Plastic Surgery Blog

Answer: I commonly hear this same question. Many women in your situation are concerned about looking overdone. Even for those who have aged well and have more changes in the neck than the mid-face, there most likely has been some volume loss and sagging in the cheek region. You should see dramatic improvement in your neck and jawline with a neck lift alone. You would most likely be completely satisfied with this procedure. I usually suggest to my patients, however that they have the full face and neck lift. This is primarily because there is virtually no difference in recovery time and only slightly more scarring with the full procedure. With this there will be equal improvement in the mid-face or cheek region which will dramatically improve the overall result. The mid-face portion of the lift can produce the desired improvement while still maintaining a natural appearance.

Answer: With fat transfer procedures, regardless of the recipient site or area being treated, the end results are permanent. There is always some amount of volume loss initially following a fat transfer procedure, with graft take varying widely between 20-80%. The fat that does take becomes viable new tissue. Those living cells and tissue will however continue to undergo changes with further aging. Facial fat transfer may be performed as an independent procedure or as an adjunctive procedure with a facelift. Facial rejuvenation with fat transfer alone is most likely to be performed in patients in their 40s. If there is good graft take the effects should be lasting. This is the benefit of fat transfer over temporary fillers. With further aging changes, an additional procedure, either another fat transfer or some type of facelift may be indicated after several years. An additional fat transfer should not be needed after only a few years unless there was inadequate take with the first.

Answer: It is very uncommon for organs to be punctured during liposuction. This is a possible complication of the procedure but it occurs very rarely. When it does the consequences could of course be serious but it would certainly not always be fatal, especially if recognized early. Liposuction is performed superficial to the muscle fascia. It is possible however, when performing hundreds of passes with the cannulas, that the muscle layer may inadvertently be penetrated. If the cannula were to penetrate deeply enough, it could possibly enter the chest or abdominal cavities and injure organs within those cavities. This would be an occurrence that the surgeon may well recognize and then be more observant for signs of internal injury.

Liposuction is a surgical procedure. It should not be taken as anything less serious. It should always be performed by a properly trained, board certified surgeon at a licensed and certified surgical facility.

Answer: Enlargement of the male breast in gynecomastia may be caused by overgrowth of either glandular tissue or of fatty tissue or by a combination of the two. The glandular tissue tends to be very dense, fibrous and firm and is usually located in the central breast just beneath the areola. Glandular tissue is often tender to touch. Prominent fatty tissue is usually more widely dispersed throughout the breast. It can be somewhat fibrous in gynecomastia but is generally much less dense and firm than glandular tissue. When gynecomastia is due primarily to excess fatty tissue, it may well be able to be removed with liposuction, especially when additional advanced techniques utilizing energy sources such as ultrasound, laser or mechanical power are employed.

When overgrowth of glandular tissue significantly contributes to gynecomastia then direct surgical excision through an incision at the lower edge of the areola is usually required. This may or may not be combined with liposuction, depending on whether or not excessive fatty tissue is also present. The other variable determining the most appropriate treatment plan for gynecomastia is whether or not excess skin is also present and if so, the amount and quality of that skin. When there is a slight or moderate amount of skin excess and skin elasticity is good, the skin should retract well and result in an acceptable contour after liposuction alone. When there is a large amount of excess skin, and/or thin skin with poor elasticity, then excess skin must be excised by combining the glandular and fatty tissue excision or liposuction with a breast lift type procedure which will result in the desired contour improvement but more scars.

Answer: A body lift improves contour primarily by removing excess skin, smoothening and tightening the remaining skin and lifting sagging surrounding structures. Some amount of liposuction is almost always done as a complimentary part of body lift procedures however, to further improve contouring in areas with prominent fat and to enhance the end result. In some body lift procedures, areas of fat may actually be repositioned by what is called an autologous flap as with a gluteal auto-augmentation.

Answer: There are many types of faceliftprocedures advertised. What is most important is for you to find a qualified, board certified plastic surgeon with whom you are comfortable and confident, and allow that surgeon to perform the procedure that he or she feels is best for you in their hands. A traditional facelift is still the gold standard by which all other modified procedures are judged. Some alternative procedures involve advances in technology (endoscopic facelift) and some represent partial facelift procedures (mini-facelift, mid-face lift, necklift). Many however are more marketing gimmicks that promise less scarring, minimal anesthesia and more rapid recovery. For some patients, these may be reasonable alternatives that provide reasonable results, but usually are not as effective or lasting as more traditional procedures.

Complete facelift procedures should equally address the parts of the lower two thirds of the face, those being the cheeks and the neck, with the jawline being the transition zone between the two. For those patients with more pronounced aging changes in one or the other of these two areas, a partial facelift procedure may be appropriate.

It is also important that a face or neck lift procedure address the deeper tissue planes beneath the skin and fat. These are the fascia or SMAS layer in the face and the platysma muscle in the neck, which are continuous. Procedures that involve tightening or lifting of these layers by flap advancement, resection or suture plication should provide more dramatic, more natural and more lasting results.

Answer: Injectable fillers would be good for you. Yours is a great indication for non-surgical options such as fillers. For augmenting the cheeks, we do use surgical and non-surgical procedures somewhat more often to correct aging changes; however for those who naturally have poor cheek projection and shape these techniques can provide equal or even greater improvement. In my practice, the surgical options would include fat transfer, cheek implants or a mid-face lift. Among the injectable fillers, I prefer either Radiesse or Sculptra for cheek augmentation.

Answer: Body lift procedures are by no means indicated only for patients who have lost a lot of weight. Many patients like you who are not and who have never been overweight, may develop laxity and sagging of the skin of the hips, buttocks and thighs. This commonly develops as a result of aging and sun damage. A body lift procedure may be of great benefit to such patients by lifting and tightening the skin around the posterior waistline, the buttocks and the posterior and lateral thighs. The skin of the inner and anterior thighs is similarly tightened and lifted with a medial thigh lift. These procedures are often combined with at least some liposuction to optimize the contour improvement; however when skin laxity and inelasticity is the main problem, then liposuction is not the ideal primary procedure but is complimentary.

Answer: It is possible for breast tissue to grow back after surgery for gynecomastia.

Gynecomastia occurs in men from an accumulation or overgrowth of glandular breast tissue and/or fat. When the excess tissue is glandular, it usually has developed because of stimulation from endogenous (internal) or exogenous (external) hormone exposure, or from hormone mimicking prescription or illicit drugs, i.e. marijuana. The treatment of gynecomastia includes identifying and discontinuing any causative agents and then surgery only if there is no spontaneous resolution. If the stimulus remains after surgery, the glandular overgrowth and associated symptoms may recur. This is due to the fact that a small amount of the glandular tissue is usually left behind on the undersurface of the nipple areolar complex (NAC). This tissue is attached to and continuous with the skin of the NAC. If it is thinned excessively during surgery then the circulation of the NAC may be compromised, resulting in necrosis and possible loss of part or all of the NAC. Also, and more commonly, the consequence may be contraction and or adhesions from scarring that may distort the appearance of the NAC.

When the excess breast tissue in gynecomastia is in part or completely fatty in nature, the risk of recurrence is less than with glandular tissue. In this case the standard treatment is with liposuction, and recurrence risk would be more or less the same as with liposuction in any other area of the body. Re-accumulation of fatty tissue may occur with subsequent weight gain after liposuction. Areas previously treated with liposuction, however are usually more resistant to this re-accumulation than other untreated areas of the body.

Answer: This is a great question. As your plastic surgeon, when seeing you in consultation for chin or sub-mental liposuction, these are exactly the options that I am considering. Improving the aesthetics of this part of the face primarily involves correcting and contouring the angle between the chin and the neck (the cervico-mental angle) as seen on profile. Other factors include achieving the ideal volume, shape and contour of the chin.

When the size of the chin is deficient, particularly in outward projection, it is augmented either with an implant, or with fillers or even with orthognathic surgery which actually advances part of the bone forward.

When excess fat has accumulated beneath the chin and in the central neck, then contour is improved either with liposuction or with direct excision.

When the cervico-mental angle is obscured due to laxity of the skin and underlying soft tissues of the neck, then tightening of these tissues with a necklift is indicated.

In general, for my patients in their 20s and 30s I most often perform liposuction, with or without a chin implant. For patients in their 30s and 40s, using a small incision beneath the chin, I often perform liposuction and or direct fat excision combined with tightening of the muscle (platysma) in the central neck. This may also be combined with a chin implant. For my patients on their 50s and over, I am more likely to recommend a full necklift, with or without chin augmentation.