Prashant Soni, MD

I generally find the back rolls improve with liposuction. There is a fair degree of skin contraction that occurs over time. I avoid laser assisted or ultrasound assisted liposuction here as it can lead to burns and seroma even though they may improve skin contraction. Don’t expect complete smoothness in this area, but the results are better than skin excision which leaves a large scar. Best regards, Prashant Soni M.D. 

based on your pictures, I would also have tried Botox first. Assuming that was ineffective at the appropriate doses(30 to 40 units), then it may be time to consider a lift. A true neck lift will tighten the muscles under the chin and often remove skin from behind the ears. After this is done, I still recommend Botox to the neck muscles every 6 months to keep the muscles from separating as time progresses. Discuss these options with a board certified plastic surgeon. Best Regards, Prashant Soni M.D.

It may be possible to open up your upper lids with an upper blepharoplasty. Another option is to use Botox to create a subtle brow lift. Possibly a combination of both is ideal. An office consultation is necessary to decide the best option. The narrowing of  your eyes  also seems to be due to thickening of the muscle called the orbicularis oculi. A little bit of Botox, placed in the appropriate area of the lower lids is a great way to soften the muscle ridge that forms when you smile and also relieves the narrowing of your eyes. Speak to a board certified plastic surgeon that has experience with surgery and Botox.  Best regards, Prashant Soni M.D. 

my first impression from looking at your photos is that you are a good candidate for an open rhinoplasty approach. Your dorsal hump can be reduced and the nasal tip can be refined under direct vision. The open approach also allows for fixation of  the nasal shape with sutures and decreases the risk of asymmetries forming due to movement of the cartilage during the healing  process.  Make sure you don’t need any septal surgery for an undiagnosed deviated septum that can result in a twisted appearance once the dorsal hump has been lowered.  Make sure your surgeon is board certified in plastic surgery and has photos of actual patients to review with you. I also like to have patients bring photos of noses taken from magazines or social media  that reflect the patients desired appearance.This is a useful guide to me during the operation and helps me guide the patient toward realistic expectations. Best regards, Prashant Soni M.D.

this separation is present at the time of the surgery with most dorsal hump reductions. Nasal bones are fractured to close this gap in proportion to the degree of narrowing that needs to be accomplished at the time. The soft tissue generally blends the transition between the bone segments. If the bones had been overnarrowed, then the bone separation may be less palpable, but the nose would likely appeared  pinched or deviated. Best regards, Prashant Soni  M.D.

you do appear to have actual ptosis of your eyelid on one side. This asymmetry is also causing compensatory elevation of the opposite eyelid and the eyebrow of the affected side. The eyebrow asymmetry can be improved with Botox but the eyelid requires tightening of the loose muscle that elevates the eyelid and maintains the resting height of the eyelid. Once this is done the brows and opposite eyelid usually settle and then it would be okay to commit to microblading. Seek a consultation with a boardcertified plastic /reconstructive surgeon or oculoplastic opthomologist for a complete evaluation.

All necks have 3 components that are affected with age. These are skin laxity, fat accumulation or  fat descent in the neck and jowls  , and platysma muscle banding. Your main issue appears to be fat descent in the jowls and muscle banding. You appear to have very little excess fat in the neck. Before you consider a neck lift speak to a plastic surgeon to see if spot liposuction of just your jowls and botox to your neck muscles is right for you. Combine these office based procedures with facial  fillers to the laugh lines and you could achieve a significant improvement. Also remember that evaluation and treatment by a board certified plastic surgeon is the safest option for any cosmetic treatment or procedure. Best Regard, Prashant Soni M.D.

I usually use the incision along the bottom of the areola. This incision gives excellent access to release the constricting bands that cause a tuberous breast. It also allows me to redistribute the protruding breast tissue within the areola area itself. Lastly, if the areola needs to be narrowed or lifted,  you will be having incisions around the entire areola anyway. There is no need to create another scar if the areola has one already. These points apply to tuberous breast surgery with or without breast augmentation as well. Best Regards, Prashant Soni M.D.

at this stage, you appear to be healing well. Swelling will continue to recede up to 4 to 6 months after surgery. After that, it is often useful to use fillers such as Belotero in the tear trough. Residual fine lines may benefit from a chemical peel. More skin removal is not usually helpful for that. Lastly, any lower lid buldging or wrinkling that happens when smiling can be smoothened with Botox placed in small doses at the tear trough level. Give it time before you try these steps. Best Regards,Prashant Soni M.D.

even though you are not symptomatic, you should see your primary care doctor and get a referral to a cardiologist. Anesthesiologists will be much more comfortable providing anesthesia  during your case if you have a proper work up. I also would consider doing your surgery in a hospital outpatient operating room instead of a stand alone outpatient operating room. Should you need to be monitored after you surgery overnight, you would conveniently be in the hospital already. Best Regards, Prashant Soni M.D.