Santa Monica Doctors

Borderline Needing a Lift. Are Subglandular Silicone Implants Right for my Ptosis? (photo)

I've had consults with 3 PS's and am considering around 450cc silicone implants placed over the muscle. I don't want a lift at this time and one PS told me this would be my best option for a lifting effect without a lift. I don't have kids yet and would be open to a full lift in the future, instead of just having a circumareolar mastopexy now. Would HP or mod profile implants be best for upper-pole fullness? And would 450cc silicone in the subglandular position be appropriate for me?

Hello MF35,

Subglandular implant placement in a ptotic breast, especially with a large implant, will quickly lead to a large ptotic breast.  I specialize in implant revision and see this all the time.  No matter how large an implant is, it will never allow the ptotic nipple areolar complex to rotate up into a better position on the breast mound, yet some surgeons do it all the time.  Another concern I have is that your inframammary folds sits high on the chest (hence the reason in your case you have breast ptosis), and a large implant will require the doctor to substantially lower the fold to properly place the implant under breast mound.  This puts you at high risk for double bubble phenomenon, as well as severe rippling.

Many surgeons, including myself, have chosen to adhere to principles based in evidence or scientific evaluation, as opposed to a subjective belief system of 'what works'. One measure of how well this objective and quantifiable system works is looking at complication rates.  The national average for complications within three years of surgery is 25%, which can be reduced to 2-3% when adhering to evidenced based principles.

You should not place an implant above the muscle just to obtain a false sense of a lift that is always temporary. In the end, you will have recurrent 'drop out', or worse, a 'ball in sock' appearance, especially with larger implants or high profile implants.  Further, subglandular implants have a host of other complications and problems that can be avoided by a partial subpectoral placement.  'Subfascial' placement shows no difference than subglandular placement, and therefore provides no benefit when examined in objectively.

A partial subpectoral placement of low or intermediate profile, properly sized implants, with a possible mastopexy (depending on your physical exam, but based on your photos you will benefit from one) will yield a long lasting, pretty result with the lowest risk of complications.

I would keep looking for a surgeon in your area who doesn't consider a large implant a real alternative to a mastopexy. 

Best of luck.

Gerald Minniti, MD

Beverly Hills Plastic Surgeon

Most Effective Treatment Regime for Female Pattern Hair Loss?

for 25 Year Old diagnosed with scalp biopsy

I would first check labs (thyroid, iron, ferritin). Make sure you don't have any medical conditions (ie alopecia aerata). If all albs are ok, and it is clearly a female pattern hair loss, I would consider aldactone. Please see a board certified dermatologist. 

Ben Behnam, MD

Santa Monica Dermatologic Surgeon

Fractional Laser Comparison of Starlux 2940, Fraxel Repair and SmartXide

Do fractional ablative lasers work the same? More specifically, is SmartXide DOT therapy as good as Fraxel Repair or the Starlux 2940?

There are many different brands of fractional CO2. There are studies reported in the literature that they are pretty much the same with respect to efficacy. I have persona;;y used the Fraxel, Active FX, Lutronics and Smartxide dot. In my opinion, they all will give you similar result. The most important component is not the laser but the practitioner doing it. If you have an experienced practitioner, you will achieve great results no matter which laser you use. I have the Smartxide Dot and I absolutely love it. I get great results with it. Dr. Behnam

Ben Behnam, MD

Santa Monica Dermatologic Surgeon