HIGH-DEFINITION DRAINLESS TUMMY TUCK WITH BEVERLY HILLS BELLY BUTTON (ABDOMINOPLASTY)

After pregnancy, the skin of the abdomen often becomes loose and rectus (six-pack) muscles have separated as the uterus grew and did not come back together after giving birth.  Tummy tuck is a procedure that removes the excess skin and tightens the muscles to give the abdomen a smooth, flat appearance.   Liposuction can also be combined to give a narrowed waist and flatter front.  This surgery is commonly performed after pregnancy and massive weight loss where the abdominal skin gets stretched out and the muscles become spread apart.  All of our tummy tucks are drainless to make the patient’s postoperative recovery easier with superior aesthetic results.  The drainless technique involves the placement of progressive tension sutures under the skin to eliminate the space where fluid can collect so that drains are not needed.  The scar is placed very low so that follows the natural curves of the body and hides well in a bikini. Dr. Ziyad’s signature Beverly Hills Belly Button allows creation of a very natural belly button appearance that gently sinks in with hidden internal scars that mimics the appearance of models.

DEEP PLANE FACE/NECK LIFT

A youthful face/neck is voluminous with elastic, tight skin.  With age, two things happen to the face/neck: (1) the skin becomes loose and drops with gravity, and (2) volume in the face is lost, resulting in a deflated appearance.  A lower face/neck lift reverses these signs of aging by lifting the muscle/connective tissue layer beneath the surface in a deep plane fashion and removes the excess skin to correct the jowls and achieve a smooth jawline. If there are prominent vertical bands of the platysma neck muscle, these platysmal bands are tightened with a corset platysmaplasty to achieve the most smooth neck contour. A deep plane facelift can also be combined with facial fat transfer to replace the lost volume for a complete facial rejuvenation.  The facelift incisions are hidden around the ears, within the hairline, and in the crease beneath the chin. A lower facelift is often combined with a Lip Lift to achieve a complete lower face and neck rejuvenation.

LIP LIFT

The upper lip tends to elongate with age as the skin loses elasticity and drops with gravity. A long distance from the base of the nose to the upper lip border is a distinctive sign of aging. A small amount of the upper teeth should naturally show in the resting position without smiling. With age and subsequent elongation of the upper lip, the upper teeth show disappears as the lip tends to cover them. This elongation can be reversed by performing a Lip Lift through an incision hidden along the creases at the base of the nose and inside the nostrils to conceal the scar. It is a relatively simple operation that greatly reverses the signs of aging, and thus is commonly combined with a facelift to achieve a a more complete facial rejuvenation. Laser resurfacing around the lips can further help reduce the fine lines and wrinkles.

BROW LIFT

The ideal eyebrow has an arched peak at the lateral third and lies at or above the bony orbital rim.  With age, the lateral eyebrows drop and not only contribute to an aged appearance, but can also interfere with peripheral vision.  Raising the eyebrows helps make the eyes more visible and produces a more youthful appearance.  A brow lift is most commonly performed via incisions well hidden within the hair of the scalp.  However, if you have male pattern baldness, the incisions can be placed along the eyebrow or within forehead wrinkles to hide them.  Brow lift is often combined with upper blepharoplasty to achieve a complete upper face rejuvenation.

UPPER BLEPHAROPLASTY (UPPER EYELID SURGERY)

Upper eyelid aging most commonly presents with loose upper eyelid skin (dermatochalasis) and can also be associated with bulging fat, particularly near the nose. This can lead to an aged or tired appearance as well as interfere with peripheral vision.  Upper blepharoplasty is a procedure that surgically removes the loose skin and any bulging fat from the upper eyelids.  The incision for an upper blepharoplasty is hidden within the natural crease of the upper eyelid.  This is one of the best healing incisions in the whole body that is almost invisible when completely healed. Some patients of Asian descent do not have an eyelid crease, and a crease can be created for a more westernized eyelid appearance (Asian eyelid surgery). In patients with a droopy upper eyelid due to weakness/detachment of the muscle that elevates the upper eyelid with age, a Levator Advancement procedure can be performed to tighten/reattach the muscle that raises the upper eyelid to naturally open the eye(s). When performing an upper blepharoplasty, the brow position must also be assessed to determine if the excess skin is due more to the upper eyelid, brow, or both; thus upper blepharoplasty is often combined with a brow lift to restore a youthful appearance to the entire upper face.

LOWER BLEPHAROPLASTY (LOWER EYELID SURGERY)

Lower eyelid aging most commonly presents with bulging fat, but may or may not present with loose skin of the lower eyelid. To address bulging fat bags in the lower eyelids, fat is removed through an incision on the inside of the eyelid (transconjunctival) such that there is no cut on the skin, which helps reduce scarring of eyelid and the potential for lid retraction/ectropion.  When only a mild amount of excess lower eyelid skin with fine wrinkles is present, the lower eyelid can be treated with laser rejuvenation to tighten the skin to avoid a scar. When a moderate to severe amount of excess lower eyelid skin is present, a pinch technique through an incision hidden just beneath the lash line is used to minimize scarring.  With lower blepharoplasty, the scar is virtually imperceptible due to the thin nature of the skin and overlying lashes. If there is mild to moderate laxity of the lower eyelid, a Lateral Canthopexy or Canthoplasty may be performed to tighten the lower eyelids to prevent drooping. For severe laxity of the lower eyelid, a Tarsal Strip may be needed to achieve the greatest tightening of the lower eyelids. In patients with a deep nasojugal groove (tear trough crease) and/or volume deflation of the cheek below the lower eyelid, fat transfer to the lid-cheek junction is often combined with lower blepharoplasty to achieve the best contour transition from the lower eyelid to the cheek. In addition, a mid face lift may also be combined to lift the cheeks to achieve a complete mid face rejuvenation.

LIPOSUCTION

Liposuction is the most commonly performed plastic surgery procedure.  Liposuction aims to improve the shape of specific areas of the body where there is a localized excess of fatty tissue. Tiny incisions are placed in easy to conceal areas in order to remove fat with a cannula.  Fat obtained by liposuction can be transferred to augment other areas of the body if desired.  The incisions heal very well and are often not even perceptible.  High-definition liposuction involves creating an athletic contour with highlights of the abdominal muscles.  When liposuction of the torso is performed, the most narrow waistline can be achieved by performing 360-degree liposuction all the way around to the back. Ultrasound-assisted liposuction such as Vaser can be combined with liposuction to add thermal energy to help tighten the skin in addition to removal of the fat.

FACIAL FAT TRANSFER

A youthful face is full with fat positioned high on the cheeks.  With aging, facial fat goes away such that the face appears deflated.  Fat is a permanent filler that can be used to correct volume deflation in the face.  Fat grafts are placed into prominent creases such as the tear troughs below the lower eyelids, the folds that run between the lips and cheek, and the temples.  Fat is obtained from the abdomen through a tiny incision hidden inside the belly button.  Unlike commercial fillers, which require repeated treatments over time, the volumizing effect of fat transfer is permanent.  Effects of stem cells in the fat are also believed to help rejuvenate the facial skin.

BREAST FAT TRANSFER

A breast fat transfer involves the removal of fat from undesirable areas such as the abdomen, flanks (love handles), and back via liposuction and transfer of that fat into the breasts to create a larger, more full, upper pole with better cleavage.  Breast fat transfer is a natural alternative to implants using your body’s own tissue.  Breasts can be increased by about one cup size with each session of fat transfer.  Breast fat transfer can be combined with a breast lift to achieve greater upper pole fullness and volume while tightening the lower pole of the breasts.  Some fat will be reabsorbed by the body, but the result is permanent once the fat settles into position and is revascularized.

BUTTOCK FAT TRANSFER (BRAZILIAN BUTT LIFT)

A Brazilian butt lift (BBL) involves the removal of fat from undesirable areas such as the abdomen, flanks (love handles), and back via liposuction and transfer of that fat into the buttocks and hips to create a more curvy, hourglass shape.  Some fat will be reabsorbed by the body, but the result is permanent once the fat settles into position and is revascularized.

BREAST IMPLANTS AUGMENTATION

Breast augmentation with implants is the second most commonly performed plastic surgery procedure.  Implants increase the size, create a more round shape, and fill the upper poles of the breasts.  Silicone gummy bear breast implants create the most natural feel and appearance.  Only smooth, round implants are used.  The implants can be inserted through the fold beneath the breast (inframammary), through the nipple-areola complex (periareolar), or through the arm pit (transaxillary).  This choice depends on each patient’s anatomy and their individual preference.

MASTOPEXY (BREAST LIFT)

Gravity, age, pregnancy, or massive weight loss can cause the breast skin to become loose and hang.  A breast lift is a procedure used to restore the breast to a more youthful shape and position on the chest wall.  Incisions used for a breast lift are decided by the amount of lift needed.  Small lifts in which just the areola needs to be raised can be performed around the areola only (crescent or circumareolar).  Larger lifts in which the lower pole of the breast needs to be tightened require a vertical (lollipop) or inverted-T (anchor) incision.  An implant can be combined with a lift to create a more round shape with upper pole fullness at the same time.

BREAST REDUCTION

Breast reduction is a procedure that can both improve the appearance and symptoms of having large breasts.  Symptoms such as shoulder/back/neck pain and skin irritation/rashes in the folds can often be resolved with a breast reduction.  A breast reduction always includes a lift that also improves the breast aesthetic.  The incisions are typically in the pattern of an inverted-T (anchor), and the areola size can also be reduced at the same time.

MOMMY MAKEOVER

After pregnancy, the skin of the breasts and abdomen can become loose with separation of the abdominal muscles.  Therefore, the term mommy makeover is most often used to refer to a combination of a breast lift (with or without implants) and tummy tuck to rejuvenate the women’s body after having children.  Other procedures can be added to further enhance the woman’s ability to regain her pre-pregnancy body such as fat transfer for reshaping.  All mommy makeovers are performed drainless in our practice to enhance recovery and improve aesthetic results.

CIRCUMFERENTIAL LOWER BODY LIFT

A body lift is a procedure that removes excess skin and fat from around the entire circumference of the lower torso.  It includes a tummy tuck (abdominoplasty) in the front and a buttock lift in the back.  The shape of the incision follows the pattern of the thong bikini in the back.  Massive weight loss patients who having drooping of the buttock tissues due to loose skin also often have simultaneous deflation of the buttocks due to the loss of fat; therefore, a circumferential body lift is also commonly combined with fat transfer for gluteal reshaping.  Fat is obtained from the removed skin and reinjected into the deflated areas of the buttocks to give a more full and round shape in addition to the lift.  All circumferential body lifts are performed drainless in our practice to enhance recovery and improve aesthetic results.

POSTERIOR BODY LIFT (PBL)

A PBL is a procedure that treats loose and droopy buttock and outer thigh skin. It is the back half of a circumferential body lift. A PBL lifts the lower half of the body from behind, leaving a very fine line scar in the pattern of a thong bikini. It can be used in patients that have already had a tummy tuck with large dog ears and loose skin that continues all the way around to the back side. Massive weight loss patients who have drooping of the buttock tissues due to loose skin also often have simultaneous deflation of the buttocks due to loss of fat; therefore, a PBL is also commonly combined with fat transfer for a lift-and-full gluteal reshaping. Fat is obtained from the removed skin via liposuction and reinjected into the deflated areas of the buttocks to give a more full and round shape in addition to the lift (this patient did not desire fat transfer). A PBL can also be combined with a bra line back lift (as in this patient) for a complete back rejuvenation after massive weight loss. All PBLs are performed drainless in our practice to enhance recovery and improve aesthetic results.

BRA LINE BACK LIFT

A bra line back lift is a procedure that treats loose back skin following massive weight loss, aging, or after back liposuction in which the skin did not retract.  Upper back skin is removed and closed as a horizontal scar that is hidden in the position of the bra band across the back.  Therefore, it can be hidden well in a bikini or lingerie.  With this procedure, the loose skin of the lower back is lifted and made tight to give the back a nice, smooth contour.

BRACHIOPLASTY (ARM LIFT)

After massive weight loss or with aging, the upper arm skin can become loose and have an unwanted hanging appearance.  In patients with mildly loose skin that is close to the armpit, a mini arm lift (mini brachioplasty) can be performed via an incision hidden in the creases of the armpit.  However, for patients with more severe loose skin that extends all the way from the elbow to the armpit (batwing appearance), a full arm lift (brachioplasty) is performed with an incision that runs from the elbow to the armpit.  The full brachioplasty incision is well placed so that it is hidden from both front and back views with arms extended out to the sides.

SIDE SLIM (LATERAL THORACOABDOMINOPLASTY)

This is a procedure performed in patients following massive weight loss that have undergone a tummy tuck with correction of their loose skin in the up-down direction but who still have remaining loose skin in the side-to-side direction.  It involves removal of excess skin from the armpit down to the waist on each side, typically ending at the tummy tuck scar.  Therefore, it tightens loose skin in both the abdomen, flanks (love handles), and back.  Side Slim is often used as a continuation of an arm lift (brachioplasty) down the side to maximize the contour of the torso.

THIGH LIFT (CRUROPLASTY)

After massive weight loss or with aging, the thigh skin can become loose and have an unwanted hanging appearance.  In patients with mildly loose skin that is close to the groin, a mini (crescent or spiral) thigh lift can be performed via an incision hidden in the groin crease so that it is completely concealed in a bikini.  However, for patients with more severe loose skin that extends all the way from the groin to the knee, a full length medial thigh lift is performed with an incision that runs from the groin to the knee.  The full thigh lift incision is hidden well between the thighs so that it is difficult to see from front and back views.  

LABIAPLASTY

Labiaplasty is a procedure used to reduce the size of the labia minora around the vagina.  The procedure has been extensively studied and found to be beneficial with high satisfaction in many women of all ages.  Beneficial effects include improved physical activity such as running and yoga, improved hygiene, enhanced sexual function, and improved genital appearance.  The incision is performed along the edge of the labia minora or as a wedge within the labia minora, resulting in a scar that is virtually imperceptible.  Labiaplasty if often combined with clitoral hood reduction, vaginoplasty, and/or perineoplasty to achieve a complete genital enhancement.

VAGINOPLASTY (VAGINAL REJUVENATION/TIGHTENING)

After childbearing and as women age, the vagina can lose tightness, which interferes with sexual function.  Therefore, vaginal laxity is a distressing problem to many women.  With vaginoplasty, the vaginal canal can be narrowed surgically to increase tightness and improve sexual satisfaction for both the patient and her partner.  Vaginoplasty is like a tummy tuck for the vagina in that it removes redundant vaginal mucosa/skin and tightens the pelvic floor muscles to restore structure support to the vagina. All incisions are performed inside the vaginal opening so that they are not visible after surgery. Vaginoplasty also often includes a perineoplasty to correct the area between the vagina and anus called the perineum that often tears or is cut during vaginal delivery to allow birth of the baby.

LABIA MAJORA FAT TRANSFER (LABIA PUFFING)

The labia majora (outer labia) become deflated with loss of fat volume due to age and/or massive weight loss. Fat transfer can be used to rejuvenate the labia major to achieve a more plump, youthful vulva appearance. This can be performed alone, or it can be combined with labialasty and vaginoplasty to achieve a complete overall aesthetic female genital rejuvenation.

INVERTED NIPPLE REPAIR

Many patients are born with one or both nipples inverted (buried).  For many patients, the appearance of an inverted nipple is undesirable and interferes with the ability to breastfeed.  The inversion is corrected through a small incision on the lower surface of the nipple.  The attachments holding the nipple inward are released to allow it to come out above the surface.  A milk duct-sparing technique is used so that the patient can still breast feed in the future.

BUTTOCK IMPLANT AUGMENTATION

Buttock implants can be used to augment the buttocks in thin patients who do not have enough body fat to harvest by liposuction for transfer to the buttocks.  Liposuction with small-volume fat transfer overlying the implants and to the hips can be performed to help create a more natural feel and appearance along with the implants.  When buttock implants are combined with fat transfer, the procedure is referred to as a composite buttock augmentation.  Buttock implants are similar to breast implants except buttock implants are made of solid silicone rather than the silicone gel used in breast implants.

BODY IMPLANT AUGMENTATION

There are many type of body implants that can be used to augment various areas of the body. These include calf implants, pectoral (pec) implants in men, cheek implants, and custom implants for other areas of the body such as the hips, deltoids, biceps, and trapezius.

GYNECOMASTIA (MALE CHEST REDUCTION)

Male breast tissue (gynecomastia) can develop due to multiple reasons.  It can occur due hormone imbalances at the time of puberty and with older age.  It can also occur due to certain medications.  When it has been present for over a year and no reversal source is identified, surgical removal is sometimes the best course of action for correction.  Depending on the consistency of the tissue, surgery can be performed through small liposuction incisions or through a semicircular incision around the areola.

SCROTOPLASTY (SCROTAL REDUCTION/LIFT/TIGHTENING OR MAN LIFT)

Excess scrotal skin is often a problem that develops in men with age; however, it can also be congenital or occur following massive weight loss. Scrotoplasty is a newer trend in male plastic surgery that reduces the excess skin of the scrotum to achieve a more aesthetically pleasing scrotal appearance as well as address the concerns associated with excess skin between the legs that can impair normal functions such as exercise and sexual activity.

BOTULINUM TOXIN

Botulinum Toxin is a naturally occurring toxin that weakens the facial muscles that create wrinkles.  It is a safe and effective medication for treating wrinkles associated with facial expression.  Areas that can be treated are forehead wrinkles, frown lines, crow’s feet around the eyes, bunny lines on the nose, and neck bands.  Over time, the weakening of these muscles softens the wrinkles and aged appearance they create. It is also able to give a mild lift of the lateral brow in patients with early signs of lateral brow descent.  This medication is available under different brand names including Botox, Dysport, Xeomin, Jeuveau (Newtox), and Daxxify.

FILLERS

With age, wrinkles develop in the face from repetitive muscle motion as well as reduced volume from loss of fat cells.  Fillers are injectable compounds used to fill in wrinkles and restore volume to the face.  Areas of the face commonly treated include the lips, cheek bones, tear troughs, temples, marionette lines, and smile lines.  Many different types of fillers exist depending on the application needed.  One of the most commonly used fillers is hyaluronic acid, which is a natural compound found in the skin.  Hyaluronic acid is marketed under several brand names such as Restylane and Juvederm.  Other fillers include hydroxyapatite, which is more commonly used to augment the cheekbones and jaw.  Most fillers last 6-12 months, but there are newer fillers that have been designed to last as long as 18 months.  Some fillers are semi-permanent.

RHINOPLASTY (NOSE SURGERY)

Rhinoplasty can be performed for both functional airway problems with difficulty breathing and to improve appearance.  Rhinoplasty can be done through a closed approach in which the incisions are made entirely within the nostrils.  However, an open approach is used when better exposure is needed such that a small incision is made in the skin between the nostrils on the outside of the nose known as the columella that allows it to be well hidden. Septoplasty is often part of a rhinoplasty to correct a deviated septum. Primary rhinoplasty is performed in patients that have never had nasal surgery and can utilize the septal cartilage to reshape the nose. Secondary or revision rhinoplasty is performed in patients that have had previous nasal surgery and often requires the use of rib cartilage to achieve surgical correction of the nose.

BUCCAL FAT REMOVAL (BICHECTOMY)

Buccal fat is a pad of fat located in each cheek.  Prominent buccal fat can make a patient’s face appear wider and less attractive with less definition of the cheekbones. Removal of buccal fat is performed through a tiny incision inside the mouth to achieve a more slim and defined facial appearance.

OTOPLASTY (EAR PINNING)

Otoplasty is used to bring prominent ears that stick out further than desired into a more natural position and defines the natural folds of the ears, which are often absent in these patients.  The incisions are placed on the back of the ear so that they are well concealed from view.

EARLOBE REPAIR

Earlobe repair can be performed in patients who were born with or developed a split earlobe due to the trauma of earrings.  Earlobe repair is also commonly performed in young adults who have changed the shape of their earlobes with large-bore gauge piercings.  The incisions are confined to the earlobe and are in the same location as the piercing.