Howard Webster, MBBS (Hons), FRACS

Hi there, You've posted several questions about your lower lids and lid cheek junction, most recently on 4 September. I've reviewed the advice you've been given and find that you've been offered a lot of conflicting advice. No wonder you're confused. This is pretty straightforward: You're in your late 20's and do have a visible tear trough and an empty looking lower lid. I don't think the cheek filler is helping you. It's too low, and almost seems to exaggerate the problem rather than mask it. I think the problem is pretty straightforward to solve. 1. I would microfat graft the lower part of your lower lid, and tear trough area to restore volume where it's needed. This needs to be done slowly, patiently and accurately to ensure a smooth result. Bad work here will look lumpy but good work should largely solve your problem. 2. I think your poorly positioned cheek filler might best be dissolved out. 3. It's possible some accurately positioned filler placed as a tenting material along the outer part of your orbital rim and extending to the zygomatic arch might give you a better and more youthful cheek, lower lid and tear trough appearance. Fat won't work in this area to do this as it is too liquid - the density of filler is required to achieve this effect. I'm a plastic surgeon, and work with a team of expert cosmetic physicians. WE could consult together on your case if that was your preference. All the best. Howard Webster Plastic Surgeon

Hi there Elizabeth,I think you can be well advised on this, but we need better images. Front, 3/4, side, from upper cheeks just below eyes to lower neck. Forward gaze, neutral expression, not smiling.If you can post these, happy to offer you some thoughts.Howard WebsterPlastic SurgeonMelbourne Australia.

HI there.Thanks for your question.I've seen some answers so far here that are good, some more risky, and I would certainly advise you not to have an permanent filler injection such as silicon. That could, if it got infected, be disastrous to your nose.Here's my approach:If you're happy with the straightness and smoothness of your nasal bones and cartilage under the skin, then the challenge is to thicken the skin or the subcutaneous layer underneath the skin. If the skeleton is not straight and smooth, then that is the problem, not the skin.Assuming the skeleton is smooth, I think you can readily be treated with a non surgical approach. The most effective method is to use hyaluronic acid filler. Its density, or viscosity, can actually fill or disguise irregularity effectively. Tethered skin points can be released via a subcision technique. It's temporary and needs to be repeated, but is also reversible if there is a problem. That's very good. A single treatment if effective, lasts for years - at least 2, maybe more.Nanofat graft is an option. It needs to be explained to you though that a single treatment will not correct the problem. Fat injected is soft, thin and has no viscosity. Irregularity would persist. With several (2 - 4) grafts, I would expect a smoother and thicker skin, and I think it would work. IT is the most natural and healthy approach for the skin, and once working well should give you a long term improvement. But it would take some time to get there.These two options are simple and can be done under local anaesthetic walk in walk out, with minimal recovery.All the best.Howard WebsterPlastic Surgeon.

Hi there,You've got this entirely wrong.You state that you are 2 weeks post op, but are talking about "the result".At 2 weeks post op you are not seeing any result at all. You are seeing a swollen abdominal wall which really hasn't even yet started to heal.At 6 months post op, you will see the final result.So:Be patient. Wear your compression garment 24/7 except showering for another 2 - 4 weeks.Have a daily massage of your abdominal wall as firmly as you can, while lying on your back. Massage oil, and firm circular motions.Wait optimistically. It will most likely all be ok. You're not going to know for awhile. When "the result" is there to see, say 6 months post op, you can assess it with your surgeon and see if you're pleased. 

Hi there,Thanks for your great question.Technically, it is definitely possible to do a full tummy tuck with an entirely vertical incision. This is occasionally indicated where there is a previous vertical scar, as in your case.As has been pointed out by another surgeon here, as your scar only goes to the belly button area, the entire scar can be removed by a conventional tummy tuck approach, plus some lipo, which would leave you with a long low horizontal incision you can hide under underwear, only. The vertical scar would be entirely removed.You would definitely benefit from having this fixed in every way, and it's not a difficult thing to do. I hope you do it, and all the very best to you.Howard WebsterPlastic Surgeon

HI there.There is simply a lot more to it than the influence on the tip through hump removal. The answer to your question is that often lowering the bridge can make a nose look longer - but that an individualised approach is necessary as there are a NUMBER OF FACTORS at play in determining real and apparent nasal length before and after rhinoplasty. Even the degree of proposed hump removal is an important factor.Some of the other comments here already show that.Your tip overprojects and in my opinion needs to be deprojected if you had rhinoplasty - so more than a hump removal is necessary.A small hump removal, leaving a fairly strong nasal bridge profile, won't increase apparent length of the nose - UNLESS - the radix is high. A high radix will make a nose look longer can be disguised by a hump, and exposed by hump removal.So the place to start is 3D imaging, and working on a profile you like, and looking at the front view consequences of that.Personally I think it likely that some tip complex deprojection will be a good idea, and probably a little upward tip rotation but not much.We cant see your radix in the images but it looks like it might be ok as it is.Hope this helps,Howard WebsterPlastic Surgeon.

Hi there, thanks for your question.You do have visible asymmetry.I do not think you have upper lid ptosis, as has been suggested. Your brow position and upper lid symmetry seems pretty good.Your images suggest skull bony asymmetry - which is common. Your left lower lid sits a little lower, and it's my impression that there is cheek asymmetry underneath that.Most likely this is harmless. What to do - if anything - the best approach may simply be to accept that it's normal - depends upon an accurate diagnosis being made.I would suggest to consult with a specialist plastic surgeon in your area who has craniofacial training, as a beginning point.Hope this helps, all the very best.Howard WebsterPlastic Surgeon.

Hi there,I'm sorry to hear of your failed muscle repair.Firstly, a muscle repair that fails is uncommon.Possible causes are:Your anatomy (weak or thin fascia over the muscle which tears at the stitch holes of the sutures and does not "hold" the stitch, or it is possible you have too much visceral fat ( if you lie on your back, is your tummy full and protruding above your rib cage, or hollow?  If full, then a repair will not work well as it would need ot be closed too tightly and will not hold. In this case, you must lose some weight before re repair to deflate the visceral fat. Plastic surgery cannot access fat behind the muscle).Your post op activity. A muscle repair is really a hernia repair, and should not be stressed by any resisted activities for around 6 weeks post op.Your surgeon's chosen suture material - if it is dissolving, or was a weak suture, it might not hold.Your surgeons technique - the repair was not strongly enough constructed.Whatever the cause: ensure your visceral fat content is low before a re repair. Then, from your surgeons point of view, a RE REPAIR WITH REINFORCEMENT is necessary to cover all bases and give you the strongest possible repair so that this time it will hold.In my hands I use a permanent external mesh about 5cm wide overlaid on any repair I do if I judge that it may be weak - ie the fascia is thin. I've never used pigskin. I'm not saying there is anything wrong with it.Your surgeons is saying to you that reinforcement of the repair is necessary. This is logical and correct. If I were you I would have the repair reinforced this time. Maybe ask your surgeon why pigskin (allplastic ADM) as the reinforcement. Synthetic mesh made of similar materials to sutures is cheaper and when placed externally does not carry the risk of mesh placed intraabdominally. It is a safe use of mesh, and is cheap. Your surgeon might have great reasons to prefer pigskin, so worth asking why, and if there are cheaper reinforcement materials - there are!hope this helps,Please post how you go!Howard WebsterPlastic Surgeon.

You ask a good question and there are many lessons in your story. You know now, that if conflicted about a possible surgery, you should wait and not have it.Having said that, the underlying character of your nose is not all that different. In the short term, I recommend you explore filler injections to add some bulk to the tip and bridge. This will tide you over for 1 - 2 years, making your nose much more like your old nose and then you can objectively review and see where you are once mentally you have been able to let some time and space occur. Be calm - I htink you can have a nose not unlike your old nose if in the long run that is your desire. But:  NOW is NOT the time to have further surgery. Give it at least a year, and have some counselling. Do not compound one decision you regret with another.Note if you explore this that you need a real expert injector - and understand the cause and treatment of vascular injury risk in filler injections, ensuring that your doctors is aware of and can treat this if it occurred.All the bestHoward WebsterPlastic Surgeon.

Hi there,You are indeed a healthy looking man.You simply have inherited lower abdominal fat deposits. Your muscular shape is normal.The issue is entirely correctable by competent liposuction. For life - as long as you stay a healthy weight.Tip for finding a surgeon:  Find the best liposuction surgeon, and don't fall for the marketing rubbish that the type of technique or the machine matters. I see a lot of people advocating a particular "method" as though that mattered.  The surgeons controls 100% of your result. A good surgeon will create a good result, and a poor surgeon will create a poor result - regardless of the tool or "liposuction machine" in their hand.So look at the work, and the reputation/If you'd like a name, my friend Chris Inglefield in London is an excellent liposuction surgeon.All the best,Howard WebsterPlastic Surgeon.