Doctor Q&A

@Magical92883 Thank you for the photos. There are limitations to what a breast augmentation can achieve. In your photos you have very lateral nipple complexes and moderate separation between the medial aspect of your breast. While you will get some medial fullness (move them closer together) with a breast augmentation, it will not create significant cleavage in your case due to your baseline anatomy. Additionally, it is impossible to change to position of your nipple complex with an implant.

Thanks for your question.
You rightly acknowledge your pre op assymetry including a slightly higher inframammary crease and a higher nipple areola on your right. This pattern is continued after surgery.

You can have the implant pocket revised by removing or scoring the capsule and possibly opening the pocket along the inferior lateral pole. You don't want to do it too much or you can have a "bottoming out" effect.

Best of Luck

Dr. J

From the photo that you submitted, it looks like the right breast implant is in a very normal position. The left implant looks like it is sitting a little high. This could be due to several issues. Was the left nipple higher before your surgery? If so, then the left implant is actually in a good position, being placed directly behind the nipple. If not, then either you have a left capsular contracture or the left implant did not drop after your augmentation surgery. If the left implant is...

Anesthesia time• For a primary lift with implants anesthesia often runs about 2.5 to 3.5 hours. The exact time depends on lift pattern and pocket work
Rupture detection• Saline rupture is usually obvious. The breast deflates over hours to days• Routine MRI is not needed. Ultrasound can confirm if there is doubt
If a rupture happens• The saline is absorbed by the body• It still requires surgery. The empty shell is removed and a new implant placed in the same outpatient session in most case...

Hello, thank you for your question and for sharing your photo.
I completely understand your concern. With your body type and the way the loose skin extends toward the sides, a mini tummy tuck can indeed leave residual skin or bulges at the hips. I think that's why your surgeon has recommended you a standard tummy tuck (shorter scar than extended) rather than mini or extended TT.
The good news is that the incision is placed low and within the bikini line, so once healed it is well hidden and...

This is one of those areas where surgeon preferences vary. Many surgeons recommend some form of compression after a tummy tuck to help control swelling and reduce the risk of fluid accumulation, especially early in your recovery.

Here's how I usually explain it:

If your surgeon prescribes a binder or compression garment, follow that plan. They're tailoring their postop instructions to how they created the internal space and managed your tissues during your surgery.

Compression should...

It is possible that your gallbladder surgery could increase the complication rate for a tummy tuck. It would depend on the length and location of the scar as well as how long ago you had your gallbladder surgery. The concern is the incision for your gallbladder surgery transected blood vessels going to your lower abdominal skin. You need those blood vessels to supply blood to the lower abdomen after a tummy tuck. You do have vessels on the other side to compensate, but it is possible that...

Having muscular glutes doesn't automatically make a BBL unsafe. The biggest safety issue is where the fat is injected. To reduce the risk of fat embolism, a rare but serious complication, the fat should be placed in the subcutaneous fat layer above the muscle, not into or under the muscle.

If you're assessing BBL safety, I'd focus on:

- Surgeon training and experience specifically with BBL

- Surgical technique and adherence to modern safety standards, such as the plane of injection and...

Based off your limited photo - there is asymmetry as you described of your glutes - (but this asymmetry was definitely there pre-op as well of some form) Asymmetry is normal and can not be fixed as our right and left sides of everything are different (eyes, breasts, hands, glutes, foot etc) The bones, muscles, foundation are different therefore trying to change it at the skin and fat level is not possible.
Exercise and decreasing body fat will be your number one thing to do prior seeking...

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...

How quickly you can wear your glasses again depends on what was done during your rhinoplasty, especially whether the nasal bones were moved.

Some surgeons allow very lightweight glasses to rest on the splint because the splint can help distribute pressure. Other surgeons prefer no pressure on the bridge at all, even with the splint in place, so this is one you should follow your surgeon's specific instructions on.

Once the splint comes off (often around a week), most patients need a...

Hello, thank you for your question.
Nicotine, whether from cigarettes or vaping, significantly reduces blood flow and directly affects healing. In rhinoplasty, good circulation is critical for skin healing, swelling reduction, and overall final results. Vaping increases the risk of poor wound healing, prolonged swelling, skin complications, and suboptimal outcomes, especially in the nasal tip.
Most surgeons recommend stopping all nicotine at least 4 weeks before surgery and continuing to...

Yes, you would benefit from a rhinoplasty. The tip can be refined, the width of the nose can be narrowed and the columella can be rotated upward lifting the nose. You will also need a septoplasty. It appears the septum is inclined to one side.

Best Wishes,

Gary Horndeski, M.D.

In general, I recommend waiting at least 6 months after delivery before considering a mommy makeover—and often closer to 12 months if you're breastfeeding, your weight is still changing, or you just don't feel fully "back to baseline" yet. That window gives your body time to recover and offers your surgeon a more accurate sense of what's truly been changed by pregnancy versus what's still in flux. Keep in mind that C-section recovery and medical clearance may influence timing.

If you're t...

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

From your photos and description, a breast augmentation, tummy tuck, and liposuction form a reasonable foundation for comprehensive contouring after massive...

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

@Enthusiastic484638,
In short, you will NOT be able to breastfeed in the future if you have a free nipple graft. The reason is when this surgery is performed we remove the nipple and it survives as a skin graft. This severs the connection between the nipple and the milk ducts within your breast.
Each surgeon has their own preferences/experiences with breast reduction and knows what works in their hands. You could be a candidate for an alternative technique to preserve your ability to...

There’s no reliable evidence that a breast reduction increases breast cancer risk. In fact, some research suggests the risk may be slightly lower after reduction, possibly in part because there's less breast tissue overall. But I wouldn't want anyone to hear that and think it replaces normal screening—it doesn't.

A few practical things to keep in mind:

- Keep up with routine screening based on your age and personal risk (mammogram, and sometimes ultrasound or MRI).

- Most surgeons sen...

Thank you for your thoughtful question. As a board-certified plastic surgeon, I commend your proactive approach to being fully informed before revision surgery—this ensures the outcome aligns precisely with your aesthetic vision.

Given the amount of residual areola, a revisional breast lift using the same anchor incisions would be an effective approach. This technique allows removal of the excess areola along with any stretched skin in the lower breast pole that may have developed over t...

Not necessarily. Whether implants "sag" over time usually has more to do with your skin elasticity and existing amount of breast tissue than whether the implant is placed over or under the muscle.

Implant placement does tie in with how the breast ages around the implant, though. A pattern we sometimes see is what surgeons call a "waterfall" (or "snoopy") effect, where the implant stays relatively stable, but the breast tissue and skin gradually settle and drape over it. When this happens,...

If you are ok with being bigger than implants might help. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

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...

Hi,
Axillary breast tissue can be treated by either excision or liposuction (+/- Skin tightening). The optimal treatment choice depends on the quality of the tissue in the axillary area, as well as the skin excess and quality (the skin's ability to contract with skin tightening as opposed to skin removal). A consultation is required for full assessment and a personalized treatment plan.
Best,
Dr. Maryam Zamani MD FRCSC
Double-Board Certified Plastic Surgeon

When performed by a properly trained, board-certified plastic surgeon in an accredited facility with appropriate patient selection, abdominal liposuction is generally safe. However, it's still surgery, and the risk increases with larger volumes of fat, higher BMI, smoking, and certain medical conditions.

As far as pain goes, you will be comfortably anesthetized during your procedure. Most patients describe feeling very sore, as if their muscles are bruised, rather than experiencing sharp...

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.

Hi,
Lower eyelid surgery to rebalance lower eyelid fat and minimize tear trough depression may be a great option for you. An in-person consultation is needed for a thorough assessment and an individualized treatment plan.
Best,
Dr. Maryam Zamani MD FRCSC
Double-Board Certified Plastic Surgeon

You have a deformity where your lower lid hits your cheek. This can be helped with a lower blepharoplasty with fat repositioning to correct the fold. You would also benefit from seeing a dermatologist about therapy for the changing discoloration of the lower eyelids.

Best Wishes,

Gary Horndeski, M.D.

Based on your age and concerns, a full facelift is often not necessary. From what you describe, a short-scar face and neck lift combined with fat transfer to the face would likely be a very appropriate option.
This approach focuses on tightening the lower face and neck while restoring lost volume to areas such as the cheeks and under-eyes, which is often what creates the tired or sagging look in your 40s. The goal is natural rejuvenation, not an overdone or pulled appearance, with smaller...