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CLAIM YOUR PROFILEOver time the skin of the breasts and the ligaments of the breasts are not as strong and cause sagging. At the same time, most women will add weight over a 25 year period. It is interesting that the skin does not stretch out significantly ( as seen by your raised arm pictures), but the volume position does change.
Liposuction can selectively reduce the breast and fatty tissue in the outer ( lateral) parts of the breast and the most dependent part ( sagging part below the nipple). This will make the breasts smaller and the nipple position may rise slightly with the skin contracture. If you want more fullness in the upper pole fat grafting or an implant will be needed.
A breast lift classically is a tailoring procedure to adjust the “extra skin” to better fit the volume and to more the nipple more cephalad. You may need some skin removed, but more likely, the volume is too heavy in the lower pole, not enough in the upper pole and so you see this as a sagging breast.
Dr. Ditesheim
Board Certified Plastic Surgeon
You say your BMI is 40 ( by ht and wt). This means that there is significant fatty tissue in your tummy and torso. You say that you are active but can’t work out the way you want. I have many patients with this situation. The most important factor for you to consider is SAFETY. You can absolutely have a better body with fatty tissue reduction and removing excess skin. You can most definitely have a breast augmentation, possible breast lift. The biggest issue is how much surgery ( how much stress) can you body take at one time. How much fatty tissue can your body lose at once (including blood loss) and not be shocked? You might consider having more than one surgery and limiting each surgery to 3-4hours. It is not as convenient and may cost more, but a complicated recovery can be very expensive, with more time out of work and take months to recover rather than weeks. I do not want to scare you, but you don’t want to take on more risk than necessary. Dr. Jeffrey Ditesheim
Board Certified Plastic Surgeon
The scars in the photos are from breast augmentation. I looked at the Horndeski method below and it is certainly a nice shape and a nice video. Here is some information that will be helpful:
The “breast skin” is actually chest skin that stretches out when the breasts develop during puberty. Therefore the breast skin is thinner and can make better scar than the “chest skin” ( the skin in the breast crease). In my experience with a Minimal Scar technique using a periareolar and vertical scar, the scars heal exceptionally well, the sensation is retained and the shape lasts for years.
You want to see pictures of scars in different skin types ( Caucasian, black, brown, Asian) both early and after at least 1-2 years. You also want to see the breast shape.
Dr. Ditesheim.
Board Certified Plastic Surgeon
Having a breast reduction is a big procedure and a major investment. When all goes well it can be absolutely life-changing. Your body feels more proportional and the disability from having large and painful, uncomfortable breasts is eliminated at surgery.
Now if the surgeon, hopefully a board-certified plastic surgeon, cannot show you any pictures of his or her work, you should ask why. It may be better to travel to an experienced surgeon to get the best result. Different surgeons use different techniques. If insurance is involved there may I be a motivation to make the breasts very small or do the quickest procedure ( because the reimbursement is discounted). If you want the best results you should have full disclosure, see the results and feel confidant you are in the best hands.
Dr. Jeffrey Ditesheim
Board Certified Plastic Surgeon
Your concerns: 1. dorsal hump, 2. crooked septum, 3. tip asymmetry are all valid and seen in the photographs. Your "crookedness' or symmetry is likely the result of a bump or ball to the nose when you were younger. It is very common and would not necessarily be noticed until you were older. The tip asymmetry is a reflection of a slightly different shape of the tip cartilages (under the skin). So yes, it is possible to either remove or camouflage the hump. It will depend on how much structural support your hump is providing for your nose. You do not need the tip pulled up.
Is there such a procedure as a "minor rhinoplasty" the answer is NO. Every nose surgery is delicate and precise, every move to reduce or change a part will have consequence on other parts of the nose and possibly breathing.
Board Certified Plastic Surgeon
This is one of the best questions I have seen on Real Self. In brief, if you have inner (muscle layer) weakness from the pregnancy(s) causing an internal stretching then an internal tightening will be very helpful in regaining your flat tummy. This is the principle behind the "corset". If on the other hand you have fatty tissue on the outside and the inside that is causing a roundness of your tummy, then tightening with a corset can be very dangerous. If there is fatty tissue under the muscle layer, which is usually the case with higher weight, then tightening the inner cavity will put pressure on the vital organs and blood vessels causing complications including blood clots and death. If the fatty tissue is located above the muscle layer ( under the skin) then liposuction can remove this fatty tissue very effectively. So if you hold your breath or tighten your tummy muscles and feel your tummy, can you pinch a "roll" of fatty tissue? If so, then the fat is likely above the muscle layer and lipo is indicated. Doing liposuction with a tummy tuck is often a good option to address extra skin I and torso shaping.
Board Certified Plastic Surgeon
First, what bothers you and what are your goals. What would you consider a "better you"? Are you concerned with your lower tummy extra skin only or do you feel your hips or waist are too full? What about the area above your belly button, is that too full or is there stretched skin there when you sit down? Knowing your answers to these questions will help you know what options are reasonable to consider to achieve a "better you". Yes, there are many types of tummy tucks, and yes there are scars with each procedure. Looking at tummies that are similar to yours will help you know what you could look like and what procedures are reasonable to consider.
Board Certified Plastic Surgeon
It sounds like you have had a few consultations with different recommendations. Welcome to the world of plastic surgery. As you know symmastia is a difficult problem to "fix". As such there are different recommendations. It is also not a common problem so no one plastic surgeon will have extensive experience. Finally, each patient is different. When you say that this is "congenital symmastia" does this mean you have real breast tissue under the sternum? Or that this problem has been present since you developed breasts or only after nursing? These are all important pieces of the puzzle in know in how best to make a plan to help you. Understanding why you have this anatomical challenge is paramount in deciding how to correct it.
Board Certified Plastic Surgeon
I do see patients with higher BMI. The best results are when there is obvious extra fatty tissue in an area that is just resistant to anything you have done. For example the torso or the lower body. You know your body and where weight goes and comes off with diet and exercise - and where it stays. Liposuction is particularly good for those resistant areas. Aquashape is water-assisted liposuction that is gentle on the tissues and can be done under local anesthesia for certain patients. Higher wt is not a restriction for local anesthesia. Hopefully this helps you, Dr. Ditesheim
Board Certified Plastic Surgeon
Here is a strategy to help you know what is the right plan for you:
1. What is your desired outcome?
"I do need a beach body"
2. What do you think you need?
"I have loose skin and even though friends say I dont need a tummy tuck, I am not sure"
"I have attached a GOAL picture ( of what you want to look like)"
3. How motivated are you to get the best result?
"I have lost 20lb and maintained it and plan to lose another 20lb"
4. What are your limitations?
So this is something to think about; are you ok to have scars from a tummy tuck in exchange for removing stretched out skin? This is a choice only you can make.
If you want to achieve the "goal photo" you want to think about tummy tuck, liposuction and buttocks fat grafting.
Make sure you get expert care from a board certified plastic surgeon so you get the very best result.
Board Certified Plastic Surgeon
Dr. Ditesheim and his staff are wonderful. I researched that I wanted abdominal liposuction. However, as I began consulting with providers, they told me, a woman in her 50's that I would not be happy without a tummy tuck. I felt dismissed until I met Dr. D. He LISTENED! Explained the reality of excess skin and asked what my goals were. My goal was to have my stomach flat so I could fit into my clothes and look good in my clothes. He determined that I was a candidate for lipo 360 and I scheduled my surgery for November 2022. He called me personally the evening of the surgery to check on me AND left me his direct number. The nurses have a dedicated line to call and text which was great. I'm 12 weeks post op and my clothes fit way better! Although there is still some inflammation, my stomach is noticeably smaller, sculpted and FLAT. I'm so please with the results. Also, my skin does not appear to be too excessive and has snapped back pretty well. I followed all his directions from anti-inflammatory supplements and gel, to wearing the foam and faja in the way he suggested. His nurses were attentive, fun, and super caring. No regrets!!!!!
Everybody was to notch from the beginning steps to the surgery to a year later and everything in-between. The process was very smooth and the only negative thing I experienced were Dr Ditesheim's very cold hands lol. I absolutely recommend Dr Ditesheim and his services!
I had the Gynecomastia procedure done by Dr. Ditesheim and he did an excellent job. I very pleased by the results!! Dr. Ditesheim and his staff were both pleasant and professional. He called later that day to check on me to make sure I wasn’t in pain which is a plus in my book
I'm 51 year old male, body type thin, but persistent "spare tire" that I could never get rid of. i could do an extreme diet (like carnivore) and lose weight everywhere except this nerf ball in my belly (and sides). I did lipo not for what I look like to other people, but because it will motivate me to eat right and work out. The before photos are 175. The after photos are 165 and exactly 3 weeks (21 days) post op. The difference is striking, so I'm obviously beyond pleased. I did this for me, but still don't mind the compliments from women half my age. At the time of this writing, I'm still wearing my compression garment and told final results are still improving. Also note that I have not been working out....I'm not allowed to for at least another month. So, any "tone" or "abs" I have are purely from the lipo (hi-def lipo / 3D sculpting) and I expect to look pretty lean and tone once I can start actually working out.
I just wanted to say thanks to Dr. Ditesheim and the entire staff, they provided excellent service from the initial phone call all the way through my surgery on last week. This place rocks!!! Highly Recommended!! Can't wait to see the results, I'm sure I will be completely satisfied
Where do I begin, Dr. Ditesheim has to be the most caring and compassionate doctor that I have ever had the opportunity of meeting. He is truly an extraordinary surgeon. Honestly, I cannot put into words how grateful I am to Dr. D and his one of kind staff. I fell in love with each member of his team, from Tammy at the front desk, Shayla and Cassie, my nurses, who were a blessing, they both gave me exceptional care post-surgery, Allisha, my surgical technician who has the sweetest spirit possible, Wendy, my esthetician, who has the kindest heart and very knowledgeable about each question I had after my surgery, as well as Dr. Williams, my anesthesiologist. From my consultation to my surgery, Dr. Ditesheim has exceeded my expectations. After surgery, my first week was the hardest, but Dr. D made sure my health/healing was his top priority. I am now on week 3 of my recovery and healing fantastically! Each week I see my results more and more. Dr. Ditesheim helped me see myself for who I am. Beautiful and Confident!
I'm transgender, and have received top surgery from Dr. Ditesheim and his team and they are just the nicest, most generous people I have worked with medically! First of all, Dr. Ditesheim was interested that I went by neopronouns and ended up further researching them and why theyre preferred over he/she/they in some cases, so hes definitely an LGBT+ ally! Secondly, him and his team answered all questions I had and made sure I was comfortable and not confused about what was going to happen to me. And lastly, the results are something im obsessed with! With plastic surgery you run the risk of your surgeon not caring how your body looks after the perceedure and that is NOT the case with Dr. Ditesheim. When I was with him i noticed he cares deeply about his work and how its done! He was very thorough with what he was doing and making sure everything was perfect for me!!! Overall, I'm obsessed with how my chest looks and I cant stop staring at myself in the mirror when I'm shirtless! (P.S. id love to send images of how my chest looks but the files are too large for this, sorry!) Updated on 21 Feb 2022: Heres what my chest looks like 5 or 6 months after surgery! Theres some scabs because one of the stitches is irritating my skin but we're going to do another procedure to remove the stitch and minimize the scar tissue but after that the scar will look closer to the one on the left that looks phenomenal! I was so worried about having a botched surgery but all my friends have been complimenting me on my chest and most of all im finally happy with the way i look! I cant wait to go to the lake on our boat (hence why im in a swimsuit lol) without my shirt or a bikini top!
Dr. Ditesheim and his team are exceptional. I had two extensive surgeries with them, about six months apart. From the beginning, Dr. D spent a lot of time with me to understand what I wanted and to explain his process in detail. During surgery and recovery I felt completely safe and well-cared-for at all times. I constantly had questions which were always answered with patience and promptness from the team. And the best part - the results are amazing. He is truly an artist.
Dr Ditesheim did a great job explaining the procedure and what to expect while recovering. I am thrilled we the results and his entire staff is top notch. I would recommend him to anyone with gynecomastia.
I have tried to fix a large scar on my scalp/bald spot for years. I’ve tried everything from tattoos to possible hair transplant. He was able to recommend an easy solution for me that has a much better chance of working. (Scar revision) he was professional and answered my questions. I would highly recommend. This has been my biggest insecurity for years and I’m so excited to be able to not worry about my bald spot showing through my hairline!
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