Great question, one that was asked of me many times by my own patients not so long ago, until I myself attained Board Certification. I will answer your question with the assumption that you are referring to plastic surgeons only, and not surgeons in some other, "non-core" specialty: - You become a Board-Eligible Plastic Surgeon when you complete both medical school and a plastic surgery residency. This can involve doing another residency first (typically general surgery for five (5) years), followed by three (3) years of plastic surgery. A "faster track" option is to do six (6) years of dedicated or 'integrated' plastic surgery residency. Others still might complete other residencies in Otolarynology (ENT), Oral Maxillofacial Surgery (OMFS), Orthopaedic Surgery, Neurosurgery, or even Urology before moving on to do their Plastic Surgery training. Folks that train in disciplines other than General Surgery before training in Plastic Surgery are quite rare. - THIS IS IMPORTANT: Board Eligible does NOT imply inferiority compared to a Board-Certified Plastic Surgeon. It just means that the BE surgeon still needs to complete (1) the Written Examination and/or (2) the Oral Examination for the American Board of Plastic Surgery (ABPS). We have a deadline of several years to do so after graduation from residency, otherwise one has to appeal and apply for a new eligibility 'clock'. Even the number one plastic surgery resident with perfect test scores, gifted hands, and nerves of steel coming out of Harvard or Johns Hopkins needs to go through this 'rite of passage' of Board Certification. - To be able to sit for the Oral Examination, one has to submit a portfolio of 'major' plastic surgery cases (a breast augmentation and an abdominoplasty both count), including all relevant clinical documentation, preoperative and postoperative photographs, with sufficient follow up (minimum three (3) months when I went through the certification process). The rules for the Oral Exam can change annually, but this applied when I underwent the process 2-3 years ago. - Once both the Written and Oral Exams are successfully completed, then you are considered a Diplomate of the ABPS and thus, a "Board-Certified Plastic Surgeon." To maintain certification, one has to stay up to date in the field and nowadays complete several online test questions annually, along with payment of fees to keep the certification current. In the past, individuals who got through their Boards were ABPS Certified FOR LIFE (grandfathered in), but nowadays our certifications last for ten (10) year cycles. You are fortunate to have two (2) surgeons working on you! It will make for a more efficient case with less operative time, which is better for your overall recovery. If the Board-Eligible plastic surgeon is collecting his or her cases to submit to the Board, then performing the breast augmentation will count toward meeting his or her minimum case numbers. You will have the more senior, Board-Certified plastic surgeon in the room to supervise and assist if necessary, which adds an extra layer of safety and oversight. With the usual breast augmentation taking anywhere from one (1) to two (2) hours, having that second surgeon there will enable him or her to assist the Board-Certified one with the tummy tuck, which involves a lot of suturing at the end. Again, the more skilled hands in the room, the better for you in terms of getting out of the OR and off General Anesthesia as quickly as possible. More sets of eyes in the room also allow for the team to evaluate your 'on-table' result and be satisfied with it before finishing up the case. For breast augmentation, you are often sat up while asleep, and everyone from the surgeon down to the circulating nurse and scrub tech all weigh in and offer their opinions about how your breast implants look. I always look up the education and training credentials of any physician or surgeon with whom I network or become connected. Doing so can give you a sense as to whether the Board-Eligible individual underwent rigorous residency training. But without knowing much more about the situation, the very fact that the surgeon is Board-Eligible is a VERY GOOD thing! It means he or she is on the cusp of becoming Board Certified. Plastic Surgery is arguably one of the HARDEST fields in medicine in which to become Board Certified, and on a "good" year 80%+ will pass the Oral Exam (meaning up to 20%, or 1 in 5, can fail). I have several colleagues this past year alone, all of whom are very smart and talented, who did not pass and will have to try again...it by no means implies that those individuals are BAD people or BAD surgeons. We exist in a competitive profession with exceedingly high standards of safety, efficacy, and ethics. Many plastic surgeons in practice take longer than 1-2 years after residency graduation to become Board Certified, particularly if they completed further advanced fellowship training. Someone who became certified one (1) year after residency graduation, without having done any fellowships, might have less extensive experience or confidence in a particular operation than someone who did advanced training in plastic surgery (among the subspecialty fields are craniofacial surgery, hand surgery, microsurgery, aesthetic surgery, and burn surgery). For all of the above reasons, it is important to DO YOUR HOMEWORK and know as much as you can about the surgeon(s) who will be doing your operation, and importantly, whether you TRUST them. Personality and rapport are huge in our profession in establishing and building trust with patients. I encourage you to go to the ABPS website to determine your surgeon's Board Certification status and to learn more about what "Board Eligible" means. [Having been Board Certified by the American Board of Surgery (ABS - dealing with General Surgery) is NOT the same thing as being Board Certified by the ABPS (Plastic Surgery). Many surgeons out there will either lie by omission or try to give a false impression of what their "Board Certification" means, so be very careful in judging a surgeon's credentials!] I hope all of this information helps you feel more at ease! Best wishes with your upcoming body transformation! I hope you have a smooth operation and even smoother postop recovery.
Considering what was done for you, and depending on what your overall goals were going into surgery, your result is reasonable. Your preoperative photos - I am assuming the first two - demonstrate a significant breast asymmetry with ptosis (drooping) on your Left side (assuming your phone did not flip the image on "selfie" mode). In my hands, I would not have offered augmentation alone with the discussion of a concomitant versus staged mastopexy (breast lift). A common move - or mistake - that surgeons do (sometimes at the express request of the patient) is to offer breast augmentation with implants alone in the hopes of filling out a sagging breast. This can work for mild (Grade 1) ptosis but not the situation that I see with your Left breast, which arguably shows Grade 2 ptosis on the 3/4 (oblique) view photograph. You are right that the implants have exacerbated your wide cleavage that was apparent preoperatively. Your surgeon's implant choice was not unreasonable - selecting a very wide implant may have compromised on projection, whereas your surgeon selected a narrower implant which enabled a high profile (projecting) to instead account for the 475cc volume. The bottoming out on the Left is not unexpected as you had a ptotic Left breast to begin with. The animation deformity is also not unexpected, but I wonder if your implants were placed with complete muscular coverage or instead placed in a Dual Plane fashion (muscle coverage along the upper portion of the breast, and subglandular coverage along the lower portion - the extent of Dual Plane depends on the extent of breast pocket dissection). The more muscle stays intact over the implant along the lower aspect of the breast, i.e., along the inframammary fold, the greater the likelihood you would experience animation deformity postoperatively. Again, your result is not unreasonable, having undergone breast augmentation alone without a mastopexy. I would live with your current implants before considering an implant exchange and revision mastopexy at a later time in your life. Whatever you ultimately do, stick with a Board-Certified Plastic Surgeon who is familiar with a variety of techniques to address your breast anatomy and current set of implants.
Thanks for your question and photographs. There is not necessarily anything "wrong" with your eyes. EVERYONE has eye and eyelid asymmetry. Your situation is just more noticeable than you might see with your friends, family, or peers. For one, the facial skeleton is asymmetric side-to-side, and that can affect the structure of your eye socket, which houses the eye (also called the globe). Our eyes have varying degrees of prominence, or the degree to which it seems to bulge from the eye socket (also called the orbit). Often-times globe prominence is genetic or hereditary. For example, I am of South Asian heritage, and many of us from that region of the word have relatively prominent eyes. Another thing that is worth knowing about is whether you have underlying thyroid disease. If you have never seen your regular primary doctor to discuss it, it may be worth having a medical workup, as conditions such as Grave's disease (a thyroid problem) can create visible globe prominence to one or both eyes. I see that you have a significant degree of scleral show below the colored part of your eye (the iris). I share the same issue. This can indicate globe prominence, but to know for sure one should measure your eyes with a device called a Hertel exophthalmometer, which any properly trained oculoplastic surgeon carries in his or her office. The Hertel measurements, as well as side (lateral) views, are helpful to give numerical data to confirm or rule out globe prominence. NEVER undergo oculoplastic surgery, such as eyelid surgery (blepharoplasty), particularly to the lower eyelids, without FIRST having someone make these determinations and measurements. You should see your primary doctor to determine if you need a workup for thyroid disease and need to see an Endocrinologist, and you should see a Board-Certified Plastic Surgeon or Ophthalmologist who has additional subspecialty training in Oculoplastic Surgery. I hope this information and advice helps you! Stay safe this holiday season.
While there is a planned sequence to any plastic surgeon's breast augmentation, there is always a theoretical risk of implant injury as it is being placed into its breast pocket. The most likely culprits of implant damage during surgery would be sharp or metallic instruments, such as scissors, skin retraction hooks (which have sharp ends), tissue forceps, and even smooth retractors (such as ribbon retractors, or Army Navy retractors), which is pushed up against an implant with enough force, can induce enough pressure to weaken the integrity of the implant shell, leading to a rupture. A silicone rupture is not nearly as concerning as it was with older generation implants, as the silicone is much more form stable and cohesive (the way the molecules of silicone bind or cross link to one another). If a rupture were to happen, chances are that a patient would not have symptoms and that the gel would nonetheless stay contained within the implant shell, as implants nowadays are 5th generation with 'gummy' characteristics. A saline rupture would be evident immediately or over the course of a few days, as saline would leak out the implant, and the appearance of the ruptured side would look as if no implant were placed (i.e., look deflated), while the other side would remain augmented. A bilateral rupture would be highly unlikely from accidental instrumentation during surgery, but it could in theory happen if bad technique were applied equally to both sides.
The short answer is yes - you are a good potential candidate for a bilateral lower blepharoplasty (lower eyelid lift). However, the long answer depends on many factors, including your health history. This can include whether you have endocrine issues such as thyroid disease or diabetes or other autoimmune condition, and whether you have chronic dry eyes or had recent LASIK surgery (within the last 6 months). In someone as youthful as yourself, many might offer non-surgical options to address your deep tear troughs, or those creases along the lower eyelids that make you appear tired. You likely have those inherited from your Mom or Dad. Non-surgical options would likely entail use of HA (hyaluronic acid) filler, but you must be careful, as satisfactory and safe placement of filler requires experienced hands. Additionally, HA fillers are not a permanent fix as surgery is. I had a gentleman with your same problem, but I performed his operation when he was much older - in his 50s/60s. Being 25, you have to ask yourself whether it is worth the time and expense to go through a significant operation such as a lower blepharoplasty, which is typically done under either IV sedation or general anesthesia. Some might offer to perform it under local anesthesia, but I would not recommend it - there is more involved in this procedure, such as fat removal/redraping and judicious skin resection, than the skin removal typically done in an upper blepharoplasty (eyelid lift). Seek a Board-Certified Plastic Surgery, preferably with experience and training in Oculoplastic Surgery, to conduct a thorough periocular and facial aesthetic examination to get the best treatment plan for you.
