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.

I would continue my search for a qualified plastic surgery that you feel comfortable with.

The general answer to this question is yes, with fat injection or fat transfer However, in your specific case, I'm not sure that would be the best approach. First of all, you are treating an area that is obviously susceptible to keloiding on your body, therefore, any trauma to that area be it cutting, piercing, or fat injections may result in development of further keloiding. From the pictures, it seems that the redness is what makes that defect most obvious. In this situation, I would recommend Laser Genesis by Cutera. It is a non-ablative laser and usually requires between 3 and 6 treatments each one being less than 5 minutes. This should improve in not completely remove the redness. I believe this would make you much happier with fewer risks than undergoing fat transfer.

Ripped earlobes will require surgical intervention to repair. Fortunately, this can be performed in your surgeon's office under local anesthesia and you can drive to and from the office without a driver. Typically, I repair the entire defect and then two weeks after the repair I would repierce the ear.

Numbness in the scalp after Ultherapy treatment to the brow region is due to irritation of the supraorbital nerve which is purely a sensory nerve and has no motor function. Unlike surgery, there is no cutting and thus the risk of any permanent injury is almost nil. Ultherapy works by generating heat beneath the skin to help stimulate collagen, unfortunately the supraorbital nerve is very close to the area being treated. The nerve can sometimes be irritated or bruised as a result. The fact that it continues to improve after 6 weeks, means that it is NOT permanent. Nerves can take up to 2 years to completely heal, but this is usually from a complete transaction. I typically do not give steroids to my patients for this and simply assure them that it will improve. I know it can be troublesome and worrisome for you as the patient, but this is not uncommon. In fact, I tell all of my patients that you will have some discomfort in the scalp region after the procedure, but it will eventually resolve. In the 7 years that I have been performing Ultherapy I have not had any permanent nerve injury. 

Despite everything you may read on the internet, in my experience most of my patients tolerate the Ultherapy treatment very well without any medication at all. That being said, if I believe the patient is very sensitive, I prescribe Valium (Diazepam) 5 mg and Percocet 5/325 prior to the procedure. I would stay away from aspirin or aspirin containing products as some of my patients have had mild to moderate bruising with these products. 

Technically speaking, you can undergo surgery during your second trimester of pregnancy. That being said, I would strongly recommend not having the final stages of the reconstruction performed at this time. Given the multiple discrepancies between the two breasts and in order to obtain the optimal result, the surgery would be quite long. Despite anesthesia being "safe" during the second trimester, to put you and your baby at unnecessary risk for an elective procedure is unwise, and I wait until several months after your delivery and your female hormones return to baseline. In regards to the pain, your surgeon could remove some of the saline in the office and this might give you great relief.