George Bitar, MD

Dear Reliable, Typically, the nasal skin shrinks down to take the shape of the nasal "skeleton" that is made from the bones and cartilage under the skin. You should not worry especially since a reputable surgeon told you that you will be fine.

There are a few reasons if the implants are in different positions after surgery. The most common is that you are still recovering. Based on your photographs, it is difficult to tell how far out from surgery you are. It may take 3-6 months for implants to settle into their final positions. If you are still early in your postoperative period, then I would give the implants more time to settle. The implants may be in different positions because of pre-existing asymmetries, such as one breast fold may have been higher than the other. It is difficult to tell if you had asymmetry based on the preoperative photo you provided. Finally, it can be related to capsular contracture. Be mindful that a capsule will always form around an implant. The question is whether the capsule is a creating a problem, such as changing the position of the implant, making the breast feel hard, or causing pain. It sounds like you are doing the correct things. I would recommend continued follow-up with your surgeon.

Choosing the implant size can be one of the hardest decisions with breast augmentation. Every plastic surgeon has their own method to pick the correct implant size with their patients. The choice of implant is determined by combining your goals for size and the appearance of the breasts with a detailed assessment of your height/weight, breast dimensions, and chest width. In our practice, we generally have patients bring photographs of the desired appearance of their breasts after augmentation. We also have them try on breast implants in the office. Bigger is not always better. There will be more thinning of the skin and soft tissues, making the implants more visible. The increased implant weight and thinning of the tissues may lead to loss of support with time, so the implants sag. Based on your ideal photos, the breasts are wide and stick out beyond the chest wall, and your arms may strike the implants with running or lifting things. I would recommend discussing your goals with your surgeon, so collectively as a team, you can determine the best implant size for you.

Burning/stinging sensations indicate that nerve irritation or damage is the cause. With any surgery, the nerves to the skin will be divided when making the incision. Generally, the skin nerves will recover and for most people, the discomfort will go away. Given your breast reduction was 8 years ago, the burning and stinging is more likely to be permanent. There are desensitization techniques and nerve medications that may help with the pain. I would recommend visiting a plastic surgeon for assessment.

The depressor septi nasi muscle can be treated nonsurgically with botulinum toxin injection to inactivate the muscle. The botulinum toxin will wear off in 3-4 months and will require repeated injections to maintain the effects. For a more permanent solution, the depressor septi nasi muscle can be cut from inside to mouth to avoid an external scar. This will undoubtedly weaken the muscle, but sometimes the ends of the muscle will still scar together, resulting in some motion still. I would recommend consultation with a board-certified plastic surgeon to discuss the options.

The rib graft should not be affected by removing the plates and screws from your double jaw surgery.

Having recurrent oozing from the belly button can occur after tummy tuck surgery. Most commonly, it is related to bacteria attaching to the permanent suture that was used to bring the tummy muscles together. I would recommend seeing your surgeon for evaluation.

Without knowing more details and performing an examination, it would be hard to determine the cause of your pain. It may or may not be related to your implants. Burning pain suggests that the pain is caused by nerve irritation. It would be helpful to keep a diary of your pain and keep track to see if there is anything that is causing the pain, whether it goes anywhere else, if there are any other symptoms associated, and treatments you have tried. I would recommend seeing your plastic surgeon to ensure that your implants are not contributing to your pain.

Generally, we recommend waiting 6 months after cessation of breast feeding to allow the breasts to reach their final size and shape. Before that, the breasts will be changing, and an accurate assessment cannot be performed. In your case, you are 6 months out from breast feeding but still having milk production. There are many reasons to have milk production from the breasts despite not breast feeding, including medications, herbal supplements, stress, and potentially a medical issue. It would be a good idea to see your primary care physician to ensure that there is not an underlying medical problem.

As you noted, rasping can be performed on the nasal bridge to decrease the height of the bone. The tip and supratip regions are all cartilage and cannot reduced with rasping. The cartilage may have to be removed or augmented and then sutured to reshape the tip and supratip.