Posts Tagged "plastic surgeons"

Question: Could I have breast surgery and Brazilian butt lift at the same time?

Surgeon’s Answer: In many cases it is cost-effective to perform two or more plastic surgeries in one setting since the patient will only pay for one anesthesia and facility fee. However, it does not apply to breast surgery and Brazilian butt lift.

Breast surgery—such as augmentation, lift, or reduction—requires that you sleep on your back for at least six or eight weeks postop. The idea is to prevent pulling on the wound and causing harm to the recovering tissue, which could happen if you lie on your stomach or chest.

Recovery after a Brazilian butt lift, meanwhile, requires that you avoid any pressure on the buttocks, which could kill the fat grafts and lead to low survival rate of fats and asymmetric shape. The general rule of thumb is to avoid sleeping on your back for two to three weeks.


Prolonged sitting while the fat grafts have not yet formed their blood supply can also lead to poor results.

The best sleeping position following a Brazilian butt lift, which in essence is a buttock augmentation via fat grafting technique, is to lie on your stomach or side, ideally leaning more forward to avoid “accidents.”

The problem can arise if you have breast surgery and Brazilian butt lift in one surgical setting. It may be difficult, if not impossible, to find a comfortable sleeping position that will not compromise your results.

Take note sleeping in your stomach during the initial stage of breast augmentation recovery is particularly detrimental because of the increased risk of implant shifting and sagging. Also, pressure on the area can lead to late-onset bleeding, persistent swelling, and pain, which can jeopardize the results.

You may argue that you can lie on your side and remain still during sleep, so combining these two procedures is acceptable. However, take note that most Brazilian butt lifts involve transferring fat to the hips or lateral side of the buttocks to achieve a more attractive silhouette, and placing pressure on this area can lead to less than optimal results.

The general rule of thumb is to stage the surgeries. For instance, you may want to have a buttock augmentation or Brazilian butt lift first and then wait for at least three months for your breast surgery.

Also, make sure that both surgeries are performed only by certified plastic surgeons who specialize in body contouring procedures.

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Protein shake, or any type of supplements, is generally unwarranted after plastic surgery if the patient is physically fit and follows a well balanced diet—i.e., more fruits and vegetables, “whole foods,” and just the right amount of healthy fat, calories, and carbs to fuel the body.

But in some situations, protein shake or supplement might be advisable to accelerate healing; this is particularly true for people with digestive problems and individuals who eat a low protein or non-meat diet. Also, post-bariatric surgery patients generally require nutritional supplementation because of malabsorption problem and malnutrition due to sudden weight loss and lifestyle change.


For these patients, it is crucial to get their protein level up to normal before having plastic surgery to avoid delayed recovery, infection, and other types of complications.

However, a small number of plastic surgeons recommend protein shakes or supplementations for all their patients, including those who are physically fit and follow a healthy, well balanced diet over belief that it could accelerate wound healing and minimize the lethargic feeling caused by surgical trauma and medications.

As of this writing, there is no scientific study proving the effectiveness of protein shakes on healthy patients who stick to healthy diet before and after surgery.

The consensus among plastic surgeons is that a well balanced diet is generally enough, but for some patients who are still interested in increasing their protein intake without predisposing themselves to constipation (which is not uncommon after any surgery), most experts recommend adding more legumes, lima and sprouted beans, and kale on their postop diet.

According to one study, the typical diet of Americans even exceeds the recommended daily protein requirement. Men in general should get around 56 grams of protein every day, and for women it should be about 46 grams, but experts have found that on average they get 100 grams and 70 grams, respectively.

Simply put, insufficient protein consumption is less likely to be a problem, but rather deficiency in some essential nutrients such as iron, vitamin D, vitamin C, and vitamin E. Studies have also suggested that Americans have the tendency to eat more calories, sodium, saturated fats, and cholesterol than is recommended.

Because the “typical” diet of Americans is not as diverse or balanced as it should be, it is not uncommon for plastic surgeons to recommend multivitamins well in advanced of their patients’ operation.

Since one’s physical appearance is not an accurate indicator of health, prudent surgeons always require blood work and lab exam to make sure their patients have no healing problems or nutritional deficiency.

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Asian eyelid surgery, also referred to as double eyelid surgery or Asian blepharoplasty, is performed to create a fold in the upper eyelid. Contrary to popular belief, its main goal is to deliver natural results, which are only achieved by taking into account the patient’s facial ethnic features.

The goal, according to California Surgical Institute website, is to create a supratarsal epicanthic fold in a way that it looks the same as those found in half of the Asian population who naturally have this feature.


Deviating from the intrinsic anatomies of the Asian eye will not only lead to higher risk of deformity, poor scarring, and other complications, but also result in unnatural appearance that “screams” plastic surgery.

Board-certified plastic surgeons from the California Surgical Institute follow the guidelines stated below to achieve natural results from Asian eyelid surgery.

*  Create an ethnically consistent upper eyelid shape. The parallel crease (it barely touches the epicanthal fold or the innermost corner of the eye) and tapered crease (it starts from the epicanthal fold) are the most ideal positions to create results that look natural on the Asian face.

The semilunar crease, which is like a deep inverted U, and laterally flared fold rarely favor the Asian face unless the patient is of mixed rate or has a notably high brow position.

*  Be conservative when it comes to height. Compared with Caucasians, Asians who naturally have supratarsal epicanthic fold have a shorter upper eyelid “platform,” usually just between 2-5 mm.

The general rule of thumb is to avoid deep crease or 7-10 mm or higher because of its westernizing effect, which of course looks unnatural and ethnically inconsistent with the Asian face.

*  Examine the underlying anatomies to determine which approach is better. Incision technique is believed to favor patients who are older, desire more noticeable upper eyelid crease, and have excess skin and/or fat. The suture procedure, meanwhile, is generally ideal for individuals who are younger than 20 and have good eyelid structure.

In the past, the suture technique (non-incision) was criticized for its short-lived results; however, a new approach called double sutures and twisting or DST has addressed the “flaws” of its predecessors by attaching the ends of the permanent internal stitches to the strongest structure of the upper lid called tarsal plate.

The sutures also “pinch” a bit of the eyelid skin’s undersurface into the deeper soft tissue, thus creating a new crease.

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Breast implant surgery has one primary goal—to provide patients with satisfying results, which is only possible through strict patient selection, careful surgical planning and preparation, and proper postop care.

Of course, honest communication between plastic surgeons and patients also plays a crucial role in achieving cosmetically pleasing results.


According to a survey involving board-certified breast plastic surgeons and female patients, the satisfaction rate after breast augmentation was around 98 percent. Nevertheless, the same study has shown that 15 percent of the respondents would have preferred a smaller or bigger result.

Dr. Tarick Smaili, one of the leading Los Angeles plastic surgery experts, explains the different options you might consider when not satisfied with your breast implant result.

*  The general rule of thumb is to wait for all the residual swelling to subside and the implant to drop to its final position—a process that typically takes around six month—before any revision is attempted to make sure the breast has reached its final size and “stable” appearance.

“Waiting” instead of rushing to make a decision is also helpful because temporary postop           blues is not uncommon after surgery, and some people just need to get used to their new    appearance. Nevertheless, some complications—such as inframammary fold asymmetry and capsular contracture—are best treated early on.

*  Return to the original plastic surgeon. Assuming that he is board-certified and qualified to perform breast augmentation, and the patient remains confident in his skills, he might be in the best position to provide a sound advice.

*  Find a second opinion. It remains helpful to consult two or more plastic surgeons, especially if you have postop complication or deformity that is difficult to address or improve.

It is particularly helpful to discuss your options with plastic surgeons who mainly focus on revision breast implant surgeries, which in some situations are more complex than primary procedures.

*  Consider non-surgical treatments first. Some postop complications can be treated or improved by “simple” procedures. For instance, breast implant massage, or medically referred to as prosthesis displacement exercise, can correct the appearance of excessive fullness in the upper cleavage.

Aside from implant displacement exercise, chest band, thong bra, and compression garment might also prevent or address minimal breast displacement.

For patients with early symptoms of capsular contracture (i.e., hardening or abnormal thickening of the scar tissue around an implant), non-surgical treatments typically include off-label use of asthma medications, ultrasound, breast massage, and vitamin E.

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It has already been well documented that a cosmetic procedure called forehead lift can treat or at least minimize the symptoms of chronic migraine for the “right” patient. However, a new study claims that “young” patients or 18 years and below could also benefit from the procedure.

A study published by Plastic and Reconstructive Surgery journal (June 2015 issue) has suggested that forehead lift could also serve as a migraine surgery for carefully selected adolescent patients suffering from chronic migraine, which is medically defined as recurrent throbbing headache often accompanied by disturbed vision, light sensitivity, and nausea.


The study involved 14 patients aged 18 years and younger who had migraine surgery that closely resembled cosmetic forehead lift. In the past, plastic surgeons noticed that many seniors who had the cosmetic procedure reported moderate to significant improvement in their migraine symptoms following their surgery.

Surgeons have realized that to some degree forehead lift can release some of the “trigger sites” or nerve branches that are “irritated” or impinged by the soft tissue, which are linked to migraine symptoms. Nevertheless, experts highlight the importance of careful patient selection and preoperative evaluation to determine one’s candidacy for this procedure.

Today’s facial plastic surgeons are using several technologies to identify trigger sites, although the most popular are the ultrasound Doppler, nerve blocks, and CT scans.

Despite the benefits of forehead lift used as a migraine surgery, doctors warn that any type of surgery should be viewed as a last resort. For this reason, patients who were included in the study all had tried non-surgical treatments first but to no avail.

The researchers who conducted the recently published study said they conducted follow-up interviews at least one year after surgery in all patients who reported improvement in their migraine symptoms—i.e., average headache frequency decreased from 25 times per month prior to their operation to five times per month postop.

In terms of average migraine severity before and after surgery, using a ten-point scale the “score” decreased from 8.2 to 4.3. The average length of time of “attacks” was also reduced from 12 hours to four hours.

Meanwhile, five out of the 14 adolescent patients reported complete relief from migraines after surgery, with one experiencing no change in the frequency of her headache although attacks were less severe and shorter postop.

According to Migraine Research Foundation, about 4 percent of the US population or around 14 million people have chronic migraine attacks that occur at least 15 days per month, with some of them not responding to conventional treatment options.

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