Latest Plastic Surgery Articles - Page 9




Rhinoplasty, or more commonly referred to as nose job, is not just about improving the outside appearance of the nose. “Goals” that are equally important include delivering results that look proportionate to the rest of the facial features, and preserving breathing functions by maintaining the underlying structural integrity.

The underlying anatomies of the nose, especially the skin thickness or lack thereof, affect the postop result and dictate the “ideal” surgical approach as well, as suggested by leading Beverly Hills plastic surgeon Dr. Karan Dhir.

Dr. Dhir says one of the advantages of thin skin, which is commonly found in Caucasian patients, is that it heals at a much faster rate than thick nasal skin, a common trait of ethnic patients—e.g., Hispanics, Africans, and Asians.


Simply put, rhinoplasty recovery for thin-skinned patients is shorter than those with thick nasal skin.

Thin skin also experiences less swelling at the nasal tip than thick skin. In fact, some ethnic rhinoplasty patients have to wait for up to two years to see the final result because of the persistent swelling, although most patients will already look presentable in public by the second week after their surgery, the celebrity plastic surgeon says.

Another advantage of thin skin is that it allows for a high degree of refinement due to its ability to redrape or shrink-wrap well to the new contour. Nevertheless, Dr. Dhir says the same trait could also pose some challenges since even the tiniest irregularities may be visible underneath the skin.

Asymmetries showing through thin skin are more common in patients whose nasal cartilage—which is the main framework of the lower two-thirds of the nose—is notably “strong.” This is manifested by a tip cartilage outline that is visible through the nasal skin.

For patients who have very thin skin and strong prominent cartilage underneath, Dr. Dhir may recommend soft tissue thickener such as acellular dermal matrix (Alloderm) or fascia to hide minute asymmetry and achieve smoother results from rhinoplasty.

Compared with thick skin, it is easier for thin skin to redrape to the new contour, thus more amount of alteration or refinement is generally possible. However, the renowned Beverly Hills plastic surgeon warns that over-resection must be still avoided because it leads to unnatural appearance, breathing problems, and collapsed nostrils or pinched tip.

Over-resection does provide little to no benefits, both long and short term, for rhinoplasty patients. This is particularly true for thick-skinned individuals who are prone to amorphous appearance after removing too much or incorrect manipulation of cartilage.



Rhinoplasty, or cosmetic nose surgery, is not just about improving the outside appearance of the nose. An equally important goal is to preserve normal breathing functions, which is possible with proper patient selection, honest communication between a surgeon and his patient, and careful planning.

Proper patient selection is the first step to achieve desirable results. Aside from being physically fit, the right candidate for rhinoplasty or any elective plastic surgery should have realistic motives and expectations. For this reason, a prudent surgeon will turn down patients seeking secondary or tertiary procedure even their result is attractive by normal standard just because it does not conform to their unrealistic goals.


Patients who have had several rhinoplastiesgenerally have a significant amount of scarring or skin contracture that is further aggravated by another surgery. Aside from higher risk of breathing disturbances, it is expected that the degree of cosmetic improvement would be limited, making another procedure no longer ideal.

Correct surgical planning also plays a crucial role in the prevention of postop complications such as breathing problem and unnatural appearance or deformity. Inland Empire plastic surgery expert Dr. Tarick Smaili says over-resection of the nasal cartilage is one of the most common causes of breathing disturbances.

Over-resection of the cartilage, which is the main structure supporting the lower two-thirds of the nose, is often the tool of “over-enthusiastic, inexperienced” surgeons whose only goal is to deliver the cosmetic goals of their patients without considering the architectural integrity of the nose.

In some cases, over-resection of the cartilage delivers the desired outcome short term, only to result in deformity (twisted nose, collapsed nostrils, droopy tip, etc.) and/or breathing problems later down the road because the structural integrity has been compromised.

Over-resection commonly occurs in reduction rhinoplasty in which the goal is to create a nose that looks proportionate to the rest of the facial features. To avoid a wide range of complications, it is important not to remove too much cartilage and to always take into consideration the changes that could occur due to natural aging of the face.

Reduction rhinoplasty should address bumps on the bridge, droopy tip, and/or excessively flared nostrils without affecting the architectural integrity of the nose.

Rhinoplasty is believed to be one of the most difficult plastic surgeries due to the involved anatomies and how they limit the amount of improvement. Further complicating things is the expectations of patients and doctors that are not always corresponding.



Facial rejuvenation surgery or facelift is not just about pulling the loose skin in an attempt to smooth out the appearance of wrinkles, jowling, and sagging tissue. Leading Los Angeles plastic surgeon Dr. Tarick Smaili treats it as a three-dimensional concept in which the lost of volume or fat must always be taken into account.

Facial fat grafting is often performed simultaneously with facelift. The goal is to correct the gaunt appearance due to volume or fat loss, a common problem of patients who are on the thin side, explains Dr. Smaili.


Oftentimes, facelift is performed first then followed by facial fat grafting, although under one surgical setting to minimize the cost. However, proponents of one-stage procedure believe the grafts should be only injected into the areas not undermined by facelift to prevent shifting and other unpredictable effects.

For this reason, Dr. Smaili may recommend a two-stage procedure for patients who need a more extensive form of facelift in which more loose skin is reshaped and/or removed. The goal, he explains, is to achieve a more predictable result since the second surgery is attempted only after recovery from the initial procedure is complete.

Nevertheless, there is no current study suggesting the cosmetic advantage of fat grating at the time of facelift or at a later date.

While dermal fillers such as Restylane and Juvederm can also correct the skeletonized or gaunt appearance caused by aging, Dr. Smaili says that fat grafting makes it easier to achieve natural results because it feels and behaves just like the surrounding tissue. Nevertheless, it involves a rather more complex procedure in which gentle liposuction, purification method, and re-injection are performed.

Structural facial fat grafting is usually performed to restore the fat or volume in the cheek, jawline, and around the eye, although it can also soften the marionette lines (creases that run downwards from the corners of the mouth) and nasolabial folds (laugh lines).

However, Dr. Smaili says some surgeons prefer the use of dermal fillers to fat grafting when the primary aim is to smooth out deep creases like the nasolabial folds and marionette lines because these biodegradable, non-reactive materials are believed to have a more cohesive nature that makes them effective in softening facial wrinkles.

Since dermal fillers are readily available materials, they are generally less expensive than fat grafting, although not in the long run as they need to be repeated every four months to two years.

Fat grafting, meanwhile, provides a longer lasting result if the grafts are able to access or form new blood supply needed for their survival, explains Dr. Smaili.



While infection after breast implant surgery could have some devastating effects, with modern surgical techniques the complication is a rare occurrence. For this reason, leading Beverly Hills plastic surgeon Dr. Tarick Smaili highlights the importance of choosing a board-certified breast augmentation surgeon.

Infection after breast augmentation surgery should be avoided, or if it were to occur, treated immediately because it is linked to capsular contracture or hardening/thickening of the scar capsule around a synthetic prosthesis.


Bacterial infection immediately after surgery often results in tenderness, persistent swelling, drainage/pus, and redness. Treatment often involves antibiotics. Take note that you must finish taking the prescribed course of these drugs to avoid reinfection caused by the surviving bacteria or the growth of antibiotic-resistant germs.

The theory is that implant contamination at the time of surgery is the most common cause of infection and its subsequent complications such as capsular contracture. To minimize such risk, the leading Beverly Hills plastic surgeon will make every effort to promote absolute sterility—this usually includes the use of “no touch” technique.

In “no touch” technique, the sterile implant packaging is only opened prior to insertion. A cone-shaped device called Keller Funnel is then used to propel the implant towards the breast pocket, without actually touching the prosthesis.

To further minimize the infection risk, Dr. Smaili says many breast augmentation surgeons these days are using antibiotic irrigation to bathe the implants, pocket, and wound.

Meanwhile, one postop factor linked to infection is seroma or formation of excess fluids within the tissue. To prevent or treat this complication, some surgeons put surgical drains at the end of the incision site. This practice is more common in revisions wherein there is a perceived higher risk of fluid buildup.

Aspiration is another way to address large seromas, which is commonly performed via ultrasound-guided technique to prevent puncturing the implant shell, while small seromas, meanwhile, tend to disappear on their own without treatments, explains Dr. Smaili.

In some occasions, breast implant infection occurs years after the surgery, which is often manifested by capsular contracture (pain and hardening of the breasts). In severe cases, implant removal is always necessary, with many surgeons recommending waiting at least six months before “replacements” are used to avoid the recurrence of infection.

Some doctors recommend taking antibiotics prior to any dental procedure in an attempt to minimize risk of breast implant infection. However, there is no scientific or clinical study proving its usefulness.



Arm lift surgery, or brachioplasty, is a body contouring procedure to remove the hanging excess skin and fat. The supportive tissue called fascia is contoured and tightened as well to further improve the upper arm, which has sagged due to weight fluctuations and/or aging.

Arm lift recovery depends on how long the incisions are and whether ancillary procedures have been performed—such as liposuction in which the excess fat is removed through the use of a hollowed stainless steel probe called cannula. However, anecdotal reports show that most patients are able to return to [light] work within three to seven days.


To make sure that you are healing properly, your plastic surgeon will require routine check ups. If he used removable sutures to close your wound at the time of surgery, these will be removed within a week or two.

As with any type of plastic surgery, after arm lift you should expect some swelling and bruising, which will subside to a significant degree by two weeks. However, a wound that appears not to be improving and inflammation that remains persistent might be signs of infection that must be addressed immediately to avoid unsatisfactory scarring and poor cosmetic results.

Your surgeon will inform you about the telltale signs of infection such as fever (38 degree Celsius or above), persistent redness and swelling within the incision site, increasing pain, and drainage/pus in the affected area.

To minimize bruising and swelling, compression garments are typically worn during arm lift recovery. These are also known to encourage healing by preventing seroma or excess fluids within the recovering tissue, and improve the postop result to some degree by helping the skin to shrink-wrap around the new contour.

The use of compression garments differs from surgeon to surgeon, although Los Angeles plastic surgery experts typically recommend four to six weeks of regular use. Take note that they should not cause discomfort, numbness, or skin changes, which are signs that they impede with normal blood circulation.

Within two to six weeks of surgery, you should avoid excessive arm movement and heavy lifting to promote good healing. You should also keep a normal heart rate and blood pressure to prevent increased bleeding, persistent swelling, and other complications that could impede with normal healing.

Nevertheless, it is important that you avoid prolonged immobility because it could lead to weight gain, more swelling, and lethargy. A good rule of thumb is to take short walks several times a day to improve blood circulation, which is also known to minimize risk of blood clot or deep vein thrombosis in the legs and to promote healing.

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