What is Rhinoplasty and How can it Benefit You?

Rhinoplasty is sometimes referred to as "nose reshaping." It can improve the appearance and proportion of your nose, or correct a breathing problem associate with the nose.

Rhinoplasty enhances facial harmony and the proportions of your nose. It can also correct impaired breathing caused by structural defects in the nose.

Rhinoplasty surgery can change:

• Nose size in relation to facial balance
• Nose width at the bridge or in the size and position of the nostrils
• Nose profile with visible humps or depressions on the bridge
• Nasal tip that is enlarged or bulbous, drooping, upturned or hooked
• Nostrils that are large, wide, or upturned
• Nasal asymmetry

If you desire a more symmetrical nose, keep in mind that everyone’s face is asymmetric to some degree. Results may not be completely symmetric, although the goal is to create facial balance and correct proportion.

Rhinoplasty to correct a deviated septum

Nose surgery that’s done to improve an obstructed airway requires careful evaluation of the nasal structure as it relates to airflow and breathing.

Correction of a deviated septum, one of the most common causes of breathing impairment, is achieved by adjusting the nasal structure to produce better alignment.

Reference: American Society of Plastic Surgeons

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Stats Show Growth of Breast Lifts Outpacing Breast Implants 2-to-1

New plastic surgery statistics released today by the American Society of Plastic Surgeons (ASPS) show that breast lift procedures are growing at twice the rate of breast implant surgeries. Since 2000, breast lifts have grown by 70 percent, outpacing implants two-to-one. Breast implants are still by far the most performed cosmetic surgery in women, but lifts are steadily gaining. In 2013, more than 90,000 breast lift procedures were performed by ASPS member surgeons.

“Many women are looking for a youthful breast by using the tissue they already have,” said ASPS President Robert X. Murphy, Jr., MD.

According to the new statistics, women between the ages of 30-54 made up nearly 70 percent of the breast lift procedures performed in 2013.

“The breast lift procedure is way up in my practice,” said Anne Taylor, MD, an ASPS-member plastic surgeon in Columbus, Ohio. “More women are coming to us who’ve had children, whose breast volume has decreased and who are experiencing considerable sagging,” she said. “For many of them, we are able to get rid of excess skin and lift the breasts back up where they’re supposed to be.”

Kim Beckman of Casstown, Ohio is one of the women who went to Dr. Taylor.

“Childbirth, breastfeeding and aging takes a toll on the body,” she said. “I finally decided one morning that I was going to lose weight and get healthy.”

Beckman started eating right and exercising and, even though she lost more than 75 pounds, she still wasn’t completely satisfied.

“From the waist down, I was happy with what I saw. But from the waist up, I knew that there was still something I needed to do in the chest area.”

Like many women, Beckman had lost volume in her breast over the years, and after losing weight, had considerable sagging. “In those situations, there’s really no other way to get the breast lifted back up without the breast lift surgery,” said Dr. Taylor.

“The ideal candidate for a breast lift is a woman who has a good amount of breast tissue left, who doesn’t necessarily want to have implants,” said Dr. Murphy. “Many women aren’t sure if they are a candidate for this type of surgery, but a simple pencil test can tell them if they are,” he said.

To perform the pencil test, a woman simply places a pencil under her breast.

“If the breast tissue holds the pencil in place against the chest, that implies that there’s a hanging nature to the breast that can be fixed with a lift.” said Dr. Murphy.

Though she eventually opted for implants, too, the idea of starting with a surgery that only used her natural tissue appealed to Kim Beckman.

“I’m a nurse myself,” said Beckman, “so I put a lot of consideration into anything medical, especially when it comes to surgical intervention.”

“Now that I’ve had the procedure, I feel confident. I’m wearing clothes that I never really thought that I would wear. I’ve worn a bikini on the beach and I’m comfortable. I didn’t feel the need to cover up in a towel or throw on a t-shirt to walk down the beach with my husband. I feel good.” she said.

According to the latest statistics from ASPS, fewer than 53,000 breast lifts were performed in 2000. Last year there were 90,006, an increase of 70 percent since 2000, marking the first time that number has eclipsed 90,000.

Breast augmentation remains the most popular plastic surgery procedure for women. In 2013, there were 290,224 breast augmentation surgeries performed by ASPS member surgeons. That represents a growth of 37% since 2000, just under half the rate of breast lifts.

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About ASPS

The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery.

Good Reconstruction Outcomes after Nipple-Sparing Mastectomy

Nipple-sparing procedures are an increasingly popular alternative for women undergoing mastectomy. Using this technique, the surgeon preserves the nipple and surrounding tissues for use in immediate breast reconstruction. In patients being treated for breast cancer, nipple-sparing mastectomy can be performed only if the nipple and surrounding tissues are completely free of cancer.

Between 2007 and 2012, Dr. Colwell and colleagues performed a total of 500 nipple-sparing mastectomies in 285 women, average age 46 years.  Fifty-four percent of the women underwent "risk-reducing" mastectomy because of high genetic risk of breast cancer.

Nearly all of the women underwent immediate breast reconstruction, usually with implants. In about 60 percent of patients, breast reconstruction with implants was completed at the same time as mastectomy.  Most of the remaining women underwent two-stage reconstruction, including tissue expansion to increase the amount of skin available for implant-based reconstruction.

The overall complication rate was about 12 percent.  The most common complications were tissue death (necrosis) of part of the nipple or skin used for reconstruction. Cancer involving the nipple area was discovered in another four percent of women. Even including these cases, the natural nipple was retained in the final reconstruction in more than 90 percent of cases.

Smoking, Radiation and Incision Type Affect Complication Rate

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The study identified several important risk factors for complications. The complication rate was more than three times higher for women who smoked. Women who had received radiation therapy were also at increased risk.

Complications were also more common when the incision was placed around the nipple (periareolar incision).  In contrast, the more commonly used incision under the breast fold (inframammary incision) was associated with a lower complication rate.  

Nipple-sparing mastectomy has been "gaining traction as a preferred surgical option" for breast cancer treatment and for preventive mastectomy in women at high risk of breast cancer. It offers effective control of breast cancer risk while preserving the patient's natural tissues for breast reconstruction. The new study is one of the first to detail the outcomes of breast reconstruction after nipple-sparing mastectomy.

With current techniques, the risk of complications appears lower than in initial reports of nipple-sparing mastectomy. At Massachusetts General Hospital, cancer surgeons and plastic surgeons follow a team approach to effectively control breast cancer risk while maximizing reconstruction outcomes.

"We are performing an increasing number of nipple-sparing mastectomy procedures as more breast oncology surgeons become comfortable with the procedure and with expansion of our indications for nipple-sparing surgery," Dr. Colwell and coauthors write. They increasingly use the inframammary incision based on patient preference, as well as the lower complication rate. The researchers add that they now perform single-stage reconstruction in more than two-thirds of women undergoing nipple-sparing mastectomy.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

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Improving augmentation results with a breast lift

By Dr. Glenn M. Davis

For the majority of women, the ultimate appearance goal for breast augmentation surgery is fuller, shapelier breasts with attractive cleavage. However, adding volume alone may not be enough to achieve the desired look, especially in women with drooping breasts. By combining augmentation with a breast lift, an enhanced breast size, shape and position is possible.

Evaluating Breast Sagging
Women whose breasts are already naturally uplifted can increase volume with breast implants while maintaining their existing youthful profiles. However, for women who notice visible sagging in their breasts, a breast lift may be indicated.

The primary deciding factor is how much sagging is present. Breast sagging naturally occurs over time, though women who have been pregnant often notice a greater degree of sagging following their pregnancies, and women who have lost a substantial amount of weight also will commonly see sagging breast tissue.

When you talk with a plastic surgeon about the appearance of your breasts, he or she will "grade" the degree of sagging, which influences the type of procedure that may be recommended. There are three grades of breast sagging.

• Grade I: The central point of the nipple is at the height of the inframammary crease (the fold where the bottom of the breast connects to the chest wall). If you are in this category, a breast augmentation only may provide a satisfying outcome.

• Grade II: If the central point of the nipple falls between 1 - 3 centimeters below the inframammary crease, a lift still may not be necessary. However, if only an augmentation is performed, the implant placement may add volume lower within the breast than is desired.

• Grade III: At a distance of 3 centimeters or more from inframammary crease to nipple, it is generally a good idea to combine breast augmentation with a breast lift. The areola and nipple will typically be resized and recentered during the procedure as well.

In addition to these three grades, there is also the possibility that the breasts will appear droopy even though the nipple remains higher than the inframammary fold. Patients may wish for a combined breast lift and augmentation even if not technically necessary to improve the aesthetic appearance of the breast shape and placement after augmentation.

Combining Procedures
While performing a breast lift and augmentation can be staged in completely separate procedures, there are a number of benefits to scheduling one surgery that incorporates both at the same time. Patients largely prefer the option of a single surgery, as the convenience factor is higher and the overall cost is lower. Both breast augmentation and a breast lift are straightforward procedures, and both have low immediate and long-term complication rates.

While in the past some surgeons believed that combining cosmetic surgery procedures could increase the risk of complications, it is now generally accepted that many common plastic surgery combinations such as breast augmentation/lift and tummy tuck/liposuction have very similar complication rates and revision rates compared to performing the procedures separately.

That said, surgeons still need to pay careful attention to the technical considerations that need to be addressed in order to achieve an optimal outcome. For instance, beginning a combined augmentation/lift with the augmentation piece allows for more accurate evaluation of the amount of skin and tissue that will be necessary to cover the additional volume before proceeding to lifting, shaping and excision.

The ideal final results of combined breast augmentation and breast lift surgery are firmer, higher breasts that have more volume as well. As with any cosmetic procedure, surgical skill and experience are integral to achieving this superior augmentation outcome for women with drooping breasts.

- information provided by www.smartbeautyguide.com

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TCA Peels (Information provided by Skinacea.com)

TCA peels, trichloroacetic acid peels, are medium strength chemical peels that rejuvenate and repair your skin. They improve skin discoloration, reduce fine lines, and even out skin texture. They also cause your skin to physically peel, so they will require around a week of downtime. However, the results are usually well worth the wait! 

This section explains what happens during the various stages of the TCA peeling process and what you can expect from a TCA peel, whether you get one professionally done or give yourself one at-home.

What do TCA peels do?

TCA peels are medium depth peels, ranging from 8% to 30% strengths. Though their concentrations might not be as high as other chemical peels, TCA peels are considered much deeper peels than lactic acid and glycolic acid peels. For instance, a 75% glycolic acid peel never made me peel, but a 12.5% TCA peel had my skin peeling for days.

TCA peels brighten and even out your skin tone by reducing the appearance of hyperpigmentation (dark spots, acne marks, sun spots, freckles) and skin discoloration. They revitalize dull-looking skin, helping skin look soft and smooth. Because of their deep exfoliating effects, TCA peels can clean out congested pores to refine the surface of your skin. Unfortunately, they don't work as well for acne scars or moles, but they can minimize the appearance of skin tags. TCA peels are also great for erasing fine wrinkles and treating sun damage.

TCA peels can be used on the face, neck, or back of the hands. They can also be used all over the face or just as a spot peel. One TCA peel will give better results than one glycolic acid peel, but more than one TCA peel is still necessary for the best results. Results generally last around 6 months, but they can last even longer when supplemented with glycolic or lactic acid peels every two weeks.

What to expect from a TCA peel

TCA peels are serious peels with about 7-10 days worth of downtime. If you are considering getting one done, definitely schedule some time off of work and clear your calendar because you don’t want to get any sun exposure after the peel and you’ll probably look too red and flaky to be presentable.

So, how do you prepare your skin for a TCA peel? How much will it hurt? And how long will the peeling last? These questions and more will be answered in the following breakdown of what the 10 day course of a TCA peel (from pre-peel to recovery) are like:

• Pre-peel:

  Before you get the TCA peel, there are a few things you should do to prepare your skin for it. Some dermatologists recommend using retinoids or an AHA serum for two weeks prior to the peel to prime the skin for a more even and penetrating peel. However, this is optional. 
  
  Three days before the actual peel though, you must stop the use of all exfoliants (manual or chemical) and especially avoid using any harsh products (such as hair removal or grainy scrubs) on the day of the peel and for the duration of the peel.
  
  48 hours before you get a full peel, you must do a patch test on the area where you will get the peel. If you are getting a peel on your face, patch test your face. If you are getting a peel on your hands, patch test your hands. Spot testing the TCA peel solution is extremely important for a safe peel because it will help you understand how your skin responds to the acid and make you aware of any averse reactions before getting a full-face peel.
  
  It's also wise to get yourself some time off work. If you can't get 10 days off, try to get the days off when your skin will start to peel the most, most likely 3-4 days after the day of the peel. Have a good moisturizer, petroleum jelly (Vaseline), antibiotic cream (usually provided by the dermatologist or Bacitracin or Neosporin), and anti-itch cream (Lanacaine or Cortaid) on hand. If you plan on going out during any of the 10 days, make sure you have a good sunscreen and a big floppy hat to wear too.

Can a lift give you a lift?

As a field of medicine, aesthetic plastic surgery is unique in that patients actively seek out procedures and pay out of pocket to not only help them look better, but to feel better. That being said, having an 87% patient approval rating with 97% recommending others and 93% coming back for more is a testament to the specialty. It’s no coincidence that the cosmetic surgery procedures that have seen landmark growth are ones that give you a lift – upper arm lift,breast lift, thigh lift, lower body lift and tummy tuck. Lift procedures help dramatic weight-loss patients remove large amounts of skin and fat left behind, as well as those who have stretched out their skin from pregnancy, weight fluctuations and the loss of muscle from aging. All that excess skin can sure weigh a person down.

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The mission of the American Society for Aesthetic Plastic Surgery (ASAPS) includes medical education, public education and patient advocacy. Plastic Surgery News Briefs are summaries of current stories found through various news and magazine outlets that relate to or mention plastic surgery and cosmetic procedures. The views expressed in these news articles do not necessarily reflect the opinions of ASAPS, but are merely published as an educational service to our members and the general public. For additional information on these subjects and other plastic surgery related topics, please go to www.surgery.org

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Body Contouring Brings Lasting Improvement in Quality of Life after Weight-Loss Surgery

Body contouring after weight-loss (bariatric) surgery produces long-term gains in several aspects of quality of life, reports the November issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"The study indicates a sustained quality of life improvement in post-bariatric patients after body contouring surgery," concludes the study led by Dr. Eva S.J. van der Beek of University Medical Center Utrecht, the Netherlands. "This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity," Dr. van der Beek said.

Improved Quality of Life after Body Contouring Surgery
The researchers evaluated quality-of-life assessments in 33 patients who underwent body contouring after bariatric surgery. Body contouring refers to various plastic surgery procedures done to remove excess fat and skin after massive weight loss.

The most common procedures were abdominoplasty ("tummy tuck") and operations on the breasts. Through an average of seven years after body contouring, the patients repeatedly completed a standard questionnaire evaluating obesity's impact on quality of life.

The results showed "mostly moderate to large, sustained improvement" in quality of life in the years after body contouring. Scores improved in six out of seven quality-of-life domains, including physical functioning and appearance, mental well-being, social acceptance, intimacy and social network.

Some domains showed a small decrease between four and seven years' follow-up. In general, quality-of-life scores were lower for patients who regained weight after their body contouring surgery.

Overall, 55 percent of patients were very satisfied with their results. All but one patient said they would undergo body contouring again, and considered it "an inevitable step to improve daily quality of life." About one-fourth of patients had further body contouring surgery-another 30 percent said they would do so if their insurance covered it.

Bariatric surgery produces sustained weight loss in patients with severe obesity. However, more than two-thirds of patients with massive weight loss are left with loose or overhanging skin. This may lead to decreased satisfaction with the results of bariatric surgery, as well as psychological, social and physical problems.

Previous studies have shown that body contouring improves quality of life after bariatric surgery, but the long-term benefits are unclear. "There is an ongoing debate if body contouring surgery is an optional or essential step after massive weight loss in the treatment of morbid obesity," Dr. van der Beek and coauthors write.

The new study shows significant and lasting improvements in quality of life for patients who have body contouring after bariatric surgery. "This suggests the importance of including reconstructive surgery as a component in the multidisciplinary approach in the surgical treatment of morbid obesity," the researchers write. They call for further study of the long-term benefits of body contouring-including possible reasons for the decrease in quality-of-life scores a few years after surgery.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

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