Leyla Arvas, MD

From your photos and description, I would recommend an in-person evaluation for revision breast surgery rather than simply replacing the implants.The right breast appears concerning for capsular contracture, although this needs to be confirmed by physical examination. The significant change in implant shape when you contract your chest muscle may also indicate an animation deformity, particularly if your implants are positioned under the pectoral muscle.There also appears to be some breast tissue and skin laxity, which is important because changing the implants alone may not correct the overall shape or asymmetry.Depending on the examination, revision surgery could involve treatment or removal of the problematic capsule, replacement or repositioning of the implants, correction of the implant pockets, and possibly a breast lift (mastopexy) to improve the position and symmetry of the breasts.I would therefore evaluate the implant, capsule, muscle relationship, breast tissue and degree of sagging together before deciding on the procedure. In some cases, ultrasound or MRI may also be helpful to assess implant integrity.Revision breast surgery is very individualized, so unfortunately it is difficult to estimate the cost from photographs alone. The cost will depend considerably on whether you need implant exchange alone or a more comprehensive revision with capsulectomy, pocket correction and/or breast lift.I recommend consulting a plastic surgeon who performs a significant amount of secondary and revision breast surgery and, if possible, bringing the details of your original operation and implant information to the consultation.

Behçet’s disease requires a more cautious approach to any elective energy-based treatment, even when the skin manifestations are minimal.Ultherapy uses microfocused ultrasound to create controlled thermal coagulation points at specific tissue depths. My primary concern in a patient with Behçet’s would not simply be the presence of superficial blood vessels, but the underlying inflammatory/vasculitic condition and the possibility of an unpredictable inflammatory response following tissue injury.I would not consider Behçet’s disease automatically an absolute contraindication to Ultherapy in every patient. However, I would consider it a significant relative contraindication that requires individual assessment. I would not perform treatment during active disease, and a history of significant vascular involvement, thrombosis, pronounced pathergy or active inflammatory symptoms would make me considerably more cautious.Your limited skin involvement and minimal pathergy may be reassuring, but they do not necessarily indicate how the deeper tissues will respond to focused ultrasound. For this reason, I would want your Behçet’s to be clinically stable and would recommend discussing the proposed treatment with the physician or rheumatologist managing your disease before proceeding.I also would not assume that Thermage FLX is automatically safer simply because it uses radiofrequency rather than focused ultrasound. Thermage also produces controlled heating within the tissues and therefore still creates a biological inflammatory and collagen-remodeling response. The two technologies deliver energy differently, but neither should be considered risk-free in the setting of vasculitis.If treatment were considered appropriate after medical clearance, I would favor a conservative, individualized protocol rather than aggressive energy settings, with careful assessment of the treatment area and close follow-up afterward.Most importantly, I would not base the decision solely on whether Ultherapy or Thermage is theoretically “safer.” In a patient with Behçet’s, disease activity, previous vascular involvement, medications, pathergy history and the expected cosmetic benefit should all be considered before exposing the tissues to an elective energy-based procedure.

At 23 and only 9 months postpartum, your skin may still continue to improve naturally over the coming months, especially if your weight is stable.From your photo, you have only a small amount of loose abdominal skin and your main concern is skin quality and texture, Thermage FLX may be a reasonable option. It works by stimulating collagen remodeling and can gradually improve mild laxity and firmness. However, it is important to understand that Thermage is not primarily a stretch-mark treatment, so I would not expect it to remove the stretch marks themselves.Stretch marks represent changes deeper within the skin and usually require a different treatment approach. Depending on their color, depth and maturity, professional microneedling, fractional laser or RF microneedling may be considered. Often, a combination or staged treatment plan gives better improvement in texture than relying on a single technology.I would also be cautious with aggressive at-home microneedling. Incorrect needle depth or technique can cause irritation, pigmentation changes, infection or even scarring without necessarily producing a meaningful improvement.Regarding the hooded skin around your belly piercing, removing a localized excess may improve that specific area, but I would evaluate the abdomen as a whole before treatment.For someone your age with relatively mild laxity, I would generally favor a conservative approach: allow adequate postpartum recovery, maintain a stable weight, and then treat the remaining skin laxity and stretch marks according to the specific problem rather than trying to address everything with one procedure.

It is important to separate forehead height, hairline shape, and the actual width/shape of the upper face, because they require different approaches.If the main difference in your edited photo comes from bringing the hairline forward or filling the temporal corners, this may be achievable to some degree with a carefully designed hair transplant. Hairline advancement surgery is another option for reducing forehead height, but it is more invasive and leaves a scar along the hairline.However, if the blue outline in your drawing represents a narrower forehead or skull contour rather than simply a different hairline, neither a hair transplant nor lowering your body fat will change the underlying bone structure. A hair transplant can create the visual impression of a narrower forehead by strategically filling the frontotemporal areas, but it cannot physically narrow the skull.Your cheekbone position is relevant because facial proportions should be evaluated as a whole. A narrower-looking upper third needs to remain balanced with the width of the cheekbones and lower face, so I would design the hairline according to your facial anatomy rather than trying to reproduce an edited photograph exactly.I also would not recommend reducing your body fat from approximately 21% to 13–15% specifically to achieve this result. Weight loss may reduce some facial fullness, but it will not significantly change your forehead width or underlying skeletal proportions. In some people, excessive facial fat loss can actually make the face look more angular or less youthful.Based on what you describe, I would first evaluate whether the desired change can be created visually through frontotemporal hairline design. In many patients, a relatively conservative hair transplant can significantly change the perceived proportions of the forehead without altering the underlying facial structure.

Although Thermage FLX can be very effective for skin tightening in appropriately selected areas, I personally do not recommend using radiofrequency-based treatments directly over the breast.The breast is not simply skin and subcutaneous tissue; it also contains glandular breast tissue. In my practice, I prefer to avoid delivering significant radiofrequency energy over this area because of the potential thermal effect on the underlying glandular structures, particularly when the expected cosmetic benefit is relatively small.The upper chest and décolletage are different and may be considered for Thermage in selected patients, depending on the treatment area and anatomy.For very mild breast laxity, especially in a young patient with good skin quality, I would be cautious about exposing the breast tissue to energy-based treatment simply to achieve a subtle degree of tightening. In this situation, I believe the potential benefit should always be weighed carefully against safety.Therefore, while I use Thermage FLX extensively for suitable indications, I would not recommend treating directly over the glandular breast tissue.

Congratulations on maintaining such a significant weight loss. After losing more than 100 lbs, it is very common to have residual skin laxity that cannot be corrected with exercise because the issue is primarily related to loss of skin elasticity rather than muscle tone or remaining fat.Renuvion (J-Plasma) may provide noticeable skin contraction in appropriately selected patients, particularly when there is mild to moderate laxity. However, after major weight loss, if there is a significant amount of true excess skin, no non-excisional treatment can reliably reproduce the tightening achieved with a tummy tuck, arm lift, thigh lift, or body lift. This distinction is important when setting realistic expectations.Renuvion can technically be performed without traditional liposuction when there is little excess fat and the primary concern is skin laxity. However, the decision depends on the thickness of the remaining fat layer, the degree of skin redundancy, and the specific area being treated. In some patients, limited liposuction or tissue undermining may be incorporated to optimize contraction, while in a very lean patient aggressive liposuction would generally not be desirable.Aveli addresses a different problem. It is designed to release the fibrous septal bands responsible for individual cellulite dimples, particularly on the buttocks and thighs. It can improve appropriately selected cellulite depressions, but it does not tighten generalized loose skin. Therefore, Renuvion and Aveli can be complementary when both laxity and true cellulite dimpling are present.Regarding Morpheus8, combining different energy-based treatments does not guarantee a better result. Morpheus8 may provide additional improvement in skin quality and mild tightening in selected patients, but I would not consider it automatically necessary after Renuvion. Treatment should be staged according to how your tissues respond rather than simply combining multiple technologies.At 32, your age and stable weight are favorable factors, but the most important factor is the actual amount and quality of excess skin. Based on an in-person examination, I would determine which areas have enough remaining elasticity to benefit meaningfully from minimally invasive tightening and which areas are unlikely to achieve your desired result without skin excision.If avoiding long scars is your priority, a staged minimally invasive approach can certainly be considered, provided you understand that the goal would be improvement rather than the degree of tightening obtainable with surgical lifting.

Renuva and facial fat grafting work in different ways, so one is not necessarily “better” than the other.Renuva acts as an adipose matrix that is gradually replaced by the patient’s own fat. This can make it an interesting option for small, targeted areas where relatively modest volume correction is needed.Fat grafting, however, allows us to transfer a significantly greater amount of the patient’s own living fat in a single procedure and to sculpt multiple areas of the face. Although not all transferred fat survives, the portion that successfully establishes a blood supply can remain long term. For this reason, fat grafting is often more practical when broader facial volume restoration or contouring is required.Another important point is that 4.5 cc of Renuva should not automatically be considered equivalent to 4.5 cc of successfully grafted fat. The final result depends on the treatment area, tissue quality, injection technique, individual healing response, and the amount of volume actually needed.In my practice, I would generally view Renuva as a useful option for smaller, localized volume deficiencies, while fat transfer may be preferable when the goal is more substantial or comprehensive facial rejuvenation.The best choice therefore depends less on the theoretical percentage of fat survival and more on how much volume is required, where it is needed, and the quality of the surrounding tissues.

If you're going from 525 cc moderate-plus implants to 400 cc high-profile implants, combining the implant exchange with a breast lift would generally give you a much better result. Without a lift, you may be disappointed because the skin may not tighten enough after the smaller implants are placed. A periareolar ("donut") lift is an option if you want to keep the scar limited to the edge of the areola. However, it's important to know that the skin around the areola can look puckered or wrinkled for some time after surgery. It may take over a year for this appearance to fully settle and smooth out. A full anchor (inverted-T) breast lift also requires time for the scars to mature and fade, and this process can similarly take around a year or longer. The best approach ultimately depends on the degree of skin laxity and the position of your nipples, so an in-person examination is essential before making a final recommendation.

Fat grafting to the upper face and cheek area is often done to restore volume that was lost with weight loss and aging, especially in patients with a gaunt appearance or hollow under-eyes. The goal is not to make the face look “full” or different, but rather to recreate the balanced, youthful contours you naturally had before volume loss occurred. When performed conservatively and strategically, small-volume fat grafting can look very natural and simply soften hollowness and improve facial harmony. In many cases, it actually helps a facelift look more natural, because lifting alone can correct sagging skin but may not fully address volume depletion. Fat grafting can also improve skin quality due to the regenerative properties of fat-derived stem cells, which may enhance skin texture, thickness, and overall vitality over time. An experienced surgeon will tailor the amount and placement carefully to preserve your natural facial shape and avoid an overfilled appearance.

After 11 years, the changes you’re noticing in your breasts are quite common due to aging, gravity, and tissue relaxation. This is a good time to have them evaluated, as revision surgery can address issues like asymmetry, upper fullness, and indentations. Rather than waiting for further aging, it’s often better to intervene earlier. The most appropriate approach is usually a combination of implant exchange (either slightly smaller for less weight or even one size larger to better fill loose skin, depending on your anatomy) and a breast lift to remove excess skin and restore a more youthful, balanced shape.