Posts Tagged "Plastic Surgeon"

Despite the media hype and potential benefits of gummy bear breast implant, it is important to note that not everyone is a good candidate for this new technology. First and foremost, the underlying anatomies play an important role in determining the “ideal” type and volume of implant.

Gummy bear implant is just an “informal” term used to describe the new technology. To be more accurate, it is a fifth generation silicone implant whose silicone gel is more cohesive than its predecessors.


And due to the form-stable nature of gummy bear breast implants, even when they are cut in the middle no silicone gel will leak. This will not be the case in fourth generation silicone implants in which the filler material is more liquid (but still cohesive).

These are the “ideal” anatomies that could help you achieve good results from gummy bear breast implants:

* You have a “sufficient” amount of breast tissue.

Because of the form-stable nature of gummy bear implants, they might feel firmer than “ordinary” silicone implants especially if you have very little “coverage.”

Aside from more palpability than what you would like, having very little coverage could also predispose you to higher risk of rotation, which must not happen since gummy bear implants are always teardrop in shape. To prevent flipping, their outer shell has a rough surface to encourage tissue adherence.

Despite the increased palpability, the advantage of gummy bear implants is that they could minimize the risk of rippling.

* You have a good skin tone.

It is easier to achieve good results and minimize the risk of rotation if you have a good skin tone or at least your breast does not have a significant amount of tissue laxity.

According to anecdotal reports, having a significant tissue laxity could increase the risk of teardrop implant rotation.

* The implant is ideal for patients with a condition called tuberous breasts.

Tuberous breasts have a base that looks too narrow or constricted, while their nipple area appears herniated. This type of breast deformity responds well with gummy bear implants because of their form-stable structure and teardrop shape that can improve the abnormal proportion.

* You are near your ideal weight.

As with any body contouring surgery, breast augmentation with implants only favors patients who are near their ideal weight or at least within 25-30 percent of their recommended body weight.

In case that you are planning to lose more than 25 pounds, your plastic surgeon will likely recommend that you postpone breast implant surgery until you have reached your weight goal in order to achieve a more predictable result.

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There is more to breast implants than augmenting a small bust size. First and foremost, they are supposed to provide results that look natural in terms of appearance and shape that a common observer will not be able to tell if you have had the surgery.

While the term natural-looking results can be interpreted in many ways, depending on the personal views of patients, in essence the breast shape should resemble a teardrop in which the lower aspect has less fullness, while the lower bottom has most of the volume, explains leading plastic surgeon Dr. Tarick Smaili.


With decades of experience, Dr. Smaili explains his techniques that help him simulate the natural breast shape with the use of breast implants:

* The inferior origin of the breast must be adequately released.

The goal of this technique is to prevent the implants from riding up too high, leading to a globular look or exaggerated fullness in the upper aspect of the breast. To simulate the natural shape, it is important for the prosthesis to drop a bit so the lower bottom will have most of the volume.

* The submuscular breast implant placement is often the most ideal choice.

Aside from minimizing the risk of rippling and palpability because the technique allows the thick layer of muscle to cover the upper portion of the implants, it is also notable for delivering natural breast shape.

And because the lower bottom of the implant is only covered by fascia, which is a strong connective tissue that serves as an “internal bra,” it allows the prosthesis to take on a teardrop shape.

* Use round implants with the right profile or projection.

Once inside the breast pocket, round and teardrop/anatomical implants adopt the same shape because of the effects of gravity—i.e., pulling most of the filler material to the bottom of the shell.

But the advantage of round implants over anatomical implants is that they eliminate the risk of deformity caused by “flipping over” since all their sides are symmetric.

To provide natural results, round implants must have the right amount of projection, which is determined by your underlying anatomies. The general rule of thumb is that only a small to moderate upper fullness in the upper breast poles must be allowed to simulate the teardrop appearance.

Using a conservative implant size (or within the limits of your chest and breast measurement)—rather than overlarge ones—can further help you achieve a more natural breast shape and a result that looks proportionate to your body frame.

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Mid facelift is a type of “isolated” or “mini” facelift in which the drooping mid facial region is lifted and reshaped, thus minimizing the appearance of sagging lower eyelid and “laugh lines” or nasolabial folds, and raising the displaced cheek fat pad.

While the chronological age of people is not the main factor that determines whether they are a good candidate for the surgery, surveys have suggested that most mid facelift patients are between the ages of late thirties and forties.


As its name suggests, a mid facelift surgery “lifts” the saggy skin and possibly the deeper layers of the mid face to make the results last for many years. However, it is important to note that “skin pulling” alone cannot address every sign of facial aging, including loss of facial volume in the cheek area.

Any skilled plastic surgeon knows that too much skin pulling could lead to unnatural appearance and wide scars, thus he or she relies more on deeper facial restructuring often with the use of internal sutures.

Aside from cheek fat pad displacement, cheek deflation due to loss of facial volume is also a common problem of the aging face. As a result, a mid facelift is occasionally performed in conjunction with cheek implants, which are often made of a medical-grade solid silicone implant.

The advantage of using solid silicone cheek implants is that they can be easily removed in case the patient is not happy with the results. On the other hand, surgical removal of implants that encourage tissue integration such as Gore-Tex could be more difficult to execute.

Cheek implants are the ideal option if one needs “large” augmentation, while dermal fillers (e.g., hyaluronic acid and collagen) and fat graft are best suited for patients who have minor cheek deflation.

Another benefit of cheek implants is that can deliver a more permanent and “predictable” result than dermal fillers and fat graft.

While the traditional way to introduce cheek implants into the pocket is through an intra-oral technique (inside the mouth, specifically within the gum line), the lower lash line incision can also be utilized if the surgery is performed in conjunction with a lower eyelid lift or mid facelift.

Nevertheless, a mid facelift through the temporal incision technique is said to provide a more drastic improvement compared to the lower lash line incision because the former can lift the skin both vertically and diagonally.

Aside from cheek implants, a mid facelift is also commonly combined with brow lift in which the forehead creases are eliminated, or eyelid lift wherein the loose skin and fat around the eyes are tightened and/or removed.

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Hair transplant via FUE, which is an acronym for follicular unit extraction, is a relatively new procedure for the treatment of male pattern baldness. While it uses the back and side of the scalp as donor site the same way as the standard technique, it has a different way of collecting hair grafts.

Instead of excising a strip of tissue that leads to a linear scar, which is the practice in standard hair transplant, during FUE technique doctors collect hair follicles from the donor site using a tiny round puncher.


In this hair transplant technique, the donor site will be first injected with local anesthesia for its numbing effects and make the process of grafting relatively painless that most patients feel relaxed enough to watch TV, listen to music, or even sleep.

FUE does not lead to scarring simply because the extraction process uses a tiny puncher with small motorized needles, which come in slightly different sizes to prevent follicular damage that could lead to low survival rate of fat graft.

It is important to note that using needles too small for a specific follicular unit during the process of extraction could cause damage. Using needles that are too large, on the other hand, could increase the risk of scarring.

With correct needle sizes and careful extraction, the donor site can maintain a good amount of “coverage” or density as if the surgery were not performed on the patient.

But since each follicular unit is extracted one at a time, FUE generally takes a longer time to perform compared to the standard hair restoration procedure; however, other factors should also be taken into consideration such as the amount of coverage needed, bald spots, quality of grafts, etc.

After extracting the follicular grafts, the surgeon will ask his technicians to prepare them for implantation, a complex procedure that involves “steady hands” and “powerful” microscopes.

The second stage of FUE involves injecting local anesthesia to the recipient site or balding area to numb it prior to implantation, which is performed through the use of microsurgical and high power magnification instruments that will implant the grafts into tiny slits on the scalp.

For natural-looking results, a skilled plastic surgeon will make every effort to place each follicular unit at the same angle of the existing hair. The caliber of grafts and shape of the face also determine the ideal placement of hair grafts.

While the back of the scalp is commonly used as a donor site, FUE might also allow the surgeon to extract hair follicles from certain areas of the body and face (like beard) and use them to cover the balding crown of the head or receding hairline.

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Scar, which is a natural part of healing process, contains a type of protein called collagen just like an “undamaged” skin although it comes in disarray. In severe cases, scarring can cause deformity and affect normal body functions.

Double board certified plastic surgeon Dr. Karan Dhir says that scar revision surgery comes in many techniques, depending on the type of scar, location, and appearance. In some cases, he works closely with dermatologists especially if the patients have Moh’s defects or they require skin cancer reconstruction.


The right scar revision technique, according to Dr. Dhir, is primarily determined by the type of scar such as keloids, contracture scars, hollowed scars, and hypertrophic scars.

* Keloid scars grow beyond the boundaries of wound and are commonly found in the earlobes and around the shoulder and breastbone area. Studies have suggested that Africans and Hispanics are about 16 times more likely to develop keloids than Caucasians.

* Contracture scars are common among burn victims who experience walking/moving difficulty because the scarring pulls the “edges” of the skin.

* Hollowed or depressed scars are often caused by severe acne, chicken pox, and surgical wound; they generally occur because the injury does not heal properly from its bottom.

* Hypertrophic scars resemble keloids in way that they also appear raised, although they only occur within the boundaries of the injury or wound. They also tend to be thick and reddish in color.

For raised scars such as the hypertrophic and keloids, Dr. Karan Dhir says that there are many ways to minimize their appearance, including steroid injections that can break down the skin’s collagen.

Silicone gel sheet is another way to treat raised scars that are primarily caused by an excessive amount of collagen that forms within the skin’s surface. Aside from giving constant “pressure,” the scar treatment also hydrates the wound and prevents itching, which may accelerate healing.

For depressed scars, collagen or fat injection/graft is the gold standard treatment. The goal is to flatten their appearance to make them less visible.

When dealing with severe scarring (e.g., contracture scars of burn victims), plastic surgeons often recommend scar revision surgery such as Z-plasty in which they cut the skin around the scars and rearrange them in a way to relieve pressure and minimize their appearance.

Other scar revision techniques include dermabrasion, tissue expansion, laser skin resurfacing, and skin grafts. Occasionally, several procedures are combined to provide the most desired results.

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