Cheek augmentation (Cheek implants)

Cheek augmentation can be done using either implants or injections. The implants that may be used are usually made from a solid silicone material. They will not feel soft to the touch (like silicone breast implants) when implanted, and will feel and look like natural bone in the cheeks.

These implants come in various shapes. Malar implants are the most common. 

They will be placed directly on the cheekbones and will result in a more projected appearance to the cheekbones.

Submalar implants are not placed on directly on the cheekbones and are the ideal choice for those patients who want to improve the appearance of their “midface” region. This is great if your cheeks have a sunken in appearance or a permanently gaunt appearance that you would like to get rid of.

The other option is a combination of both the previous types. They will fill in the midface of the patient while also improving the profile of their cheekbones.

The incisions for this procedure are made in the top of the mouth right about at the gum line. The implants will then be slid in to position from below. This method carries some risk of infection since the human mouth has a large amount of bacteria in it. If you are concerned about that, your doctor is also able to make an incision externally instead—it would be placed near the eye, but it will leave a visible scar. Be sure to discuss your options with your doctor if you think you want the external incision option.

One important thing to note with this procedure, is that the implants MAY shift. This could become so bad that it moves up and begins blocking your vision.

If implants are not what you want,  you can always look in to fillers or injectables. Hyaluronic acid compounds, like Restylane or Juvederm can be used—but these are not permanent options. An injection of your fat can be done as well, and would provide a more permanent solution. Choosing injectables over an implant is based on your current appearance and the changes you want to make, so be sure to ask your doctor about all of your options. One great thing about these methods is that there is no scarring and your recovery time will be less than with implants—although cheek implants typically only take about a week to recover from.

Check out some before and after shots to get an idea of what this procedure could do for you:

This is a popular procedure for both men and women. As you can see in these pictures, subtle is best. Both of these patients have a very nice looking bone structure in their after images. You can see the difference the implants have made in the relaxed appearance of the face. These implants will alter more than just your cheeks-- they can make wrinkles less noticable, change the shape of your lips/mouth, and overall restore a more youthful appearance.

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Breast Lift (Mastopexy)

Breast implants are a great idea for somebody who wants to increase their size, but what if you are happy with your breast size and just want to restore a youthful appearance by making them perkier? A mastopexy (or more commonly known as a breast lift) may be the right choice for you. This procedure can even be done in combination with implants if you are looking for an increase in size as well as better shape and placement of your breasts.

A full breast lift is where the doctor makes a cut in the crease below the breast, a cut around the areola (nipple) and then an incision from the areola to the cut in the crease—this is known as an anchor incision and as you can see below, it resembles an anchor.

Once the incisions are made, the excess tissue will be removed and the breast will be moved up; often, the areola will be reduced in size too.

This procedure will result in different scarring than a typical breast augmentation would. The scar around the areola will often not be noticeable, since it will be hidden in the color of the nipple. The scar at the bottom of the breast, located in the crease, will also be fairly hidden since the breast will often lay over that area. As a quick side note, these two incisions are also used in breast augmentation since they do not leave extremely noticeable scarring, so I wouldn’t worry too much over the marks they will leave. The last scar, and the one you do want to concern yourself with, is from the incision connecting the areolar cut to the cut in the crease. This straight line from nipple to the base of the breast will  fade over time but will probably not ever be perfect.

A modified breast lift will result in scarring that is much less noticeable—however, since this procedure uses fewer incisions (which mean less scarring) it is not able to alter the breast shape as well. For this reason, this type of procedure is often done in combination with breast implants. The popular incisons for this are either the donut lift or the crescent lift.

The donut lift (or Benelli lift) removes a ring of skin around the nipple and then sutures it back together thus removing tissue from the breast.

The crescent lift will have an incision around the top of the nipple and basically move the nipple up on the breast after removing the tissue above it, thus lifting the breast.

Here are some examples of what a breast lift can do:

Both of these women had a crescent incision breast lift as well as implants inserted. As you can see, a breast lift can make a tremendous difference.

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More about breast augmentation

Although deciding which implant material you want for your breast augmentation is a big step, there are other important decisions to me made- like implant shape, incision type, and implant location.

To start with, there are different shapes of implants. Most people only think of the round ones but in fact there are more options available to you. Teardrop shaped implants are becoming quite popular, they have a sloping portion that is at the top which many feel makes the implant look more natural once inserted. These implants require a textured surface because if they rotate, the breast will look deformed (a problem that won’t occur with a round shaped implant since it is perfectly symmetrical).

Another aspect of implant shape is the profile you want. Most of the time, doctors assume that you want a medium profile- those are what the majority of people get. However, depending on the look you are trying to achieve a higher or lower profile might be appropriate. Basically this aspect is when you set and implant down on the table, how tall is it.

This is an example of a patient who has gotten high profile implants. Keep in mind, these look relatively new and therefore they have not fully settled yet, but they ARE high profile and are probably not going to drop down very much—they will continue to have that very full appearance at the top of the breast. On a related note, you should always remember that what you look like immediately post surgery is not what you will look like permanently. Breast implants often take a couple months to fully “settle”. The body is recovering from a trauma (the surgery) and is adjusting to a foreign body (the implants) so there will be swelling and adjustments that the body makes before everything reaches its final positioning.

Below, is a patient who got low profile implants. You can clearly see the difference between these two types. If you are on the smaller side to begin with and are aiming for a very natural look with a modest size increase, low profile implants might be right for you!

The next important thing to consider is the incision type. As I mentioned before, silicone implants are at a disadvantage to saline implants in that they require larger incision types. The implant comes pre-filled and so you require a large incision to provide the surgeon access to place the implant. I know that reducing scarring is one of the TOP priorities for you and your doctor, so it is important to weigh incision types before you decide implant material.

Periareolar incisions are right around the nipple. This incision can be used for silicone implants, but they would need to be small since that would be very difficult—however it is not unheard of, just uncommon. These scars will be less noticeable than other methods and often blend in with the areola. One major advantage of this type of incision is that it permits the doctor great accuracy in placing the implants. The image below gives you an idea of where this incision is located; the scarring will be quite light, and really only noticeable upon close inspection… if somebody’s that close to your boobs, I’m pretty sure they aren’t going to complain about a faint line.

Inframammary incisions are located in an area called the inframammary fold. This is pretty much the crease where the bottom of your breast meets your rib cage. This type of incision can leave pretty noticeable scars, but is the ideal type for silicone implants. Again, if you think you wan silicone implants, you need to decide if they are worth the additional scarring.

A transaxillary incision will be located in the armpit and placed through a tunnel that is made to the breast. This is a nice option for those who do not want any visible scars on their breasts, but will leave scarring in the armpit (it’s quite small though) and can NOT be done with a silicone implant. One disadvantage however, is that this incision type more often has issues with symmetry of implants.

Now I’m sure that most of you have come hear about “no scarring” breast augmentation. That is achieved using a transumbilical (often called TUBA) incision. Saying that this has NO scarring is a bit misleading, really it is simply placing the incision inside of an existing scar—your belly button. The doctor makes a small incision in the belly button, makes two tunnels up to the breasts and places the implants. There are no visible scars on the breasts, and usually the scar inside the belly button is completely invisible. This incision is ONLY for saline implants and you must find a specific doctor who has been trained in this, since it is a relatively new procedure and not all surgeons perform this type.

Finally, implant location is one more choice you can make. An implant may be complete submuscular, partial submuscular, or subglandular.

Complete submuscular is where the implant is located completely below the pectoralis. This is often the best option for those undergoing reconstructive surgery after a mastectomy since the muscle will add tissue between the implant and the skin and allow for a more natural appearance.

Partial submuscular is when the implant is placed mostly under the pectoralis with the bottom portion only covered by breast tissue, not muscle.

Subglandular is when the implant is located on top of the muscle and underneath of the breast tissues. Many feel that this is the ideal location for realistic results, however this placement type is thought to lead to a higher rate of capsular contracture than the other locations.

On the left is subglandular and on the right is complete submuscular.

This should cover most of the basics about breast augmentation. I’m going to start discussing other types of cosmetic surgeries and will come back later to address the potential complications that may arise from breast augmentation. In the meantime, let me know if there’s a particular surgery you would like to read about!

Image sources:

 http://hubpages.com/hub/Teardrop-Breast-Implants

http://www.locateadoc.com/pictures/breast-augmentation-breast-implants-15004after1.jpg

http://www.markhenley.co.uk/images/procedures/breast-augmentation/breastenlargement-augmentation-post6w-scar-patient1.jpg

http://www.breastsurgeryhawaii.com/_images/incision_options3.gif

Breast Augmentation

“Boob jobs”, the bread and butter of a plastic surgeon; this is easily one of the most common procedures and it is definitely one of the first things people think of when you say “plastic surgery”. Since this is such a popular procedure, countless variations exist from what type of implant material you choose to the implant location to the incision types. For this reason, I will be posting a few articles on the topic so I am able to go in-depth enough on these topics to give you all of the information you really need. Keep in mind, I am not a plastic surgeon, just an enthusiast; I know my stuff, but since I don’t know you and each patient is different, make sure you discuss your options with your doctor.

Ok, to start with you are able to get saline or silicone breast implants.

Although silicone implants have a bad reputation, that applies to PAST implants. The FDA took older models off the market but newer, better versions are currently available and are completely safe for use. Back in the day, silicone implants were what everybody used. Then they had lots of problems with capsular contracture and leakage of the implants. Once the silicone got in to your body, it caused a heck of a problem. Doctors would have to go in and remove a big, sticky mess. For this reason, older models are no longer available.

This is what a ruptured implant looks like. The tissue material on the side (the red stuff) is a capsule that had formed in the patient, likely in response to the leakage.

However, in the late ‘90’s though, the FDA looked in to silicone implants and decided that there was no significant difference in side-effects for patients with silicone implants. Prior to this, silicone implants were only permitted for patients having reconstructive breast surgeries done (like after a mastectomy).

Now that you have a bit of background and understand that both types of implant are safe, let me explain the benefits of each type to you.

Silicone:

These are often called “gummy bear” implants. They are made up of a silicone gel inside of a silicone shell. These newest models are much better than their predecessors. They have lower rates of capsular contracture (a side effect that I will go in to in a later post) and do not rupture as much as the older versions did.

These implants are available in various shapes, sizes, and profiles. However, their sizes are NOT adjustable. The implant comes to the surgeon pre-filled in certain increments and that is it. If you had been hoping to get a 643cc implant, you are going to have to settle for a 650cc or a 600cc.

Silicone implants are generally considered to be more “realistic” feeling than saline and have a similar texture to that of your natural breast tissue. A drawback for these is that they are more likely to rupture than saline implants. Also, if they do rupture, it is harder to detect since they retain their shape; if a ruptured implant goes unnoticed, the silicone could leak to surrounding areas and cause health problems.

Saline:

These implants are made of a silicone shell that is filled with a saline solution. They can be inserted into your body and then filled with saline; the doctor then closes the valve and stitches up incision. This means that these implants are available in virtually any size you want. A 600cc shell can be filled with 575cc or it can be over-filled with 625cc, for example. These will result in different appearances of the implant.

The drawback for these implants is that they have a higher rate of cosmetic side effects than silicone implants. There may be rippling or capsular contracture. One major benefit though, is if these rupture you will notice immediately. Saline solution is matched to your body’s saline levels and is similar to what you will find in an IV bag; because of this, if the implant leaks you will not have any problems from the saline entering your body. Your tissues will absorb the liquid and you only need to worry about getting in to have it fixed- unlike silicone ruptures which can lead to severe health problems.

Another benefit is that since these implants can be filled after they are placed in your body, the incision can be MUCH smaller than with silicone, and a smaller incision means a smaller and less noticeable scar. The “scar-less” techniques that you have heard about (and that I’ll talk about later) utilize saline implants.

Overall, you need to weigh what is important to you. You body type, desired results, and even your lifestyle can all affect which type of implant you want. Incision type is another important factor in picking the implant type, and I’ll discuss those later. Implant material is just one of a variety of choices that you can make to reach your ideal appearance and feel great about yourself.

Choosing your doctor

Cosmetic surgery is a big decision. There are countless choices to be made once you decide you want a procedure, and your surgeon is the person who will help guide you through those decisions. Above all other things, picking the right doctor is critical. That choice can make the difference between whether you are happy with your procedure or not.


First things first, do NOT try to save money on ANY surgery of any kind, especially something as serious as breast augmentation. Find a licensed and accredited doctor. See if he has hospital privilege nearby. Ask to speak with previous patients. All of these are good ways to pick a competent surgeon. Picking a "back alley" doctor may save you money at first, but the cost of surgeries to repair whatever damage is done will far exceed the cost of picking a good doctor the first time around.


Feel free to "shop around" and meet with various doctors to see who you feel the most comfortable with, but do not let the price affect your choice. All reputable surgeons will charge pretty much the same amount. Whatever little variation there may be in the price, is worth it to be comfortable with your doctor.


Think about it, you are going to have this procedure for the rest of your life. What difference does $100 make when you spread it out over the next 30 years?? Bottom line, choose the surgeon who you are comfortable with and who is knowledgeable about the subject.


There are two important things to keep in mind to help you decide if the doctor you are meeting is decent. Your consultation should be free, if it is not then just hang up the phone and pick a new doctor. Also, if while you are at your consultation, the doctor (or any staff) try to talk you in to a procedure that you did not come in for and did not express any desire for, LEAVE. Nobody should tell you how you need to look, they are there to help you achieve YOUR desired look- not how they think you should look or what will line their pockets the most.


I'll be going though the various types of surgeries and procedures and explaining all of the details about them (average costs, how they are done, healing time, restrictions, etc.) so be sure to check back as I add more stuff!!


Also, if there is any specific procedure you want me to address, let me know and I'll add it to the top of my list!