Thomas A. Pane, MD

Assuming you get regular primary care breast surveillance and all is fine, these are typically just cosmetic concerns. Whether or not a second surgery is for you or not depends on how you like the current appearance, which is in line for the surgery and timeline you describe. A second procedure can address your concerns with the residual lower pole tissue. If you choose to have surgery and like having implants, I would change them given it's been 11 years.

Some 'bumps' are often just needle injection points that swell a bit, but that doesn't look like the situation here.  What I don't like about this story is being told you needed another syringe because the filler ran out. Almost all experienced injectors will place the filler from side-to-side so you cannot run out with one side being significantly uneven.  

In Florida we limit fat removal in the office setting to 4000 cc, which is a lot. Only very large patients will need more and that would have to be in stages or in an ASC/hospital setting.  The other consideration is the quality of your skin. If it is too loose, liposuction is not as effective, say if there has bee significant weight loss. 

Given your anatomy and desire to avoid scarring, you can most likely get by without a vertical scar.  The dual plane is an option as is a periareolar lift.  As you do not want a big implant, you probably won't get a double curve inferiorly, but that is something to be aware of as well.  

You were larger on the left going in, and ideally more should have been taken from that side to make you more symmetric.  It looks as if the inner portion on the right may have separated during healing, it is possible this is the source of the pain but difficult to say without an in-person exam.  At 4 months it's better to wait longer to revise, but I think you can get a good result.  I agree the clitoral hood tissue doesn't look like it was addressed at the initial procedure.  

Overall you look quite good.  Your question regarding why he didn't to the inverted-T (fleur de lis) procedure is odd because that is decided prior to the surgery.  That procedure is more involved but is safe overall.  However, you were someone who could have done either procedure, with pros and cons of each approach.  In your case, the result you got is quite good and saved you the vertical scar.  At this point, if you want to do everything to further improve your result, a full session of abdominal liposuction with or without a mini-tuck is an option.

In this situation, waiting is the best approach.  Your surgeon will guide you but typically scar massage and time do the trick here.  There are options for attempting to lighten the skin including specific topical medications and light-based therapies, but they may not be necessary. 

It's too early to worry about a revision. Your scar looks thin and you should take care of it with massage (or whatever your surgeon likes to recommend) for about 3 months.  Scars take a while to fully mature, and the result is far from final right now. 

Liposuction - regardless of the specific technology - will remove fat under the skin.  This can improve your contours but if you have lax skin, that will remain. So in your case, you may consider an abdominoplasty either as a second procedure or initially, if you mainly want to lose that lower portion of skin and fat.The specific technology (SmartLipo, Aqua, or whatever) is not important though you can expect to hear otherwise. None of these have been shown to be superior to standard liposuction and good postoperative care.

This is an interesting problem but usually can be helped. However you should be seen by your surgeon in person to make sure nothing else is causing this, such as a breast lump.  Scarring between the breast tissue and muscle is the usual cause of what you describe.  You are early in your recovery so much more time and massage is needed.  There are surgical options to try to help the situation but these should be deferred until you are far enough out from the implant removal, typically six months to a year.