Ian Lytle, MD

You may benefit from a different style implant. You have several options that may help. I think the best options, would be to use a higher profile implant or even an "over-filled" implant like the Mentor XTRA implant. With these 2 options, you could stay the same breast size. Lastly, you could have a larger implants placed,  which may give more upper breast volume, but that all depends on your desired breast size. 

A brow can be lifted a few different ways. The brow lift was originally designed and done, as you described, excising skin at the top of the scalp from ear to ear. This is called a coronal brow lift. The major disadvantage is the large scar that is easily seen across the top of the head. The second approach is called a pretrichial or hairline brow lift. This is similar to the coronal, but the scar is at the hairline.  A third technique is a "direct brow lift" where the skin is excised either directly above the brow or along one of the creases/lines at the mid-brow. This is good for elderly patients where the scar is easily hidden in a deep ceases,  but not a great option for you.The final option is an endoscopic brow lift, this is done through a few small incisions in the hair, the scalp is lifted and then suspended on dissolvable "tacks" that are secured to the bone. It is hard to tell by your photo, but I think you would be a good candidate for either the"pretrichial brow lift" or the endoscopic brow lift. By doing the brow lift, you will see the your eyes open up and you will not have the excess skin at your upper eyelids. I recommend that you see a board certified plastic surgeon who is comfortable doing these procedures. Good luck, Ian Lytle, MD

For your size breast and chest, a 200 to 250 cc implant will give you a full B cup or small C cup. The computer generated images help, but I think a sizing system works out a little better as you can see what the implants look like on your body. Remember,  the difference between a 225 and 250 is really quite small, so don't get hung up on numbers. It's more important to have a surgeon the understands your desires and goals to get the best results. Good luck, Ian Lytle, MD

I do not think that you are being unrealistic. I think that there are still great improvements that can be made for you. There are a few options for you, depending on the areas that concern you the most. I'm looking at the photos, it looks like you would best be served by a reverse abdominoplasty for the front and upper back lift at your back along the bra line. Basically it is another circumferential body lift, but approaching areas like your upper abdomen, back, and the excess skin at your lateral chest. As always, I recommend that you see a board-certified plastic surgeon that is comfortable performing these types of procedures.Good luck, Ian Lytle, MD

You can definately have a little fat grafted at your breast.  The surgeon just needs to be careful not to puncture the implant, but that is a very low risk.Good luck, Ian Lytle, MD

A few flights of stairs should not be a problem, medically.  It is unlikely to have an increased risk of infection or wound formation. As a matter of fact, I often recommend walking as much as possible to decrease your risk for blood clots. It may, however, be very uncomfortable for the first few days or week to climb stairs. I would assume that oncertain you are in your apartment, you won't be going up and down that often the first week anyway.Good luck, Ian Lytle, MD 

It depends on the procedure. For very routine procedures, complication rates are low and the need for the patient to follow up with the physican is minimal. Personally, however, I prefer if patients are reasonably close. I see my patients at least twice before the day of surgery to review the surgery, risks and to answer questions. I also typically see my patient within the first week following surgery, at week 2, week 6, 3 months 6 months and at a year. Of course more often if the patient has any concerns. At each of these time points, there are different things to evauluate: pain control; infection/wound healing; swelling; scarring; final results. If your surgeon finds it important to see you often, it may mean more long distance trips for you. On the other side of the coin, don't compromise on a surgeon solely based on a convenient location.Good luck,Ian Lytle, MD 

It doesn't have to be under 35. However some surgeons who work in their own Office operating suite have restrictions or regulations regarding the safety of treatment of patients with a BMI greater than 35. The risks are higher above a certain BMI.

I agree with most of the other surgeons comments. I also usually prefer to go under the muscle, but there are a few indications to go above the muscle including; if there is a moderate amount of breast posts or droop and a breast lift is trying to be avoided, sometimes over the muscle will improve the breast shape. Also, some patients do want as much upper breast fullness as possible and have a rounded/implant look to the upper breast. It all depends on what your goals are and what your breasts look like prior to surgery.Good luck, Ian Lytle, MD 

Unfortunately, there are not many options for getting rid of loose skin without cutting out skin. That will always leave a scar. Mini tummy tucks can have a shorter scar, but the shorter the scar is, the leSS amount of skin wI'll have been taken out. With having had five kids, your rectus muscles may also be widened/stretched and you may need to have the muscles tightened. It's best to be evaluated buy a board certified plastic surgeon, but I don't think you would be happy with any procedure that didn't require skin excision. Good luck,Ian Lytle, MD