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.


Case 47: This patient’s primary surgery left her with valve collapse, nostril notching, persistent tip rounding and hanging columella. Secondary surgery involved correction of these issues with repositioning and reconstruction of the tip cartilages to improve tip contour. Although she is still a little swollen in the after photos, she is already happy with her new nose.


Implants come in various sizes, and your surgeon will guide you on choosing the right size to help you achieve the look you desire. In addition, your surgeon will help you decide whether you want a more natural, teardrop shape or a more rounded look. Implants also come with either smooth our textured shell surfaces, and your surgeon will help you decide which is best for you.
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.
When Kelsi took me home shortly after I woke up, I felt fine. We talked and watched TV, then I dozed off for a bit. I couldn't stay awake for more than an hour or two before needing to rest. My throat was raw from the breathing tube. And it hurt to laugh. When the hospital meds wore off, I had a full-on headache, almost like severe caffeine withdrawal. But the discomfort never got so bad that I needed Percocet; Tylenol alone made it manageable. That first night, I thought I'd sleep terribly, but I was out cold from 9:30 p.m. to 6 a.m. It was tricky settling in, though, because I had to sleep with my head propped up on several pillows to minimize swelling, which isn't exactly easy for a side sleeper.
Manufacturer’s warranty programs can mitigate some of the costs of treating complications. But, the warranty payment is only available if a rupture is detected. Some surgeons fail to inform their patients of the need for periodic MRIs, or downplay the FDA recommendation in order to make a sale. “Many women don’t know about the maintenance costs and potential expenses of silicone gel implants,” reports Dr. Ellen Mahony, board-certified plastic surgeon in Westport, CT.  “Because rupture with a silicone gel implant is ‘silent,’ it can go undetected for an extended period, often not becoming obvious until the process of capsular contraction has begun.” Capsular contraction leads to a more complex surgery. That means added surgical costs which your warranty may not cover.
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.
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.

For the second part....it depends where your butt is starting at. There is a point in which there is too much pressure in the butt that no more fat can really be injected. Pressure kills the fat cells (which is why you cannot sit on the butt for a few weeks after surgery). It also means that we cannot just keep injecting if the gluteus has fully expanded and is not able to take any more. If you are starting with a small butt.....there is a smaller limit. If you are starting with a medium sized butt.....there is a bigger limit. I like to use power assisted "vibration expansion filling" to really push the boundaries of how much fat can be injected into the buttocks. This helps to expand the buttocks on the table and get more fat into more stubborn areas. Typically, even for smaller girls, I will inject at least 1000ml per side (and up to 1600ml for larger girls). After this, as you have probably read, 30-50% of the fat will either reabsorb or "not take". However, with the removal of a large amount of fat around your midsection combined with careful technique and contouring of the butt and hips, we can make a very large difference in your overall proportion. Best of luck to you!
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.
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.”

The U.S. Food and Drug Administration established the age ranges for women seeking breast implants; for breast reconstruction, silicone-gel filled implants and saline-filled implants were approved for women of all ages; for breast augmentation, saline implants were approved for women 18 years of age and older; silicone implants were approved for women 22 years of age and older.[120] Because each breast implant device entails different medical risks, the minimum age of the patient for saline breast implants is different from the minimum age of the patient for silicone breast implants—because of the filler leakage and silent shell-rupture risks; thus, periodic MRI screening examinations are the recommended post-operative, follow-up therapy for the patient.[121] In other countries, in Europe and Oceania, the national health ministries' breast implant policies do not endorse periodic MRI screening of asymptomatic patients, but suggest palpation proper—with or without an ultrasonic screening—to be sufficient post-operative therapy for most patients.

Platinum is a catalyst used in the making of silicone implant polymer shells and other silicone devices used in medicine. The literature indicates that small amounts of platinum leaches (leaks) from these implants and is present in the surrounding tissue. The FDA reviewed the available studies from the medical literature on platinum and breast implants in 2002 and concluded there was little evidence suggesting toxicity from platinum in implant patients.[67] The FDA revisited this study and additional literature several years later, reaffirming prior conclusions that platinum catalysts used in implants is likely not ionized and therefore would not represent a risk to women.[68]

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.
Since the late nineteenth century, breast implants have been used to surgically augment the size (volume), modify the shape (contour), and enhance the feel (tact) of a woman's breasts. In 1895, surgeon Vincenz Czerny effected the earliest breast implant emplacement when he used the patient's autologous adipose tissue, harvested from a benign lumbar lipoma, to repair the asymmetry of the breast from which he had removed a tumor.[110] In 1889, surgeon Robert Gersuny experimented with paraffin injections, with disastrous results.[further explanation needed]
We strongly recommend you choose an implant type with your surgeon, who will be able to match the right type to accomplish your desired results. All available implants are considered good, safe choices. However, this article will explain the pros and cons of each of the three main types of breast implants so you can get an idea of what might be the best fit for you.
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.
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