Ventura Plastic Surgeons

Breast Implants and Lift to Achieve Tear Drop Shape?

I'm 27, no kids. My current breast size is 34FF I'm am 5'7". I want fuller breast shape and bigger but no bigger than 400cc. Will a Periareolar Breast Lift work?

I do not want the more extensive Breast Lift, I don't think I need it ...or do I? I have been looking at the 410 Natrelle or the Silimed Enhance. I think this will give me the fuller tear drop shape I like.

I am sorry to pick on you, but I think that we need to be honest with each other.

• You may be overweight. It's difficult to "size" breast implants in bigger gals, especially if they are young and their weight might continue to fluctuate.
• Your breasts already appear pretty big. Do you really want implants to make them even bigger?
• Your asymmetry is significant. The breasts are not only different sizes, but they are shaped differently.
• Periareolar breast lifts (also known as Benelli mastopexies or dough-nut mastopexies) flatten breasts. Periareolar lifts do just the opposite of what you want; you will not get tear-drop shapes.

Truthfully, some sort of lollipop lift or inverted-T lift would probably be your best bet. Scars seem distasteful before surgery, but most post-operative patients are not bothered.

Good luck!

Michael C. Pickart, MD

Ventura Plastic Surgeon

Refining Nose Sides Possible with a Nose Job?

Hi there, I have been considering a "nose job" for a while where I would just want the sides of my nose thinned and refined (and perhaps the tip refined a bit if it was really needed for balance).

Saphira,

Sounds like and looks like that you would benefit from a surgical rhinoplasty. You are very attractive, and a nose job would help to harmonize your nose with the rest of your face.

However, I can't give you specifics without side views ("laterals") and a "worm's eye" view (from your feet looking up into your nostrils).

I suspect that you will require a full rhinoplasty, involving the tip, sides, and top....

• Usually, I make a small incision in the skin of the columella (the middle portion between the nostrils) for optimal visualization. This is called an "open" approach and is great for decreasing the bulk of a "piggy" tip.
• I trim, augment, and reconfigure the tip cartilages.
• I might reduce the height of the nose, or augment the base of the nose between the eyebrows (as seen from the sides).
• You will probably require fracturing (breaking) the nasal bones to thin the nose.

I hope my suggestions help. Post some more photos, and we can all be more specific.

Michael C. Pickart, MD

Ventura Plastic Surgeon

Best Procedure for Excess Fat and Skin After Lapband Surgery?

I've lost 100lbs after having a LapBand put in nearly 4 years ago. My stomach issues are very unique looking, which is why I'm having the difficulty in determining what procedure I need. My unwanted fat and loose skin are mainly only above the bellybutton, like it's sitting on a shelf. I am unsure of which procedure would benefit me the most between simple liposuction, a modified Tummy Tuck, full Tummy Tuck, or extended. I'm open to any other suggestions as well. I believe my skin has shrunk back as much as it can already. Thoughts?

First and foremost, congratulations on your weight loss! What a wonderful transformation. In addition to your improved health, your figure already looks terrific.

Second, even though you might think that your tummy has "unique" issues, nothing could be further from reality. I see at least one patient per week whose tummy looks like yours.

Third, go for a full tummy tuck.

• After 4 years, your skin is not going to shrink on its own any farther--no matter how much exercise you do.
• Liposuction will not be helpful to treat the upper tummy and bellybutton. Since liposuction is a fat removal technique (without any significant skin tightening), liposuction is the wrong answer. You are already skinny! The problem is too much skin without good tone, not excess fat.
• Mini tummy tucks are nonsense operations. I have never found the right patient for a mini tummy tuck--in 8 years of practice! A mini tummy tuck is for that very rare patient whose problem area is limited to her lower middle abdomen, just above her pubis. Obviously, this is not where you are concerned.
• A standard tummy tuck will work. To minimize "dog ear" formation on the bilateral hips, weight-loss patients generally get their best results when the tummy tuck is extended all the way around circumferentially. Whether you choose to keep the surgery just in the front or all the way around will be your decision. Both are good choices, but the circumferential technique generally produces better contours.
• Do not do a fleur-di-lis abdominoplasty. The vertical portion of the scar is ugly, and the operation is now recognized as obsolete. If a plastic surgeon offers you this surgery, run away! He is out of date!!

Fourth, make sure that your lap band port is exchanged from a high-profile to a low-profile. Now that you are thin, the low-profile port will be less visible. You don't need that extra prominence to find the port anyway; you've got no subcutaneous fat. (Congratulations again!)

Fifth, make sure that your surgeon is certified by the American Board of Plastic Surgery. And, better yet, research whether he specializes in weight-loss patients. I do a lot of post-bariatric contouring, and let me tell you that weight-loss patients are very different from "regular" plastic surgery patients. Your surgeon needs the expertise only garnered from years of experience with your peer group.

Good luck!

Michael C. Pickart, MD

Ventura Plastic Surgeon