Doctor Q&A

Generally, with any descent of the breast, a lift is usually required to truly correct that—even if implants are added for fullness.

I completely understand your concern about scarring. When a lift is necessary, it does involve scars, but with optimal attention to incision closure, they heal as hairline scars that become barely visible over time as they fade. The trade-off is in a more youthful shape and better overall balance.

An in-person consultation will help determine this more p...

Based on your description, this sounds like pseudoptosis (the nipple is at or near the fold, but the breast tissue has fallen below it after weight loss).In these cases, a small, well-chosen implant can often restore upper fullness and improve the overall shape without creating that “overdone” look you want to avoid. It may give a subtle lifting effect visually, but it won’t truly raise the nipple—so expectations need to be realistic.If your nipple position is still acceptable, you m...

Thank you for your question and for sharing your photo. The good news is you are not too old for a tummy tuck at 59. I always tell my own patients that you deserve to look and feel your best at every stage of life.

It’s important to understand that while a tummy tuck can remove excess skin and improve contour, deep stretch marks won’t completely disappear—those in the lower abdomen are often removed with the excess skin, while those above may improve but not fully resolve.

In my exper...

Congratulations on your weight loss—that’s a fantastic accomplishment!
A fleur-de-lis tummy tuck is definitely a good option to achieve the most skin tightening. However, I often remind patients that while we can always add a vertical scar later, we can’t take one away once it’s there. In many cases, a traditional or extended tummy tuck can still provide a very nice result, even if there’s a small amount of looseness side-to-side. Many patients are very happy with this approac...

Thank you for your question and for sharing your photos. This is a common concern, but one that can be remedied with a thoughtful approach.

The tip turning downward with smiling is usually caused by the depressor septi muscle, along with tip support and nasal length. The dorsal hump is a separate issue, but both can be addressed together.

This is a pattern that generally responds very well to rhinoplasty, allowing refinement of the bridge and improved tip support so the nose remains more...

Hello and thank you for your question. That timing should be fine. Make sure you are going to a surgeon with hundreds of long-term before and after pictures on their website with standardized lighting and standardized backgrounds. 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

I can see some of the natural highlights of folds of the tip cartilages under the skin, and we wouldn't be able to see that if your skin were thick. It just looks like you have strong, broad tip cartilages that make the tip look wide and make it hang in a low position.
Couple things about the last two photos you posted -- the 3/4 view and the morph. First of all, it's an absolutely fantastic morph! How did you do it? How did you get the nostril to show and have a natural shape in the "after"...

A BBL after hydrogel injections has to be approached very carefully, because hydrogel does not behave like normal tissue.
Over time, these substances can:
* spread through different tissue planes* mix with fat and muscle* and create chronic inflammation and fibrosis, even years later
The concern is that liposuction — which is necessary for a BBL — can disturb the material and potentially:
* spread it further* increase inflammation* trigger fluid collections or infection* and make...

Based on your history of significant weight loss and the photos provided, it appears that the main issue is not only volume loss but also substantial skin laxity in the lower trunk and buttock area. In patients with this type of tissue quality, a lower body lift is often the most appropriate primary procedure because it removes excess skin, tightens the tissues of the abdomen, flanks, and back, and simultaneously lifts the buttocks. A traditional BBL alone usually cannot correct the degree...

Thank you for your question and photos. If you want "optimal results" I would do VASER liposuction 360 degrees with fat transfer to the buttocks and hips. At a second stage a sculpted tummy tuck can be done. With the skin shrinkage from the liposuction surgery first, the tummy tuck incision and scar will be shorter as well. I do these surgeries in our accredited in office surgery suite under deep intravenous sedation and not general anesthesia. I would recommend hyperbaric oxygen therapy...

First off, congratulations on your weight loss. Based on your current height, weight, and history of weight fluctuations related to PCOS, you would likely be a very good candidate for a tummy tuck with liposuction. The question of whether you “need” an extended tummy tuck really comes down to where your excess skin and fullness are located. An extended tummy tuck is designed to address more lateral (side) skin laxity, but it does come with a longer scar.
In many cases like yours where the...

Hello, and thank you for your question.
After three C-sections, many patients achieve an excellent result with a tummy tuck combined with liposuction. A tummy tuck with liposuction of the flanks can create a very nice hourglass contour and flatten the abdomen. However, this approach treats the front and sides of the torso and does not address the back. If fullness of the back is a concern, then I recommend liposuction 360.
Based on your description, and photos, I do not think BBL is...

Dear RealSelfMember09903993,

A mini tummy tuck is great if you are just looking to flatten the skin below the belly button. It does nothing for the skin above the belly button.

A full tummy tuck address all of the skin laxity and abdominal wall laxity. It repositions your umbilicus as well. It costs more and has more downtime associated then either of the above.

I would recommend consulting with a plastic surgeon that can go over in detail these three options and spends time answering...

Even though small amounts of milk after weaning are common, active residual lactation before breast surgery is not something that should be completely ignored.
Milk inside the ducts and glandular tissue can increase the risk of:
* prolonged swelling* wound healing problems* dehiscence* infection* galactocele formation (milk cysts)* and persistent drainage after surgery
This becomes more important in breast reduction surgery because:
* large areas of glandular tissue are manipulated* ducts...

Hello, yes you can be brought to a small B as long as there is some realistic expectation of what a b cup is. Do you buy bras at JCPenney or Victoria's Secret? Patients will buy bras based on the comfort of the cup, the strap size etc., not necessarily what properly fits the breast mound. As long as there is a reliable blood supply to the nipple and areola based on an experienced plastic surgeons' technique, you can have a small breast of your choosing. Best of luck

Hello,
Thank you for the question. It is difficult to assess from the photos only. The next best step would be an in-person examination with your plastic surgeon.
I wish you the best.
Vasileios Vasilakis, MD, FACSDouble Board Certified Plastic SurgeonHouston, TX.

It is very understandable to feel this way after a breast reduction. Many patients expect relief from heaviness or discomfort, but later realize they also miss the fullness and shape they had before.
The important thing to understand is that:
* grams of breast tissue removed and* cc’s of an implant
do not correlate perfectly.
Breast tissue is made of:
* fat* glandular tissue* skin* and natural breast structure
while an implant is a fixed-volume device with a very different shape and d...

At 39 years old, 5’6” and 121 lbs with firm skin, you are in a very favorable position for breast enhancement surgery. Good skin quality like yours typically allows for excellent shape control and predictable results.The best approach will depend on your current breast volume and nipple position, but in general:If you’re looking to restore or enhance fullness, a small to moderate silicone implant can provide a natural, balanced result.

The consultation process is designed for potential patients to wade through the available options and make the choice which is most appropriate for them. The time to ask questions and change your mind is before surgery...not after.

I invite patients to take an active role in preoperative planning. As the surgeon, I am merely serving as a guide to inform their decisions. I don't choose the implant...I make suggestions. Patients will commit to a size range pre-op...rather than a single...

Based on your photos, you would likely benefit from a combination of:
* aggressive back and flank liposuction* waist contouring* and skin retraction techniques
The good news is that you are already losing weight, and that is extremely important. Reaching a more stable weight first will improve:
* your surgical result* skin contraction* and long-term contour
At your height, even losing a little more weight can create a very noticeable difference in the back rolls and side folds.
Now,...

Hello and thank you for your question!

Whether liposuction alone will give you a good result depends on two main factors: skin elasticity and whether there is any loose skin or muscle laxity.

Liposuction is excellent for removing fat, but it does not tighten skin. Even if your skin has been elastic in the past, factors like age, weight changes, and perimenopause can reduce how well the skin contracts after fat removal. In patients with any degree of skin laxity, especially in the lower...

Hello hcrouse in Waterloo, ON, Thank you for your question about whether you can get lipo with your stomach tattoos. Thank you for your history and photos. Yes, you can have lipo on your abdomen even with your abdominal tattoos. Liposuction removes fat and is an excellent tool for patients with isolated pockets of fat. Your abdominal tattoos should not become warped. However, you must consider your goals. Indentations and irregularities due to soft-tissue damage caused by gastroschisis may...

I truly hear your concerns, and it is completely understandable that you would want to avoid further surgery after such a serious experience as a pulmonary embolism. What you are describing is a common concern where the remaining fat above the surgical site becomes more noticeable as the surrounding areas are flattened. Since surgery is off the table, we can focus on non-invasive body contouring treatments like CoolSculpting to freeze and reduce those specific fat cells, or radiofrequency...

Thank you for you question. I would best recommend ptosis repair as your upper eyelids are sitting lower than ideal. During this procedure, the eyelid muscle that is responsible for lifting (the levator) is tightened so the lids sit higher, are open more and even, and the very high crease softens and appears smaller. I would also recommend a lateral canthopexy, where I support and tighten the outer corner of the eye to correct the negative canthal tilt and create a more lifted, balanced...

Thank you for your photos. An endoscopic brow lift would likely only move your brows a millimeter or two. A subcutaneous temporal brow lift would not be a good option for you as you have a very high forehead. I believe the simplest way forward for you would be to have a skin only upper blepharoplasty, which will help define your upper lid crease and can remove some of the skin responsible for the hooding. This can be done under local anesthesia and has a quick recovery time. Best wishes.

Lower eyelid skin pinch only removes skin. Your problem is volume as you have fat bulging. You will need a lower blepharoplasty to remove or reposition the fat pads.

Best Wishes,

Gary Horndeski, M.D.

The only way to improve your current look is to fill the space underneath the bone with small amount of fat graft. This should be done conservatively and will need at least two stages to avoid lumpiness. I hope this helps.

I can certainly understand how unsettling it can feel when changes seem to happen so quickly, especially at your age. However, at 26, a facelift is almost never the appropriate first step.

In my decades of experience treating facial aging across a wide range of patients, the most natural approach for someone your age is typically to restore support rather than remove or tighten tissue. This can often be achieved with thoughtful use of fillers. In some cases, micro-fat grafting can provide...

Hi, it.s Dr.Phuc DinhAt 58, it’s important to set the right expectation first, no treatment can completely remove all wrinkles, but we can significantly improve your appearance in a natural and effective way.What I see from your photos:-Moderate to significant skin laxity in the lower face and neck-Deep wrinkles and folds (especially around the cheeks and mouth)-Loss of jawline definition and early jowling-Forehead lines and skin texture changesThe best approach is a combination, not one s...

Thank you for sharing your details.At 56 years old, 5’6” and 114 lbs, very fit and in good health, you are generally considered a very good candidate for a facelift, especially if you are noticing sagging in the lower face and loss of jawline definition. Good overall health, stable weight, and realistic expectations are key factors for success.In your case, a facelift (often combined with a neck lift) can effectively:Improve jowls and jawline definitionTighten loose skin in the lower fac...

Thank you for your question—this is a very common one.

At this stage, you appear to be a great candidate for non-surgical treatments like radiofrequency, Morpheus, or Sculptra. These can help tighten the skin and restore some volume with subtle, natural-looking results. Because you currently have only minimal sagging or jowling, a facelift would likely not provide a dramatic enough improvement to justify surgery and scars just yet. In a few years, when those changes become more n...

Thank you for your inquiry and sharing your photographs.

My advice is to wait until the effect of the Sculptra treatment fades away.

It generally takes approximately 9 to 12 months for this to happen.

There is little benefit from rushing into a surgical intervention at this stage, because the effect of the Sculptra treatment is, by its nature, temporary.