S. Larry Schlesinger, MD, FACS

First question to be answered is, are your breast implants above or below the muscle? The top of the left breast shows the edge of the implant in the upper one-third. This almost always indicates a capsular contracture, but most importantly, pain and hardness are the two most common signs. I agree with the previous responder that an in-person evaluation will give you the quickest answer.At first glance, I would say you have a left sided capsular contracture, and more than likely a Baker III. That means both you and your surgeon agree that your breast is hard. A second eval from a Board Certified plastic surgeon would be advisable. The sidebar comment is that, if you are getting Singular as a treatment for possible capsular contracture, then you're wasting your time since Singular has a terrible record and has been "Black Boxed" by the FDA. Using zifurlukast (Accolate), an AstraZeneca product, has the greatest chance of softening your breast. However, a more modern 21st Century approach would be to find a Board Certified plastic surgeon with experience in PRP treatment for capsular contracture. If the PRP is transmitted into your tissue using a collagenizer, this will allow you to get the treatment without any incisions or surgery. Using PRP and Accolate is the simplest, least painful and least chance of recurring encapsulation.

Hi Emily. Your retrusive mandible can be corrected by facial injections. The retrusiveness of your mandible does not allow you to close your mouth naturally, and this causes the closure of the lower lip to have a forced look which makes you look unhappy. The reason for the problem is that the two muscles on either side of your anterior jaw called mentalis muscles have the job of closing your mouth by pushing up your lower lip. This normal closing process is inhibited when the profile of the mentalis muscles are not in line with your lower lip. This anatomic mumbo jumbo, in short means, when the lower lip and the chin are not in the same vertical plane, the lip won't close naturally. If you were my patient, I would do an injection of Volux, an Allergan product that lasts in my experience over a year, and sometimes up to two years. It usually takes 2-3 ccs to correct the retrusive chin. This can be done in an office setting with minimal discomfort. Since your bone structure has not fully matured, I would use an injectable rather than a surgery, and injectables such as Volux are completely reversible. The process should take less than 15 minutes, including topical numbing with BLT. To decrease bruising, I recommend both ice and DMSO.

Wow, what a great question. Obviously, it depends on the size of your wallet and the skill of your Board Certified plastic surgeon which will determine order of treatment. As I'm sure you know, as we get older, every part of your face goes south. If you do PRP first, you will add fullness to your cheeks, fill in the infra-orbital area with fullness rather than flatness, and, for that reason, you may want to try PRP first. Also, it's a lot less expensive and the skill of your surgeon doesn't have to be as great. On the other hand, your marionette lines will not be improved by PRP and PRP will not tighten the excess skin on your lower eyelids. If you were my patient, my recommendation would be to do the PRP first. It will improve the flatness of your checks, add fullness to the infra-orbital area, and will somewhat pull up your nasal labial folds without spending a lot of money. With quicker results and a significant amount of surgical skill, you will experience instantaneous happiness. If you choose to do the infra-orbital lift with tightening of both skin and muscle as described by Dr. Malcolm Paul, you should get better nasal labial fold obliteration but chance the problem of multiple complications and the need for a secondary surgery to get rid of the extra lower lid skin.

There are two basic ways to elevate the tip of the nose without changing the position of the bridge of the nose. One way to elevate the tip is surgically by using cartilage as an on-lay graft from the septum of the nose or the ear, by re-positioning the medial aspect of the lower lateral cartilage or by placing a graft in the columella. These techniques require a very well-trained Board Certified Plastic Surgeon. A simpler and more predictable technique is the use of hyaluronic acid fillers injected into the columella, the peri-pyriform area at the base of the nose, and a very small amount of filler injected directly into the tip of the nose. The configuration of the tip of your nose lends itself to an injectable tip graft which will give you a dip before the tip and will also give you a very aesthetic profile-pasty. Whichever technique you choose, be sure that your surgeon or your injector has a great deal of experience in these areas. Look at before and after pictures, talk to previous patients, and most of all, be sure you get a warm and fuzzy from the person you choose to give you tip-pasty projection.

Thank you for this often-asked question and the photograph of your post-surgical abdomen. There are obviously many techniques that would be helpful to you, however, if you were my patient I would use tumescent liposuction. This is a process of putting fluid under the skin to help break up the scar tissue and decrease the amount of intraoperative bleeding, which will allow quicker recovery with fewer complications. Initially, I would use a blank canula to loosen free fat cells and break up existing scar tissue. After, I would harvest and process fat from other areas and thinly distribute this fat in areas of previous dents. Post operatively I would spray the donor site and recipient bed with DMSO, which will decrease bruising, swelling, and unwanted scar tissue. I would put the patient in a girdle and apply a sheet of Reston foam directly to the girdle (non-sticky side facing the previous dented areas). This will allow for an even dissemination of the grafted fat. In conjunction with the DMSO treatments, I would also use therapeutic ultrasound to increase the number of white blood cells in this area. Increasing the white blood cells will carry away injured fat cells and other causes of dents and elevations. The irregularities of your post-surgical abdomen are not uncommon, and this treatment is done by many plastic surgeons. Now it becomes your responsibility to consult with multiple board-certified plastic surgeons. When consulting, ask to see multiple before and after pictures. Use these pictures to choose the best board-certified plastic surgeon who you feel you can work with.

Thank you for this question and the photographs shared with us. The cant of your lower eyelid is set by the point of insertion of your lateral canthal ligament into the periosteum of your lateral orbital bone. All the above mumbo jumbo doctor talk means the ligament at the outer corner of your eye inserts into the outside bone of your orbit. In your case it is set too low and the reason for scleral show. To correct this will require a surgery known as a canthoplasty which will disconnect this ligament and move it higher on the bone. The insertion of this ligament is usually through a small drill hole in the bone and sewing the ligament through the bone and through the covering of the bone. Once this tightening of the lower portion of your orbit is accomplished, your surgeon will also need to release the bones above to allow room for your eye to move freely. Obviously, this is a complex surgery and you will need to consult with multiple plastic surgeons. When consulting plastic surgeons, ask for before and after pictures of patients with similar scleral show.

In every area of medicine, doctors are taught to diagnose the problem then determine which therapy is the best. Historically, aesthetic plastic surgery only is concerned with which therapy is correct, but now Board Certified plastic surgeons are diagnosing the problem before treating the problem. All breasts are not created equal. You have tuberous breasts & there is a short distance between the nipple areolar complex and the inframammary fold. Once you find a plastic surgeon who can correctly diagnose what type breasts you have, then and only then will you get the correct treatment or therapeutics necessary to give you the breasts you are hoping for. Because you have tuberous or constricted breasts, then the appropriate treatment would be a breast augmentation through an incision at the edge of your areola and lowering of the fold underneath the breast (inframammary fold). Also, since the bottom portion of your breasts below the areola is missing (you have a Type II tuberous breast), then the tissue below the areola needs to be released so that the implant can replace the missing lower pole of your breast. All the above mumbo jumbo means that you have constricted breasts. If you feel the upper part of your breast, you have plenty of tissue. If you feel underneath your breast, you find that there is basically no tissue because it never developed after puberty. In short, the diagnosis = tuberous breasts with minimal volume, and the treatment = a breast augmentation while lowering the inframammary fold and releasing the lower breast pole constriction.

The short answer to your question is, PROBABLY NO. Most women after having birthed two children have a separation of their abdominal muscles which leads to a midline bulge of various dimensions. This separation makes it difficult to pull one's stomach in, and therefore over time and after a second child, most women have a convex abdominal wall which leads to poor posture and chronic low back pain. Secondly, most women after two children have unwanted abdominal fat which is difficult, if not impossible, to exercise and diet away. And finally, most women after the second child have excess loose skin which, while it does not eliminate the possibility of abdominal liposuction, insures that abdominal liposuction is debunking but not aesthetic. A tummy tuck will get rid of loose skin, excess fat, and correct the separation of abdominal muscles. A well done tummy tuck sounds like it costs too much, is too painful, and the scars are unacceptable. However, a highly skilled Board Certified plastic surgeon with lots of tummy tuck experience can hide the scar, use appropriate medication to treat the pain before it occurs, and get you the result you were looking for.

The short answer answer to your question is, MAYBE. From your pictures, it looks as though you have minimal fat on your inner thighs, and therefore I doubt seriously that liposuction of any kind would give you a thigh gap. The one surgery that insures a thigh gap is a medial thigh tuck, but your certainly don't have enough fat or loose skin to need or want a medial thigh tuck. Liposuction of the inner thigh is good at taking away bulging fat, but liposuction of the inner thigh leading to a thigh gap depends on whether the patient had a pre-existing gap which was just uncovered by the liposuction and not created by it. Obviously, at this point, an in person evaluation by a Board Certified plastic surgeon will help you answer the question.

Liposuction of the upper arm is a relatively simple procedure. Most people with upper arm fat are women, and the most common area for this upper arm fat is the tricep area from the armpit to the elbow. The incision should be made just superior to the elbow, and liposuction can be easily accomplished with four different length canulas, 8, 17, 21 and 24 cm. I most commonly use a canula with an internal diameter of 3 mm. Aggressive liposuction in this area is safe and aesthetic as long as, in the post operative period, the patient gets ultrasound therapy (the kind physical therapists use for sore muscles) to this area to break up bumps, divets, and ridges. I have used this four canula technique for over thirty years with very few touchups. A fifth canula with a solid shaft is used after the first four canulas has sucked out the fat. This canula allows the plastic surgeon to smooth out the suctioned area. Suctioning other areas of the arm often leads to dents and divets which cannot be corrected. As to your question why so few plastic surgeons have liposuction of the upper arm on their website galleries is probably because it is not an often-asked-for surgery. Thank you for your suggestion. I will see that a few of my liposuction of upper arm cases are put up today.