Doctor Q&A

As breast implants settle into their appropriate position within the pocket and as swelling goes away, some patients are left disappointed that they are "smaller" than they were originally after surgery. But keep in mind that right after surgery, most patients are swollen and with implants that are sitting a little high and so this may give the appearance of a slightly larger, fuller cup size.

To address this, I ask all of my patients to bring in 2-3 "Inspiration Photos" of a volumetric...

Thank you for your question. There is no right or wrong answer to your question as both are reasonable options. Over the muscle carries a higher risk of capsular contracture than dual plane placement in most studies, but does have less risk of animation deformity. The other drawback with over the muscle placement is increased palpability of the implant and wrinkling in thin patients. Your concern about weight lifting, specifically shoulder presses and pull ups, is not really an issue in the...

Dear Madelinelily,
Thank you for your question.
Breast implant volume is a key consideration in surgical planning. There are a number of ways of approaching it - some solid and reliable; others gimmicky in nature that may be for marketing purposes. You ought ensure that your surgeon is able to justify to you how they have arrived at their recommendation to achieve your desires and complement your frame size.
I recommend selecting a specialist plastic surgeon who is experienced in such...

Thank you for your question and photos. First, liposuction 360 means removing fat from all around or circumferentially from the body. Based on these photos, without the advantage of a physical examination, you would get the best results with liposuction 360 degrees and a full abdominoplasty. Lipo 360 is not interchangeable with a tummy tuck procedure. They complement each other to deliver the best body shape based on your muscle and bony anatomy. I would recommend light liposuction of the...

Hi, lymphatic massage is generally optional after a tummy tuck and is not required for every patient. Even when the procedure involves primarily loose skin removal and muscle repair, some degree of postoperative swelling is expected as part of the normal healing process. Gentle lymphatic massage may help with swelling and comfort in some patients, but your body will naturally resolve this swelling over time.

After three C-sections, abdominal fullness can come from diastasis, loose skin, scar tethering, or a combination. If there is true muscle separation, exercise can improve core strength but usually cannot fully close the separation once the fascia is stretched.
A full tummy tuck is usually the most complete option because it can repair diastasis from the upper abdomen to the lower abdomen, remove lower abdominal skin, and improve the C-section scar area. It also allows the belly button to be...

Thank you for your questions and photos.
The goal for a rhinoplasty should always be based on your concerns and aesthetic ideals, not necessarily a one-size fits all type of approach. With that being said, the most common concerns I hear from patients with similar nasal anatomy as yours would be lack of tip definition and nostrils that appear too wide. In these situations I often discuss lengthening/projecting the tip of the nose to increase the tension on the skin and improve the tip...

A let-down or preservation rhinoplasty can be a good option in selected patients who want to reduce a dorsal hump while preserving the natural dorsal lines and avoiding an overly operated look. It is specifically designed to lower the bridge rather than aggressively shave down the top of the nose.
That said, it is not the right technique for every anatomy. It works best when the hump, nasal bones, septum, and nasal width are suitable for controlled lowering. In some noses, a structural or...

It’s definitely possible to have scar tissue inside one nostril after rhinoplasty, but without examining the area in person, it’s difficult to know whether what you’re feeling is actually scar tissue, cartilage, or another part of the nasal lining/framework.
If it has been there for years and isn’t causing pain, breathing problems, or significant irritation, sometimes the safest option is simply to leave it alone. A small revision may be possible depending on what it is, but I would want to...

Thank you for your question and photos. You are correct, this is an adhesion and not a volume deficit. Trying to fat graft this area without scar detachment and biostimulator placement will lead to further distortion, since fat transfer will not release the depression. Cellulite can happen too, if the surgeon injects the fat too superficially. All that is treated with the above stated procedure. The scar depression is treated with subcision and placement of biostimulators like Radiesse. This...

These are two major surgeries and should be done separately for reasons such as blood loss, danger of thromboembolism, prolonged recovery, shaping of the abdomen. In patients who may require minimal TT without any undermining, exception can be made. Good luck.

Hello! Thank you for your question.
After pregnancy and significant changes in weight, the abdominal skin and underlying tissues can become lax and may not return completely to their original shape. In these cases, an abdominoplasty combined with liposculpture can be one of the most effective ways to restore abdominal contour and define the waist.
The liposculpture can be used to strategically treat areas such as the back, flanks, waist, and abdomen, creating a more feminine and defined...

Yes, this would usually be considered a breast reduction, and because you had a mastopexy many years ago, it is also a revision breast surgery. The prior lift matters because the surgeon needs to understand the old scar pattern and likely blood supply to the nipple.
At 69, age alone does not prevent surgery. Your lack of hypertension, heart disease, and diabetes is favorable. The bigger questions are overall fitness for anesthesia, smoking/nicotine status, BMI, medications, skin quality,...

I recommend you find photos of women’s breasts you consider to be pretty and share those photos with your plastic surgeon. Trust your surgeon with regard to recommendation of Round versus Ergonomix. The “Round” can potentially look slightly less natural. If a natural appearance is important to you, Ergonomix is advisable. I don’t think you have a serious risk of rippling since you appear to have adequate breast tissue to conceal your implant. Best of luck to you.

Clear or yellow nipple discharge years after breast augmentation should be evaluated in person. It may be related to hormonal changes, pregnancy/breastfeeding effects, duct irritation, infection, skin breakdown, or less commonly an implant-related problem.
Because the fluid is increasing and sticking to the bra enough to pull skin from the areola, I would not ignore it. You should see a breast specialist, gynecologist, or plastic surgeon for an exam.
The evaluation may include breast...

Thank you for your question and photo.
The question will always come down to whether you would need a revision facelift or something less invasive like laser resurfacing. In particular, the finer wrinkles around the mouth will respond better to laser than another lift. The fullness of the neck and jawline will respond better to a lift. Your best option would be scheduling a consult with a plastic surgeon well versed in facial rejuvenation to discuss these options and determine the best...

I agree with your instinct: elective facelift surgery should wait until the reason for the persistently high platelet count is understood.
A platelet count of 587,000 is above normal, and if it has stayed elevated over several months, it needs hematology evaluation. High platelets can be reactive, such as from inflammation, iron deficiency, infection, or recent illness, but they can also come from a bone marrow condition. The treatment and surgical risk depend on the cause.
For facelift...

I can tell you that a deep-plane facelift is exceptionally effective for precisely the concerns you are describing.
Even if you do not have many fine lines or loose surface skin, a facelift is fundamentally a structural procedure, not a skin-tightening one. In your 40s, facial aging is driven by gravity pulling down the deeper muscle and fat layers (the SMAS), which causes:Cheeks: Descending from the high cheekbones, which flattens the midface.Nasolabial Folds: Deepening because the fallen...

Absolutely not. Being 74 does not automatically mean you are too old for a facelift. What matters much more than your age is your overall health, medical history, skin quality and whether you are a good candidate for surgery.
If you are bothered by significant laxity in the lower face, jowls or neck, a properly planned face and neck lift can still provide a very noticeable and natural rejuvenation. In fact, for someone who is healthy and wants a meaningful, long-lasting improvement, surgery...

Hello Rational322108,
Thank you for your question and photographs. Well done on your weight loss of 30 Kg!
The issue relates to the ability of your upper arm skin to retract after liposuction alone on the basis of skin integrity and elasticity given your skin has stretched with weight gain. Whilst liposuction involves minimal scarring and shorter recovery, brachioplasty surgery to remove the excess skin may be required to remove excess skin if liposuction alone results in loose skin.
My...

We have reviewed your question. Liposuction may be possible with a J-plasma, but you should first be evaluated and cleared by your colorectal specialist. An in-person consultation is recommended.

In your 40s, if you are noticing both sun damage around the eyes and hollowing under the eyes, I would definitely consider a lower blepharoplasty. This can address the under-eye area in a much more direct and long-lasting way than trying to simply camouflage the hollowing with filler.
Depending on your anatomy, the procedure can include repositioning or carefully adding fat to create a smoother transition between the lower eyelid and cheek. If there is any excess or damaged skin, that can...

We have reviewed your photos. Upper blepharoplasty revision may help improve the residual crepey skin. An in-person consultation is recommended to determine the best approach.