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.

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.
If you’re researching “how much do breast implants cost,” chances are you are imagining all the benefits they offer. Breast augmentation is the top cosmetic plastic surgery procedure performed in the United States for a reason. Breast augmentations have a high rate of patient satisfaction according to research. In a study published in the May 2013 issue of Plastic and Reconstructive Surgery, researchers gathered information from 225 women after their breast augmentations. The study revealed that 91.1% of women felt improved self-esteem, 64.3% had an improved quality of life, and 98.7% would repeat the surgery. But there is another side to breast implants, one you should know about before scheduling your plastic surgery consultation. While the initial costs and satisfaction rates are similar between implant types, the long-term maintenance costs and emotional toll differs in important ways. Silicone gel breast implants carry a high rate of certain complications and an increased anxiety when compared to the newest breast implant on the market, IDEAL IMPLANT® Structured Breast Implants.
When the patient is unsatisfied with the outcome of the augmentation mammoplasty; or when technical or medical complications occur; or because of the breast implants’ limited product life, it is likely she might require replacing the breast implants. Common revision surgery indications include major and minor medical complications, capsular contracture, shell rupture, and device deflation.[44] Revision incidence rates were greater for breast reconstruction patients, because of the post-mastectomy changes to the soft-tissues and to the skin envelope of the breast, and to the anatomical borders of the breast, especially in women who received adjuvant external radiation therapy.[44] Moreover, besides breast reconstruction, breast cancer patients usually undergo revision surgery of the nipple-areola complex (NAC), and symmetry procedures upon the opposite breast, to create a bust of natural appearance, size, form, and feel. Carefully matching the type and size of the breast implants to the patient's pectoral soft-tissue characteristics reduces the incidence of revision surgery. Appropriate tissue matching, implant selection, and proper implantation technique, the re-operation rate was 3 percent at the 7-year-mark, compared with the re-operation rate of 20 per cent at the 3-year-mark, as reported by the U.S. Food and Drug Administration.[64][65]
Structured implants were approved by the FDA and Health Canada in 2014 as a third form of breast implant.[97] Structured implants incorporate both saline and silicone gel implant technology. The filler is only saline solution in case of rupture and has a natural feel like silicone gel implants.[98] The implant uses an internal structure which consists of a series of nested shells that support the upper pole with the two lumen being filled with only saline. The implant is inserted empty and then filled once in place which requires less of an incision than pre-filled implants.[97] If one of the lumen of the structured implant ruptures, it leaks and empties. The other lumen remain intact and the implant only partially deflates, allowing for ease of explant and replacement.[97]
My roommate, Kelsi, who's also my childhood best friend, came with me to Dr. Kolker's office. After a few final checks, Dr. Kolker took more pictures, then marked up my nose. He said people generally puff up under anesthesia, and things can get distorted, so this, in his words, "helps keep him honest." A nurse led me into the OR, and the last thing I remember before going under was this feeling of deep gratitude and thanking everyone there for playing a part in helping me feel better about myself.
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Although reviewing before and after photographs is an important element in selecting the right rhinoplasty surgeon, choosing your surgeon solely on the basis of website photos is ill-advised. Indeed, countless disappointed rhinoplasty patients can attest to the deceptive and misleading nature of many rhinoplasty websites. Moreover, viewing online photos is no substitute for the consultation visit, where I can share numerous other before and after photos, many with noses similar in appearance to your own – a far more meaningful comparison. Although I have been slow to incorporate internet marketing into my rhinoplasty practice, the growing number of individuals who look to the internet as their sole source of medical information cannot be overlooked. Consequently, I offer this website as a source of candid information to equip the prospective rhinoplasty patient with accurate information and honest advice.

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] 

Of course, the breast reduction vs. breast lift question is not really cut and dry because every woman is unique. You may be unsure of what volume you would like with the breasts in a more favorable position. Breasts may be different sizes (asymmetric). The position of the nipple may be out of proportion to the amount of breast sag. Breasts may be ‘deflated’ after pregnancy. You may have heard that breast implants are the only reliable way to lift breasts. These questions can easily be addressed at the time of your consult.
If you’re hoping your breast implants will be covered by insurance because of something like asymmetry or changes after pregnancy, you probably need to explore other financing options. Breast implants are considered cosmetic surgery, so insurance companies typically won’t cover them. However, “Breast Implants are covered if they are being used as part of reconstruction after breast cancer or mastectomy,” says Houston plastic surgeon Dr. C. Bob Basu in a RealSelf Q&A.

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.
A: During your initial consultation, you will discuss your desired results with Dr. Hochstein so he can fully understand your expectations. You will be provided with before and after photos so that you can see some of the results Dr. Hochstein has achieved with his other patients. He will examine your breasts and evaluate other factors that may affect the outcome of your surgery. This will help determine the appropriate breast size and incision location.
the second technological development was a polyurethane foam coating for the shell of the breast implant; the coating reduced the incidence of capsular contracture, by causing an inflammatory reaction that impeded the formation of a capsule of fibrous collagen tissue around the breast implant. Nevertheless, despite that prophylactic measure, the medical use of polyurethane-coated breast implants was briefly discontinued, because of the potential health-risk posed by 2,4-toluenediamine (TDA), a carcinogenic by-product of the chemical breakdown of the polyurethane foam coating of the breast implant.[92]
A breast reduction with lift surgery combines two procedures to improve the size and shape of the breasts. A reduction involves decreasing the size of overly large breasts by removing excess tissue and skin. A breast lift is done in order to raise and reshape the breasts. The breast reduction and lift procedure helps to alleviate problems caused by overly large, sagging breasts, including:
The IDEAL IMPLANT Structured Breast Implant is often compared to silicone gel breast implants because they both offer beautiful, natural looking results. But, beyond the aesthetic comparisons, the IDEAL IMPLANT Structured Breast Implant and silicone gel breast implants are very different. The IDEAL IMPLANT Structured Breast Implant is filled with saline for a woman’s peace of mind. Saline is naturally absorbed by the body in case of a rupture, and a rupture can be easily detected by simply looking at the breasts. Without silicone gel inside there is no need for repeated MRIs and no anxiety about silent ruptures. The risk of complications such as rupture and capsular contracture are also much lower with the IDEAL IMPLANT based on clinical trial results at 8 years. That means the cost of your primary breast augmentation is likely the only cost you need to consider when asking how much do breast implants cost.

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.


Case 61: The concerns in this case were crookedness and a significant breathing issue due to a severely deviated septum. She also felt her nose was over-projected and a little too big for her face. Here we can see resolution of her crooked septum on base view. The tip has been defined and de-projected and the bump brought down to create a naturally pretty and more balanced contour.
The breast implant has no clinical bearing upon lumpectomy breast-conservation surgery for women who developed breast cancer after the implantation procedure, nor does the breast implant interfere with external beam radiation treatments (XRT); moreover, the post-treatment incidence of breast-tissue fibrosis is common, and thus a consequent increased rate of capsular contracture.[108] The study Breast Cancer Detection and Survival among Women with Cosmetic Breast Implants: Systematic Review and Meta-analysis of Observational Studies, reported an average later stage in the diagnoses of women who developed breast cancer after undergoing breast augmentation, when compared to breast cancer patients who had not undergone breast augmentation, although this did not ultimately affect the patients prognosis. The use of implants for breast reconstruction after breast cancer mastectomy appears to have no negative effect upon the incidence of cancer-related death.[105][109]
The Summary of Safety and Effectiveness for each of the FDA-approved saline- and silicone gel filled breast implants details safety information known at the time of FDA approval. As the FDA learns of new safety information, it requires companies to update their product labeling. The most current safety information about saline- and silicone gel-filled breast implants can be found in the labeling.
Case 25: This patient had what is called a tension nose wherein a convexity on the bridge pushes the tip forward and down. Notice how this also puts tension on the upper lip and appears to tether it from inside. a combination of straightening, improving breathing, removing the hump, and setting the tip appropriately also helps to relax the upper lip and complete the look.
Fat is harvested from one part of your body, washed and purified, and then carefully reinjected with specially designed needles into the areas that need augmentation. It may be necessary to repeat the fat grafting procedure several times to achieve the desired result. Fat grafting can be explained as a three-stage process: (1) harvesting (2) purification and transfer and (3) placement.

Case 34: Hispanic Rhinoplasty in this patient meant removal of a high dorsal bump on profile and correction of a droopy-appearing tip. On front view, there is correction of a left nasal bone fracture and refinement of the nasal tip. All of this was done while still maintaining her unique individuality and while bearing in mind the various challenges Rhinoplasty in Latino patients present- thicker skin and softer cartilage.
The study Safety and Effectiveness of Mentor’s MemoryGel Implants at 6 Years (2009), which was a branch study of the U.S. FDA's core clinical trials for primary breast augmentation surgery patients, reported low device-rupture rates of 1.1 per cent at 6-years post-implantation.[49] The first series of MRI evaluations of the silicone breast implants with thick filler-gel reported a device-rupture rate of 1 percent, or less, at the median 6-year device-age.[50] Statistically, the manual examination (palpation) of the woman is inadequate for accurately evaluating if a breast implant has ruptured. The study, The Diagnosis of Silicone Breast implant Rupture: Clinical Findings Compared with Findings at Magnetic Resonance Imaging (2005), reported that, in asymptomatic patients, only 30 per cent of the ruptured breast implants are accurately palpated and detected by an experienced plastic surgeon, whereas MRI examinations accurately detected 86 per cent of breast implant ruptures.[51] Therefore, the U.S. FDA recommended scheduled MRI examinations, as silent-rupture screenings, beginning at the 3-year-mark post-implantation, and then every two years, thereafter.[22] Nonetheless, beyond the U.S., the medical establishments of other nations have not endorsed routine MRI screening, and, in its stead, proposed that such a radiologic examination be reserved for two purposes: (i) for the woman with a suspected breast implant rupture; and (ii) for the confirmation of mammographic and ultrasonic studies that indicate the presence of a ruptured breast implant.[52]
“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.”
Case 61: The concerns in this case were crookedness and a significant breathing issue due to a severely deviated septum. She also felt her nose was over-projected and a little too big for her face. Here we can see resolution of her crooked septum on base view. The tip has been defined and de-projected and the bump brought down to create a naturally pretty and more balanced contour.
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.
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]
Women with ruptured silicone gel implants also need to factor in downtime when asking how much do breast implants cost. Whether you take time off work, hire a babysitter for your kids, or make other accommodations while you recover from surgery, you need to factor in these costs. Dr. Jane Rowley, a board-certified plastic surgeon in Lubbock, Texas, explains the difference between removal of silicone gel implants and the IDEAL IMPLANT, “there’s a big difference between removing a ruptured IDEAL IMPLANT and a ruptured silicone gel implant. A ruptured IDEAL IMPLANT can be removed easily with a local anesthetic. A silicone gel implant, if they’re not ruptured, can come out that easy. But if they are ruptured, most of the time its stuck, and it bleeds, and you have to put drains in. So it’s not an easy recovery, it’s not an easy surgery. With an IDEAL IMPLANT I can almost guarantee them ahead of time, if your implant is leaking it will be easy to remove and replace, you will be back to work in a day or two at the most. With a silicone gel implant I’ll say, ‘I don’t know what your recovery is going to be, it might come out easily, it might not come out easily. You might need to take week off work, you might have to take two days off work.’”
I love so many of my features. For instance, the green eyes I got from my mom, my naturally full lips, and smile, but my nose has been a source of insecurity. Around 15, as puberty hit, my nose just...changed. One day, it suddenly looked large and awkward, with a pronounced bump and protruding tip that I simply didn't identify with. I'd catch my profile in the mirror and be uncomfortable with the face staring back.
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]
In some cases, a breast lift alone may not achieve a patient’s desired results. If you feel your breasts look “deflated” or have lost volume due to aging, weight loss, or pregnancy, your cosmetic surgeon can place breast implants during breast lift surgery to restore fullness and shape to the breast. If you have always wanted larger, lifted breasts, a breast augmentation with lift can help you achieve both with a single procedure and recovery.
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.

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.
Saline-filled Breast Implants. Saline-filled breast implants are filled with sterile saline (salt water). They come in both smooth and textured shells and can be round or anatomically (tear-drop) shaped. Saline breast implants are also available in low and high profiles, and in many sizes. A saline-filled breast implant is usually empty before implantation. The doctor moves it into place during your surgery, and then fills it. The saline is administered via a process that ensures the implants remain sterile.
After reviewing the medical data, the U.S. Food and Drug Administration concluded that TDA-induced breast cancer was an infinitesimal health-risk to women with breast implants, and did not justify legally requiring physicians to explain the matter to their patients. In the event, polyurethane-coated breast implants remain in plastic surgery practice in Europe and in South America; and no manufacturer has sought FDA approval for medical sales of such breast implants in the U.S.[93]
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