FAQ / My Response & My Recommendations

The information provided below on procedures and associated risks are to be used as a reference only, as only on consultation can your expected results be discussed and agreed upon with your surgeon. At All About Beauty we feel you should be fully informed prior to making any decisions.

Many people request information on a thread lift or feather lift, I have provided some information below for you on face lift procedures.

General Risks of Surgery:

No surgical procedure is risk free, but fortunately, in the hands of a skilled surgeon, complications are seldom and usually correctable. Your plastic surgeon can and should do several things to reduce your chances of unwanted results.

You will be advised to stop medications previous to surgery that can promote bleeding, and you will be required to have pre surgery tests to ensure suitability and safety to make certain that it is safe to proceed.

Your surgeon offer you specific pre- and post-operative orders that are carefully intended to minimize your risk of complications. While serious complications are rare, they do occur from time to time, even with the most skillful surgeons under the strictest conditions.

In some instances complication risks frequently have to do with the patient's health and emotional well being. If a person is not physically healthy or has a history of illness that might boost plastic surgery risks, they should be advised against having plastic surgery.

Certain types of medications and supplements may also increase surgery risks so it is imperative that these issues be discussed prior to surgery. Smoking and alcohol consumption can also add to surgery risks and should be stopped prior to surgery as recommended by your surgeon. Smoking can lengthen the time it takes for a patient to recover from surgery and may make scarring worse.

As with all surgical measures, there are surgery risks due to anesthesia complications. Numerous types of surgery are performed under a general anesthesia. The following surgery risks involve complications with anesthesia: abnormal heart rhythm, blood clots, airway obstruction, brain damage, heart attack, stroke, temporary paralysis, and even death. It is important to keep in mind that these surgery complications are rare and there are a number of things that a good anesthesiologist can do to alleviate these surgery risks.

Surgery risks can be greater for patients who are undergoing multiple procedures at the same time. This is due to the fact that a patient is under general anesthetic for longer periods of time and there is more trauma linked with multiple procedures. Amplified operating time can increase the surgery risks of developing blood clots and other serious complications.

Plastic surgery risks also involve complications in the outcome of the surgery. In some cases surgical errors can result in subsequent problems in plastic surgery results. Surgery risks can include asymmetries in the surgical area, irregularities, dimples, puckers, and divots. Other more serious surgery risks are long term or permanent loss of sensation, or tingling in the exaggerated area caused by nerve damage. Sarcoma development can also occur as fluid collects under the skin after some types of surgical procedures. Skin death can also occur if infection or bleeding plastic surgery risks occur after the procedure is over.

Tear Drop Implant. Not recommended:

• Teardrop, Anatomical and Contour:  These are some of the names given to implants that were designed to create a more mature or sloping look at the top of the breast. Teardrop implants are rarely used because once inserted under the muscle they don't seem to maintain that sloped look and don't appear as natural looking as the round implants.
• Tear drop implants also have higher incidence of turning and complications.
• Round or Standard:  These implants look the most natural and are used most of the time.

 

What is SmartLipo? Not recommended:

Using a laser passed under the skin the laser melts the fat and liquefies it. Small areas then can be left for the body to absorb the fat without using a cannula. For larger areas a cannula must be inserted to aspirate the liquefied fat.

I think this will have the most benefit for tiny areas, but for larger areas this will have little advantage because a cannula must still be used. A potential advantages may be more skin tightening, however, burning the skin from the heat of the laser is a real possibility.

Breast Augmentation Complications: Capsular contraction, what is it ?
After placement of an implant, your body will form a barrier around the implant called a capsule.  This natural tissue is your bodies normal response to breast augmentation.   If the capsule stays soft and pliable, your breast implants will feel soft to touch.  If the capsule tightens a little, your breast implants may feel a little firmer to you, while still maintaining a good shape.  Severe tightening of the capsule, is most often associated with the term "capsular contraction" and can lead to distortion of breast shape and hardness to touch.

The good and bad of varying degrees of capsular tightness :

• Sometimes it is beneficial to have a little capsular tightness, even though it may feel a little firmer. Some of the women like how it creates more fullness in the upper breast.
• Severe capsular contraction can make the breast shape distorted or too round and unnatural looking, requiring additional surgery.

Treatment of severe capsular contraction :

• Surgical release (capsulotomy) or removal of the capsule (capsulectomy) around the breast implant.
• Accolate - an asthma drug which can be effective in treating capsular contraction following a capsulotomy or capsulectomy. This drug should be taken for 6 months.

Rippling: What is rippling and how does it happen?
Rippling or visible waves in the breast skin can happen on rare occasions.  This rippling is caused by the implant folding as you move or lean forward.  If you are extremely thin and have very little breast tissue to cover the implant when it is folding, you have a greater chance of developing rippling.

Ways to minimize rippling :

• Smooth implants, unlike textured implants move around in the breast pocket and are less likely to show a visible fold.
• Overfilling saline implants helps to avoid implant folding.
• Sub muscular placement:   This extra layer of coverage over the implant may also help to hide the implant folds.
• Silicone implants have a thicker inner core and are less likely to be visible.
  

Double bubble: What is it?
A double bubble is seen when the implant is placed under the muscle in sagging breast.  The breast tissue rolls off the top of the implant and implant is seen as a bulge under the natural breast at the very bottom. Sometimes accepting a small double bubble is a reasonable compromise, if you do not want to have additional scars from a Breast Lift.

Ways to minimize a double bubble:

• A sub glandular (on top the muscle) placement may avoid this
• A Breast Lift first, with good shaping, followed a few months later with a breast implant.
• Sometimes a sub-pectoral placement with 1/2 the implant under the muscle will avoid this.

Face Lifts:

Contour Thread Lift and Feather Lift? not recommend :

The thread lift uses small incisions in the hair to passed barbed sutures into the face, that when pulled upwards hook on to the tissue under the skin to lift it upward.
The Contour Thread Lift and Feather Lift suffer from the following disadvantages:

• Very costly, with minimal changes to the face.
• Not a good procedure for correction to the jowls or neck.
• It is not long lasting- probably 1 year or slightly longer.
• The barbed sutures may break, stretch or work their way through the skin requiring additional minor surgery to remove the visible barbed end.
• Difficult to move a large area of tissue with a suture to get more than subtle results.

Estimated cost, $8,000 plus costs for ongoing adjustments

What is an S-Face Lift?
The S-Face Lift has an incision in front of the ear and also tightens the supportive muscle system (SMAS), but unlike the Limited Incision Face Lift does not have the ability to pull this SMAS both an upward and backward for better muscle tightening.

What is a Mid- Face Lift?
You should consider this if you have early signs of aging, such as a sagging mid-face which means the cheek and lower eyelid area. You might see a deepened of the folds of the lower cheeks called the nasolabial folds.

Non-Surgical Face Lifts
Poor substitutes for a surgical Face Lift, as they do not tighten the face, jowls and neck area like surgery.

More Information about a Face Lift Procedure

• Tightens the neck, jowls and lower face, eliminating many wrinkles
• Surgical time 3-5 hours
• 8-12 years, depending on the skin texture and tone
• Anesthesia: General
• Swelling and bruising lasts for a few weeks
• Full recovery without limitations is 3-4 week

Breast Augmentation:

Sub muscular or Sub glandular: Which is best for me?
This is the most misunderstood concept about breast augmentation.  Women will request sub muscular (under the muscle) placement without knowing why and whether it is appropriate for their needs.  If you are seeking beautiful breasts in addition to larger breasts, then sometimes it is better to place the implant sub glandular (on top the muscle).   

Sub muscular (underneath the muscle)
Breast implants will be placed under the muscle if your natural breast and nipple measurements are high.  An example of this would be; if you have small breasts, say an A or B cup, almost no looseness to your breast tissue.

Sub muscular placement will provide you with the following advantages:

• This additional layer to cover the implant makes it less likely to see or feel the implant.
• Sub muscular implants make it easier to read a mammogram for breast cancer detection.
• During normal activities the contraction of the muscle massages the implant, which can help keep the breasts softer after a Breast Augmentation.

Sub glandular (on top of the muscle)
If you are a little older, heavier, had children and your breast tissue has sagged to the bottom of your breast, you may need a sub glandular breast implant placement.  Because your Pectoralis muscle is located high on your chest, if the breast implant is placed under your muscle it will not be low enough to shape you properly.  This can result in your natural breast rolling off and falling below the implant, pushing your nipple downward.  Sometimes this is called a double bubble. An example would be: if you have a small C cup, 10 pounds heavier than you want to be, with a nipple distance of 22cm as described above.

Sub glandular placement will provide you with the following advantages:

• Give you a better shape than sub muscular if you fit the criteria described above.
• Sub glandular can help even out your breast shape more than sub muscular if your breasts sag.
• You will have less pain and easier recovery.
• You may be able to avoid a full Breast Lift (Mastopexy), by placing the implant subglandular.
  

Smooth or textured implant surface: What implant surface I like to use?

• For Sub glandular-Textured coating:  Generally, the textured coating is designed to adhere to the implant capsule and inhibit the capsular contraction (hardening of the tissue around the implant).
• For Sub muscular - Smooth coating: The smooth implants are better as they move around in the implant pocket and are less likely to be visible.  Textured coating is unnecessary, because the contraction of the muscle massages the breast implant and helps to keep it soft.  Smooth implants also last longer than textured implants.

I like to replace ruptured textured implants that are sub glandular with new smooth surface implants.  

Size: What is the best size for my body?
The most common requested cup size is a C.    However, if you are a petite woman or a large woman, than a full B cup or D cup respectively, may produce a more natural look.

Both saline and silicone Mentor brand breast implants come in several profiles; moderate, moderate plus and high.  If you take each breast implant profile with the same volume (e.g. 300cc) and set them all on a table next to each other, you would notice that the moderate profile breast implant is the widest and lowest and that the high profile breast implant is the narrowest and tallest.  The moderate plus profile breast implant falls in between the other two.  

My breasts sag and I would like an augmentation to increase fullness:
A Breast Lift will be required when inserting the implant at the same time.

Safety: Are breast implants safe?     
All breast implants have a silicone outer shell and some type of filler.  The filler material is either saline used in intravenous solutions or silicone gel.  Although there has been much controversy about silicone gel, current studies do not demonstrate a causal relationship between silicone and diseases such as Rheumatoid Arthritis or cancer.  The FDA released silicone implants for general use in November of 2006, after years of restrictions and further testing.

Saline or Silicone - What are the pros and cons of each type?

Silicone: Tends to be softer and more natural in feel and appearance.
                  Attends to last longer.
                  More difficult to replace if there is a rupture of the outer shell.
                  Can provide less fullness at the top of the breast, for women who like a more sloped look.

Saline: Adjustable, which especially valuable in those women with two different size breasts.
                  Very easy to replace if the outer shell of the breast implant fails.
                  Easier to see the breast when performing a mammogram.

What about Silicone breast implants ?
The silicone gel breast implant is different now, then prior to 1990.  That is because the gel is cohesive, rather than liquid. The most widely used Cohesive Gel breast implants are Mentor Corporation's Memory Gel implant. Mentor are one of the most reputable companies because they have been manufacturing breast implants for many years

Breast feeding: Is it possible after breast implants ?
The answer for is most likely.  However, some women are unable to breast feed after having an enlargement.   I do think it is best not to get a periareolar incision if you are thinking about breast feeding, because this incision requires more cutting of ductal breast tissue needed during milk distribution.

Mammogram's: ?     
Most of the time breast implants make it slightly more difficult to read a mammogram.  Saline implants are easier for the radiologist to interpret your mammogram, because they block the x-ray less than silicone.

In some women who are very flat, a breast implant will actually aid in performing a mammogram by allowing the x-ray unit to hold, compress and position the breast better.In some cases a mammogram is requested prior to a breast augmentation, generally around 35 years of age.  After surgery it may take up to 6 months before the effects of surgery will allow for an accurate reading of a mammogram.

Rupture: Why does this happen?     
Implant failure or deflation can result from the following: normal wear and tear as the implant folds on itself with movement of the body, or a accident that may incur a hard blow to the chest.

Liposuction:
Liposuction, liposulpture, lipo contouring are all the same thing.  The basic principal is to pass a cannula under the skin and withdrawal fat under negative pressure.  Small cannula size is important, so as not to take out to much fat at one time.  In liposuction, like most things, it is easy to remove more than to put back.  Areas that respond the best are chin, abdomen, thighs and buttocks, knees and arms.  Other areas can be addressed, but the fat is more difficult to remove, since it has a different texture.

Results

After targeted areas of fat have been removed, our patients notice that their body features appear to be more in proportion with each other. Lumps and bumps give way to smooth contours, improving the fit of clothing and, in many cases, enhancing self-esteem.

Abdominoplasty (Tummy Tuck):

Abdominoplasty, also commonly called tummy tuck, is a comprehensive procedure that not only removes excess fat and skin from the midsection but also tightens the abdominal muscles for a firmer, flatter appearance.

Good candidates for abdominoplasty include patients who have reached their weight loss goal, yet retain flabby areas in the abdomen, as well as patients who have weakened abdominal muscles or excess skin due to aging, weight loss, or pregnancy.Women considering abdominoplasty should wait until they have given birth to their last child, as a pregnancy tends to undo the beneficial effects of the surgery.

The incision for abdominoplasty is made horizontally across the lower abdomen. In most cases, the scar from this incision can be hidden by underwear and swimsuit bottoms. The doctor may also make a second incision to allow the belly button to be moved. After excess fat is removed, the surgeon tightens the abdominal muscles and secures them in their new positions. Any excess skin is removed, and then the incision is sutured closed.

Abdominoplasty is often performed in conjunction with liposuction for the most natural results. Depending on the desired outcome and the existing condition of the muscles, some patients may be eligible for a version of abdominoplasty that uses a smaller incision.

Recovery

After abdominoplasty patients are required to wear an elastic compression garment that will need to be worn for about three weeks. Pain medication can be taken to control the discomfort caused by the surgery. Depending on the patients' pre-surgery fitness level, they may expect to return to work and other activities between two and four weeks after abdominoplasty.

Blepharoplasty

Lower eyelid surgery is performed to tighten up the loose skin and  remove the bags under the eyes. There are two fat pads in the upper eyelid and three in the lower eyelid. When these are bulging and creating puffiness, the fat pads are either removed or repositioned to fill in hollow areas.  
The most common is an just under the eyelashes of the eyelid. This is called the subciliary incision. With this incision skin is removed.

• General
• Surgery time 1 to 2 hours
• Same day surgery
• Most persons also need a Brow Lift
• Possible bruising which might last 2 weeks
• Relatively pain free surgery

Brow Lift ?

If it appears your eyes are drooping, feel heavy and you see puffiness, bags or looseness in the skin around the eyes, your probably ready for a brow lift and/or eyelid surgery. 

The Brow Lift is an excellent procedure to achieve a more  youthful appearance in the eye area.  It has very little postoperative pain associated with it and a quick recovery time. 

• Elevates the brow into a most pleasing position
• Less eyelid skin will need to be removed
• Surgical time 1-2 hours
• Usually lasts 8-12 years, depending on the skin texture and tone
• Anesthesia: General
• Swelling and bruising lasts for a few weeks
• Full recovery without limitations is 3-4 weeks

Gynecomastia: (breast enlargement) 

A condition referred to as pseudo-gynecomastia or false gynecomastia mimics true gynecomastia.  In pseudo-gynecomastia the breast enlargement is due to fat deposits rather than true glandular enlargement.

Treatment consists of excision of the firm glandular tissue through a semicircular incision placed at the base of the areola, similar to that used in breast augmentation. Liposuction is often required to contour the remaining breast area which has fat interspersed with the enlarged glandular tissue.

• Anesthesia: General preferred
• Surgical time: 11/2 to 2 hours
• Recovery time: 3-4 week

Restylane (Hylaform):

Restylane contains hyaluronic acid which is a substance present in all human beings. It works in skin by combining with water in your tissues to create volume, and therefore a more youthful and healthy appearance. Restylane contains hyaluronic acid in the form of a crystal-clear gel injected into the skin to lift the lip, wrinkle or fold. Once in the skin, Restylane works together with the body's own hyaluronic acid and joins forces to create volume.

Restylane can last anywhere from 4-12 months. After the first injection a touch-up in 2-4 weeks may be necessary.

Injections are usually put into the frown lines, lines around the mouth (nasolabial folds and marionette lines), to fill the lip for more fullness and into the lip lines.

Restylane is used for filling lines that are seen when your facial muscles are relaxed. If you are trying to prevent the wrinkles from appearing with motion or to prevent wrinkles from deepening, then Botox® should be used instead or with Restylane.

It is most common to do a small nerve block around the mouth when using the filler in this area.

Restylane has been shown to be a safe product and has been available for many years in Europe.

Do not apply ice, excessive heat or massage the area for about a week as this may breakdown the Restylane quicker.

After the injection you may see some redness or swelling for 2-3 days.

Restylane does not have to be tested for allergies

       Other trade names for hyaluronic acid are Perlane and Hylaform

Breast Reduction:

The Breast Reduction is a common operation, which both reduces the volume of the breast and reshapes the breast.  Women seeking breast reductions are generally seeking relief from the symptoms they cause.  These include; pain, back and neck aches, poor posture, numbness of the fingers and rashes under the breast.

The operation involves reducing the size of the areola, reducing the volume of the breast and advancing the nipple and areola up into a more appropriate position.

The Anchor Incision Breast Reduction is used on very large breasts whose nipple position is very low.

• Length of surgery - 2-4 hours
• Anesthesia - general
• Same day surgery or short hospital stay
• Full activities resumed in 3-4 weeks
• Breasts shaping takes place over months

Rhinoplasty:

Female noses are easier to shape because the skin is less thick and oily and if your nose is very large it is impossible to make it small.

• Usually a small incision is placed on the middle column of the nose. The advantage is so great with this incision that it is used in almost all Rhinoplasty procedures. This incision allows direct access to the cartilage and bone structure of your nose for better shaping.
• Anesthesia: General
• Operating time: 1-3 hours
• May receive Internal nasal packing for few days
• Possible Splint to the nose for about 7 days
• Bruising for 1-2 weeks
• 4 weeks before a return to full activities
• Swelling will decrease over a matter of months.

Lasers for skin rejuvenation:

Their are two lasers that are most popular for skin rejuvenation.  The pulsed CO2 laser and the Erbium-YAG laser.  Each laser works by vaporizing the water within the living cells, thereby shaving off layers of skin cells with each pass of the laser. The CO2 laser is much more effective in both removing wrinkles and tightening the skin.  As with any treatment to the skin, the results vary depending on the depth.

Generally, you should expect some crusting and possibly scabbing up to 2 weeks, followed by redness to the skin which can last from weeks to months. 

BOTOX®

• BOTOX®is a purified protein toxin produced by bacterium
• To date there have been no serious side effects related to the injection of BOTOX®
• Only small amounts of BOTOX®are used and therefore it does not spread throughout the body
• BOTOX®works by blocking nerve impulses, thereby weakening the muscle that is causing the wrinkle
• BOTOX®does not affect the nerve itself, so there is no numbness in the area of injection
• Most common areas of usage are: frown lines, horizontal forehead lines and the lines at the corner of the eye
• The effects of BOTOX® usually last 3-5 months and sometimes longer with repeat injections
• In rare instances, some individuals see little effect from BOTOX®
• Some wrinkles are caused by skin laxity and cannot be corrected by injecting BOTOX®
• BOTOX® seems to help relieve migraine type headaches in some people

Risks of BOTOX®Injections

Although the long-term results of BOTOX®are not known, it has been used to treat eyelid muscle twitching and for wrinkle therapy for about 10 years Temporary drooping of muscles, other than those intended for wrinkle therapy resulting in a droopy eyebrow, eyelid, lip or looseness of the neck area.
This unwanted effect is not common and lasts for a few weeks

Hypersensitivity to BOTOX®

What to expect

• Redness and swelling for a few days at the injection site
• Bruising may result from the injection and may last a few weeks
• The effects of BOTOX® will begin to become noticeable in 3 to 5 days

My research continues to be a lifelong project and a full time pursuit. I am eternally grateful to my fellow cosmetic surgery patients who have generously contributed details of their case histories over the years. I am also grateful to the outstandingly talented medical professionals who took the time to teach me the things I wanted to learn and helped me realize my vision through their expertise in the operating theatre. We have all learned and worked together, and will continue to do so as we grow older together.

This site is not intended to be used as medical advice and should not be used to assess the suitability of any patient for any surgical or non surgical procedure. This site provides an overview of available procedures, and how they are best performed, and the anticipated result, that one would hope to achieve. Questions and answers have been provided as a reference and general risks of surgery for your information. Christa Bradley is not a medical practioner and any information provided must be cleared by your surgeon at the time of consultation.