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.
Upper arm liposuction can result in a leaner, more contoured appearance when performed on the “right” candidate. Nonetheless, it entails profound understanding of aesthetically pleasing arm and its anatomy as well.
Dr. Tarick Smiley, one of the leading Los Angeles plastic surgeons, explains the challenges of upper arm liposuction, which must be recognized beforehand to deliver feminine and aesthetically pleasing arms. (Note: The procedure is almost an exclusive procedure for female patients.)
Dr. Smiley places the incision in the elbow to access the heavy fat deposit that causes the posterior surface of the upper arm to sag.
- Identifying the ideal candidates.
Not everyone with “thick” upper arms is a good candidate for the surgery. As with any body contouring, it is only reserved for healthy, normal weight patients with realistic goals and expectations.
The quality of skin is another critical factor that identifies good candidates. During physical evaluation, the patient is asked to extend her arms horizontally or with the elbows bent to determine the location of fat deposits and the degree of tissue laxity. If the “sag” is less than or equal to the thickness of the subcutaneous tissue layer (the layer beneath the skin’s dermis and epidermis), satisfactory results are most likely achieved.
Skin shrinkage can also be assessed by asking the patient to contract her triceps and biceps simultaneously. In general, younger people who have not experienced large weight fluctuations and do not have sun-damaged skin are good candidates for upper arm liposuction.
Meanwhile, patients with too much fat in the anterior surface of the upper arm are often considered poor candidates since this fat distribution is linked to obesity. Also, individuals with significant skin laxity cannot achieve good results from liposuction unless combined with standard arm lift (brachioplasty).
- Understanding the quintessential elements of an attractive feminine arm.
While most people agree that the aesthetic arm has an overall lean appearance, there must remain minimal convexity of the posterior (between the arm and elbow) and the anterior surface as well. Hence, Dr. Smiley says that over-liposuction must be avoided to prevent unnatural contour or too muscular appearance.
The superficial fat layer of the upper arm is circumferential and therefore smooth results are generally achieved when most of the circumference or at least 75 percent of its surface is treated by liposuction cannula. Nonetheless, the medial or inner aspect of the arm is prone to sag due to its thin skin and thus it requires less aggressive removal compared to the posterior surface.
Due to the circumferential distribution of superficial fat, most patients need incisions both in their armpit and elbow, which are notably small and thus expected to fade into the background. In general, the scars are barely visible after 6-18 months.
In nipple incision breast augmentation technique, the surgeon places a small scar right at the border of the areola, which is the heavily pigmented skin. When the scars heal nicely, which is often the case, they are almost invisible even to the patients themselves.
(Note: The nipple incision breast augmentation is just another term for the peri-areolar technique.)
For Dr. Tarick Smiley, one of the leading Los Angeles plastic surgeons, the incision technique offers unique benefits, although as with any method it requires meticulous examination of the patient’s underlying anatomies to reap its full benefits and reduce the risk of complications as well.
The celebrity plastic surgeon regularly demonstrates the nipple incision breast augmentation on his Snapchat account to shed light on its benefits, the challenges or caveats, and the corresponding methods to offset them.
The U-shaped scar will almost always blend in with the surrounding skin. This is particularly true when it is precisely made at the areola’s border and the wound closure technique ensures no or very little tension on the skin.
Meanwhile, patients whose areola is distinctly darker than the surrounding skin are at an advantage.
- The areola complex can be slightly elevated
Some patients with mild breast sagging can benefit from a modified form of nipple incision breast augmentation in which the faint scar is positioned along the upper border of the areola. With this technique, Dr. Smiley can remove a small piece of skin above the areola to slightly elevate it.
- The enlarged areola can be corrected
To achieve a more proportionate result, some patients ask for simultaneous areola reduction in which a cookie-cutter device creates an “imprint” to guide the surgeon.
- More options in terms of breast implant placement
The nipple incision breast augmentation allows the surgeon to place the implants over or under the muscle.
- The incision technique gives the surgeon more control over the final result
Because the surgeon works in close proximity to the breast (which is not the case of “through the navel” or “through the armpit” incision technique), it gives him a great deal of control. And for this same reason, the technique favors women with some type of asymmetry or less than optimal breast shape.
Large buttock implants are difficult to “define” because of varying factors such as soft tissue coverage, butt dimension prior to surgery, and body frame. For this reason, a 450 cubic centimeter (cc) might be too big for a petite individual, but for someone taller (and with broader hips) this could be a good size.
Buttock implants come in different sizes, from 190 cc to 690 cc. While custom implants can be ordered larger, they always come at a higher price and a higher risk of complications as well.
Photo Credit: Sientra.com
To avoid a gamut of complications and achieve the most natural results possible, the general rule of thumb is to measure the actual dimensions of the butt cheeks and the soft tissue coverage. According to anecdotal reports provided by Los Angeles plastic surgeons, the most common butt implant size range is 400 cc to 550 cc.
It is important to use implants whose size and shape is within the anatomical boundaries of the buttocks. Failure to adhere to this rudimentary principle can lead to increased risk of wound healing problems, palpability, inadvertent implant malposition, and of course the eventual need for a revision surgery.
Using disproportionately large buttock implants can result in too much tension on the wound, thus increasing the risk of healing problems. Also, it is important that the implants are positioned beneath or at least within the gluteal muscle, which is noted for its strength and thickness.
While the under-the-muscle placement can limit the implant size, many surgeons today still prefer this technique because it lowers the risk of complication and provides a more natural look compared to placing it above the muscle, with only the skin and tissue supporting the implant.
Without the thick gluteal muscle, the skin is exposed to the wear and may eventually lose its elasticity, leading to implant palpability and inadvertent displacement.
On the other hand, placing the implant above the muscle allows for bigger augmentation, which is not really an ideal option for patients who are naturally thin or whose soft tissue coverage is limited.
Aside from the issue of size, the shape is also critical. Butt implants these days come in round, teardrop, oval, and “oval bubble” to deliver the patients’ desired results.
All efforts must be made to avoid or at least minimize the likelihood of revision breast lift in the future. For this reason, the surgery is generally reserved for normal weight patients who are done having children. It is important to note that pregnancy and drastic weight fluctuations can affect if not reverse the procedure’s results.
Despite best efforts, some patients require revision breast lift due to the following reasons:
- Inadvertent weight gain that leads to saggy breast and sometimes even tissue regrowth
- Pregnancy affects tissue and skin elasticity due to breast involution—i.e., enlargement and eventual shrinking after breastfeeding
- The continuous process of aging
- Asymmetry arising from the initial surgery. It may involve size or projection disparity between the two breasts, unnatural nipple position, asymmetric areola size, among others.
- Poor scarring due to improper wound closure, poor healing, or inherent susceptibility of the patient
- Poor breast shape and/or projection due to insufficient “internal” support to hold the tissue in place or use of incorrect incision technique
The approach that will be used in revision breast lift will vary depending on the specific reasons and the patient’s cosmetic goals. As much as possible, the previous incision techniques are used again to avoid additional scars, although patients who need a great deal of work—i.e., large and pendulous breasts—may have to accept longer or additional incisions to achieve optimal results.
The standard breast lift technique, which uses an anchor-shaped incision, remains the best option for women who need “more correction.” The scars go around the areola’s border, within the inframammary fold, and vertically between the nipple and the natural crease.
To achieve long lasting results, it is of critical importance to reshape and tighten the actual breast tissue than rely on skin [tightening] alone because over time it settles due to the effects of gravity and aging. Reinforcing the deeper structures of the breasts involves the use of dissolvable or permanent sutures.
It may be safe to surmise that most Los Angeles plastic surgeons use absorbable sutures, which often take 6-12 weeks to dissolve—enough time to promote strong tissue adhesion.
Occasionally, revision breast lift also entails incorporating the use of implants; this combo approach is particularly ideal for women who want to have more upper fullness in their breast. It is important to note that as stand-alone surgery, breast lift has no or very little effect on the area above the nipple.
Most surgeons these days recommend silicone implants to patients particularly those with skin laxity; this anatomical feature might increase their risk of palpability and rippling should saline implants are used instead.