Daryl K. Hoffman, MD

Liposuction may be an option for patients with a pacemaker, but it requires careful evaluation. You will need medical clearance from your cardiologist and close communication between your plastic surgeon and cardiologist. Energy-based liposuction, such as ultrasound-assisted lipo, could pose more of a risk than traditional liposuction.

Congratulations on your commitment to losing weight. Combining liposuction with body contouring surgery, such as some type of abdominoplasty (tummy tuck), will significantly improve your comfort and quality of life. Liposuction (which is surgery) without a procedure to address the other issues won't produce the desired results.

Thank you for seeking advice before scheduling a procedure. Based on your photos, I don't see any reason for a surgical procedure. Frankly, you appear to have good skin tone and an attractive facial shape. If you have concerns about midface volume, I would recommend discussing fat transfer with a board-certified plastic surgeon. Best of luck.

This is a great question because it recognizes that facial rejuvenation usually involves more than a single procedure to address signs of aging. Based on your photo, it appears you can benefit from combining a facelift and neck lift, along with laser skin resurfacing. Fat transfer to the face can also help restore volume. This combination addresses the 3 D's of aging: descent, deflation, and deterioration.

Lax facial skin is common following significant weight loss. Fillers add volume, but won't be enough to produce the results you desire. A conservative facelift that elevates the underlying muscle and fat can produce natural-looking results that will last for years. Be sure to consult an experienced plastic surgeon who specializes in facelift procedures.

Thanks for this excellent, detailed question. Facial aging involves what I describe as the 3 D's: descent, deflation, and deterioration. A facelift addresses the descent of muscle, fat, and skin, while fat transfer and laser skin rejuvenation treat volume loss (deflation) and the deterioration of skin quality. Although a personal consultation is required to determine the best approach for you, it appears you could benefit from a conservative facelift.

I do advise my breast augmentation patients to sleep on their backs for several weeks after surgery, but I don't believe sleeping on your side during a nap will affect your long-term results. Body pillows can help prevent rolling onto your side while sleeping.

Fat transfer breast augmentation is a procedure I perform at my practice, and it is an excellent choice for the right patients. One factor involved in determining who is a good candidate is having enough excess fat in other areas of the body. It doesn't appear that's the case for you. I believe you could benefit from submuscular breast augmentation with or without a breast lift. It's possible to use fat transfer to soften the appearance of the implants.

Losing a significant amount of weight is a wonderful accomplishment. Congratulations. Unfortunately, based on your photo, breast augmentation on its own will not result in the natural-looking, full breasts that you want. Breast implants add upper pole volume, but they can not eliminate the need for a breast lift. An experienced plastic surgeon will make precise incisions and provide incision-care instructions that will minimize the appearance of scars.

Congratulations on your pregnancy! Laser liposuction, such as the Smartlipo® procedure I use at my practice, removes excess fat and can help tighten moderately lax skin. After multiple pregnancies, a "stomach pooch" likely involves excess skin that would require abdominoplasty (a tummy tuck) to produce the desired results. A plastic surgeon could also repair separated abdominal muscles (diastasis recti) during a tummy tuck. Consult with a board-certified plastic surgeon to learn about your options.