Doctor Q&A

Thank you for your question. I have been in practice for over 30 years, and breast surgery is a large portion of my practice. In my field, there were very few black and white issues, and everything we do considers advantages and disadvantages. You have thin skin and a saline implant will cause considerable amount of wrinkling for you. The silicone implant devices have gotten so much better in their engineering so that even if they do rupture, the cohesive gel really is not an issue. The...

Based on the information you provided, your BMI is ~20-21. I agree with your surgeon's recommendation that placing the implant underneath the muscle using dual plane will give a more natural appearance to the breast. The muscle covering the top of the implant will make it less likely to see/feel any rippling, and the muscle will create a more gradual slope to the top of the breast. The Demi Ergonomix will also be great for creating a natural appearance. The Demi profile is Motiva's...

Hello, thank you for asking this question and attaching your photos.
What you’re seeing is due to very thin tissue coverage now that your implants are above the muscle. This makes rippling and dents visible and it won’t improve on its own. The solution is to increase coverage over the implant. This is usually done by changing to a more cohesive silicone implant, moving the implant back under the muscle if possible, and or adding fat grafting to thicken the tissue. Even small amounts of fat...

Great question — and you’re thinking about exactly the right details.Short answerIn your situation, an internal bra is usually NOT necessary.Why Motiva Preserve changes the equationThe Motiva Preserve technique is specifically designed to:Preserve the native ligaments, fascia, and IMF integrityMinimize internal dissectionAvoid weakening the natural support structures of the breastBecause those internal supports are kept intact, the breast is already doing the job that an “internal bra...

Yes, you are a candidate for a tummy tuck. In terms of whether you need muscle repair can be done through an examination. In cases of severe muscle damage, it is possible to use mesh to reinforce the fascia repair. The muscle is actually not repaired but the fascia is repaired, which contains the muscle.

Best Wishes,

Gary Horndeski, M.D.

Unfortunately, no laser or microneedling will help the scar. I would suggest a series of steroid injections to see if this helps. If this doesn't work, a scar revision is your only option.

Thank you for your question and photos. As a Total Definer plastic surgeon, I would recommend VASER liposuction 360 degrees, fat transfer to the buttocks for shaping and enhancement and a full tummy tuck with muscle tightening. This will transform your current rectangular body shape into an hourglass figure. I do these surgeries in our certified office surgery suite under deep intravenous sedation and not general anesthesia. See a board certified plastic surgeon with extensive experience in...

Hello, that is a great question and thank you for asking. Yes, a thinner person can get a BBL, but the result will be subtle, not dramatic. At your height and weight, there is usually limited fat available, so the goal is shape and contour rather than major volume.
This is often called a skinny BBL, and it works best when expectations are realistic and fat is carefully harvested from areas like the abdomen, flanks or thighs.
A consultation is needed to confirm how much fat is available and...

Hello and thank you for your question! I agree that you have a great frame/underlying shape. In my opinion, lipo 360 and BBL can certain enhance this shape and contour by subtracting the excess fatty tissue from areas like your abdomen, flanks, and lower/mid back, and adding some of this volume will help with the overall contour and projection of the gluteal region. The other important factor to address would be the excess skin. If you are not finished having children, I would ultimately...

Dear Nice18501,

it is hard to tell for sure without an examination. Generally speaking, you can get fat transfer only to specific areas. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello and thank you for your question. Based on your photographs, you are a great candidate for a revision rhinoplasty. Maneuvers for your surgery would include placement of extended alar contour grafts to help treat nostril asymmetry and alar retraction, tip refinement, tensioning of the tip, among other maneuvers. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate...

Hello, thanks for your photos.
In your case, fillers are not a good solution. The split and irregularity you’re seeing in the nasal bones is structural. Fillers cannot fix bone asymmetry, they can only camouflage it by adding volume, which would make the nose look wider and heavier. They also require repeat treatments and carry higher risk in the nose.
In my opinion a rhinoplasty would address everything in one procedure: smoothing and straightening the nasal bones, refining the bulky and d...

Thank you for your question and for sharing your photos. This is a very understandable concern, especially this far out from surgery, and it’s reasonable to want clarity and reassurance. In patients with thicker nasal skin, swelling—particularly along the nasal sidewalls and tip—can be more persistent and may take significantly longer to fully settle compared to thinner skin. That being said, in some cases, what feels like “swelling” could also represent scar tissue, soft-...

You would benefit from a breast reduction using The Bellesoma Method. The breasts are reduced and reshaped creating upper pole fullness without implants, elevate higher on the chest wall and more medial to increase your cleavage. The weight of the breast is transferred to the underlying pectoralis major muscle resulting in pain relief without excessive reduction. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained.

Best Wishes,

Gary...

You will not be flat.From a 32H, removing ~500 grams from each breast typically results in a C–D cup range, not a flat chest.Why the confusion happensCup size prediction is not exact, but surgeons often use a rough guideline:~150–200 grams ≈ 1 cup size (very approximate)So:500 g ÷ 150–200 g ≈ 2.5–3 cup sizesFrom 32H, that usually places you around:32E–32D (sometimes a full C depending on density and shaping)Being “basically flat” would require far more tissue removal than 500 g per side.Why...

Yes you can add breast implants for upper fullness. Six months should be ok if healing from the lift is complete.

Size would be determined by your measurements and goals.

An exam and consultation with yoir/a plastic surgeon is recommended to discuss your options and expectations as well as low risks and complications.

Hello, thanks for your photos.
Yes, based on your photos and age you can have implants without a lift. You have mild sagging, but not enough to require a lift right now. An implant alone will improve upper pole fullness (especially with high profile/round implants) and overall shape, though it won’t raise the nipple position. Round implants are usually the better choice for long term shape and simplicity. A lift can always be considered later as you age if needed.
Choosing a moderate size i...

Intuitive852736,
Based on the photographs you have shared, your tattoo location is at the lower edge of your stream overlying your xiphoid process and then extending onto your upper abdomen. The most commonly used incisions for breast implant placement, infra areolar and infra mammary are both well above your tattoo. I do not think implants will affect your tattoo.
Dr Stein

When doing an augmentation we want the implant to be centered on the nipple. This will give the most natural look. You have excellent shape to start. Remember that measurents of chest width are never exact. The human body moves and is not symmpetric R to L. For example your nipple height is different on each side. Totally normal. The most important consideration is volume. Did you like the look with a 350 cc sizer in a bra? (Sizers typically come in 50 cc increments). I would definitely not...

Pioneering742783,
Before any procedure, surgical or noninvasive, your doctor will assess your history of blood clotting disorder and decide how to proceed. If in fact its determined that you are not appropriate for a tummy tuck, but could undergo a less invasive surgery, liposuction with J-Plasma® (also called Renuvion®) is a technique we use to remove unwanted fat while also helping tighten the overlying skin. Traditional liposuction is excellent for contouring, but it doesn’t tighten ski...

Your eyebrows are below the level of the orbital rim, you have excess upper eyelid skin, excess lower eyelid skin as well as mid face descent. You would benefit from an extended browlift. This will pull up the eyebrows, help with the upper eyelid skin and pull the mid face tighter. After this, you may or may not need a revision of the upper and lower eyelids.

Best Wishes,

Gary Horndeski, M.D.

It is very difficult to evaluate underlying deformity (hollowing) on these photos. A condition is known as malar hypoplasia, small cheek bone. Depending of the extent of hollowing correction with the cheek implant would be my first thought. Milder hollowness can be corrected with fat grafting or even bone grafting. In person consultation with a board certified plastic surgeon with experience in this type of correction is recommended. Good luck.

Great question and very helpful photos!
I am not sure why they were so hesitant to recommend a lower blepharoplasty, but from what I can tell you have slightly prominent lower eyelid fat bags that are causing the fullness and would likely do well with a lower blepharoplasty. I like to perform a trasnconjunctival (hidden incision in the lower eyelid) as it 1) doesn't have a visible scar and 2) is less likely to cause issues with ectropion (pulling down of the lower eyelid). Other things you...

Let's summarize:
SMAS lift followed by
-loss of sensation sides of face
-parts of neck (side not mentioned)
-occasional numbness under R eye
-tingles on top of head on R when R eyebrow area touched
-recent diagnosis of Grave's disease and psoriatic arthritis
-no change for months

It is not unusual to have numbness temporarily after a SMAS lift due to skin undermining. This should all come back on both sides of the face.
The occassional numbness should also resolve.
The tingling on top of...

Hello, thanks for adding your photo.
From what’s visible, you have moderate lower-face and neck laxity, with the neck contributing significantly to the tired appearance. Your skin quality is still reasonable, but the face and neck are clearly aging together, not independently.
Doing the procedures in stages is possible, but there are trade-offs. If staged, the neck lift should be done first, as it would give the most noticeable improvement with less attention from others. The face lift can b...

Based on what you’ve shared, I do feel you would ultimately be an excellent candidate for a deep plane face and neck lift; however, it’s important to move forward with that type of procedure only when you feel both emotionally and financially ready.

In the meantime, there are meaningful, non-surgical and minimally invasive options that can provide improvement without undergoing procedures that offer limited benefit. Rather than a unilateral blepharoplasty, I would be more inclined to rec...

You seem to have acquired a horizontal line above the right upper lip and you may benefit from an eccentric lip lift. This does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. This takes 1 hour to perform under local anesthesia and costs $4,000.

Best Wishes,

Gary Horndeski, M.D.