Patience is important after your mommy makeover

patience is important after your mommy makeover

Motherhood is a beautiful experience. Yet, while mothers adore their children, they are often left feeling unhappy with the ways pregnancy and childbirth have changed their bodies.

Loss of volume in the breasts, sagging skin, stubborn fat and weak or separated abdominal muscles are often the results of having one or more children, driving many women to seek a mommy makeover as a solution. This customizable procedure has the ability to transform the way a woman feels about herself.

However, it is critical that patients understand what to expect after a mommy makeover – including some of the stranger things that happen.

“Mommy guilt” is real

Mothers are told to always put everyone else first, and in many cases, may even be actively shamed for prioritizing their appearance, as if spending money or time on themselves is wrong. Given that plastic surgery is a major investment in yourself, opting to get a mommy makeover can leave you feeling guilty. It is easy to picture where else that money could have gone and how it could have benefited the rest of the family.

Then there is the guilt over “vanity.” This can be especially hard on mothers with daughters, as it is easy to think that by getting a mommy makeover, you have failed to demonstrate the self-confidence you want your girls to have. Yet for many women, getting plastic surgery is what they need to engage in positive self-talk and demonstrate the self-love they want their children to develop.

Keep in mind that giving yourself what you need to be your best is actually an extremely important and valuable way to care for your family. A happy, confident mother is better able to raise happy, confident children.

You have to rest – and that might be hard

A mommy makeover, especially one that includes a tummy tuck, requires a lot of downtime. During this time, there is no running after toddlers or picking kids up. Even dressing and bathing them is off the table. Many mothers struggle with the idea of not trying to do it all.

When you have to ask for help and then sit and watch others do what feels like your job, it can be stressful. Many women find themselves jumping back into things too early and harming their recovery. Do not give in to this temptation, as you could easily injure yourself. Gear yourself up for this mentally and get comfortable with the idea of relying on others, at least for a few days so you have time to heal.

Things take a while to settle down

The results of a mommy makeover are not fully realized the instant you leave the recovery room. Right from the start, there will be bruising, swelling and discomfort, but this is a normal part of the recovery process. It often takes weeks to feel fully like yourself again, and several months before all bruising and swelling has dissipated.

But even when you keep this in mind, it can be easy to feel panic when your breasts look too large or your stomach seems lumpy after surgery. Try to keep in mind that the results are coming and you need to be patient until you are a good six weeks into your recovery to have a good sense of your mommy makeover results.

Numbness can play tricks with your brain

After surgery, numbness, itchiness and tingling are common side effects in the areas where you had surgery. You might feel itchiness on your abdomen and try to scratch it, only to find that you cannot relieve the sensation. For many women, this is one of the weirdest things that happen after a mommy makeover. These sensations are a sign that the nerves and blood vessels are healing. Fortunately, these symptoms should subside as you continue to heal.

There are highs and lows

We tend to frame surgery as a physical experience, but it is an emotional one too. From feeling tired, to the healing process, to the effects of pain medications, it is normal for women who’ve had a mommy makeover to experience a lot of emotional highs and lows. Be prepared for mood swings and teary moments, and make sure your family and caretakers are ready for it as well. Don’t be afraid to take a nap when the lows hit, as they might be a symptom of being overly tired.

You might have moments of “regret”

Once healing is completed and final results are visible after surgery, the vast majority of women are happy to have gone through with their surgery. But during the healing process, it is common to experience moments of regret. This can take the form of panic, especially when your initial results don’t exactly match up with the vision you had in mind.

As you struggle to deal with various aspects of recovery, you might feel remorse that you elected to have a procedure that is temporarily limiting you. There is also typically worry about whether or not this was truly the right choice.

Understand that temporary regret and worries are normal, and just as much a part of the healing process as incisions closing and scars fading. So long as you understand what to expect after a mommy makeover, you should get through it without much trouble and find that you very much enjoy the results.

Starting your mommy makeover journey

If you think that a mommy makeover might be right for you, be sure to meet with a board-certified plastic surgeon for a consultation. You can use the ASPS Plastic Surgeon Match referral service to find ASPS member surgeons in your area.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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Want to go bigger or smaller? Maybe you need a breast implant exchange

breast implant exchange

Year after year, breast augmentation surgery ranks as one of the most popular aesthetic procedures in the world. This is thanks to its ability to completely transform a woman’s entire body as well as her sense of self.

While most patients are happy with their initial breast implants, for some, their bodies, as well as their aesthetic interests, change. If size is the main issue, going bigger or smaller with your breast implants can typically be easily achieved with a breast implant exchange.

Reasons for breast implant exchange

A dissatisfaction with the look of your initial breast implants, however, is only one of the many reasons why a patient may desire a breast implant exchange. Others include:

  • Changing aesthetic with age
  • Desire to switch from textured to smooth breast implants
  • Want to exchange the type of implant from saline to silicone
  • An issue with your breast implants such as capsular contracture
  • Need for a breast lift to address ptosis that may result from age, pregnancy and weight gain/loss

Furthermore, no breast implant lasts forever. Having said that, the old rule that a breast implant needs to be exchanged every decade is not clinically relevant. Assuming that you are happy with the look and feel of your breast implants and are experiencing no complications such as:

  • Swelling
  • Asymmetry
  • Malposition (implant has dropped out of position either below the inframammary fold or laterally towards the armpit)
  • Hardening of the capsule around the implant
  • Implant rupture

Breast implants can last for 10, 15, 20 years are longer. But if you are unhappy with the look of your breasts or suffering from a potential complication then it is time to schedule a breast implant exchange consultation.

Breast implant exchange consultation

The journey to your ideal breasts should always begin with an in-person consultation, preferably with a Board-Certified Plastic Surgeon. Thanks to its ever-expanding popularity, there are a lot of surgeons performing breast augmentation procedures in this country. Finding one that is board certified is a simple way to separate out those of us with the rigorous training and expertise to deliver exemplary results. This is particularly important whenever you are considering any kind of revision surgery.

During your consultation, your plastic surgeon will listen closely to what bothers you about your breasts. It’s a good idea to bring in your original surgical report and information about your implants, if possible, as well as photos of the new “look” that are you are wanting to achieve. Your surgeon will then perform a thorough physical exam, taking careful measurements. Choosing the right size implant is part art, part science, so I’m always looking for that sweet spot between your desired outcome and the physical limitations of your anatomy. No matter how big you might want to go, the width of the base of the implant has to fit within your chest wall.

Breast implant exchange procedure

For some patients, a breast implant exchange is as simple as switching out one size or type of implant for another. I typically use the existing incision lines to make the exchange.

However, there are exceptions for some patients:

  • Exchange a larger implant for a smaller implant
  • Have developed ptosis with time
  • Had a too large implant initially that has stretched the skin & tissues of the breast

These patients may require a more complicated procedure. Any time that a foreign device is placed in the body whether it’s a new hip joint or a breast implant, a capsule of “scar” tissue forms around the device. This is simply the body’s way of healing.

In cases where a patient is downsizing her breast implant or where there is an issue with the capsule such as capsular contracture, the capsule will need to be removed. Otherwise, the new, smaller implant will not stay in position. Then, there are those patients whose breast skin and tissue have stretched.

Breast lift with breast implant exchange

Father Time exacts his toll on the skin everywhere. With age, your body produces less collagen and elastin. The first provides support for the skin while the latter provides “snap back.” Other changes may include:

  • Pregnancy
  • Breastfeeding
  • Weight gain/loss
  • Menopause

These can all cause the skin and tissues of the breast to stretch and sag. This, in turn, can cause your breast implants to move out of their initial position. The best solution for this scenario is to combine a breast lift with a breast implant exchange.

The lift allows me to reposition your nipple so that it’s centered on the chest before exchanging your old implants for newer ones. The end result is a perkier, more youthful-looking breast. Additionally, many patients find that their breast aesthetic changes with age. What looked great at 20 may feel too large at 40 or 50. A breast implant exchange with a breast lift is the perfect procedure for addressing all of your breast aging issues at once.

If you are unhappy with your breast implants, schedule a consultation with a board-certified plastic surgeon to discuss a breast implant exchange. It will have you looking and feeling your best in no time.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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What is a labiaplasty and what does it involve?

what is a labiaplasty?

Even though plastic surgery is very common, very few people have heard about labiaplasty. You may have heard the name but may not have any idea what it is and which part of the body is involved.

Well, if you are here, then maybe you want an insight. Today we will give you some insight into labiaplasty and what it entails.

What is a labiaplasty?

A Google search may yield other terms like “vaginal rejuvenation” or “designer vagina,” however, the goal of this article is to first distinguish a labiaplasty from other forms of vaginal rejuvenation, then educate you on the actual labiaplasty procedure.

Vaginal rejuvenation is a broad term that encompasses a tremendous number of options for this ever-growing field of elective healthcare. New devices and treatments are entering the market almost every month, as more and more women are utilizing these treatments more frequently.

Therapies for “vaginal rejuvenation” typically include energy devices like lasers, radiofrequency and ultrasound just to name a few. Most vaginal rejuvenation procedures utilize some form of energy to accomplish a myriad of outcomes such as vaginal tightening, decreasing incontinence and eliminating vaginal dryness.

However, the FDA recently released a statement on these types of treatment, explaining that some of the manufacturers of these devices were not being totally transparent with the clinical claims of these devices.

The main difference between a labiaplasty and another treatment under the “vaginal rejuvenation” umbrella is a labiaplasty is a surgical procedure. The labiaplasty procedure aims to decrease the size of the labia minora (inner tissues of the female genitalia) so that it is flush with the labia majora (outer part of the female genitalia). This procedure involves utilizing several different surgical techniques depending on the patient’s specific situation. There are no energy devices required with a labiaplasty, and you will work with your plastic surgeon to determine the goals of your surgery.

Reasons for a labiaplasty

There are a host of reasons females have enlarged labia, including childbirth, aging, sexual activity and genetics. Females choose to have surgery for several reasons. First, there are several functional benefits when electing for a labiaplasty. Many females who suffer from an enlarged labia experience difficulty with exercise, hygiene, urinary tract infections, sexual activity and other physical activity.

Furthermore, with the increasing trend of wearing yoga pants, workout pants and swimming suits, an enlarged labium can make it difficult to wear such clothes. However, most female patients describe feeling extremely self-conscious when becoming romantically involved with their partners. These reasons and others are what females consider when choosing a labiaplasty.

Labiaplasty procedures

Initially, there was a single procedure for labiaplasty, and it was very popular as well. With the change of time and advancement in techniques, several techniques have evolved. Some of them are as follows:

Trim procedure

It is the original technique and is most natural to perform. It is also the most widely used technique used by surgeons. In this procedure, the excess part of labia minora is removed and sutured so that it is symmetrical with the labia majora.

Wedge procedure

In this procedure, a partial thickness wedge is removed from the thickest part of the labia minora. The submucosa (layer tissue beneath a mucous membrane) must be left intact by removing only a partial thickness. This procedure gives the vagina a natural look after the surgery as well, preserving the wrinkled edges.

There are several other techniques for reducing the labia minora, and all these techniques have certain advantages and disadvantages. If you are considering a labiaplasty, the key to ensure appropriate outcomes is to make sure you are going to a board-certified plastic surgeon that specializes in this procedure.

Anesthesia for a labiaplasty

Labiaplasty is an outpatient surgery. The procedure can be performed within an hour, either individually or with other cosmetic surgery. It can be performed under local anesthesia or general anesthesia, depending on the treatment plan discussed with your plastic surgeon.

Postsurgical care

The genital region of females is very sensitive and requires proper care in general. So, when undertaking a procedure like a labiaplasty, there are some post-operative instructions you need to be aware of before having the procedure.

You should avoid long showers and should pat the wound dry every time after washing. The antibiotics prescribed by the surgeon should be taken to reduce pain and inflammation, which can be present after the procedure Riding bikes, running and other physical activities will need to be avoided until you have been released by your plastic surgeon. Premature return to the activities can exert pressure on the wound and will unnecessarily delay the healing process. You should not wear tight clothes or undergarments as they cause friction against the wound. Also, you cannot indulge in sexual intercourse for at least four weeks.

Choosing to have a labiaplasty

Labiaplasty has functional and cosmetic benefits. Most women undergo surgery to reduce the excess labia which twists and turn and causes pain and irritation. Others want to restore their youthful look after childbirth or aging. Though the reasons are numerous, you should seek a board-certified plastic surgeon that understands the medical, mental and emotional factors of a procedure like a labiaplasty.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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Tackling common tummy tuck myths

tackling common tummy tuck myths

For men and women alike, a toned and flat stomach is considered to be the epitome of a fit, healthy and attractive figure. But whether due to genetics, childbearing, weight fluctuations or lifestyle habits, achieving that slim and smooth belly can feel impossible with so many factors actively working against you.

Tummy tuck surgery, otherwise known medically as an abdominoplasty, is a frequently requested surgical cosmetic procedure that helps patients attain the otherwise unattainable by tightening the abdominal muscles and eliminating excess fat and skin from the midsection for a more toned and sculpted stomach that lasts for years to come.

If you are bothered by the appearance of stretched skin, stubborn fatty deposits or weakened muscles in the abdominal region, tummy tuck surgery may be the perfect solution for getting the body you want. We’ve debunked some of the more common myths about tummy tucks to help you determine whether tummy tuck surgery is right for you.

Myth: Tummy tucks are a weight loss procedure

One of the more common misconceptions patients have regarding tummy tucks is that it is a surgery intended for those who would like to lose a substantial amount of weight from their midsection. However, a tummy tuck is not considered to be a weight loss or bariatric procedure.

In fact, the ideal candidate for tummy tuck surgery is someone who is at or close to a normal weight for their physique and who is otherwise active and healthy but is troubled by the appearance of a protruding abdomen or sagging, loose skin on their stomach.

That’s not to say that a tummy tuck won’t address excess fat within your abdominal region. Often times, liposuction techniques will be utilized during your tummy tuck surgery to gently minimize stubborn zones of fat that have proven resistant to diet and exercise to improve the contours and tone of your midsection.

While your stomach will be flatter and slimmer after your abdominoplasty, it will not drastically lower the number you see on your scale. For this reason, if you are considering a tummy tuck you should be within a reasonable range of your goal weight before undergoing the procedure but will also need to have maintained a stable weight for at least six months. Any future significant weight fluctuations can start to reverse the results of your surgery.

Myth: You can get tummy tuck results with diet and exercise

When it comes to getting the slimmer and sleeker stomach you desire, diet and exercise are well-known as the most effective tools in your toolbox for losing weight, building muscle and improving your overall health and wellness.

However, while each of us should incorporate eating right and exercising into their daily lives, traditional weight loss methods still have their limitations in terms of the results they can provide. No matter how much time or energy you put into these efforts, you cannot control where you will lose weight from and may still struggle with a stubborn belly even if you’ve hit your target weight.

Additionally, there are some aesthetic concerns that working out and eating right simply cannot address alone. Excess or stretched abdominal skin, for example, can usually not be reversed or tightened without surgical intervention, especially when it is a result of pregnancy or massive weight loss.

Childbearing or significant weight fluctuations can also weaken the abdominal muscles and stretch the inner girdle of connective tissues known as the abdominal fascia, which only further exacerbates the appearance of a protruding belly. If your skin, abdominal wall or fascia have become stretched, tummy tuck surgery is the only way to restore a taut and youthful midsection.

Myth: Tummy tucks are only for women

Tummy tuck surgery was the fourth most popular cosmetic surgery among women in 2018 with 152,446 women undergoing the procedure. Abdominoplasty has been an incredibly popular cosmetic option for women for years, in part due to the many irreversible changes to the midsection that accompany pregnancy and childbirth, such as stretched skin and abdominal muscles.

A tummy tuck is frequently included in “mommy makeover” procedures, which refer to a full suite of cosmetic surgeries performed concurrently to help women restore their pre-baby body and men to regain a leaner physique.

While women did make up for 96.8 percent of the total tummy tucks performed in 2018, men can also benefit from this procedure. Tummy tuck surgery was the fifth most popular cosmetic surgery for men in 2018. While men may not have to worry about the physical changes that women’s bodies endure from pregnancy, they are not necessarily immune from developing a “dad bod.”

Heredity or significant weight loss can leave men with stubborn belly fat or loose skin that leaves them feeling self-conscious of their midsection. Whether you are male or female, tummy tuck surgery will tighten and tone the contours of your abdomen to allow clothes to fit better and restore a fit and youthful stomach you are thrilled to flaunt.

Myth: You’re too old to get a tummy tuck

When it comes to cosmetic surgery, age truly is just a number. While a majority of patients who underwent tummy tuck surgery in 2018 were between the ages of 35 and 50 (56.3 percent), 21 percent were between the ages of 51 and 64 and four percent were over the age of 65.

There is no wrong age to opt for a tummy tuck procedure, however, there are more critical factors that will be considered by your board-certified plastic surgeon when determining your candidacy for the procedure.

To be a good candidate for abdominoplasty, patients must be:

  • Physically healthy: You must be in good overall health before undergoing invasive surgery to prevent complications.
  • A nonsmoker: Smoking can inhibit the healing process or cause serious complications both during and after your tummy tuck surgery. If you do smoke, you will be asked to quit for two months before and after your procedure.
  • Within a stable, healthy weight: Tummy tuck surgery is not intended for significant weight loss or for treating obesity.
  • Realistic with their expectations: While a tummy tuck will dramatically enhance the contours of your midsection with long-lasting results, no cosmetic surgery will stop the aging process or deliver perfection, or fully camouflage a larger core abdominal shape.

Next steps on your tummy tuck journey

When you are ready to schedule your tummy tuck consultation, be sure to choose a board-certified plastic surgeon on the ASPS Plastic Surgeon Match service.

Board-certified plastic surgeons undergo a rigorous training process and are vetted by their peers through both a written and oral board examination process. Each and every ASPS member surgeon is board certified in plastic surgery, making them the most qualified plastic surgeons to perform your procedure.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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Frontal Sinus Transillumination in Cranioplasty for Facial Feminization Surgery

Cranioplasty in facial feminization surgery (FFS) contours the frontal bone to achieve an improved feminine appearance of the forehead. The surgery was first described in 1986 by Whitaker et al1 and then in 1987 by Ousterhout.2 Since then, multiple articles have focused on the technique and the clinical outcomes of the surgery specific to FFS.3,4 In general, the frontal bone is approached via a coronal incision to contour frontal bossing and the orbital rims. Variable techniques to address frontal bossing are reported, including using a burr alone, onlay implants, and osteoplastic flap setback. One critical component of frontal cranioplasty is the ability to safely and effectively reduce bony prominence overlying the frontal sinus/absent frontal sinus. Previously, the amount of bone reduction was based on the external appearance with or without imaging. Interestingly, frontal sinus transillumination for estimation of frontal sinus configuration in osteoplastic flap surgery is described in the context of rhinologic disease but not FFS.5,6 Here, we describe the use of frontal sinus transillumination in cranioplasty during FFS (Video 1).

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How better body contouring options give you more choices

better body contouring options give you more choices

There are many people out there who feel they could benefit from some sort of body contouring but are confused about which body contouring option would be best for them. The phrase “body contouring” encompasses a wide variety of cosmetic procedures and treatments.

By using both new and traditional procedures in addition to being able to choose between surgical, minimally invasive and noninvasive body contouring treatments, men and women are able to customize their body contouring to fit their needs.

Narrowing your search

With all the options you have available to enhance your look, it can feel as though the choices are overwhelming. Fortunately, there are five questions you can ask yourself to begin the determination of how to pick body contouring procedures.

  • Are you within 10 pounds of your optimal weight? People who are within a healthy weight range can benefit the most from liposuction or one of the many nonsurgical body contouring procedures. These individuals are considered to be generally fit but have particular areas of stubborn body fat that they wish to remove.
  • Is your body mass index (BMI) 30 or less? A person should have a BMI of about 30 or less in order to be fit enough for most body contouring procedures. If someone’s BMI is over 30, a good idea for them is to concentrate their efforts on diet and exercise before exploring procedure options.
  • Do you have sagging muscles or loose skin? Sagginess is a common cosmetic concern, particularly as people get older, have experienced weight fluctuation throughout their lives or lost a dramatic amount of weight recently. Separation of the abdominal muscles is common during pregnancy and can be addressed with an abdominoplasty. Excess skin and stretched and weakened muscles can be tightened or surgically eliminated.
  • Are you wanting quick results? Liposuction and other surgical body contouring choices can provide results that can be seen in a matter of days or a few weeks. Nonsurgical body contouring procedures often need multiple treatment sessions stretched out over time for the best results.
  • Do you have the time to recover? Surgical choices such as liposuction and tummy tucks need dedicated recovery time in which physical activities are restricted. Nonsurgical treatments can offer less downtime or even no downtime since they do not involve surgical incisions, anesthesia or needles. So, you can get back to your daily activities fairly quickly.

Surgical options for body contouring

There are many surgical and nonsurgical body contouring options to consider. Body contouring can be an excellent option for anyone who is looking to redefine their figure. It’s especially effective for people who have experienced major weight loss. A combination of procedures can help reduce the stubborn fat deposits and tighten up the loose skin and muscles often left behind.

Here are some common surgical procedures that people opt for:

  • Liposuction involves the removal of unwanted stubborn fat pockets to create a slimmer, more streamlined body. This can be performed on practically any area of the body that has excess fat.
  • Abdominoplasty, commonly known as a tummy tuck, involves the toning and tightening of the stomach area. With this procedure, loose skin is removed and stretched and weakened muscles are repaired.
  • A thigh lift and body lift can help the condition of baggy skin surrounding the buttocks and thighs which can be caused by genetics, aging or major weight loss. This is accomplished by getting rid of excess skin and stubborn fat and tightening the underlying musculature.
  • An arm lift can help improve the appearance of loose sagging skin on the upper arms by removing the excess, hanging skin.
  • A Brazilian butt lift can enhance the buttocks, providing a better balance of natural curves. This is achieved by using a person’s own fat cells to augment the buttocks.

Minimally and noninvasive body contouring options

Nonsurgical options can be great for individuals who want to address mild body contouring concerns that may not need extensive treatment from a surgical procedure. They are also a popular choice for people who have busy schedules and can’t take the necessary time to recover after surgery. For instance, a busy mom who wants to achieve some toning and tightening now has nonsurgical options to consider, where 10-15 years ago, a surgical mommy makeover was her only reliable contouring option.

There are many nonsurgical treatments to consider. Some use cold temperatures to kill unwanted fat cells, some use heat. There are also treatments that use ultrasound waves aimed at fat cells under the skin to break down the fat. All of these options then rely on your body’s natural cleansing process to remove the destroyed cells and create a slimmer look in the treated area. Most of these require a 30-90 minute treatment sessions, with several sessions needed for noticeable body slimming. In some cases, nonsurgical treatments can also tone and tighten the skin in the area being treated.

When considering nonsurgical options, it’s important to visit with several board-certified plastic surgeons to see which treatments they offer and find out why they’ve chosen one method over another. See how each one might be able to help your specific cosmetic concern, get pricing and take the time you need to make a good decision for your own goals.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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Alopecia Following Deoxycholic Acid Treatment for Submental Adiposity

Alopecia is an increasingly recognized adverse effect of deoxycholic acid treatment. A retrospective review of 66 male patients demonstrated an incidence of alopecia of 15% (8 patients).1 The alopecia was first noticed approximately 4 weeks after injection and in this series, 5 of the 8 patients reported improvement or complete resolution of the alopecia. Review of the literature identified 4 other cases with varying degrees of regrowth observed.24 Herein, we report a case of alopecia following deoxycholic acid treatment.

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Where will your breast implants be placed?

breast implant location

If you are considering breast augmentation there are many questions you will want to have answered by the plastic surgeon before making your final decision.

Among a host of other important questions that you should ask during your breast augmentation consultation is “where the breast implants will be placed?”

Many patients are not aware that there is an option when it comes to the placement of the breast implants. Implants may be placed either over the muscle or under the muscle, and there are several factors which help determine the optimal implant placement for each individual patient, including:

  • Your body type
  • Your current health
  • The actual size (cc’s) of the implants
  • Saline vs silicone implants
  • Your individual goals and desires

Board-certified and experienced plastic surgeons who have performed a high volume of breast augmentation surgeries will be able to direct the best position to determine optimal implant placement, and it is extremely important for breast augmentation patients to understand the pros and cons for the two different placement options.

Subglandular placement

Also known or referred to as “over-the-muscle” placement, the subglandular placement technique is where the implant is positioned between the chest muscle and the existing breast tissue areas. The over the muscle positioning is done so the implant lies below the glands of the breast, thus providing the ability for the patient to breast-feed in the future.

PROS: Patients tend to have less movement of the implants during physical activity, as well as less discomfort immediately following the surgery.

CONS: The appearance can me more artificial. In addition, during mammograms the readings may be less accurate. Also, patients may experience a higher rate of capsular contracture, which occurs when the scar tissue or capsule that normally forms around the implant tightens and squeezes the implant.

Submuscular placement

The other option is known as submuscular, or under-the-muscle placement of the breast implant. This technique includes placement of the implant partially under the pectoralis major chest muscle.

PROS: Patients experience more accurate mammograms. In addition, the submuscular placement tends to produce a more natural appearance, and a reduced rate of capsular contracture.

CONS: Some patients experience slightly more discomfort after surgery, with a longer postsurgical recovery.

The role of the chest muscle

The muscles in the chest play an important role in breast augmentation procedures with regards to optimal placement of the implants. Each individual patient will vary in the amount of muscle they have and this could be a factor in determining whether subglandular or submuscular placement is best.

The anatomy of each patient must be factored in. For example, women who have very large or strong chest muscles will be best suited for over-the-muscle positioning of the implants. One reason for this is with larger chest muscles there will be a tendency for distortion of the breasts as the chest muscles move and are flexed. In these cases, subglandular placement is advised.

How much breast tissue is present

In addition to the muscle density and mass, the amount of tissue in the breast area before surgery will also have an impact on where the placement should be for optimal postsurgical results. When there is a significant amount of breast tissue, there will be adequate soft tissue coverage making the pectoralis muscle superfluous in this regard.

As you move through the process of selecting your breast surgeon, and during your consultation about the procedure, you will want to discuss the placement of the breast implants, going over which option – over the muscle or under – will be best for you.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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Masseteric Nerve Transfer and Selective Neurectomy for Rehabilitation of the Synkinetic Smile

Key Points

Question  Is masseteric-to-facial nerve transfer combined with selective neurectomy associated with improved synkinetic smile?

Findings  In this case series, 7 patients underwent masseter-to-facial nerve transfer with selective neurectomy for synkinesis. Patients experienced a statistically significant improvement in multiple eFACE domains including smile, dynamic function, synkinesis, midface and smile function, and lower face and neck function at 1-year mean follow-up.

Meaning  Masseteric-to-facial nerve transfer with selective neurectomy may provide significant smile improvement with a long-term decrease in synkinesis for patients.

Importance  Synkinesis is the involuntary movement of 1 area of the face accompanying volitional movement of another; it is commonly encountered in patients affected by facial palsy. Current treatments for synkinesis include biofeedback for muscular retraining and chemodenervation via the injection of botulinum toxin. Chemodenervation is effective in reducing unwanted muscle movement, but it requires a commitment to long-term maintenance injections and may lose effectiveness over time. A permanent solution for synkinesis remains elusive.

Objective  To evaluate masseteric-to-facial nerve transfer with selective neurectomy in rehabilitation of the synkinetic smile.

Design, Setting, and Participants  In this case series, 7 patients at a tertiary care teaching hospital underwent masseteric-to-facial nerve transfer with selective neurectomy for synkinesis between September 14, 2015, and April 19, 2018. The medical records of these patients were retrospectively reviewed and demographic characteristics, facial palsy causes, other interventions used, and changes in eFACE scores were identified.

Intervention  Masseteric-to-facial nerve transfer.

Main Outcomes and Measures  Changes in eFACE scores (calculated via numeric scoring of many sections of the face, including flaccidity, normal tone, and hypertonicity; higher scores indicate better function and lower scores indicate poorer function) and House-Brackmann Facial Nerve Grading System scores (range, 1-6; a score of 1 indicates normal facial function on the affected side, and a score of 6 indicates absence of any facial function [complete flaccid palsy] on the affected side).

Results  Among the 7 patients in the study (6 women and 1 man; median age, 49 years [range, 41-63 years]), there were no postoperative complications; patients were followed up for a mean of 12.8 months after surgery (range, 11.0-24.5 months). Patients experienced a significant improvement in mean (SD) eFACE scores in multiple domains, including smile (preoperative, 65.00 [8.64]; postoperative, 76.43 [7.79]; P = .01), dynamic function (preoperative, 62.57 [15.37]; and postoperative, 75.71 [8.48]; P = .03), synkinesis (preoperative, 52.70 [4.96]; and postoperative, 82.00 [6.93]; P < .001), midface and smile function (preoperative, 60.71 [13.52]; and postoperative, 78.86 [14.70]; P = .02), and lower face and neck function (preoperative, 51.14 [16.39]; and postoperative, 66.43 [20.82]; P = .046). Preoperative House-Brackmann Facial Nerve Grading System scores ranged from 3 to 4, and postoperative scores ranged from 2 to 3; this change was not significant.

Conclusion and Relevance  This study describes the application of masseteric-to-facial nerve transfer with selective neurectomy for smile rehabilitation in patients with synkinesis, with statistically significant improvement in smile symmetry and lower facial synkinesis as measured with the eFACE tool. This technique may allow for long-term improvement of synkinesis and smile. This study is only preliminary, and a larger cohort will permit more accurate assessment of this therapeutic modality.

Level of Evidence  4.

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What type of tummy tuck is right for you?

tummy tuck types

Are you feeling discouraged because exercising isn’t giving you the results you desire? Do you still have a tummy pooch despite eating well? Do you wish your tummy was trim, toned and tight?

It can be difficult to regain your body’s shape after significant changes in your figure (such as pregnancy or major weight loss), and even a healthy lifestyle may not be able to restore your slender midsection. Even if you have lost belly fat, you may still be experiencing a decrease in skin elasticity, which can cause your skin to sag.

A tummy tuck can be an effective solution when your best efforts have not yielded any results in regards to the appearance of your midsection. With multiple procedure options, a tummy tuck can tighten your sagging skin and help you regain subtle tummy contours.

How does a tummy tuck help?

During your tummy tuck surgery consultation, your plastic surgeon will examine the condition of your skin and tissue to determine which of the following types of tummy tuck is best suited for your needs.

Mini tummy tuck

A mini tummy tuck focuses on the area of the tummy that lies below the navel. Your plastic surgeon will make a single incision at the bikini line that is easily concealed under a swimsuit. He will stretch the skin downward as he smooths and adjusts the skin. If you are also in need of muscle tightening to correct a slight pooch, this type of tummy tuck would be appropriate. Women who are wanting to correct the physical changes after pregnancy are ideal candidates for a mini tummy tuck.

Full tummy tuck

This is the most common type of tummy tuck procedure since it focuses on the entire midsection. Your surgeon will make two incisions – one will be located in the lower abdomen and the second is made around the navel. Though scarring is more obvious with this procedure, these incision sites allow your surgeon to remove sagging skin from both the upper and lower abdomen. He will also tighten the abdominal muscles necessary to give you a more toned midsection. Many patients benefit from this type of tummy tuck, including women who are post-pregnancy, have experienced major weight loss and are unhappy with how their bodies have changed due to genetics or aging.

Extended tummy tuck

An extended tummy tuck is most commonly performed for patients who need removal of significant amounts of skin. This typically occurs after a massive weight loss. Your surgeon will make a single incision; it will wrap around the abdomen to reach the hips. Such a large incision allows him to tighten the skin evenly down across the tummy. It can leave a larger scar than the other procedures that may be hard to hide under intimate clothing.

BodyTite™

BodyTite™ is a radiofrequency-assisted liposuction (RFAL) procedure that uses cutting-edge technology to help eliminate stubborn fat for a smoother, slimmer physique. During this procedure, a thin tube, also known as a cannula, is inserted under the skin while an electrode is placed on the outer surface. The radiofrequency waves from the electrode melt the fat, making it easier to remove. These waves heat the skin, which stimulates the production of collagen to tighten the skin. This procedure is used in conjunction with liposuction.

Starting your tummy tuck journey

If you think that tummy tuck surgery might be right for you and your aesthetic goals, be sure to meet with a board-certified plastic surgeon for a consultation. You can use the ASPS Plastic Surgeon Match referral service to find ASPS member surgeons in your area.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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