Breast Implant Surgery. How We Do It?

Weekend  (mini) facelift surgery involves smaller incisions and a shorter recovery time, so this procedure is sometimes referred to as a "weekend facelift." As with the mid-facelift, this surgery targets a smaller area, primarily treating the jaw, lower cheeks, and neck. The doctor will usually find the incisions along the hairline and behind the ear. The doctor will lift the muscles, remove fat and unwanted fat deposits, and cut excess skin through these incisions. Many surgeons perform mini facelifts using endoscopic techniques. Like mid-facelifts, this procedure is standard among younger patients showing the first signs of aging.

Neck lift surgery is done to emphasize the elements that characterize a youthful neck. A cosmetic surgeon should target a distinct inferior mandibular border, visible sub-hyoid depression, noticeable thyroid cartilage bulge, visible anterior sternocleidomastoid line, and 90_ angle with the submental line and cervical mental angle of 105 to 120. These criteria are seen in glamour models. In evaluating the neck properly, the neck aging changes may be due to skin excess, fat accumulation, platysma laxity, digastric hypertrophy, submandibular gland abnormalities, or anatomic variants such as a low hyoid bone. Surgical approaches to neck rejuvenation include liposuction, anterior or submental incision, direct skin excision, and Z-plasty. Straightforward neck procedures include defatting superficial to the platysma, subplatysmal and interplatysmal defatting, and medial platysmaplasty.

Acne scars treatment needs knowledge, skills, and artistry. Acne scars lead to emotional embarrassment, poor self-esteem, social isolation, low confidence, body image alterations, unemployment, lowered academic performance, and exacerbation of the psychiatric disease of anxiety or depression. Acne scars treatment must consider the cost of treatment, the severity of lesions, physician goals, patient expectations, side-effect profiles, psychological or emotional effects on the patient, and prevention measures. Treatment modalities include topical therapies, chemical peelings, micro-needling or microdermabrasion, subcision, and autologous ⁄ non-autologous dermal fillers. Furthermore, energy-based technology includes fractioned ⁄ non-fractionated lasers, pigment or vascular-specific lasers, and minor surgical procedures. Whatever the choice, it should be clearly understood by both physicians and patients that, at present, improvement of scarring, rather than total cure, is the goal. Any intervention or treatment aims to improve scars, not for a total cure or perfection.

Hair transplant surgery or hair restoration involves moving hair from one body area to another for cosmetic improvement. The latest advances in the field, such as smaller grafts, follicular unit extraction or FUE, and novel pain reduction methods, make hair restoration treatment successful, safer, and more comfortable. Hair transplantation is most used for male pattern baldness. The second most common use is to treat female pattern baldness. Many women do not experience recession but wish to advance their hairline because of the congenital high hairline, traction alopecia, or previous facial cosmetic surgery. There are several key differences to note in the appearance of the male verse female hairline. It has been previously reported that the male hairline is typically 7 to 8 cm above the glabella and 5 to 7 cm in women. Besides, a variety of conditions can be successfully treated with hair transplantation, such as scalp scarring, facial scars due to trauma or surgery, and hair loss due to traction can be repaired with hair transplantation. Finally, hair transplantation can be successfully used to restore hair to the eyebrows, eyelashes, beard, mustache, or goatee area; and even in areas of the body, such as the pubis or chest. The PRP and growth factors are used pre-operatively, intra-operatively, or post-operatively. Added to the scalp where hairs are transplanted, it decreases bleeding and bruising, accelerate healing, and reduces shock hair loss. The injection of nanofat or enriched microfat is performed subcutaneously above the galea and in proximity to the hair bulb, which is the region where stem cells exist.

Around the eyes, (periorbital) fat injection demands a thorough understanding of the complex anatomy. Complex periorbital consists of the upper brow, upper eyelid, lateral canthus, lower eyelid, and infraorbital rim—begins to show signs of aging in the mid to late 30s. Aging skin is characterized by the appearance of fine and coarse rhytides (wrinkles), rough and uneven texture, dryness, and changes in pigmentation. Fat atrophy occurs in the upper and lower periorbital region leading to progressive skeletonization of the orbit. Fat atrophy in the lower periorbital complex leads to a more prominent infraorbital rim, increasing the height of the lower eyelid and the overall soft tissue vertical dimension of the orbit. With new advancements in cosmetic medicine, nonsurgical and minimally invasive procedures have become first-line treatment options. Treatments commonly used today include topical therapies, mechanical and chemical skin resurfacing techniques, lasers and radiofrequency devices, fillers, and neuromodulation by use of botulinum toxin (Botox). A conservative trans-conjunctival blepharoplasty or skin-only upper blepharoplasty combined with fat grafting can provide reliable rejuvenation and limit morbidity associated with higher volumes of fat grafting that would otherwise be necessary without concomitant excisional-based surgery.

Fat transfer or fat injection is known by various names, of which the commonly used are fat transfer, fat injection, and autologous fat graft. The word autologous means material (fat) is harvested from one area and donated to another in the same individual. Fat transfer has become essential in cosmetic facial surgery. Fat transfer is particularly suited for restructuring the proportion of the face. Typical facial structures can also be aided by adding constructive elements to correct a broad range of perceived facial deficiencies. For example, a stronger jawline creates a youthful, more powerful-looking face; eliminating the hollowness of lower lids helps reduce that tired, sad appearance; and fuller lips create a more youthful, attractive appearance. Fat transfer is also used for augmenting body contours, such as the breasts or buttocks.   A simple analogy to understand the benefits of fat injection is looking at a whole and a ripe grape that becomes prune-like (wrinkled, puckered) over a period like a convex, youthful face that undergoes contraction and involution with age. Rather than remove what appears to be excess tissue and transform that raisin into a pea, perhaps it would be better to re-inflate that tiny raisin back into a grape. The minimally invasive technique using Fat transfer has become a standard procedure in facial rejuvenation. Fat injection is simple, inexpensive, permanent, and permanent. Other indications include congenital, traumatic defects, or surgical defects and scars. Fat injection meets all the fundamental criteria of ideal augmentation materials: availability, low antigenicity, minimal donor morbidity, reproducible, predictable results, avoids non-auto graft disease transmission or incompatibility, not likely to elicit an immune response, last reported complications, and longer survivability. Fat transfer provides a very appealing resource for soft tissue volume augmentation in small and large volumes. Other areas where fat injection techniques are considered superior to synthetic fillers in terms of the total amount required to perform more substantial aesthetic corrections include the buttocks and breasts. Prof. Moawad and many others insist on the dynamic, unique quality of fat as it will age as we age. This exceptional fat quality is perfect for soft tissue augmentation since facial structure changes as we age, and a permanent filler will be out of proportion if used. The Disputes about longevity and the technique variation have postponed the announcement of fat as the perfect filler, added Prof. Moawad. Furthermore, fashion and trends change, and what is accepted now as beautiful maybe not be accepted later. Best of all, fat injections are forgivable, while the mistake of permanent filler is permanent!!! ” Prof Moawad says. The only relative drawback of fat injection has been the resorption of some of the fat transfer. However, with proper technique, approximately 30–70% of the fat is retained, Prof Moawad says.

HD Liposuction, the number one cosmetic surgery performed globally, is a procedure removing unwanted lumps, bulges, and areas of resistant fat deposits from specific areas of the body. Patients should be in good health, emotionally stable, and have realistic expectations. Age is not a consideration, but older patients usually have diminished skin elasticity and thus will probably not achieve the same results as a younger person with tighter skin. While no method of liposuction is a substitute for proper nutrition and physical exercise, nor is it an alternative for general weight reduction, it is ideal for permanently removing localized areas of fat that are diet and exercise-resistant. The most common areas for treatment include upper thighs (saddlebags), abdomen, flanks (Love handles), and upper arms. Other areas include facial fat accumulations, including a double chin, neck and jowls, breast, hips, buttocks, and knees. I can do cheeks, calves, and ankles, but the results are less impressive in these areas. In men, liposuction can be used to correct gynecomastia (enlarged breasts) and, more recently, scarless breast reduction in females. In addition, liposuction is used to remove sweat glands in the underarm to reduce excessive sweating without affecting the body’s ability to cool itself. The application of external ultrasound before liposuction is a technique that applies the transcutaneous application of high-frequency ultrasonic fields delivered into the wetted fatty tissue to melt fat cells and make it easy for extraction. All types of energy (mechanical, ultrasound, laser, and radiofrequency have been combined with liposuction to reduce surgeon effort and improve the result. The “power” in power-assisted/power-tumescent liposuction (mechanical energy) refers to the use of a cannula with a back-and-forth motion of the tip passes through tissue to suction out fat in fibrous (male breast) or the back with reduced effort. Power-assisted liposuction helps skin tighten during the recovery period.

Face and neck BOTOX injections have been used to treat facial wrinkles in the last 20 years and have become one of the most popular cosmetic procedures. BOTOX is a powerful and flexible tool in the aesthetic physician’s armamentarium. Progress in aesthetic medicine has supplied contemporary insights into practices that maximize its use. A range of product- and patient-specific factors influence the treatment plan, and genuinely optimized outcomes are possible only when the treating physician has the requisite knowledge, experience, and vision to use BOTOX as part of a unique solution for each patient’s specific needs.