Fat transfer surgery is a hot topic among today’s elite plastic surgeons. Dr. Mess researched and trained in fat transfer during her six-year residency at Georgetown University Hospital and incorporated the procedure early in her practice. She has refined her technique to offer the advantages of fat transfer to augment and reconstruct. Dr. Mess performs fat transfer to the face, breast, hands, and buttocks to add volume and fullness and restore a youthful and vigorous appearance.

The correction of capsular contracture might require an open capsulotomy (surgical release) of the collagen-fiber capsule, or the removal, and possible replacement, of the breast implant. Furthermore, in treating capsular contracture, the closed capsulotomy (disruption via external manipulation) once was a common maneuver for treating hard capsules, but now is a discouraged technique, because it can rupture the breast implant. Non-surgical treatments for collagen-fiber capsules include massage, external ultrasonic therapy, leukotriene pathway inhibitors such as zafirlukast (Accolate) or montelukast (Singulair), and pulsed electromagnetic field therapy (PEMFT).[60][61][62][63]
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.
By the next day, I was looking more like a monster and didn't want to see anyone. The bruises around my eyes shined a bright greenish-purple, and I was swollen all over with some intense pressure in my head. I couldn't breathe through my nose anymore, because of all the blood and swelling. I felt congested and uncomfortable, almost like I had a bad cold, but again, nothing Tylenol couldn't handle. But I fully expected this, as Dr. Kolker said it could take two weeks for everything to run its course.
Transaxillary: an incision made to the axilla (armpit), from which the dissection tunnels medially, to emplace the implants, either bluntly or with an endoscope (illuminated video microcamera), without producing visible scars on the breast proper; yet, it is likelier to produce inferior asymmetry of the implant-device position. Therefore, surgical revision of transaxillary emplaced breast implants usually requires either an IMF incision or a periareolar incision.
I had wrongly assumed he could simply flatten the hump and be done, but he explained that you can't sculpt one area without considering how it'll impact everything else. If he smoothed the bridge and did nothing else, my nose could wind up looking far too wide from the front. So ultimately, he would need to break my nose and seamlessly draw it in closer to create the precise size and shape I was after. He'd also have to reduce the cartilage at the tip and turn it up slightly, from 91 to 93 degrees. In the end, my nose would be smaller, with a straighter bridge, a refined tip, and more clearly defined nostrils.
When you choose a breast implant, you are choosing a device that will be part of your body for many years. Breast implants are not lifetime devices, but if your implants do not encounter complications, there is no reason for a revision. Your implants could be with you for over 30 years, so you should spend some time weighing the benefits and compromises of each implant type. Pick an implant that you feel comfortable with, but also gives you great results. The IDEAL IMPLANT Structured Breast Implant the lowest rates of rupture and capsule contracture in primary augmentation at 8 years, but still gives women a beautiful, natural look and feel. Silicone gel breast implants give women beautiful results, but at an increased financial strain and emotional toll, Dr. Mahony tells us.

Since the mid-1990s, the fifth generation of silicone-gel breast implant is made of a high-strength, highly cohesive silicone gel that mostly eliminates the occurrences of filler leakage (“silicone gel bleed”) and of the migration of the silicone filler from the implant pocket to elsewhere in the woman's body. These implants are commonly referred to as "gummy bear breast implants" for their firm, pliant consistency, which is similar to gummy candies. The studies Experience with Anatomical Soft Cohesive Silicone gel Prosthesis in Cosmetic and Reconstructive Breast Implant Surgery (2004) and Cohesive Silicone gel Breast Implants in Aesthetic and Reconstructive Breast Surgery (2005) reported low incidence-rates of capsular contracture and of device-shell rupture; and greater rates of improved medical-safety and technical-efficacy than that of early generation breast implant devices.[94][95][96]
There are four general types of breast implants, defined by their filler material: saline solution, silicone gel, structured and composite filler. The saline implant has an elastomer silicone shell filled with sterile saline solution during surgery; the silicone implant has an elastomer silicone shell pre-filled with viscous silicone gel; structured implants use nested elastomer silicone shells and two saline filled lumen; and the alternative composition implants featured miscellaneous fillers, such as soy oil, polypropylene string, etc. Composite implants are typically not recommended for use anymore and, in fact, their use is banned in the United States and Europe due to associated health risks and complications.
Recovery from fat transfer to the breast is relatively short. Patients will be advised on post-procedure bras and will have regular follow up with Dr. Mess. There will also be some recovery from the liposuction part of the transfer. In general, patients can return to normal activities in 2-3 weeks but are advised to avoid strenuous activity and any “fat burning” exercises for up to 6 weeks.
A breast reduction typically includes a lift.  However, a lift does not necessarily require a reduction.  Both operations have similar incision patterns and resultant scars, but they have different indications.  One of the first questions I ask a patient who desires an improved appearance of her breasts is if she would like to be the same size, smaller, or larger.  The patient who wants to be the same size and is happy with her breasts when wearing a bra but unhappy with the amount of sagging without a bra is a candidate for a breast lift alone.  The patient who desires to be smaller or has one breast noticeably larger than the other, is a candidate for a breast reduction-lift combination.  Sometimes patients feel their breasts look smaller after removal of the excess skin with the lift even though no breast tissue was removed; the reason for this is that some of what fills your bra cup is excess skin.  The patient with sagging who desires to have larger breasts is a candidate for a breast lift with implants.

Case 37: Achieving a beautiful, natural change in an already beautiful woman is one of the great challenges we love in rhinoplasty. In front view you see a beautifully defined, natural change that simply looks great. Then on profile and 3/4 views, you see an elegant change where the tip is deprojected (made smaller) but retains a beautiful, natural aesthetic- this is finesse rhinoplasty.

Functional breast-feeding difficulties arise if the surgeon cut the milk ducts or the major nerves innervating the breast, or if the milk glands were otherwise damaged. Milk duct and nerve damage are more common if the incisions cut tissue near the nipple. The milk glands are most likely to be affected by subglandular implants (under the gland), and by large-sized breast implants, which pinch the lactiferous ducts and impede milk flow. Small-sized breast implants, and submuscular implantation, cause fewer breast-function problems; however, it is impossible to predict whether a woman who undergoes breast augmentation will be able to successfully breast feed since some women are able to breast-feed after periareolar incisions and subglandular placement and some are not able to after augmentation using submuscular and other types of surgical incisions.[101]
Case 40: Excessive nasal width can cause the nose to dominate other fine, delicate facial features. In Ethnic Rhinoplasty, the key to obtaining a more refined nose is to create a nasal framework upon which the thick skin will wrap around. This pretty young Persian woman wanted to reduce her nasal width, the fullness in her tip, and the sense that her tip was downturned. These six month photos show significant improvements in achieving these goals and her nose will only get better yet.
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.
Once I firmly made the decision to move ahead with the rhinoplasty surgery, I told my family. With four siblings, there's never a shortage of opinions, but they were all extremely supportive. I inherited my nose from my mother, and when I told her the news, she revealed for the first time that she had once considered getting a nose job, too, which was majorly shocking, because my mom is very reserved and rarely criticizes, or even talks about, her appearance. She's just always seemed so comfortable in her skin. I really admire that about her.
When you choose a breast implant, you are choosing a device that will be part of your body for many years. Breast implants are not lifetime devices, but if your implants do not encounter complications, there is no reason for a revision. Your implants could be with you for over 30 years, so you should spend some time weighing the benefits and compromises of each implant type. Pick an implant that you feel comfortable with, but also gives you great results. The IDEAL IMPLANT Structured Breast Implant the lowest rates of rupture and capsule contracture in primary augmentation at 8 years, but still gives women a beautiful, natural look and feel. Silicone gel breast implants give women beautiful results, but at an increased financial strain and emotional toll, Dr. Mahony tells us.
For women who experience breast sagging, I would recommend a breast lift; not breast reduction surgery. Breast reduction can provide a more modest breast size by removing tissue and skin from the breasts; however, a breast lift is needed to achieve a perkier, higher-positioned breast contour. It’s very common for patients to combine their breast reduction surgery with a breast lift to achieve more comprehensive breast enhancement results.
Your medical history. The most important question your doctor will ask you is about your motivation for surgery and your goals. Your doctor will also ask questions about your medical history — including a history of nasal obstruction, surgeries and any medications you take. If you have a bleeding disorder, such as hemophilia, you may not be a candidate for rhinoplasty.
Subglandular: the breast implant is emplaced to the retromammary space, between the breast tissue (the mammary gland) and the pectoralis major muscle (major muscle of the chest), which most approximates the plane of normal breast tissue, and affords the most aesthetic results. Yet, in women with thin pectoral soft-tissue, the subglandular position is likelier to show the ripples and wrinkles of the underlying implant. Moreover, the capsular contracture incidence rate is slightly greater with subglandular implantation.

In 1988, twenty-six years after the 1962 introduction of breast implants filled with silicone gel, the U.S. Food and Drug Administration (FDA) investigated breast implant failures and the subsequent complications, and re-classified breast implant devices as Class III medical devices, and required from manufacturers the documentary data substantiating the safety and efficacy of their breast implant devices.[113] In 1992, the FDA placed silicone-gel breast implants in moratorium in the U.S., because there was “inadequate information to demonstrate that breast implants were safe and effective”. Nonetheless, medical access to silicone-gel breast implant devices continued for clinical studies of post-mastectomy breast reconstruction, the correction of congenital deformities, and the replacement of ruptured silicone-gel implants. The FDA required from the manufacturers the clinical trial data, and permitted their providing breast implants to the breast augmentation patients for the statistical studies required by the U.S. Food and Drug Administration.[113] In mid–1992, the FDA approved an adjunct study protocol for silicone-gel filled implants for breast reconstruction patients, and for revision-surgery patients. Also in 1992, the Dow Corning Corporation, a silicone products and breast implant manufacturer, announced the discontinuation of five implant-grade silicones, but would continue producing 45 other, medical-grade, silicone materials—three years later, in 1995, the Dow Corning Corporation went bankrupt when it faced large class action lawsuits claiming a variety of illnesses.[113]

Case 60: Facial aging can be hard on someone who is naturally thin by creating a more severe and skeletonized appearance as facial fat is lost. A combined approach was used to create a beautiful transformation, including a trichophytic brow lift, lower lid tightening, and facelift along with a conservative rhinoplasty to straighten and balance her nose. Notice how the eyes are opened up and facial hollows are smoothened without the surprised look that can accompany over-aggressive lifts. You’ll also see that incisions are hidden within the hairline and natural skin creases making them almost invisible.
By and large, there is no 'perfect type' of breast implant. What looked stunning on one of your best friends doesn't necessarily mean that the same implant will be the best choice for you. This is why we recommend face-to-face consultations; an honest discussion with an experienced, knowledgeable plastic surgeon about your desired enhancement is a must. And you'll want to consider your surgeon's opinion and recommendations based on your existing body type and physical assessment.
Bellesoma is a new breast reduction and lift technique that seems like it would be a great fit for you.  This procedure utilizes 3-D volumetric scanning and a multi-point measuring system to design a precise surgical blueprint exactly tailored to your body and the reduced breast size that you desire. The Bellesoma procedure reduces the sagging and weight of your breast, lifts your breast and reduces areola diameter, preserves the nipple sensation and ability to breast feed.  After Bellesoma, your breasts will look as full and perky as if an implant had been placed without using any implant, so no need to compromise.  One of the huge positives of this technique is that there is NO vertical incision traveling down the front of your breasts.
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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