Robert Nemerofsky, MD

Unfortunately, antibiotics will not correct the issues you are having right now. You appear to have a chronic low grade infection. The only solution is to remove the implant at this time, resolve the infection, and then in 3 to 6 months undergo a reconstruction which may involve tissue expanders followed by implants. I would schedule a follow up appointment with your plastic surgeon now.

There is a lot of confusion between Botox and filters Botox is a paralyzing agent. Therefore, if you have wrinkles with grimacing or facial animation, Botox may help. But if you have deep folds like nasolabial folds or wrinkles when at rest, Botox will have no effect and could possibly make things worse. A hyaluronic acid filter, like Juvederm or Belotero, would be more appropriate.

Ultherapy is not performed directly in the eyelids. It may be performed directly over the eyebrows. Which will help raise the eyebrows, will will take approximately 3 to 6 months to get the final result. If your eyebrows are dropping laterally, sometimes a little Botox under the lateral brow may help. Otherwise, simply waiting 3 months when the Botox losses its effectiveness is the only solution. Botox cannot be reversed with an injection

I am uncertain when this picture was taken in comparison to the date of your second surgery on June 14, 2018. In general, there is frequently some delayed healing after having extensive reconstructive surgery like you had, i.e. mastopexy, excision of fat necrosis, liposuction, and fat grafting. If this photograph was taken on June 15, 2018 or you have no sensation postoperatively compared to preoperatively then I would be concerned. If you still have sensation and this photograph is more than 3 days postoperatively then I would be less concerned and the risk of nipple loss is almost nil. In my practice, I like to use Venelex ointment twice a day and have found good results. It is possible, that you may have some local skin loss along the incision line, but this can be treated with local wound care.

After reviewing your pictures, in my opinion it would be very difficult to attain the final result you desire in 1 procedure.

• Your surgery was performed 13 years ago and thus your skin has significantly retracted and is likely adhered to the underlying muscle.
• It seems that you desire breasts on the larger side such as a full C.
• Your nipple areolar complex are uneven on both sides and asymmetrical.