A pre-jowl chin implant extends more laterally to fill in the skin creases or conceal the “bulge” on each side of the chin caused by sagging tissues such as the skin and deeper structures. This is different from the standard chin implant whose primary purpose is to improve the convexity and profile (or forward projection) of the chin.
A face that is deemed youthful and attractive has a taut jawline, but with aging (or massive weight loss) it develops dips and bulges on each side of the chin; these are referred to as pre-jowl sulcus.
Unlike the jowl that extends far more laterally and so facelift might become warranted, the pre-jowl sulcus can be concealed with a special type of chin implant, as suggested by leading Los Angeles plastic surgery expert Dr. Tarick Smiley.
Placement of pre-jowl implant to conceal the bulge or dip on each side of the chin. Notice that it extends more laterally compared to “ordinary” chin implants. (Photo Credit: Implantech website)
Pre-jowl chin implants are typically designed having a relatively thin anterior portion while the lateral sides are thicker so only the pre-jowl sulcus is augmented. However, some newer designers provide additional volume to the chin and the pre-jowl area as well.
To determine the most ideal pre-jowl chin implant design, Dr. Smiley highlights the importance of a candid discussion between a surgeon and his patient to outline the latter’s specific goals. Of course, a physical exam will further help the surgeon identify the most cost-effective approach.
Instead of using pre-jowl chin implant, patients with smaller “bulges” on each side of their chin may opt for dermal fillers such as Radiesse. By adding volume along the depressions, the dip is concealed and there is now a smoother transition between the chin and the adjacent area.
But for a full-blown jowl—i.e., the entire jawline is affected by the loose skin and deeper structures—facelift is generally the best approach. This surgery can create a tauter jawline by pulling its skin at a 45 degree angle, which is the correct vector of pull as it can also tighten the neck skin and reposition the sagging mid face.
Breast reduction consultation will play a critical role in patient satisfaction. This gives the patient the opportunity to describe her goals in precise detail, express her concerns, and assess the qualifications of her doctor.
On the other hand, breast reduction consultation allows the surgeon to explain the benefits, limitations, and potential risks of the surgery. Nonetheless, he must be able to allay the concerns of his patients by describing the preparation guidelines, surgical techniques, medications, and postop care that will reduce if not eliminate risk of complications.
A good surgeon will make every effort to create a relaxed atmosphere, making it easier for his patients to express their goals, concerns, and medical history.
Oftentimes, the initial breast reduction consultation lasts 45 minutes to an hour, allowing the surgeon to listen to his patient’s input, goals, expectations, and medical information, particularly relating to current medications, family history, previous surgery, and medical condition, if there is any.
Afterwards, the surgeon may proceed with breast examination to determine its dimension, shape, nipple position, and skin quality, which will all determine the “best” incision pattern. To some extent these anatomical details will also dictate the final results and so the right patient should have realistic goals and expectations.
Then, the surgeon or his staff will take photographs of the breasts. This is particularly important when the patient is seeking insurance coverage. (Note: Many insurance issuers in Los Angeles plastic surgery require at least 500 gram of breast tissue removed from each side of the breast before they pay the surgery’s cost.)
It is not uncommon for patients to feel uncomfortable during breast exam. However, a good plastic surgeon will make every effort to create a more relaxed atmosphere.
The breast exam will allow the surgeon to determine the most helpful incision pattern. In general, patients with overlarge, pendulous breasts will need the standard anchor technique in which the scar goes around the areola, down to the midline, and across the base.
The anchor breast reduction is aptly called this way due to the resulting shape of its scar—i.e., like a nautical anchor. Over time, the scar is expected to fade into the background that most patients are not bothered by its appearance after 1-2 years.
Most surgeons will show the before-and-after photos of their actual patients to would-be patients to help the latter set realistic goals and to further improve the discussion.
At the end of consultation, surgeons typically provide a written material about breast reduction and possibly all the costs involved in the surgery.
Should the patient decide to go ahead with the surgery, a second consultation is scheduled so her doctor can tell her what medications to avoid and the lifestyle changes she needs to adopt to avoid or at least minimize risk of complications. Lab screening is also required to ensure that she is physically fit for the surgery.
Breast implants and cleavage appearance have become synonymous issues in breast augmentation. However, it is important to note that the “starting” anatomy of the patient—the natural distance between the breasts and the nipple position—will have a large impact on the final result.
In general, after surgery patients will have a cleavage quite similar to its natural or pre-operative state. Nonetheless, there are certain steps that can improve the distance between the breasts without causing unnatural appearance and other complications.
Leading Los Angeles plastic surgery expert Dr. Tarick Smiley says good results starts with correct implant size and meticulous pocket dissection.
Excessive lateral dissection of the implant pocket can lead to malposition, resulting in the appearance of breasts that are abnormally far apart. To prevent this from happening, Dr. Smiley emphasizes the importance of surgical precision to prevent implant displacement.
Despite meticulous pocket dissection, some patients remain susceptible to implant malposition due to their loose skin or weak fascia and ligaments. This might be true for some women aged 55 years and above who may benefit from the use of biological mesh called acellular dermal matrix.
ADM works as a “sling” that will support the implant’s weight, thus preventing the prosthesis from migrating too low (sagging) or too laterally (excessive lateral bulge). And because this is derived from cadaveric skin whose cellular components are removed, except the basement membrane or “foundation,” the risk of rejection and viral contamination is nearly absent.
To further promote better cleavage, meticulous implant selection will also play a critical role. In general, the implant’s horizontal width and projection must reflect the patient’s natural breast and chest measurement.
However, patients with adequate breast tissue could tolerate an implant whose width slightly goes beyond the chest/breast horizontal dimension in an attempt to narrow the gap between the breasts. It is important to note that this will not work on women with little soft tissue coverage because of the increased risk of wrinkling (along the implant’s edges) and palpability.
Despite the use of correct implant dimension and meticulous pocket dissection, some patients may still opt for fat injection to further improve their cleavage appearance.
Fat injection is basically a reversed liposuction in which the “unwanted” fats are collected from two or more areas, purified usually with the use of centrifuge, and then re-injected into the area that needs additional soft tissue coverage or augmentation.
Mommy makeover recovery tips all aim to keep the swelling, bruising, and pain to a minimum. Nonetheless, the “specifics” may differ from patient to patient due variables such as individual health, type of surgeries involved, and presence of risk factors (e.g., longer operative time and medical conditions).
Leading Los Angeles plastic surgery expert Dr. Tarick Smiley has shared his mommy makeover recovery tips that can help patients bounce back quick after their operation.
Photo Credit: Exparel website
(Note: All his patients are required to pass lab screening to ensure that they can handle mommy makeover surgery, which is basically a combination of two or more procedures that aim to reverse the effects of pregnancy. For most of his patients, some type of breast enhancement with tummy tuck is the most common “combo surgery.”)
Keeping the amount of postop pain is one of the critical factors that can guarantee a quick recovery. When patients feel no or very little pain, they breathe better and move with more ease, which then promote healing.
Dr. Smiley injects Exparel into the abdominal muscle right after tummy tuck surgery when the patient is still on the operating table. This drug contains bupivacaine, which causes temporary numbness in the area and so the patient relies less on oral painkillers, which may cause nausea, lethargy, and constipation.
Exparel can numb the injection site for up to four days, says the leading plastic surgeon.
Multiple surgeries typically entail a more challenging recovery as compared to “single operation.” Hence, it becomes more important than ever to have a competent adult who is committed to stay with the patient for at least 1-2 days after surgery.
Occasionally, it is more ideal to stay for a few days in a licensed recovery facility, which is staffed by specially trained medical professionals who will monitor the patient’s health before she is able to return home to recover.
It is important to note that for 2-3 weeks, the patient’s main focus should be her recovery. For this reason, she needs someone to take care of her small children and do all the daily chores until she has recovered fully to do all these tasks without compromising her healing.
Dr. Smiley provides all his patients with a list of supplies they will need for their recovery. This can range from ready-to-eat foods, bottled water, pain medications, to compression garments
Breast implant extrusion is a rare complication that occurs when the prosthesis comes through the skin. Typically, the underlying cause is poor wound healing or breast tissue weakness; hence, risk factors must be recognized and eliminated prior to surgery to achieve good results.
Leading Los Angeles plastic surgery expert Dr. Tarick Smiley has explained the fundamental guidelines to prevent or at least minimize risk of breast implant extrusion.
- Respect the patient’s underlying anatomies
Using breast implants that are too big for the patient’s anatomy, particularly relating to chest dimension and soft tissue coverage can lead to increased risk of breast implant extrusion, poor healing, rippling, palpability, and a wide range of problems.
To prevent most known implant-related complications, Dr. Smiley measures the breast and chest width to determine the most ideal breast implant size range, profile, and base dimension.
- Prevent or treat immediately signs of infection
Infection can lead to wound not healing/closing properly that the implant comes through the skin. Fortunately, there are several steps to minimize risk of infection such as irrigation of the breast pocket with antibiotic solutions prior to implantation, use of oral antibiotics a few days postop, and complete cessation of tobacco products and medications with blood thinning properties (aspirin and ibuprofen).
Patients should also know the telltale signs of infection such as increasing pain, persistent swelling, fever, nausea, vomiting, and/or diarrhea.
Radiation therapy has an effect on breast tissue and thus may increase the likelihood of breast implant extrusion. A good rule of thumb is to wait for the body to recover fully from its effects before reconstructing or augmenting the breast with synthetic prostheses.
- Meticulous closure of wound
To further minimize risk of breast implant extrusion, the celebrity surgeon closes the wound in several layers to protect the implants. Additionally, he ensures that the uppermost layer of the skin wound edges are just allowed to kiss each other to promote the best scar possible. Tapes or steri-strips are then used to hold the wound together and to minimize “superficial” tension, further promoting favorable scarring.
- Over-exertion during the initial phase of healing
Heavy lifting and strenuous exercise particularly involving the upper extremities must be avoided for a few months to prevent healing problems and breast implant extrusion.