The process of 'drop and fluff' - how implants settle following breast augmentation

breast augmentation implants

The breasts undergo significant changes during the first few months after breast implant surgery commonly referred to as a period of ‘settling’. Early on, the breasts often look and feel unnatural – the implants sit high on the chest, especially when placed partly under the muscle (submuscular or dual plane), and feel hard. Although it can be disconcerting, this is normal. 

As the swelling resolves and the tissues loosen, the implants ‘drop’ into a lower position on the chest filling out the lower pole of the breast. This has two effects on breast appearance, which breasts begin to look and feel more natural with a full lower pole (‘fluff’) and smooth take off from the upper chest. Secondly, the nipples begin to project forwards or even upwards as more volume fills out the lower pole of the breast. 

The length of time it takes for the implants to settle varies from patient to patient from a matter of a few weeks to several months and is often different in each breast. The process tends to take longer with larger implants, patients with minimal loose skin and implants placed beneath the pectoral muscle (submusclular or dual plane). During this early period, I often see my patients regularly to ensure everything is progressing normally and to reassure them.

Preparing for a Breast Augmentation Consultation

It is important to get the most out of your breast augmentation consultation by preparing beforehand. It is a chance to meet with your plastic surgeon and decide whether he or she is the right person to help you achieve your goals and someone you can trust and be confident in.

breast augmentation

The consultation typically lasts 45 minutes if done properly. Here are a few things to think about:

Beforehand:
•    Learn about the procedure - implant insertion/placement techniques and breast implant types. This information will help you get the most out of your consultation and help you make informed choices. It is always best if the patient is involved in the decision making process!  
•    Check the credentials of your surgeon . In the UK, it is best to see a fully accredited Plastic Surgeon who is a member of either BAAPS (British Association of Aesthetic Surgeons) or BAPRAS (British Assoication of Plastic Reconstructive and Aesthetic Surgeons). Be aware that some ‘cosmetic’ surgeons may offer this procedure but are not trained in Plastic Surgery! 

What to bring to the consultation
•    A list of questions
•    Goal photos – this is important to guide expectations - as what one patient thinks of as a ‘natural’ look may in fact be overinflated and fake-looking to another! My special interest is in delivering natural, proportional and beautiful breasts but some surgeons specialise in very large implants!
•    A spouse, family member or friend for support – someone to help remember what has been said (there is often a lot of detail to digest) and to help advise.

What to expect during the consultation
•    Questions about any medical illnesses and medication you take.
•    An examination of the breasts with a chaperone breast (always) – the measurements help determine what the best range of implant shapes/ sizes are for your particular frame and goals.
•    A trial of implant sizers – trying on different sized implants in your ‘goal bra’ (provided by the surgeon). This helps refine decisions about implant selection. It is helpful to bring eg a top to get a feel for how the chosen implant size looks in your natural clothing. 
•    A detailed discussion about the best surgical plan in your situation including risks and complications.
•    A chance to review the surgeon’s portfolio of before and after photos. Ask about patients with a similar frame/ stature to yourself.

Finally, if you are keen to proceed, ask to meet up again before surgery to go through the details of the procedure and sizing again.

The Short Scar Neck Lift - simple solution for contoured jaw and neck line in young men and women!

double chin neck lift

A nicely contoured neck and jawline is an attractive feature in men and women. Fullness under the chin leading to a 'double-chin' is something that commonly happens to everyone with age. But, it can affect young people too and is often not something that can be improved just by going to the gym more or eating less! 

There are many treatments out there (botox, laser, liposuction) which are totally ineffective as they do nothing to address the cause of the double-chin - usually an accumulation of deep fat and prominent salivary glands.

The Short scar neck lift is a simple minimally invasive technique that involves a small incision under the chin (3cm)  that can make a significant and long-lasting improvement to neck contour and therefore jawline! Through this approach, the extra fat and tissue can be removed and the skin redraped over the neck to give a much more contoured and attractive appearance.

Facial Plastic Surgery Visit to San Francisco

This week I am in San Francisco visiting Dr. Tim Marten, a world renowned facelift expert.

William Townley Plastic Surgeon

 

Evan as a Consultant, it is important to keep learning and improving your own skills. Dr. Marten is one of the pioneers of 'lift and fill facelifts' - a modern concept that is about restoring both youth and beauty in a natural manner. 

It has been an incredible visit. His attention to detail and results are phenomenal and I will certainly be looking to incorporate some of his ideas into my own technique. Facial aesthetic surgery, particularly face and neck lifts, is an area I have a great interest in.

Preparing for a Rhinoplasty Consultation

rhinoplasty surgery consultation

It is best to be prepared for your consultation to get the most out of it. Here are a few things to think about beforehand:

1. Be clear about what changes you are hoping for - what part of your nose you are unhappy with (tip, side profile, size, crookedness). Goal photos can be helpful as articulating your goals can be difficult as the terminology is often quite confusing.

2. Think about how surgery may impact your life and have a list of questions relating to recovery/ time off work.

3. Be confident in your surgeon. Ask to see a portfolio of before and after photos and make sure this is a routine part of their practice and therefore and area they have genuine expertise in.

4. Consider a follow-up consultation if you are keen to proceed with surgery. It is often helpful to go through the plan again and provides a chance to mop up any unanswered questions.

New Technique to Help Restore Speech and Swallowing in Mouth Cancer Reconstruction

I have just returned from the American Society of Reconstructive Microsurgery meeting in Arizona. It was a great opportunity to catch up with colleagues from around the globe and share information about the latest techniques in complex reconstruction. In particular, it was fantastic to catch up my mentor, Stefan Hofer, and colleagues in Toronto who performed the first successful hand transplant in Canada earlier in the month.

I was fortunate to be giving a lecture on a special technique in mouth cancer reconstruction that we are developing at Guy's & St. Thomas' Hospital. It involves transplanting a special bit of tissue from the patient's calf to help restore speech and swallowing - two functions that are often compromised after treatment for mouth cancer. We now have a good series and the results are very promising.

William Townley 

Lecture on 'Lift and Fill' Face-Lifts at London Conference

face lift surgery

This week I had the pleasure of lecturing on modern techniques in face-lift surgery at a Head & Neck Surgery Update meeting in London. The course was run by Mr. Luke Cascarini, a phenomenally dynamic and excellent Maxillofacial Surgeon who I work with at Guy's.  Face-lift surgery is an area of Plastic Surgery that I really enjoy.

It is fascinating to see how techniques have evolved over the last century in parallel with changes in cultural tastes. Today's face-lift patients are modern professionals who want to maintain their youth with a natural and refreshed look rather than the taboo of an identity-changing procedure. They want a low morbidity, less invasive procedure with minimal downtime. Today's techniques aim to deliver on that promise by being more effective - taking aim at the root of the ageing process.  Specifically, by resuspending the deep facial tissues and replacing lost volume (by fat transfer),  modern so-called 'lift and fill' face-lifts can deliver a really natural and refreshed look.

Uganda Visit - Teaching and Operating!

I have just returned from a fantastic two week visit to Uganda. I was working at the CoRSU Hospital in Kampala. As well as being involved in a selection of interesting and challenging reconstructive cases, one of my main roles was teaching the new generation of Ugandan Plastic Surgery trainees in facial reconstruction. 

The Chief Plastic Surgeon, Andrew Hodges, has done an incredible job at developing services at the hospital under challenging circumstances and instigating the training program.  One of the striking features of the visit was the extreme pathology the team encounter on a daily basis - massive facial bone tumours, extreme burns affecting not just the scalp but the skull too etc. And also notable was the prevalence of (treatable) chronic diseases (TB, malaria, HIV) that result in further chronic disability.

It was a very rewarding experience - both teaching and learning! I hope to return in the future.

Facial rejuvenation - 5 steps to help your face before considering a face-lift

 

facial rejuvenation

 

1.    Don't smoke. Smokers show accelerated signs of ageing.

2.    Use a broad-spectrum sunscreen year round. Golfers, horse riders, swimmers, tennis players especially beware: cover up as much as possible with hats and long sleeves in addition to using sunscreen.

3.    Look after yourself - use a good skin care regimen daily, watch your weight and exercise regularly. Eat foods high in antioxidants and fresh vegetables and fruits.

4.    Botox and fillers at a young age when wrinkles start to appear. Try to stick to hyaluronic acid products; much less tendency to lumpiness. The 8-point filler face-lift is a great way to rejuvenate the face.

5.    Small simple operations when issues start to arise that are not fixed by filler and Botox – fat transfer to face, eyelid bag removal, mid-face lifts.

 

Finally, beware of gimickry such as lasers that do everything, no-incision weekend techniques, puppet face-lifts – treatments that are over promise and under deliver. Almost every treatment looks better for a few months,  but then the swelling goes away (and the outcome)!

Optimising Scar Appearance

I was interviewed by Jane Oddy about scar treatment for an article in today's Daily Mirror (17th March, page 33). It followed an interview with Lorraine Kelly about a riding accident that resulted in a horrific injury to her leg. Here are some points about how to get the best scar outcome following an injury.

Getting appropriate treatment at the time of injury is critical to outcome. To produce a fine neat scar, the wounds edges need to be clean (all dirt and devitalised tissue removed) and accurately opposed with no tension. On the face, this is achieved with fine sutures.

Example of Nasty facial laceration with multiple separate cuts

Immediately after wound closure

Immediately after wound closure

Once healed, there are certain measures that can be performed to improve the final scar appearance. These include daily massage and application of moisturising cream, silicone gel or sheets (e.g. Dermatix) . Certain areas (limbs, earlobes) are amenable to pressure dressings, which have been shown to reduce scar thickening. Occasionally, injection of steroid into the scar may be indicated.

10 days after injury. The sutures were removed after 5 days.

10 days after injury. The sutures were removed after 5 days.

The scar maturation process takes 12-18 months. Once mature, a scar revision may be considered if there are ongoing issues with appearance (thick, lumps, unsightly) or function (pain, loss of movement). Scar revision is a surgical procedure that aims to improve the scar appearance using different techniques:

  • Scar excision. Removing the old scar and closing the wound again may help if the original wound was very dirty at the time of injury.
  • Scar realignment. Realigning scars so that they lie in natural skin creases where they are less visible. This is particularly useful on the face.
  • Break up straight scars. Linear scars are very conspicuous and can be made less visible by adding small zigzags. 
  • Fat grafting. In cases where there are contour irregularities, injecting fat underneath the scar can improve the overall appearance.

 

Facing the Elements - Article Published in Country Life

country life magazine

I am very excited to have published an article in this week's edition of Country Life. It discusses the importance of continued skin protection throughout the winter months - a time when most people let their guard down but the sun continues to damage the skin and speed up the signs of facial ageing.

You can read the article here: Facing the Elements

PROMs - King of outcome assessment tools

I have recently co-authored a blog on patient-reported outcomes measures (PROMs). PROMs are an important assessment tool designed to capture the patient experience - telling us whether the procedure has made a difference to the patient beyond what can be gleaned from simple photographs or tape measurements. In the blog, we describe the importance and relevance of PROMs to cosmetic surgery - 'beauty is in the eye of the beholdee as well beholder'. 

The article was published on the official blog of PRS (Plastic & Reconstructive Surgery) - the international voice of authority in all matters relevant to Plastic Surgery. It was a great honour to have Dr. Rod Rohrich (Chief Editor PRS) co-authoring.

For patients coming to be reviewed in my clinic, you may be asked to complete a simple questionnaire ( a type of PROM) before the procedure and afterwards. During the initial consultation, I will also aim to show you PROM data from my patients specific to your procedure.

You can read the article here: PROMs – King of outcome assessment tools: Understanding how patients feel about their cosmetic surgery

Facial Palsy Magazine Article

I have just published an article on facial palsy treatment for the online health magazine 'Total Health'. It provides an overview of management of patients with what can be a very socially and functionally disabling condition. It is also surprisingly common with up to 25,000 people affected by Bell's palsy every year in the UK. There are many treatments available depending on the nature of the disability and the nerve dysfunction. This is a subspecialist area I am keenly interested in - both treating patients and engaging in research to improve outcomes.

You can read it here:   Facial Reanimation - putting the smile back in patients with a facial nerve disorder

 

 

 

Rhinoplasty Photos Uploaded

I have just added some examples of rhinoplasty cases to the ‘Before & After’ section.

What is rhinoplasty?

Rhinoplasty is the term used to describe nose-reshaping operations. The aim of rhinoplasty is to improve the appearance of the nose delivering a natural, non-operated look that is well balanced with the rest of the face.

Who would benefit from rhinoplasty?

1.     Cosmetic rhinoplasty. The desired appearance of the nose is very individual and culture-specific. Rhinoplasty can remove bumps, adjust length and width and improve tip definition and projection.

2.     Rhinoplasty after broken nose. Rhinoplasty can straighten crooked noses, remove bumps and adjust abnormalities on the inside of the nose (septoplasty) that are the result of previous trauma, improving appearance and function.

3.     Revision surgery. If you’ve already had a previous rhinoplasty and are unhappy with the result or would like some aspect adjusted, revision surgery may be appropriate.

The operation

Rhinoplasty is carried out under general anaesthesia. Incisions are well concealed on inside the nose and underneath the tip. The procedure takes around 2 hours. It is usual to stay overnight in hospital.

What to expect

A small splint is placed on the outside of the nose for 7 days. Some bruising occurs around the eyes, but usually subsides over 7-10 days. A more in depth discussion of the individual operative plan, risks and expectations will be covered over two pre-operative consultations.

What is liquid rhinoplasty?

Liquid rhinoplasty is a non-surgical treatment that changes the shape of the nose using injectable fillers. It is not as effective or long-lasting as surgical rhinoplasty but may improve the overall appearance of the nose by concealing humps, dips or depressions. This is a simple technique that can be done in outpatients.

Made to Measure: Facial Reconstruction with 3D Printing

November is Mouth Cancer Action Month (www.mouthcancer.org), and therefore a great opportunity to raise awareness of the condition and to highlight some of the advances in reconstruction, namely use of 3D printing technology.

In the UK, more than 6,700 people develop mouth cancer each year. The incidence has increased by 30% over the last decade and is expected to continue rising! It typically presents as a mouth ulcer (under or on the tongue) that enlarges and fails to heal. In the advanced stages, it can invade the jaw bone (mandible), which then has to be removed with the tumour.

We are fortunate to have access to a fantastic prosthetic team at Guy’s. From the CT scan images, they make a 3-dimensional image of the jaw (left). A resin replica of the patient’s jaw is then made with pinpoint accuracy using cutting edge 3D printing technology (middle). In this example, the planned excision of the jaw has been marked with red ink. After tumour excision, the jaw was reconstructed with the patient’s own fibula bone (image on right for demonstration only), which was accurately shaped to the 3D model using small bone cuts.

The accuracy of the reconstruction makes simple activities such as eating and talking much easier for the patient and facilitates dental implant insertion at a later stage. The 3D printing technology can be used for any aspect of facial bone reconstruction or even for planning aesthetic procedures. 

Three Myths about Silicone Breast Implants

silicone breast implants

1. Implants have a ‘shelf-life’
Breast implants do not have an expiration date. If you are pleased with the outcome and shape, there is no need to change the implants no matter how long they have been in for. However, with the effects of gravity and scarring (capsular contracture) around the implant over time, further revision surgery may be desirable to maintain the shape and a youthful appearance. As a rough guide, about 20% of women will have implant revision surgery within 10 years.

2. Implants prevent breast feeding
There is no evidence that breast implants interfere with the ability to breastfeed. My favoured approach is through a breast-fold incision (inframammary), which is therefore remote from the nipple.

3. It is easy to tell when a woman has breast implants
Actually, a carefully planned and performed operation can deliver a very natural result in most patients, such that it is difficult to tell if someone has had a surgical helping hand. Selecting the right implant size and shape as well as choosing the right pocket placement are key factors in achieving a natural result.

What Is Microsurgery?

Microsurgery is a special field in reconstructive surgery that allows surgeons to transplant tissue from one area of the body to reconstruct another. It is commonly used in Head and Neck surgery to reconstruct complex facial deformities (jaw, mouth, face) after cancer surgery or trauma.

By attaching tiny blood vessels from the transplanted tissue (or ‘free flap’) using an operating microscope to blood vessels at the new site, a circulation is established allowing the transplanted tissue to survive. 

In this short clip, skin (MSAP flap) is being transplanted from the lower leg to reconstruct a defect in the mouth following cancer excision.

See full list of reconstructive surgery procedures >