Latest Plastic Surgery Articles - Page 6




During a weight loss surgery, or bariatric procedure, doctors make some changes to their patients’ stomach and/or small intestine in an attempt to improve their satiety. For the right candidates, studies have suggested the surgery can significantly improve their health, mobility, and overall quality of life.

Weight loss surgery insurance has become more accessible for obese patients after the passage of the Affordable Care Act (Obamacare) in which issuers from 23 states are required to cover the procedure’s cost for all Individual, Family, and Small Group Plans.


Nevertheless, some insurance companies exclude weight loss surgery from their plans, while others have very stringent requirements that would make it next to impossible to receive pre-approval.

But to allay some concern, take note that many patients have successfully gain insurance approval after appealing the initial decision of their issuers and presenting additional evidence suggesting that their weight loss surgery is the only long-term, viable solution for their life-threatening weight-related health problems.

Aside from medical documentation, it is not uncommon for health insurance issuers to require their policyholders to have tried medically supervised weight loss options (which have failed) before coverage becomes even possible.

To increase your chance of pre-approval, ask your surgeon to contact your insurance company since his office will be very familiar with the requirements and the entire approval process. He can also send them letters of recommendations and complete documentation—such as diet and medical records, and previous attempts to lose weight—stating that your bariatric surgery is “medically” warranted.

Another viable option is to check your policy, including the “fine print,” and then contact your insurance company to ask for additional details.

Aside from your surgeon’s recommendation letter, other experts such as your nutritionist, dietician, and behaviorist’s “endorsement” verifying the medical necessity of your weight loss surgery insurance can also help build your case, increasing your chance of getting approved.

While many health insurance issuers now cover the cost of bariatric surgery, this is not the same with plastic surgery after weight loss, which is generally categorized as an elective procedure. Nevertheless, patients may resort to other financing options such as bank loans, regular credit cards, medical credit cards, home equity loans, unsecured medical loans, and doctor’s payment plans.

It has been well documented that plastic surgery after weight loss such as tummy tuck and lower body lift can serve as a strong motivation for post-bariatric patients to maintain a health, stable weight long-term.



Facelift surgery comes in several techniques and terminologies, which differ from surgeon-to-surgeon. Nevertheless, good results are only achieved by customizing the surgery based on the patients’ cosmetic goals and their underlying anatomies such as skin quality and bone structure.

A standard facelift primarily targets the sagging cheeks, jowling, and turkey neck appearance. It has no effect on the upper third of the face, which requires a different procedure called forehead lift. Meanwhile, combining these two surgeries or other techniques that aim to rejuvenate the entire face, or at least most of its area, is called full facelift.


On the other hand, a mini lift procedure is a very broad term that may describe a mid facelift, lower facelift, brow lift, forehead lift, or short-scar lift. But despite the confusing terminologies, it is generally used in patients with early features of facial aging or “isolated” problems such as sagging cheeks, jowling, neck bands, or laugh lines (nasolabila folds).

Also, a mini lift typically uses shorter incisions than a standard or full facelift wherein the scar lies behind the hairline near the temple and then goes around the ear, specifically within its natural skin creases to hide any telltale sign of the surgery.

In mini lift, a scar is typically hidden just behind the ear or around it.

While a mini lift procedure can deliver impressive results, it is only suitable for patients who have maintained a good amount of skin elasticity, with just mild changes in the lower third of their face, specifically the jaw line and neck area.

Performing mini lift surgeries on individuals who have more noticeable signs of facial aging is like under-correcting the problems. In worst case scenario, it leads to unfavorable scarring or skin asymmetries, which are telltale signs of plastic surgery. Simply put, proper patient selection is crucial to achieve impressive results from any type of facial rejuvenation surgery.

Regardless of the facelift technique used at the time of surgery, it is always crucial to go deeper into the facial structures to achieve more rejuvenating effects and longer lasting results. The idea is to lift the SMAS, which is a layer of skin where the soft tissue and muscle are attached, and not just the skin alone.

A skin-only lift, while it provides immediate rejuvenating effects and shorter facelift recovery, almost always leads to short-lived results because the skin will eventually sag due to the “weak” or loose SMAS that has not been reinforced.



Eyelid surgery, or blepharoplasty for hooded eyes, is a highly customized procedure because the underlying cause of the problem is different from patient to patient. Other factors that are taken into account include a person’s cosmetic goals and anatomies, as explained by leading Beverly Hills plastic surgeon Dr. Tarick Smaili.

One of the most common causes of the hooded appearance is the excess skin in the upper eyelid, which happens with advancing age, although sometimes genetics could also play a role.


Skin resection via incision within the natural eyelid fold (to hide the scars), with or without fat removal, is usually enough to correct the aforementioned problem. However, it is crucial not to over-do the procedure to avoid skin retraction, unnatural appearance, and unfavorable scarring.

It is equally important to preserve some fats in the upper lid area to simulate the “youthful plumpness” of the face. Over-aggressive fat removal, meanwhile, can lead to a skeletonized appearance of the eye socket, Dr. Smaili warns.

Another possible cause is the descent of the lateral eyebrows that is better addressed by a brow lift, which is way different from the primary goal of eyelid surgery.

Most brow lift surgeries just address the lateral aspect of the eyebrow because the medial part rarely sags to a significant degree to the point that it requires some lifting. The idea is to raise just the “outer half” of the brow to show more of the eyelid platform.

The third cause of a hooded eyes appearance is eyelid ptosis in which the levator muscle becomes weak to the point that it can no longer support the skin and other structures of the lid. This underlying problem requires a more complex approach than a skin-only resection.

Patients with ptosis need their levator muscle to be tightened, which could be done with the use of strands to raise the lids (they are positioned between the eyelid and eyebrow). While this technique can correct the underlying problem, it is not uncommon for patients to experience temporary incomplete blink and dryness of the eye.

With time, patients should be able to close their eyes fully, although in the initial healing stage they will have to frequently lubricate their eyes with drops and/or ointment to prevent them from drying out.

Sometimes, plastic surgery insurance is possible if the excess upper eyelid skin or muscular ptosis is affecting a patient’s vision. But proper documentations, e.g., photos, clinical exams results, visual field tests, and specialist’s recommendations are needed for pre-approval.



Liposuction procedure removes the excess fat underneath the skin with the use of suction. Nonetheless, it is not a weight loss surgery since it is too risky to remove the deeper visceral fat, which only responds to “real” weight loss—regular exercise and healthy diet.

According to a recent report published by the Plastic and Reconstructive Surgery journal, the safe amount of fat to remove during liposuction is determined by the patient’s body mass index or BMI.


While the perceived safe volume during liposuction surgery is up for debate, with current guidelines suggesting that no more than 5 liters of fat should be removed per treatment, the study has shown that people with higher BMIs who had a greater liposuction volume experienced a lower complication rate.

Patients with lower BMIs who had a greater liposuction volume, meanwhile, experienced an increased risk of complication arising from seromas or collections of fluids beneath the skin.

Nevertheless, patients who had large-volume liposuction—or removing more than 5 liters of fat in one surgical setting—had the highest complication rate: 3.7 vs. 1.1 percent.

The study analyzed data of around 4,500 patients who had liposuction in which the overall complication rate was 1.5 percent, with no death reported. Meanwhile, the average amount of removed fat was approximately 2 liters.

Aside from the amount of removed fat relative to the patient’s BMI, liposuction risks are also tied to concomitant procedures (breast augmentation, tummy tuck, body lift, etc.), length of surgery, and overall health of the patients, as suggested by the researchers.

Celebrity LA plastic surgeon Dr. Tarick Smaili, who is not part of the study, also suggests that liposuction risks are also higher among smokers because the nicotine found in tobacco products constricts the blood vessels, thus retarding wound healing and leading to poor oxygen circulation.

Other risk factors include hypertension and medical conditions that can affect healing, use of blood-thinners, malnourishment/undernourishment, and excessive surgical trauma due to unrelated procedures performed at the same time as liposuction, he further explains.



Breast implants with lift can accomplish two goals in one surgical setting—raise the drooping breasts and create more fullness, especially in the upper pole that has the tendency to appear deflated with advancing age. For the right patients, this is a cost-effective approach because they will only have to pay for one facility and anesthesia fee.

Contrary to popular belief, breast implants with lift in general does not lead to longer recovery than breast lift- or augmentation-alone procedure.


Leading Los Angeles plastic surgeon Dr. Tarick Smaili says the combo procedure favors women who need mild to moderate correction of their sagging breasts, while individuals with a significant amount of drooping may have to stage their surgeries to achieve a more predictable result.

Ideally, the surgery should involve the use of smaller breast implant sizes to prevent pulling on the wound used during the concomitant breast lift. And by choosing a more conservative augmentation, the patient can also expect a more straightforward healing.

Overlarge breast implants, meanwhile, are tied to longer, more painful recovery because they can pull on the wound and stretch the skin, which over time could lead to a wide array of cosmetic problems such as rippling, palpability, implant displacement or shifting, and bottomed-out appearance.

Breast implants that are too large for the pre-existing tissue can also lead to accelerated aging of the breast and sagging, thereby defeating the purpose of breast lift surgery, warns Dr. Smaili.

With proper patient selection and judicious surgical approach, most patients are back on their feet seven to ten days after surgery, although they should wait for another two to three weeks before they can resume their rigorous exercise routine and other physically demanding tasks.

In the first few days of surgery, Dr. Smaili says it is normal to experience swelling, bruising, soreness, stiffness, and mild to moderate pain in the chest region—symptoms that can be controlled by painkillers, muscle relaxants, and rest.

These symptoms are supposed to subside as the patient moves forward to her recovery, thus any increasing pain and persistent swelling should be reported immediately because these might be a sign of infection or healing problem, says the celebrity Los Angeles plastic surgeon.

Numbness or hypersensitivity of the nipples or certain areas of the breast is also a common part of recovery. This will resolve over time, although some patients may experience tingling sensation for several weeks caused by the nerves starting to “awaken.”

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