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Is Plastic Surgery Permanent?
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Is Plastic Surgery Permanent?

Episode 36: Is Plastic Surgery Permanent?

The answer to this is it depends. And it's really a very good question. Plastic surgery procedures can be a significant investment of time and money. So it's only natural to want to know how long your investment is going to last. Let's go through several kinds of plastic surgery procedures and discuss how long they're likely to last and which of them are in fact, permanent.

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Is facial plastic surgery permanent?

First, let's talk about facial anti-aging procedures like facelifts and neck lifts and blepharoplasties or eye lifts. And the first thing to do here is to really consider exactly what these procedures are doing.

Over time, most facial aging is essentially due to the loss of volume and the descent of tissues, and these are caused by gravity and its effects on tissue over time, and also changes in the soft tissue over time, such as the loss of elasticity, it becomes less springy. It's less likely to retain its shape over time. So what we're doing with most facial rejuvenation procedures like facelifts and brow lifts and eye lifts, is we are volumizing areas that have lost volume and resuspending the soft tissues in cases in which they have descended.

After these procedures are performed, unfortunately we do not yet have the ability to stop time as plastic surgeons. Although believe me, we're working on it. Time does continue on. And even though we have achieved significant success in restoring the structure and volume of the face, it still will be subject to gravity and the passage of time after the procedure. So the best way to think about the longevity of facial rejuvenation procedures is that they essentially set back the clock. And it more or less holds true that the more invasive our procedure is, the further it will set the clock back. For example, a good face left and there's of course variability here, will often set the aging clock back by a good seven to 12 years.

In contrast, some of these noninvasive approaches, and I really like face tight for rejuvenation of the neck, for example, they'll often give us a nice three or four years back of aging. So, while the results of both of these procedures can be quite impressive, you will continue to age after you have them, but you will have reset things by a number of years, depending on the nature of the procedure that you've had.

Moving into less invasive facial anti-aging procedures, let's address injectables. And as we've discussed in earlier episodes of the podcast, there are two main kinds of injectables, and those are fillers and Botox. By way of review, Botox is a neurotoxin or a neuromodulator that works by selectively in a very controlled way, weakening muscles of facial expression in the area of interest so that those muscles are essentially slowed down and can't effectively contract and wrinkle overlying skin. Botox treatments tend to last on average from three to six months. So while Botox is really geared towards these dynamics, facial lines, those lines that come when your face is moving, fillers are targeted at static facial lines, those lines that are present when your face is at rest. And the longevity of fillers is really quite variable based on the composition of the filler and also the location of the filler.

Hyaluronic acid fillers, which are the majority of fillers that we use in our practice, can last anywhere from three months to two years, depending on exactly what that filler is and how it's formulated. And this is something you can discuss in depth with your injector at the time of your treatment. Aside from the composition of the filler, the location of the filler comes into play because the more mobile the area of the face that is injected, the faster that that filler will dissolve. So the more quickly it will go away. And the reason for that is simply that the more an area of the face is moving, there is more physical disturbance of the filler, so it is apt to be dissolved by your system more rapidly.

Another very popular facial aesthetic procedure is rhinoplasty or nose job. And in a rhinoplasty or nose job, we are performing a series of maneuvers to rearrange the structures of the nose, the bone, and the cartilage in such a way that we achieve a more aesthetically pleasing shape. And since we are performing osteotomies or bone cuts and suturing structures together and placing cartilage grafts, rhinoplasty does tend to have very long-lasting if not permanent results.

Now let's move into some body procedures.

Is liposuction permanent?

Well, as we discussed in an earlier episode about liposuction, when we perform a liposuction procedure, we are permanently removing fat cells. And we know from recent studies on fat biology that while the body after you've reached adulthood is constantly making and destroying fat cells, the number of fat cells you have actually remains relatively constant. So when you gain weight, your existing fat cells increase in size, and when you lose weight, your existing fat cells shrink, you're not creating more fat cells to store more fat or losing fat cells to get rid of fat. So it stands to reason that if you have a liposuction procedure on your stomach, for example, and we remove say 75% of the fat cells in your stomach, and then you gain a significant amount of weight after your procedure, you are not going to produce more fat cells in your stomach or abdominal region to account for this weight gain.

Instead, all of your existing fat cells are going to increase in size, including the fat cells that are remaining in the area that was treated with liposuction. Because when we perform liposuction, we never remove all of the fat in the treatment area because that wouldn't look natural. We usually remove, we say about 75% of the fat in the treatment area and leave about 25% of the fat behind. So when you gain a lot of weight after liposuction, you'll kind of gain weight more or less evenly distributed throughout your body or consistently with however you usually distribute your weight. And you'll also gain weight in the area that was treated with liposuction, but to a much lesser degree, because there are fewer fat cells left there to expand with weight gain. So as far as liposuction goes, if you maintain your diet and exercise after liposuction, the results should last a very long time.

And now let's consider some breast surgery procedures.

Is breast augmentation permanent?

Well, breast augmentation is a very powerful and very popular procedure that we can perform usually in about an hour with instant results in about a two-day recovery time.While breast augmentation is very long lasting, there are two things preventing it in most cases from being permanent. The first is our old friend gravity. So when we perform a breast augmentation and we're using either silicone or saline implants, in most cases, that adds weight to the breasts. So they will descend over time and this can lead to an appearance that will lead to a patient, either wanting to exchange their implants or have a breast lift or mastopexy over time. On the other hand, if smaller implants are used or in folks with stronger connective tissue, gravity may not play such a role and the position of the implants can remain relatively constant over time.

The other thing working against breast implants being permanent is the fact that since they are essentially foreign bodies, they are subject to problems over time, such as braking or rupture or capsular contracture, which is when the scar capsule around her breast implant shrinks and that can become painful or even change the position of the implant. So while breast implants last a very long time in general, and in some cases can last for someone's entire life, we usually say that about 10 years is a reasonable expectation in terms of longevity of breast implants.

Is a breast lift permanent?

Well, a breast lift (mastopexy), just like a lot of these other procedures that we were talking about is also susceptible to gravity. So if someone has droopy breasts or tonic breasts, and we perform a breast lift or mastopexy to rearrange the tissues of the breast in such a way as to improve the appearance of the breast and to move the substance of the breast up on the chest wall, that improved breast structure will be subject to gravity and will gradually descend over time. So while not permanent, the results of a breast lift, when well executed, will last a very long time. And this will also vary according to the individual's soft tissue quality. For someone with weaker soft tissues, with more laxity and less elasticity, a breast lift will not last as long as for someone with very good quality soft tissue.

For individuals that have more skin laxity and lack elasticity, and this sometimes is in someone that's lost a lot of weight or a patient that's come in for a breast lift after childbearing or breastfeeding, we'll sometimes use a product like GalaFLEX, which is a dissolvable scaffolding, which essentially functions as an internal bra to help hold the position of the breasts against gravity for an extended period of time.

Conclusion

So is plastic surgery permanent? It depends, and that's why it's very important to have an in-depth conversation with your board-certified plastic surgeon, to make sure that the procedure that you're planning is going to meet your needs.

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  • Darren M. Smith MD
  • Darren M. Smith MD
  • Darren M. Smith MD

All photos are of models except before and after images.

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