Doctor Q&A

Choosing the right size and profile breast implants for you. 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 actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very...

Congratulations on your surgery! I know it's hard to be patient but it's much too early to judge your results. You are swollen and the implants have not dropped into their natural position. Continue to closely follow your surgeon's instructions and discuss your concerns. You should get a better feel if the size is right for you after a few months.

Upper pole fullness refers to having volume at the upper portion of the breast (versus a sloped breast). From the photos you have a rounded appearance to the breasts which includes fullness in the upper pole. What is important is not how you describe the breast but more that you are happy with your augmentation and how you look.

BMI is a straightforward calculation that only takes into account your weight and height. It does not factor in implants or other enhancements. This is one of the reasons why BMI is only considered one factor when assessing a patient. Other factors such as body frame, overall health, and general lifestyle also taken into account when evaluating a patient.

As you are a year out from surgery you can consider a surgical revision to improve the appearance of your scar. This essentially removes the scar in hopes that the new scar will heal more favorably. It's best to begin scar treatments as soon as it's approved by your surgeon. Over the counter silicone sheeting and other creams should be used consistently for best results. Other options are steroid injections and lasers.

If the patient has sufficient fat in the abdomen to be treated with liposuction, I will liposuction that fat at the same time as the tummy tuck. As long as the liposuction is done properly, the patient will heal very well and the recovery time is no different than a tummy tuck performed without liposuction. Combining these procedures will give a better result than if no liposuction were done. It is also more efficient, allowing liposuction and the tummy tuck to be done at one procedure.

In reviewing the pictures you have submitted, they show loose skin above the belly button. In my experience, this requires a full tummy tuck and not a "mini". In performing this, I have the patient wear a bikini bottom on the day of surgery. I draw where the bikini bottom sits on the patient, then design the incision quite low so it is hidden beneath a bikini bottom. The incision curves slightly upward as it heads toward the hip bones. It's length is dependent upon how much skin is removed....

Yes, I will repair an umbilical hernia at the time of a tummy tuck. In repairing the diastasis recti, the surgeon is looking directly at the umbilical hernia. The hernia sac can be opened, hernia contents reduced and hernia repaired directly with sutures under direct vision. After the umbilical hernia is repaired, the diastasis recti is repaired with sutures and this repair reinforces the umbilical hernia repair. I have not seen recurrences of the umbilical hernia repair. Hope this helps!

Sorry to hear this is happening after what sounds like an amazing result! It is not uncommon for tissues to stretch as they are put under strain. At 15 months, the surgery is well healed and you are not really “undoing” the surgery so much as likely stretching the abdominal wall fascia or even developing a hernia. An examination by your surgeon can help determine exactly what is happening. Some patients ultimately require a tightening of the abdominal wall again, usually with placement of ...

Based on your concerns, a mini abdominoplasty is likely suitable if most of the loose skin and stretch marks are below the belly button. With this approach, can also perform a revision of your umbilical piercing scar for a smoother result. A full tummy tuck is only needed when there is significant upper abdominal laxity.

I think you have a couple different options, and it really boils down to how dramatic of results you want to achieve. Liposuction +/- a skin tightening procedure does a really nice job of removing the excess subcutaneous fatty tissue. If you are just wanted to address the "apron belly" that you described, that would certainly be a reasonable option. Liposuction to the abdomen would address that; and if you wanted to do address excess subcutaneous tissue in areas like the flanks or back, you...

Hello, thank you for your question.
I'm afraid yes, it's possible to lose volume in your buttocks during your weight loss process. The fat will act like any other fat in your body. The amount you lose will depend on how much weight you lose and how your body naturally stores fat.
Most people maintain some shape, but some volume loss is normal.
Andaç Aykan, MD, Assoc. Prof.

Hello,
Thank you for the question.
Best on the shape of your body, I would recommend at least adding small volume of fat to your hip dips and buttock. You will still maintain your athletic look. I wish you the best.
Vasileios Vasilakis, MD, FACSDouble Board Certified Plastic SurgeonHouston, TX.

Hello, If you have Undetectable HIV and a good CD4 Count as well as normal Blood Test results and a Normal Cardiologist Evaluation, BBL with Fat from Hips and arm fat transfer is definitely possible. Jaime Caloca Jr., M.D.

I certainly understand the differing opinions that you have received. Their perspective is certainly valid. Based on the photos you submitted, a reasonable but aggressive option that some practices offer is combining the procedures you have described. Doing liposuction 360 with an extended abdominoplasty and BBL as a single procedure is an option at some surgical centers. If you find one where that is possible, I would recommend (as in most cases) to ensure that the facility is JCAHO or Quad...

Based on your photos, you can certainly have a rhinoplasty of just the tip. The curved cartilage can be straightened which creates a more defined tip, while keeping it looking natural at the same time. Be sure to see a rhinoplasty expert for consultation.

Based on your photos, you are a great candidate for rhinoplasty. You can certainly do a tip only rhinoplasty, but I think your best result would involve the bridge as well. The procedure is usually done under general anesthesia. Be sure to see a rhinoplasty expert for consultation that can do computer imaging at the same time.

Hello and thank you for your question. Generally speaking, at least six millimeters of lower lateral cartilage should be left after cephalic trim. There are many maneuvers which can be performed during a revision to correct this depending on your anatomy. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Hello and thank you for your question. Based on your photographs, you may benefit from a tip refining rhinoplasty. A surgeon can accomplish this by trimming, suturing, and reshaping the cartilage in your lower nose. Fascial grafts may also be used to help improve tip refinement. You are a great candidate for rhinoplasty. Septoplasty can also be performed safely at the same time. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with...

Hello and thank you for your question. Based on your photographs, you are a great candidate for rhinoplasty. Maneuvers for your surgery would include dorsal hump reduction, tip refinement, nasal tip deprojection, tip elevation, among other maneuvers. Septoplasty can also be performed to help improve breathing at the same time. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who...

Thank you for your photos. As you have had no prior surgery on your breasts, your breast lift should be straightforward. The skin pattern for your breast lift would need to be determined by your surgeon based upon the skin laxity, and the amount of elevation of your nipple/areola that needs to be done. Your prior mini tummy tuck and liposuction created scar tissue. While your old mini tummy tuck scar could be removed, the scarring from your liposuction extends everywhere in the tissues...

I encourage you to meet with board certified plastic surgeons near you for consultations to learn about the procedures and get a price quote. Many offices accept financing through companies such as PatientFi and CareCredit that specialize in financing for medical procedures. "Shopping" solely for price may lead to sub par results, or worse, compromise your safety.

Surgeons and facility staff are very used to dealing with allergies and finding alternate medications to help their patients. There are several pain medications that can be prescribed for pain management after a Mommy Makeover. Speak with your surgeon about what is right for you.

You would be surprised how quickly you are woken up after surgery! Within minutes of the procedures being completed the anesthesiologist begins to wake you. You won't likely remember it, because you are still so sleepy. You will be taken to a recovery room unit after surgery where you will wake up more. You are monitored continuously by a highly trained staff to ensure your safety.

Total cost for a Mommy Makeover will vary by surgeon and location. There are three components that make up the total cost including surgeon's fees, facility charges, and anesthesia costs. In addition there are costs associated with the implants or other optional selections. I encourage you to visit with a board certified plastic surgeon near you for a consultation to learn more about the procedures that interest you and get a quote. Some practices can offer a ballpark cost over the phone.

Yes, a breast reduction could help create better symmetry and also improve any symptoms you may have from your large breasts, like back pain. Talk to your surgeon about your goals and he/she should be able to help you achieve a very nice outcome. Best of luck!

I would advise allowing your surgeon to reduce your tissue as much as safely possible without doing a free nipple graft. You will be very surprised at how much relief you will get from the breast lift alone, the tissue reduction on top of that is a great added bonus. Safer surgery is always the best option, especially when choosing elective surgery.

You will first want to visit with the physician you see for breast health to verify that the lump is benign. A benign lump can sometimes be removed at the time of a breast reduction depending on the size and nature of the mass. See your board certified plastic surgeon to learn more.

It's best to be as close to your ideal weight as possible and able to maintain it when considering a breast reduction. Some women will notice changes in their breasts with weight loss or gain so it is best to have your weight stable before surgery. Big fluctuations in your weight in the future could impact your surgical results. See a board certified plastic surgeon near you to learn more.

From your description you sound like a good candidate for a breast reduction. This surgery will remove excess skin and tissue to bring your breasts into better balance with your frame. A lift is also part of this procedure so your nipples will be raised to the correct position aesthetically. Your board certified plastic surgeon can assist you in deciding the correct size for you. I've included a video I hope you find helpful.

Hi! Thanks for sharing your concern—it’s completely understandable to notice changes and feel uncertain about the timeline for your face to fully return to its original state.

Typically, Botox effects last about 3–6 months, which is when the muscle gradually regains movement. Most people notice that their face starts looking more “natural” as the Botox wears off. However, it’s not unusual for it to take a little longer in some cases, especially if it was your first treatment or if higher d...

Thank you for sharing your experience and concerns. It’s completely understandable to feel nervous after a complication, even with an experienced provider. Your caution is very wise—building trust and gradually moving forward is the safest approach.

When considering low-risk procedures to start with, the key is to focus on less invasive treatments with minimal downtime and low complication rates. Among the procedures you listed:

Masseter Botox: This is minimally invasive, reversible, and...

Thank you for sharing your concern. It’s completely understandable to feel nervous, especially when seeing a different injector.

When treating the “11s” (the vertical lines between the eyebrows), Botox is often injected near the brow area. The key is precise placement and correct dosing to relax the muscles without affecting the brow’s position. If injected too close to certain muscles, there is a small risk of temporary brow drooping or eyelid ptosis, but this is uncommon with experie...

Botox can provide a conservative brow lift. Depending on the strength of the muscle and degree of asymmetry Botox may not be able to provide enough of a change to make the brows symmetrical, but it often can provide some improvement. Without examining you and knowing more about your treatment it's difficult to give you a specific recommendation.

It can take up to two weeks to see your final results from your Botox injection. However many patients begin to see some changes after five to seven days. So if you are not noticing any issues within the next week or so you are probably not going to have any.

Choosing the right size and profile breast implants for you. 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 actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very...

Implants are centred behind the nipples so without a lift, yours would sit rather low on your chest and provide no fullness in the upper pole.

Thank you for your inquiry. We would love to sit down with you and discuss your goals. Schedule a consultation with a Board Certified Surgeon.

Thank you for your inquiry. We would love to sit down with you and discuss your goals. The best way is to try on multiple sizes/styles of breast implants with a sports bra during a consultation. Schedule a consultation with a Board Certified Surgeon.

Thanks for your question. Based on your pictures, it seems you would be a good candidate for a breast lift with implants for optimal results. However, an in-person evaluation would be best to determine a tailored plan for your breast enhancement. I suggest scheduling a consult for a proper evaluation. Be sure to always consult with a board certified plastic surgeon. Take care, Dr. Salama, Board Certified Plastic Surgeon.

You do appear to be a great candidate for body contouring with liposuction to help define your waist. Liposuction is not a good tool for weight loss or to make you 'skinny,' but it can enhance contours and modify shape when applied correctly. When done properly, liposuction takes away the deeper layer of fatty tissue and leaves the top layer of fat behind to keep your skin smooth. If liposuction is performed to superficially or too close to the skin, then you can see a lumpy bumpy appearance...

Thank you for your question. There are several soft tissue structures in the axilla, and the most 'bulky' of them include fat and lymph nodes, but important blood vessels and nerves also cross this area. Your latissimus muscle also crosses in this area, and can contribute to bulkiness of the underarm. If you are seeing change in soft tissue, I recommend that you see your general physician for an examination to make sure you do not have enlarged lymph nodes. Liposuction can in theory be used,...

No there is no limit to how many times you can have liposuction. With each surgery you will need to be evaluated from a candidacy standpoint. Are you in good health? Are you a good candidate for the procedure that interests you? Will the procedure produce results that are in line with your surgical goals? If liposuction is done repeatedly on the same areas you do increase risk of issues such as contour irregularities. Your board certified plastic surgeon will help you determine if the...

Yes it is possible to target a small area to remove a pocket of fat. The area in question appears small enough that the procedure could be performed with local anesthesia. The question is if doing so would give you the result that you want. I encourage you to begin by visiting with a board certified plastic surgeon near you to discuss your concerns and learn more about your options.

From the photos it does appear you would be a good candidate for liposuction of the hips/flanks to address your concerns. An exam is best to determine if you have abdominal muscle separation. If so then a tummy tuck would be recommended to repair it, which would also remove excess skin and subcutaneous fat. I've included a video that I hope you find helpful.

Great question! It looks like (although hard to tell given no true lateral view) that you might have what is called a negative vector, which is where your cheek is recessed compared to your eye. What would help best in that situation is a small implant to correct that deficiency, +/- bleph depending on what the exam shows for fat/skin excess and correction of the tear trough.

If your concern is primarily excess fat and lower lid bags, and you have little to no excess skin and tight lower lids, you may only require a fat removal/repositioning to achieve the results you want and you could get evaluated any time for that. If you need any skin excised or the lid tightened with a canthoplasty/pexy, I would wait a minimum of 3 months before surgery. You could always present for a consultation and plan around a future surgery date. Remember, it takes time for the...

Blepharoplasty, especially revision cases, really require a detailed exam to determine the best treatment. Your left eye appears to have more skin that needs removed to make that component symmetric, but also you appear to have less volume and a mild “A” frame deformity. I believe you would require some fat grafting to restore some of this volume to achieve symmetry and make a more youthful appearance. Again, a good examination would give more information on what exactly would be req...

Thank you for your inquiry! We would love to sit down with you to discuss your concerns. Blepharoplasty will remove excess skin and fat pads. Schedule a consultation with a Board-Certified Plastic Surgeon to help you reach your goals.

From the photo, the puffiness and shadowing under your eyes appear to be caused by a combination of mild under-eye fat protrusion and volume deficiency along the tear trough. When these two features overlap, they can create a persistent “tired” look even after filler is dissolved.
In cases like this, the most effective and long-lasting option is typically a lower blepharoplasty with fat repositioning, which smooths the transition between the lower eyelid and the cheek.This procedure add...