Brendan Alleyne, MD, FACS

The waterfall deformity happens when breast tissue begins to descend from the implant to a different level than the device. Not uncommon with implants over 300cc depending on your anatomy and measurements as well as weight fluctuations. I see this commonly in patient who have had those characteristics and are typically 10-15 years out from surgery. Typically after 1 year as you mentioned, not much further change is going to occur, but if you are at a goal and stable weight and otherwise back to baseline health, a surgical revision can address your issues.
A breast fold reset is usually advised which involves internal bra support with Galaflex Mesh, implant exchange, internal lift with capsule revision as well as an excision of excess skin.
Thanks for asking a helpful question for people to learn from!

From the photo it appears to be early prejowling. This is commonly seen in rapid weight loss greater than 25-50 lbs in a short period of time. It is likely not related to neck liposuction as it is descent of the facial volume and skin sag over the cutaneous ligaments. A starting approach would be to add fat grafting along the jawline but completely treating the area would be a mini face and neck lift but with your age most people would wait and get to a stable weight while treating the area with fat grafting or fillers potentially combined with jawline liposuction.

Thank you for your question!

Sincerely,

BA

Without an internal nasal exam it is difficult to give an answer but by 1 year after a primary rhinoplasty, scar is typically defined at that time. If cartilage grafts were used sometimes that is also palpable and can be normal. That would not affect a revision rhinoplasty however, thinning skin associated with ongoing scar can make further surgery difficult and more surgery typically leads to thinner skin with subsequent surgeries making cartilage grafts more visible as well as contour differences.

Thanks for your question.

BA

This is not uncommon after scar from a primary rhinoplasty sets in. Again, an in-person exam of the nasal skin would need to be done. But likely what someone could do would be to derotate the nasal tip, use donated rib graft (I use MTF cadaveric frozen rib for revision rhinoplasty patients that I see) to support the tip in its new lowered position, and lengthening the nose with grafts. Starting massage of the nasal skin at least 5 times 5 minutes daily to stretch the skin pocket can help with breaking up the scar and stretching the pocket. Typically revision rhinoplasty rates especially if needing cartilage grafts can range from 25-65K. I see many of this type of patient but I always strongly suggest people to see the original surgeon first as he or she will best know what they have done. However, because many surgeons prefer not to address revision noses I do see many of these from the midwest as well as the coasts. Thanks for your complex but specific question! I hope this helps.

Typically if this is someone's first rhinoplasty this can range from 15-20K and it is unusual not to balance the entire nose during a tip-plasty as changing one area of the nose may look unnatural without addressing all areas. However with good dorsal aesthetic lines and if no other concerns for breathing issues or other refinements a preservation technique can be used.

A Tip-plasty as part of a revision after a prior rhinoplasty can range from 25-65K depending on complexity or if other issues going on. Great question!

Typically depending on the amount of scar, most revision labiaplasties can be completed comfortably in the office under local anesthesia. If weight change occurred, in extreme cases this can deflate the mons as well as the labia majora. In these instances fat grafting can be added onto the procedure to help with the volume loss issue. Thank you for providing your helpful questions and description of your healing journey.

With local anesthesia and sedation almost any primary surgery can be accomplished. However, it mostly depends on the patient. If someone is calm and has minimal surgical complexity it makes sense. Revision cases where longer surgical times may be needed often times people are more comfortable and the surgery can be accomplished with less total time and anesthetic under MAC sedation or “Big MAC” which uses an LMA and avoids paralysis while also allowing the patient to stay shallow enough to protect their own airway. Not everyone is a candidate but it makes recovery faster and people feeling like themselves quicker. It also keeps everyone much more comfortable during the procedure.

Complex situation but one I do see routinely in my revision and reconstruction breast augmentation practice. Given your NAC position likely you would not need a lift even if downsizing pretty significantly. A more natural appearance could be had by doing a combination approach. Downsizing the implant and going to a lower profile in a submuscular dual plane. So doing a plane conversion. Then capsulorrhaphies to redefine the pocket.

Likely 3 weeks in a breast bra splint and then wearing compression bra 6 more weeks at night. 6 weeks of limited lifting weight.

I often see patients with similar concerns who come in for revision breast augmentation concerns. I typically change the profile of the implant if bottoming out and lateralization concerns are both happening. Combined with a slow dissolving or permanent suture capsulorrhaphy and a breast splint that is worn for 3 weeks continuously and then 6 more weeks at night.

Dear Fierce,
From the photos you are aging well and very gracefully! Many would say you don’t need to do anything and I would agree but I do see many patients in more recent years who want to do preventative surgery earlier in life. And what I have noticed is that the results tend to heal better and last longer the earlier the intervention is done (younger skin and soft tissue usually will heal better than older soft tissue). So this makes sense to me. Fat grafting or filler can make the area more subtle, the more modern approach is to combine that with a mini facelift.