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.
Cosmetic surgeons may use the “crescent lift” technique for women who have a very small amount of sagging to correct. This involves a small incision running halfway around the top half of the edge of the areola. Usually, a crescent lift is only done when a patient is also having breast augmentation, and even in these cases the crescent incision type is less frequently used.

Case 39: The facial plastic surgeons at PROFILES Beverly Hills tailor every Rhinoplasty to achieve just what you are looking for. Sometimes, the most subtle of changes take just as much effort as the most dramatic ones. This pretty model didn’t want to drastically change her look. Her Los Angeles Finesse Rhinoplasty gave her the refinement she wanted, especially on her front and three-quarter views. Along with fat transfer to the lower eye area, her overall look was softened to make her that much more camera ready. 

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.
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] 

Women who are experiencing mild sagging, yet still will benefit from a breast lift, are often good candidates for a peri-areolar lift. This involves a circular incision running around the edge of the areola, and like the crescent lift, is commonly performed in conjunction with breast augmentation. This lift can also be effective in helping reduce areola size. The resulting scar traces the edge of the areola.

The amount of time the procedure takes is also an important factor. The longer and more complicated the procedure, the more you can expect to pay for it. This is why a breast augmentation with fat transfer and a breast lift with implants cost more than a standard breast augmentation with implants. Some surgeons include their fee in the price they give you for your entire procedure. Be sure to ask during your consultation! 

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.

Case 88: The goals of this septorhinoplasty were to straighten her crooked nose and improve breathing. She also hated how her nasal hump and length brought attention to her irregular profile. In our opinion, the mark of a good rhinoplasty is that the nose should become a background feature, and she’s very happy to have achieved that goal with her Profiles rhinoplasty.
Dr. Mess receive patients from many for Washington DC and nearby cities and performs the fat transfer in her office in Columbia, Md, at Northwest Hospital near Baltimore, and at Howard County General Hospital. There are different techniques for fat transfer depending on the area being treated; small volume to face and hands vs. medium volume to enhance breast reconstruction vs. large volume to enhance buttocks and augment breast without implants. Common donor sites are the patient’s abdomen, thighs, or love handles.  The fat is suctioned by hand for small volume and by liposuction machine for large volume.  The fat is gently separated to concentrate the viable fat from fluid and nonessential matter.  The concentrated fat is re-injected into the desired area with small cannulas designed to maximize the survival of the transferred fat.  Dr. Sarah Mess has spent years refining her fat transfer technique to offer her patients outstanding fat transfer outcomes.
Both saline-filled breast implants and silicone-filled implants have an outer shell composed of silicone elastomer. This shell is basically a flexible envelope that contains the implant filling. In the case of some anatomically shaped implants, the shell also gives the implants shape. Some models of implants have a "double lumen." This is an elastomer envelope inside of another elastomer envelope (sort of like double-bagging your groceries) which may reduce the risk of implant rupture.
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:

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.
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.

Dr. Kolker then laid out his surgical plan for me: He'd perform an open rhinoplasty, explaining that the difference between an open and closed procedure amounts to a small incision on the underside of the columella (that skinny strip of skin between the nostrils), which can be seen only from below and fades rapidly. Both procedures require incisions inside the nose, but an open rhinoplasty adds that small columellar incision.

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:
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]
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.

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.
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]
Dr. Rotemberg will examine the area of your body you would like to improve upon for muscle strength, skin elasticity, and fat loss, as well as the area in which she believes the fat should be transferred from. At this time, she will also ask you pertinent medical questions, and do a full exam, to make sure you are a good candidate for any procedure.
This includes the cost of the implants, which ranges from $1,000 to $1,300 as well as a facility fee of $800 to $1,200, an anesthesia fee of $600 to $800 and the surgeon's fee that averages $4,005 for silicone-gel filled implants and $3,583 for saline implants. Patients in the western United States can expect to pay the highest average surgeon's fee of about $3,949, while patients in the south central part of the country generally pay lower fees with an average of $2,739.
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.

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4. Last but not least, your preference matters a lot!  Before surgery, I ask my patients to bring photos of buttock shapes that they like.  This helps me understand how much of a buttock size increase and shape each patient desires.  Some patients like a more curvy, rounded shape with wide hips (hour-glass figure) while others prefer a more projected or athletic shape.  Your preference of buttock outcome is a very important factor in the decision of how much fat is transferred, so I spend a lot of time with each patient before surgery to understand your goals and express what I think can be achieved.  Good communication between patient and surgeon is very important to achieving optimal surgical outcomes.

Case 4: 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.
Since the early 1990s, a number of independent systemic comprehensive reviews have examined studies concerning links between silicone gel breast implants and claims of systemic diseases. The consensus of these reviews (outlined below under Safety of Breast Implants heading) is that there has been no evidence of a causal link between the implantation of saline or silicone breast implants and systemic disease After investigating this issue, the U.S. FDA has concurred and since reaffirmed that “the weight of the epidemiological evidence published in the literature does not support an association between fibromyalgia and breast implants.”. A comprehensive systemic review by Lipworth (2011) [66] concludes that "any claims that remain regarding an association between cosmetic breast implants and CTDs are not supported by the scientific literature".

The amount of time the procedure takes is also an important factor. The longer and more complicated the procedure, the more you can expect to pay for it. This is why a breast augmentation with fat transfer and a breast lift with implants cost more than a standard breast augmentation with implants. Some surgeons include their fee in the price they give you for your entire procedure. Be sure to ask during your consultation!
When talking about the price with your plastic surgeon, it’s important to know exactly what the cost covers. Is it just the surgeon’s fee? Or will it cover anesthesia, facility fees, implant cost, medical tests, pre- or post-op appointments, and medical supplies you’ll need during recovery? Do you need to purchase a specific bra for recovery or will they provide one?
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.
Dr. Rotemberg will not only explain to you what to expect during the recovery process, will also detail the recovery process in take home instructions for you. She wants her patients to know that recovery is not a one size fits all, and while she creates an individualized program for recovery for each patient, she knows that questions and concerns may come up during this period. She would prefer if you have any questions or concerns at any time during the recovery process that you contact her or her friendly and knowledgeable staff.
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]
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.
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