Jules Feledy, Jr., MD

Thank you for your question. There have not been any studies regarding the efficacy of 'postoperative compression garments'. Nonetheless, they are widely used - and I do not know a single body contouring physician who does not use them. The value is controlling postoperative swelling. The garments are placed to provide external compression and allow the skin to compress against the underlying tissue, and this process helps minimize the presence of excess seroma fluid. Over time, there has been a 'development' of stage 1, stage 2, stage 3, etc. I see my coordinators using these terms. I think the benefit is that there is attention to how a particular patient is responding to the swelling, and taking care to monitor their progress. I do not believe that a particular garment will make or break your result, however, it may make the process a little smoother getting there. Best of luck! Jules A Feledy, Jr, MD American Board of Plastic Surgery, American Society of Plastic Surgery

Hello. Thank you for your question. Your photos and BMI indicate that you are in very good shape with very good proportions. I believe that this is a question of 'expectation' rather than 'actual numbers.' You would be able to liposuction the abdomen, flanks, peri-buttocks, arms, etc. There will be a lot of shaping that occurs with liposuction that will help shape your torso even without fat transfer. There is no issue with suctioning the inner thighs and anterior legs except that the surgeon will have to be very limited in the volume removed so as to avoid contour deformities. Some amount of fat will be harvested and will contribute to the total harvest amount. It may only be a couple hundred cc. The total volume would be prepared for fat transfer. It may be that you only have 500, 600, or 700 cc/side. But that might make a very nice contour enhancement to an already very nice shape. I am not a fan of gaining weight for the sake of transfer. Best of luck! Jules A Feledy, Jr, MD American Board of Plastic Surgery, American Society of Plastic Surgery.

Hello. Thank you for your question. Your BMI is approximately 32 (see link below), which means that you would be expected to have enough fat for harvest with liposuction. Without a medical history or photographs, it is only posslible to give generalities. Ideal candidates for a Brazilian Butt Lift tend to have enough fat of the abdomen, love handles, back and inner thighs for liposuction. A general guide is that you need twice as much fat to liposuction as you need for injection. BBL is a very effective procedure for contouring unfavorable buttock features. Further, research has shown that regardless of height, weight, or ethnicity, a waist to hip ratio of 0.7 is considered attractive and healthy in women and 0.9-1 in men. This is calculated by dividing your waist measurement by your hip measurement at its widest point. Preoperative shape, buttock projection, skin tightness, skin laxity, and the amount of surrounding fat are the features that determine your outcome after surgery. Best of luck! Jules A Feledy, Jr, MD American Board of Plastic Surgery, American Society of Plastic Surgery.

Hello. Thank you for your question. Your photos indicate that you have a very good starting point for a mommy makeover - Liposuction/BBL and Breast Augmentation/Mastopexy. You have a natural shape to your torso and buttock regions. Liposuction of the abdomen, flanks, and peributtock regions will result in a nice contour and harvest of fat. Liposuction of the inner thighs and knee regions will definitely help increase the volume. I believe that you will have enough harvested fat to transfer to the buttock regions nicely. Your photo shows that you have sloping breasts and are missing volume especially upper pole volume. The breasts have laxity. It is possible that a breast lift could be performed without adding an implant but you would have smaller breasts. It is also possible that fat grafting from the abdomen to the breasts could be performed. But if you wish for fuller, perkier breasts, realistically an implant is required for adding volume. I believe that you would get the best result with the following: at surgery, an implant is placed first. The size of the implant would be based upon your chest and body measurements, and then modified by your preferences- such as breasts that are slightly larger or slightly more moderate. Then the breast lift is performed. The excess skin would need to be reduced and tailored so the nipple-areola is centered over the implant. The areolae would be made smaller. Lastly, I recommend an in-person consultation. Depending on the discussion, chaperoned examination, and the final recommendations, you will receive a written estimate. Best of luck! Jules A Feledy, Jr, MD American Board of Plastic Surgery, American Society of Plastic Surgery. Stafford, VA and Chevy Chase, MD

Hello. Thank you for your question. Your photos indicate that you have a very good starting point for your BBL. You have a natural shape to your torso and buttock regions. Liposuction of the abdomen, flanks, and peributtock regions will result in a nice contour and harvest of fat. You seem to carry some volume of fat in your thighs, so liposuction of the inner thighs and anterior regions will definitely help increase the volume. I believe that you will get close to 2000 cc, maybe not exactly, but this can be transferred to the buttock regions nicely. Best of luck! Jules A Feledy, Jr, MD American Board of Plastic Surgery, American Society of Plastic Surgery

Hidradenitis suppurativa (HS) is a chronic skin disease which causes painful, boil-like lumps that form under the skin. The lumps in HS form because of blockages of the hair follicles. The blocked hair follicles trap bacteria, which leads to inflammation and rupture. HS usually affects areas where the skin rubs together, such as your armpits and groin. The lumps become inflamed and painful. They often break open, causing abscesses that drain fluid and pus. As the abscesses heal, they can cause scarring of the skin. HS has mild, moderate, and severe forms. As you note above, you have had a good response to Clavaris. The qualifications for you are the following: 1. there would have to be no evidence of HS actively going on; 2. you would be placed on prophylactic antibiotics pre and post surgery; 3. you would have to know the risks that HS could flare up at any time. The scarring can be severe. I hope this helps! Jules A Feledy, Jr, MD American Board of Plastic Surgery, American Society of Plastic Surgery

The ABPS is one of the specialties that is certified through the American Board of Physician Specialties (ABPS). The ABPS is the official certifying body of the American Association of Physician Specialists, Inc. (AAPS). The AACS is not.

Hello! Thank you for your question. Your photos show excess skin of the lower abdomen, stretch marks, outpouching of the mid-abdomen, and full flanks. How you wish to proceed will depend on your personal preferences and how they fit in with your budget and lifestyle. There are several variables that plastic surgeons use to evaluate abdomens - skin, volume, and shape. Liposuction with certainly reduce your 'volume' but it will leave skin draping or wavy as there is an excess of skin. Your skin will not tighten very well as evidenced by the excess (draping on the side view) and the stretch marks. It is likely that you will be disappointed with non-invasive techniques. It is not to say that there will not be any benefit but the question is - will it be enough benefit? That is a question that only you can answer. Further, it is true that not everyone wants/is willing to undergo an abdominal wall tightening procedure, but it is possible to perform a panniculectomy, a procedure similar to a TT but without the musculature tightening. It tends to be an easier recovery. That would help reduce the overall skin surface area. It is great that you are going to a plastic surgeon to discuss your options. I would encourage you to be open and honest about what you would like your body to look like. From these photos, it seems that a full TT would be a choice. But that is a very personal choice. It very well may be that liposuction was selected based on minimal downtime, less invasiveness, easier recovery, etc. And it may leave you underwhelmed in the long run. Best of luck! Jules A Feledy, Jr, MD American Board of Plastic Surgery, American Society of Plastic Surgery

Hello. Thank you for your question. The nasal bridge wrinkle is often challenging to treat. A first line treatment is Botox in the procerus region. Despite this, the wrinkle is often under treated. The addition of filler is generally required. Even so, the line is improved but still present.

The DAO (Depressor Anguli Oris) pulls the corners of the mouth downward and slightly outward when you frown. Botox injections in this area can weaken the muscle enough to allow the corner of the lip to rise a little. The injections are medium depth, about 2-5 mm deep. Before injection, I ask patients to turn their lip down so that the muscle can be identified. I inject just to the outside of the marionette line to avoid hitting the DLI (Depressor Labii Inferioris) muscle which overlaps with it in the inner area. We used fine insulin needles without any issues. If patients are nervous, we apply a topical numbing cream for a few minutes, but most patients do not require this. Jules A Feledy, Jr, MD American Board of Plastic Surgery, American Society of Plastic Surgery