Andrew Smith, MD, FACS

First congrats on the weightloss that is amazing, beyond the cosmetic result you are healthier! In terms of breast ptosis you are a great candidate for a breast lift. A wise pattern mastopexy (anchor pattern) would help address the nipple position and reposition your tissue. However what a breast lift will not do is provide a dramatic change in the upper pole of the breasts, the area above your nipples. While you may notice a nice change in the overall shape of the breasts and nipple position from a mastopexy alone an implant often gives that "perky" apperance. If you plan to have more children in the near future I would focus on that first. First, congratulations on your weight loss—that’s a tremendous accomplishment. Beyond the cosmetic changes, you’ve made a meaningful investment in your overall health, which is the most important outcome. Based on your photos, you are an excellent candidate for a breast lift. A Wise-pattern mastopexy (anchor technique) would allow us to reposition the nipple and reshape the existing breast tissue to create a more youthful contour. It’s important to understand, however, what a lift alone can and cannot achieve. While it will significantly improve breast shape and nipple position, it does not typically create a dramatic increase in upper pole fullness—the area above the nipple. If your goal includes a fuller, more “perky” appearance in that region, an implant is often recommended in combination with the lift. If you are planning to have more children in the near future, I would advise focusing on that first, as pregnancy can impact your surgical results.

It’s important not to be misled by the promises of liposuction, VASER, or Renuvion alone. While these technologies can effectively contour specific areas and offer some degree of skin tightening, they are not designed to correct significant skin laxity or deliver the comprehensive result you’re seeking. In my experience, patients who undergo abdominal liposuction in the presence of loose skin often end up with increased irregularities and, in some cases, more noticeable laxity. Liposuction removes volume, but it does not remove excess skin. An abdominoplasty is the procedure that directly addresses both excess skin and underlying tissue, including the mons area, creating a smoother and more refined abdominal contour. When the incision is properly placed, the scar sits low and is typically well-concealed beneath a bikini bottom. When combined with VASER liposuction, we can further enhance the waistline and overall contour for a more balanced, natural-looking result. My concern is that if you invest the time, energy, and resources into VASER liposuction with Renuvion alone, you may ultimately feel underwhelmed by the outcome. My goal is to guide you toward the approach that will provide the most satisfying and lasting result.

While not common for the umbilicus to become irritated following an abdominoplasty, it can occur as sutures from the muscle plication begin to dissolve or work their way to the surface. This can present as localized redness, tenderness, or drainage. The most important next step is to be evaluated by your plastic surgeon. A physical exam will help determine whether this is a normal healing response or if there is an underlying issue, such as a suture reaction or retained material. In some cases, imaging may be appropriate to better identify the source of the irritation. Close follow-up with your surgeon is essential to ensure proper healing and timely management of any concerns.

An upper blepharoplasty, which is often performed under local anesthesia, is an excellent option for addressing excess skin of the upper eyelids. If you are satisfied with your current brow position, this is typically the most appropriate place to begin. Following surgery, we can reassess your overall result. If you feel that you have not achieved the level of openness you desire in the upper eye area, a brow lift can be considered at a later time to further enhance the outcome.

The Motiva Preserve technique is currently gaining popularity and has been very effectively marketed. While it is often promoted as a “no anesthesia” and “low downtime” approach, it is important to understand that it is still a surgical procedure and carries real risks—most notably, the potential for hematoma. In my experience, Motiva Preserve cases are typically higher in cost, largely due to positioning and marketing around the concept of avoiding anesthesia. However, I believe that optimal outcomes are achieved through precision—and that is best accomplished in a controlled surgical setting. When placing implants, I prefer a subfascial approach using Motiva implants under appropriate anesthesia. This allows for significantly greater accuracy in pocket creation and implant positioning, while also providing a more comfortable and predictable experience for the patient. In contrast, placement within the glandular tissue without anesthesia can limit precision and control. Ultimately, patient safety, surgical accuracy, and long-term outcomes should guide decision-making—not trends or marketing.

If your primary goal is increased volume and you are satisfied with your current nipple position, you may be a candidate for a crescent lift. A thorough in-person evaluation with a board-certified plastic surgeon is important to assess your degree of ptosis or pseudoptosis, determine an appropriate implant size for your breast pocket and frame, and develop a surgical plan tailored to your goals. In cases similar to yours, I have been utilizing the Motiva implant in the subfascial plane and have been very pleased with the aesthetic outcome and volume achieved. Compared to traditional submuscular placement with other silicone implants, this approach can provide enhanced upper pole fullness and a more natural contour in appropriately selected patients.

This condition can be very challenging to correct. One important consideration is whether your symmastia is congenital or developed after prior surgery, as this can significantly impact both the surgical approach and expected outcome. The tissue in this area typically has limited laxity, which often necessitates extensive internal suturing and, in some cases, the use of mesh to help re-establish the natural separation between the breasts. When symmastia is congenital, it can be especially difficult to recreate and maintain a defined anatomical boundary. While surgical correction with mesh and diligent postoperative compression can improve the contour, there remains a higher likelihood that revision procedures may be necessary to achieve and maintain the desired result.

If you’re bothered by mild abdominal muscle separation (diastasis) and have a small amount of loose skin, a mini abdominoplasty can effectively address these concerns and provide a beautiful result. In many cases, the umbilicus (belly button) can remain attached while the surgeon tightens the skin and repairs the diastasis. Liposuction is not always necessary for this procedure, and it’s important to feel comfortable advocating for your preferences during your consultation.

I have cared for several patients who previously underwent a breast reduction and later chose to have breast augmentation. It’s important to understand that an implant will behave differently than natural breast tissue, which is made up of a mix of fat, dense tissue, and glandular tissue. The implant helps restore lost volume and enhances fullness in the upper portion of the breast (upper pole). The final result will depend on several factors, including the type of implant used, the placement plane of the implant, and your own breast tissue characteristics and skin elasticity.

The BBL is not actually a laser but utilizes Intense Pulsed Light to treat the upper dermis layer and does not go down deep enough to damage the deeper fat layer. It will help with texture, tone, and pigmentation. Treatments with RF will likely have a greater impact on fat in the face.