Latest Plastic Surgery Articles - Page 8




Liposuction surgery or lipoplasty removes the excess superficial fat, which lies just underneath the skin, through several small incisions that can heal and fade well without causing visible scar. But as with any body contouring surgery, it is not a substitute for weight loss and healthy lifestyle.

Aside from the patient’s weight, her skin quality—particularly when it comes to its elasticity and firmness—also affects the liposuction result.


A skin with a “decent” amount of elasticity, which is commonly found in younger patients who have maintained a healthy weight throughout their lives, can redrape better to the new contour than loose skin. Nevertheless, “older” individuals could a still expect good cosmetic results after surgery.

Meanwhile, patients with noticeably poor skin elasticity could develop some visible wrinkling. For this reason, liposuction is occasionally followed by certain procedures such as Thermage in which the goal is to “heat” the skin and/or break up the cellulites.

Most patients below the age of 40 have a decent amount of skin elasticity, which allows it to contract during the healing phase and leads to a smooth result. However, the “process” of redraping could take up to six months.

Nowadays, the most commonly treated area is the abdomen because it has the tendency to carry excess superficial fat even among thin people. It is important to note that abdominal liposuction could only deliver good results if the patient has maintained good skin quality and has no splayed muscle caused by pregnancy.

If there is a significant amount of loose skin and splayed muscle, which might be caused by pregnancy and massive weight fluctuation, a tummy tuck is a far better option than liposuction.

However, plastic surgeons have noticed that the lower aspect of the abdomen can redrape better than its upper region after a liposuction surgery, a characteristic that is attributed to the presence of a membrane called scarp fascia.

Simply put, liposuction of the lower abdomen tends to provide a smoother result than surgery involving the upper abdomen.

Nowadays, liposuction uses a thinner cannula that can easily fit into smaller incisions—about the size of a small grain of rice. This is the main reason why most scars fade and heal efficiently even without the use of sutures, although dark-skinned patients might have to wait a little longer than fair-skinned individuals for their scars to become less noticeable.

Also, patients with a darker complexion might experience skin discoloration (hyper- or hypo-pigmentation) after liposuction surgery. To avoid or at least minimize such risk, the use of microcannula that requires a very small incision is important, as well as positioning the scar in “discreet” areas—e.g., underneath the bikini line and within the natural folds of skin.



About three-quarters of breast augmentation patients today are choosing silicone implants over saline implants because the former can deliver better cosmetic results even in patients with little “coverage.”

While both breast implants are made of an outer silicone shell, their main difference is the filler material that moves and “behaves” distinctly from each other.


Saline implants are inflated at the time of surgery with a predetermined amount of sterile saltwater solution, while silicone implants are always prefilled with a viscous type of medical-grade silicone gel.

The main appeal of saline implants is that they do not pose any risk of gel leak and its side-effects such as pain and tissue inflammation (in the event of rupture) because the saltwater solution is easily and quickly absorbed by the surrounding tissue.

Because asymptomatic or “silent” leak is not a concern with saline implants, regular MRI exam—which might be too expensive for some patients—is not a requirement, unlike with the use of silicone implants in which the procedure is part of their “maintenance.”

To compensate for the “sloshing effect” of saline implants, certain techniques and appropriate implant design and size are used to deliver more natural results.

The first step to deliver natural results with breast implants, no matter what kind of filler material they are using, is to choose a conservative size based on the patient’s chest/breast measurement (vertically and horizontally) and the amount of her existing soft tissue.

By going conservative, the soft tissue is more palpable than the implants, leading to a softer and more natural result.

Smaller saline implants, or at least not larger than 350 cc, can also reduce the likelihood of visible rippling.

Patients who are opting for saline implants also fare better with a submuscular technique wherein the prostheses are placed underneath the thick layer of pec muscle, which provides additional coverage. While it results in more post-op pain and longer recovery, the “cosmetic” benefits still far outweigh the “temporary” drawbacks.

Using the right implant profile or forward projection can also help saline implants deliver results that look and feel more natural. The rule of thumb is that women with a narrower chest are best suited for implants whose base is equally small, while patients with a wider frame need a design that complements their anatomy.

And for patients whose breast tissue is saggy, while their upper cleavage looks deflated, breast implant with mastopexy (or more commonly referred to as breast lift) is the only surgical approach that could provide them good aesthetic results.



Recovery after liposuction surgery differs from patient to patient; some individuals are able to return to their work within two to three days, while others require a longer work off to give the swelling and bruising enough time to dissipate.

Meanwhile, it is not uncommon to experience lightheadedness after liposuction, which is caused by several factors. But in most cases, the “feeling” will only last about a day as the body flushes out the anesthetics and other excess fluids.


Aside from the surgical trauma and anesthetics, the lightheadedness might be also caused by decompression of the lower extremities after removing the compression garments.

While the temporary “fainting episode” does not pose serious threat, certain steps to prevent fall injuries and inconvenience remain important.

Anecdotal reports show that lightheadedness is common after urinating the morning following the surgery. For this reason, the usual advice is to stand up slowly and carefully after using the toilet.

Just to be on the safe side, some patients may also ask a capable adult to accompany them in the bathroom.

In case the patient starts to feel dizzy or lightheaded, the best thing to do is to sit down or lie down immediately on the floor until the feeling subsides to prevent fall injuries.

Because decompression could lead to lightheadedness, compression garments must be removed slowly if the patient is going to take a shower, preferably with another person’s assistance. Some doctors also believe that eating a small amount of food before taking off the garment could also prevent fainting episodes.

Eating small amounts of food every couple of hours could prevent hypoglycemia or low blood sugar, which is another cause of dizziness. It is important to note that the body needs glucose to have enough energy to perform its normal functions.

While the most common sign of hypoglycemia is hunger, patients should also look out for irritability, racing pulse, shakiness, confusion, and headaches.

It is important to note that while lightheadedness is normal within a day or two after a liposuction surgery, the patient is supposed to feel better as her body heals from the surgical trauma and anesthetic. For this reason, any persistent postoperative symptoms such as dizziness, swelling and bruising that are not improving must be immediately informed to a doctor.



Every time the skin is injured or cut, the body releases collagen to repair the wound—a process that can lead to the appearance of scars. This is something any plastic surgery patient should consider before going under the knife.

However, a good plastic surgeon will make every effort to hide or make the scar less noticeable by placing the incisions within the natural folds of skin, underneath the bikini region, and/or area where scar tissue is less likely to form.


But scar migration remains a real concern with any plastic surgery, especially when it comes to facelift, breast enhancement surgery, tummy tuck, and body lift.

Leading Los Angeles plastic surgeon Dr. Tarick Smaili says that one way to avoid or at least minimize the risk of scar migration is to take most of the tension off the skin; this is often done by using deep internal sutures to create a stronger “support” to the new contour.

For instance, instead of lifting the facial skin alone during a facelift surgery, doctors today also re-sculpt and tighten the subdermal fat and muscle. While this technique leads to longer swelling and recovery, its results are way better than a skin-only lift which is criticized for its higher risk of wide scarring and short-lived results.

In tummy tuck surgery wherein scar migration is particularly problematic, the hip-to-hip incision positioned underneath the bikini region is supposed to remain low so the patient will have no “issue” wearing a two-piece swimwear.

To prevent the tummy tuck incision to ride up too hide, the renowned Los Angeles plastic surgeon highlights the importance of removing or at least minimizing the tension on the superficial layers of the closure. This technique not only encourages the scar to remain thin and inconspicuous but also leads to accelerated healing.

Aside from too much tension on the superficial layers of the wound, scar migration is also caused by excessive excision of skin during facelift and tummy tuck and other forms of body lift such as arm lift, breast lift, panniculectomy, and thigh lift.

Nevertheless, the right amount of skin excision remains important when dealing with massive weight loss patients suffering from redundant skin whose primary goal is to achieve a near normal appearance.

In the case of breast augmentation surgery in which the inframammary crease (or natural breast fold) is the most commonly used incision site, the risk of scar migration could be avoided by using a conservative implant size, which is determined on the amount of existing skin and other soft tissue.

The problem with using overlarge breast implants is that the scar may migrate too high or too low because they can overstretch the skin and tissue.



Any time the skin is cut or injured, a specific type of growth cell called fibroblast produces collagen, which in turn leads to the appearance of scar. Nevertheless, LA plastic surgeons will make every effort to place the incisions within the natural folds of skin or in an area where they will appear inconspicuous.

A “good” scar is supposed to appear flat, thin, and “faded,” which is possible through the use of suturing techniques wherein the skin receives no or very little tension.


But despite all the best efforts, some plastic surgery patients are simply prone to scar tissue or more appropriately called as keloids and hypertrophic scars, which both appear raised and discolored. According to studies, dark-skinned individuals are more vulnerable to heavy scarring than fair-skinned people.

While keloids go beyond the original incision area, hypertrophic scars just remain within the injured site.

Steroid injection, specifically Kenalog, is one of the most common scar treatments used after plastic surgery. It works by breaking up the bond between collagen tissue, thereby shrinking the scars.

Despite the relatively high success rate of steroid or Kenalog injection, only a qualified practitioner should perform the treatment because its incorrect use could lead to depression and thinning of the skin. As a result, most doctors start with a low dose and they usually wait six to eight weeks before another session is performed, but only if there is a need to.

While it is possible to inject higher doses of steroid, once the skin depression occurs it is difficult, if not impossible, to correct.

The success of steroid injection also depends on the scar’s age. Conventional wisdom suggests waiting at least three months after plastic surgery so the swelling can resolve on its own. During this period, silicone sheet or tape can be used to prevent or minimize the formation of scar tissue within the dermis.

Meanwhile, Kenalog injection is particularly helpful in minimizing the swelling after rhinoplasty or nose surgery, which is most apparent in the tip area. This has also been found to prevent the formation of scar tissue especially among ethnic patients who are prone to keloids.

The treatment can also help minimize the appearance of post-surgical scars in patients who had facelift, breast reduction, mastopexy, gynecomastia surgery, body lift for after massive weight loss, and breast augmentation.

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