John L. Burns Jr., MD

fat transfer is a great procedure for the very difficult lower eyelid area. I suggest using a filtering system like Tulip as full fat can be irregular. Nano or micro fat is much smoother in this area and still has all the benefits with a finer ability to inject in this delicate area.

Loose skin typically only responds to removal. There are devices that are less invasive like Renuvion but a mini tummy tuck would give you the best result. The scar is small and hidden below your bikini line. The abdominal muscles are also tightened in the procedure.

Hip dips are common and very easily address with a fat transfer. The abdomen and flanks are an excellent donor site. You'll get some improvement in your abdominal contour and repurpose the fat for the hip dips.

The amount of asymmetry is minimal and well within a standard deviation. If the animation is an issue for you the implants could be placed in a sub glandular or subfascial pocket. In my opinion you have a very nice result based on the photos you have submitted.

A good tummy tuck always includes addressing lax abdominal muscles: rectus plication. Occasionally patients have pain associated with this that is prolonged. In most cases this resolves in time. I'd be patient and try and work through the discomfort. If it becomes debilitating then the plication could be removed in a surgical procedure.

The Ergonomix implant has a softer, less viscous gel which allows it to assume a tear-drop shape and thus appear more anatomic. The weight of the implants should be the same. Also, the shell is the silk surface in both which protects against capsular contracture and has less reactivity in the body. Lateral position and bottoming out would be less with Motiva in my opinion but the same for round and ergo implants. The surgical technique and preserving breast support is more important than the implant in preventing lateral position and bottoming out.

Recovery from a subfascial augmentation is much quicker due to leaving the muscle in place and using preservation techniques. Return to exercise is also much quicker as the muscle is preserved in this approach.

The parent company for Motiva, Establishment Labs, is working with the FDA on getting these approved as well a diamond shaped implant and a transaxillary device to place implants; Mia. This process is costly and time intensive and it would be almost impossible to predict the timing.

No, Motiva Ergonomix are simply a tear drop shaped natural implant with a softer gel. They are placed exactly the same. These implants provide a more natural breast shape.

I recommend a subfascial augmentation. Going under the muscle in athletic patients leads to animation deformity. The size you have chosen is quite large in my opinion. Going from a 32b to full C might require around 275cc in my opinion. You might also look into the Preserve method which works extremely well in my athletic patients