A Systematic Approach to Non-Surgical Neck Rejuvenation

Gabriela Casabona shares her seven-step approach to treat skin laxity and restore volume to the neck

December 27th 2022 | Minimally Invasive, Injectables, Aesthetic Features

A Systematic Approach to Non-Surgical Neck Rejuvenation, by Dr. Gabriela Casabona et al. 

Aesthetic procedures can have a positive impact on self esteem and therefore improve lifestyle; rejuvenation of the neck is a highly popular request from patients seeking improvement of their appearance. When approaching aging of the neck we have to inform patients that the problem is not just an issue within the skin but is due to a combination of aging in other areas such as the mid-face, mandible (lower jaw and mouth) and temples. To therefore understand the aging within each layer; SMAS (Superficial Muscular Aponeurotic System; a thin fibrous layer covering the anterior face and neck), skin and fat is vital to be able to evaluate and determine a plan for each patient when considering energy based devices, threads, biostimulators, or fillers. 

In 2019 a study was carried out using 200 patients whereby the ageing of the SMAS, superficial and deep fat layers in different age groups, gender and BMI (body mass index). Im 2022 a similar study was carried out but this time included skin thickness as a variable. Both studies concluded that, with age, the SMAS became more superficial in specific areas such as; pre-auricular (in front of the ear), submandibular (lower jaw and mouth), and neck due to the loss over time of superficial fat layer, as well as an evident age-related thinning of the skin especially in the neck. 

Therefore, when addressing neck rejuvenation in a patient over 45, it is more likely that the skin will require thickening as well as to add support to the skin below the dermis by adding or restoring the lost fat layer. For this the combination of : PRP, micro needling or radio-frequency can be used for the skin, plus HA (Hyaluronic Acid) or Bio-stimulators to restore the sub-dermal layer (or any other layer) in order to cover the ageing process holistically. 

The anatomy of a patient also assumes an important role in making a responsible decision for the treatments used. In 2019 Casabona et al highlighted the importance of the order in which the areas of the face are treated makes a significant impact on the effectiveness of the treatment as well as the amount of product required.  The same applies for the neck; treatments in posterior temples and lateral face affect the lower face, or more precisely in mandible area, as much as treatments in the chin area also improve the submandibular area. 

We observed the results from a pool of Ocean Clinic’s neck rejuvenation patients over the last five years and recognised that each was satisfied when there was a certain pattern in their treatment plan. It was very important to understand and consider what the patient really wants and how much they are willing to invest to get there, as well as how much post-procedure downtime they can afford. Using a scale helps to visualise a language and reference point for patients to gauge their own severity and pinpoint whether they have a lack of volume or laxity. Over the last 5 years at Ocean Clinic we have developed a systematic approach to evaluate a patient to ensure that the treatment plan we construct for them is more precise and accurately meets the patient’s expectation. Considering the fact that most patients have high expectations in the improvement of their neck laxity and/or volume we developed the following seven steps to follow for assessment and development of combination techniques.  

STEP 1- Choose regions to treat (the more severe the case, the more regions involved). Consider the anatomy in order to understand the impact each region will have on the rest -  e.g., treatment of the zygoma area has a great impact on the mandible area, and, after treatment of the posterior temples we see a great impact in the lateral face; zygoma and  mandible regions will therefore impact in the upper neck. 

STEP 2- Choose vectors; during the ageing process we experience the loss of bone, fat, and skin thickness, each of which have a different impact in the vectors against gravity, and so each region of the face has more important vectors to treat. For lower face and neck rejuvenation, the vertical and horizontal vectors are more important than the projection. (FIG 2) Specifically for the neck, the vertical vector means either to enhance the vertical height of the mandible or to shorten structures such as the SMAS (Platysma + fascia) from mandible to clavicle, and horizontal vectors - to create some shortening in the direction of the back the neck by strengthening the SMAS - skin connection or creating skin retraction. The only projection vector that can affect the neck is the width enhancement of the chin or masseter, but those can be only performed in few individuals with that kind of need.

STEP 3 - Identify the problematic layer: bone, fat, muscle, fascia or skin. 

STEP 4 - Choose treatment according to the vectors: every procedure we do strengthens or weakens a different vector against gravity. E.g., if we inject a bolus of HA (Hyaluronic Acid) in the zygoma area we strengthen the projection effect, whereas if you inject CaHA dilute in lateral face, you strengthen the horizontal vector of the face. Or, if you inject the same HA in lower border of mandible, we strengthen the vertical vector. (Figure 3,4)

Figure 4 (A) was taken during injection of a patient for projection of zygoma with CaHA in bolus on the bone. 

(B) was taken during injection of CaHA dilute in subdermal plane for biostimulation.

STEP 5 - Choose the layer to treat according to best use of the products. Sometimes one product has a better projection capacity if used in the supraperiosteal area instead of in the subdermal area. The use of a bolus rather than retrograde injections have a better projection capacity. (Figure 4)

 

STEP 6 - Choose the amount of product to use depending on the severity (Figure 5)

STEP 7 - Choose a maintenance plan depending on the severity (Figure 5). 

After the step-by-step approach for treatment, the next step is to follow-up with our patients through their journey and to monitor results, but also to follow up in the short term to prevent any possible complications. Depending on the procedure there is a specific time that should be respected for immediate and long term follow up, for example: filler injected should be followed up the next day to check for any lumps, pain, bruising or discoloration, to guarantee there is no complications. For toxin injection follow up occurs around day 15 as this is when any major complications can present, such as ptosis, asymmetries and lack of result. 

figure 6

Figure 6 (A) Before and (B) after 1 year of combination treatment: Ulthera®(Merz Aesthetics, Germany), Radiesse® (Merz Aesthetics, Germany) dilute 1:1 and Belotero Soft® (Merz Aesthetics, Germany) taking place on the same day.

When severity differs, different goals and different layers are involved and so patients will be given contrasting treatment plans and combinations of treatments. This illustrates very well how complicated the decisions for neck rejuvenation can be.

The conclusion from these studies show that is that is vital to be systematic not only in the evaluation of neck aging, but also when electing procedures and the specifics for each patient; each decision makes a difference to the amount of product required and time needed to achieve optimal, desired results. 

REFERENCES :

1. Cohen JL, Rivkin A, Dayan S, Shamban A, Werschler WP, Teller CF, Kaminer MS, Sykes JM, Weinkle SH, Garcia JK. Multimodal Facial Aesthetic Treatment on the Appearance of Aging, Social Confidence, and Psychological Well-being: HARMONY Study. Aesthet Surg J. 2022 Jan 12;42(2):NP115-NP124. doi: 10.1093/asj/sjab114. PMID: 33751048; PMCID: PMC8756087. 
2. Friedman O, Shamban A, Fabi S, Duncan DI, Artzi O. The Aging neck-A Case base treatment algorithm. J Cosmet Dermatol. 2021 Feb;20(2):569-576. doi: 10.1111/jocd.13877. Epub 2020 Dec 19. PMID: 33340202
3. Casabona G, Kaye K. Facial Skin Tightening With Microfocused Ultrasound and Dermal Fillers: Considerations for Patient Selection and Outcomes. J Drugs Dermatol. 2019 Nov 1;18(11):1075-1082. PMID: 31738490.
4. Pérez P, Hohman MH. Neck Rejuvenation. 2022 Feb 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 32965900. 
5. Casabona G, Frank K, Koban KC, Schenck TL, Lopez VP, Webb KL, Hamade H, Freytag DL, Green JB, Cotofana S. Influence of Age, Sex, and Body Mass Index on the Depth of the Superficial Fascia in the Face and Neck. Dermatol Surg. 2019 Nov;45(11):1365-1373. doi: 10.1097/DSS.0000000000001909. PMID: 30882511.
6. Kwon SH, Ahn GY, Lew BL, Shin JW, Na JI, Huh CH. Clinical Implication of the Regional Thickness of the Lower Facial Skin, Superficial Fat, and Superficial Musculoaponeurotic System on High-Intensity Focused Ultrasound Treatment. Dermatol Surg. 2022 May 1;48(5):527-531. doi: 10.1097/DSS.0000000000003393. Epub 2022 Jan 26. PMID: 35093961.
7. Casabona G, Frank K, Koban KC, Freytag DL, Schenck TL, Lachman N, Green JB, Toni S, Rudolph C, Cotofana S. Lifting vs volumizing-The difference in facial minimally invasive procedures when respecting the line of ligaments. J Cosmet Dermatol. 2019 Aug 12. doi: 10.1111/jocd.13089. Epub ahead of print. PMID: 31402563.
8. Casabona G, Frank K, Moellhoff N, Gavril DL, Swift A, Freytag DL, Kaiser A, Green JB, Nikolis A, Cotofana S. Full-face effects of temporal volumizing and temporal lifting techniques. J Cosmet Dermatol. 2020 Nov;19(11):2830-2837. doi: 10.1111/jocd.13728. Epub 2020 Oct 5. PMID: 32946624.
9. Gawdat H, Allam RSHM, Hegazy R, Sameh B, Ragab N. Comparison of the efficacy of Fractional Radiofrequency Microneedling alone and in combination with platelet-rich plasma in neck rejuvenation: a clinical and optical coherence tomography study. J Cosmet Dermatol. 2022 May;21(5):2038-2045. doi: 10.1111/jocd.14331. Epub 2021 Jul 10. PMID: 34214220.
10. Vanaman Wilson MJ, Jones IT, Butterwick K, Fabi SG. Role of Nonsurgical Chin Augmentation in Full Face Rejuvenation: A Review and Our Experience. Dermatol Surg. 2018 Jul;44(7):985-993. doi: 10.1097/DSS.0000000000001461. PMID: 29309340.
11. Truswell WH. Complications in Lower Face Rejuvenation: Avoiding, Minimizing, Recognizing, Dealing with Them, and Helping the Patient through the Process of Fixing the Problems. Facial Plast Surg. 2020 Aug;36(4):462-477. doi: 10.1055/s-0040-1713823. Epub 2020 Aug 31. PMID: 32866983.
12. Gentile RD. Renuvion RF-Helium Plasma for Subdermal Skin Tightening, Facial Contouring and Skin Rejuvenation of the Face and Neck. Facial Plast Surg Aesthet Med. 2020 Jul/Aug;22(4):304-306. doi: 10.1089/fpsam.2020.0070. Epub 2020 May 5. PMID: 32379988; PMCID: PMC7374633

What really works for treating stretch marks?

How do we diagnose the best treatment for stretch marks?

At Ocean Clinic each individual is treated as unique and our approach comes from a holistic point of view at all times. The ethos is to assess the patient and create a multi-level, multi-technological approach to our skin rejuvenation treatments, designed specifically for the case in question. This will take into account skin quality, age, skin types, severity of the case, skin laxity, overall health condition, and whether a combination of procedures would be better suited to the particular situation. Often it is more effective to combine more than one treatment in order to best treat the person’s condition. This varies from case to case and so we have to consider all the varying factors for each individual client - in the treatment of stretch marks this concerns the level of damage to the fascia level (the internal lycra we have which gives support to the skin and fat), level if damage to the dermis (the thicker part of the skin with a high concentration of collagen and elastin), the amount and the depth of the stretch marks. 

Importantly we must also consider the client’s expectations very highly as we are aiming to achieve the results that they are requesting - sometimes this looks very different in their minds compared to what can be achieved with certain treatments, another reason to consider a combination of procedures. For example, a person may wish to remove stretch marks on their stomach but their actual desire is for their tummy to also appear tighter, smoother and flatter afterwards. This cannot be achieved by treating the stretch marks alone, so perhaps this patient is also requiring a little liposuction, or a mini tummy tuck. It is a difficult thing to assess which is why we have to have in depth consultations with our potential patients in order to work out what it is they really want and then carefully select which procedures best suit their needs to get the results they are looking for. 

What are stretch marks exactly? 

Stretch marks are indented streaks which vary in size, colour and shape from person to person, caused by severe stretching of the skin envelope (the skin and the layers right under the skin that provide support to it). They vary depending on how long you've had them, what caused them, where they are on your body and the type, depth and amount of skin you have. They can present as pink, red, black or blue streaks and can cover large areas of the body. The most common areas  in women are the tummy, thighs, upper arms, and buttocks, for men (generally caused by rapid growth or weight gain/loss) stretch marks are more common in the arms, lower back, biceps and hips. Their severity is affected by several factors, including genetics and the level of stress that was placed upon the skin. Cortisol levels can also affect the severity of stretch marks; cortisol is an adrenal hormone that can weaken the skin’s elasticity.

Rapid stretching causes the connective tissues and fibres of the dermis (the middle layer of the skin) to become thin and overstretched. In some places, they may break, allowing deeper layers of skin to show through. This is why stretch marks can appear red or purple in colour.

As we age, skin becomes less able to stretch and snap back into shape due to decreased collagen levels. Collagen is a protein that functions to hold or bind skin cells together and which serves to keep skin supple alongside a multitude of other substances such as elastic, proteoglycans, immune cells, which all work together to form the ECM - extracellular matrix of the skin. When the ECM is reduced, the skin is more likely to develop stretch marks or wrinkles.

How we treat stretch marks at Ocean Clinic, Marbella…

Working with varying and advancing technology over the last 20 years has brought the practitioners at Ocean Clinic, Marbella to the conclusion that no tech is good enough alone. 

“There is always more than one layer to be treated and more than one target to be hit in order to achieve an holistic result,” Gabriela Casabona, head of aesthetics department at Ocean Clinic, Marbella.

Stretch marks are a highly challenging condition to treat. It is a distortion to the skin which often varies in severity in different ways; superficial, deep, thin, wide, etc.  A severe stretching of the skin can be caused through pregnancy, weight gain, muscle gain or rapid growth and usually presents as red lines when the trauma was recent, and fades as time goes on. The reason for the stretch marks is that there is a breakage in the collagen and elastin in the skin which creates a gap and a depression as well as the change in colour and superficial atrophic layer of the skin. 

Taking into account the ethos of Ocean Clinic’s holistic treatments, our team came up with a highly effective method of treating stretch marks which was published 5 years ago. The treatment needed to include various tools that could treat all of the issues which cause the appearance of the stretch marks; the gap, the depression, the colour change, and the superficial atrophic layer of the skin. Our new stretch mark treatment works by combining procedures that boost the production of collagen. They do this by causing micro-injuries beneath the surface of the skin and triggering the body’s natural healing response. 

To do this we combine different types of treatment taking into account the severity of the case; For recently formed and very fine stretch marks we first use Venus Viva which stimulates collagen production and encourages the skin to repair itself combined with a follow up of skin boosters either HA based or PRP (hyaluronic acid or platelet rich plasma). 

For Recent to older stretch marks with a moderate depth we would use Microneedling with Dermapen, Vitamin C PRP and PRF (platelets extracted from the patient) and non cross-linked HA, followed by Radiesse dilute to bio-stimulate the inner part and correct the colouring and gap. For recent or severe stretch marks with severe depth we would star with Ultherapy which is used to stimulate collagen and elastin from the superficial layers of the skin all the way deep into the dermis and fascia layers. Then, Radiesse which is used to treat the gap and reduce the discolouration. And lastly, Dermapen to improve the superficial atrophy as well as providing a boost to the other treatments. Depending on the severity of the stretch marks, it may often be necessary to have more than one session for the best result. 

What is Venus Viva? 

Venus Viva is a skin resurfacing treatment that uses nano-fractional radio frequency to heat the cells deep in the dermis. This stimulates collagen production and encourages the skin to repair itself. As the skin regains elasticity and tightens, stretch marks become smoothed out.

Delivering up to 700 pulses of energy, the device is very powerful but still gentle enough to be used on even the most delicate areas of the face and body. It is often used to treat facial wrinkles but has also been shown to have a significant benefit on stretch marks (referred to medically as striae). A published clinical study showed that four weeks after treatment with Venus Viva, total surface area, length, and width of stretch marks significantly decreased and patient satisfaction for overall improvement was 96.97%.

What is Dermapen? 

The effect of Venus Viva is enhanced with Dermapen, the only microneedling device with a dedicated setting for stretch mark scars. The pen uses 12 tiny needles to create microscopic punctures to the inner and outer layers of skin. This results in a regeneration of the collagen and other elastic fibres.

The “channels” created by the derma pen also allow for the delivery of nutrient-rich serums deep into the skin. Topical creams can provide real benefit when they’re able to penetrate beneath the skin’s surface. We use a vitamin C serum, which is well known for boosting collagen production.

What is Ultherapy?

Ultherapy uses focused ultrasound to heat and generate micro-coagulation zones in different depths. The micro-coagulation zones trigger a direct and indirect effect on fibroblasts inducing new collagen and elastin production. It is a precise and effective way of really bringing enough new collagen and elastin to achieve a satisfactory clinical result. Microfocused ultrasound is the best and most versatile heat technology that can bring new collagen and elastin to 3 different depths, different densities and is approved as a non surgical lifting tool. This treatment does not require any downtime and results can last from 1-1.5 years depending on the initial severity and specific area treated. 

What is Radiesse? 

Radiesse is a form of injectable filler which also promotes the production of collagen, elastin and ECM in the skin. When used as a treatment for stretch marks the Radiesse is diluted with saline and Lidocaine and helps to make the area more firm, improving volume as well as overall skin texture.

For more information on treatment of stretch marks at Ocean Clinic, Marbella please contact us to arrange a consultation. 

NOSE CORRECTION - what can and can’t be fixed with Rhinoplasty surgery?

Our noses are the central and most prominent part of our face and so it goes 

without saying that this is a focal point of our overall looks. The shape, size and

projection of our noses affects the whole appearance of our face, and so, if we 

are unhappy with our looks, quite often it is the nose which is the cause of this 

dissatisfaction.

“The anatomy of the nose is complex and minor deviations in the configuration of bones, cartilages and soft tissue may lead to an aesthetically unpleasant appearance; the size and/or shape of the nose may not be in harmony with the rest of the facial features.” 

Dr. Kai Kaye, Plastic Surgeon at Ocean Clinic, Marbella. 

Rhinoplasty is also often carried out to repair birth defects, fractures, or a breathing difficulties, for example, it is not solely for cosmetic purposes. Rhinoplasty (nose surgery) is one of the most common plastic surgery procedures worldwide, but there are many things to understand before opting to undergo this treatment. 

Nose correction can be as subtle or dramatic as a patient requires, though the extent of the surgery and the manner in which the nose is altered all depends on the possibilities which lie within the rhinoplasty boundaries. An experienced surgeon will be able to determine the possibilities for an individual case during consultation, giving an in-depth analysis of the entire nose (internal and external situation). A rhinoplasty is a long-term procedure; your new nose will be for life if you are happy with the outcome. Taking this into account, one of the most vital parts of your consultation is to get across to your doctor exactly the what you want. The surgeon needs to identify with your expectations as, once the procedure is done, you want this to be the nose you were hoping for.

What types of rhinoplasty are there? 

“Depending on your individual case, a nose correction can either address the outer nose - cosmetic rhinoplasty, or the inner nose and the septum (in case of functional deficits like difficulties with breathing or snoring) - functional septorhinoplasty, or both at once.”

Dr. Kai Kaye 

 

What can be addressed with a rhinoplasty procedure…

It is important to know, if you are considering rhinoplasty, what is possible to accomplish with the procedure and what isn’t. The following concerns are common complaints which ARE possible to alter/fix with a rhinoplasty procedure. 

My nose sticks out too far..

Projection is one of the most common and obvious complaints when it comes to a patient not liking their nose. Basically, the nose is too big and juts out too far from the face for the person’s liking. 

I don’t like the bump on my nose…

A ‘hooked’ or ‘Roman’ nose is what is referred to as having a bump on the bridge of the bone, this can be genetic or caused by injury or bone or cartilage overdevelopment, or scar tissue from a trauma. During surgery the doctor can use specific tools to smooth out the bone or cartilage and give a flatter, straighter nose profile. 

The tip of my nose is ugly…

The surgery typically focuses on reshaping and reducing the size of the nasal tip and making sure it is in proportion to the rest of the face.The surgeon might use either open or closed approach to tip plasty. In the case of open approach, he makes a small incision under the nose tip between the nostrils. Open surgery is used when the patient requires more extensive sculpting of the nose.

Closed tip plasty means that the surgeon makes the incisions inside of the nostril. This approach is often used in rhinoplasty procedures when minor adjustments to the nasal structure is required.

To achieve this, the surgeon repositions and reshapes the cartilages in the nasal tip according to the specific deformities of the patient. Or removes excess soft tissue from a bulbous nose tip. 

My nose is crooked…

An asymmetrical nose can be from birth or perhaps a trauma such as a breakage or deviated septum - the nasal bones or septum are not sitting symmetrically or centrally with the face. A crooked nose can be repaired with rhinoplasty, though if there is severe long term scar tissue or multiple breakages there is a possibility of more than one surgery being required to fully straighten the nose. Generally this should be able to be repaired with one straightforward open rhinoplasty procedure. The angle of the nose can also be adjusted in this way.

I hate my nostrils!…

So often people are unhappy with the size and/or shape of their nostrils. Some are upturned, some are considered too wide, too small, or too flared, some are different sizes to each other, etc. This issue can easily be fixed with a simple rhinoplasty procedure. Once the patient and doctor have determined the best shape and size for the nose in question this is a quick surgery which requires far less downtime than a full (open) rhinoplasty. 

My nose is too big (or small) for my face…

When a nose seems disproportional to the rest of the face a rhinoplasty procedure can be used to alter the size of the nose. This would most likely entail an open rhinoplasty procedure as the internal parts of the nose and bone will need to be addressed during the surgery. 

What can NOT be changed with nose correction surgery…

No matter which type or level of surgery you opt for, a rhinoplasty cannot completely change the genetics off your facial anatomy or bone structure - it can aim to blend and reshape your existing nose structure to suit and be more aesthetically pleasing but not change how it will develop/change with age. The nose skin quality will also not be changed by rhinoplasty, this is something that will need to be addressed non-surgically with cosmetic treatments if so desired. The most important thing to consider is that your nose, your rhinoplasty, needs to be something that will suit your particular face and anatomy - like a haircut, someone else’s nose may not suit you. The surgery you opt for needs to be that which will best apply to your own needs but taking into account the existing genetics you have to work with; you still want to look like you - your best you! 

At Ocean Clinic, Marbella, pre-operative considerations include a thorough evaluation of your anatomy and bone structure. This includes the possible recommendation of complementary procedures such as a chin implant, for example, to correct facial skeletal imbalances which often exist in rhinoplasty patients. Our advice regarding the combination of procedures, your understanding of the 3 dimensional composition of your face and our in-depth knowledge of the different available techniques are paramount in obtaining long-lasting and natural results. Please contact us for a consultation if you are considering rhinoplasty. 

When should I change my breast implants?

Common signs you should change your breast implants. 

Those of us who have had breast implants were made aware at the time that they were not for life; that at some point they would need to be changed. So when is that moment, and what are the signs that this needs to happen soon? 

There are many questions surrounding when implants should be changed, you could be experiencing pain or discomfort, dislike the shape or just simply are not satisfied with the ones you have. The following are the most common reasons to change implants and how to know when it is time to get checked by your doctor. 

Common signs you need revisionary surgery (or breast implant change)

PAIN / DISCOMFORT 

You have been experiencing pain or discomfort due to your implants - if the implants themselves are causing this pain or discomfort then you must request a breast implant revision. There are a number of causes for implants to become uncomfortable such as: 

• Capsular Contracture - There are varying levels of severity of this - the formation of scar tissue surrounding the implant is normal for the healing process yet when this ‘capsule’ becomes hard and contracts around the implant this can lead to aesthetic and physical problems (pain in extreme cases). 

• Lymph node damage - Some patients with breast implants have been found to have enlarged lymph nodes, or lymphadenopathy, often occurring in the armpit area.

• Seroma - The symptoms of seroma include swelling and possibly leakage of fluid at the site of the wound/scar. Occasionally accompanied by redness and mild pain, and can appear as a lump or cyst.

• Badly placed implants - the positioning of the implants could be interfering with the body’s natural situation, for example, if the implant was not placed correctly the muscle could be sitting differently causing you to feel uncomfortable. 

• Rupture - if you have silicon implants there is a possibility they can rupture or leak if the integrity of the implant is disturbed.

Pain is not a normal occurrence with breast augmentation, so you should seek your surgeon’s advice if you are experiencing any (once you have fully recovered from surgery). Daily life with breast implants should be just as it was before, you shouldn’t feel any discomfort at all. 

RUPTURE

While this is not life-threatening, a ruptured implant should be treated as urgent, seeking medical attention immediately is strongly advised in order to prevent any infection or internal scar tissue. 

How can an implant rupture? Generally the materials which implants are currently made form are extremely durable however if extreme pressure was placed on the area there is a possibility of a rupture. A car accident for example. Another cause can be that the shell of the implant may have weakened over time. 

Ruptured Saline Implants

If your implant is a saline version the affected area would be visibly noticeable straight away as the implant would naturally deflate once ruptured. This is nothing to worry about internally as the fluid within the implant is absorbed naturally by the body and does not cause further complications. Aesthetically though the breast will appear deflated. 

Ruptured Silicon Implants

These are not easy to detect and so need to be diagnosed via ultrasound or MRI. If a silicon implant ruptures the gel leaks out slowly meaning that the difference would not be visible immediately if at all. 

BOTTOMING OUT

If your implant shifts and sits lower than it should, below the breast crease, this is known as bottoming out and is obvious to look at. It can appear almost as a double breast as the implant slips below the nipple area sometimes causing the nipple to rise a little and the outline of the implant becomes visible. This is more common with larger breasts due to the weight of the implants but skin laxity with age can also cause this to occur. The tissue within the breast area is unable or no longer able to support the implant and causes it to ‘bottom out’. 

ROAMING IMPLANT

The breast implant should always be in the correct place once it has settled in its position, if your implant is rotating or moving dramatically then this is cause for concern and medial attention. Implants can shift for the following reasons:

• Lateral displacement- if the area within the breast, or the implant pocket, is too large then the implant has the space to move too far away from the centre line of the chest.
• Symmastia -when the implants move too close together - this can occur (very rare) if too much tissue is removed from around the breastbone area as this can cause detached muscles between the breasts.
• Rotational displacement - rotation can also be caused if the implant pocket is too large. This can be difficult to notice with round implants but the teardrop shape will appear unnatural should it change position.

IMPLANT SHAPE CHANGE

If the shape of your implants has changed significantly this could be due to any of the causes above. Generally this won’t occur to both implants at the same time so it can be detected easily. Again, this is not a huge medical risk but may cause serious dissatisfaction and emotional stress. 

CAPSULAR CONTRACTURE

When the body treats the implant as a foreign object and creates excess scar tissue in order to isolate it, this can cause capsular contracture. An overproduction of hardened tissue which is graded at four different levels of severity - 

1. No interference with the implant or the augmentation results, no symptoms.
2. Minor cosmetic symptoms - can feel firmer to touch but aesthetically fine. 

3-4. Hard misshapen breasts which are not aesthetically pleasing and can even become painful. 

Grade three and four are often treated with a change of implant. 

NOT HAPPY!

If you are simply not satisfied with your augmentation then this may prompt you to seek a breast implant change. Whether you prefer to go larger or smaller it is advised to allow the body to heal prior properly before you proceed with another surgery. Speak to your surgeon and they will advise you how to best move forward. 

For more information on breast augmentation or breast implant change at Ocean Clinic, please contact us today.