Leonik A. Ahumada, MD

Thank you for your question. It is a common scenario to work out regularly and feel like you are not making progress in certain areas. Your muscles may be strong and feel tight when you flex but appear loose when you are relaxed. This is due to the fascia loosening which cannot be tightened by working out at the gym. The added difficulty is that excess skin will only retract a certain amount and working out further will not improve that.  Once there is skin excess overhanging the belly button or the pubic area it is difficult to tighten these areas without surgery. Based on your photos it seems you would benefit from an abdominoplasty which would remove the skin excess and allow further tightening.  A board certified plastic surgeon can evaluate you and provide you with an complete evaluation.

Thank you for your question. Early postop the breasts can have various shapes that will eventually smooth out. Swelling can exaggerate the normal appearance of the breasts and highlight changes created by the implants. The changes seen in the skin can be different for implants placed above or below the muscle. For implants placed on top of the muscle you may see indentations or skin tethering from sutures placed to support the surgery.  Implants placed below the muscle can have a combination of shapes. This is due to the round implants & triangle shaped pectoral muscle combining shape to create an angulated/shelf appearance.  Along the bottom of the breasts the flatness may be related to sutures or that the implants have not descended. The important thing is that positive changes will continue as more time passes. If you continue with concerns discuss them with your surgeon.

Thank you for your question. Laser resurfacing of the face with an ablative CO2 laser can be performed under local anesthesia with sedation. Your surgeon can perform regional blocks and this combined with the sedation can allow the procedure to be performed safely and comfortably.

Thank you for your question. During lower eyelid surgery there are techniques that divide the orbicularis muscle along its lateral aspect to gain access to the orbital septum and fat pads. This muscle division is then repaired during the closure. Another lower eyelid surgery technique removes the fat without dividing the muscle but instead the muscle fibers are separated to access the fat that may not be completely accessible through transconjunctival approach. In the upper eyelid a narrow strip 1-2 mm of orbicularis muscle is removed in some techniques to help define the upper eyelid sulcus and to access the fat pads. Other techniques simply separate the muscle without removing any in order to access the fat pads. In general the thin muscle resection of the upper eyelid does not affect movement. In the lower lid there can be a loss of tone of the muscle and although this typically recovers it can contribute to lateral scleral show, lid laxity and changing the shape of the eye/aperture. Discuss your concerns with your surgeon in regards to the effect the surgery may have on your muscle exercises.

Thank you for your question.  The confusion with the "mini tummy tuck/abdominoplasty" is the multiple definitions you will encounter. Typically it involves skin and fat removal AND tightening of the fascia/rectus sheath from the belly button to the pubis. This implies that the majority of skin and fat excess is located below the belly button, that the bulging or looseness of the rectus sheath/fascia is primarily below the belly button and that the distance from the belly button to the pubis is of sufficient length that removal of the excess skin will not result in distortion of the belly button or excess elevation of the pubis. (ie you don't want a sad face belly button nor do you want your belly button right next to your pubic hair).  The length of the incision is not part of the definition and this length is related to the amount of excess skin and how it drapes along your lower abdomen. The main source of discomfort after the procedure will be the plication=tightening of the fascia/rectus sheath. This will be slightly less in a mini abdominoplasty vs a full abdominoplasty as the mini confines the plication to the area below your belly button while the full abdominoplasty performs the plication from the xiphoid (area where your ribs meet) down to the pubis.   You have shared you have a hernia. This implies there is some weakness to your fascia/rectus sheath and this will require repair.  Depending on where this is located (above or below) your belly button will also determine the extent of plication. Discuss your concerns with your surgeon and they will be able to illustrate how a mini vs a full abdominoplasty may appear in your specific case.