William Andrade, MD

Thank you for your question. You're correct that trying on sizers is not a perfect representation of your final result because the implants are sitting loosely on top of your breasts, rather than within the breasts. Many of my patients will go slightly larger to take this into account, especially if they are debating between two implants that are only a few millimetres different in size. Other ways to help narrow down the size include looking at before-and-after pictures of other patients with similar anatomy or 3D breast imaging, but these are not perfect either. Your own surgeon will be the best source of advice on your final choice because they presumably took detailed breast measurements and can advise which implants are appropriate for your dimensions.

Hello, in my experience the type of lift with a scar only around the areola (periareolar mastopexy) only elevates the position of the nipple by a modest amount, so I typically only offer this procedure for patients with mild sagging (stage I - II ptosis). For patients with more advanced sagging in which the nipples are near the bottom of the breasts (stage II-III ptosis) I will usually do a procedure that involves more incisions on the breast, which permit more nipple elevation and breast reshaping. However, every procedure must be tailored to the patient's goals and expectations. If a patient were to accept less of an improvement in nipple position, the periareolar mastopexy might be an option. Every lift plus implants (augmentation-mastoepexy) consultation is thorough and involves breast examination and measurements, trying on implant sizers, and a long discussion to understand the possible outcomes of different procedures.

Hello, for people with only mild-to-moderate breast sagging (i.e. the nipples are not pointing straight down on the breasts), many will seek to have breast implants alone. There is always the option of having a lift later on if they are unhappy with the result. However, the right procedure for you depends on multiple factors, including your expectations of the final result in terms of shape and nipple positions, tolerance of the risks/costs/scars of breast lift surgery, and the advice of your plastic surgeon. For my own patients, I encourage them to look at lots of before-and-after results of breast implants alone, compared with implants + lift. This will give them a better idea which operation will meet their goals. Thanks and I hope your research goes well.

Hello, most surgeons consider a "mini tummy tuck" to be a procedure that tightens skin on the lower abdomen only. The length of the scar can be short or long for this procedure, since it depends on the location of the loose skin. For example, if a person has loose skin extending to their sides, unless the surgeon makes a long incision to remove it, there still will be loose skin in that area (causing dog ears, etc). On the other hand, if a person just has a bit of skin hanging over their c-section scar in the middle of their abdomen, there is no reason to make a long incision to fix the problem. The procedure needs to be customized for each person. I always assess the skin laxity of each patient and explain how the scar length will affect their particular result.

Thank you for your question. If you don't have a rectus diastasis and you are happy with your upper abdomen, a mini tummy tuck may be a reasonable option to tighten the lower abdomen. You noted that your belly button sits a little low on your abdomen, and if anything a floating belly button tummy tuck would move it even lower, so that might not be an ideal option in your case. Hopefully you will get more information on the pros/cons of each procedure by seeking an in-person consult, where the surgeon can take a more detailed history, assess the degree of skin laxity, etc. All the best.

Hello, your stated concern and photos all indicate your main concern is the loose skin on your abdomen, so it would seem reasonable to avoid flank liposuction. Based on the photo you don't appear to have dysproportionate flanks or much fatty tissue in that location, plus you already have a defined waistline. Your best advice will always be achieved during an in-person consultation, because the physical exam provides a lot of important information, such as skin tone, tissue thickness, checking for hernia or spread of the muscles (rectus diastases), etc. Thank you for your question.

Hello, there are less invasive options to decrease the appearance of jowls. These include tightening the skin using an external device, or device inserted under the skin to heat the underlying connective tissue. One can also fill the space in front of the jowl with a person's fat, or temporary absorbable filler. Technically this does not get rid of the loose tissue that caused the jowl, but it smooths out the jawline, which has a similar effect. At my clinic we usually treat this issue with temporary absorbable fillers, but there are many other options. Thank you for your question.

Hello, the two implants your are considering are only a few millimetres different in size, so regardless which you choose the final outcome would likely be very similar. There are many ways to help narrow down the final choice, including trying on implant sizers, looking at before-and-after photos of women with similar breast size and shape, 3D breast simulations, and last but not least, seeking the advice of your plastic surgeon. Most surgeons will take detailed breast measurements, assess skin tone and tissue thickness, differences in breast size or nipple position, then advise you accordingly. Since your own surgeon should have all of this information, they will always be the best source of advice regarding implant selection. I hope your surgery goes well and you are happy with the outcome.

Hello, in my experience, I find that Botox will only completely eliminate the 11s if they are just starting to develop; for example, in a younger patient in their late 30s - early 40s. Once deep skin creases or furrows develop, I find that Botox only provides a partial improvement in their appearance. When you consider that Botox just relaxes the underlying muscle but does not actually fill the furrow, it makes sense that a very established crease might not go away just by relaxing the muscle underneath. Fillers injected right into the skin can help with this issue, but even then, if one injects a large volume of filler, it might start to spread away from the injection site, making the entire area look "puffy" rather than eliminating the crease. There are surgical options but you would need to seek a surgeon who focuses on facial cosmetic surgery to better understand if this would be beneficial in your case. These are just general observations, so for specific recommendations you could consider getting a second opinion by a plastic surgeon in your area. Thank you for your question.

Hello, a standard breast augmentation procedure does not involve reducing the size of the areolae, but this certainly could be done at the same time. For example a "donut lift" (perieareolar mastopexy) involves removing a donut-shaped strip of skin around the edge of the areolae to make them smaller. If you seek a consultation with a plastic surgeon with experience doing this procedure, they can advise you on the additional scars, healing time, risks and costs. Thank you for your question and I hope your procedure goes well.