Shawn Greathouse, MD

This is not an easy question to give an exact answer because there are multiple structures that will need to be reconstructed.  If you are able to get evaluated at one of the centers doing facial allotransplantation (NYU, Harvard, Cleveland Clinic, etc.) that would be your best bet if you are a candidate.  There are osteo-integrated implants for a prosthesis in place so I'm guessing you wear that device most often.  The nose alone may take upwards of 4 surgeries spaced at least 3 to 4 weeks apart.  The first stage (and most difficult) would likely require a free flap (or 2 or 3) to bring bone and lining to replace what is missing from the midface (orbital rim, nose, palate).  This may be able to designed in such a way as to provide structure to the orbital rim and soft tissue for the upper lip.  This stage alone may require more than one "flap" from shoulder blade, pelvis, or leg (fibula).  You may also need to bring additional soft tissue from your arm for the upper lip depending on how your blood vessels are oriented.  This will be a major surgery (many many hours) and likely a recovery of 1 to 2 months.  Once there is a solid base and lining to the nose you can shape or graft the structure of the nose and bring forehead tissue down to provide the outer surface of the nose - this will require a second surgery to divide and inset the "forehead flap" 3-4 weeks later.  More than likely another surgery or intermediate surgery to "debulk" and reshape the nose will be needed.  At the same time you could tighten the right lower eyelid and bone graft the orbital rim if still needed.  I would estimate this would take the better part of a year and would not give as good of appearnce as a transplant or prosthesis. 

It's difficult to tell exactly what's going on from photos since the post-op is slightly at an angle.  In your pre-op photo it looks like there is a small size discrepancy with a slightly outward point to the nipple on the right. I don't think its really a volume issue as long as both implants are the same. Typically this will become less evident when you go up in size due to the proportion of difference being smaller.  In your photo I agree that the right breast looks larger, but this may be an illusion due to downward and lateral displacement of the implant.  This may be why people only notice it when you are not wearing a bra.  If you push the breast upward and together they will look almost identical I bet.  Larger implants (typically only goes up to 800 cc) have a higher chance of implant malposition.  You can talk to your surgeon and see what your options might be.  In patients that are unwilling to decrease the size then an option would be to tighten the capsule and possibly reinforce with a biologic such as acellular dermal matrix (alloderm, dermacell, flexhd, strattice, etc.). 

When considering changes to structure of the face you need to keep in mind that proportion is the most important factor.  The photo of the model may not be possible with your proportions, but I think that it would be possible to get you closer to your goal.  To give you that angle you desire a silicone mandibular angle implant is your best bet.  I have used similar implants from Implantech before.  They have a lot of information on different styles of implants on their websites.  From the frontal view I suspect you would need to either augment the chin to create more of a point with an implant (or bony advancments) OR reduce the sides of the chin to give it more of an angle.  There are many nerves in this region so making these changes can cause weakness to the lower lip or numbness to the chin or lower lip.  The "pouch" under chin is the submental fat pad.  This can be corrected at the time of surgery by excision or liposuction.  If you want a less invasive solution then Kybella injections or Coolsculpting may be an option.

It sounds like you've done a lot of the right research.  Going to a board-certified plastic surgeon is one of the best things you can do to be certain you have the best experience.  I would also ask the surgeons to see photos of similar procedures or sometimes ask for references.  Make sure your surgeon has all your medical records and has given you a thorough physical.  If you are on any medications let him or her know.  Also make sure they are aware of family histories of wound healing problems or blood clots.  You may also want to ask about post-operative protocols for dressings/garments or scar managements (massage, silicone scar pads, creams, etc.) Good luck in your search.

It's not uncommon to second guess yourself after cosmetic surgery in the first few weeks.  I hear this frequently.  Things are very difficult to evaluate this close to surgery, but if you are just 1 week I would say that your recovery is going quite well.  I often tell my patients that things can change anytime from several weeks to 3 months after surgery.  Sometimes even the size can change substantially as swelling goes down. I know it can be difficult to do but be patient and you may find that things will turn out great.