David R. Stephens, MD

Hi Versatile5038; based on your age, you are a perfect candidate for FaceTite; however if you are thin with no facial fat, than FaceTite may not be an optimal treatment for you. However, the Morpheus 8 or Fractora might be the answer. There is also the option of a face lift. We offer all of these options and more and will provide an objective view of which is most suitable for you. We will be soon offering the Accutite, which is specifically designed to tighten skin in the jowls and the mid-facial area in thin patients. We are pleased to discuss this further if you would like a consultation. We are the exclusive practice for these treatments in Seattle using these devices for three years now. Sorry for the late response. Best in 2020!

Hi jess82; I don't think that you need to do orthognathic surgery for you chin unless there are problems with your teeth/jaw occlusion or you have breathing/snoring or sleep apnea problems that requires this surgery. You are correct; that is big surgery with risks of significant complications and a long recovery. However, it is very effective in those patients who have these issues but must be performed by very experienced surgeons with in conjunction with orthodontists. I am less of a fan of the sliding genioplasty as it sometimes fails to provide enough chin projection. There are quite a few options regarding the variety of shapes of chin implants. I have extensive experience in performing implant based, chin augmentation using the "Implantech" facial implants that were designed by many of the best and innovative plastic and facial plastic surgeons in the industry. You can view these on the Internet and we have all of sizers and styles of them in our office that I use with our consultations. I think that there are some that work better for women and others that are better in men and it is important to look at these with you in consultation. Most importantly, we have a "Vectra 3D Imager" that is specifically developed for rhinoplasty and chin augmentation and is a great way to view your potential results. There are also some ways to show this to you in person as well. Interestingly, certain fillers and fat grafting are other less invasive ways to provide chin augmentation without implants as an option as well.  

Hi jillsyourfave, There are several non-surgical devices for fat reduction, the most marketed being Coolsculpting. You are correct that each one of these will have their advocates depending on the one purchased by the office. Often these practices use "patient counselors" who have little if any medical knowledge but may be salespeople who offer treatments that may not be indicated for the particular individual's condition. These devices are also sold to physicians and other medical providers, depending on the state, who have little or very elementary knowledge of aesthetics. So I understand your confusion. Simply put, the non surgical devices that remove fat without incisions do so in small increments which may require multiple visits with minimal, but not no, downtime. The other doc's here are offering different liposuction based procedures that require a few small incisions but will get it taken care of in a "one and done" procedure with a reasonably fast recovery and safety. The problem with Coolsculpting is that it will definitely take more than one visit and it is a "stamping" procedure that may leave a shelf between the treated area and the surrounding region. Through the years, I have used traditional liposuction and Power Assisted Liposuction (PAL) that still work very well in straightforward "saddle- bag" fat contouring as they will smooth out the treated saddle bag. when done by skilled surgeons. I also have extensive experience with "Smart Lipo" as well, when there is any risk of loose skin due to skin and subcutaneous laxity. I now use the InMode, "BodyTIte" system that uses radiofrequency (RF) to get superior tightening compared to the other energy based devices. This procedure is done safely and comfortably under mild sedation and local "tumescent" anesthetic with a relatively fast and easy recovery. Regardless of the procedure you decide on, make sure that you are seen by a reputable, "board certified" plastic surgeon with extensive experience in body contouring who examines at you at the consultation and who recommends the best option for you. 

HI Scarlett52227; When using surgeon monitored, intravenous, "nurse sedation", the patient is placed in a "conscious" sedated state, where they are awake and responsive but (may or may not) have any memory of the procedure. In order to completely ensure that there is no memory or awareness of a procedure, the patient must be in a deeper anesthetic state using deeper intravenous sedation or a general anesthetic administered by a professional anesthesia provider, either a board-certified anesthesiologist or certified nurse-anesthetist. I would find out what you are having and if it is the former, I would respectfully but firmly request that you have the latter in a certified and fully licensed outpatient surgical facility. I don't mean to cause any more concern than you already have but remember Joan Rivers and insist on this. If your surgeon cannot do this, I would consider another doctor and look further into his or her credentials. The type of surgery you describe is not what the overwhelmingly vast majority of professionals do these days. 

Hi ImagineExtrodinary, just a warning; please PLEASE, be very careful of laypeople out there who are doing hotel-room buttock injections; they are very dangerous!! They have resulted in disfiguring, severe life-threatening, deadly infections. These individuals come into an area and do these on unsuspecting women while stating their experience and credentials. They leave the country or they are eventually caught and sent to prison. The injections are of an unknown foreign substance, often industrial grade silicone or a non FDA approved substance that is impossible to completely remove from the tissues. I am aware of an individual who, in at least one instance, did this here in Seattle a few years ago. She recruits unsuspecting (mostly) young women to bring their friends. BEWARE!! To the other doctors comments: Sculptra, a tissue collagen stimulant, is used to enhance the buttocks and also to even out irregularities. It is known to last up to two years or longer in the face but the longevity in the buttocks varies; and it takes quite a few vials, so it is not practical for those other than the very wealthy. While buttock implants are used, they should be placed intra-muscularly. They have a high frequency of complications and can leave an unnatural result, particularly over time. Fat transfer remains the most practical and natural way to enhance the buttock however you state that you are quite thin. BBL can be done safely when the correct technique is used by the subcutaneous placement of fat. There have been a high number of deaths recently with BBL, with a fatality rate of roughly of 1 in 3000 due to the inadvertent injection of fat by piercing the deeper blood vessels within the muscular tissue of the buttocks. It should be done carefully and by experienced plastic surgeons only.As an experienced body contouring surgeon, through the years, I have found that reducing the hip rolls, sometimes the outer thighs and inner thighs, that even in thin women, this and the strategic placement of fat in the buttock can provide some finesse, giving the impression of better shape in the buttock. It will not markedly enhance the size but the proportion and shape is better. After all, like breast augmentation it is not always the size, but the relative proportionate changes that make a nice result.  It is important to review the expectations with this though; and over aggressive fat removal can lead to deformities. You didn't include photos so it is hard to advise, generally, in your case. Photos are limited anyway. We provide a thorough personal, individualized consultation and examination to review your specific concerns and expectations. Best, DS

Hi Norarol, I agree that that doing liposuction of your arms at this time the best consideration. In addition, I would use our BodyTite to improve skin and subcutaneous tightening as well. Please go to the InMode website and review the arm procedures. Radiofrequency based skin tightening treatments, in addition liposuction, are the most effective way to treat this without the risk of wound healing problems, etc. I have over 20 years experience in body contouring and thousands of cases of liposuction, using the newest technology. It is best to see you, evaluate and discuss your concerns in consultation. Best, DS

Hi angelsmiln; Kybella does not tighten skin and while we have Kybella in the office, unless there is a small, discreet amount of fat, it is not economic to treat the area with Kybella. Any other fat reduction procedure such as Cool Sculpting will not tightening either. For loose skin and some fat we use the InMode, FaceTite minimally-invasive procedure which combines skin tightening with fat removal where this is necessary. This gives similar results as a neck lift without the scars but is not as successful when there is an excessive amount of loose skin where a neck lift with face lift will give the best results. The FaceTite procedure has become the "go-to" procedure for minimally-invasive definitive neck tightening with a high satisfaction rate. 

Hi alex9283; Haha, the photo, you mean Ariana as in Ariana Grande right? One might argue that her middle eyebrows are too high. High middle eyebrows are thought to be sympathetic and trustworthy. They are sought after by some male actors as expressive and intelligent, (think Woody Allen), but in women, most models these days look for a slightly raised peak and outer eyebrow without a severely arched eyebrow. See a fellowship trained-board- certified plastic, oculoplastic or facial plastic surgeon with good photographs of his or her work and good reviews who is in good standing with their local hospital and the state. Then get a in-person consultation. At 22 years old, you may have anatomic facial structures, such as very deep set eyes, that gives you the appearance of low eyebrows and there may be several solutions short of surgery to help your appearance. Botox or fillers may help your situation without too much other; or perhaps, if you have thick eyebrows a careful brow threading or shaping may help. Before you do anything look carefully with your doctor in a hand mirror and look at 3D or standard photos of yourself to help to communicate your concerns,  

Hi b_ritt4590; In the 21st century, a woman seeking information regarding her breast augmentation consultation should expect to have 3D imaging. We have used the Vectra 3D system over the past 4 years and it is a simple yet powerful tool in decision making involving the type and size of implant shape to results in the individual person. Of course, this is only a part of the consultation which should consist of a very thorough discussion of the available types of implants and their trade offs, (including examples of them), a comprehensive discussion of the procedure and long term considerations of breast implants as well as an examination and a discussion regarding options. Any plastic surgeon who is serious about communication regarding breast procedures should have 3D imaging. We have a busy practice in breast procedures including complex salvage procedures and find the Vectra 3D system has been an important component of our practice in the breast and face and nose.  

Hi Scarlett Gannon; I concur with the other surgeons; I have never had a reason to consider a reverse abdominoplasty. I think it is an ill conceived procedure. Perhaps to move a small amount of tissue upwards, which would be rare. First, the most skin in the abdomen is in the lower half and is of poor quality from pregnancy and weight gain. In cases such as yours, where you might have carried a lot of weight in your abdominal area, you can have a double pannus with a skin band splitting the upper abdominal skin from trhe lower skin. This can be undermined and brought down more effectively than lifting all of it up. Second, the lower scar is hidden in clothes. Third, moving skin in the lower half of the abdomen gives a far better result. I rarely do fleur-des-lis vertical excisions with the abdominoplasty due to their justified reputation of poor healing. Most people will loose weight after an abdominoplasty but you can also do liposuction after in combination with BodyTIte. Your condition is highly correctable. Our abdominoplasty patients are among one of our happiest!