Doctor Q&A

Ally,
I have seen this several times in patients that work out heavily, especially when they are doing intense upper body exercises. I would try limiting the upper body exercises and trying Alleve once a day and see if it improves. You don’t mention if it is bilateral. Usually it is on one side. You can use a cold gel pack on it and see if that helps as well. The good news is that once you get it to calm down you can return to working out gradually and it should stay improved.
Be sure to f...

Thanks for your question! You may be able to try some laser treatments or microneedling. If you'd rather get the best outcome, you could have the scar revised, but that means healing all over again. Good luck!

Thank you for your pictures. For best and optimal results, you are a great candidate for Lipo360 with a tummy tuck with fat grafting to your buttocks/hips. It is possible that when performing lipo360, especially the full waistline, can accentuate your buttocks as well without having to have a BBL. If a tummy tuck if off the table for you, you may also benefit from Lipo360 with skin tightening with the understanding that a tummy tuck is still your best option. We would love to schedule a...

Thank you for sharing your concerns. Buttock asymmetry and sagging are prevalent and are usually caused by uneven fat distribution, skin laxity, and natural body anatomy.

Exercise can improve muscle tone, but it cannot fully correct sagging skin or significant asymmetry. Weight loss may help in some cases; however, if there is already looseness, it can sometimes make sagging more noticeable.

In these situations, a customized surgical approach gives the best results. Depending on your...

Thanks so much for your question,
Yes, in general, it is better to do a brow lift before a hair transplant or hairline-lowering procedure. A brow lift changes the position of the brows and the forehead skin, and in some techniques it can subtly affect the hairline position or tension. If you did the hair transplant first and then lifted the brow later, you could end up distorting the transplanted grafts or shifting the hairline in an unpredictable way. Doing the brow lift (and...

This photo does not provide enough information for good advice about facial rejuvenation, unfortunately. It is very likely that rhinoplasty would improve overall facial harmony , possibly lower eyelid surgery, periorbital fat grafting? In person consultation with an experienced board certified plastic surgeon would give you opportunity for in depth analysis and meaningful advice. Good luck.

You do have a narrow nose but actually reducing the dorsal hump will make the nose look less narrow because it is decreasing the anterior projection. You appear to be an excellent candidate for a rhinoplasty.

Best Wishes,

Gary Horndeski, M.D.

Hello and thank you for your question. I highly recommend that my patients focus much more on real longterm before and after photographs rather than 3D imaging.   I encounter so many patients in my practice who see me for revision rhinoplasty who previously had surgery elsewhere who feel like they were mislead into surgery by surgeons who relied heavily on 3D imaging without adequate real before and after pictures to back it up. Photoshop is easy but real surgery is very different.

I a...

A March surgery date can absolutely be realistic, but it depends on a few key factors. If you have your consultation in December or January, and there are no medical issues, March is typically achievable depending on the surgeon’s availability, financing approval, and completion of pre-operative requirements.
As far as recovery and time off work, this varies by procedure and the physical demands of your job. For mommy makeovers that include a tummy tuck, I generally recommend 2 weeks off f...

Breasts are seldom perfectly symmetric. The symmetry can generally be improved as a part of a breast reduction.

Hello and thank you for this question. This is a topic I’m asked about during every consultation I do for both breast reduction and breast augmentation. There is an area of fat right under the armpits that plagues women of all shapes and sizes. It’s very simple to treat with liposuction during your procedure. It’s not typically covered by insurance but the cost, time and recovery are often minimal and can be done at the same time as your reduction or performed later under local anest...

Yes, it is absolutely possible in many cases to keep your current implants and still perform a breast reduction — but it must be done with the right technique and for the right reason.This situation is actually a classic indication for a Push-Up Lift–style reduction.How breasts get “too big” with implantsOver time, breasts can enlarge due to:Weight changesHormonal factorsPregnancySkin and tissue stretchIn these cases, the excess volume is usually your own breast tissue, not the impla...

Your breasts are low on the chest wall and the breasts are asymmetrical in volume, shape and position. If implants are placed, they have to be centered underneath the nipple-areola complex, which is below the level of the pectoralis major muscle, so the implants will end up low on the chest wall. You may be better off doing a lift by itself and then doing implants.

Best Wishes,

Gary Horndeski, M.D.

The implant (Motiva) is what reduces capsular contracture. The technique is what is so totally different. Instead of cutting tissue to create a space, either in the subpectoral, subfascial, or subglandular plane, a balloon is employed in the inter-fascial space between the deep fascia of muscle and the basement fascia of the breast gland. This allows for preservation of the vertical fibers that run through the breast from skin to muscle (Cooper's ligaments). They get pushed out of the way...

Thank you for your inquiry. We would love to sit down with you and talk about your concerns and goals. Yes, implants have the cc and a serial number on them. The implant that is used has the information on them. Schedule a consultation with a Board Certified Surgeon.

Based on these very limited photos which do not show entire periorbital area, it does not look like you should expect much of the improvement after lower or upper blepharoplasty. In person consultation is recommended.

A mid facelift can tighten the skin around the orbits to smooth out some of the contour irregularities. A lower blepharoplasty can be done to transpose fat to hide the tear troughs.

Best Wishes,

Gary Horndeski, M.D.

Hi there—hope all is well. Based on the photos alone, here are a few observations:
Asymmetric eyebrow position (left lower than the right)
Brow ptosis (overall low eyebrow position)
Excess upper eyelid skin, possibly more pronounced on the right than the left
Possible eyelid ptosis, particularly on the left, which should be ruled out
My recommendation would be an in-person evaluation by both an Ophthalmologist and a Plastic Surgeon for a thorough physical examination. Based on those...

Thank you for your inquiry. We would love to sit down with you and talk about your concerns and goals. Upper eyelid surgery removes excess skin to the upper eyelid giving you a natural more rejuvenated look to the eye. We recommend a consultation in person to see what would benefit you the most. Schedule a consultation with a Board Certified Surgeon.

The first photo shows bilateral upper eyelid retraction which is worse the anatomic left side in this image (assumes you have not reversed the images). In the second image pair, both upper eyelids are heavy with a relatively flat upper eyelid contour, the other eyelid demonstrates peaking of the upper eyelid just later to the lateral limbus—where the colored part of the eye meets the white of the eye. Should you have your original surgeon fix this? I can almost guarantee that your surgeon w...

In our practice CRNA providers have shown reliability and safety regarding both twilight and general anesthesia. Careful selection of patients, preoperative clearance by primary care physician and other specialist as needed are part of preoperative evaluation. Providing that anesthesia provider is someone who works with your surgeon for long time you should feel safe. Good luck.

Thank you for your question and photo. Based on this single frontal view photo, you would do best with a full facelift, neck lift, upper lip lift and fat transfer to the upper face. The brow and eyelids can be done later. Now you can waste your money on smaller, ineffective procedures like what you have done already, which BTW, will make a facelift more challenging. You do have an asymmetrical face with one side significantly smaller, significant perioral aging, loose ski and platysmal...

Hi TBD.  In most cases, the key issue in determining whether to suggest dermal fillers or surgery is volume loss vs. skin laxity.  If the skin is loose and drooping, then surgery is often the best option.  If the skin is taught and firm, but the patient is thin or has volume loss, then we suggest dermal fillers.  In your case it appears that you have not lost much elasticity in the skin but do have a depression in what's called the malar area.  We commonly use Radiesse and Restylane Lyft...

Thank you for your question. I would consider the face and the neck as one aesthetic unit. The face and neck belong together. Anatomically, the tissue layers of the face transition into the neck. It only makes sense while performing a deep plane face lift to address the neck as well. The most beautiful results are obtained when both is combined usually with some ancillary procedures of the face, to address all the aging processess - like the eyes, volume loss, upper lip ptosis, brow...

You appear to be a great candidate for a deep plane facelift and neck lift, especially given your concerns about nasolabial folds, midface sagging, and heaviness along the jawline. This technique lifts the deeper facial layers rather than just the skin, providing a more natural and long-lasting result.
I often combine this with fat grafting to restore volume in the cheeks and around the mouth, which helps smooth folds and balance the facial contour.
While your photos are helpful for an...