Case 78: A combination approach was used here to create a really meaningful but completely natural transformation. Otoplasty made prominent ears all but disappear from the field of view and no longer distract or draw attention. At the same time, rhinoplasty, chin augmentation, and neck liposuction accomplished were able to remove a nasal hump and overprojection while improving chin and neck laxity to achieve a nice overall balance.
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]
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.

Unfortunately, as time goes on it is often difficult for patients to remember the specifics of the type of breast augmentation surgery and implants that they had.  Your are not alone!  The easiest way to determine what type of implant you had is to request a copy of the operative report from either the hospital, surgery center or your surgeon's office.  The implant specifics are recorded on this document.  Your office record also includes this information.  If it has been over ten years since your procedure, sometimes these records are no longer available.  Ultrasound or MRI can help to answer this question but it is an expensive way to solve the mystery and not an indication for these procedures.  If you registered your implants with the manufacturer at the time of surgery, the company will have a record of this information.  Fortunately, this inforation is not absoltely critical to your health unless you are having a problem with your implants.  Your surgeon can often develop a reasonable treatment plan even without this information.  I would strongly recommend that you register your implants and purchase the affordable insurance program if you have surgery again.  These programs are helpful in storing vital information regarding your implant type, size, filler, model and lot number.  Should there be a recall or long term problem requiring additional surgery, this information is readily available.  There is often also some fiancial support to offset costs.  Investigate the options available by contacting your surgeon or the implant manufacturer's websites.
Does the nipple/areola sit below the crease underneath my breast? One trait cosmetic surgeons frequently look for when evaluating a breast lift candidate is the position of the nipple/areola in relation to the inframammary fold, or crease beneath the breast. Try this test: slide a plain sheet of paper underneath your breast (no bra) so it sits against the breast crease. When looking in the mirror, do your nipples sit below the top edge of the paper? If so, this is a good indication that you have enough sagging to warrant a breast lift.
Dr. Mess performs fat transfer to the face to fill facial hollows and lines as a standalone procedure or in addition to neck lift or blepharoplasty. Fat transfer to the face is a more permanent and more natural alternative to fillers. Fat transfer to the hands can restore volume and provide a more youthful-looking hand. During your consultation, you will discuss your goals and expectations and review photographs to understand the plan.
Prepectoral or subcutaneous: in a breast reconstruction following a skin-sparing or skin- and nipple-sparing mastectomy, the implant is placed above the pectoralis major muscle without dissecting it so that the implant fills directly the volume of the mammary gland that has been removed. To avoid the issue of capsular contracture, the implant is often covered frontally or completely with a mesh in biomaterial, either biological or synthetic.

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.


While more experienced surgeons may charge more for their expertise, that’s not always the case. “You should not choose a qualified surgeon based on high fees any more than you should choose one based on low fees,” says Boca Raton, Florida plastic surgeon Dr. Hilton Becker in a RealSelf Q&A. “The most important factors should be education, experience, certification, and your ability to feel comfortable with your surgeon.”
During your consultation, your surgeon will ask about your habits, including whether or not you smoke and what medications you take. You may have to quit smoking for a period before and after surgery to ensure proper healing. You also may have to stop taking certain medications, such as aspirin or other anti-inflammatory drugs such as Motrin or Aleve. Your surgeon will give you instructions about what you need to do.
Furthermore, The Effect of Study design Biases on the Diagnostic Accuracy of Magnetic Resonance Imaging for Detecting Silicone Breast Implant Ruptures: a Meta-analysis (2011) reported that the breast-screening MRIs of asymptomatic women might overestimate the incidence of breast implant rupture.[53] In the event, the U.S. Food and Drug Administration emphasised that “breast implants are not lifetime devices. The longer a woman has silicone gel-filled breast implants, the more likely she is to experience complications.”[54]
“The old saline implants offered peace of mind but a less realistic result; silicone gel implants offered a more realistic look and feel but with concerns about silent rupture as well as long term safety and complications. The timing could not be better for the structured breast implant, which uniquely offers women the benefits of natural look and feel in addition to an unparalleled safety profile and peace of mind. This would be my personal choice for breast augmentation and has become the choice the majority of informed women in my practice are making for themselves.”
In addition to the financial cost of breast implants, women need to be aware of the emotional cost when asking how much do breast implants cost. Not knowing the status of their implants can take a toll on woman’s peace of mind. Recent survey findings* showed over 98% of women reported feeling concerned about silent rupture, including many women who already had silicone gel implants. When rupture is detected, it can result in feelings of insecurity and anxiety, as they don’t know how long it has been going on or whether they could have found out sooner. Both the worry and reality of silent rupture take a real toll on a woman’s overall well being, yet too many women don’t have all the facts before making a decision about their choice of implant.

As a top female plastic surgeon in Miami, Dr. Rotemberg, understands how important every person’s decision is to choose cosmetic surgery. She encourages an open-door policy, in which all of your questions and concerns are addressed, before, the day of, and after the procedure. It is imperative that patient is aware of all their options in order to make the right decision for their body.


Tip: Learn about the possible complications of breast augmentation, which include breast pain, changes in nipple sensation and hardening of the breast tissue around the implant. The FDA provides information on risks. Also, be aware that if you choose to have the implants removed, your breasts probably will not look the same as they did before surgery.
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.
I felt particularly insecure about my nose when starting college, as I was presenting myself to the world, independently, for the first time. Whenever I met anyone new, I'd be very careful to talk to them only head-on, so they couldn't glimpse my profile. By 19, I was researching rhinoplasty surgery, and my dad even took me for a nose-job consultation, but I didn't feel the surgeon was a good fit, so we decided to table the idea.
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.
Dr. Mess typically harvests fat from the abdomen through a tiny incision in the belly button using state-of-the-art cannulas specifically designed to create small particle size for greater accuracy and for maximal fat cell viability. If the patient does not have adequate abdominal fat she may harvest from the thighs, love handles or other sites. The fat will be placed in a centrifuge where the fat will be separated from fluids and non-essential elements. The fat will then be transferred to the recipient site using precisely placed injections on multiple plains to achieve the structure and look you desire. On the day of the procedure, donor and graft sites will be laid out and marked following the plan designed during your consultation.  Dr. Mess uses markers to map the surgery and distinguish between donor and recipient sites.

The current lifetime risk of BIA-ALCL in the U.S. is unknown, but estimates have ranged between estimated to be between 1 in 70,000 to 1 in 500,000 women with breast implants according to MD Anderson.[73] Certain geographic locations have demonstrated variable risks. For instance, a December 2016 update from the Therapeutic Goods Administration of Australia and New Zealand reported a risk of 1:1,000 to 1:10,000 for textured implants.".[71] To date (2017), there has not been a case of BIAL reported where the patient had only implantation of smooth shell breast implants or a textured tissue expander that was exchanged for a smooth implant. The paucity of cases reported in Asian populations has raised the possibility that there may be a range of genetic susceptibility to the phenomena, or alternatively merely reflect differences in how cases are identified and reported.

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