Doctor Q&A

There is always a certain degree of inherent asymmetry from left to right. This can be accommodated be differences in volume, profile.

Based on your photos, you have an objectively excellent result. Slight variance in upper pole can be addressed via asymmetric implants. A narrower or smaller device can deliver less upper pole fullness. However, your small differential will be difficult to account for with the variations from one implant to another. Absolute symmetry is not realistic as a...

Based on your photos, I do not believe that a vertical incision will be necessary. A vertical incision is typically placed at the site of the original belly button. From your images, it appears that you have sufficient skin laxity for your surgeon to remove the excess skin from below the belly button down to the mons region without requiring a vertical incision.
If, however, there is insufficient skin laxity at the time of surgery, a small vertical incision may be needed. In that case, the...

Given that your skin elasticity appears to be quite good, I believe that an abdominoplasty could remove your tattoo, provided that the incisions are extended significantly to the sides of your abdomen. Of course, these will always be covered by your underwear or swimwear, but they will necessarily have to extend beyond the typical length of a classic tummy tuck. Additionally, it is possible that the site of the umbilicus (belly button) may not reach low enough; therefore, in addition to the...

Hi, thanks for your question. Possible surgical goals could include reducing the dorsal hump and reducing columellar show. The appearance of your nostrils is likely due to a low hanging columella, which can be due to elongation of the nasal septum and/or the positionining of the medial crura of the lower lateral cartilages. These issues be addressed surgically by trimming the nasal septum as necessary and repositioning the medial crura.

Thank you for your question. You are an excellent candidate for rhinoplasty. I think it is one of the most beautifying surgeries that we do as plastic surgeons. A large portion of my practice is dedicated to rhinoplasty surgery. In your case, You do not have excessively thin skin or thin bones. Your quite normal.. You do have a hanging columella and arched alar rims. This is the most common problem I see when addressing revision rhinoplasty. It is easily fixable. It is important to only...

You would benefit from a rhinoplasty. Your tip is slightly wide and needs to be refined. Also, the dorsum can be straightened. Your nose looks different from different angles because of the super tip hollow.

Best Wishes,

Gary Horndeski, M.D.

Hi, thank you for your photos.
Yes, you can be a candidate, but only for a small / subtle BBL. At your size, there is limited fat available, so the result would be modest shaping rather than a dramatic increase. In that sense, I would advise to keep your goals realistic. If you want more volume, weight gain or focusing on liposuction only contouring may be better options.
— Andaç Aykan, MD, Assoc. Prof.

Hello and thank you for your question! I agree that you have a great frame/underlying shape. In my opinion, lipo 360 and BBL can certain enhance this shape and contour by subtracting the excess fatty tissue from areas like your abdomen, flanks, and lower/mid back, and adding some of this volume will help with the overall contour and projection of the gluteal region. The other important factor to address would be the excess skin. If you are not finished having children, I would ultimately...

Hi, great question to ask.
A free nipple graft (FNG) is usually used only when breasts are very large or very droopy and the nipple needs to be moved a long distance. In these cases, keeping the nipple attached may not be safe, so the surgeon removes it completely and grafts it back on. This is done mainly for safety.
If a free nipple graft is done, the milk ducts are cut. This means you will not be able to breastfeed in the future. Nipple sensation is also often lost.
Because you are only...

You’re asking a very real and very common question — and your symptoms are absolutely valid, even if insurance criteria don’t always reflect that.At 5’7”, 135 lbs with a 32DDD, your breasts may not sound “large” on paper, but on a petite, athletic frame they can be biomechanically very heavy. Pain with running and limits on activity are legitimate medical concerns.Why insurance is the sticking pointMost insurers use gram-based criteria (often ~500 g per breast) to approve reductions....

Thank you for your question. I have been in practice for over 30 years and revisionary breast surgery is a large portion of my practice. When considering breast augmentation above or below the muscle, it is the lesser of two evils. Usually, the animation deformity from breast augmentation is minimal, however when you place implants on top of the muscle, the complications are significantly worse - slide down and wrinkling. I have a whole gallery of patient's with long-term changes with...

Your tattoo is far enough away from your breasts that it most likely will not be affected by the implants.

Yes — at your age, it is absolutely reasonable to have breast implants without a lift, especially if avoiding scars is important to you right now.You’re also thinking about this the right way by accepting that you may choose a lift later in life if your priorities change.Do you really need a lift at 20?In most 20-year-old patients:Skin elasticity is still goodSagging is usually mild or borderlineThe issue is more volume than true droopIf your nipples sit at or above the breast fold, a...

Skin adhesions, in the anterior neck in particular, can be seen after neck lift surgery relatively frequently. Too aggressive liposuction of the skin and removal of fat tissue over the muscle may create condition which favor skin adhesions. However, it is still something that can not be entirely predicted. You should discuss with your surgeon whether additional liposuction of the skin flap is absolutely necessary . Good luck.

You have facial asymmetry and would benefit from a rhinoplasty to straighten the nose and correct the uneven nostrils. You would also benefit from an eccentric lip lift. This does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners.

Best Wishes,

Gary Horndeski, M.D.

Hi, thank you for your question and photo.
At 37 years young, with your good skin quality, I think this is more of a volume and support issue rahter than excess skin. A full facelift would be too aggressive and I don't think it's necessary for your face. The most appropriate surgical options are a limited midface lift to reposition tissue and improve asymmetry, or fat transfer to restore volume. A small midface lift can reposition descended tissue and improve asymmetry, and many patients are...

Based on what you’re describing — lower face heaviness, early jowling, loss of jawline definition, and sagging — a deep plane facelift (often combined with a conservative neck lift) is the more appropriate and durable option, even at age 42.Your age does not exclude you from a deep plane lift. In fact, it often makes the result better and more natural.Why surgeons are split in their recommendationsThis is very common and usually reflects philosophy, not confusion.Surgeons r...

Let's summarize:
SMAS lift followed by
-loss of sensation sides of face
-parts of neck (side not mentioned)
-occasional numbness under R eye
-tingles on top of head on R when R eyebrow area touched
-recent diagnosis of Grave's disease and psoriatic arthritis
-no change for months

It is not unusual to have numbness temporarily after a SMAS lift due to skin undermining. This should all come back on both sides of the face.
The occassional numbness should also resolve.
The tingling on top of...

Thanks for your question and the photos.
I think any time you are concerned about results after surgery you should absolutely discuss with your primary surgeon. In particular, with ptosis surgery, I would make sure you are seeing a plastic surgeon with specialty in eyelids or an oculplastic surgeon. I agree it looks like you still have some drooping of the upper eyelid and depending on their exam, it might be worth considering a revision, though there is certainly alot of nuance and...

Thank you for your photos. The correct position for the brow is to be at, or above, the bony orbital rim of the eye socket. Your brow appears to be above your orbital rim and elevating it further with a temporal brow lift would not provide an aesthetic improvement. An upper blepharoplasty, with only skin removed, would help to freshen and rejuvenate your upper eyelids while retaining all the youthful volume in your upper eyelid. This is commonly done with only local anesthesia, plus/minus...

Surgeons who perform a “skin pinch” love the notion implied by the nickname of this procedure: what could possibly go wrong. However, this is still a transcutaneous lower blepharoplasty and it is a not so uncommon reason people show up to my Beverly Hills office to fix botched eyelid surgery. A canthopexy or its stronger sibling, canthoplasty will not fix your lower eyelid retraction. It will not prevent well meaning surgeons who claim to be in the fix-it business from trying canthal tig...

Your eyebrows are below the level of the orbital rim, you have excess upper eyelid skin, excess lower eyelid skin as well as mid face descent. You would benefit from an extended browlift. This will pull up the eyebrows, help with the upper eyelid skin and pull the mid face tighter. After this, you may or may not need a revision of the upper and lower eyelids.

Best Wishes,

Gary Horndeski, M.D.

It is very difficult to evaluate underlying deformity (hollowing) on these photos. A condition is known as malar hypoplasia, small cheek bone. Depending of the extent of hollowing correction with the cheek implant would be my first thought. Milder hollowness can be corrected with fat grafting or even bone grafting. In person consultation with a board certified plastic surgeon with experience in this type of correction is recommended. Good luck.