Diane L. Gerber, MD (retired)

Your nipple-areolar complexes are low.  It appears that the right is lower than the left.  I think your breasts would be more symmetric, perkier, and more youthful, if you had a lift with your implants.  The lift would change the shape of your breasts, if done properly, to a more rounded contour.  I don't believe you would need a large implant to achieve a prettier shape and size, with a nice cleavage, if you had a lift.  There will be more scarring, but I believe in time, the scars would fade, and the tradeoff would be worth it.

The drains would normally be used for the tummy tuck portion of the procedure.  The length of time they need to remain in place varies.  Removal usually is determined by the amount and color of the drainage.  The color of the drainage should be a clear yellow or light pink.  The amount of drainage should be under a certain number of cc's.  I usually wait until there is less than 30cc's in each drain for a 24-hour period.  (This amount may be different for different physicians.)  Generally the amount of time, if everything goes smoothly, is less than 1 week.

Rhinoplasty and otoplasty can certainly be done at the same time.  If the nose is being revised, you may need the cartilage that is removed from the ear,  to achieve the best results on the nose.  Be sure that the cartilage from the ear is not wasted, should this be the case.

There are many qualified plastic surgeons in the Chicagoland area.  Be sure to check credentials and results.  You should go to a plastic surgeon certified by the American Board of Plastic Surgery.  You can first check on the surgeon's website, and, if you like what you see, make an appointment for consultation.  Check the before and after pictures, carefully, and be sure that you and the doctor have a similar aesthetic taste.  

There are no other procedures that do what a facelift does, but there are many kinds of facelifts.  The most natural and longstanding results occur with full facelift, that includes a full lift of the internal structures, as well as the skin. A simple skin lift or a mini-lift do not last long, and can make it more difficult to do a full lift in the future. The usual age range for a facelift is 40 - 65.  The best results occur when the procedure is performed when you start to develop jowls and excess neck.  The nature of your skin is also important.  Sun damage and smoking seriously change the elasticity of the skin, so that the results will not be quite as good as they would be in someone with healthier skin.  I think 55 is better than 65 for your  lift.  Be sure to ask the surgeon for "before and after" pictures, so that you know that you are both on the same wavelength with respect to your aesthetic taste.

It looks as though you had liposuction of the lower abdomen, but not the mid/upper abdomen or hips.  Frequently, it is necessary to add a few scars to get to the area around the belly button and to transition into the hips.  Once the tissues have softened, you may need a revision which would include those areas.  Then, hopefully, there won't be a noticeable stepoff, and the result will look more natural.

When I look at your pictures I see asymmetry, with the right breast being more ptotic (saggy) and larger than the left.  Your areolae are both a little big and lower than they should be, especially on the right.  I believe you need a lift on both sides, probably a little more extensively on the right.  The lift will give your breasts a rounder, perkier shape.  The implants, which will give you volume and projection, should always be placed under the muscle when possible.  You may need different size implants, or removal of a little tissue on the right, when the lift is performed, to achieve symmetry in size.  The scars should fade, in time.  I think the end result after a lift with submuscular implants is worth the tradeoff of having a few scars.

If you have very small breasts, and the implants are placed in front of the muscle, you will not have enough tissue coverage to allow for a natural look.  It is better to have implants under the muscle, under any circumstances, because mammogram readings are more accurate, there is less chance for hardness from capsular fibrosis, and the result is more natural and attractive.  Also, it may be better to achieve a beautiful, full breast without determining an exact cup size (which varies with the back size) or number of cc's ahead of time.  Sizers may be used during surgery, and you can have the largest size that looks appropriate for your chest wall, as determined by looking at you in an upright position during the procedure.  It will probably be a D if your back size remains a 32.  If you try to go too large, you can have problems with displacement, and you may have an obvious, "done",  appearance.  Natural and full is much sexier than phony and huge.

I would disagree with your first doctor.  If the breast pocket is made properly, there is no need to wear a bra 24/7 after 1-2 weeks.  The capsule of scar tissue should be well formed by then, holding the implant in place.  You should be able to submerge in water when the wounds are completely healed (usually by 2-3 weeks).  However, swimming and other upper body exercise  should be delayed for at least 4-6 weeks, to prevent bleeding or displacement of the implants.  Different surgeons will vary on their choice of bras.  The main thing is that you should not wear an underwire for at least 1 month, and you should have good support without flattening of the implants.  The implants may, initially, look high, and then descend into their normal position over the following few months.  If one, or both, implants are not descending quickly enough, you may need a chest band, instead of a bra, to speed the process before the capsules are well formed.  You do,however, need to be careful not to use too much pressure. ( If an implant descends too far, you may need surgical correction.)  Good luck.

With your tuberous deformity, I have found that the best results are achieved with full mastopexies and small submuscular round silicone implants.  The mastopexies reduce the size of the areolae and place them in a better position.  The pexies also change the shape of the breasts so that they are more round and normal.  The implants will help to stretch the skin that is constricted at the bottom of the breasts and add to their fullness.  You also have asymmetry in the size of your breasts, which could be corrected by removal of a small amount of tissue from the larger breast and/or by using a larger implant  in the smaller breast.  Sometimes, if the lower tissue does not stretch well, a second, small procedure may be needed, after several months, to release the tissues further and to make minor adjustments to improve symmetry.