The Beast Lift is one of the most frequently performed Cosmetic Plastic Surgery Procedures. For every three Breast Augmentations, a Breast Lift, also know as a Mastopexy, is performed. I had the opportunity to discuss Breast Lifts on the San Francisco Bay Area’s Body Beautiful on KRON 4. If you missed the live broadcast, the segment is embedded below. More Breast Lift Videos are also available on the DrMele.com Bay Area Breast Lift Video Gallery.
Mastopexy | Breast Lift Video Presentation on KRON 4
When Is A Breast Lift Recommended?
Unlike Breast Augmentation, which enlarges the breasts, Breast Lifts change the shape of the breasts. Breast Augmentation and Breast Lifts are complementary, and are often performed together. Breast Lifts are used to lift saggy breasts and to reshape birth defects like moderate to severe forms of Tubular Breast Deformity.
Little Breast Lifts
The smallest breast lifts are performed to reposition the nipple and areolae higher on the breasts. Common types include the Periareolar Lift or Round Block Lift and the occasionally effective Crescent Lift. These types of lifts are not effective for lifting the breast mound, and have the potential to deform the areolae when they are asked to do too much.
Moderate Breast Lifts
More effective breast lifts require incisions elsewhere on the breast. The next largest lift is the Vertical Breast Lift. A Vertical Lift includes the periareolar and a vertical incision, which runs from the lowest aspect of the areolae to the folds under the breasts. This lift is more effective for raising the nipple, controlling the size of the areolae and lifting the breast mound.
Big Breast Lifts
The biggest, and most versatile breast lift includes a horizontal inion that lies in the breast fold, and the incisions used in the Vertical Breast Lift. It goes by many names, but the most common include: The Anchor Breast Lift, The Inverted-T Breast Lift and The Keyhole Breast Lift. The names come from the shape of the incisions and pattern of skin removal. This lift provides superior control of the breast mound compared to the vertical lift, specially for larger breasts.
More About Breast Lifts
If you are looking for more information on Breast Lifts, there are many more breast lift posts here on the San Francisco Plastic Surgery Blog and on my other websites linked above and in the margin. However, the only way to get specific information about the Breast Lift that will work best with your body is to consult a Board Certified Plastic Surgeon in person. If you would like to schedule a private consultation, give me a call at (925) 943-6353.
The Mommy Makeover has become the most popular combination Cosmetic Plastic Surgery. The procedure addresses the two areas that women complain about most after childbirth: the belly and the breasts. While Tummy Tuck with Breast Augmentation is the most popular combination, many variations exist.
Mommy Makeover Video Presentation with Before and After Pictures
I’ve appeared on the Bay Area’s News Station, KRON 4 in the San Francisco Bay Area, numerous times over the last eight years. My most recent Body Beautiful appearance, was all about Mommy Makeovers. The following television segment goes over the highlights of what’s involved. It covers many of the most frequently asked Mommy Makeover questions and illustrates results with before and after pictures.
Mommy Makeover Video Presentation on KRON 4
What Can a Mommy Makeover do for Your Belly?
Mommy Makeovers usually include a Tummy Tuck. The tummy tuck cinches the abdominal wall muscles, removes disproportionate fat and tightens loose skin, reversing much of what pregnancy does to the belly.
Sometimes less is needed, and there are several variations of the Abdominoplasty available including the “Floating Belly-Button” Tummy tuck and the Mini Tummy Tuck. When the skin is still tight, but disproportionate fat is the problem, Liposuction may be all that is needed. Click here for more Tummy Tuck Information.
What Can a Mommy Makeover Do For Your Breasts?
The other half of the Mommy Makeovers is Breast Enhancement. The most common enhancement is Breast Augmentation, which fills loose breast skin and enhances both volume and shape. For the loss of breast volume typical after childbirth, Breast Implants can fill the need.
When volume is not a problem, a Breast Lift may be what’s needed. The Breast Lift or Mastopexy, tightens the breast skin without changing the breast volume. Many different breast lifts exists, and the best Mastopexy for you will depend on how much lifting is needed.
Sometimes breasts increase in volume after pregnancy, and remain too large. Breast Reduction Surgery can help. A Breast Reduction, or Reduction Mammoplasty, will remove excess breast volume and tighten the skin, like a Breast Lift. The result is smaller, firmer and perkier breasts. This is especially helpful in cases where your breasts are heavy and causing pain in the neck, back or shoulders.
For mommies who had Breast Augmentation prior to pregnancy, your breast tissue changes with pregnancy, too. While the breast implant will retain it’s volume, sometimes the shape of the breast is impacted with the normal growth and involution of your breast tissue. When the shape is negatively impacted, Breast Implant Revision Surgery can help shape things up again.
Mommy Makeover Consultations
If a Mommy Makeover is in your future, give me a call at (925) 943-6353. We can review the options that address your concerns, and create a personalized treatment plan that fills your specific needs. More information about Mommy Makeovers and the Plastic Surgery procedures that are utilized, is available by clicking the links included in the post above. More videos are coming soon on Breast Lifts, Breast Reduction and Chin Augmentation. See you next week.
The benefits of music on healing have been well documented. Music in the operating room is no different.
Plastic Surgery and Music combine synergistically on many levels. Both embody the objective details of science and the subjective nature of art. Music can be documented on sheet music, but the performance depends on the artist, and the quality is ultimately judged by the audience. Similarly, the goals of plastic surgery can be described objectively; however, the paths and the outcomes are often subjective.
Plastic Surgery and Music
Personally, I enjoy both. At age 15, I selected medicine for my career. At the time, I played clarinet and sax, and sang everything from English Madrigals to Punk Rock. During my pre-med training at UC Davis, I marched with the Cal Aggie Band-uh, and was Music Director for the campus radio station, KDVS. Through my career as a San Francisco Bay Area Plastic Surgeon in private practice in Walnut Creek, CA, I have continued my love of music. In 2011, my operating room musical selections were quoted in the article The Plastic Surgery Playlist: What Are Doctors Listening to in the OR? I enjoy music every day in the operating room. It provides a calming and cohesive environment for the surgical team and helps patients relax.
How Music Helps Plastic Surgeons
How about live music in the OR? The Louis and Lucille Armstrong Music Therapy Department at Beth Israel Medical Center has been supported by the Louis Armstrong Foundation since 1994.
Music not just an enjoyable stress reliever, it improves surgical outcomes, an effect that can be objectively measured. In a recent Aesthetic Surgery Journal article, the positive influence of music on plastic surgery was proven. The study, from The University of Texas Medical Branch at Galveston, shows that when plastic surgeons listen to music they prefer, their surgical technique and efficiency when closing incisions is improved. This is regardless of the type of music played.
Plastic Surgery Procedure Playlists
I prefer a wide variety of music, and my playlists have been described as eclectic to the point of causing auditory whiplash. Variety is the spice of life, and outcomes are only improved when the plastic surgeon likes the music. For selected procedures, I have preferred play lists. For Blepharoplasty, I prefer classical. For Liposuction, something with a beat is helpful. For longer cases, upbeat music seems to keep the momentum of the operation moving forward.
Keeping Your Plastic Surgery Teammates Happy
Previous studies show little objective correlation between the quality of surgical outcomes and whether patients like the music played during surgery. This makes sense, because when patients are under general anesthesia, there is no recall. Outcomes are not significantly improved when operating room team members other than the operating surgeon are asked to select the music, unless the surgeon likes it. However, subjectively, I feel it matters. A happy Plastic Surgery Team functions better, and has less resistance to doing more, when necessary. For patients, music is especially helpful during the pre- and post-operative experience. On the other hand, one study showed that when patients selected the music for their operation, and their surgeon did not like it, outcomes were worse!
The Evidence is Reproducible
In the 90’s, carrying around a bulky case of CD’s was still worth it for good tunes in the OR.
A study out of Buffalo, New York, published in the Journal of the American Medical Association in 1994, measured surgeons’ blood pressure and pulse rates during surgery. The data confirmed the quickest, most accurate performances, those with the lowest surgeon heart rates and blood pressures, came when surgeons listened to the music of their choosing. It was also demonstrated that it was better to have music selected by the study team than no music at all. In 1994, if you wanted to play music in the operating room it took some effort. You had to lug around your own CD’s, and often bring your own player to the operating room. Today ORs are bluetooth enabled, so all you need is your phone and a streaming service.
It’s Not Just an American Thing
Articles from the leading medical journals in the UK show that surgeon selection of music helps outcomes. In fact, the Guardian lists several doctors’ preferred playlists. Articles from the Lancet showed that compared with standard care, music was associated with a 20% reduction in postoperative pain, a 10% reduction in anxiety and a significant reduction in the use of pain medication. Music did not affect length of hospital stay, but it increased patient satisfaction slightly, so even hospital administrators might see the benefit.
Musical Request During Surgery Accepted
The nice thing about liking a wide variety of music is that your requests for music during Plastic Surgery are easily granted. With a variety of streaming music services like Pandora, Slacker and Spotify, access to music has never been easier. So if you have a favorite band or genre, let me know. For a Plastic Surgery Consultation in the San Francisco Bay Area give me a call at (925) 943-6353.
Breast Lifts come in many shapes and sizes, and if you are considering a Mastopexy, you should know your options. While every option will not be appropriate for every breast, it’s good to know the pros and cons of the most common types of Breast Lifts.
Breast lift before and after pictures show lifting of the nipple and breast tissue from the side. This makes the breasts perky and youthful.
Reasons for Breast Lifts
The most common reasons for Mastopexy are: deflation of the breasts after pregnancy, weight loss and congenital breast deformity (i.e. born this way). Saggy breasts are often a mismatch between the size of the breast and the amount of skin; however, large breasts can also be saggy.
Little Breast Lifts
The Plastic Surgery term for sagging is ptosis. The degree of ptosis determines the Breast Lift most likely to provide adequate correction. When there is little ptosis, a little breast lift may be all that is needed.
The smallest breast lifts are the Crescent Lift and the Periareolar Lift. Both involve making an incision around the edge of the areola (the pigmented skin surrounding the nipple). For the Crescent Breast Lift, the incision is about half way around, forming a crescent of skin that is removed. For the PeriAreolar Breast Lift, the excision is doughnut shaped and surrounds the areola completely.
Breast Augmentation with a Periareolar Lift Before and After Pictures: Periareolar lifts are often used to both lift the nipple and to reshape tubular breasts during breast augmentation.
Medium Breast Lifts
For moderate ptosis, a Vertical Breast Lift is often performed. This allows for additional lift of the breast mound and more upward movement of the nipple. The vertical lift is also called the Lollipop Breast Lift, because the shape of the scar looks like a lollipop. The incision surrounds the areola like a periareolar lift, but has a vertical component that runs from 6 o’clock on the areola down to the fold under the breast, the inframammary fold or IMF.
Vertical breast lift before and after pictures show how the lift elevates the breasts and the nipple and reduces the areolae more effectively than the periareolar lift can.
Big Breast Lifts
The biggest lift, and the most common type of lift, is the Inverted-T Breast Lift. Also called the Anchor Breast Lift or Keyhole Breast Lift, the lift has the same scar as the Vertical Lift with the addition of a scar that is hidden in the fold under the breast, the IMF. The allows for additional removal of the skin responsible for the positive pencil test. Sometimes, when the nipple is very low on the breast, the vertical scar can be eliminated. The so called Horizontal Breast Lift uses a periareolar and an IMF incision alone.
Inverted-T or Anchor Breast Lift Before and After Pictures: This type of lift allows for maximum rejuvenation. Tired, old-looking breasts become youthful and perky. The IMF incision is hidden in the fold under the breast. Out of site. Out of mind.
With Breast Lift Options Comes Confusion
My goal is not only present the options, but to reduce the confusion that comes with options. While I wish I could perform breast lifts without any scars, it is the excision of excess skin that allows for the enhancement in breast shape. More information is available here on the San Francisco Plastic Surgery Blog, just click on “Breast Lift (Mastopexy)” under “Categories” in the column. Additional information is also available on DrMele.com’s Breast Lift Page, San Francisco Breast’s Breast Lift Page, and in Spanish on Cirugia Plastica San Francisco’s Página de Levantamiento de Senos. Information for changing the size of the breasts at the same time is also available.
If you are considering a Breast Lift, Breast Augmentation or Breast Reduction, there is no substitute for an in-person private consultation. To schedule an appointment in the San Francisco Bay Area call (925) 943-6353. I will discuss your options and provide personalized, professional guidance as to what will work best for you.
When I see a new patient for a Tummy Tuck (Abdominoplasty) consultation, I consider all the options. Usually, one method has the clear advantage, but occasionally there are multiple approaches to a good result. A Tummy Tuck may be the perfect fit, but sometimes less is more, like when Liposuction or a Mini Tummy Tuck will fix what’s broken. Other times, more is more, like doing a Mommy Makeover to combine belly and breast rejuvenation, or in case of a Fleur-de-Lis Tummy Tuck after massive weight loss. It’s good to see a Board Certified Plastic Surgeon who has experience with all your Belly Flattening options.
Abdominoplasty (Tummy Tuck) Before and After Pictures
The full Tummy Tuck is the only true Abdominoplasty. Its triple threat of skin tightening, muscle tightening and lower abdominal fat removal is hard to beat.
The Abdominoplasty is the go to procedure for fixing bellies. The Tummy Tuck removes the excess skin and fat from the lower belly, and it tightens the skin and muscle layers right down the middle, from the ribs to the pubis. For post pregnancy belly and after most weight loss, the Tummy Tuck gets the job of tightening the belly done right. For some patients, the Tummy Tuck is more than is needed, and for others, it is not quite enough.
When Less Tummy Tucking is Needed
For those patients who have less skin laxity there are several options. For the tight bellied person who has disproportionate fat, Liposuction may be the best choice. The procedure requires that the skin tone is good before surgery. When skin is folding on itself, the Tummy Tuck remains the better choice.
Liposuction Before and After Pictures
Liposuction removes disproportionate fat through very small incisions that can be placed away from the contouring. When the skin is tight, Liposuction is an excellent way to reduce belly bulge and muffin tops.
The Mini Abdominoplasty
One step above Liposuction on the Plastic Surgery stairway to a better belly is the Mini Tummy Tuck. A Mini Abdominoplasty combines Liposuction with repair of the muscle below the belly button and some skin excision. Small amounts of lower abdominal skin redundancy and muscle laxity respond well to the Mini Abdominoplasty. If you have loose skin above the belly button, you will want to explore other options like a “floating belly-button” Tummy Tuck or a full Abdominoplasty.
Mini Tummy Tuck Before and After Pictures
When there is less tummy to tighten, the Mini Abdominoplasty or Mini Tummy Tuck can give great results with a shortened recovery.
When More Tummy Tucking is Needed
More than a full Tummy Tuck is needed when the skin above the belly button is very loose. This is seen primarily in patients who have lost a large amount of weight. Whether you have lost weight from diet and exercise or after Bariatric Surgery does not matter. When the upper abdominal skin is very lax from side-to-side, a vertical scar is used down the middle of the abdomen to remove the excess. This is called a Fleur-de-Lis Tummy Tuck, and more about these Tummy Tucks and Lower Body Lifts (Belt Lipectomies) can be found here: Fleur-de-Lis Tummy Tucks, and on my Post Bariatric Plastic Surgery Page.
Sometimes, the Tummy Tuck will fix the Tummy, but more is needed elsewhere. A little Liposuction can be added around the sides and the back to reduce the Muffin-Top, or Breast Enhancement can be added for a full Mommy Makeover. When desired, other procedures are combined with the Abdominoplasty to help keep your body balanced.
Mommy Makeover Before and After Pictures
The Mommy Makeover combines abdominal and breast repairs in the same operation. The advantage is that there is only one recovery period.
Belly Flattening Consultations
If you are considering Plastic Surgery to flatten your belly, be certain to visit a Board Certified Plastic Surgeon near you. In the San Francisco Bay Area, you have many excellent Aesthetic Plastic Surgeons to choose from. If you would like to schedule a consultation appointment, call (925) 943-6353, and I can review the options that are most suited to your body. You can explore your options fully, so that you will know that the decision you are making is the best one for your needs. If you have questions, many frequently asked questions are answered here on the San Francisco Plastic Surgery Blog and my other websites, or you can ask via the contact form in the side column.
I am humbled to tell you that I received “Top Doctor” certification from RealSelf. Since its founding in 2006, RealSelf has created the world’s largest on-line community for learning and sharing information about Cosmetic Surgery, Dermatology, Dentistry, and other elective treatments.
Who is a RealSelf Top Doctor?
The RealSelf Top Doctor recognition is awarded to less than 10% of doctors on RealSelf. This status is earned by achieving high patient satisfaction (as reported in RealSelf reviews), getting favorable feedback on expert answers, and after investing significant time in Q&A and other doctor activity.
What Is RealSelf?
If you didn’t already know, RealSelf is a cross between Facebook and Yelp. You can view cosmetic surgery before and after pictures, and read reviews and Q&A for most Cosmetic Plastic Surgery procedures. If you join the community, you can also interact with other members, ask questions in forums and pose questions for doctors to answer. You may also rate your doctor and your procedure.
One of the unique features of RealSelf is the Worth It rating. You can rate your procedure by giving it a thumbs-up, thumbs-down or not sure rating. These are tallied and reported as the procedure’s Worth It Rating.
The most reviewed procedures are Breast Augmentation and Tummy Tuck. Breast Augmentation currently has 13,221 reviews, while Tummy Tuck has 12,957 reviews. Both receive 97% Worth It ratings. Both were also discussed on my last KRON 4 appearance on BodyBeautiful. The combination of Breast Augmentation and Tummy Tuck, also known as a Mommy Makeover, received a 98% Worth It rating after 5,198 reviews. Mommy Makeover is also something I will be discussing on this week’s Body Beautiful.
Body Beautiful on The Bay Area’s KRON 4 TV
Dr. Joseph Mele appears on KRON4’s Body Beautiful this Wednesday at 11 AM to discuss, Mommy Makeovers, Breast Lifts, Breast Reduction and Chin Augmentation with Chin Implants.
This week, I will be appearing on the San Francisco Bay Area’s News Station, KRON 4, Live. The show, Body Beautiful, airs this Wednesday, September 9, 2015, at 11 AM. If you can’t catch it live, I will post it to the San Francisco Plastic Surgery Blog in the coming weeks.
San Francisco Bay Area Plastic Surgery Consultations
We are fortunate to have many excellent and well trained plastic surgeons in the Bay Area. Thank You to RealSelf, for making me feel like a contributing member of the plastic surgery community. If you are considering Cosmetic Plastic Surgery of the Face or Body, call (925) 943-6353 to schedule a private consultation appointment. If you have questions about a procedure, general information is available here on the San Francisco Plastic Surgery Blog indexed under “Categories”, or any of my other sites listed under “Useful Links.” There is also a contact form to use, if you have questions.
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Saturday morning cartoons confirm, when an artists wants to impart strength to the hero, a Strong Chin is part of the package. By their nature, cartoons exaggerate normal features, but here, art imitates nature. Strong chins are often found on the faces of our favorite movie star heroes and heroines. Whether it’s the smooth strength of Brad Pitt or the clefted chiseled look of Henry Cavill, leading men lead with their chins. Wether you like him or not, there is no denying that Mission Impossible Rogue Nation leading man, Tom Cruise, has a strong chin. The same is true of many leading female stars including: Angelina Jolie, Olivia Wilde and Jennifer Aniston.
The Chin Augmentation Before and After Pictures above demonstrate the difference a strong jaw makes on the profile view. Chin Implants can provide balance to a disproportionately small jaw.
Size Matters But…
Chin Augmentation can dramatically change one’s profile and the way people see your facial features. Small Chins are frequently referred to as weak. Smaller chins are normal in children. The upper jaw, the maxilla, usually is formed by age nine. The lower jaw, the mandible, takes twice as long to reach its adult size. So, for most of our childhood, the chin is small. For women, the lower jaw stops growing around age sixteen, while for men, it’s closer to nineteen. Since the lower jaw takes until adulthood to develop fully, we associate the smaller chin with children.
A strong female chin still looks feminine and helps to define the border between the face and neck.
The Aging Chin
Small Chins are also associated with old faces. As we age, the skin thins, the soft tissue of the chin drops and the bone of the jaw begins to resorb. Chin Augmentation can be an important part of facial rejuvenation. A Chin Implant can replace lost volume, support the drooping soft tissue of the chin and enhance the jaw line. With a Facelift or Necklift, a Chin Augmentation can be a winning combination. Below is an example.
Chin Augmentation and Facelift Before and After Photos
Chin Augmentation can be combined with neck and face lifts to correct a small chin and enhance the jawline.
How to Pick the Best Chin Implant
The single most important aspect of selecting the best Chin Implant size is selecting one that balances your face. No one wants a cartoonish face, and that is the risk of going too large. It’s not the size of the chin, it’s the proportion that is most important. This is why Chin Augmentation is often considered during Rhinoplasty consultations. On profile, the apparent size of the nose is influenced by the projection of the chin. The smaller the chin, the larger the nose appears. Computer imaging has been very helpful in my San Francisco Bay Area Plastic Surgery practice in helping to demonstrate how a Chin Implant can help balance a larger nose.
Chin Implants and Rhinoplasty Before and After Pictures
Chin Augmentation can provide proportion to the profile and balance a nose that is too large for the chin.
Chin Implants and Chin Augmentation Consultations
If you are considering a Chin Implant, select an experienced, Board Certified Plastic Surgeon near you for your Facial Plastic Surgery needs. Computer Imaging has removed some of the guess work and anxiety from Chin Augmentation, by providing a simulation of what is possible. The images help you communicate to me what you are looking for, and help me explain what is possible. Computer images are not a guarantee. Your exact results will depend on the properties of your chin; however, computer imaging can assure us both that we understand the goals and the limitations of the procedure, before proceeding with surgery.
To schedule a private consultation appointment, call (925) 943-6353. There is no substitute for an in-person consultation; however, if you submit a question via the contact form in the margin, I will do my best to answer you.
Sientra continues to push breast implant boundaries with their latest offering – the style 107.
Sientra of Santa Barbara, CA, announced this morning the release of a new breast implant. The Style 107 HSC+ smooth round breast implant will be available in September. The HSC+ stands for High-Strength Cohesive plus, the stronger, more cohesive silicone gel that they are filled with.
What’s New About Sientra’s Style 107?
Sientra’s style 107 breast implants will offer additional options for my Breast Augmentation patients. The main features include:
Most Cohesive Silicone Gel available in a Round Implant
UPDATE:Currently, there are no details on Sientra’s website regarding the dimensions of the new Style 107 breast implants, but I got my hands on the new catalogue and here’s the scoop. The Sientra Style 107 HSC+ Breast Implants will be the same dimensions as the the Style 106 implants currently available; however, they will have the new HSC+ gel inside, and provide the benefits listed above. According to the Sientra home office in Santa Barbara, samples are on their way, so I will keep you posted. (pun intended)
Are the New Style 107 Breast Implants for Everyone?
The short answer is no. The dimensions of the implants, the details of your chest anatomy and the ultimate desired goal size will determine if you are a good candidate for this style of breast implant. They will be especially helpful for some of the more challenging Breast Augmentation cases as well as Breast Implant Revision Surgery.
Where Can I Get These New Breast Implants?
Sientra is unique among all US breast implant manufacturers. Sentra is the only US breast implant company that sells exclusively to Board Certified Plastic Surgeons. The company’s President and CEO, Hani Zeini, has emphasized his commitment to all plastic surgery patients by selling only to Board Certified Plastic Surgeons, the specialty best trained and most committed to breast augmentation excellence. If you are looking for any of the excellent Sientra Breast Implant styles, start by finding a Board Certified Plastic Surgeon near you with lots of training and experience in Breast Augmentation, and ask if they use Sientra Breast Implants.
SF Bay Area Sientra Breast Implants
I have been using Sientra’s Breast Implants since their approval three-and-a-half years ago. As a primary investigator for Sientra’s long term follow-up study, I continue to be impressed with the quality of the implants and the strength of the gel used to fill them. With zero reports of gel migration on their long term studies, it gives me confidence that their Silicone Breast Implants are made in the safest and most reliable way currently possible. If you are interested in Breast Augmentation with Sientra, Allergan or Mentor Breast Implants, give me a call at (925) 943-6353. There is no substitute for an in-person consultation appointment for learning the best options for your body and your goals.
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Ariel Winter at PaleyFest 2015, three months before her breast reduction procedure.
Ariel Winter made an appearance at PaleyFest LA in March of this year. She is seen above, three months before her Reduction Mammoplasty. Per her interview in Glamour, prior to her surgery she was wearing a 32F bra. If Ariel is anything like the many Breast Reduction patients I have taken care of, her preoperative bra size was probably too small. Women with large breast wear bras that are too small in an effort to control the weight and momentum of their large breasts. A smaller band size is tighter against the chest and helps to control bounce, while a smaller cup size can help hold and minimize the breast itself.
The Problems With Larger Breasts
Ariel Winter at the January 2014 SAG Awards. Not too many cute little teeny-bopper dresses will fit an F-cup.
For most men and women with small breasts, it may be hard to understand why a woman would want Breast Reduction Surgery. Unless you or someone close to you has the problem, ample breasts may seem more like a blessing. The truth is large breasts hurt. Their weight pulls down on the shoulders, causing ruts where the bra straps dig in. The muscles of the neck and upper back often spasm trying to support the torque caused by the large, cantilevered breasts, leading to chronic neck and back pain. Rashes under the breasts are common, especially in hot Walnut Creek summers, from the skin-on-skin contact.
The Pain is Not Just Physical
The emotional pains associated with large breasts may weigh more on the mind than the physical pains. Ridicule and teasing are commonly experienced by women with large breasts. Ariel was often criticized for her weight, due to her out-of-proportion breasts on her 5′-1″ frame. She does great work as an actor on Modern Family, but felt undermined by headlines like “Ariel Winter Shows Huge Boobs At… (fill in the event)!”
Breast Reduction Before and After Pictures
Breast Reduction Before and After Pictures illustrating the typical goals of reduced size and lifted breasts.
Typically, the Reduction Mammoplasty has two goals. The primary goal is to reduce the size of the breast, and the secondary goal is to lift the breasts. Both reducing the breast volume and tightening the skin envelope provide less torque on the neck and back. A smaller breast is lighter, and a tighter breast stops moving when you do, and the improvement is immediate. Most patients notice improvement of their symptoms as soon as they wake-up from surgery.
Ariel Winter After Breast Reduction
Ariel Winter after her breast reduction. The size, while still large, is significantly better proportioned to her body, and her physical and emotional improvement was immediate.
Ariel Winter describes her motivation for Breast Reduction in an article in Glamour Magazine. Quite a bold move from a courageous young woman. I thank her for sharing her story, because she is not alone. There are many young women with similar stories who may now feel more comfortable discussing the subject with someone close to them after hearing Ariel’s Story. Unfortunately, as the benefits of Breast Reduction become more well known, many insurance companies are removing Breast Reduction as a covered procedure. This a real injustice to women who are disabled by their disproportionately larger breasts.
Breast Reduction Consultations
If you or your daughter is considering Breast Reduction Surgery, there are several options. A focussed medical history is important to determine whether the breasts’ development has plateaued and to determine a goal size that is most appropriate. To schedule a private Breast Reduction Consultation call (925) 943-6353 today, or send your questions via the contact form on the San Francisco Plastic Surgery Blog.
This is part two of a series on Eyelid Surgery or Blepharoplasty. Last week, we reviewed Upper Blepharoplasty. This week, it’s all about the lower eyelids. Lower eyelids have different anatomy, different function and are operated differently than the upper lids.
Lower Blepharoplasty Before and After Pictures
There are four major components that distract from a pretty lower eyelid: bags, wrinkles, lower position and increased height of the lower eyelid. Lower Eyelid Lifts are designed to improve all these.
Lower Eyelid Surgery (Lower Blepharoplasty)
Last post we discussed the changes usually desired for the upper eyelids: removal of excess skin, removal of fat from the inner and central aspect of the upper lids if disproportionate, changing the upper eyelid fold and repositioning the lid margin to open the eye. These goals apply to the lower eyelids too, but the methods and priorities change. For Lower Eyelid Lifts the goals are: removing lower eyelid bags, tightening the lower eyelid skin, creating or maintaining normal lower eyelid position and shortening the length of the lower eyelid.
Removing Lower Eyelid Bags
The primary concern with the Lower Eyelids is the baggage. As we age, the facial fat over the lower eyelid thins and descends, revealing the fat pads located under the eyes. For some, these bags enlarge with age. For others, the large bags are present at birth and become more noticeable as the facial fat descends. Either way, Lower Blepharoplasty is designed to reduce excess fullness under the eyes.
Transconjunctival Lower Blepharoplasty
The heading above is a mouthful, but easily understood. Trans means across, or in this case through, and the conjunctiva is the pink lining of the eyelid. Lower blepharoplasty, from last post, means lower eyelid changing surgery. Transconjunctival Lower Blepharoplasty is a method of reducing the lower eyelid’s fat pads through the lining of the eyelid. The advantage is that the scar is completely hidden inside the eyelid. This method works best for younger patients who do not have excess skin and wrinkles on the lower eyelids as shown below, and is common enough to be shown on the Wikipedia blepharoplasty page.
Transconjunctival Lower Blepharoplasty Before and After Pictures
The Transconjunctival Lower Blepharoplasty before and after pictures above show how the lower eyelid is smoothed by removing the excess fat contained in the lower eyelid via an incision inside the eyelid.
In the Lower Blepharoplasty Before and After Pictures shown above, you can see the bulge in the lower eyelid caused by the excess fat this woman was born with. You can also see her attempt to minimize the appearance with a lighter shade of makeup over the bag. After her Lower Blepharoplasty, the eyelid is smooth and flat. Just enough fat is removed to flatten the bump the excess causes. Removing too much, will cause a hollow. If this patient had wrinkles of loose skin on the lower eyelid, the transconjunctival approach would not be used. Unlike the external approach described below, excess skin cannot be removed with the completely internal transconjunctival method alone.
Tightening the Lower Eyelid Skin
Bigger problems require bigger tools. When the excess lower eyelid fat is combined with loose baggy skin, a Subciliary Lower Blepharoplasty is preformed. Cilium is Latin for eyelash, so the subciliary incision is placed just below the eyelashes on the lower eyelid. This area heals very well, making the incision difficult to see, hidden in the shadow of the eyelashes.
The most frequently used approach for rejuvenating the lower eyelid is the external, subciliary approach. Not only can it remove excess fat like the transconjunctival approach, but it can also tighten the loose skin while lifting and supporting the lower eyelids.
The advantage of the subciliary approach to Lower Eyelid Lifts is the ability to remove excess skin at the same time as reducing the lower eyelid fat. The lower blepharoplasty before and after pictures above show a marked reduction in the lower eyelid bags with tightening of the lower eye skin using the subciliary approach. In this case, only removing the fat is treating only half the problem, and would leave a deflated bag of excess skin under her eyes.
While deep lines caused by skin folds are improved by Lower Eyelid Lifts, the fine lines within the skin need different treatment. The analogy made is between the eyelids and a quilt. Wrinkles in the quilt can be smoothed by gently tugging the quilt flat. This is what lower eyelid surgery does. However, no matter how hard you pull, you cannot smooth the quilting stitched into the fabric. This requires modifying the quilt, not how it lays. For the skin, topical treatments like chemical peels, lasers and dermabrasion are used.
Creating or Maintaining Normal Lower Eyelid Position
The normally positioned lower eyelid covers the lower edge of the colored iris and white sclera under the iris. When the lower eyelid weakens, more of the iris and sclera are revealed. This is termed scleral show, and is associated with a tired, stressed appearance. As the lid descends further, the lower lid may progress to frank ectropion – gapping away from the eye, and interfering with the lower eyelids function of protecting the eye. The pink conjunctival lining may be seen and the tears may not flow properly. This makes the eye feel dry and look red and inflamed. Lower blepharoplasty can be combined with eyelid tightening procedures to prevent or correct this problem.
Before and after photos of lower blepharoplasty with tightening of the lower eyelid support show how the lower eyelid moves up to its ideal position. On the other hand, simply removing the excess fat and skin without the lid tightening would most likely expose more of the white of the eye beneath the iris.
Lower Blepharoplasty for the above patient was more risky. He already had scleral show, and the normal lower blepharoplasty removes the excess fat and tightens the lower eyelid skin potentially removing support and pulling the eyelid down further. However, when the problem is recognized before surgery, the lower blepharoplasty is modified to include a lid tightening procedure. This improves the eyelid position and prevents the scleral show from progressing to hound-dog appearance of frank ectropion. Nothing against hound-dogs.
Shortening the Length of the Lower Eyelid
All the pictures above show a reduction in the overall height of the eyelid. More accurately, this is caused by a decrease in the how far onto the cheek the eyelid descends. As discussed above, supporting the eyelid during Blepharoplasty is important to preserving the function of the lower eyelid and for maintaining a rested, alert appearance. A shorter eyelid is also associated with youth. An infant’s lower eyelids are so short that often it looks like the cheeks are encroaching on the eye opening. As we age, the cheek drops, and the lower eyelid becomes more apparent. Around puberty, the eyelid appears as its own aesthetic unit, and as we age, it occupies more vertical space above the cheek, While blepharoplasty can help decrease this appearance, the underlying cause is the cheek descending. Cheek decent is more directly treated with a Facelift, or in cases where the cheeks are small or retruded, with Cheek Augmentation.
Blepharoplasty Consultation Appointment Available Now
If you are considering tightening up you eyelids, give me a call at (925) 943-6353. Eyelid surgery and other facial cosmetic plastic surgery procedures are provided by my San Francisco Bay Area private practice in the East Bay city of Walnut Creek, CA. Your personalized consultation will include reviewing the areas you want addressed and creating a plan specific to your goals.