Facelift

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Breast Implant Revision

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!

The doctor I went to in 2023 for a breast implant revision (went from 350cc to 600) said that I needed to wait until they settle because they seemed uneven to me 6 months post op. I waited til about a year, maybe year and few months and still I see they are uneven. I had some Health issues last year, unrelated, but had to put the follow up on hold but I did send his secretary an email (she and I conversed a ton via email and text prior to surgery) and Got no reply. When I called and looked the doctor up it seems like he retired and closed his office. What can I do no, if anything? Even after settling they are uneven. Thank you! I am also concerned with the parts under the breast sort of where you seem to be able to see the implant?

Settled but still seem “uneven”? Doctor has retired. What can I do? (Photos)

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

Hi doctors, I am a 19-year-old girl. I used to be overweight, and I had neck liposuction last year. I have lost the extra weight with the help of a doctor. However, I have an unsightly fat pocket (I think it is fat) over and under my jawline. I'm not sure if it is fat or a result of the lipo cannula. But I hate it and want it gone. Should I get a facelift? Please help me

Fat pocket over and under my jawline - how can I fix this? (Photo)

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

Hey! It seems that I have a ton of scar tissue in my nostrils. It's hard and wavy. I'm 1 year post rhinoplasty. Is this amount of scar tissue normal? II will need a revision rhinoplasty. My nose has to be widened significantly. It’s pinched. Will this amount of scar tissue affect a revision rhinoplasty negatively or does it even make it impossible? I also have very thin and contracted skin.

Is it normal to have this much scar tissue 1 year after rhinoplasty? (photo)

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.

Seven years post-primary rhinoplasty for dorsal hump reduction left me with an over-rotated "piggy" tip. A revision using rib cartilage (harvested via 8 cm incision by a thoracic surgeon) provided minimal radix augmentation and no tip improvement. Key questions: Does large incision/non-plastic surgeon suggest technical issues? Can another revision de-rotate the tip and restore a natural profile?Are grafts/tissue expansion viable for reconstruction despite limited skin? Thank you.

Revision Rhinoplasty Concerns – Rib Cartilage Harvest, Nasal Tip Correction, and Skin Envelope Limitations (photo)

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!

The cartlidge on my nose tip is split and is very very prominent. It is something I am looking at getting obliterated. Due to it being such a smaller area of the nose is there a chance it will be cheaper then most nose job costs ?

How much would a tip plasty cost to fix a significant deformity in my nose tip? (photo)

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.

I have included a before, one month post op, and current results of a labiaplasty I had with a world renowned surgeon I am worried that this surgeon will be too conservative or create another issue that was not there before (see the fold across my majora in the right? sometimes when I stand, it gives the appearance of 3 majoras rather than 2), so that I’ll keep having to go back to him again and again. My tissue used to be smooth and more taut and now it is wrinkly and saggy. He said that the results were caused by unprecedented healing but I documented my healing journey from hour 0 post surgery and it is clear the fold in my majora, which I feel I must hide with hair, immediately appeared from the operation and only became more obvious as swelling went down. The surgery was 6 months ago. I am 25, 50kg, 158cm, don’t drink, don’t smoke, healthy nutrition, not pregnant.

Labiaplasty revision - Looking for new surgeon to correct appearance of 3 majoras (photo)

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.

Thinking of having procedure with only numbing and Valium. Thoughts?

Deep plane revision without general anesthesia, thoughts?

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.

Started C cup. 2020 Had breast aug w/lift Silicone Mentor moderate plus 300cc L, 325cc R above muscle. DD cup now. Complication on R w/more bleeding/swelling &amp; have capsular contraction on right. Never liked projection or size. Contemplating explant w/lift vs implant exchange w/lift. Curious if natural breast tissue is now compressed from implants? If I replace implants, would like lowest profile &amp; much smaller, possible? Chest diameter: 31" Breast diameter: 9", waist: 29", hips: 37. 5'11" 150lb

Want to downsize implant, can I go from high profile to low profile? (Photos)

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.

I had a botched BA 8 yrs ago. Implant immediately removed but capsule in and left w/ window shading. Explained this to new PS and assured could be fixed. New BA above muscle. Only repair was about 3 in. Inferior dissolvable stitches. Can feel implants moving under skin. Implants sliding towards armpits and medial skin tenting. The whole border of skin is loose. Concerns that the inferior stitching won’t hold for long. Can the lateral/inferior/medial border be secured w/ perm stitching?

Is this lateral displacement? Can the lateral/inferior/medial border be secured w/ perm stitching? (Photos)

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.

I am in my mid 40s and have visible nasalabial folds and marionette lines. I've been to few facelift consults and ended up with conflicting opinions. Some surgeons say I won't need a facelift for 5+ years, while others say I'm a good candidate now. Do I need a facelift or can I just fix the nasalabial folds and marionette lines with either fillers or fat transfer? Is adding fat to the lower face a bad idea because there will be more volume to sag in the future?

Mid 40s & visible NL folds & marionette lines - do I need a facelift or just fat transfer or fillers? (Photos)

Brendan Alleyne, MD, FACS

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