Aaron Jacobs, MD

Staging these surgeries is a safe, sensible plan. Most surgeons recommend waiting at least 3 to 6 months between major procedures. That gives you time to heal, lets swelling settle and your blood counts recover, and allows the surgeon to see your BBL result before planning the tummy tuck. On lipo type: Vaser and traditional liposuction can give similar results in experienced hands. The surgeon's skill and technique matter more than the device. Vaser can be helpful in areas with scar tissue, which may apply since you've had lipo before. Ab etching is a sculpting technique, not part of Vaser itself. It can be done with different methods. During a tummy tuck, surgeons are careful about how much liposuction is done on the abdomen to protect blood flow to the skin, so aggressive etching may not be possible at the same time. Your surgeon can tailor a plan once they examine you. – Dr. Aaron Jacobs

Congratulation on your weight loss! That's an awesome accomplishment. The right option depends on how much loose skin you have and where it sits. Renuvion with liposuction works best for mild to moderate looseness with good skin quality and no large hanging fold. There's no long scar, but the tightening is limited.A mini arm lift removes skin near the armpit, with the scar hidden in or near the armpit crease. It's a good fit when the extra skin is mostly in the upper third of the arm. This would potentially avoid the longer scar down your arm and can be done in conjunction with liposuction.A full arm lift is best when loose skin runs from the armpit to the elbow. It gives the most dramatic change, and with careful technique the scar usually fades well over time.After significant weight loss, the skin often has less elasticity, so energy treatments alone may not give the result you're hoping for. An in-person exam, including pinching the skin to see how much there is, is the best way to choose. Based off of your pictures provided, you may actually be a good candidate for the mini arm lift given that most of your loose skin is higher on your arm. This, in conjunction with liposuction and potentially the Renuvion, could provide the results you are hoping to achieve and avoid the longer scar. I would defintiely need to examine you in person and discuss your goals in more detail.– Dr. Aaron Jacobs

Indents like this are common after an injury damages the fat under the skin. There are a few options. Fat grafting is a good fit for many contour dents. For small areas, the fat is often placed with very fine cannulas through openings only a few millimeters long, which usually heal well. The entry point can often be placed away from the dent, sometimes in a less visible spot. Some of the fat may not survive, so a second session is sometimes needed. Filler can work in small areas but is used less often in the lower leg, and results there tend to be temporary, especially given the frequent movement of this area. Scar tissue under the dent can hold the skin down as well. Releasing it, called subcision, is often part of the treatment. An exam will show how deep the area is and how your skin moves, which helps decide the best approach. – Dr. Aaron Jacobs

Both options can add natural-looking volume, and each has pros and cons. Hyaluronic acid filler is quick and predictable, and it can be dissolved if you don't like the result or a lump forms. It is temporary, usually lasting 6 to 18 months. Usually dissolving faster in areas with increased movement. Fat transfer uses your own tissue and can be long-lasting. However, not all of the fat survives, so results are less predictable, especially in the lips, where it moves a lot. At a slim body weight there may also be less fat available to harvest. Fat lumps can usually be improved, but they can't be dissolved like filler. It's often possible to add fat grafting to another surgery, but that's a decision for your rhinoplasty surgeon. Ask them directly before your surgery date. Since you're planning lip piercings, mention that too, as it affects timing and healing. – Dr. Aaron Jacobs For you specifically, after viewing your photo, you are young and thankfully HA fillers are temporary. Very often, we will recommend starting with filler in areas like your lips for example, so you can decide if you like it and then discussions about possible more permanent options can be had moving forward. I would also be careful adding volume to your pre-jowl sulcus. You have a very beautiful face with nice volume, I would be hesitent to add more volume as this may make your face look fuller or puffy. It is difficult to get a complete assessment of your temples from only this view, but this may also be a good place to start with HA fillers to see if you like the look provided knowing it is temporary.

Thank you for the detailed history. What you describe is something we do see. When the masseter muscle shrinks, it can stop supporting the skin and fat of the lower face, which can show up as hollowing and early jowling due to the volume loss. Treatments close together, combined with neck and jawline Botox, can add to that effect. The good news is that Botox wears off, and muscle volume usually returns partly over several months. Common next steps include: Taking a break or spacing treatments further apart, often with a lower masseter dose.Pausing the Nefertiti lift while the lower face recovers.Restoring support once things settle. Fat transfer is a longer-lasting option that uses your own tissue.At 26, surgery is rarely the first step. An in-person exam can show how much of this is muscle, fat or skin, and help you keep a slim look in a way that's sustainable. There are options, but only an in-person exam and visit will allow a trained professional to give you the more detailed answer that truly fits your unique anatomy. – Dr. Aaron Jacobs

I am sure that was very traumatic and I'm glad you're recovering. Before any injections, check with the surgeon who treated your fracture, because only they know how your healing is going and whether plates or screws were placed. Forehead Botox treats muscles far from the jaw and is often reasonable once you're cleared. Fillers around the mouth and lips are closer to the injury. Any filler carries a small risk of infection, and an infection near healing bone or hardware is something we want to avoid. Swelling and numbness after a fracture can also make it harder to judge an even result. Many surgeons wait until the fracture is fully healed and swelling has settled before treating the lower face. Bring your injector the details of your injury and treatment so they can plan safely with you. – Dr. Aaron Jacobs

There is no great evidence that nicotine patches stop Botox from working or wear it off faster. Botox binds to the nerve endings within the first day or so, and nicotine does not reverse that. Your own experience of no noticeable change is consistent with that. A few general tips after any Botox treatment: Stay upright and avoid rubbing the treated area for about 4 hours.Skip strenuous exercise for the rest of the day.That said, nicotine in any form narrows blood vessels and slows healing. I always tell patients, 1 cigarette equals roughly 90min of constricted blood vessels and therefore 90min of delayed/decreased wound healing. This increases risk for surgical site infections, breakdown and worsening scarring. That matters much more for surgery than for Botox, and most plastic surgeons ask patients to stop all nicotine, including patches and pouches, for several weeks before and after any surgical procedure. Let your injector know you use nicotine so they have your full history. – Dr. Aaron Jacobs

In many cases, yes. Hyaluronic acid filler can soften lower-cheek hollowing, and results typically last 9 to 18 months depending on the product. The key is understanding why the hollow is there. Common causes include weight loss, natural aging with loss of fat and bone support, genetics, or volume loss after procedures like buccal fat removal. Sometimes the best result comes from supporting the mid-cheek and cheekbone rather than filling the hollow directly, because adding filler right in the hollow can look heavy or unnatural. For patients who want a longer-lasting option, fat transfer uses your own tissue and can be more permanent, though it involves a minor procedure and some swelling. An in-person exam lets your provider check your skin quality, facial structure and how your face moves before choosing a plan. – Dr. Aaron Jacobs

Great question, because the injector matters more than the product. Look for a board-certified plastic surgeon or dermatologist, or a nurse injector working under one in a medical practice. Ask how often they inject and whether they treat patients with goals like yours.Good Botox comes from understanding facial anatomy. Each person's muscles differ in strength and position, so dose and placement should be tailored to you, not a set number of units. A skilled injector also considers how Botox affects nearby muscles, so you avoid a heavy brow or droopy eyelid.At your consultation, ask:• Who will perform the injection, and what training do they have?• Which product is used, and is it bought directly from the manufacturer?• How many units do you recommend, and why?• What happens if I need a touch-up?• Can I see before-and-after photos of your patients?A good provider will spend time on your goals, explain realistic results, and tell you when Botox isn't the right tool. – Dr. Aaron Jacobs