Mary Ghere, MD

I echo some of the other surgeons, in that it is difficult to fully assess a picture.  However, I think you are are the right track and that submental lipo and some skin tightening will help.  On initial glance and without seeing the entirety of your face, you may also need augmentation of your chin.  This can be done in several ways and I would discuss with your plastic surgeon.  The chin position must always be examined in context of the jawline and neck.

FaceTite can certainly be very effective in this area.  I would not expect full correction.  You may be better served with a face lift.  Depending on the particulars of your situation, I would try Facetite and give it 6-12 months.  If you are not satisfied at that point, I would consider  a facelift.

Like a lot of things, pain is very much an individual patient specific thing.  I often have patients that do not need narcotic pain medication.  Quite frankly, that is my preference.  The sooner you can be off of prescription medication the better.  Having said that, in the first week you may find you need it, and I would not hesitate to use it in the immediate post operative period.

You are correct that wound healing problems are not uncommon with breast reduction surgery.  With breast reduction surgery the breast are completely rearranged and the blood supply to the breast parenchyma and the overlying skin can be altered.  Additionally swelling after surgery can further compromise blood flow temporarily.  It is these temporary changes in blood flow to certain areas (often the T zone due to the multiple incisions) that set up an environment that leads to wound break down.  The good news is that generally these heal very well and will just require some local wound care for a while.  Widened scars if they are present can be revised to be more cosmetic usually under local anesthesia in the office.

So it is difficult to truly know with out examining you.  Mosts states have height and weight requirements to determine insurance eligibility for a breast reduction. I would want to know what that amount was in you to know whether I thought that would be reasonable for your body habitus and goals.

Otherwise,

Some of it is really semantics.  With most lifts there is a slight reduction/removal of breast tissue, in a breast reduction there is just more.

You minimally need the lift/mastopexy and depending on the type of breast your have (density etc) you may need more or less tissue removed.  

These are two of the most commonly performed breast procedures and a plastic surgeon should be able to readily answer your questions.