Matthew Zeiderman, MD

Looking at your photo I'm guessing you had preoperative asymmetry of the breast fold/lower border as well as where the nipple is located. Your incisions are probably at different "heights" because the base of your breast is at a different height on your chest. Breast implants can make pre-existing asymmetries more obvious. The left sided implant could be lowered a bit to improve the asymmetry. You should speak with your surgeon again or seek a second opinion.

These are good questions and concerns. First, it's important to understand that a skin only facelift can also have hematoma, hardness, and tightness. That is a risk with any facelift procedure. A skin only facelift has a greater tendency to relax more quickly and scar poorly because there is no additional support or lift from the deeper SMAS layer, which is the strength layer for a good face and/or necklift. Not every patient needs a "deep plane" facelift. There are many different techniques, which one is best for you is a conversation to be had with the surgeon who can assess your individual needs.

Looks like you've done your research. I've found Morpheus8 to be helpful for patients with mild malar edema and that would be a good place for you to start. Doxycycline injections are a reasonable option, but like anything results are variable and a lot of patients get very inflamed for a week or two.

At 34 you're a little on the young side, but a "mini" facelift could be an option to correct some of the early jowling you have. There's also a little bit of volume loss in your cheek. If you'd prefer to avoid surgery, you could also look into some filler along the jawline and in the cheek to help refine some of the facial contour and slightly "lift" the jowling tissue. IF you're not a skin care regimen, I recommend meeting with a medical aesthetician. Good skin care goes a long way for maintaining a youthful look and healthier looking skin.

Thank you for the question. You have plantsman bands which come from a thin muscle in your neck. We don’t know what it creates bands. Botox may provide some help, I’m guessing you’ll find it unsatisfactory for your needs and will really need a anterior platysmaplasty (isolated front next lift) or a neck lift or Mini face lift depending on hoew your lower face and jawline looks, overall, I suspect your best result will be surgical.

Easy answer. Fat transfer to the hand. Permanent, fast procedure, minimal scarring, and can be done under local anesthesia only. Much longer lasting result than juvederm or other fillers.

Good question. Limited incision to arm pits for arm lifts only work for a very small subset of patients. The vast majority of patients with a bat wing deformity won’t have a good result with an excision only in the armpit. These are ideal candidates or perhaps sensationalized results? It’s hard to say without seeing what’s posted.

Good question. You are a good candidate for a lift. It usually take about 2 hours to perform, but this depends on your surgeon. The method of anesthesia is also a matter of discussion between you and your surgeon. “Twilight” may me an option but this is often surgeon specific preference.

Thanks for the question. The size of implant you can accomodate depends on how wide your chest is, which requires measurement. From looking at your photos and height I'd imagine you could have a 500cc+ implants that will fit. a 500cc implants on top of the muscle will be much more likely to drop and "bottom out" much faster than an implant under the muscle. Implants under the muscle usually don't drop like that so there is less long term stretching of the skin. implants under the muscle also have a lower rate of capsular contracture. These are reasons why more plastic surgeons recommend under the muscle. Recovery time with under the muscle is only slightly longer (usually only a few days, maybe a week or two) but in my experience worth it. Hope you find that helpful.

You could certainly have a one stage procedure with implant and lift. I don't see why a mesh would be needed for you if you haven't had implants before. The base width of your breasts is quite narrow so there are limits to how large of an implant you can have. Implants and lift at the same time is very common but does carry a higher risk of needing a revision because you are doing two procedures at once. Perhaps that is why one surgeon suggested a two stage procedure.