Doctor Q&A

In a thin patient with very little soft-tissue coverage, rippling is one of the harder problems to solve, and modern cohesive silicone implants generally give better results than overfilled saline. Saline implants ripple more by nature because they are essentially a fluid-filled bag; overfilling reduces it somewhat but firms the implant and doesn't reliably eliminate the visible and palpable waviness when there is minimal tissue to hide it. Highly cohesive ("gummy") silicone gels hold their...

Dear Pollypolly1,


breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.
Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and...

Choosing the right size and profile breast implants for you under the muscle for a natural look. I recommend an in person evaluation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see...

In a situation like yours, the area that looks like a "hip dip" is usually a relative depression — the fullness above it makes the indentation look deeper. Reducing the fat in the area just above the dip with liposuction and placing fat into the hollow itself will, in most cases, improve your overall body contour substantially.
Ideally, a tummy tuck and a BBL/fat grafting are done in separate sessions. However, if you do not want two operations, a single-session combination of a tummy...

Dear Babylifter,

based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because 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,...

Based on the photos, you appear to be a good candidate for conservative tip refinement. The projection and pointiness of the nasal tip can often be reduced without significantly changing the appearance of the nose from the front. This is typically achieved through tip-modifying rhinoplasty techniques that decrease projection and soften tip definition while maintaining overall balance and support. The key is a conservative approach, as excessive reduction can affect both the front view and...

Thank you for your question and photos!
From what you've described it sounds like that small bump could be cartilage instead of bone. If your goal is simply to reduce this without significant changes to the tip of the nose you should consider a closed rhinoplasty. This is a rhinoplasty without incisions on the outside and works by making small incisions hidden within the inside of the nose. Pockets can then be created underneath the skin to the dorsum where this asymmetry can be addressed....

Your photos show a lean, fit frame with what appears to be limited visible donor fat, so the amount of added roundness from a second BBL may be more modest than in someone with more available fat. A second BBL can sometimes improve contour, hip-to-waist transition, and symmetry, but it cannot reliably create a large change if there is not enough safe donor fat to harvest and transfer.

Fat survival varies, and careful aftercare helps but does not control everything. The key questions are how...

I think you are an excellent candidate for a breast reduction. There is always a chance your nipple sensation will be affected, but not always. The benefits of better proportion, higher and tighter breasts with you ripples located centered on the new perky breast mound will meet your expectations. I hope this helps. Thanks for sharing!

Thank you for such a thoughtful and well-prepared question, and congratulations on taking this step. Your dilemma, feeling caught between "natural" and "proportional," is one of the most common and legitimate tensions in breast augmentation, and it is even more relevant on a tall, broad frame with a wide chest wall like yours. The key concept to hold onto is that because all three implants share the same base width, they will all "fit" your chest equally; the only variable you are choosing...

Dear NewBootyCutie101,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

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

Yes, breast implants can often help restore volume after a breast reduction, but the relationship between grams removed and implant volume is not a direct one-to-one conversion.
In your case, having approximately 400 grams removed from each breast does not necessarily mean that a 400–425 cc implant will return you to your exact pre-reduction size. Breast tissue is a combination of glandular tissue, fat, and skin, while implants add volume in a different way and create a different shape. F...

The degree of breast sagging is significant enough that a breast lift should be strongly considered.

While it is possible to undergo breast augmentation with implants alone, it is unlikely to provide a substantial lifting effect. It may improve the loss of upper breast fullness to some extent, but using larger implants could result in an unnatural appearance, known as a waterfall deformity.

For this reason, I would recommend undergoing a breast lift (mastopexy) in addition to augmentation.

In general, having a J-pouch does not automatically prevent you from undergoing liposuction. However, because you have had major abdominal surgery and bowel reconstruction, it is important to evaluate your surgical history, the location of any scars, possible adhesions, and your overall health before proceeding. Many patients with a J-pouch can safely undergo liposuction, but a thorough review of your operative records and an examination by a board-certified plastic surgeon are essential....

Dear Phenomenal997037,

it is hard to tell for sure without an examination. 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

Because a DIEP flap depends on the abdominal skin, fat, and perforator blood vessels, any liposuction near the abdomen, waist, or flank area should be discussed with your microsurgical breast reconstruction team before it is done. Liposuction of the lower back and sides may not directly enter the DIEP flap itself, but swelling, scarring, contour changes, and changes in available tissue can still affect planning, donor-site closure, and symmetry.

If your reconstruction surgeon feels...

At 24 years old, I would not recommend a facelift.
Looking at your photos, I actually don’t see the type of facial aging or tissue descent that would typically make someone a facelift candidate. What I do see is a young face that has likely been through significant physiologic stress from rapid weight loss, smoking, and perhaps some volume depletion. Those factors can absolutely affect skin quality, facial fullness, and how you perceive your appearance.
The good news is that a facelift is a...

Hi trans4mation4me, thank you for explaining your goals so clearly.

One honest point first. A facelift, mini or full, lifts soft tissue that has dropped. It does not change the underlying structure or make a face read as more feminine. That belongs to facial feminisation, contour and sometimes volume, not to a lift. So if your main concern is still looking masculine rather than loose or sagging, a facelift may not be the thing that gets you there, and it is worth being sure of the goal...

Your photos show mild smile-line/nasolabial fold prominence that becomes more noticeable with expression, without an obvious lower-face or neck sagging pattern. At age 32, this is usually more related to normal facial movement, subtle midface volume loss, skin quality, and facial anatomy than to something a facelift would reliably correct.

A facelift mainly improves jowls, loose lower-face skin, and neck laxity; it is not the best operation for lines that appear mostly when smiling. Options...

Based on the photo, there appears to be mild asymmetry and fullness of the upper eyelid that could be related to residual changes following Bell’s palsy, although other causes such as eyelid inflammation, fluid retention, or changes in eyelid muscle function should also be considered. If the swelling has remained stable for years, an evaluation by an oculoplastic surgeon would be appropriate. Depending on the underlying cause, treatments may range from conservative management to eyelid s...

Based on your photo, the asymmetry appears to be related primarily to differences in eyelid position and upper eyelid contour. Given your history of dry eyes, a conservative approach is important. Depending on your examination findings, options may include ptosis repair, conservative upper blepharoplasty, or brow adjustment. An oculoplastic surgeon can determine the safest and most effective treatment plan.

Thank you for your question and photos.
When it comes to eyelid surgery I will always have a thorough discussion with patients about conservative skin excision. I think it is very easy to pull the upper eyelid skin and think you need a significant amount of skin removed. However, I would caution this approach as most of the "bad" results after a blepharoplasty come from over aggressive skin removal. A small amount of fullness of the upper eyelid is actually a youthful feature and this often...