Luke J. Curtsinger, MD

It is difficult to assess your asymmetry on the picture because of shadowing, but I think that I see some heaviness just above your nasolabial fold.  The treatment could involve some conservative liposuction along that line.  Facial aging is often a combination of sagging and volume loss, and the optimal treatment of facial aging often involves correction of both.  I am sorry that your volume restoration was less than you hoped for, but improvement is likely possible.  

I recommend that your present your wish pictures to a BC PS for an evaluation. Once you get an idea about the volume desired (I like for patients to try on implants), then the critical factor is that you then pick a base width that complements your goals. That is the best way to pick the profile, no matter what Marketing name (like ‘high’ profile) that the implant company has placed on that implant. 

If your doctor is on vacation, there should be a mechanism to get your questions answered. Your doctor probably has coverage, either a nurse in his office, or coverage by another PS. Call the office and get your questions answered to your satisfaction.  

See your PS. If this is developing in the second year, it could be signs of capsular contracture. Other possibilities include a late seroma. Radiation increases the chance of capsular contracture.

That doesn't look like a bruise.  More like a rash that could be fungal or hypersensitivity rash.  Additionally, you are now getting some dark, hyperpigmentation spots.  That can be toned down with some hydroquinone, but I think a dermatologist would be ideal to help make a proper diagnosis.  

Most implants start out 'high and tight', and over the first 3-6 months they almost always drop down and forward into the breast envelope, which looks much better.   I would agree with the breast band, to help this happen.  Trans-axillary breast augmentation does seem to have less predictability on the pocket matching the fold.  Give this some time and the band and let it settle first.  

I am sorry that you did not get the size that you want.  I believe that your doctor was concerned about the blood supply to your nipples and breast flaps.  The more that these are 'thinned down', the greater chance of poor healing or necrosis.  It is challenging to take a very big G breast and make it very small.  I would give it 6-12 months, but in the mean time, you can communicate your wishes to your PS.  Some additional reduction is possible after things have settled down.  

The transverse scar of breast reduction is usually placed at or near the fold, and then as the breast settles, it can migrate up or down a little.  Better too high of a transverse scar, than too low, which is more likely to migrate out of a bra or bathing suit.  I am not sure about your pain.  I dont think that the scar is 'causing it', but with the previous implant surgery followed by reduction, there are more than one possible causes.  I believe that you should evaluate this with your PS.  

I have managed to do several breast lifts and reductions under local with sedation, but it is a struggle to keep the patient comfortable.  I would recommend that you go over your fears of anesthesia and the risks and benefits of both choices with your PS.  If the patient is comfortably un-aware, the surgery procedes smoothly and quickly. Give me a well planned, well controlled, general anesthetic by an experienced provider any day.   

Most women find the trade offs (scarring, perioperative pain) are far and away worth the benefits (decreased back pain, neck pain, shoulder pain)You need to clarify your history of scarring with your PS.  Many patients dont have keloids, but hypertrophic scarring, which is easier to manage.  Either case, these scars can usually be managed well to make the procedure worth the risk.