Male rhinoplasty for large nose is a highly customized procedure in which the patient must be able to describe his goals in the most exact detail. Furthermore, the surgeon must conduct a comprehensive physical exam to evaluate skin thickness, underlying structures of the nose (cartilaginous and bony framework), and even the entire face to achieve proportionate, natural-looking results.
Rhinoplasty, or in layman’s term nose-reshaping surgery or nose job, is one of the most technically challenging plastic surgery procedures that its success is determined by minute changes measured in millimeter. Hence, it requires deep understanding of the anatomy and respect of the patient’s ethnicity, gender, and facial and nasal anatomies.
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a series of videos on Snapchat to demonstrate a male patient who required rhinoplasty for large nose.
Aside from having a hugely disproportionate nose (relative to his “small” face), Dr. Smiley said the patient also complained of the following cosmetic issues:
- dorsal hump or excessive fullness along the bridge of the nose
- hooked or drooping tip
- bulkiness of the tip
For this patient, Dr. Smiley performed the closed rhinoplasty, meaning all the incisions were made inside the nostrils, specifically within their inner lining. Aside from eliminating the risk of visible scar, the technique is also known to result in shorter “social” recovery because of the minimal postop bruising and swelling.
The incisions allowed Dr. Smiley to access the cartilaginous framework of the nose and to remove the piece of cartilage causing the dorsal bump along the bridge. But instead of discarding this tissue, he resized and reshaped it so it could be used to support the tip and refine its appearance at the same time.
With additional tip support, Dr. Smiley was also able to address the excessive bulkiness of the tip.
Afterwards, the celebrity plastic surgeon rasped or shaved down the bone (the upper one-third of the nose is made up of bony framework, while the lower two-thirds is made up of cartilage that is relatively flexible) to further reduce the fullness along the bridge. This was done with the use of a device closely resembling a nail file.
Because the patient has thick nasal skin, the amount of reduction must be on the conservative side. The idea is to allow the overlying skin to redrape beautifully around the new contour, as opposed to looking bulbous or amorphous, which could happen after an over-aggressive tissue resection.
The Brazilian butt lift or BBL results will primarily depend on the surgeon’s qualifications, which include his education, training, experience, and arguably the most critical variable: board certification.
Inland Empire plastic surgery expert Dr. Tarick Smiley says the general rule of thumb is to choose a surgeon who is a member of the American Board of Plastic Surgery, which is the only board certifying body recognized by health authorities.
Apart from the surgeon’s qualification, BBL results will also depend on his “tools” and surgical techniques, Dr. Smiley said in his recent Snapchat video.
The celebrity plastic surgeon has explained the tools that help him achieve smooth and proportionate BBL results.
One female patient had large lateral indentation on her buttocks. This “depression” is typically caused fascia or thread-like anatomy that is pulling the skin inward. Hence, her surgery required the use of a “fork.”
A surgical “fork” is a long slender tube whose tip has two prongs to “release” the skin tethering through a small round incision. Dr. Smiley said it is important not to “overdo the process” to prevent “herniation” and skin asymmetries.
- Liposuction microcannula (hollowed steel tube attached to a vacuum pump)
All BBL surgeries start with liposuction in which large amounts of unwanted fats are collected from two or more donor sites. Doctors may choose large or standard cannula, or microcannula during this process.
Microcannula removes smaller bits of fat; therefore the process of fat extraction (i.e., liposuction) becomes longer although at least they give surgeons greater precision compared to large cannulas.
Large cannulas (4-5 mm outside diameter), meanwhile, remove large masses of fat and so the perceived risk of skin asymmetries and other untoward side effects of over-correction is higher.
The use of microcannula is also ideal when treating the back area (bra rolls, flanks, and lower back), which is notorious for its fibrous fat.
The use of laser light allows Dr. Smiley to achieve the highest level of symmetry in terms of forward projection and overall shape of the buttocks.
While breast augmentation trends come and go, there are universal guidelines that help surgeons achieve natural-looking results and minimize risk of complications, particularly relating to aesthetic issues such as sagging or bottoming-out, and rippling.
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley, who performs over a hundred breast augmentations every year, has provided basic explanations of the current breast augmentation trends.
Although many trends and new technologies have paved way for safer, longer-lasting implants, Dr. Smiley says the ideal choice still boils down to patient compatibility, meaning that one’s underlying anatomy and aesthetic goals must be in line with her implant type, design, and size.
- Breast implants that “acknowledge” and “respect” patient lifestyle
Patients who participate in sports and fitness programs generally seek breast augmentation to achieve a more balanced figure, instead of having a “cup size” that will be the focal point of their physique. For this reason, they choose the conservative route—i.e., breast implants not bigger than 350 cubic centimeter or cc.
While cc is not directly correlated to the final breast size (due to variables such as pre-existing tissue, chest shape, and other anatomy), patients with an active lifestyle typically ask for a full B or small C cup result, or simply want to restore the lost volume in their upper breast pole following pregnancy.
- Gummy bear breast implant
This is a marketing term used to describe fifth generation silicone implants. But instead of a “runny” silicone gel, it uses solid silicone whose molecules have stronger crosslinks and so it is highly cohesive just like a gummy bear candy.
The solid silicone will keep its form when cut in half and so the risk of rupture is markedly low, with one study suggesting it is only 2.6 percent within a nine-year period.
While fat injection is a growing trend in buttock augmentation surgery, it is rarely used as a primary method to reshape and increase the breast size. Unlike the butt area, the breast can only “take” a lower volume of fat.
Nonetheless, fat injection—which involves liposuction as a way to collect unwanted fat, and purification prior to re-injection to achieve a high survival rate—can serve as an additional soft tissue coverage to prevent or minimize risk of rippling and palpability.
- Postoperative breast massage
A 2016 survey conducted among active members of the American Society of Plastic Surgeons has shown that more than half of the 1,067 respondents recommended postoperative breast massage, which basically requires pushing the implants into the outermost corners of the pocket.
The idea is to retain the thinness and softness of the scar tissue sac encapsulating the implant, which in turn prevents capsular contracture and high riding implants.
BBL surgery results should appear smooth—i.e., the skin surface must show uniformity and there should be a smooth transition between the buttocks and the “adjacent areas” such as the posterior thigh, hips, flanks, and lower back.
BBL, which is an acronym for Brazilian buttock lift, is basically a combination of two procedures: liposuction and fat transfer/injection.
Liposuction is the process of removing the “unwanted” fat, which is then re-used to augment and reshape the buttocks and hips to achieve a more feminine figure.
Fat injection, meanwhile, is the process in which the buttocks and hips are reshaped in a way that they look natural and proportionate to the patient’s underlying anatomy. The final results should also reflect the individual’s cosmetic goals and expectations, which she must be able to describe in details during the preoperative consultation.
Inland Empire plastic surgery expert Dr. Tarick Smiley, who performs over a hundred BBL surgeries every year, says that fat transfer is a meticulous process. Instead of dumping the fats all out once, the use of microdroplet injection technique is critical to achieve smooth results and high survival rate of fat grafts.
Any amount that survives after a few months of fat injection is expected to last a lifetime, he says in one of his recent Snapchat videos.
Dr. Smiley warns that incorrect fat injection and over-filling the buttocks can lead to a gamut of aesthetic-related problems such as cellulites, dents, and sagging appearance.
Cellulites and other skin surface irregularities are generally caused by “disturbing” the fascia system, which resembles a cluster of threads connecting the muscle into the skin.
When too much fat volume has been injected into the buttocks, the extra weight causes the fascia to weaken and the butt cheek to sag. This “problem” can be further aggravated by aging and large weight fluctuations.
To avoid skin irregularities and sagging appearance, Dr. Smiley says he never injects “fat volume that goes beyond the capacity of the patient’s fascia system and other relevant anatomies.”
“The key to achieve natural, proportionate BBL surgery results is to respect and acknowledge the anatomical limits. This core principle has also helped me avoid most known complications,” he says.
To further avoid “unnecessary weight” that could make the buttocks susceptible to sagging, Dr. Smiley says he avoids or at least minimizes fat injection into the lower aspect of the butt cheek, focusing more on the upper half portion and the lateral side (hips) instead.
Facelift for cheek enhancement must address these following problems: hollowness below the cheekbone, sagging of the mid face, and laugh lines (nasolabial folds).
It is important to note that the cheeks can easily reveal a poorly executed facelift. With incorrect direction of pull or excessive tension, the patient can end up with flat cheeks, overly tight mid face, and/or skin pleating behind the ears where the wound is closed with sutures.
To avoid these aforementioned problems, renowned Inland Empire plastic surgery expert Dr. Tarick Smiley explains the critical components of facelift for cheek improvement:
- Going beyond skin pulling and tightening
Dr. Smiley warns that relying too much on skin pulling and tightening can lead to flatness below the cheeks that can appear immediately after surgery or years down the road. For a more stable and natural-looking result, he highlights the importance of “deeper” tissue reposition, which is only possible when the underlying structure beneath the skin (fat, tissue, and muscle) is tightened and reshaped as well.
Dr. Smiley prefers deep plane SMAS technique in which the fat, connective tissue, and muscle are all being lifted to achieve natural and long-lasting results.
The SMAS technique has also been known to prevent flatness of the cheek, sunken mid face, and other surgical stigmata, he further explains.
- Volumizers in the form of fat transfer
Fat and tissue reposition alone has no or very little effect on patients with gaunt appearance due to advancing age or inherited feature. For this reason, Dr. Smiley often incorporates fat transfer in his facelift surgeries for a more natural, three-dimensional rejuvenating effect.
Fat transfer not just corrects the hollowness below the cheekbone; it can also create a smooth transition between the lower lid and cheek, and soften the laugh lines.