Donato A. Viggiano, MD

Your photographs show early signs of ageing, particularly in your skin texture.  I would start with topical medications for your skin first, such as Obagi or Dermesse (there are others also). I would seek the one-on-one examination and discussion you can get from a boarded plastic surgeon since a plastic surgeon can treat you non surgically as well as surgically if the latter is indicated.  

Although the illness that you describe likely would have no effect on whether Botox would work for your back tightness, it is best to be healthy when any elective procedure is performed.  

At 4'11" and 160 pounds, you are overweight.  Plastic surgery of any kind is not a weight loss procedure.  Though some tissue may be removed, the amount is usually not significant.  The best thing you can do at this time is to get on a weight loss life style change in order to live a long healthy life.  Surgery in overweight people has a higher risk than in those closer to their ideal body weight.  Make it your goal to attain your ideal body weight of around 100 pounds, then see if less drastic "tweeks" of your figure would be helpful.

I agree that recovery time varies by the patient, the post procedure activity one wishes to engage in, and the amount of liposuction.  Recovery can take days to several weeks depending on the above.  It is important to remember that liposuction can permanently change where your fat is stored but cannot dictate your weight.  When a person gains weight, each fat cell gets larger, but you do not make more fat cells.  Once a fat cell is removed through liposuction, it is gone for the rest of your life, and it cannot get larger if you gain weight.  So liposuction is excellent for localized fat.  Generally if you are considering "massive" liposuction, perhaps what you really need is a change in eating habits in order to loose weight.  If your fat is "localized" in many areas, perhaps it is not localized at all and you would be better served with a life style change.

You have two very different conditions: breasts that you may want larger and breasts that are sagging (ptotic).  Breast enlargement is performed by placing a breast implant.  Studies show that whether the implant is high, medium, or low profile is not as important as the size (in mL) of the implant.  I suggest you visit a plastic surgeon who has sizers that you can place over your breast and below your clothing to get an idea how the different implant sizes can change your appearance.  The larger the implant, the greater the enlargement but also the greater the base diameter (too large and the implants could touch in the middle - a very bad idea).  There is a limit as to how large an implant your body can tolerate.  Also larger implants cause greater tension of the skin which can thin the skin and stretch it.  I agree that 500 mL may be too large for you.  (The average implant size used in Florida is 350 mL.  With 500 mL, you would probably be LARGE.)  Keep in mind that no implant will shorten the distance between your nipples and your clavicle and therefore no implant will "lift" your nipple / areola.  However, the larger the implant, the more the infra mammary fold may need to be lowered (just to get enough room for the implant with the nipple centered over the implant).  Lowering the fold has its own problems, but it can reshape the breast somewhat to make it look "lifted".  Consider having the implants placed first, see how you look, then perhaps consider a mastopexy (uplift procedure) later.  A mastopexy requires incisions around the areola and variably down from the areola to the infra mammary fold and perhaps side to side in the inframammary fold.  Scars are scars and, though they may improve over time, they are permanent.  You might decide that a mastopexy is not needed after the breast implant augmentation, but if it is, you may have a more accurate result after the breast augmentation surgery has settled down.  

Thank you for your question and the photographs.

It appears that you have wrinkled excess skin below your umbilicus (belly button).  I do not see folding of excess skin in your upper abdomen.  Although many plastic surgeons might recommend a full abdominoplasty, in your case, based upon your photographs, I would recommend that the best procedure for you would be a mini-abdominoplasty.  In this procedure, the upper abdomen is treated with liposuction only if needed.  The lower abdomen is treated in a manner similar to the full abdominoplasty with removal of excess lower abdominal skin with a resultant scar from hip to hip.  The upper abdominal skin is tightened only as much as the umbilicus will allow without surgery around the umbilicus with its resultant scars.  The mini-abdominoplasty is much less painful than the full abdominoplasty, has no umbilical scarring, is less costly, and has fewer complications than a full abdominoplasty.  Being slender will make your recovery easier and your result better than otherwise.

Seek out a Board Certified Plastic Surgeon.  Wish you the best.  

Unfortunately you did not provide photographs and so this discussion needs to be a bit general.

If you are overweight, than the treatment, although simple to describe, is not easy.  Lose weight.  There are many ways one can go about this but the most effective is to change the way you eat.  Going on a diet is generally not effective long-term because it does not lend itself to maintenance of the new weight.

If you are at the body weight that you desire but you have areas of fullness, then liposuction may be the treatment for you.  Although you have control of your body weight, you do not have control of where the weight is stored.  Spot reducing by diet or exercise (or even those jiggling fanny belts of old) do not work to reduce spot bulges.  Liposuction does.

Liposuction is highly effective and does an excellent job at spot reducing.  Once the area fat has been removed, the way your body distributes your fat is permanently changed.  You will never have the same shape again.  Standard liposuction works well with no need to use add complicating high pressure water jets, ultrasonic, or laser which can have their own issues of damaging untargeted tissue like nerves, blood vessels, muscle, or skin.  Standard liposuction minimizes damage to tissue that is not fat.

Wish you the best.  Do search for a Board Certified Plastic Surgeon.

Excess fat in any area is best treated with liposuction.  There are non-surgical treatments for spot fat reduction (for example, cooling the fat) but the results are much more subtle.  Neither treatment addresses the excess skin and either one can result in the skin sagging more since the contents are reduced but the covering skin is not.  Removing the excess fat with liposuction and the excess skin with surgical removal (a brachioplasty) is likely your best choice recognizing that it requires surgery and leaves an unattractive scar in the armpit and down the inside of the arm.

If you are adamant about not having surgery, than consider the fat cooling treatment.  Please realize that it alone will not do all that you likely will need for the optimal improvement (ie, your skin will sag). 

There are several ways to treat a person’s abdomen depending on the presenting problem.  The simplest is abdominal liposuction.  This procedure is best done when there is little or no excess skin but fullness that can be pinched between the fingers.  If the fullness can be pinched, that is an indication that the fullness in due to fat that can be removed with liposuction.  If the fullness is due entirely or partly because of fat beneath the abdominal muscles and therefore around the intestines, any abdominal procedure result will be compromised since intra-abdominal fat is not treatable by removal.  If there is excess skin, then skin should be removed.  If the skin is excess both at the top as well as the bottom of the abdomen, then a full abdominoplasty might be the best approach.  This procedure tightens the skin by removing excess lower abdominal skin and advancing the remaining abdominal skin inferiorly.  The resulting lower abdominal scar usually goes from hip to hip and around the umbilicus (belly button) as upper abdominal skin is pulled down past the normal position of the umbilicus and a new opening is required for the umbilicus.  Although many plastic surgeons might recommend the full abdominoplasty, in your case, based upon your photographs, it appears that you do not have significant excess skin of the upper abdomen but only excess in the lower abdomen.  I would therefore recommend that the best procedure for you would be a mini-abdominoplasty.  In this procedure, the upper abdomen is treated with liposuction only.  The lower abdomen is treated in a manner similar to the full abdominoplasty with removal of excess lower abdominal skin with a resultant scar from hip to hip.  The upper abdominal skin is tightened only as much as the umbilicus will allow without surgery around the umbilicus.  The mini-abdominoplasty is much less painful, has no umbilical scarring, is likely less costly, and has less complications than a full abdominoplasty.

If there is more than one way to do a procedure, there usually are reasons why one way is better than another in certain, but not all, situations.  With respect to the nipple (actually areolar) incision, the advantage is that the areolar scar may be difficult to find when fully healed.  On the other hand, the areolar scar may become unsightly (I have seen both), and therefore obvious when exposed.  The areolar scar also requires cutting the breast gland to get to the space behind the breast.  Bacteria can dwell within the breast ducts, and this, as well as the bacteria resident in the nipple, has led some plastic surgeons to recommend avoiding the areolar incision.  Personally I think that cutting through the breast gland is best avoided when possible.  In any case, the areolar incision can be used as an access to either the retro-glandular space (the space behind the breast tissue) or the retro-muscular space (the space behind the muscle).   In other words, placement of an implant under the muscle can be performed through a nipple incision.  Whether the implant is placed behind the breast tissue (above the muscle) or behind the muscle is also a point of discussion.  There are pros and cons here also and you should talk to your board certified plastic surgeon for advice.  Generally behind the muscle can be more painful and may cause the implant to move with muscle contraction but it covers part of the implant with muscle which may decrease the rate of capsular contracture (making the breast feel hard) and the ability to feel the deep seated implant.  The latter is especially important in thin women.  Placing the incision near the fold beneath the breast or through the armpit avoids any cutting of the breast gland and the bacteria in the breast or nipple.