February 2nd, 2012 drtim Beverly Hills Breast Augmentation and Capsular Contracture is discussed by Board Certified plastic surgeon, Dr. Tim Neavin.
Yesterday in my Beverly Hills office I saw a young woman who had a breast augmentation followed by two subsequent breast augmentation revision surgeries for capsular contracture years later. Her first capsular contracture developed on the right side not long after her surgery. This was revised (by her report – I didn’t do her prior surgeries) with a capsulectomy and breast implant exchange. But, years later a capsulsar contracture developed on the LEFT
side. This unusual situation inspired me to write about capsular contracture after breast augmentation surgery, since it is a rather frequent finding that many women don’t understand well.
A capsular contracture is the medical term for what many people describe as a hardening of the breast implant. In fact, the breast implant stays soft. The hardening is from the scar tissue that forms around the breast implant. Why does capsular contracture develop? Here are some of the known risk factors:
Autoimmune disorders: Disease such as lupus or scleroderma may be associated with increased risk of capsular contracture.
Smoking
Radiation therapy (as in radiation treatment for breast cancer)
Severe trauma to the breast (car accident, for example)
Hematoma (for instance if one had an accumulation of blood in the breast pocket after surgery. Blood is very inflammatory.)
Seroma (a collection of fluid under the skin. This can occur after breast augmentation surgery)
Bacterial infections (sometimes even subclinical infections may increase risks. Some believe the periareolar incision, since the dissection is carried through or close to the ducts which may harbor bacteria, may *slightly* increase this risk
Silicone molecules leaching into the pocket surrounding the implant (less likely now with the new generation implants that don’t have the leaking problems that their older cousins had)
Breast implant placement. That is, one be more likely to develop capsular contracture when your implants are placed over your chest muscle (subglandular).
The incidence of capsular contracture occurence is about 3 percent per year. Depending on the symptoms, it may or may not be beneficial to undergo surgery. For more information about capsular contracture, go this link.
Posted in 90210 Plastic Surgery Blog, breast augmentation, breast implants, capsular contracture | 1 Comment »
December 30th, 2011 drtim 
Dr. Tim Neavin is a Beverly Hills breast augmentation specialsit, with offices in Beverly Hills, Dubai, and Glendora.
surgery and an unusual complication:
This is a most interesting story about breast augmentation and breast implants. This is a story about a woman who had breast reconstruction followed by heart surgery. During a Pilates session she had a small accident. Her breast implant got sucked into her chest next to her lungs. How could this happen? Good question. You’re right if you are thinking that breast implants should stay out of the lungs. This woman had a double mastectomy (removal of both breasts) for breast cancer, followed by heart surgery which involves opening up the sternum, or breast bone. This weakened the chest wall, and during exercises, the sternum became unstable and the breast implant got swallowed up into her chest with heavy breathing! Now, before you say “what in the world!?”. I’ll say it. Truth is, this type of complication from breast surgery, namely breast implant surgery, is exceptionally rare. For one, it was the heart surgery not the breast reconstruction surgery that led to this complication. Secondly, this would be nearly impossible with a breast augmentation alone. For a breast augmentation, the surgery stays above the rib cage. So while this breast implant story is interesting, it is rare, which I guess why it is so interesting, right?
You can find the original article here: http://www.medicalnewstoday.com/articles/239370.php.
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December 24th, 2011 drtim 
Beverly Hills breast augmentation specialist Dr. Tim Neavin is Certified by the American Board of Plastic Surgery and has offices in Beverly Hills, Dubai, and Glendora.
, beautiful breasts, Hollywood celebrities, and NASA. What do all four things have in common? And is there any more real news now that Congress is on vacation? No.
There has been speculation that 19 year old superstar Miley Cyrus has had a recent breast augmentation. Tabloids abound are touting that her breasts sprung up two to three cup sizes in the last month, presumably from the addition of breast implants. However, Miley Cyrus denies having a breast augmentation; But, recent pictures have indeed shown much more volume and breast size and cleavage. This of course is not the first time tabloids and the press has drooled over the thought of young starlets getting cosmetic surgery. The prospect of young, famous women in Hollywood going under the knife for larger breasts is a much sexier topic than getting an appendix removed. Well, for most it is.
I personally reviewed some of the photos that led to the speculation that Miley Cyrus enlarged her breasts. I must say that although there appears to be more cleavage and volume, it is easy to be fooled. There has been a rather shocking advancement in bra and breast support technology which can nowadays convert an A cup into a C cup with the realism that would leave Hollywood CGI programmers envious. Such technological progress has led me and a few fellow Beverly Hills plastic surgeon colleagues (who have asked to remain nameless in this blog) that NASA space engineers are secretly subcontracted with Victoria’s Secret. And on their days off when they aren’t planning the next mission to Mars, draft elaborate support mechanisms that defy all Newtonian laws to suspend big, beautiful breasts. The truth is, on determining whether breasts are truly breasts under clothes, it is virtually impossible to actually appreciate true breast volume without seeing the outline of a nipple. Thus, the photos presented lead simply to pure speculation. Until Miley Cyrus appears in a tabloid wearing an unpadded bathing suite where all is visible, or a tight shirt without a bra, her breasts will remain a mystery, even to NASA.
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December 23rd, 2011 drtim I do quite a bit of facial fat grafting in my Beverly Hills office (also called fat transfer). There has been a lot of buzz in the media about fat grafting and stem cells. (Please refer to the stem cell blog for details about stem cells.) Typically, facial fat grafting it is a procedure that can be done under local anesthesia with no need for intravenous sedation or general anesthetic. It is a great way to rejuvenate a face or add volume to the cheeks or cheekbones (cheek augmentation)
It is often a very, very, very safe operation. However, there was a recent article dealing in the New England Journal of Medicine that reported blindness from a plastic surgeon in Korea from injecting fat into the glabella. (The glabella is the area between the eyes.) Often, the glabella is an area that gets sunken in with age and develops creases.
Although the nature of the injection was not described in detail in the journal article, there had been isolated reports over the last several years about this type of complication with injections in this region. For one, I do not inject fat or any volumizing product (injectables such as Juvederm, restylane, Radiesse) into region primarily because there are a few cases of blindness that have been reported. This one case in Korea is not the first. Number two, I do not think fat injections works that well in this particular region. These areas are better addressed with Botox that relaxes the muscles that cause these frown lines. And, of note, there are no reported cases of blindness from Botox injections.
Also, significant advancements have been made in fat grafting technique. Almost exclusively the few isolated reports of blindness related to fat grafting were in this region (the glabella) and from the use of high pressure syringes with very small needles. For that reason, I as well as most of my colleagues use low pressure syringes and larger cannulas (not needles). With this technique, I do not believe there were any reports at least in the American literature of this terrible complication. The theory behind these few isolated events of blindness are that the high pressure syringes with a small needle actually allow an injection of either fat or any product (such as Juvederm or Restylane) directly into a vessel associated with the eye. Abrupt occlusion of this vessel led to the tragic blindness in these cases. Large cannulas (too large to embolize a small vessel) under lower pressure have proven to be exceptionally safe. This article reported in New England Journal of Medicine should be a stark reminder that you should choose your plastic surgeon wisely, namely, the one that is familiar with fat grafting procedures and uses the latest technologies to reduce the risk of complication.
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December 9th, 2011 drtim This blog is about Beverly Hills breast augmentation, breast enlargement, breast implants, breast implant rippling, capsular contracture, and beautiful breasts.
Silicone-Saline-Breast-Implants, capsular contracture, and beautiful breasts.
Another frequently asked question about breast augmentation is if the breast implants need to be replaced every 10 or 15 years. The answer to this is no. With breast implants basically, if they are not broke, you do not fix them. That is, there is no need to prophylactically replace breast implants. While it is true that the longer they are in the body, the more complication may develop such as breast implant rupture, capsular contracture, implant rippling, and asymmetry; if these problems have not developed, there is no need to replace implants to prevent them from developing.
Of note, regarding to capsular contracture, every year the rate of a capsular contracture developing is approximately 3%. So over the lifetime of your breast implant, the longer any implant is in your body, the higher the chance that a capsular contracture can develop. Regarding breast implant rippling, it is true that saline breast implant can develop more rippling than silicone implant, particularly if the implant is placed above the muscle (subglandular), or the implant is under filled. Therefore, if rippling is a problem, the saline breast implants can be replaced for a silicone implant, and placed under the muscle (submuscular) if the saline implants are subglandular. Regarding breast implant rupture or deflation, if a saline breast implant deflates, the saline will be re-absorbed into the body and within days it will be evident that there is a major loss of volume on that side. If a silicone implant ruptures, one may not even know. In fact, there are many “silent ruptures” walking around Beverly Hills and every other city in the world right now. These “silent ruptures” (called “silent” because there are no side effects) are often detected incidentally on imaging studies for other medically related issues. These are women who have had silicone breast implant breast augmentation and somehow was identified (again, usually by imaging of the chest or breast for any number of reasons) to have silicone slowly leaking into the capsule of the breast. More often than not, there are no ill side effects. Silicone is one of the most inert substances we use in medicine. In fact, silicone devices are not unique to plastic surgery. Silicone devices have been used in orthopaedic surgery for decades. So in summary, as long as the breast implants in your body are not having problems and you are happy with their size and shape, do not waste time and money in breast surgery for removing them and/or replacing them.
Posted in 90210 Plastic Surgery Blog, beautiful breasts, breast augmentation, capsular contracture | 1 Comment »
November 30th, 2011 drtim 
Looking up accentuates bags which can be removed with small incisions behind the lid.
Blepharoplasty is surgery of the eyelid, often to rejuvenate the face. I saw a woman in the Beverly Hills office today who wanted to look more rested. Her main complaints were dark circles and bags under the eyes. This is a common complaint for women and men as they enter their fourth decade of life. These generation of large bags under they eye are somewhat genetic, but also can be related to factors such as fluctuations in weight gain or loss.
A great ways to actually view these bulging bags is to ask the patient to look up. This will accentuate any of the protruding bags in the lower lid. Or, one can gently press in the eyeball and see if any of the fat which constitutes the bag protrudes from the skin. If yo do these maneuvers and there doesn’t appear to be an bulge in the lower lid, the issue is probably not the “bags”. It is probably volume loss. Sometimes, the hollowing out below the rim of the eye with aging can create a shadow making the patient look tired. Thus, there are two very different mechanisms that can generate very similar looking problems. Not surprising, the two ways to correct this vary significantly. Whereas one can improve the appearance under the eyes by removing fat in a situation where there is a protruding herniation or bag of fat below the lids, the management of a hollowed out lower lid/cheek involves ADDITION of volume such as fat or Juvederm. In some cases, the combination of both approaches work when a person has both issues to correct. That is, when there is a hollowing out below the rim of the eye plus a protrusion of the fat in the lower lid, then both removal of fat bags with fat grafting or Juvederm to the depression below the rim may be indicated. If the problem with diagnosis is made incorrectly, then adding products such as fat or Juvederm below the rim may actually accentuate the protrusion of the fat bag. Best thing to do if you think your eyes make you look tired? See your plastic surgeon that you trust and allow them to do these simple maneuvers and see what the best treatment is for you.
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November 30th, 2011 drtim
Anatomy of Ear
An old friend interested in plastic surgery called me about prominent his ears. He was interested in surgical correction of his ears, which is called otoplasty. Typically, prominent ears are result of two different things. One is the actual concha which is the major concavity of ear. In certain people, this is prominent and overdeveloped. The other component to prominent ears is the antihelical fold. This is the second fold in the ear. The more folded this is, the less prominent the ear protrudes. In people with really prominent ears, you often see an effaced antihelical fold where this portion is flat. That is, there is virtually no second ear fold. Hence the correction of prominent ears can either be partial resection of the conchal bowl or recreating the antihelical fold, sometimes with a combination of both. It can be done under local anesthesia in the office setting without the need for going to sleep (general anesthesia). The result is often dramatic and immediate, with virtually no obvious scars. However, your surgeon will usually “over-correct” the the ear because you will lose about 25% of the correction in about six months. The procedure typically takes about an hour to an hour and a half and the postoperative course is generally well tolerated with no downtime.
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October 10th, 2011 drtim I saw a male patient in my Beverly Hills
office today who was interested in rhinoplasty. He had seen four other plastic surgeons prior to seeing me. When we discussed some of his features of the nose and the plans proposed by other plastic surgeons, it reminded me of how much variability there is in diagnosis and management of cosmetic nasal deformities. The aesthetic ideals of the male nose are certainly different than the female nose. For one, male noses can be larger. Two, they can be straighter, with less of a slope to no slope at all. Third, they should be tilted just above 90 degrees (ideally 95 to 100) from the side view in comparison to the lip. This gentleman had what is considered a low take off point from the forehead. That is, the nose should start just at the upper eyelid crease. If too high, it looks like the nose is part of the forehead. If too low, it looks like a beak. When I brought this to his attention, he had mentioned that only two of the other four plastic surgeons had mentioned a low take off. This surprised me, because if the nose were rasped down he would have ended up with a beak appearance. His rhinoplasty plan, would have to consist of addition components as well as subtractive components. While the tip that bothered him had to be refined with subtractive surgery (removing cartilage), the upper third of the nose had to be rebuilt with addition of cartilage, In rhinoplasty, clearly the diagnosis is just as important if not more important than the actual surgery itself. Technically, nasal surgery really is not that difficult, however, making the proper diagnosis, getting on the same page with the patient, and managing that for the patient is truly the art of rhinoplasty.
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October 10th, 2011 drtim In Beverly Hills and abound, many women ask for improvement of their arms. Brachioplasty describes surgery to improve the upper arm appearance. It is sort of like an arm ‘lift’, to use an analogy like mastopexy (breast left), or abdominoplasty (tummy tuck). Droopy or saggy arms are often referred to “bat wings”. Bat wings is when the skin and fat hangs from the arms. It generally occurs in the third or fourth decade of life and then progresses rather rapidly. Massive weight loss and weight gains can exacerbate the issue. With younger patients, arm bulk or fat can often be suctioned through circumferential liposuction.
However, there is a point when the skin envelope is too large for the fat deposit, and in this instance, liposuction can actually make the problem worse. Thus, a proper diagnosis is important prior to performing liposuction of the arms. With brachioplasty, the excess skin and fat are both excised. There are different incision approaches, depending on severity of skin laxity. However, sometimes it is necessary to carry the incision down the arm hidden in the bicipital grove. In other minor cases, the incisions can be hidden as we approach the armpit. In any case, the results can be excellent and restore the patient’s body image regarding the arms, once the proper diagnosis is made along wiht an appropriate treatment plan. Links to some of my book chapters with renown plastic surgeon Dennis Hurwitz can be viewed here (brachioplasty) under publications tab.
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September 24th, 2011 drtim Recently, a wonderful patient of mine, September Sarno, put together a charity event for the S.H.A.R.E. organization in Beverly Hills. This is a charity for children with disabilities. She had organized a bachelor auction for which myself and my anesthesiologist, Dr. Michael Simon-Baker and 22 other single men in the city participated. It was an extremely fun night with over 450 people in attendance. For better or for worse, I was the first bachelor up on the runway. Each bachelor in the auction was asked to provide a theme through their walk and to describe the date for which the bachelor is going to take the winning bidder. This required a bit of brainstorming on my part because I have never done anything quite like this, neither has my friend and coworker, Dr. Michael Simon Baker. Of course, we were asked to wear tuxedos for the event. I had recently seen the movie Casino Royale and despite the fact that I do not have blonde hair like Daniel Craig, I looked nothing like Sean Connery, and I cannot even fake a good British accent, I decided to go with the James Bond theme. Thus, my bachelor date included me picking up the winning bidder in my vintage Jaguar Convertible and driving to a fine-dine restaurant for dinner. Naturally, I walked out to the James Bond theme song. My anesthesiologist, Dr. Michael Simon-Baker was perhaps a bit more creative. Other than being one of the best anesthesiologists that I have ever worked with, he is an amazing guitar player and singer. So, he had hooked up a microphone through the guitar to his chest and walked out playing and singing the song, “Your Body is a Wonderland” by John Mayer. On the end of his guitar, he had roses attached and will walk down the runway over to bidding women and give them roses. It was quite a spectacle and immensely entertaining night, and all for a good cause.
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