As a plastic surgeon treating breast implant associated deformities and illnesses for over 25 years, I have seen many patients such as Dolly Parton who now complain of pain associated with the breast augmentation. For example, I treated award winning actress Sally Kirkland back in the late 90s for breast implant related pain. I removed her implants and their associated encasing collagen capsules and corrected her resultant “empty breast” via a mastopexy or breast lift in common parlance.
Actual breast pain tends to be more frequent in patients with very large (i.e. heavy) implants. especially in conjunction with thin, stretched-out overlying breast tissue. Indeed, the implant itself becomes the main culprit responsible for the thinning; essentially, a vicious cycle develops taking the patient down a one-way street of pain.
Heavy implants especially in delicately framed women can also contribute to cervical, deltoid and upper back pain. Again, this could simply be represent the long term effects of heavy implants upon the upper body. The only way to alleviate this painful ball-and-chain effect is to either reduce the implant size or just remove them completely. A breast lift is often done in conjunction with implant removal to tighten the excess loose skin left behind.
Capsular contracture is another reason for breast pain extending to the shoulder like a vice, limiting one’s range of motion . When implants are placed in a pocket under the breast a capsule composed of your body‘s natural collagen develops to line the pocket. This capsule can have a mind of its own and decide to shrink down tightly around the implant causing distortion and in some cases significant pain. This can be torturous and removal of the scar tissue is the only way to effectively treat the problem.
Left Baker’s Grade IV breast implant associated capsular contracture Right mild Baker’s III encapsulation (Grade I -Normal Grade II- Hard & stiff, but fairly normal appearance Grade III- Hard & distorted Grade IV- Hard, distorted with pain)Postoperative results after Dr Haworth, a foremost breast implant revision specialist, performed a bilateral total capsulectomy and implant exchange “under the muscle”
Finally, many patients suffering from breast implant-related pain have attributed their problems to auto immune disease caused by the very implants themselves. Often times, these patients may complain of other systemic painful symptoms includingfibromyalgia and fatigue. Though few doctors question their pain, there has been little scientific proof that there’s a link between painful auto immune disease such as fibromyalgia and breast implants.
Most women end up loving their breast augmentation and even accept mild discomfort in order to maintain their new cleavage. However, for the unfortunate minority who experience severe pain, parting ways with their breast implants may be their only solution.
When we choose to undergo a plastic surgical procedure, we do so to get a beautiful result which is balanced for the face and one that is as permanent as possible and one which doesn’t interfere with function.
I don’t think anyone would argue with the above.
Lips are a unique anatomical future. They connote youth, beauty and sexuality. However, their job is not only to look beautiful, they have to also function. This is contrast to a nose or an ear which have no moving parts.
And as a plastic surgeon helping to advance the field of lip reshaping surgery (LRS), this is where the challenge lays. When a patient asks me to make them a beautiful set of lips, I have to ensure:
a. A beautiful upper lip
b.A beautiful lower lip
c. Both upper and lower lips harmonize with each other
d.The harmonizing upper and lower lips harmonize with the surrounding face in terms of shape and scale (volume)
e.The upper and lower lips continue to harmonize well into the future (akin to a long-lasting result)
f. Scars are as imperceptible as they can be
g.The chance of nasal distortion and other complications are kept to a bare minimum
h.Lip function is retained (perhaps even improved with the new found confidence!)
i.Recovery is minimized whenever possible
j.A patient’s expectations are aligned with reality.
(Of course, “j.” should be at the top of the list. If a patient has unrealistic expectations, then no matter how successful a surgery is, if a patient in the end is dissatisfied, the surgery is a failure to them).
One of the cornerstones of lip reshaping surgery is the upper lip lift. Most of us appreciate that beauty is mostly conferred through shape and less so by colour and volume. The lips are no exception. An upper lip that is considered beautiful on a primal, instinctual level is one comprised of a short nose-to-lip distance, a beautiful “O” arch, a visible vermilion balanced with the size of the lower and, of course, an appropriate upper tooth exposure.
Sexy
After performing thousands of upper, corner and lower lip lifts, the secret to unparalleled longevity and a naturally beautiful lip shape is stability. One must understand that, like the hands, the lips move hundreds of thousands of times a day- eating, talking, expressing and other things that shall go unmentioned in this post. Therefore, for an upper lip lift to be successful in terms of beauty and longevity, it should not only resist the downward pull of gravity but also be stabilized against everyday movement (which contributes to re-stretching of the lip, obvious wide scarring and downward pull on the nose).
The OOS (Orbicularis Oris Suspension) superficial muscle technique provides this very stabilization by anchoring the superficial layer of Orbicularis Oris just below the dermis to the periosteum (or lining of the bone) below the nose. (The Orbicularis Oris is the circumferential, sphincter muscle that surrounds the oral aperture).
By stabilizing the lip in two directions bilaterally I am able to customize the curl and expression of the upper lip to make it not only youthful but sensual as well. The two direction approach is analogous to the way a marionette can come to life by the hands and strings which control it.
The skin-only lip lift is a far simpler operation to perform and solely involves removing skin and sewing the skin edge of the lip to that of the bottom of the nose. The only thing holding the skin-only lip lift in position are the dissolvable stitches in the dermis which are no match against constant daily mouth movement and gravity’s pull. As a result, there is a far greater likelihood of the nostrils being pulled downwards, obvious scarring, significantly decreased longevity and suboptimal aesthetics.
After a “modified “upper lip lift by another Beverly Hills Plastic surgeon, which is basically a skin-only lip lift marketed as something other than it really is. Note severe right nostril pulldown with bizarre pleat along with an “A frame” deformity and an exacerbation of her downward slanting can’t of her upper lips.
I can personally attest to the dramatically decreased longevity, unremarkable results, worse scarring and nasal distortion from the thousand or so skin-only lip lifts I performed in the 90s. Though the skin-only recovery is easier, the current version of the OOS upper lip lift may allow the patient to appreciate results as early as 10 days. Not only does the OOS technique shorten the distance between the nose and lip but it also allows upper tooth show( that goes without saying really), subtle added rollout of the upper lip’s pink vermilion, welcomed narrowing of the aperture of the mouth (that gets wider with age) and even noticeable reduction in the nasolabial folds. Contrary to some misperceptions, no muscle is removed and no cases of permanent numbness or any paralysis ever encountered.
After an OOS upper lip lift by Dr Haworth. Note minimal scar and no nostril descentAfter an OOS upper lip lift by Dr Haworth. Note minimal scar and no nostril descent
More and more people are realizing that the upper lip lift( and other LRS techniques) may play as important a role as a facelift and eyelid surgery in facial rejuvenation. Choosing proper techniques, performing them well and understanding how all elements of the lip work together can be the ultimate magic trick to transform a face from “Meh to Mwah”!
Dr Haworth
July 2018
