Jaw Augmentation

A strong jawline (mandible) indicates strength and youth and is an attractive feature in both men and women. Some people are born with a strong jawline, but the definition is slowly lost over time as the aging process takes over. Other people were born with a relatively weak jawline that just tends to get weaker over time. The demarcation between the face an the neck is increasingly obscured as the skin loses its elasticity and as the jowls begin to form.

There are three main areas where the jaw may need augmenting:

1. The angle of the mandible, where the mandible angles sharply below the earlobe;
2. The body of the mandible, midway between the angle and the chin; and,
3. The area between the chin and the jowl, a depression known as the labiomandibular groove.

In the past, mandibular implants were really the only option out there for mandibular augmentation. These implants, usually made of solid silicone rubber, were placed through an incision in the mouth. The implants were often somewhat difficult to position properly and the implants tended to shift with mouth movements such as chewing in some people.

For the past several years, my procedure of choice for augmenting the mandible is fat grafting. Fat grafting is quick and easy and works quite well for this purpose. I usually tell my patients that they may need more than one fat grafting session, but many patients seem to get great results with just one session.

Another filler that I have used quite a bit is Radiesse. Since Radiesse can tend to lump if placed in areas of thin skin (like the nasojugal grooves of the lower eyelid), I use it exclusively in areas where there is a fair amount of soft tissue coverage, such as the mandible . It seems to last a year or more in these areas.

With the recent FDA approval of Arte-Fill, I have been using Arte-Fill more and more for mandibular augmentation. Last week, I placed a few syringes of Arte-Fill into a male patient’s mandibular angle and the results were dramatic. Instantly, he looked more masculine, more handsome and more youthful. Pretty powerful stuff!

The only anesthesia required for mandibular augmentation is numbing cream on the skin. The procedure takes ten minutes and the patients walk out with immediate results. Typically, patients note that that their jaws are slightly sore for a few days, especially when chewing.

The evolution from a surgical procedure (mandibular implants) to a more minor surgical procedure (fat grafting) to a non-surgical procedure mirrors the overall trend in cosmetic surgery: more and more is being done with fillers and other noninvasive methods.

Silicone Breast Implant Update

Since the wide release of silicone breast implants by the FDA in November of 2006, I have not used a single saline implant. In fact, my surgery center is sending our supply of saline implants back to the manufacturer to make room for silicone implants. On the rare occasion in which we need saline implants, we will have them shipped special order from the implant manufacturer.

For the past fifteen years, 90% of the breast implants used in the United States were saline. During that same time period, over 90% of the breast implants placed in much of the rest of the world were silicone. Most plastic surgeons anticipate that in time, over 90% of the implants used in the U.S. will be silicone.

When patients ask me, “Dr. Ryan, which implants are better, saline or silicone?”, I respond that, like everything else in life, they each have their pros and cons, so I can’t say that one is “better” than the other. I tell my patients that before 1992 (when he FDA put restrictions on the use of silicone implants), over 90% of implants placed were silicone and that I anticipate that we will return to close 90% usage in this country.

When patients ask me, “But aren’t silicone implants dangerous?”, I respond “Of course they’re dangerous! We doctors love doing dangerous things to our patients all the time! And the malpractice lawyers love it even more!” I then explain to the patient, after we both finish laughing, that there is no way that I — or any other doctor — would ever do a procedure or use a device that we feel is dangerous. I then recite the many well-done, peer-reviewed scientific studies that refute that there is any link between silicone breast implants and cancer, autoimmune disorders or any number of other diseases that people have tried to link with silicone breast implants over the years.

In summary, it appears that silicone breast implants are here to stay and that the vast majority of surgeons and patients are welcoming their return.

The Ribbon Lift

As I discussed in my April 4, 2006 post entitled "Jowls", the jowls can be a very stubborn problem. Since that last post, I have been doing a procedure called the Ribbon Lift. Unlike the so-called thread lifts, which many surgeons criticize as yielding disappointing results, the Ribbon Lift appears to be promising, since it is based on time-tested basic surgical principles. Furthermore, because the Ribbon Lift is based on sound surgical principles, the results seem to be long-lasting.

The Ribbon Lift involves placing a dissolvable device (the ribbon) under the skin of the face. An incision is made just below the sideburn and scissors are used to create a tunnel to the the jowls in the lower face. The ribbon, which measures about five inches long by less than a quarter inch wide, is a soft, flexible material with tiny points (like miniature spikes) at one end. It is made up of the same material that dissolvable stitches are made of. The ribbon is slid into the incision and the tiny points are pressed firmly into the jowl tissue. When the end of the ribbon is pulled up near the ear, the tiny spikes pull up on the jowl tissue as well. The jowls are thereby either eliminated -- or at least reduced significantly. A stitch holds the end of the ribbon in place and a series of stitches is used to close the sub-sideburn incision.

The procedure takes about a half hour and is performed with the patient wide awake, under local anesthesia. Some patients opt to take a Valium before the procedure, but this isn't necessary for most patients.

After the procedure, the patient is told to minimize activity for a few days. The ribbon dissolves after several months. For the first week or two, the ribbon can be felt if a finger is run along the cheek, although does not seem to bother the patients.

The Ribbon Lift appears to hold promise for the treatment of jowling and it has become a part of my armamentarium for the treatment of facial aging.

Please go to the "Videos" section of www.drfrankryan.com to a more thorough discussion of the Ribbon Lift.

Why Adrianne Curry Had Plastic Surgery :: Reprint from US Weekly

[REPRINTED FROM US MAGAZINE (www.usmagazine.com), Issue 618, December 18th, 2006]
[By Shirley Halperin]

AMERICA's NEXT TOP MODEL
ADRIANNE CURRRY

WHY I HAD PLASTIC SURGERY
The My Fair Brady and ANTM star shares her diary of the painful -- and funny -- moments of her breast reconstruction and recovery.

THINK ALL MODELS HAVE PERFECT BODIES? Adrianne Curry, 24, a former AMERICA"S NEXT TOP MODEL champ, would beg to differ. Ever since she was in her early teens, the 5-foot-11 newlywed (in May, she married her SURREAL LIFE co-star Christopher Knight, 49, with whom she is currently filming the third season of VH1's MY FAIR BRADY) was hyperconscious of the fact that her breasts were noticeably different in size. After years of feeling badly about her chest, the reality-TV star contacted Beverly Hills plastic surgeon Frank Ryan to correct the imbalance with implants. Curry underwent the procedure on November 14 and shared her experience with US.

["It would be so embarassing when photographers would yell out, 'Your left boob is larger than the other'" Curry tells US.]

THE NIGHT BEFORE

I'm having surgery tomorrow at 7:30 a.m. I've always shown my boobs and acted confident with them, but I wasn't. My left breast is a full B or a small C-cup, and my right breast is a full A-cup. My friends jokingly call me One Hang Low. I used to stuff wads of toilet paper in my bra to fill out the smaller side [see "How She Did Her Asymmetry, below]. Being a model and having something so gravely different, it's like having a hug f--king birthmark on the side of your body and trying to hide it in every shoot. I'd get uncomfortable when Chris grabbed my boobs. One night, he was really drunk and said, "Don't worry, baby, it's like being with two different women." That was the last straw.

I've made it very clear to Dr. Ryan that I don't want to look like a cartoon character. I'm a very skinny girl, and I'd look ridiculous with big boobs.

SURGERY DAY

I was nervous. The anesthesiologist said, "Don't worry, because before we knock you out, we're going to shoot you up with happy venom." I have no recollection of what happened after. Chris told me that as they wheeled me into the operating room, he me the hand sign for "I love you," and I lifted my head halfway, gave him the finger, then passed out.

Dr. Ryan gave me a larger silicone implant on the right and a smaller implant on the left to make both breasts the same size -- a medium C-cup. I was really happy because the implants look and feel very natural. My surgery lasted three-and-a-half hours. The incisions were made through the nipples. He put in two stitches and glued the rest.

When I woke up and I couldn't open one of my eyes, the nurse tried to pry it open for me. I was so uncomfortable. I wanted to ditch everything and just run. When we got to the after-care facility, I was screaming in pain, and they shot me up with morphine. Later, I was perscribed Percocet and Valium, but think because I was addicted to cocaine and heroin as a teenager, they didn't really affect me. The doctor said I was on enough drugs to take out an elephant.

SIX DAYS LATER

Chris had been so helpful. He's pulled down my pants to help me pee and given me sponge baths. it's been very hard because I hate people doing things for me, and I was literally rendered helpless. I don't have any bruises, but my right side is swollen. It's amazing to look down and think, Oh, my God, I don't have deformed deformed boobs anymore.

16 DAYS POST-OP

My nerve endings are starting to heal and tingle, and I'm in even more pain now than I was right after the surgery. It feels better when I wear a compression strap -- which keeps pressure on the implants so they don't get rounded at the top and look fake. Realistically, it'll take a year before I'm 100 percent healed. I just threw out my chicken cutlets because I'm never shoving anything in my bra again.

HOW SHE DID HER ASSEMETRY

Before going under the knife, Curry spent years trying to make her breasts appear equal-sized.

PADDING. At red carpet events, she would wear two bras and stuff her right cup with a "chicken cutlet" gel pad -- or crumpled toilet paper. "I've had toilet paper fall out on the red carpet," she US. "Thank God no one noticed."

POSING. At photo shoots, she would twist her body to show off her bigger breast and throw her right arm in the air to distort the smaller breast. "If you look at my PLAYBOY shots, every single one is cheated," she says.

PUMPING. Curry headed to the gym thinking pectoral-muscle exercises would help balance out the unevenness: "It didn't work."