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.
Lower facelift and neck lift: Are they the same?
Most Los Angeles plastic surgeons consider lower facelift and neck lift to be the same thing, hence the difference is nothing but semantics. In general, the incisions are positioned behind the ears to tighten the jowls and sagging neck skin.
Because each surgeon uses different surgical techniques and terminologies, a prudent patient should do her homework, which should always include ensuring that she only deals with a facial board plastic surgeon who performs facelift and its ancillary procedures on a regular basis.
Instead of the technical terms, what matters most is the “actual” effects of facelift. For this reason a lenghty, honest discussion is critical to produce the results that will make the patient happy with her new appearance.
Lower facelift or neck lift is a highly customized procedure to produce natural-looking results and to avoid surgical stigmata such as overly tight appearance. Nevertheless, women in general require more contouring along their jaw line than men.
With incisions behind the ears, the surgeon can remove the excess skin that contributes to the appearance of jowling and “fleshy” neck.
While a lower facelift may not always entail a small incision beneath the chin, most neck lifts require this approach to tighten the loose platysma muscle that contributes to the unsightly bands. To create a smooth chin-neck junction, this muscle is tightened and sutured in the mid line with internal sutures.
Meanwhile, it is not uncommon to combine standard facelift and neck lift to achieve more rejuvenating effects. This approach is particularly ideal for patients who need an extensive amount of work.
Any type of surgical dissection that aims to rejuvenate the face will not just depend on the techniques and the surgeon’s skill set. It is important to note that the patients’ underlying anatomies, particularly the quality of their skin, will have a significant impact on the final results as well.
According to California Surgical Institute website, patients with good skin elasticity and minimal facial fat generally achieve optimal results from facelift and neck lift.
Aside from proper skin care that should always include regular use of sunscreen and healthy lifestyle, keeping a stable, healthy weight is one of the most critical ways to preserve the results of facelift and neck lift.
Gynecomastia surgery for bodybuilders involves a host of unique challenges. Nevertheless, its goal remains the same—to correct the appearance of overdeveloped or woman-like breasts by removing the excess glandular tissue and possibly some fat.
Dr. Tarick Smiley, one of the leading Los Angeles plastic surgeons, explains the key variables that make gynecomastia surgery for bodybuilders different, or even more challenging than when the procedure is performed on men with “average” physique.
* Bodybuilders have higher expectations. Not surprisingly, these people have high regard to their physique sometimes to the point that they want perfect results. However, perfection is not possible with any form of plastic surgery as it always comes with some caveats and potential risks.
Nevertheless, the surgery can deliver satisfying results for patients with realistic goals and expectations.
It is important to place the incision within the border of the lower areola, and ensure the resulting scar will not migrate, so there will be no obvious signs of the surgery.
* The overdeveloped chest muscle poses a unique challenge. Not only does it increase the risk of bleeding and hematoma (pooling of blood beneath the skin), having this anatomical feature warrants a more meticulous surgical maneuver to deliver impressive, long-lasting results.
While gynecomastia surgery typically involves simultaneous liposuction (fat removal) so the breast tissue will become more compressed prior to its excision, bodybuilders rarely require this ancillary procedure because of their low body fat percentage.
* They may require a different maneuver. Aside from the no-liposuction approach, male breast reduction for bodybuilders typically entails a more aggressive glandular tissue removal to prevent or at least minimize the risk of recurrence. However, it is critical to leave behind 2-3 mm of tissue beneath the skin to avoid nipple-areola collapse and other surgical stigmata.
* Continued use of anabolic use. Surveys have suggested that most bodybuilders who sought for gynecomastia surgery had overlarge breasts due to the use of anabolic steroids or hormone-laden sports drinks/supplements. And even after complete cessation, this “condition” persisted until plastic surgery was performed.
Despite knowing the strong link between anabolic use and overlarge breasts, one study has suggested that continued use was very common among bodybuilders who had the surgery.
* Physical restriction may discourage some patients from seeking gynecomastia surgery. The consensus is to avoid rigorous exercise programs, particularly if they involve the chest muscle, for at least four weeks to avoid bleeding, hematoma, persistent swelling, and other factors that could lead to poor healing.
Due to prolonged downtime, some bodybuilders with overdeveloped breasts avoid or postpone having the surgery.