Doctor Q&A

It looks like you have lateral displacement on one side and a capsular contracture on the other. These are unusual, but are the most common complications of breast augmentation. I would return to your surgeon. The correction is very straightforward. The lateral pocket is closed on one side and the fibrous scar tissue causing the contraction (tightness) can be removed on the other side. This should give good position, softness and symmetry to both of the implants.

Thaks for the photos and info. Picking the exact size in cc's or shape of an implant before surgery with precision is nearly impossible.

The reason for this is because your breast tissue and your skin stretch in a very individualized manner, so precise rpediction is impossible. I do assure my patinets of a size range after we go thorugh a careful measuring process, and I will also explain why one profile mnight suit their needs better than another.

In the end, you'll need to rely...

The breasts continue to noticeably develop until the early 20s, therefore you may want to wait a few more years before considering breast augmentation. If you have one done too soon, your results may be negatively affected should further development occur.

It appears that you already have a midsection that curves in, giving you an hourglass shape. It would be helpful if you can provide wish pics that illustrate how much more of an hourglass shape you’d like. Rib removal is not recommended. It does appear that there is some bulging in your side photo. It is difficult to see, but if the area of concern is located below your belly button, a mini tummy tuck may be sufficient.

Beausmom20 great question! While it is safe to combine some procedures (i.e. Breast lift w/ implants & Tummy Tuck), it is uncommon that a surgeon will agree to perform all of the surgeries listed in one trip to the OR. This is because the complication rate increases with longer anesthesia time and you're more likely to have wound healing problems. Additionally, it is difficult to recover from surgery on all 4 extremities at the same time.
I would recommend going to a surgeon who discusses...

Hi, thank you for sharing your question. It’s difficult to identify significant skin laxity in these photos so recommending a standard tummy tuck may be tough to do without a proper evaluation. Based on the photos alone and your information given, I would consider a mini tummy tuck.

Dear raniung13,

based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because only after a thorough examination you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American...

Hi, thank you for your question.
No. After 9 years, BBL fat behaves like normal fat and cannot be damaged or destroyed by massage, even very deep pressure. Grafted fat is not more fragile once it has fully healed.
What you’re noticing is more likely temporary inflammation, muscle soreness, skin laxity, or normal changes that became noticeable around the same time.
Sculptra can improve skin firmness and mild fullness, but it does not replace lost fat. Its effects last about 1.5–2 years. Tru...

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...

Since the lower 1/3 of the nose remains swollen for some time after rhinoplasty surgery, some people, especially with thick skin, can have puffiness above the tip that can resemble a polybeak. Dilute Kenalog injections may be helpful for improving upon supratip swelling. It is not helpful for diffuse nasal tips swelling, or asymmetries involving the nasal bridge. Thank you for this question.

First of all, congratulations on your weight loss! Losing 100 pounds is a tremendous accomplishment and a major investment in your health and well being. As a board certified plastic surgeon, the next step is to match your surgical plan to your anatomy and aesthetic goals as safely and efficiently as possible.

From your description, a breast lift, tummy tuck vs lower body lift, and liposuction are all reasonable components of a comprehensive contouring plan after massive weight loss. Given...

Dear Rational46570,

it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.


Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

It is extremely likely that you will benefit from a breast reduction! Even without seeing any photos, I can say based upon your description that it would be beneficial. I have many breast reduction patients who are in their twenties, and each one was elated with her results. Definitely meet with a board certified plastic surgeon to be evaluated and find out more!

I attached a link to a 20 year patient of mine with very large breasts and asymmetry. She loves her results!

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...

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...

Hello, thank you for your question and photos.
Yes, based on your photos, you do have enough pinchable fat in the flanks for conservative liposuction. In lean, athletic patients, the key is gentle, precise fat removal. When done conservatively by an experienced surgeon, the risk of bumps or irregularities is low. This would be for subtle contouring, not dramatic fat removal.
Best regards,Andaç Aykan, MD, Assoc. Prof.

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.

Your concern is a common one. Eye puffiness is caused by lower peri-orbital fat. As we get older the septum (a tissue layer that acts like a dam to hold the fat in) loosens and allows the fat to bulge out. This is nicely treated with a lower eyelid procedure that removes this excess bulging fat which removes the bulge. This smooths the lower eyelid and reduces shadowing and dark circles giving that tired look. You appear to be a good candidate for the procedure. Other nonsurgical treatments...

I do not think the answer is filing the upper eyelid with hyaluronic acid fillers or grafted fat. What is going on here is your surgeon made your upper eyelid crease too high, removed too much upper eyelid fold, and surgery damaged the insertion of the tendon that raises the upper eyelid. You have mild upper eyelid ptosis and a compensatory eyebrow elevation. There is a degree of eyelid platform skin crepiness and too much eyelid platform exposure. Stuffing the upper eyelid fold with...

Great question and thank you for providing the photos!
I think you are asking the right questions. While I can certainly appreciate a degree of brow ptosis (heavy brows) and excess skin of the upper eyelid, it is hard to determine which one is the predominant factor causing your issues. I think your best option is to schedule a consultation with a plastic surgeon that specializes in eyelid surgery who can perform a thorough exam to determine which of these factors (brow vs eyelid) is...

YES! There is no reason that you can't have aesthetic surgery in the US. I would recommend planning surgery with plenty of time for recovery prior to traveling internationally.

Young women with smaller cheek bones (malar hypoplasia) frequently present with this type of deformity very early in their life (13-19 years). Surgical correction includes correction of muscle attachment which creates tear trough deformity (via transconjuctival blepharoplasty) and augmentation of cheek bones with implants or fat grafts. In person or teleconference consultation with a board certified plastic surgeons with experience in this procedure is recommended. Good luck.

From your photos I can see the dropping that you mention. There is no better way to provide predictable long lasting results than with surgical tightening. Though you are young, we are seeing younger and younger patients who are good candidates for facelift or mini-facelift due to significant weight loss. There is no defined age to get lifting procedures done. I usually tell my patients that when the facial laxity is at a point that it really bothers you, then that is the time.

I recommend a facelift and browlift. The browlift can be done to lower your hairline, move your eyebrows higher and medially and take care of the excess skin in the mid face as well.

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...