Minneapolis Plastic Surgery
4825 Olson Memorial Hwy., Ste. 200, Minneapolis, Minnesota, 55422
Richard H. Tholen, MD, FACS
VERIFIED
Board Certified Plastic Surgeon
4190 Questions Answered
AREAS OF EXPERTISE
MEET RICHARD H. THOLEN, MD, FACS
🩺38 YEARS OF EXPERIENCE
As an aesthetic plastic surgeon for the majority of my 3+ decades career, I am continually striving to find innovative ways to solve patients' aesthetic concerns, to improve sub-optimal results from other surgeons (as well as a few of my own), and how to best
Richard H. Tholen, MD, FACS VIDEOS
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With due respect since I was not in your operating room, one breast has scars that are beautiful, and the other has scar hypertrophy and post-inflammatory hyperpigmentation. This thicker scarring and dark discoloration respectively are due to inflammation and irritation (or even mild stitch infection as they dissolve) being present on one side and not (or less) on the other.
Leading to my title.
Too often surgeons will have an associate, resident, medical student, or nurse sew one side while the surgeon does the other. If the skill set (or just attention to the details) don't match up, the results won't either. This is not only common, it is rare for one surgeon to completely and personally do both sides. So, if there is disparity in results, this is the most common reason. Sure, one surgeon could have done both sides and just had rotten healing on one side (or bad luck), but what I just described is the most common and truthful answer to your concern.
Here's how I avoid the problem. First, I teach my first assistant in surgery to sew as well as me--same accuracy, same suture material, same careful tissue handling. She helps me sew one breast and may place one perfect stitch for every 5 that I place. Maybe at first one perfect stitch for every ten that I place. Thus, I'm still 10-20% faster than if I place every suture myself. And I really insist each suture is perfect.
Eventually (and it takes about a year), she is both as good as me, and almost as fast. But if you accept speed as your goal, assistants never get much better at their sewing, they just try to go fast and keep up with me, and I've been sewing for over 30 years (over 40 if you count my own 7 years of surgical training). But if they learn to sew beautifully and as perfectly as possible, they will always suture that way, and gradually get faster, with me verifying they are still sewing just like me.
I can certainly understand why you are wondering why one side can be so nice, and the other suboptimal (that's the kind way to describe it), but this is the truth. All surgeons know this, but few will admit it. I do both sides myself, and my nurse sews both sides with me. If they ever heal differently, we look at the reasons, and it better not be that one of us rushed, was preoccupied, or sloppy. Sometimes circulation can be different on one side or the other, but this is also uncommon, The real reason is most likely that two persons of dissimilar skill each closed one side, and one simply healed better. After all, the same person's genetics of healing and scar formation were present in both breasts. so it has to be something else.
By the way, in a teaching hospital or training program, or practice with high employee turnover, this may not be an unusual occurrence, but in a private practice where you pay top dollar for surgery by the surgeon whose name is on the door and the card you are handed, this should not happen. Just saying! Best wishes, Dr. Tholen
Richard H. Tholen, MD, FACS
Board Certified Plastic Surgeon
Your breasts are small, but not small enough for periareolar (keyhole) surgery to work; plus, your areolas (and nipples) are too large. Removal of the nipple/areola complexes and "just going without" will leave your chest looking abnormal-enough that you will likely be self-conscious about your appearance, limiting your ability to ever remove your shirt, wear swim trunks without a t-shirt, or feel comfortable in a locker room. Trust me on this! Keep your parts, just reduce the nipple and areola sizes and ensure they are grafted to an appropriate masculine position.
Sure, you will have scars, but if your surgeon skillfully places them to mimic your pec creases rather than slope down like a mastectomy scar, they can be pretty acceptable once they fade. It's taken me many years to learn how to minimize dog ears and poorly-positioned scars, but if you look at my website's before and after photographs (or those here on RealSelf), you can see how my results stack up against other surgeons performing this surgery. I state this not to "brag" but to support my recommendation.
This surgical procedure (transgender mastectomies) is NOT being taught in most plastic surgical programs, and top surgery is NOT the same as mastectomies taught in our general surgery programs for cancer surgery, nor is this a "mega" breast reduction/lift. Female scar patterns are as bad as transmen being described by "she" or "her."
Your anatomy requires skin reduction (double-incision) total mastectomies, proper scar position and orientation along your lower pec borders, avoidance of dog ears, as well as nipple and areola reductions and placement of your masculine-sized nipple areola complexes in masculine position. Anything else will land you a place on the "disasters of top surgery" page, and require re-do surgery. Best wishes! Dr. Tholen
Richard H. Tholen, MD, FACS
Board Certified Plastic Surgeon
Will taking androgen blockers help increase breast size for male to female? I am using herbals now but I really want breasts
Asked By:AnonymousANSWERS (1)I have performed breast augmentation for M-F transgender patients for three decades, many who have been on maximum hormone therapy, both prescription medications and herbal. The most breast growth I have seen is only one bra cup size, and most commonly, around a half-cup size increase.
That is why I end up placing implants! Thanks for your question. Best wishes! Dr. Tholen
Richard H. Tholen, MD, FACS
Board Certified Plastic Surgeon
Exercise and diet will cause muscles to strengthen and fat to diminish, but skin elasticity will only go so far in re-tightening after weight loss! The same goes for fascia (the gristle layer that surrounds muscles), which is stretched by pregnancy, but often remains stretched after you deliver and lose your post-pregnancy weight.
You can lose fat (both inside your abdomen, and under your skin), and you can strengthen muscles (but not the fascia), yet you cannot exercise skin once it has been stretched past its innate elasticity.
A tummy tuck tightens the stretched abdominal muscles by suturing the fascia (rectus sheath plication, or muscle repair), and removing the excess skin. You keep your own belly button, but it now has a new opening through the tightened abdominal skin. Skillful choice and placement of the umbilical incision can avoid a "bullseye" scar around the belly button. Short-scar "mini-tucks" sound appealing, but a longer scar is still hidden by most bikini bottoms and removes the "dog ears" that shorter scar mini-tucks leave. Plus, the amount of loose skin your photos show requires a full, or even extended, tummy tuck.
Please select your ABPS-certified plastic surgeon carefully. Best wishes! Dr. Tholen
Richard H. Tholen, MD, FACS
Board Certified Plastic Surgeon
I’m 240 lbs and 5’3". I’m a A-B cup and want implants to balance figure. Do I need to lose weight?
Asked By:AnonymousANSWERS (1)I've changed your question, since your BMI is 42.5, and there is no place for elective surgery with the documented increased risks of potential complications in someone with a BMI over 30.
Our own accredited surgical facility anesthesia providers will not anesthetize anyone with a BMI over 35, and even these patients undergo more rigorous screening before surgery. Add COVID-19 concerns, and elective surgery becomes even more potentially problematic for higher-risk patients.
Please lose weight and then decide what surgery will most effectively "balance your figure." You may indeed benefit from breast implants, but may instead choose a lower body lift or tummy tuck first! Best wishes! Dr. Tholen
Richard H. Tholen, MD, FACS
Board Certified Plastic Surgeon
Can a man get breast implants to look like a woman but without taking hormones and male gets a BBL?
Asked By:AnonymousANSWERS (1)Many surgical options are possible, including breast implants and BBL (fat grafts to the buttocks), regardless of your own gender description. If you are not receiving hormone therapy, your fertility is unchanged.
But if you are concerned about fertility, you would need to have sex with a committed female partner, who may have her own concerns regarding gender definitions, gender non-binary fluidity, and how you will interact with your extended family (including any offspring), co-workers, and community in general.
In all frankness, fascination is not a sufficient motivation to fulfill a request such as yours. Gender issues are serious life issues, and gender reassignment surgery (even for non-genitalia secondary sexual characteristics) is serious surgery, with real risks. I might suggest that elective surgery should be a later step in your own personal gender-identity journey. All the best wishes! Dr. Tholen
Richard H. Tholen, MD, FACS
Board Certified Plastic Surgeon
At two years post-op, your tissues have healed and matured and nothing other than revision surgery can improve this. Note that all 5 answers thus far (prior to my answer) involve more surgery--there is nothing (other than more surgery) that you can do (including thong bra) that will re-attach the stretched tissues between your breasts.
The problem is skin that is youthful and taut, coupled with implants that may be exactly the size you wanted, but are too big (tight) for your chest/breast skin. That's why some answers talk about smaller implants--think two basketballs beneath a blanket vs. two baseballs beneath the same blanket. Too large and/or too close equals more "tenting."
With breast implants in this situation, it's called symmastia (or synmastia), breadloafing, or most commonly, uniboob.
The vast majority of plastic surgeons place augmentation implants beneath the muscles because of clear advantages in minimizing risk of capsular contracture. . . despite the occasional disadvantages of activation distortion and slightly more discomfort and surgical difficulty. Some surgeons still go above the muscles because it's easier, quicker, less uncomfortable for the patient, and sometimes "better in cases where there is breast ptosis" (droop or sag), than going below the muscles. (You had no breast ptosis, so you and your surgeon will have to answer the "Why" of above the muscles.)
HINT: "My surgeon has been no help" may help you understand.
Going below the muscles and maintaining the muscular attachments to the sternum will avoid most symmastia, but too large and/or too close can still cause this! So revision below the muscles is another approach to dealing with this issue, but what to do with those two above the muscle cavities that are now empty? Hope both of the old pockets "snap shut" and stick down (heal) perfectly without collecting blood or serum? How about two drains? (Not with implants, I hope)! Tape both side of the skin up till it heals in place (weeks)? Or just stay in the same pockets and try to suture the medial capsules down to the sternum (bilateral caspsulorrhaphies) with new smaller implants, or tighten the pockets and use the same implants in now-tighter, smaller spaces, making the beasts more firm? Lots of tough choices!
BTW, although this is straightforward surgery revision for experienced breast surgeons, it is NOT a quick, easy, or inexpensive "touch-up" surgery. (HINT: "My surgeon has been no help" may have something to do with this as well.)
So, to answer your last question, you can return to your original surgeon, who MAY charge an existing patient less, though usually only for the first year (review your consent and the written information provided by your surgeon regarding secondary or revision surgery).
Or, you can go to another experienced, ABPS-certified, ASAPS member plastic surgeon who does lots of secondary breast surgery and pay for the surgery required. With new implants, this can be as much or more than the original BA surgery, especially if you initially went to a "cosmetic surgeon" who is not a "real plastic surgeon," or someone who may have the proper credentials but has less skill, experience, or ethics. Unfortunately, both types of these doctors exist, and they will happily take your money, do subpar surgery, and then refuse to deal with the suboptimal outcome. Your choice. Sorry.
Be safe, consider your options, get virtual consults (for the time being), and when elective surgery resumes, proceed with a well-reasoned revision. Best wishes! Dr. Tholen
Richard H. Tholen, MD, FACS
Board Certified Plastic Surgeon
It's not actually about recovery and the correlation with higher BMI, it's that BMI over 30 is associated with higher risks of all types after surgery. This makes elective surgery in the setting of increased risks something of concern not only for the patient and the effect on recovery, but the plastic surgeon having to deal with complications, and that's after the anesthesia provider has to safely get you to sleep for the surgery, and then get you safely awake in order to recover.
In our accredited (AAAASF) office-based surgical facility, our anesthesia providers will not agree to perform elective surgery on a patient with a BMI over 35. And between 30 and 35 we know there are increased risks, so we screen other factors even more scrupulously!
Following instructions is important, but you can still have wounds break open, pneumonias develop, and blood clots form (not to mention many other potential complications). These are not trivial issues, and patients who otherwise are healthy (save for their high BMI), can still die from elective surgery if they follow every instruction but "Lose more weight.".
Joan Rivers did not have a high BMI and still died during a "simple" procedure. Kanye West's mom died after liposuction. Plenty of non-celebrity similar stories exist. The reality is that your height and weight may well give you a BMI that "qualifies" you for elective surgery. If it's over 35, I would ask you to lose more weight before proceeding, and if between 30 and 35, still encourage safe and healthy weight loss before performing any elective plastic surgery. The risks WILL be less.
And following instructions is indeed equally critical! Best wishes! Dr. Tholen
Richard H. Tholen, MD, FACS
Board Certified Plastic Surgeon
What kind of breast lift would I need in order to get minimum scars? (Photo)
Asked By:AnonymousANSWERS (1)Every patient wants the least scarring, but also the best results. Often these are at opposition with the other. You have significant breast ptosis (droop) and nipple/areola complexes that are situated below your inframammary creases, plus point down slightly.
Your breasts require a significant "lift" in both horizontal and vertical dimensions. Only a full Wise-pattern (anchor) breast lift will give a satisfactory aesthetic outcome. Even attempting a vertical (lollipop) type lift will end up with unsatisfactory scarring, not to mention inadequate shaping of your breasts, so don't fall prey to promises, of "I'm experienced with this kind of lift--I can make it work!"
The laws of physics do not bend because of someone's experience, skill, or best wishes.
You need a full lift. Or you can try for less scarring, and end up with more surgery, more scars, more cost, and a less satisfactory outcome than if you had just accepted reality and had the full lift you should have in the first place. Take a look at the example in my web reference below--even though this patient also had implants, it was the desire for less scarring for the lift part of her surgery that led to bad surgeon decisions, and three operations by two other surgeons before I finally performed the lift she needed in the first place! Best wishes! Dr. Tholen
Richard H. Tholen, MD, FACS
Board Certified Plastic Surgeon
Of course, but elective surgery safety guidelines may not allow anesthesia providers to proceed without review with your cardiologist. It's not CAN you have elective surgery of several hours' duration, it's can you safely have this operation, muscle relaxation or paralysis to repair your diastasis, tighten your abdominal contents into a smaller cavity with pressure on your diaphragm, and have you recover form not only the operation, but the anesthesia!
If the someone is you, you may think the decision to take this risk is all yours to make. But you would be wrong, since the decision to participate in an elective procedure on someone with known heart disease is also your surgeon's, your anesthesia provider's, and every member of the operating room team. No one wants a death, or even an avoidable complication, on their conscience, or their "record."
So, if you're getting "No" for an answer, take that to heart (no pun intended) and understand that this may not be for you. But if you haven't asked, go ahead! Best wishes! Dr. Tholen
Richard H. Tholen, MD, FACS
Board Certified Plastic Surgeon
Richard H. Tholen, MD, FACS reviews
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aprilooo
He’s Real and Will Tell You the Truth!
He’s awesome and spot on! Although I didn’t want to hear I need an extended tummy tuck or belt lift, he is 100% right and his expertise and knowledge makes me feel comfortable with him as my soon to be doctor for my face only and perhaps breasts someday too. Thank you Dr Tholen.
5YS
pleased with results - 29 years old - Mom of 3 - 345CC L/375CC R
Hello! After 5 years of following Dr. Tholen and his work on Realself and doing my own research, I've finally made the decision and got my boobs done. Here are a few things about me: - Surgery: August 2022 - 4'11" - 120lbs - 30 years old as of today - Asian - Mother of 3 - 345 cc on the left - 375 cc on the right. - Now wears mostly size M in bralettes - 36 C bra (previous size 32B) The surgery went smooth and fast. I had no pain and recovered quickly even with all the bruising and swelling lasting for almost two weeks. The team was helpful, friendly, kind, and great. I would recommend and is satisfied with the results after 1.5 years. I'm sure I left a few things out so, feel free to ask if would you would like to know more. Updated on 27 Mar 2024: Here are photos of my results from after the surgery and how my breasts look today. Let me know if I should add more photos. Or if there are any questions, leave them below and I will respond to them as best as I can. Updated on 21 May 2024: Here’s an update on my results. It’ll be two years in August. Updated on 21 Oct 2024: For those who are curious about and what implants I got. Updated on 21 Oct 2024: For those who are curious about and what implants I got.
ellerk799x
The Best of the Best
Dr. Tholen is simply the best plastic surgeon you will find, period. Not just skilled but kind, honest, personable, and professional. Had breasts, arms, belt lipectomy, and thigh lipo, all post weight loss. He is la crême de la crême of plastic surgeons. Additionally, his staff and his facility are top-notch. I have VERY high standard and am also prone to anxiety. I always feel safe with Dr. Tholen and his whole staff, and know that I'm getting the best treatment and care. I would give 10 stars if I could. No, Dr. T is not cheap, but you will never regret choosing him. Worth every penny.
Modest662517
The Best Experience and an Amazing Doctor
Dr. Tholen, is absolutely amazing, honestly one of the best Doctors I've ever had. His thoroughness, detail and descript instructions is exactly what I needed to feel comfortable and confident in my choices and breast augmentation. hands down, he is the best!As an incentive for posting a review, this reviewer received an entry into RealSelf’s monthly $500 gift card giveaway.
Mmorris4286
Highly Recommend Dr. Tholen!
If you are looking for a surgeon for a breast augmentation or reduction, look no further than Dr. Tholen. I could not recommend him more. He is meticulous and thorough and trustworthy and provides a top notch experience from consultation through the multiple follow ups after, ensuring perfection for all his patients. Highly recommend!
tjaner5
3 days post-op breast augmentation, wonderful at putting my nerves at ease
I recently (3 days ago) had a breast augmentation done by Dr.Tholen at Minneapolis Plastic Surgery. I cannot say enough good things about my experience so far. Within the first 2 mins of my initial consultation, I loved Dr. Tholen. You can tell he truly cares about his patients. His consultation was extremely informative and was not rushed at all. He is amazing at answering all questions and explaining what is to be expected throughout your experience. I found him to be incredibly knowledgeable and he is so kind. I definitely felt 100% comfortable with him and that I was in the best hands. This surgery was my first one ever and I was very nervous the day of. Dr Tholen and his team were wonderful at putting my nerves at ease. Everything went smooth and I woke up not feeling sick at all from the anesthesia. My pain has been extremely manageable, and I found that I don't even need to take the prescribed painkillers. I had a question for Dr Tholen the evening after my surgery, so I left a message with the on call staff and Dr Tholen called me back within 2 mins, happy to answer my question. (I had some swelling on my side that he assured me was completely normal). Again, I cannot say enough good things about Dr Tholen and his team at Minneapolis Plastic Surgery, they are all wonderful! If you are looking for a plastic surgeon, I really do urge you to meet with him.
Response from Dr.Richard H. Tholen, MD, FACSThanks for your kind words, and I appreciate your taking time to write a review! Dr. Tholen
Passionate333333
Love!!! No Implants, Just Lift!
Beyond thrilled that I discovered Dr. Tholen! His precision and skilled surgical technique is bar none. Looking through his before and afters are incredible, but looking at my own results are blowing me away!! Expect exceptional after care as well. His attention to detail starts during your consultation and continues even when you're home recovering from surgery. (Critically important!) Lots of conveniences to enjoy when you book here, such as a messaging app directly to his nurses/office staff, all of your prescriptions being delivered right to the clinic, surgery taking place at the SAME location, discounted hotel rooms minutes away and more! His staff is friendly, anesthesia is great and the results are picture perfect! I'm 2 weeks post op today, so I'll attach photos of my experience so far! Thank you Dr. Tholen. You are truly the best. Updated on 5 Feb 2023: Here's a before pic for comparison, it was deleted from the first post somehow and apparently I can't add to that. I haven't taken too many pictures recently, but the scars are healing very well! I've taken/am taking Arnica (early on post op), turmeric from Further Foods and Ageless Multi Collagen. I think all of these are helping the healing process immensely!
TDBW
Surgery went well - scarring is more pronounced than anticipated
I had a breast augmentation in 2014 by Dr. Tholen. He was very nice and seemed knowledgeable, which is why I booked with him. The surgery and recovery went well, but my scarring is definitely more pronounced than I anticipated. Regarding the incision he said he sews one side and his nurse sews the other, and to be honest, there’s a considerable difference in the scars. One is more flat and is closer to the color of my skin but the other is raised, bumpy and much darker than the other. While this isn’t a huge issue for me now I would have felt very self-conscious if I was still dating. I’m writing this now as I was thinking of getting other work done but after seeing a few poor reviews on his facelift patients I felt compelled to share my experience as well. If you’re going to see him just ask lots of questions and it’s probably a safe assumption that only the best results are shown in his before and after photos.
Response from Dr.Richard H. Tholen, MD, FACSThanks for writing a review. To clarify without being defensive, I am present from first incision to last stitch, but with the assistance of my team and surgery first assistant for the entire operation, including closure. This is NOT nurse doing one side and me doing the other. We both do both sides. Healing and scarring are often unpredictable and asymmetric. I would be happy to perform a scar revision under local anesthesia at no charge if we can make things better. Dr. Tholen
Luzar86
beyond impressed with the professionalism and picture perfect results
Absolutely beyond impressed with the professionalism, picture perfect results, welcoming atmosphere of the clinic, and wonderful staff attitudes. I thought somewhere along the way I’d hit a snag with either lack of communication skills, off end results, the vibes in the clinic or with staff but I was pleasantly surprised and it’s been a dream ride the entire way!! All the ladies are amazing and Dr. Tholen is the most charismatic, personable and professional doctor I’ve had the pleasure of meeting. I can’t say enough how happy I am that I trusted my BA to him and it came out EXACTLY like my wish pics! Even if you think you’ve found your PS, I URGE you to meet with Dr. Tholen, and it’ll change your mind :)
BariatricPatientJN
Pure joy and validation for all the hard work I did
Dr. Tholen did my belt lipectomy on July 6, 2022 after I lost 100 lbs in one year with the help of bariatric surgery. At the 24-hour check in appointment I got to see my incisions, and they were amazing! Smooth, completely shut, very mild bruising, and perfect positioning. Nothing scary-looking about them, which is incredible considering my skin is usually very fragile and prone to severe bruising. For my fellow individuals with Ehlers-Danlos Syndrome or other connective tissue disorders, Dr. Tholen knows what he’s doing, and he knows how to take care of you. Don’t be scared to go to him for your cosmetic surgery. The best part was actually seeing my body without the extra fat and loose skin for the first time in my life—truly the first time in my life. I was so happy I cried a bit. Dr. Tholen has given me something I’ve never had: my actual figure. Even with my drains and my compression garment on, I feel beautiful and I finally feel like me. It looks like this procedure definitely lifted my thighs, my buttocks, and especially my pubic area. Dr. Tholen’s amazing job with my belt lipectomy may save me from a thigh lift in the future. I just could not believe that was actually my body in the mirror. It was pure joy and validation for all the hard work I did. I am SO glad I took it upon myself to find my own surgeon, and I am SO glad I found Dr. Tholen. The rest of the staff at Minneapolis Plastic Surgery are also 5/5 stars. The way everyone handled me before the surgery and the day of the surgery made me feel very confident in them, and I did not have a single question left unanswered. The surgery day very calm, considering what I was about to undergo, thanks to everyone there being calm and confident in their process for the surgery. Amazing anesthesiologist, too. I’d had a mild waking event during my bariatric surgery a year ago, and that surgery was 45 minutes at the most; this surgery at Minneapolis Plastic Surgery was about 4 1/2 - 5 hours under anesthesia and I did not have a single second of inappropriate waking. I went to sleep on the table and woke up in recovery just as I should’ve, and I’m so grateful for their anesthesiologist and their anesthesia delivery method. Zero nausea upon waking or afterward, too. I had awful nausea a year ago after my bariatric surgery, but I had absolutely none after this surgery. They are truly the absolute best at Minneapolis Plastic Surgery in every aspect. I am beyond grateful for all the wonderful front desk staff members, the techs, the nurses, the anesthesiologist, and of course, Dr. Tholen. All wonderful, caring, helpful, highly skilled people. I 100% recommend them above any other clinic or hospital. Updated on 8 Dec 2022: I was doped up on pain medication during my last review, so I was a bit gushy and probably jumping the gun on the thigh lift thought—having a good laugh now at my gushy review, though. However, I still see what I saw at the time of my first review, and I still stand by my recommendation of Dr. Tholen for anyone. Back then I was insanely swollen and I couldn’t yet stand upright, but I could easily imagine my real figure under the swelling and stiffness. As the swelling continued to go down, what I could imagine was under the swelling became real. Now I’m wearing size 4 jeans, and small or extra small sizes for other clothing. I’ve never had that before. I actually feel like myself, and I don’t feel like I’m trapped by all that loose skin I had. It’s so much easier to move around without all that heavy extra skin—I think it was 8.2 lbs. It’s still incredible to actually see ME. I feel beautiful and transformed. I am so thankful. I do notice that my thighs are lifted a bit, too. The only thing that bugs me a bit is that my butt crack appears longer. However, after a busy day I do still have very noticeable swelling in my lower back, buttocks, and thighs, so I am optimistic that over time things won’t always be so squished together from swelling and creating a long crack. In the photos I’m attaching you can see a bit of the swelling in those areas, but not nearly as much as it still gets.
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