Reza Nabavian MD: Plastic Surgeon Santa Monica California

Q: Fat Stored After Liposuction Not Good Anymore?

I had an abdomen Liposuction done a few years ago. The doctor gave me my fat to freeze and I have had it since then in my freezer. The problem is that my lights went out for 2-3 days. I would to like know, is the fat is not good anymore? I want to use it for fat grafting to my buttocks.

A. Say no to stored fat!

First of all, if biologic material such as fat, is to be stored for re-use in the body, it must be maintained with the standards of blood banks. So physicians’ offices or patients’ own would not qualify.

Secondly, intuitively and scientifically, fat that is harvested, traumatized, then stored, is likely not going to be a quality product. Not very difficult to harvest fresh fat at the time of injection.


Q: Shorter But Bigger Nose After Rhinoplasty

I sustained a nose injury and met with a surgeon to have Rhinoplasty. I had photos of this famous model whose features were close to mine except her nose. Anyhow, I wanted her nose. I wanted a smaller, well-defined nose. During surgery, cartilage from my ear was put in my nose. Seven months later, my nose appears larger with no definition. It’s shorter but bigger. Could it be due to too much cartilage, and it failed to shrink as predicted? Does cartilage in the nose shrink over time, and if yes, what is the percentage of shrinkage?

A. Many factors can be contributing to the nasal shape

It would be difficult to provide a helpful answer without photographs, but generally, it sounds like you are not happy with the width of you nose as well as the amount of tip projection.

Cartilage does shrink a bit over time but I doubt it is the main reason for the mismatch here (between your expectations and the results).


Q: What Are the Largest Breast Implants I Should Consider?

I am looking into having a breast augmentation within the next 3 months, but the only potential surgeon I’ve met with so far told me that he would not do the breast augmentation unless I would consider a smaller breast implant size. I was completely shocked by this. My breasts have been extremely small my entire life (AA cups) — I have always had to wear a “training bra” and was teased about this a lot growing up. I want to get DD or larger breast implants. Lots of women get breast implants WAY bigger than DD, so why am I being told my request is unreasonable? How do breast augmentation surgeons decide how big is too big for different people?

A. There are important anatomic considerations for breast implant size

The size of your chest wall, (the dimensions of the boney chest) serves as a starting point to determine what implants may be tolerated. Next, one has to have enough native breast skin that can be stretched to accommodate the implant. If someone has very small breast with minimal skin laxity, it will limit what size implant can be placed under the skin. Other factors such as the amount of existing breast tissue and nipple position also need to be considered.

In general, an inappropriately large sized implant can create a lot of problems for you and your surgeon has the responsibility to inform you properly.


Q: How Effective Are Post-Liposuction Touch-ups?

I had liposuction 6 months ago and up with a few contour irregularities. They look like mogul-type lumps, not dimply like cellulite. My plastic surgeon said he could do a touch-up with a cannula that resembles a cheese grater, but not remove any more fat.
He said this would help smooth the lumps. But he also mentioned that one complication of using this instrument could be damage to the blood supply to the overlying skin. He hasn’t seen this personally, but it does worry me. Is this a good procedure to smooth out lumps, and are the risks to the skin worth it?

A: It is important to know whether the bumps are excess fat or post-liposuction scars.

The bumps you are referring to could be either scar tissue that has formed after liposuction. If that is the case, time and massage should provide some improvement. A persistently hard scar may respond to corticosteroid injection, however, this injection can have its own set of complications such as tissue atrophy and telangiectasias, so not a great choice.
If the bumps are due to under-suctioned fat deposits, then liposuction with a small cannula could be helpful. The closer these deformities are to the actual skin, the less likely it is to achieve excellent correction.
Being prudent about revisional surgery is very smart. In the case evolving scars, time is usually on your side.

Q: Thermage or Blepharoplasty for Sagging Under Eyes?

Will Thermage Fix My Under Eye Sagging Skin, Or Will A Lower Blepharoplasty Work Better?

A: Thermage is not the answer to your problem.

Thermage may work on some areas of the body in some individuals some of the time!! For specific and distinct skin excess, the results may be disappointing. For mildly loose skin or to prevent it, Thermage may be valuable. Lower eyelids can be improved with Fraxel, peels or surgery.

Looking Done is So Last Decade

Looking Done is So Last Decade: The Cultural Shift Towards Age Appropriate Cosmetic Procedures

Looking done is so last decade

Middle aged is no longer synonymous with matronly. The over 40 woman is a force with whom to be reckoned. She is no longer seeking the fountain of youth, but rather seeks to look as good as possible – for her age that is. Women want to look refreshed, healthy and energized. They are less concerned with looking 20 years younger

Instead, women over 40 are wearing their hair longer, sporting bikinis and have more economic power and independence than ever before. And, say these women, why should beauty be intrinsically linked to youth?

In an “age appropriate” movement, plastic surgery too has evolved. “Ironically, older techniques may have removed excess skin to combat aging, but these procedures did nothing to restore youthfulness,” says Clinical Assistant Professor of Plastic Surgery at USC, Dr. Reza Nabavian.

Dr. Nabavian reflects a school of thought that subtlety is best, advocating for minimally invasive and preventative techniques that avoid nipping and tucking where ever possible.

The first defense and treatment of aging, he says, resides in proper skin care. “Signs of aging begin with the condition of the skin itself. Sun damage, environmental factors and overall physical and mental health contribute to the health of the skin.” For younger patients, he suggests treating hyperactive glands and acne using treatments such as glycolics and sunscreens. More mature patients require more intensive agents, such as retinoids and vitamin C to gradually resurface the skin and decrease sunspots and wrinkles.

And where wrinkles stand their ground, Dr. Nabavian advocates the use of Botox, Thermage and fat transfers. Where Botox is concerned, Dr. Nabavian warns that, “Botox is commonly misused and has been known to cause a masked and unnatural appearance. One needs to keep in mind that facial movement is a natural process that needs to be preserved.”

Fat transfers, he says are the most natural and non invasive way of rejuvenating hollow or aging skin. “We can now use a patient’s own fat cells to restore fullness and proportion to the face and body. This procedure enhances the appearance with no use of synthetic fillers, implants and drastic surgery.”