Case 43: Rhinoplasty in this pretty professional woman was all about removing the bump she had hated for years and correcting the tip droop and asymmetry that had worsened with age. Relatively small changes here have created a real sense of refinement while maintaining her long, elegant profile. A lower face and neck lift along with facial fat transfer helped to round out the enhancements in her already beautiful appearance.
From your description, you seem to be a very good candidate for this new technique and should really get the look that you are desiring without implants or any unnecessary visible scars. I would recommend that you search for an ABPS board certified plastic surgeon who is also a member of the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons in your area or an area that you would like to travel to on holiday who offers the Bellesoma technique to discuss your breast reduction and possible results.  You've provided great information - the only thing that would be more helpful in order to give you the best advice about your options would be an in-person exam.

The ASPS and the Plastic Surgery Foundation (PSF) have partnered with the FDA to study this condition and in doing so created the Patient Registry and Outcomes For breast Implants and anaplastic large cell Lymphoma Etiology and epidemiology (PROFILE). The United States FDA strongly encourages all physicians to report cases to PROFILE in an effort to better understand the role of breast implants in ALCL and the management of this disease.[74]


Breast reconstruction with fat grafting: If you have breast defects following lumpectomy for breast cancer, fat grafting is an effective method for filling in these defects. Fat grafting is also an option for total breast reconstruction following mastectomy; however, to achieve sufficient breast volume, this is usually a multistage process that requires at least two to four sequential fat grafting procedures.
Hello and thanks for your post and questions. It seems that you would potentially be a fantastic candidate to have a breast reduction and lift using the Bellesoma technique with NO vertical scar! With this technique you should be able to reach a smaller,  but perky and proportional breast size that fits your frame along with achieving upper pole fullness. You've provided great information - the only thing that would be more helpful in order to give you the best advice about your options would be an in-person exam.
Photographs. Someone from your doctor's office will take photographs of your nose from different angles. Your surgeon may use computer software to manipulate the photos to show you what kinds of results are possible. Your doctor will use these photos for before-and-after assessments, reference during surgery and long-term reviews. Most importantly, the photos permit a specific discussion about the goals of surgery.
© 2019 North Texas Plastic Surgery, PA. All rights reserved. Disclaimer: The information throughout this plastic surgery website is not intended to be taken as medical advice. Use of this website does not create a physician/patient relationship between you and North Texas Plastic Surgery, PA. The photographs of models displayed on this website are for decorative purposes only. See before and after photos for possible results. The information provided by North Texas Plastic Surgery is intended to provide general information regarding breast augmentation, liposuction, tummy tucks, facial plastic surgery, mommy makeovers, dermal fillers, and more for residents of Dallas, Plano, Southlake, DFW, and nearby areas of north Texas. This website is not intended for viewing or usage by European Union citizens. If you are interested in finding out more, please contact our plastic surgery office today for a personal consultation.
Case 48: This is a good example of finesse rhinoplasty where subtle changes can make for a very nice and meaningful difference. This young woman liked the overall shape of her nose but wanted it slightly smaller in all dimensions to match her pretty, petite features. We were able to achieve these goals by always relying on techniques that produce stable and precise results. Subtle fat transfer to the under eye area further helped to reduce under eye circles and soften her overall look.
The amount of good quality, transferrable fat will depend on how much can be retrieved from the donor sites. This can be partially estimated after examination (the surgeon inspects and pinches the areas of potential fat harvest to get an idea of how much fat can realistically be harvested), but it is hard to know for sure until the procedure is well underway. Abdominal and love handle/flank fat tend to be the best sources because the fat is more easily retrieved and softer than back fat, but the back is also routinely liposuctioned in the BBL procedure to both obtain extra tissue for transfer and to improve the 360 degree shaping of the torso. I have transferred anywhere from 300cc per buttock to over 1200 in some patients, depending on the circumstances.
In surgical practice, for the reconstruction of a breast, the tissue expander device is a temporary breast prosthesis used to form and establish an implant pocket for the future permanent breast implant. For the correction of male breast defects and deformities, the pectoral implant is the breast prosthesis used for the reconstruction and the aesthetic repair of a man's chest wall (see: gynecomastia and mastopexy).
In 1997, the U.S. Department of Health and Human Services (HHS) appointed the Institute of Medicine (IOM) of the U.S. National Academy of Sciences (NAS) to investigate the potential risks of operative and post-operative complications from the emplacement of silicone breast implants. The IOM's review of the safety and efficacy of silicone gel-filled breast implants, reported that the "evidence suggests diseases or conditions, such as connective tissue diseases, cancer, neurological diseases, or other systemic complaints or conditions are no more common in women with breast implants, than in women without implants" subsequent studies and systemic review found no causal link between silicone breast implants and disease.[113]
Many women are tempted to brush aside the idea of complications when asking how much do breast implants cost, thinking it won’t happen to them. Knowing your statistical risk of complications will help you plan ahead and pick an implant that is more likely to keep you out of complex surgery in the future. For primary augmentations, silicone gel implants have a higher complication rate for both capsular contracture (10.9-16.2% at 7-8 years) and implant rupture (7.2-13.6% at 8 years), than the IDEAL IMPLANT. “The silicone gel from a ruptured implant can stick to the tissues on the chest wall and a capsulectomy is often required,” explains Dr. Mahony. “The warranty may not fully cover these costs. In contrast [for primary augmentations] structured breast implants have a capsular contracture risk of only 6.6% and a rupture risk of only 2.1% at seven years, with revision surgery generally being less invasive.” Dr. Larry Nichter, board-certified plastic surgeon in Newport Beach, California, tells us about the likelihood of subsequent surgeries with IDEAL IMPLANT saying, “It’s incredibly safe and so there’s far fewer lifetime surgeries with an IDEAL IMPLANT Structured Breast Implant, compared to silicone gel implants.”
Sucking fat from your hips and thighs and injecting it into your boobs or butt may seem like a dream come true—and for some, it is. The process, called fat transfer or fat grafting, involves removing fat from one part of the body via a gentle liposuction, and then injecting it elsewhere. It works well all over the body, but is most commonly used on the face to enhance cheeks, fill hollow lower eyelids, and build up areas that have lost volume due to aging, explains New Jersey plastic surgeon Parham Ganchi, M.D. It’s also commonly used to plump up butts and to increase breast size and improve breast shape.

There are a few alternatives to breast augmentation with implants. Fat grafting breast augmentation involves harvesting fat via liposuction from another area of your body and injecting it into your breasts. Fat grafting is typically used to improve the appearance of your breasts after surgery to treat breast cancer, to correct a congenital breast deformity or to even out any imperfections occurring after breast augmentation with implants, such as wrinkles or ripples. The long-term effects of fat grafting to a normal breast are not fully understood, and the degree of augmentation possible via grafting is only modest at best. For these reasons, fat grafting for cosmetic breast augmentation is still considered experimental by many plastic surgeons.


Some might think that this patient had had previous rhinoplasty with tip collapse, but she did not. Occasionally, the shape of the tip cartilages is very vertically-oriented, causing a deep groove in the nostril. She felt this, along with her marked tip crookedness, drew unwanted attention to her nose. Now, her nose is smaller, smoother, more defined, and just blends with the rest of her face.
When you decide to have breast augmentation surgery, part of the preparation will involve discussing the cost with your surgeon. You'll receive an itemized list of the costs associated with your surgery, and you'll have a chance to ask questions if you have them. Your breast augmentation cost can be broken down to include the following fees and items: 

Subfascial: the breast implant is emplaced beneath the fascia of the pectoralis major muscle; the subfascial position is a variant of the subglandular position for the breast implant.[77] The technical advantages of the subfascial implant-pocket technique are debated; proponent surgeons report that the layer of fascial tissue provides greater implant coverage and better sustains its position.[78]
When a silicone breast implant ruptures it usually does not deflate, yet the filler gel does leak from it, which can migrate to the implant pocket; therefore, an intracapsular rupture (in-capsule leak) can become an extracapsular rupture (out-of-capsule leak), and each occurrence is resolved by explantation. Although the leaked silicone filler-gel can migrate from the chest tissues to elsewhere in the woman's body, most clinical complications are limited to the breast and armpit areas, usually manifested as granulomas (inflammatory nodules) and axillary lymphadenopathy (enlarged lymph glands in the armpit area).[41][42][43]
Potential candidates should also have adequate fat reserves for transfer. This becomes especially important when one considers the anticipated rate of fat resorption and graft loss. I typically recommened patients aim for at least 500 cc transferred per cheek. This would amount to 1 liter of fat (not lipoaspirate) after processing. Candidates with inadequate fat reserves are likely to be disappointed with their ultimate volume once healing is complete. 
A fat grafting procedure, or fat injection, transfers fat from areas in which you have excess fat, such as the outer thighs, and injects it into areas that may be lacking in volume, such as your face, hands, breasts or buttocks. This safe, long-lasting, well-tolerated procedure produces natural-looking results. Every year, thousands of people undergo successful fat grafting and are pleased with the results.
Traditional plastic surgery with implants requires an incision, dissecting a “pocket,” and placing the implant into that pocket before stitching to finish. In fat transfer, there is only a small incision and almost no cutting, says Ganchi. Injecting into smaller areas of the face, like the cheeks, lower eyelid hollows, and lips, will cost less since you’ll only need a partial liposuction. This kind of procedure can cost from $2,000 to $8,000, depending on what you're having done, according to estimates from online cosmetic surgery community RealSelf.com. By comparison, an eyelid lift comes at an average national price of $4,525, per RealSelf.com. 

For detailed indications, contraindications, warnings, and precautions associated with the use of all MENTOR® Implantable Devices, which include MENTOR® Saline-filled Implants, MemoryGel® Implants, MemoryShape® Implants, ARTOURA™ Expanders, and CONTOUR PROFILE® Expanders, please refer to the Instructions for Use (IFU) provided with each product or visit www.mentorwwllc.com.

The ‘gummy bear’ implant comes in both round and teardrop shapes. They have a firmer gel, which may give a better shape and may last longer. The round gummy bear implant is often a good choice for women with looser tissues and who want a more durable implant that remains soft. The teardrop shaped gummy bear implant may be a good choice for women whose tissues are relatively tight and desire a very proportionate and natural looking enhancement with less fullness of the upper portion of the breast and more projection and fullness of the lower portion of the breast.
You will want to limit physical activity, use ice packs to bring down the swelling, and follow all of Dr. Rotemberg’s instructions. Within five to seven days after the fat transfer procedure, you will have a follow-up visit. During this visit, the doctor will examine the area, ask how your recovery is coming along, and give additional recommendations, if necessary.
Case 21: For our patients who are in image-centered occupations such as modeling or acting, nasal refinements often focus on small changes that will enhance the overall look and remove subtle cues about the nose that preoccupy or distract the eye. This successful model had a look that really worked for her but had always felt that her tip and nostrils were too wide, flared, and slightly droopy. Creation of a slightly narrower and more structured tip draws unwanted attention away from her nose and, instead, enhances her overall look.

Make sure your cosmetic surgeon is board certified; this ensures that he or she is specifically trained and experienced in cosmetic surgery and that your procedure will take place in an accredited facility, which is essential for your safety. Finally, don’t choose a cosmetic surgeon based on price alone. Your safety & results are too important. Most cosmetic surgeons offer financing options to help patients budget procedure costs.
Many patients return to work within the first week after breast lift surgery, depending on the nature of their jobs, and resume most daily activities after a week or so. You will need to limit exercise other than walking for the first 2-6 weeks after a breast lift; your cosmetic surgeon will provide you with detailed instructions about when it is safe to resume any activity.
Before surgery, friends and family would say they didn't see anything wrong with my nose, but to have something that's so personal and integral to you feel so wrong...it's exhausting and disheartening. Now I feel not only more beautiful but way more comfortable in my own skin — just like my mom. And now those same friends see the difference and compliment me.
Then he took a bunch of pictures from different angles and stepped out to review them. A few minutes later, we sat down in his office to go over the images. He showed me three distinct perspectives: front, profile, and from below, which he called the worm's-eye view. With each photo, he presented a revised image of what my nose could look like with surgery — and, wow, what a rush of happiness! It was honestly everything I was hoping for: smoother and smaller, but still me.
Sometimes insurance pays for a rhinoplasty, but it depends on the insurance policy. Before scheduling surgery, your doctor's office will help you get prior written authorization from your insurance company. Although this isn't a guarantee of coverage, it's the only way to confirm that rhinoplasty is a covered benefit. Sometimes insurance will pay for a part of a nasal surgery, but not other parts. In these cases, you can contact the business office to get a quote for the operation.
In 2006, for the Inamed Corporation and for the Mentor Corporation, the U.S. Food and Drug Administration lifted its restrictions against using silicone-gel breast implants for breast reconstruction and for augmentation mammoplasty. Yet, the approval was conditional upon accepting FDA monitoring, the completion of 10-year-mark studies of the women who already had the breast implants, and the completion of a second, 10-year-mark study of the safety of the breast implants in 40,000 other women.[119] The FDA warned the public that breast implants do carry medical risks, and recommended that women who undergo breast augmentation should periodically undergo MRI examinations to screen for signs of either shell rupture or of filler leakage, or both conditions; and ordered that breast surgery patients be provided with detailed, informational brochures explaining the medical risks of using silicone-gel breast implants.[113]
A fat grafting procedure, or fat injection, transfers fat from areas in which you have excess fat, such as the outer thighs, and injects it into areas that may be lacking in volume, such as your face, hands, breasts or buttocks. This safe, long-lasting, well-tolerated procedure produces natural-looking results. Every year, thousands of people undergo successful fat grafting and are pleased with the results.
In the early 1990s, the national health ministries of the listed countries reviewed the pertinent studies for causal links among silicone-gel breast implants and systemic and auto-immune diseases. The collective conclusion is that there is no evidence establishing a causal connection between the implantation of silicone breast implants and either type of disease. The Danish study Long-term Health Status of Danish Women with Silicone Breast Implants (2004) reported that women who had breast implants for an average of 19 years were no more likely to report an excessive number of rheumatic disease symptoms than would the women of the control group.[26] The follow-up study Mortality Rates Among Augmentation Mammoplasty Patients: An Update (2006) reported a decreased standardized mortality ratio and an increased risk of lung cancer death among breast implant patients, than among patients for other types of plastic surgery; the mortality rate differences were attributed to tobacco smoking.[27] The study Mortality Among Canadian Women with Cosmetic Breast Implants (2006), about some 25,000 women with breast implants, reported a 43 per cent lower rate of breast cancer among them than among the general populace, and a lower-than-average risk of cancer.[28]
No. Rhinoplasty is a challenging operation. This is due to several factors. First, the nose is a complicated 3D shape that is in the middle of the face. Changes made during rhinoplasty are often very small. But these changes can make a major difference in the way the nose looks and functions. Because these changes are small, so is the margin for error.
Inframammary: an incision made to the inframammary fold (natural crease under your breast), which affords maximal access for precise dissection of the tissues and emplacement of the breast implants. It is the preferred surgical technique for emplacing silicone-gel implants, because it better exposes the breast tissue–pectoralis muscle interface; yet, IMF implantation can produce thicker, slightly more visible surgical scars. 

Some might think that this patient had had previous rhinoplasty with tip collapse, but she did not. Occasionally, the shape of the tip cartilages is very vertically-oriented, causing a deep groove in the nostril. She felt this, along with her marked tip crookedness, drew unwanted attention to her nose. Now, her nose is smaller, smoother, more defined, and just blends with the rest of her face.
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