Breast augmentation and lift accomplishes two important things in one surgery: Increase the “cup size” and correct the sagging appearance. But sometimes, they are done separately to minimize risk of complications, which can be an issue if the patient wants bigger implants.
Breast augmentation, which is accomplished with the use of saline- or silicone-filled implants, increases the volume, while breast lift tightens the skin and deeper tissue. While combining these two procedures is known to enhance the overall contour, it is important to note that they have conflicting effects—tighten and expand the skin simultaneously.
The first step to achieve high satisfaction rate is to identify the ideal candidates for the combo procedure, and whether the surgeries can be performed simultaneously or in stages, says leading Inland Empire plastic surgery expert Dr. Tarick Smiley.
The placement of the nipple is one of the key elements that determines if a concomitant breast lift is warranted. One established aesthetic guideline suggests that the ideal distance between the nipple and the sternal notch (dip between the collarbone and neck) is 17-21 cm. Of course, women with longer torso and larger breasts can have a “larger gap” without their breasts looking saggy.
Furthermore, the nipple area should lie a few centimeters above the submammary fold, but then again the exact distance will depend on the breast size. Nonetheless, one study has suggested that the nipple position should “support” the 45:55 breast volume “distribution” ratio, which leads to the teardrop shape.
If there is too much distance between the sternal notch and the nipple, or the nipple falls at the same level as the submammary fold or beyond, a simultaneous breast lift is warranted lest an implant-alone approach can exacerbate the sagging appearance.
The standard or anchor breast lift suits women whose “breast bottom” has sagged more than 6 cm below the submammary fold. This entails a donut-shaped incision around the areola’s border, a vertical one between the nipple area and the crease, and another one that goes across the base of the breasts.
Meanwhile, patients whose nipple area remains above the submammary fold but can still benefit from a conservative elevation of their areolar complex will only need a donut-shaped incision technique.
After elevating the breast tissue and repositioning the nipple higher, implants are then propelled into their pocket, which should lie centrally behind the nipple area. The use of overlarge implants (or more than 600 cc) is generally discouraged unless breast augmentation is performed at a later date, ideally 3-4 months after breast lift.
If overlarge implants are simultaneously used during breast lift, they tend to ride higher on the chest wall leading to unnatural fullness in the upper pole/cleavage. In addition, they increase the risk of poor wound healing and less than optimal results.
All efforts are made to hide the facelift scars and so the incision is always placed at the face-ear junction. Meanwhile, it is important to preserve the tragus or small knob in front of the ear to achieve natural-looking results.
Some doctors prefer placing the incision in front of the tragus, while others favor positioning it behind this small bump; hence some part of the scar lies inside the ear. Others do both depending on the patient’s request and/or anatomy.
Dr. Smiley ensures that the patient’s tragus remains the same after surgery, further contributing to the natural appearance.
Inland Empire plastic surgery expert Dr. Tarick Smiley has recently posted a video showing a post tragus facelift incision, which hid a portion of the scar inside the ear. Nonetheless, the technique is plagued with “potential traps” if used without extra caution.
Because the incision is behind the tragus, the bump made up of cartilage may become distorted or even disappear lest proper wound closure is employed. Dr. Smiley says all efforts are made to eliminate tension on the skin, which is also known to promote favorable scar.
The newly redraped skin may also need to be thinned so the tragus contour will show through.
Small Bump, Big Deal
Dr. Smiley says that one of the keys to achieve natural-looking results from facelift is to preserve the tragus in front of the ear, making it distinct from the face. The absence of this small bump can make the ear look like an extension of the face.
Simply put, the surgery should preserve the natural border that “signals” the separation of the ear and face.
Both the pre- and post-tragus facelift techniques can provide good results, although the latter is believed to entail a steeper learning curve in order to ensure natural-looking results.
Some doctors, meanwhile, only reserve the post tragus facelift incision in patients with these anatomical characteristics: The thickness of their cheek skin is quite similar to the skin on the ear cartilage; their ear cartilage is markedly flat; and they have wrinkles or skin webbing right next to the earlobe.
Brazilian butt lift for older women can still deliver great results provided that the patients possess the “ideal” starting anatomy. For instance, the right candidates possess good skin tone and their weight is within the normal BMI range, says leading Inland Empire plastic surgery expert Dr. Tarick Smiley.
Contrary to popular belief, the patient’s chronological age plays no role in her candidacy for most body contouring surgeries. Doctors consider more pertinent factors such as physical fitness, weight, skin quality, and condition of connective tissue and other soft tissues during patient selection process.
Nonetheless, it remains important to recognize the anatomical traits commonly found in older patients (55 years and above). For instance, the outer skin layer thins with aging, while its blood vessels become more fragile, which leads to more bruising and bleeding beneath the skin following surgery.
Also, certain health conditions are linked to advanced aging, although with healthy lifestyle these can be avoided or at least controlled. Hence, older patients may require more extensive lab screening to ensure that they can handle the surgery and its ensuing recovery.
Because there is a perceived increased risk of bleeding and bruising, older patients are suitable for the tumescent liposuction, which is the preferred technique of Dr. Smiley. This involves infusing the fatty area with tumescent fluids that contain epinephrine, a drug that constricts the blood vessels and thus reducing bleeding by up to 90 percent when compared to the dry technique (no wetting solution is injected into the liposuction site).
The fats collected during liposuction are then processed before these are injected back into the buttocks and hips.
Because older women typically have less skin elasticity and strength due to age-induced changes in its connective tissue, Dr. Smiley says over-injection of fat should be avoided to prevent sagging appearance and cellulites and other skin irregularities.
To further avoid the aforementioned side effects, Dr. Smiley says most of the fat volume should go to the mid and upper butt, while the lower half aspect should not receive too much weight or augmentation. This approach also ensures natural results as scientific studies and artworks throughout history have depicted attractive female buttocks having most of their prominence found in the upper half.
Meanwhile, the celebrity plastic surgeon says that about one-third of the purified fat should go to the hips, or the lateral aspect of the buttocks, in order to achieve a more hourglass figure.
Aside from the surgeon’s core competencies, several factors can also affect facelift results such as the patient’s diet, skin quality, sun exposure, weight fluctuations, and commitment to recovery and healthy lifestyle.
Dr. Tarick Smiley, a prominent Inland Empire plastic surgery “figure,” has recently posted videos on Snapchat to explain the impact of skin elasticity on the feasibility and long-term effects of facelift.
The patient achieves impressive facelift results due to Dr. Smiley’s core approach and her starting anatomy. She has a relatively good skin tone and a great bone structure.
“It is important that you take care of your skin by limiting sun exposure. When the skin has significant sun damage, facelift will have no or very little effect,” he says.
Furthermore, he advises his patients to avoid sun exposure or at least use sunscreen and protective clothing for one year following their facelift surgery to prevent hyperpigmentation in which the scars turn darker permanently.
Aside from photo aging of the skin caused by sun damage, Dr. Smiley explains the other factors affecting facelift results to help people realize that its long-term success would also depend on their level of commitment.
Aside from natural effects of aging, sagging skin and lax facial soft tissue also stem from massive weight loss. Hence, the patient’s chronological age does not determine her candidacy for facelift.
Meanwhile, the right candidate for facelift should be near her ideal weight (at least 25-30 percent of her ideal BMI) and must be fully committed to healthy lifestyle to prevent weight gain, which can affect if not completely reverse the results of surgery.
While postop instructions may differ from doctor to doctor, there are generally agreed upon guidelines such as avoiding over-exertion for at least three weeks; complete smoking cessation one month before and after surgery; use of sun protection for one year; and sticking to the advice of one’s surgeon without any modification.
When the patient rushes her recovery, she runs the risk of less than optimal results, poor scars, and wound healing problems.
All facelift patients are required to achieve their optimal health prior to surgery, which a superb diet plays a critical role. Moreover, consuming the right nutrients can aid in healing and prevent delayed recovery and less than optimal scar appearance.
While the surgeon’s skillset will have a large effect on facelift results, it is important to note that the patient’s underlying anatomy, particularly her facial structure, will also dictate the outcome. For instance, someone with a thinner face generally achieves more rejuvenating effects than someone who carries more weight in her cheeks and neck.
Again, poor lifestyle choices can have a detrimental impact on skin quality. This is particularly true for smokers who are prone to premature skin aging and thus the rejuvenating effects of facelift become limited.
Furthermore, the vast majority of facial plastic surgeons discourage or at least limit the types of procedures they perform on smokers—unless they are committed to complete smoking cessation for at least one month—because of the increased risk of skin necrosis, poor healing, bleeding problems, and serious surgical complications.
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.