clay it is better that you see every subtle change in real time. This can help us achieve smoother results from rhinoplasty,” he further explained.
Breast augmentation fat transfer precludes the need for implants and thus it avoids risk of capsular contracture (hardening of the breast tissue), implant malposition, rippling, and palpability.
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a video on Snapchat demonstrating a patient who requested for breast augmentation fat transfer to achieve more fullness to the upper breast pole and the lateral side.
One of the notable advantages of fat transfer over breast implants is the additional contouring effect.
“The patient needs more volume to her upper breast pole and the lateral side, which fat grafting can help improve. But in breast implants, we are highly reliant on their base. Simply put, using fat allows us to focus more on the area that needs the most correction,” Dr. Smiley says in the video.
But in terms of size, the effects of fat grafting can be limited particularly in patients with low body fat percentage.
“There are many breast implant sizes to choose from. Fat grafting, meanwhile, can only give one to two cup size increase,” says Dr. Smiley.
Dr. Smiley says that breast has fibrous tissue, which does not allow large volume fat transfer due to risk of pressure.
“Pressure is the enemy of high survival rate of fat grafts,” he further explained.
Aside from injecting just a conservative amount of fat, Dr. Smiley says another way to promote high survival rate is to inject fat cells closer to the muscle, which contains more blood supply.
Fat grafts need to integrate with the existing blood vessels, which can provide them the much needed oxygen and other nutrients. Also, their amalgamation with the extracellular matrix, which resembles a mesh that holds the blood vessels and other tissues together, is critical to ensure long-term results.
Meanwhile, Dr. Smiley collected the “unwanted fat” from multiple areas including the abdomen, flanks, and lower back. Prior to its injection, it was washed, sorted, and purified to remove all the biomaterials (blood and oil) and the anesthetic solutions used during surgery.
Face and neck lift with fat transfer can provide a holistic facial rejuvenation effect by correcting not just the sagging skin and deeper soft tissue, but also the volume/fat loss that comes with aging.
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate face and neck lift with fat transfer performed in a female patient with advanced signs of facing aging.
Dr. Smiley has described the patient’s facial aesthetic issues, which all required a customized approach to achieve the most rejuvenating effects without causing surgical stigmata such as flatness of the cheek, visible scars, and overly pulled countenance.
- drooping of the cheek
- loss of volume in the cheek, particularly the area between the mouth corner and the nostril
- recessed and sagging chin that almost disappeared from the neck
- appearance of jowl
- “heavy” neck due to excess skin
To improve the aforementioned aesthetic issues, Dr. Smiley used an incision pattern starting from the forehead area (behind the hairline) that went behind the tragus (small bump in front of the ear) and behind the earlobe and into the hairline at the nape; hence, all the scars would be hidden.
Afterwards, the celebrity plastic surgeon separated the skin from the SMAS, a layer of soft tissue that extends from the neck to the temple area. The SMAS and the platysma muscle of the neck move as a single unit, said Dr. Smiley in a recent Snapchat video.
“When doing the lifting, we have to do the deep lift, as a skin-alone lift is not enough to support the new elevated contour, Dr. Smiley further explained.
A deep lift also provides more natural results as the skin receives no or very little tension during wound closure, thus eliminating the risk of windswept appearance, overly flat cheeks, and other telltale signs of facelift, said Dr. Smiley.
Elevating the deeper layers of the soft tissue created immediate rejuvenating effects to the patient—i.e., her jawline appeared more defined, the upper cheek regained its “youthful plumpness”, and the angle or transition between the chin and neck was smoother.
To further improve the neck contour, Dr. Smiley created a small incision beneath the chin to access and tighten the platysma muscle towards the middle and side, thus creating a “sling effect on both directions.”
Because face and neck lift alone does not address facial volume loss, the patient also received fat transfer to the cheek, particularly the area between the nostril and mouth corner. The adjunct procedure was also used to create a smoother transition between the lower lid and the upper cheek.
Meticulous breast exam and surgical planning is the key to achieve breast augmentation and lift results that look natural and proportionate, said leading Inland Empire plastic surgery expert Dr. Tarick Smiley on his recent Snapchat post.
Dr. Smiley has recently demonstrated this “combo surgery” performed on a patient who had these following aesthetic problems:
- Sagging breast tissue
- Deflated upper breast pole
- Disproportionately huge nipple that dropped below the level of the submammary fold
While the patient’s preexisting soft tissue was sufficient, a breast lift-alone approach would not give her the upper pole fullness she wanted; hence, the use of concurrent small implants was fitting to deliver her aesthetic goals.
The use of small implants would give her not just additional fullness of the upper pole, but would also improve the overall projection of her breasts, Dr. Smiley said.
To give her more cleavage and “overall fullness,” the celebrity plastic surgeon used moderate profile implants whose forward projection is predetermined by their width. They are perceived to be the standard design as the provide just the right amount of “roundedness” without causing excessive fullness in the upper breast pole; hence, they simulate the look of an attractive breast that occurs “naturally.”
In the context of breast lift, Dr. Smiley performed the standard technique in which the incisions were created around the new smaller areola. The incisions were then extended down the midline and across the base of the breast, leading to an inverted T scar.
To ensure lasting “perkiness,” the surgeon elevated the internal breast tissue with “special sutures” that would act as a sling. This “fine-tuning technique” also allowed the silicone implant to remain centrally behind the areola.
Furthermore, he created more distance between the smaller areola and the submammary fold (about 3 cm), further contributing to the perkier and more youthful appearance.
Dr. Smiley noted that “all efforts are made to eliminate tension” in order to promote the best scar possible. During the creation of areolar incisions, he made them into perfect circle so the tension could be equally distributed. In addition, the wound was sutured in several rows so the skin would not receive excessive “tautness.”
The use of smaller or conservative-sized breast implants also favored the patient because of the reduced tension. It should be noted that overlarge implants used concurrently with breast lift might create too much “opposing tension” on the skin, which could result in higher risk of unfavorable scars and poor healing.