Are my nipples going to permanently point down? (Photo)

Hello!
It is still very early and you can assist in modifying outcome. I typically recommend to my patients to massage their implants daily, particularly if they are smooth round implants. This will help soften scar tissue and overlying breast tissue. Talk to your plastic surgeon about your concerns and see what she/he recommends as well.
I give it at least 4 months for the breasts to settle, up to a year.

The phenomenon of "settling" after sub-pectoral breast augmentation needs to be clearly understood.  Your implants will settle into a lower position over the first 12 months after your surgery.  I would defer areola transposition surgery until at least 6 months have passed.  Let gravity and natural muscle contractions do their thing.

At only 3.5 weeks post op it is too early to tell how much more lower pole settling you can expect.  Most likely the bottom of the breast will bloom out to accommodate the implant decent.  This will improve the look greatly.  By six months wysiwyg.  If you are still unsatisfied further modification of the implant pocket can take you closer to your desired result.Keep your PS in the loop so everyone is aware of your concerns and will prepare for revision if necessary.I hope this helps.

It is most likely that over the course of the next few weeks or maybe even months that your implants will settle into a little lower position & the upper pole swelling will lessen.   Thus your nipples are not likely to remain pointing down.If your appearance is the same in 3 months as it is now then discuss revision with your surgeon, but not until at least then.All the best

Ki,Thanks for the question and photos.At 3.5 weeks, you are still in the early healing phase, but I do like my breast implants lower by this time.  It is not too late to help them along.  Three time a day massages with both keep them soft and can aid in their further descent downward.  Using a 3 inch ace bandage most of the day and or during the night above the implants to push them downward works very well too.Clear all of this with your Plastic Surgeon first.Good luck with your continued healing.Dr T

At his point you are still early in the healing process. I would give it a good 4-6 months to see how they settle before considering any areola lift surgery.

Hello,I can understand your concern. At 3.5 weeks, it is still very early, however, you should be performing implant massage at this point. This could help the implants settle and drop into the correct position. Currently (at least as the photos show) the implants appear centered above the areolae and they should be centered under the nipple. Continue visiting with your surgeon to make sure things are progressing as desired.Thank you,

Thanks for the great question. You should be ok! You are still very early post op and as Dr. Salzman already explained, it can take 1-3 months for smooth implants and 3-6 months for textured implants to settle completely. This can be a frustrating process for the patient as it takes time and sometimes the implants come down at different rates. I would wait at least 4-6 months before even entertaining the idea of doing any sort of revision. Best,~Dr. Sieber

Especially early in the post-operative phase of healing, it is not uncommon to have one or both implants appear to be high up by the clavicle. Although the “pocket” may be made correctly, the implant may not have access to the bottom for several reasons. If the overlying muscle or skin is tight, this will move the implant to the path of least resistance which is up and towards the underarm where there is little or no pressure. As the pressure relaxes, the implant will drop down to the bottom. Smooth implants, because their surface is slippery, may move faster downward than a textured implant with its rough surface. Because these variables mentioned above can be different for each side, it's not uncommon that one side will drop faster to the bottom of the pocket than the other. Similarly, sometimes one breast will swell more than the other or be more painful than the other early in the postoperative phase. After the first month or two, usually things will even out. It wouldn't be, in my practice, until four months or so has passed that I would entertain going back to the operating room to “touch up” the location of the breast implant in the pocket. Sometimes specialized bras or straps as well as massage and stretching protocols may be helpful in allowing this process to happen more quickly. Each plastic surgeon will have different thoughts on what the best protocol is for the patient. Your operating plastic surgeon will be your best resource to have this information passed on to you. I recommend that you faithfully follow up and follow the instructions of your chosen plastic surgeon. Congratulations on your surgery, and good luck on an uneventful recovery.