Dennis J. Bang, MD

Another vote for waiting for swelling and healing to occur.  You bring up an interesting point.  Without knowing your age a discussion of a browlift is appropriate and necessary in certain individuals.  A upper eyelid surgery alone can do more harm in some patients who require a browlift to correct significant brow ptosis.  It is a big mistake to remove to much of the skin of the upper eyelid.  This skin is irreplaceable and appearance of the thick brow skin that has dropped to just above the lid skin surgically removed eyelid skin can create problems.  This is not only aesthetic because the thin skin of the eyelid sutured to the thick skin of the brow creates a harsh look which is difficult to correct.  Even worse this may create lagopthalmos (inability to close the eyelids).  Although you may be able to close your eyes voluntarily with force, asleep the lids will not fully close causing a disturbing appearance to others.  Typically the eye is protected due to a dolls eye phenomenon but it can cause drying and irritation.  Just a word of precaution.  Overall, you should do fine and time should help with any concerns. 

Anyone who has eyelid surgery will see and notice things more critically than ever before.  Anything that doesn't appear to be normal would cause concern as being a complication or a problem.  Almost always this is normal and it is a result of the time following surgery when you often regret your decision due to postoperative swelling, bruising, and discomfort.  Compounded by to time spent focusing on one area of concern and the feeling of what have I done to myself.  Asymmetry is also another concern which is common.  We are all somewhat asymmetric and this seems magnified after surgery.  Any difference between the two sides will improve with time and a common concern.  Now is the time to relax and follow instructions.  Your concerns are legitimate but any areas of concern almost always resolve with time.  One week is early and you should see consistent improvement of your results from this point.  Keeping your head elevated during the immediate postoperative period helps to reduce swelling as does cool packs during the first day or two.  Do not disturb any sutures or excessively manipulate this area as this could cause harm.  The bump may be related to a suture used to create the crease and if necessary a simple procedure should solve this issue.  IF, it is necessary at a later time.  The upper eyelid skin is remarkable in its ability to heal quickly.  Just give it time and things should be great.

I can empathize with your situation. Having a dramatic change in appearance can never be timed perfectly and ideally spending time away from you normal enviroment would be ideal in a sense. But, think about what you are about to undergo. It will most definitely change your appearance but at the same time ideally you desire that other people will not really notice a drastic difference. There are different components that will affect your recovery. The actual procedure performed along with your unique anatomy and the skills of your surgeon are all important in how your body will recover. Using an incisional technique prolong the edema or swelling after the operation. The nonincisional technique will result in a faster recovery. The trade off is that this operation is not for everybody and only your surgeon will be able to determine if you are a candidate. The other issue is the know issues with longevity of this surgery (nonincisional) since the entire operation is based on sutures alone. Although it is true that you will be better in about 2 weeks to feel comfortable in public, the reality is that in my hands using an incisional technique with removal of fat, skin and dissection of the pretarsal area (below the crease and above the lashes) will inevitably cause some changes that can take longer to improve. How long? This process changes over the course of several months and photographs will show subtle but real changes with time. Understand that you are making a positive change and people will notice. Feel confident that the price you pay today will pay dividends in your future. I also share an answer that my patients in this situation can use as an explanation for those who have to ask. Good Luck.

This has to be one of the procedures that I enjoy the most.  The technique continues to change but the basic technique involves using minimal incisions to obtain what used to take a long incision over the top on your head from ear to ear.  Doesn't sound appealing.  Well, that is what most patients would think.  Numbness and tingling in the scalp.  Not exactly a desirable side effect.  The use of a small endoscope about 5mm in diameter allows surgeons with the valuable information that is needed to safely operate with direct visualization of important structures.  What used to require a long incision can now be performed with incisions small enough to allow use of the endoscope.  This is the future of many surgical procedures as it will allow a faster recovery, less trauma while still providing excellent results.  The traditional open brow lift is a very powerful procedure and will sometimes provide the best results.  But, a skilled endoscopic surgeon can provide excellent results with less potential for problems.  Some may say that the results are not long term or cannot provide good results.  It really depends on the surgeon.  Experience and skill does make a difference because the surgeon needs to perform an adequate dissection to allow the proper end result.  It is easy to make the incisions and perform part of the procedure.  It requires an complete dissection which is performed safely that is the difference in the end result.  An adequate release of the deep structures allows the lift to last as it is intended.  Otherwise, the forces that hold the forehead in the current location will bring it back to the previous location.  The equipment, instruments and additional cost due to fixation devices may make this not accessible to all patients and surgeons.  But, it is the procedure of choice for surgeons who have worked to improve this valuable skill.

It is obvious from the other surgeons what the answer is but I need to add another vote.  NO, the thought of putting yourself at risk which are small normally but higher due to your other medical problems is something that should be a decision for yourself.  Nobody should be able to push you into the decision for surgery which you do not desire.  What will be his next request?  Since you are a more mature individual, a augmentation may not be enough.  This would make the surgery not result in the best appearance without some sort of lift.   This would add additional time and risk to any patient.  COPD can be defined broadly.  Chronic Obstructive Pulmonary Disease is serious.  We are talking about Emphysema or Severe Chronic Bronchitis.  This is usually related to smoking.  If you still smoke that only increase risk to an unacceptable level.  Please think carefully before others make you take action which may affect your long term health.  

One of the important aspects of your end results is how was the tip enhanced.  The use of a cartilage graft or a silicone implant with or without alteration of the lower lateral cartilages or alar cartilages will ultimately determine the changes in your appearance as the swelling subsides and the skin re drapes over the underlying framework.  It is common to use a silicone implant to enhance the tip in Korea.  Although it can give a quick result, there are some potential issues related to the material with time.  It  is very important that you wait as your nose will continue to change for more than the recommended one year.  Many people prefer the closed technique for the lack of a visible scar.  But in my opinion, the most precise way of altering the tip is by an open approach.  It is similar to working on the engine of a car with the hood up and out of the way vs. the limited view of the same area with a chain preventing the hood from lifting more than a foot.  Techniques involving the placement of sutures between and within the lower lateral cartilages are very powerful way of improving the tip.  The best thing to do at this point is wait as you are currently at the start of your experience.  I can see the improvement.  Your nose is "crooked" before the surgery and smiling in the photo does make it harder to compare.

You may already know that a bra cup size varies according to manufacturers.  What is right for you depends on many different factors.  

Some of the important factors in determining your postoperative size:

1.  Patients desires are of primary importance and this is discussed in preoperative consultation.  Some women are really looking for a lift and would like insurance to cover what is considered a cosmetic operation.  Insurance companies may use many different parameters.  One of the primary issues is grams of breast tissue respected and this is often determined by height, weight or B.M.I.   If enough breast tissues is not removed then an insurance company could argue that it was a cosmetic operation.  Some ladies have asked for essentially a mastectomy but In my opinion many plastic surgeons would not do such a surgery.  We can always take more but we cannot easily add your breast tissue.  Generally, women want freedom from symptoms and this normally results in an attractive postoperative appearance that is proportional to your body

2.  Nipple in relation to inframammary fold.  In the ideal setting the nipple should not be below the fold at the bottom of the breast.  We typically use the inframammary fold as a landmark for the repositioning of the nipple during surgery.  The midpoint of the humerus ( bone of the upper arm) is considered to be another ideal location for your nipple.  Nipple location is a critical part of any breast surgery because their location on the breast may enhance but also distract from an otherwise good result.

3.  Distance from collar bone to nipple of over 40cm a limit for pedicled techniques.  Longer distances would need a free nipple graft.  This requires complete removal of the nipple and similar to a skin graft placement on a viable area of breast.  This is now considered more of precaution with surgeons having success with pedicles of greater than 40cm.  Some surgeons may still stick to this rule.

4. Remember that your upper half is giving a balance to your lower half.  I tell women that are about to have a reduction that I did not make their stomach or hips larger.  The reduction of the upper half gives the illusion of the hips and lower torso increasing in size.  So patients may complain that something was added during surgery to their lower half.  

These things I learned as a plastic surgery resident and they hold true today.  I thank everyone who shared a piece of knowledge that stick with me after over 10 years.  

To answer your question, the size is what you and the surgeon can agree upon.  There is no magic device that can give you the exact cup size.   Just the trust that  we are honored to hold fulfill your desires to the best of our ability.  

It seem you saw that doctor on a bad day because as a surgeon, it is our duty to provide information which help you make an informed decision in a difficult situation.  Especially when one is charging for a visit, it should be as comprehensive as possible.  Without seeing your  nose, it is difficult to say what made the doctor respond in this manner.  I suspect that he has a good reputation with rhinoplasty because one could not survive very long with such an attitude.charging $250 for a consult.   If that is the case, then he likely has significant experience and may have seen a difficult problem to solve.  He did ask to see records which is important and appropriate in this setting.  I hope that this unfortunate experience has provided you with information on how to get the most of r your  next consult.  An accurate history of any previous surgery and medical issues along with any medications and allergies are some of the most important facts that a surgeon uses to help evaluate your needs.  I would normally  keep the initial visit short and waive the fee for a second visit with proper records if it was that important.  It is easier to charm a patient to proceed with surgery but it is our duty to do the most that we can in preparation for your case.  Especially in any secondary operation.  Good Luck 

When a breast reduction is performed, the majority of patients in my practice are getting them for physical symptoms and the surgery is covered by insurance if approved.  That is the first hurdle.  Insurance companies can have very strict criteria for what is considered a reduction.  Things that may be considered and documentation requested include photos, height, weight, Body Mass Index (BMI), previous nonsurgical treatment, prior physicians care.  That is just the beginning.  Then, you must state how much breast tissue will be removed and a weight in grams of breast tissue to be removed must be the goal.  That is an important aspect of this surgery and will dictate some of the answers to the other questions you have asked.  Especially since implants and reduction would not be O.K. with insurance companies.

You state that you would like a perky D cup from a 34DDD.  Unfortunately this is not an exact science.  Both reducing to a certain cup size and the bra to fit are variables that are not precise measures but rather general guidelines.  Manufacturers of bra vary on similar bra sizes and especially when you go above a D.  Some will use DD, E, or F so bra size is at best a guideline. 

To answer your question, a reduction in general includes the lift as a part of the surgery. So every woman who has a reduction will get a noticeable improvement in appearance.  The fact is that the breast will not keep that initial shape since the thinner skin below the breast will stretch and superior pole fullness (the fullness of breast which is lifted above the nipple) will move down and "bottom out."  The key is that if your breast look perfect after the surgery that with time this shape will change time and the breast will appear more bottom heavy.

An implant will help maintain that superior pole fullness as it will not sag with the rest of the breast.  The timing of implant placement in a case like yours varies with doctors.  Since you would like to keep a relatively large breast, I would expect for some bottoming out.  Your plan of reduction first seems reasonable and waiting on any implants would be wise.  This is one of the most difficult aspects of breast surgery.  How to make something bigger and smaller at the same time.  You should be happy with a reduction and time will tell if you desire more.  Just my opinion and good luck

The answer is simple but the real answer is not.

The simple answer - you have included your overall body size and that is helpful.  Being a petite individual, size can play a more important role in some of larger stature.  The important information to know is the base width and other parameters regarding your breast.  Keeping an implant with the dimensions in mind will result in a more natural outcome.  The implant should not be larger than your breast for a natural result.  This will also prevent other more difficult problems in the long term.  When a large implant is placed, the skin and breast tissue thin and stretch significant causing the implant to be more obvious.  Rippling of the breast and palpability are much more common. As your implant goes up in size, the probability of anything adverse occurring are also elevated. Placing the implant under the muscle will typically best

Not so simple - Depending on where you live - Country, State, City   what is considered normal greatly varies.  What is nice in L.A.. may not be in Chicago, or Stockholm.   Our image of what is normal and attractive is altered by print media, commercial and films.  So natural has been redefined to many people.  Because , you may not know it but that actress has implants, and model and celebrity.  Watch out what you ask for because natural may result in a less than happy you.  I have heard many  patient say, "I wish I had gone bigger"  Maybe 2 of my patients in 12 years say that they wish had smaller. 

Just an estimate.   much less than 300 cc for you would be require for a "natural"