Donn M. Hickman, MD

Practically speaking, most plastic surgeons have a primary patient wait about a year to perform a general revision such as further shaping and remodeling. For asymmetries and issues such as irregular nasal bone reshaping this may be done slightly sooner or  within that period.  At 10 years, while most scar tissue has softened to the max, it is the location of the scarring that still makes the performance of surgery a skill set that relies on experience and judgment.  Good equipment, lighting, and an able staff plus a clear idea of what it is that the patient desires and what the surgeon can achieve, go along way in helping the patient obtain corrective rhinplasty.  Ordinarily the delicate refinements seen right away from rhinoplasty can fade, and require secondary work, nostrils can retract, the nasal tip can buckle or rotate improperly, or simply that a hump may not be perfecty removed, or leave a not so perfect sweep or depression.  Whatever it is, 10 years should allow the next surgeon to perform the necessary corrections within reason.  Best wishes.

Thank you for the time you are taking to ponder your options which is compounded by a variety of recommendations by well qualified and experienced surgeons.  For a 32DD cup breast size, and what I can see from the photos, you are a good candidate for a periareolar mastopexy without implants. While ideally many surgeons limit periareolar lifting to 2 cm of nipple elevation, I believe your nipple position can be elevated to 5 cm without difficulty. I have been performing this procedure on cases of breast lift since 1992 with nipple elevation from 4 to 9 cm. The best cases are when only 4 to 5 cm is required.  Without implants, the periareolar scar should not stretch as much, although the final scar will be a light starburst pattern. All or any further approaches to the breast can be done through the original circle made at the first surgery. Another variation in opinion for your review.  Best wishes for now.

Hello and thank you for your question.  While we work with patients on this issue when they desire over muscle augmentation, it is those patients who return with good long term results from over the muscle saline and silicone, that we can accommodate again.  But------ we do know that it is best to have some muscle cover for all implants long term. Saline implants can reveal rippling over time particularly if you become a fitness enthusiast reduce body fat even further.  I think the size selected at 500cc plus will unfortunately lead to major sag and rippling and you would be best served by under muscle saline or gel, perhaps at a slightly lower volume such as 425cc to 475cc.  This is our most common sizing that we see at 12 to 25 years after augmentation with little or no saline rippling problems, except some detectability along the undersurface--------but again the implants are primarily  placed in the under muscle position. Silicone over muscle is always a little better for visible and palpable implant concealment but hardening can be more common. You have a slight glandular ptosis which does not require a lift or areolar tightening.  You be  the judge,  but my opinion is  higher profile saline at the size you selected, through the areola and behind the muscle with lower pole release.  This is my preference in 75% of cases.  Best wishes.

In the properly prepared and evaluated patient with a body mass index at or under 35, one can consider safe removal of less than 5 liters of fat for an outpatient procedure. This parameter can vary from one state to another and from one ambulatory center accreditation body to another. Surgical judgment can change this value to a range of 2-5 liters for outpatient considerations. Staging the liposuction is often done for large volumes being removed under local anesthesia. While large volumes of 5-8 liters can be safely removed under the right circumstances, it is usually the younger healthier patient, one not considered obese or having an BMI over 30-35, is monitored by way of inhalation general anesthesia, has plans for retention overnight, does not combined major procedures included with the liposuction, and the patient is managed for lower extremity venous blood flow to avoid clots. A thorough preoperative exam, and battery of blood tests us usually required for liposuction with general anesthesia in one major session. Again, local anesthesia can permit staging of fat removal. It is however, best to reduce the general risk by losing weight and getting the BMI under 30 if possible, and have the procedure done by a Board Certified Plastic Surgeon in a properly credentialed ambulatory surgery or office center, when larger volumes of fat are considered to removal in one session. With all this said, the risks of high volume liposuction do increase when the volumes exceed 5 liters in one session. 5 to 8 liters equals  11 to 18 pounds of fat as a rule. Weight loss prior to liposuction should be tried in order to reduce anesthesia risk class, whether you be treated with local, sedation, or general anesthesia.  Your BMI is clearly over 35. Discuss this with your attending surgeon.   

Hello and thank you for your question.  You have a very nice vertical scar element which is quite thin and almost imperceptible, but I do see some faded green as you mention. I would first ask your surgeon what he or she thinks.  Some of us do use a heavy permanent braided suture called Ethibond for the muscle repair at the deep level, and to some extent in the deep superficial soft tissue layer. This suture is green in color.  While rarely a single suture may pop up under the skin as evidenced by a green bump, it is possible some the pigment (but not the sutures themselves)  could leech out and released into the healing tissues. It could be an attempt by the body to disperse the pigment color and it has reached the level of deep skin. There is a laser wavelength  at the 755nm range which is used for skin pigments of green and blue in tattoos which may be a suggested remedy here.  Again, having used this suture myself, I have only seen the rare ethibond green suture spit out or be rejected, but have not seen green pigment dispersal into the skin.  There are sometimes unknown unknowns that occur with plastic surgery. I do think a light-based laser or pulsed light treatment might be mentioned.  The scar is so minimal, that one would be hard pressed to recommend a scar excision and revision with nonpigmented suture, and risk a wide scar.  Discuss the matter with your surgeon and see what might be best for you.