Edward P. Miranda, MD, FACS

We advise our patients who had a photo facial, IPL, fraxel, or the newest non ablative fractional laser, Frax 1550, that using a high quality moisturizer with sunblock is important for reducing irritation after treatment. In general, the use of hyaluronic acid immediately after these minimally invasive procedures can cause some irritation in more sensitive skin types. The best advice is to ask your physician because he or she will know how deep the treatment was and know your skin type best.

In general, hairline lowering is a much more efficient method of advancing the hairline. Particularly in women where their hairline is stable, hairline lowering gives the advantage of preserving your natural hairline. The result is much more immediate and the scar is generally well hidden.  Occasionally hairline lowering is augmented by additional hair grafts, however when hair grafts are needed they tend to be a much smaller number (in the hundreds rather than thousands) and typically less expensive. Hairline lowering is a very specialized procedure that requires significant attention to detail. Hair transplant (FUE or FUT) also requires attention to detail but has a much lower barrier to entry than hairline lowering. Consequently, many less skilled or less trained physicians offer hair transplantattion. Hair transplant is also more expensive (usually).  For a woman's hairline I highly recommend that you see a Board Certified Plastic Surgeon in a practice that specializes in both procedures. A consultation (virtual or in person) will help further delineate your best option.

It is difficult to determine ptosis from a single image. Examination for eyelid ptosis requires measuring the difference in upward motion of the eyelid. However, in general, puffy upper eyelids can be a condition with the medical term blepharochalasis. Repeated swelling in the upper eyelids can cause stretching of the skin resulting in excess skin. This condition can run in families and worsens with age. One must also consider the position of the brow. In general, treatment for blepharochalasis involves removing a thin strip of skin of the upper eyelid. If there is true eyelids ptosis it can also be repaired at that time. Additionally, sometimes the brow needs additional support or elevation. You should seek a consultation with a board-certified plastic surgeon who is a member of ASPS or ASAPS.

Choosing the proper size for breast implants depends on patient desires, the size of the woman's frame, as well as the measurements of the breast and chest. It is impossible for any surgeon to give accurate recommendations without doing a physical examination and precisely measuring the breasts. However we do know the following: the larger the implant, the more upper pole fullness you will get. Additionally we also know that the larger the implant, the higher risk of the implant being visible or having other complications, such as rippling. The difference between a 415 CC implant and a 445 CC plan is usually difficult to tell. However a 470 implant is a significant increase from a 330 CC implant size, particularly for a woman who started out with an A cup. With regards to concerns over spacing of the breasts, this is only partially controllable. The spacing of the breasts are defined by your pectoralis muscles. Placing wider implants can sometimes give the illusion of the breasts being closer together, however in reality, the breast spacing is not changed. Attempts to change the breast spacing usually are not effective and can actually lead to complications, including loss of cleavage. The best solution is choose a board-certified plastic surgeon you trust to have a complete examination, including measurements, and collaboratively come up with a mutually agreeable plan that maximizes your desires within a reasonable safety profile.

The best and safest method to determining the implant size for you is by proper measurement. This is best done in person at your consultation with a board certified plastic surgeon. After measuring your chest your surgeon should recommend a few sizes that would be safe, meet your goals and for your body. With hundreds of different implant sizes, projections, widths, and volumes (cc), you should not have to worry about each of these features. You need to trust your surgeon to find what range of implant sizes for your body and then choose from a small range of options. Many women are concerned about asymmetry. However, in general, the appearance of asymmetry decreases after breast augmentation if a judicious choice if implants are made.

Thank you for providing the photos along with your inquiry. While it is difficult to evaluate how tuberous your left breast is from the photo it is apparent you have significant asymmetry which likely will not be addressed with a breast augmentation alone.  We recommend you make a consultation with a Board Certified Plastic Surgeon to discuss who you can achieve more symmetry.  The left breast would benefit from radial scoring of the fibrous tissue and implant while the right breast may benefit from a mastopexy to provide a more symmetric look to the left breast. 

The implants you mentioned may be too large for your frame which may also be why you have developed symmastia and "pinching" sensations. It is not unreasonable to either go back to your surgeon or seek another Board Certified Plastic Surgeon to have another consultation with re-measurements and more informed process of picking the best implant for your body. There are many great implant options that can accommodate your preferences with your body type.

Based on your description of events we think there probably was enough UV protection from the sun even while the grafts are still "taking" to their donor site.  In the future if you'll be exposed to prolonged sun exposure use a loose fitting hat to cover you head.  And as always, don't forget to protect the rest of your skin, especially face, with sun screen.

There are many effective non invasive treatments that can increase collagen, plump skin and tighten skin. Things like botox and fillers can be used to smooth out wrinkles and enhance different facial features. Botox can be a great preventative treatment for someone in their 20s-30s to minimize permanent wrinkles from forming such as crow’s feet, forehead lines and the lines between the brows. Fillers are also great to create for fullness in the cheeks, minimize the appearance of nasolabial folds, fine lines, etc. Profound RF is a great treatment that uses microneedling with radiofrequency energy to stimulate your own body to build new collagen, elastin and hyaluronic acid to tighten skin and improve tone, texture and laxity. Its a great treatment to improve jowls and nasolabial folds that is long lasting. For someone as young as 35, Profound RF can not only serve as a tightening treatment but also to build new collagen for the future to look more youthful longer. 

Typically "fake" appearing breast augmentations are from implants that are large for the patients body size placed in the above the muscle position. Alternatively this is a sign of capsular contracture as well. With regards to asymmetry or unevenness from the right breast to the left breast this can be adjusted using the proper size implant or other techniques depending on the examination of the patient. Our website has extensive information regarding size and incision. There are also many before and after photos of patients with a similar profile as you. Their implant size is referenced in their photos.