Body art traditionally refers to tattoos and piercings, but some would say cosmetic plastic surgery is a form of body art. It is not scalpelling, but a scalpel is used. As body art becomes more main stream, questions regarding breast augmentation before and after nipple piercing come up more often than you might think.
Preexisting Body and Nipple Piercing - Before Breast Augmentation
After Breast Augmentation - Body and Nipple Piercings Survived.
Pre-Existing Nipple Piercing
If you have pierced nipples, and are considering breast implants, breast augmentation can be safely performed in the presence of pierced nipples. A few precautions need to be taken to maximize the safety and predictability of you surgery:
The piercings need to be clean and without irritation. Irritated piercings are a set up for infection, and this could lead to an infection around the breast implants.
The jewelry should be removed from the piercing immediately before surgery. Electrocautery is used routinely during surgery to prevent bleeding. An electric shock to your piercings would cause a burn.
The jewelry should be replaced immediately after surgery. At the end of the breast augmentation I normally replace the jewelry to prevent the piercing from closing.
If the piercing should become irritated or infected after surgery, it should be addressed immediately. Sometimes this means removing the jewelry from the piercing.
Nipple Piercing After Breast Augmentation
If you already have breast implants, and are considering getting your nipples pierced, I don’t recommend it. If you are still determined to get a nipple piercing, you need to be especially vigilant. Choose a reputable establishment, which uses sterile technique. Infections can occur with any piercing, and every infection has the potential to spread.
Nipple piercings can be especially problematic as the breast gland itself can become infected. This can put the both the breast tissue and the breast implants at risk, especially if your breast implants are in front of the pectoralis muscle. If there is any redness, swelling, discharge or increasing pain at the piercing site, call you plastic surgeon, and seek immediate treatment. The jewelry may need to be removed, but it is better to lose a piercing than to lose a breast implant.
The previous two posts were about Rhinoplasty and Chin Augmentation. Sometimes combining procedures gives the best result. The Mommy Makeover, for example, combines breast enhancement with a tummy tuck. The two areas are anatomically independent, but by addressing two areas simultaneously, the recovery periods can be combined, and the results appreciated more quickly. When the two procedures are anatomically related, like when Rhinoplasty and Chin Augmentation are combined, simultaneous treatment allows for the creation of the optimal facial proportions and a pleasing cosmetic result.
Rhinoplasty and Chin Augmentation to refine the nose, improve the jaw line and create more balanced proportions of the face.
The Balanced Nose and Chin
The woman above presented with complaints of a bump on her nose (a dorsal hump) and a weak nasal tip that curved downward. She also had a small chin (microgenia) with a chin prominence well behind the projection of her lips. A rhinoplasty and chin augmentation were performed to smooth the dorsal hump, define and elevate the nasal tip and bring the chin forward. By combining the procedures, not only could each complaint be addressed, but the mid face and lower face profiles could be made harmonious.
How the Nose and Chin are Related
A small chin makes the nose appear larger, and visa versa. Modifying one will have the opposite effect on the other. In other words, if you make the chin larger, the nose will appear relatively smaller. By combining the procedures, the aesthetic balance of the nose and chin can be addressed, while each individual area is enhanced.
How to Choose a Plastic Surgeon for Combination Procedures
Combination procedures are best performed by a Board Certified Plastic Surgeon who is experienced with each component, and with the synergy that the combination provides. If you are looking to combine surgeries, you want a Board Certified Plastic Surgeon with experience in a wide range of cosmetic plastic surgery procedures, and the ability to seamlessly combine them.
How to Check if Your Plastic Surgeon is Board Certified
Facial enhancement can be accomplished with a filler or an implant. Fillers (Restylane®, Perlane®, Juvederm®, Radiesse®) are by far, the most common means of providing enhanced fullness. They provide almost instant results, with minimal recovery. With fillers, results need to be maintained with periodic treatments. Implants, on the other hand, require a recovery period, but can provide long lasting enhancement.
Facial Implants
Chin implants are the most frequently used facial implants. Over 11,000 chin implants were inserted last year alone. The implant shape, size and material can be varied to help achieve the desired result. Even chin implants with clefts are available. The chin implant may be inserted through a small incision under the chin or inside the mouth.
Chin Augmentation – Before and After
Chin Augmentation with Chin Implant. Before (Top Row) & After (Bottom Row)
The woman above presented with a desire for a stronger chin. The before pictures (top row) show that the most prominent aspect of her chin is well behind her lips. This relationship is most often seen in children. In an adult, the weak chin is not necessarily youthful, instead it gives a meek or timid look. Before surgery, the jaw line is also not well defined.
After chin augmentation (bottom row), the chin implant moves the chin profile anterior, and in line with the lip prominences. A strong jaw, with a well defined jawline is the result. More youthful appearance, and a more beautiful balance between the middle and lower face is the result.
How Much Chin is Enough?
On the profile view, the ideal chin extends as far forward as the lips. When the chin is shorter than the lips, this is called microgenia; literally “small chin” in latin. Computer imaging can help decide how much chin augmentation is enough. A digital photo of your profile can be modified to provide just the right amount of chin augmentation. This is used to guide implant selection, and helps provide you with a predictable result. To find out is if chin augmentation is right for you, schedule a consultation appointment today. Give me a call at (925) 943-6353.
The world is crazy. There has been a lot of chatter about terrorists implanting women with exploding breast implants in a effort to crash planes. But first, if you are reading this to find out if your normal, non-explosive, breast implants will explode the next time you board an airliner, rest assured, they won’t.
Why Your Breast Implants Won’t Explode in the Airliner
Airliners are pressurized, and must be maintained to atmospheric pressures below 8000 ft. While the air inside our ears and belly expands, the fluid inside breast implants barely does. Cabin pressure regulations are more complex than you might think. (Reasons for maintaining cabin pressure and the allowed tolerances can be found on Wikipedia’s Cabin Pressurization page.)
While Lady Gaga is red hot, and her fans may enjoy the visual, there is nothing entertaining about the sudden loss of cabin pressure. That would be a terrorizing event. TSA would not allow her to board with the outfit pictured to the left, the concern is that explosives inside a breast implant would be difficult to detect.
If you are still worried about your non-explosive breast implants, in the event of a complete loss of pressurization, your breast implants would easily survive the pressure change. Since they are mostly water, the breast implants would expand about the same amount as the rest of body. (I will not elaborate on all the real problems that would occur elsewhere in the body, but Wikipedia has a page on uncontrolled decompression with many unpleasant facts.)
Booby Traps
It sounds like a script contrived for a Hollywood movie: terrorist implanting their breast with PETN filled breast implants. The idea of surgically implanting an explosive inside the body is horrifying. Though from the terrorist’s perspective, it is only a short leap past strapping on a bomb. The worst part is, it is entirely possible. A small amount of explosive would be enough to disrupt cabin integrity, and cause explosive decompression with devastating results.
Media Coverage – KABC Los Angeles
It’s not surprising that the possibility was broadcast this February in Los Angeles.
But by March it has made world headlines on Fox News and The Sun. and the story is now being given further credibility by the need to discredit the report on True/Slant with science and with satire.
It Could Happen
Possible?
Yes. With enough determination and thought, anything is possible.
Probable?
No. I’m no terrorist, but there must be easier ways.
Reality
There is a fine fine line between a cautious and phobic. The reality is, we could spend our entire lives worrying about what could go wrong, and become paralyzed.
Bombshells not Bombs
As a plastic surgeon, the surgery I perform is elective and is held to a higher standard. While I worry about the complications of surgery, this is my motivation to achieve safer and more predictable results, day after day. This is why I spent years in training to become a Board Certified Plastic Surgeon. This is why I operate only in Accredited Surgery Centers, and use only Board Certified Anesthesiologists. This is why my patients trust me, and can keep their thoughts on the goal, rather than the process. No matter how bizarre the news from the outside world, when I am performing surgery, there is only one thing I am thinking about — my patients well being and happiness, and there is no greater gift I can give this crazy world than a happy patient. ( …and non-explosive breast implants)
If the red color of the lips (the vermillion) is with barely visible, adding volume may not be enough. If the vermilion is short, over filling may lead to increased projection without adequately increasing the height of the vermillion. This can result in a “trout pout”, rather than a fuller more voluptuous lip.
Lip advancement surgery can help. This is not the most mainstream lip enhancement, but in carefully selected patients it is the best option. Originally designed to improve the function and appearance of the lips after removing lip cancer, it preferentially enlarges the red part of the lip (the vermillion). The upside, lip advancement surgery will reveal more vermillion and can be done with or without increasing lip volume. The down side, it leaves a scar along the border of the skin and the vermillion of the lip.
Here is an example of an average scar at 4 months after surgery. The volume is stable at this point in time, and the scar will continue to improve, it is hard to see already. Most patients can cover the scar one week after surgery with lipstick.
Lips before lip advancement with reduced height.
Lips after lip advancement with full restored height.
Lips before lip advancement with lip skin projecting farther forwards than the vermillion.
Lips before lip advancement with lip vermillion now projecting farthest forwards.
If you have very thin lips, that are barely visible when the lips are at rest, lip advancement surgery may be the answer to how to achieve fuller lips. If dermal fillers increase lip projection forward, but are not revealing more vermillion, lip advancement may help. Lip advancement surgery is the most direct and effective method of increasing the amount of red lip that shows.
Several alternative methods are available for enhancing your lips. To learn more click on the links below:
Dermal fillers (Restylane®, Juvederm® and Perlane®) are the most popular way to enhance the lips. The procedure is safe, effective, predictable and relatively simple. It is the best way to “try out” large lips, as it is reversible. In order to maintain your results with lip filler, you need periodic touch-ups. These can be from 3 to 12 months apart depending on your lips.
Sometimes an alternative treatment is desired that has the potential to last years. Lip surgery can give longer lasting results. The local lip tissue can be advanced from inside the lip to provide fullness (V-Y lip advancement), or dermal tissue can be taken from elsewhere on the body and used as implant (dermal grafting).
This entry focusses on V-Y lip advancement, a procedure that rearranges the lips tissues to preferentially give fullness to the vermillion (the red part) of the lip. For information on other methods of lip enhancement, please see the links at the bottom of the page.
Lip Enhancement with Local Tissue Rearrangement
The upper row shows before and the lower row shows after lip enhancement with V-Y flaps. The soft tissue of the lip is moved forwards to enhance the fullness and natural curves of the lips. (Click picture for an enlarged view.)
This particular type of lip enhancement borrows fullness from the inside of the lip to enhance the outside. The soft tissue inside the lips can be pushed forward to enhance lip fullness and the central pout.
The Pro’s and Con’s of Surgical Lip Enhancement
The Advantages:
No artificial materials are necessary … no allergies or foreign body reactions.
Stability … Soft tissues won’t migrate.
Softness … Since lip is enhanced with lip, it feels like lip.
Results … Longer lasting results
The Disadvantages:
Recovery … weeks rather than a few days with the fillers.
Size … maximum volume is limited to the soft tissue available.
Cost … more than one filler treatment, but often less costly over time .
Complications … overall complications rates are low, but slighter higher than with fillers.
Alternative Lip Augmentations
Several alternative methods are available for enhancing your lips. To learn more click on the links below:
The two main goals of lip enhancement surgery are to:
Increase lip volume, and
Increase the amount of vermillion (the red part of the lip) seen.
To accomplish these different goals, different procedures may be selected.
Lip Enhancement Surgery – Volume, volume volume
Lips: Woman in her late 50's with thinning lips before lip implants (dermal grafts taken during a facelift)
Lips: After lip enhancement with dermal grafts. Notice restoration of the balance and projection of the lips.
Adding volume to the lips is how lip fillers work. Dermal fillers like Restylane®, Juvederm® and Perlane®, add volume from right off the shelf. The amount of volume is virtually unlimited, and can be added directly to where it is needed.
Surgery can add volume too. This can be accomplished with:
Lip Implants
Natural Implants (Dermal and/or Fat Grafts)
Man-Made Implants (Gortex, Silicone)
Man-Made Natural Implants (Restylane, Juvederm, Perlane, Collagen – man made but normally found in the lips)
Rearranging the soft tissue already present in the lip (V-Y flaps, lip advancement flaps)
This article focuses on Lip Implants, information on the other available methods of lip enhancement San Francisco, and lip augmentation can be found via the links at the bottom.
Lip Augmentation With Man Made Materials
Gortex® and SoftForm®
Lip implants have been used for years. The most frequently used artificial lip implants are made of Gortex®. It was selected because it is soft. In fact, one of the most popular Gortex® lip implants is named SoftForm®. While it can work well in carefully selected patients, unfortunately, it is not soft enough. I am not a fan of artificial lip implants for several reasons.
Because lips move, and because lips are softer than artificial lip implants, lip implants can:
Tether the lips, and prevent the lips from stretching when smiling fully (even when the implants is sectioned).
Be felt along the edges.
Can cause a visible bulge at the ends of the implant (especially with motion).
Can erode through the skin causing exposure and infection requiring removal of the implant
Silicone Lips
Silicone is available in two forms for lips: Solid (Silicone Lip Implants) and Liquid (Injectable Silicone). I am a fan of neither. Solid implants have the same problems as Gortex® implants, except worse. They are more stiff and thus more likely to erode and get infected.
Liquid silicone injections are even less predictable. They may give you the softest, poutiest lips one day, and then become hard, lumpy and uncomfortable without warning. Once this happens, it is rarely correctable, ask Lisa Rinna. Last year, while touring for the release of her book, Rinnavation, she confessed to having silicone injected into her lips. She also disclosed her personal silicone lip injection problems.
Lip Augmentation With Your Own Cells
Dermal Grafts
Because of the recent advancements of dermal fillers, I rarely use artificial lip implants any more. Instead, when injectable can’t do the trick, I rearrange what is already there. Dermal tissue can be taken from elsewhere on the body and used as an implant (dermal grafting), or the local lip tissue can be advanced from inside the lip to provide fullness (V-Y lip advancement discussed in the next article).
A small incision is made hidden in the corner of the lip, and the dermis is inserted under the vermilion. The results are similar to adding volume with a filler; however, can be much longer lasting. The swelling after this type of surgery lasts longer too. Instead of a couple days, it may take a couple weeks.
Fat Grafting
When more volume is necessary, fat can be retained on the dermal graft. This adds volume, with better volume predictability and better contours than injecting free fat grafts.
Free fat grafting is when fat is removed (liposuctioned) from one area, and reinjected into an area where more volume is desired. For small volumes this can be safe and predictable, and I use this technique most frequently for the nasolabial folds (the parenthesis around the mouth). On the lips it can be more problematic. We want soft lips, especially when kissing, and free fat grafting can cause firm lumps in the lips. Because better alternatives are now available, I rarely use free fat grafting to the lips.
These are minor surgical procedures, and can be done as an outpatient with local, sedation or under anesthesia. Lip augmentations can be done as a stand alone operation, or can be incorporate as part of plan for overall facial rejuvenation. My patients considering a facelift are frequently also experiencing lip thinning. A lip enhancing procedure can be incorporated to solve two problems at the same time.
Alternative Lip Augmentations
For information on other methods available for enhancing your lips, click on the links below:
Nothing says youth like full lips. Research shows that full lips are a requirement for a youthful face. Grace Gold of AOL’s StyleList reports in The Pursuit of Beauty: The Secret to Youth: Full Lips. Her inspiration? An article in the DailyMail.
Thin is Not Always In
It is an unfortunate truth that as we age, our lips shrink. Whether conscious or unconscious, the size of the lips is one of the most important variables programmed into our brains’ youth calculator. In other words, thin lips are aging. There are several ways to turn back the clock on lip aging, and dermal fillers are currently the most popular treatment.
Off the shelf dermal fillers, are safe, effective and convenient. These lip fillers are supplied as prefilled, single use syringes. Any volume can be used, and a simple block with local anesthesia, makes the procedure an in office option. All three of these products have received FDA approval for new formulations with Lidocaine in the mix to ease the injections.
What Makes Lip Fillers so Popular?
Lips before enhancement with a Dermal Filler (Restylane®, Juvederm® and Perlane® are the most popular in the US)
Lips after enhancement with a Dermal Filler. Notice the augmentation and preservation of the normal curves.
The advantage of this type of lip enhancement is its simplicity. I can choose different products for different lips. Lip enhancement can be performed in the office, with local anesthesia if needed, and the results are quickly apparent. There is sometimes mild discomfort, swelling, and bruising, which normally resolve quickly. While the enhancement is instant, it is best to have a few days for the lip augmentation to settle before an important event.
Dermal fillers provide two main benefits for the lips: increased volume, and wrinkle reduction. Lip enhancement is performed for small, thin lips, to increase volume. In this situation, the main goal is to increase the size of the lips. Lip enhancement can also be used to smooth the wrinkles that can form around the lip. Sometimes called Smoker’s Lines, they can occur without smoking. Often radially aligned, the wrinkles that form around lip edges can cause the lipstick to bleed. For lip wrinkles, the primary goal of lip enhancement is to attenuate the aged appearance. Both volume enhancement and wrinkle reduction may be desired for the same pair of lips, and these techniques can be easily combined for optimal results.
The longevity of the results can vary. Most results last 3-6 months, and many patients experience longer satisfaction. It is the perfect product to try out larger lips. The volume can be gradually increased to your comfort, and maintained.
But, what if you are looking for a longer lasting result? The are several surgical alternatives for enhancing lips. While no results are permanent, surgery can give longer lasting, natural results.
Lip augmentation is a popular and very satisfying procedure. Full lips are one of the most significant signs of youth. In my San Francisco Bay Area, Walnut Creek office, I perform hundreds lip enhancements. The most common method for lip augmentation is with a dermal filler like Restylane®, Juvederm® or Perlane®. While fillers of the most widely used method for lip augmentation, there are several other options available.
When I first started writing this week’s article on Lip Enhancement Walnut Creek, my goal was to quickly cover today’s options for lip augmentation. I realized, however, this is going to take more than one post. Over the next two weeks I will briefly review the latest trends in enhancing lips. Be it the ubiquitous injectable fillers you see advertised daily on TV, or lip enhancing surgical procedures known to a smaller group who desired a longer lasting result, and who can afford a little more downtime.
There is more to lip augmentation than meets the eye. In the coming weeks, links to the latest and the most popular ways to enlarge and rejuvenate your lips will be activated at the end of this article. I will try to illustrate each method with lip enhancement before and after pictures. The goal is to provide general information, but to determine the methods best for your lips, you will want to make an appointment with a board certified plastic surgeon, and explore your options.
It Seems So Simple
Plastic surgery often looks simple, but it takes careful planning and the meticulous attention to detail to makes it look simple. Lip enhancement is more than just lip enlargement. While making the lips larger is often the goal, it must be done carefully to keep the lips balanced. It is important to match the volume of the lips to the size of the face, and more importantly, to maintain proper proportions between the upper and lower lips. Hint: the lower lip is meant to be bigger.
So What is Important for Beautiful Lip Enhancement?
The goals:
Volume, volume, volume … the correct volume is very important
The shape of the lips … maintaining or creating the curves
The projection of the lips … the proper pout (not the trout pout)
The height of the lips … must match the facial proportions
The amount of vermilion (red stuff) seen on the lips … fillers may not be enough
The softness of the lips … one of the big benefits of HA’s over Collagen
The motion of the lips … one of the limiting factors for lip implants
Correcting the wrinkles around the lips … last but definitely not least
Most lip enhancement treatments can help with more than one of these goals, but no treatment is perfect. It is important to discuss all the available options with a Board Certified Plastic Surgeon who is experienced in all methods of lip enhancement. This way, you can be certain that you are getting the best possible treatment for your individual lips.
Alternative Lip Augmentations
Several alternative methods are available for enhancing your lips. To learn more click on the links below:
Lip Enhancement 101 – Lip Augmentation San Francisco (Lip Enhancement): Introduction (You are here.)
Radiant Life – RLM Success Files features breast augmentation by Dr. Joseph A. Mele.
As seen in Radiant Life Magazine. (Click to enlarge.)
Radiant Life® Magazine is The Aesthetic Wellness Magazine, and is dedicated to innovations in cosmetic plastic surgery. The current issue of Radiant Life® features an article by Lindsay Haakenson on the latest innovations in Breast Augmentation entitled Breast Surgery 2.0.
Radiant Life Magazine approached me with a short deadline and the need for an example of modern breast augmentation. My staff contacted a few of our many satisfied patients. Jennifer was the first to respond, and she immediately agreed to both an interview with Radiant Life Magazine and the use of her pictures, and for that she gets my sincere thanks. This is a true testimonial* to how worthwhile breast augmentation surgery has been for her. Thanks goes out to my other happy patients who also graciously responded, and to Lindsay Haakenson for including me.
Jennifer first came into the office for a consultation after noticing her breast volume had decreased after pregnancy. She was interested in restoring what mother nature had both given and then taken away. She expressed a desire to maintain proportions with her body, and wanted a natural look that would be attractive, without being distracting.
The excerpt to the right is from the Breast Surgery 2.0. At the top are her breast augmentation before and after pictures. Before submuscular (subpectoral) breast augmentation, her breasts where asymmetrical, small, had a relatively low set nipple and a constricted base. The distance between the nipple and the inframammary fold was short, and the remaining breast tissue was firm. She had a mild form of what is sometimes referred to as a tubular breast.
The simplest way to correct a tubular breast is with a subglandular breast augmentation. Often a periareolar mastopexy is performed to lift and reshape a protruding nipple/areolar complex at the same time. Okay, that may not sound so simple, and in Jennifer’s case, the easiest way was not necessarily the best way.
Every patient requires careful thought and consideration. In Jennifer’s case, the tubular deformity was mild, and a periareolar breast lift was not needed. The lack of breast tissue higher on the chest meant that the upper pole of the implant was more likely to be seen. A saline implant was placed behind the muscle to help soften the upper pole of the implant, and to give a more teardrop shape. A periareolar incision was used, and this, as is usual, healed very well.
For a more pronounced tubular breast deformity, this approach may not work. Unlike the approach using a periareolar lift, it will not correct a bulging areola that is often seen in concert with the narrow constricted breast base. If you are considering breast augmentation, it is important to seek a qualified and experienced, board certified plastic surgeon, so that the safest and most predictable plan can be constructed.
I want to thank Jennifer for volunteering to share her results with you. The best part of my job is helping my patients. I am thrilled that Jennifer is happy with the results of her breast augmentation.
* As per the latest American Society of Plastic Surgeons Code of Ethics this is a true testimonial. I have not reimbursed my patient in any way for her kind words, and I have not paid Radiant Life Magazine to be included in this article. To read the entire Radiant Life Magazine article, click here. You need to be able to view pdf files in order to display the contents properly. To download the latest version of Adobe Reader for free click here.
Lip augmentation is a popular and very satisfying procedure. Full lips are one of the most significant signs of youth. In my 
