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Hi!
Great question. Fillers that are used on the lips (usually Hyaluronic Acid) remains being a cohesive gel after injection. The body will produce a mild inflammatory reaction to contain it which result in a stable position of the gel while the body degrades it. So, YES, a significant trauma can shift the gel to a different position. 
Best,
Rafael Ramos Vecchio MD Plastic and Reconstructive Surgeon Coral Gables, FL

If you get lip fillers rather it’s a thick or thin one and you get in a car accident or punched in the lips will filler leak out If you get lip fillers regardless if it’s a thick or thin filler an get in a car accident and recieve trauma to the mouth and lips or hit in the face with a football from high impact or any trauma to the lips that is high impact will filler leak out the lips? Or is this only when the filler is fresh that this is a risk of it leaking out under these circumstances? Or does the filler integrate with natural lip tissue hence it wouldn’t leak out?

If you are hit in the lip area does filler leak out?

Hello! I hear your concerns. Internal scaring and fibrosis is a real struggle for both patients and surgeons because it can be unpredictable in the long term. Steroid injection can decrease the amount of scar burden but it can be a double edge sword. the same way it thins down the fibrosis, it can spread an thin out adjacent healthy soft tissues or skin. A rhinoplasty surgeon should do a physical exam to determine if the amount of fibrosis and the location is susceptible to treatment with injected steroids or requires a surgical revision. I would not aim to get the steroids from anyone different than a plastic surgeon focused on rhinoplasty or face aesthetics.
Best!
Rafael Ramos Vecchio MD Plastic and Reconstructive Surgeon Coral Gables, FL

I’m a 29-year-old male, 6’1” tall and 93 kg. I had a septoplasty two years ago, during which no nasal packing was used. Following the operation, I developed two haematomas around the nasal tip that went undiagnosed for about a week before they were removed. Since then, I’ve developed internal fibrotic tissue within the nasal tip (not on the surface), which has caused persistent swelling and a bulbous appearance. I’m wondering whether Kenalog (triamcinolone) or similar corticosteroid injections could help reduce the internal fibrosis and restore my nasal tip to a more normal size and shape.

I’ve developed internal fibrotic tissue - How to fix this bulbous tip? (Photos)

Hi! Thanks for sharing your concerns. When the surgeon gives a recommendation on implant size there is a thought process behind it. It includes measuring the distance between the nipple and the inframammary fold, the with of your breast and ribcage, the position of the nipples within the breast and the elasticity of your tissues. 
It's difficult to make an accurate judgment based on a photo, but you are tall and young and your skin skin will likely adapt to that size. It's not an unreasonable volume, but the bigger you go the greater the changes your body will go through in the short and long term. 
Best wishes! 
Rafael Ramos Vecchio MD Plastic and Reconstructive Surgeon Coral Gables, FL

i am 5’8 and 133 pounds. i currently have aa/a cup breast and was told i can choose between 375/400/425cc implants. i went with 425cc but am worried i dont have enough breast tissue for that implant size. any thoughts are so appreciated!!

AA cup (i think) and want to be full C or small D - do I have enough breast tissue for 425 cc? (Photos)

Hi! A better exam and more questions about the behavior of this is needed. Best case scenario you have been rejecting the suture material they could have used to reduce the width of the base of the columella and creating granulomas that end up draining to the skin. Worst case scenario, you have a chronic infection of the cartilages they manipulated during your surgery. This can only be treated by a combination of antibiotics and a surgical procedure where they remove the infected cartilage and wash profusely. Getting cultures from the tissues and drainage is also important to find the right medication to treat it with. 
You should visit a rhinoplasty surgeon in person to get a better assessment and treatment plan.
Hope this helps!
Rafael Ramos Vecchio MD Plastic and Reconstructive Surgeon Coral Gables, FL

I underwent a septorhinoplasty in January 2022, everything went well and I thought I had healed fine. Fast forward to December 2023 and the inside of one of my nostrils was getting itchy, which then developed into scabs and leaking a green and then clear discharge. My nose was also noticeably swollen. I did realise that the scabs seemed to be along where my incisions were. It did eventually go away within about 10 days. Fast forward to now (Oct/Nov 2025) and the exact same thing is happening again. I did get in contact with my surgeon the first time it happened and he recommended a cream to put on it (that wasn’t available in the UK). Can anyone advise on what exactly it could be and should I be concerned about it?

Recurrent scabs with green discharge nearly three years after my septorhinoplasty. What could be the cause of this? (Photos)

Hello!
Thanks for sharing your concerns. 
When we do a breast lift we are reducing the size of a 3D shape, treating the side-to-side excess (with a vertical incision), the up-down length (with a horizontal incision at the breast fold) and sometimes we need to reduce part of the content tissue to make it fit on the new lifted position. 
In your case, the up-down excess seems to be predominant (the long distance between the nipple and your bottom fold). I don't see a problem with do a limited skin reduction at the bottom fold without changing the rest. There is a trade-off though: The breast shape will change from being round to being oval in a side-to-side direction as this lenght wasn't changed. With time it will probably round up again.
So answering your questions, yes, it is possible with some trade-offs that your surgeon could explain in person with a good exam.
Hope this helps!
Rafael Ramos Vecchio MD Plastic and Reconstructive Surgeon Coral Gables, FL

Why can’t i jusy have a cresent lift with the incision on the lower or something less invasive than a full lift again to fix the retained areola from previous lift? I don’t want to loose more sensitivity. My precious lift was in 2020 with auto augmentation (own tissue) no implant and lollipop. I don’t need my areola reduced more and I don’t need them any hire. I am not oppsed to the anchor pattern I just don’t want to have healing issues and loose more sensitivity I barely have any now as is.

Breast lift revision - can I have something less invasive than a full lift? (Photos)

Hello! Thanks for sharing. What you are seeing is the result of your natural tissue gravity pull with an implant that is fixed in a static position, likely under the muscle. We call this waterfall deformity. Yes, after 3 lifts, the risk of compromising the blood flow to the nipple/areola goes up if they aim to do an aggressive lift. If the concern is more about the vertical distance between the implant and your breast tissue, it would be worth it having a discussion about changing the plane in which the implant sits. An implant that sits in front of the muscle tends to age more naturally and descend in closer proximity with the rest of the breast tissue. The shape of the breast tissue can benefit from extra refinement but understanding there might be limits due to your surgical history. 
Hope this helps!
Best,
Rafael Ramos Vecchio MD Plastic and Reconstructive Surgeon Coral Gables, FL

I’ve had a lift in 2023, then implants and another lift 2024, then another lift in April of this year. I don’t think k it was aggressive enough any of the times but now I’m going next Thursday for another revision and my surgeon says it won’t make any difference and they can’t do an aggressive lift because they’re worried about the tissue and nipple

Implant separate from breast - will a lift help? (Photos)

Hello! Thanks for sharing your question. The procedure you are referring to is called reverse abdominoplasty, when we remove the skin excess from the upper part of the abdomen right at the inferior breast fold. This procedure is ideal for patients who had most of the laxity above the belly button, have had or plan to have breast surgery with a scar at the fold and patients who don't wish to change the belly button. 
Bringing the muscles together to the midline is optional but most patients benefit from it both cosmetically and functionally. Having a super flat abdomen depends also on the volume inside the abdominal wall and sometimes is hard to achieve in some patients, independently of the muscle approximation. 
Regarding your previsou scar, a conventional tummy tuck might be sufficient to remove it, either completely or partially and hide the lateral tail near the groin, depending on the laxity of the skin.
Overall in your case, with the limited information, I consider a conventional tummy tuck will better address your abdomen including, skin tension on the lower abdomen, concealing of scars, abdominal wall repair and belly button quality.
Hope this helps!
Rafael Ramos Vecchio MD Plastic and Reconstructive Surgeon Coral Gables, FL

I’m an RN researching a tummy tuck. I’m smaller framed 5’2, 110 lbs, I had 3 pregnancies, no Csections. I don’t need muscle repair it’s pretty much skin. I don’t reallly want a super tight flat tummy, I’d like to look natural. Can skin be lifted Close to under the breasts just to remove skin? I did have an abdominal surgery that left a horizontal Scar next to my belly button. Thank you for your opinions and recs.

Early Tummy Tuck/loose skin research - can skin be lifted close to under the breasts? (Photos)

Hi! Hope you are well. Glad to hear you are working on your health and weight loss. Big steps for overall health and quality of life. Most important part would be achieving your ultimate weight goals for a more precise facial enhancement. You seem to have a good idea already. Beauty is subjective and you will hear many different things from each provider. I would say rhinoplasty is a good start, followed by restoring the volume of the midface (cheeks). Jawline enhancement will aim to masculinize even more your features. Hyaluronic acid filler would be a good alternative to cheeks and jawline during your weight loss process. Fat transfer will follow to some degree the variations in weight, so better leave if for the end of your journey once your weight is stable. 
Hope this helps.
Dr. Rafa Ramos, MD Cleveland Clinic-trained Plastic & Reconstructive Surgeon Coral Gables, FL

Hi, I’m looking for honest, professional feedback on my overall facial aesthetics and proportions. I’d like to know what treatments or procedures (surgical or non-surgical) could enhance my facial balance, symmetry, and profile — while still keeping a natural look.i I’m open to suggestions such as rhinoplasty, chin or jawline enhancement, filler, Botox, or skin treatments. Please let me know which areas could be improved, which features are already balanced, and what would give me the best aesthetic result overall. I’ve attached front, side, and angled photos for reference. Thank you in advance for your time and honest input (Also im currently working on losing weight right now I’m 210 pounds looking to hover around 170 6ft male)

Facial aesthetic analysis - what improvements would best suit my face? (Photos)

Hello! Thanks for sharing your concerns. To explain the asymmetry of the upper face, we have to separate in 2 components: The shape and position of underlying bony and eye structures and the skin and muscles on top of it. From this limited POV I would say that most of the difference is due to where your orbits (eye sockets) are located and the shape of the overlying bone underneath the brow. 
While modifying the position of the brow could improve to some degree the asymmetry, I would advice trying less invasive interventions before commiting to a unilateral brow lift to give you an idea of how it could look. A meticulous aesthetic provider can design a very customized neurotoxin application to balance your brows. If you like it (or not), you can use it to make a better decision on a surgical Lateral brow lift.
Hope it helps,
Dr. Rafa Ramos, MD Cleveland Clinic-trained Plastic & Reconstructive Surgeon Coral Gables, FL

I am getting a rhino done soon to fix dorsal hump/improve crooked nose and I am wondering if it would be worthwhile to do an eyebrow lift for the one side to even out my eye lid shape. I am trying to make my face more symmetrical as it is a bit uneven.

I am trying to make my face more symmetrical. Should I have a brow lift for one side? (Photo)

Hello!
I can see you have very fine (limited assessment) lines on your upper eyelid. You seem to have an otherwise young looking face. These are common and don't usually make a significant impact on your appearance. If you would like to pursue improvement, different modalities of laser can soften those andmake them less noticeable. It's important that you visit a facility with well trained providers to avoid injuries to such delicate skin and eyes. 
Hope this helps!
Dr. Rafa Ramos, MD Cleveland Clinic–trained Plastic & Reconstructive Surgeon Coral Gables, FL

Hello I would like to know if there is any procedure out there that will get rid of these lines in the inner corner of my eyelid

Is there any way I can get rid of these lines in the inner corner of my eyes? (Photos)

Rafael Ramos Vecchio, MD

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Dr. Rafael is a wonderful surgeon and an even better person. The professionalism and kindness that he showed me throughout and after the surgery was amazing. Checking in to make sure I was healing properly, answering questions that may have seemed trivial, but brought much ease when the answer was received. The results of the surgery are fantastic and he helped me achieve the final body I wanted after my weight loss

Perfect Blend of Professionalism and Kindness. Perfect Result

Rafael Ramos Vecchio, MD

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