This is an article taken from Cosmetic Surgery Times.
Lifestyle Lift’s dirty little secret
September 10, 2009
This is an article taken from Cosmetic Surgery Times.
Lifestyle Lift’s dirty little secret
September 10, 2009
Taking these steps before scheduling a consultation with a cosmetic surgeon will ensure that you find a plastic surgeon with the highest qualifications.
Many patients have asked if they can continue smoking up until their cosmetic surgery. The procedures most often in question are breast lifts (with or without implants), breast reductions, tummy tucks, and facelifts. Simply put, smoking and these surgeries can be recipes for disaster. Tobacco, nicotine, and carbon monoxide—key components of cigarettes—are proven to impede wound healing, making the stakes incredibly high for patients who smoke. Let’s delve into the risks and evidence, emphasizing why quitting smoking before surgery is not just advisable but crucial.
Smoking significantly affects the body’s ability to heal wounds. Nicotine constricts blood vessels, reducing blood flow to tissues. Carbon monoxide decreases oxygen levels in the blood, while tobacco’s toxic chemicals damage collagen and elastin, which are essential for skin strength and elasticity. Together, these factors severely impair the body’s capacity to recover after surgery.
In surgeries that involve lifting and tightening large amounts of skin, such as tummy tucks or facelifts, reduced blood flow can result in serious complications:
Some cosmetic procedures pose greater risks for smokers due to the extensive skin manipulation involved. Here are examples of surgeries where smoking can have disastrous effects:
Facelifts involve tightening the skin and underlying tissues of the face to achieve a more youthful appearance. The skin’s blood supply is already reduced during this procedure due to the surgical lifting of the tissues. Smoking compounds this reduction, greatly increasing the risk of skin necrosis, especially around the incisions near the ears. Smokers are more likely to experience prolonged bruising, hematomas, and suboptimal scarring after facelifts.
Tummy tucks involve removing excess skin and tightening abdominal muscles. This procedure disrupts a significant amount of blood supply to the abdominal skin, leaving it reliant on a network of smaller vessels to heal. Smokers face an elevated risk of wound dehiscence, infection, and skin necrosis. In extreme cases, large portions of the abdominal skin can turn black and die, requiring additional surgeries to address.
Both breast lifts and reductions involve reshaping and lifting breast tissue while removing excess skin. Smoking dramatically increases the chances of nipple necrosis, where the nipple and surrounding areola lose blood supply and die. This catastrophic outcome often requires further reconstruction surgeries and can leave devastating scars.
Even minimally invasive treatments like laser resurfacing can be affected by smoking. Smoking impairs the skin’s ability to regenerate and heal after laser treatments, leading to prolonged redness, irritation, and subpar results.
Multiple studies have documented the dangers of smoking in surgical patients:
Certain cosmetic procedures are considered somewhat safer for smokers, as they involve less extensive skin manipulation. These include:
Even so, smokers undergoing these surgeries are still at a higher risk of complications compared to non-smokers. Surgeons often provide strong warnings and disclaimers to ensure patients understand the risks.
Because cosmetic surgery is elective, the goal is to minimize all potential risks. Quitting smoking even two to four weeks before surgery can significantly improve outcomes. Here’s how:
Surgeons may also recommend quitting all nicotine products, including vaping and nicotine replacement therapies, as these can have similar effects on blood flow.
The risks of smoking before cosmetic surgery are too significant to ignore. From facelifts to tummy tucks, the combination of smoking and extensive skin manipulation can lead to devastating complications, including skin necrosis, delayed healing, and infection. For those considering elective procedures, quitting smoking is not merely a recommendation but a vital step to ensure a safer surgery and optimal results.
If you’re planning cosmetic surgery and currently smoke, talk to your surgeon about strategies to quit. Your health, safety, and aesthetic outcomes depend on it.
Many of my patients ask how I choose the optimal size for a breast implant. Some women are very concerned about choosing too large of an implant, as they know this can make their breasts look unnatural. Other women worry that they won’t choose a large enough implant to see a discernible difference. To address these concerns, I use a variety of tools and techniques to help my patients select the best breast implant size:
Having patients bring photos of breasts they like and breasts they dislike helps me determine their goals. Visual references are invaluable in understanding each patient’s aesthetic preferences. Some women desire subtle enhancement, while others want a much more dramatic enlargement. By reviewing these photos together, I can better tailor my recommendations to their vision.
Accurate measurements of the chest wall diameter, breast width, and breast height are crucial. These factors ensure the implant fits the patient’s anatomy. The breast skin envelope has natural limits; selecting an implant that is too large can cause it to sit too high, too low, or too far to the sides, resulting in an unnatural appearance. Taking precise measurements allows us to avoid these pitfalls and achieve balanced, proportionate results.
In-office trial sizing is a less valuable tool, having being largely replaced by 3D imaging. Although not an exact science, trying on different implants in a bra provides patients with a rough idea of how their new breasts might look in clothing. This exercise often sparks important conversations about their goals and helps patients feel more confident about their choices.
Every implant has unique characteristics, including shape and profile, which significantly impact the final result. For example, a high-profile implant creates a different appearance compared to a moderate-profile implant, even if they are the same volume. Through open and thorough conversations during the preoperative consultation, I ensure that patients understand these differences and how they align with their desired outcomes.
One of the most exciting advancements in breast augmentation planning is the use of 3D imaging technology like Crisalix. This powerful tool allows patients to visualize their potential results in real time. By uploading images of their body, Crisalix creates a virtual simulation of how different implant sizes and shapes would look on them. This technology takes much of the guesswork out of the decision-making process and provides patients with a clearer idea of their future appearance, helping them feel more confident in their choice. To schedule a 3D breast augmentation consultation using 3D imaging, begin the process by clicking here.
Even with careful preoperative planning, intraoperative sizing plays a vital role. During surgery, I often use trial implants and sit the patient up to evaluate the breasts from multiple angles. This step is especially important for patients with breast asymmetry, as it allows me to make real-time adjustments to achieve the best possible symmetry and aesthetic result.
Each of these tools serves a unique purpose, and together, they provide a comprehensive approach to selecting the optimal breast implant size. My goal is always to create results that are both beautiful and in harmony with the patient’s body. By combining measurements, imaging, trial sizing, and conversation, I can help patients achieve the look they’ve always wanted with confidence.
Almost all patients have several questions about the meaning of breast implant profiles. Patients have seen pictures on the Internet of patients with breast augmentation results they liked and wanted the same style implants as in the pictures. These patients had a limited understanding as to what breast implant profile refers, prompting this blog entry.
The naming for implant profiles predominantly refers to smooth, round implants, which are the most common type of implants used for cosmetic breast augmentation. The profile of the implant has nothing to do with the fill of an implant, with the vast majority of implants placed these days being cohesive silicone gel implants, otherwise known as “gummy bear” implants. The two major breast implant manufactures have different names for their implants. Allergan refers to its implants as low, low plus, moderate, full and high profile. Sientra has similar names, but also has a moderate profile plus implant, which is between its moderate and high profile implants. Motiva sticks with the same principles, but gets fancier with its names, referring to the implant profiles in the United States as mini, demi and full. In Europe, they offer an additional profile, Corse, which is the equivalent of an extra high profile implant.
The profile of an implant equates to the projection of that implant. For a given volume, the higher the profile, the fatter and narrower an implant is. As a result, higher profile implants tend to provide more fullness and a rounder appearance to the upper portions of the breast. Higher profile implants tend to be really useful in women with relatively narrow breasts who want significant enlargement of the breasts; in these women, if a low or moderate profile implant were selected, to achieve the desired volume may entail the implant riding into the underarm region. In contrast, a patient with a wider build or wider breasts may find that high profile implants may fail to adequately fill their entire breast; they often times benefit from implants with lesser projection. Higher profile implants also tend to be useful in women who desire a small breast lift without the incisions associated with a formal lift.
In recent years, there has been a notable shift in the preferences of patients seeking breast augmentation, with increasing interest in low-profile and low-profile-plus breast implants. These implants are characterized by a wider base diameter and less projection compared to high-profile implants. This design creates a more natural, subtle enhancement that aligns with the growing trend toward understated aesthetics. Many patients are prioritizing proportionate results that complement their natural body contours rather than opting for the more pronounced, rounder look traditionally associated with higher-profile implants.
The appeal of low-profile implants is also influenced by their suitability for specific body types. Women with broader chest walls often find that low-profile implants provide a harmonious fit that enhances their shape without looking artificial or out of proportion. Additionally, these implants are often favored by patients who wish to restore volume after pregnancy or weight loss while maintaining a soft, natural slope to the breast. As societal beauty standards continue to evolve, the demand for implants that achieve balanced, subtle results is expected to grow, making low-profile and low-profile-plus implants a significant choice in modern breast augmentation procedures.
Treatments with injectable fillers, such as Juvederm, Restylane, Radiesse, and Sculptra, not to mention others, can restore a youthful appearance to the lips, nasolabial folds, marionette lines, midface, jowls and lower eyelids, with minimal to no downtime. Many patients avoid these treatments, though, because they have heard horror stories from friends or colleagues about the pain associated with these treatments. Suffice it to say, this needn’t be the case – there are steps your plastic surgeon can take to make these treatments more comfortable.
Recently, BioForm Medical, Inc., makers of Radiesse, received approval from the Food and Drug Administration to mix the filler with lidocaine, an injectable local anesthetic, prior to injection into the skin. This approval was based on a large study of patients, in which 100% of patients reported feeling less pain when Radiesse was pre-mixed with lidocaine. Many plastic surgeons, including me, have begun to pre-mix lidocaine with all fillers, including Juvederm, Restylane, and Evolence, not to mention Radiesse, prior to injecting into patients. The results of treatment are still great, but patients are significantly more comfortable during treatment.
Others things your plastic surgeon can do to make your treatment with injectable fillers more comfortable include:
• Using topical anesthetic gel for at least 30 minutes prior to commencing any injections.
• Augmenting treatment with topical anesthetic gel with injections of local anesthetic into nerves above and below the lips.
• Using small gauge needles and slow injection techniques
Combining all of these treatments can ensure that you’ll not only look great after your treatment with injectable fillers, but you’ll feel pretty great during the treatment too!
Breast implants are a popular option for enhancing breast size and shape, but like any medical procedure, they come with risks. These risks can range from mild to severe, depending on individual circumstances, implant type, and surgical technique. Here, we break down the potential complications and discuss differences among textured and smooth implants as well as saline, silicone, and Motiva implants.
Understanding the risks associated with breast implants and the differences among implant types is crucial for making an informed decision. Patients should discuss their goals, medical history, and concerns with their surgeon to determine the best option for their needs. While risks exist, choosing an experienced surgeon and following post-operative care instructions can significantly improve outcomes and minimize complications.
Beauty is a personal and evolving concept, with different features holding more importance as we age. A recent survey from Beauty for Life, a collaboration between leading plastic surgery organizations, sheds light on what individuals value most about themselves and others, as well as their primary concerns about their appearance.
When asked about the most appealing aspects of beauty in others, responses varied by age:
When reflecting on their own concerns, however, respondents showed different priorities. For example, in their 30s, many individuals focused on their abdomen and hips, while in other decades, concerns about the face took precedence.
When it came to personal concerns, the focus on specific areas of the body also changed with age:
These results suggest that priorities shift over time, but the abdomen and hips often remain areas of focus for those seeking aesthetic improvements.
When asked why maintaining physical appearance was important, self-confidence was the leading motivator across all age groups. Other reasons, however, changed with life stages:
These insights highlight how personal and professional contexts influence our approach to beauty and self-care over time.
When it comes to maintaining beauty, respondents emphasized the importance of a well-rounded approach:
These survey results underscore that beauty concerns and priorities evolve throughout life. For younger individuals, the focus may be on certain physical attributes or relationship goals, while older adults may place greater importance on maintaining a youthful appearance for social and professional reasons.
Recognizing these shifts is important for anyone considering aesthetic treatments, helping individuals make choices that align with their personal goals and values at every stage of life.
If you’re interested in exploring options for enhancing your appearance, it’s helpful to consult with a board certified plastic surgeon like Dr. Jejurikar who can guide you through the best approaches to meet your needs and priorities.
The world of dermal fillers has evolved significantly over the past two decades. Once a leading option for non-surgical facial rejuvenation, collagen fillers have largely been replaced by hyaluronic acid (HA) fillers as the go-to choice for patients and providers alike. But why have collagen fillers fallen out of favor, and what makes HA fillers the superior option today? Let’s explore the key differences, benefits, and limitations that have shaped this shift in aesthetic medicine.
Collagen fillers were among the first widely used dermal fillers, offering a way to restore volume and smooth wrinkles. Derived from bovine (cow) or human sources, collagen fillers work by supplementing the skin’s natural collagen levels, which decrease with age.
Popular collagen-based fillers in the past included Evolence, Zyderm and Cosmoderm. These products provided temporary results, typically lasting around 2-4 months, before requiring re-treatment.
Hyaluronic acid fillers, introduced in the early 2000s, have become the gold standard in non-surgical facial rejuvenation. Hyaluronic acid is a naturally occurring substance in the skin that helps retain moisture, provide hydration, and add volume. HA fillers like Juvederm, Restylane, and Belotero offer immediate, customizable results that can last from 6 months to 2 years, depending on the product and treatment area.
Collagen fillers were groundbreaking in their time, but several limitations led to their decline:
Hyaluronic acid fillers have set the standard for non-surgical facial rejuvenation thanks to their many advantages:
While collagen fillers have become less popular, they still have a place in aesthetic medicine. For patients who are specifically looking for subtle, temporary enhancements, collagen fillers may be an option. Additionally, advancements in bioengineered collagen products, such as Sculptra (a poly-L-lactic acid injectable that stimulates collagen production), have renewed some interest in collagen-stimulating treatments rather than collagen as a filler material.
The rise of hyaluronic acid fillers over collagen fillers is a testament to the progress and innovation in aesthetic medicine. While collagen fillers paved the way for modern injectables, HA fillers offer superior longevity, versatility, safety, and results, making them the clear choice for patients and providers today.
If you’re considering injectable treatments to rejuvenate your appearance, schedule a consultation with a board-certified plastic surgeon or experienced injector. They can guide you through your options and recommend the best product to help you achieve your aesthetic goals.
The cosmetic surgery industry has evolved dramatically over the past 15 years. However, one challenge remains constant: the growing trend of marketing branded surgical and nonsurgical procedures as quick fixes for aesthetic concerns. Names like “Lifestyle Lift,” “Thread-Tox,” and “Smart-Lipo” promise miraculous results with little to no downtime. But are these highly marketed procedures the best option for achieving your desired results? Experts emphasize that while marketing has advanced, patient safety and outcomes must always remain the top priority.
Branded procedures often fall into two categories:
As new technologies and procedures emerge, the Aesthetic Society continues to stress that a procedure is only as effective as the surgeon performing it. Branded procedures often simplify or oversell the complexities of aesthetic surgery. This can lead to mismatched expectations and, in some cases, unsafe outcomes.
Dr. J. Peter Rubin, a board-certified plastic surgeon, highlights the importance of selecting the right procedure for the right patient. “In the wrong clinical setting, the results may not come close to the promises made in the advertising,” he says. The judgment and expertise of a board-certified plastic surgeon remain the most critical factors in achieving optimal results.
Marketing for branded techniques often implies a one-size-fits-all solution. However, according to Dr. Sherrell Aston, past-president of the Aesthetic Society, “The human anatomy and aging process vary significantly from person to person. A single facelift technique, for example, cannot appropriately address the unique needs of every individual.”
Short-incision facelifts, “minimally invasive” techniques, and other marketed solutions can yield excellent results—but only when tailored to the right patient by a highly skilled surgeon.
Patient safety has become an even more critical focus in today’s cosmetic landscape as the demand for procedures has surged, along with the number of underqualified providers offering them. Procedures such as facelifts, liposuction, abdominoplasty, and breast surgeries require extensive training and expertise.
Dr. Renato Saltz, a past president of the Aesthetic Society, emphasizes that the rigorous residency training required for certification by the American Board of Plastic Surgery (ABPS) equips surgeons to handle the complexities of these procedures. This training ensures not only technical skill but also an understanding of ethics, safety, and patient-centered care.
If you are considering a cosmetic procedure, follow these steps to ensure your safety and satisfaction:
In 2024, advances in technology have introduced new, minimally invasive options for facial and body rejuvenation. Treatments such as radiofrequency microneedling, laser liposuction, and injectable fillers can address some aesthetic concerns with less downtime than traditional surgery. However, these are not replacements for surgical procedures in cases requiring more significant changes. Consulting with a qualified plastic surgeon ensures that your chosen treatment aligns with your goals and delivers realistic, long-lasting results.
Branded procedures may promise convenience and fast results, but the most critical factor in cosmetic surgery remains the skill, training, and judgment of your surgeon. Marketing trends come and go, but patient safety and individualized care are timeless. By choosing a board-certified plastic surgeon and prioritizing a personalized approach, you can achieve beautiful, natural results that align with your aesthetic goals.
If you’re considering a cosmetic procedure, visit the Aesthetic Society at www.surgery.org to learn more about qualified providers and the latest advancements in the field. Your safety and satisfaction depend on making informed decisions guided by experts.