Q&A with Dr. Sattler

The process of making a decision about cosmetic surgery and non-surgical treatments involves asking Dr. Sattler questions and learning as much as possible about the treatments you are considering. Dr. Scott Sattler has compiled a list of frequently asked questions from his Seattle area patients. Take note that Dr. Sattler answers emails from patients personally, so feel free to email him any questions you don't see listed below. You can ask Dr. Sattler any questions by emailing him at scott@scottsattlermd.com

 

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General Questions & Answers

Face and Neck Lift Surgery

Rhinoplasty

Breast Augmentation

Arm Lift

Body Lift

Botox

Brazillian Butt Lift

Breast Implant Removal

Breast Implant Revision

Breast Implants

Breast Lift

 

General Questions & Answers

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Is plastic surgery safe?

All surgical procedures are accompanied by a certain degree of risk, whether the procedures are for medical or cosmetic reasons.  Our expert team is dedicated to making your operation go smoothly.  We careful review your medical history and current health condition before deciding if it is safe for you to proceed with surgery.  It is important that you fully disclose all pertinent information so that we are able to make an accurate assessment of the risks involved.  We will take every precaution necessary to reduce the possibility of any complications.

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Can I have several procedures performed simultaneously?

It is a relatively common practice for a plastic surgeon to perform multiple procedures during one operation.  This allows the surgeon to better "sculpt" your final appearance.  In addition, having several procedures done simultaneously saves you the expense of paying the operating room and anesthesia costs more than once.  However, having too much done at one time can lead to complications.  The decision to have multiple procedures done depends on which procedures are being done, the extent of surgery, the operating time, and your age/health.  Ultimately, the surgeon decides whether or not it is appropriate to include more than one procedure in your operation.

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Face and Neck Lift Surgery

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I am interested in improving my neck and jawline. I also dislike my sagging cheeks and jowls. What options are available ?

Facelift surgery is a broad set of cosmetic facial surgical procedures designed to improve the appearance of the face and neck. There are a variety of facelift techniques that address each specific areas of concern. A consultation in our Seattle area plastic surgery practice is essential to design a treatment plan that is right for you.

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How can fat grafting be used during a facelift procedure? Or are there better methods out there?

Fat transfer techniques can aid with cosmetic facial rejuvenation. Fat transfer is a useful tool to optimize facelift outcomes outcomes. Fat transfer techniques can be used to improve cheek volume and reduce the appearance of tear troughs beneath the eyes. Fat injection techniques are offered in our Seattle area cosmetic surgery clinic.

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How is necklift surgery done ? What are the scars like ?

Necklift procedures are usually combined with a facelift procedure to maximize the rejuvenation of the face and neck. Most necklift procedures involve a small incision beneath the chin which is well concealed. The muscles of the neck (platysma) are tightened and fat is also removed from the neck region. This tightens the neck contour significantly. Dr. Scott Sattler offers facial plastic surgery and necklift surgery in his Seattle area cosmetic surgery practice.

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Can a facelift be done under local anesthesia ?

It is possible to do a facelift under local anesthesia. For most patients, the cosmetic surgery is more comfortable and can be done more efficiently with the addition of intra-venous sedation or general anesthesia. We use certified anesthesia providers to enhance patient safety during facelift surgery. In my Seattle area plastic surgery practice, it takes me about three hours to do a face and neck lift. Other procedures, such as eyelid lift, brow lift, fat grafting and rhinoplasty can be added to a facelift to enhance the overall result.

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I had a facelift surgery about 2 years ago, and have since gained about 30 lbs. I am struggling with my weight and am wondering if that will affect my results. If I lost all of the excess weigh, how would my face look ? Would I need a re-do of my facelift ?

Weight gain and weigh loss will affect the appearance of your face, and other regions of you body. Time will determine if you would benefit from a facelift revision after losing a substantial amount of weight. A common scenario in our Seattle cosmetic surgery clinic is a patient that has lost substantial amount of weight after bariatric surgery. These weight loss patients are generally excellent face and neck lift surgery candidates.

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Rhinoplasty

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Do Spreader Grafts Make the Tip of the Nose Stiff ? Do spreader grafts limit the nose's ability to 'bend' ?

Spreader grafts are pieces of cartilage that are added to the nose between the nasal septum and upper lateral cartilages. These grafts can be used for a variety of problems - they can reduce airflow resistance within the nose, widen the dorsum of the nose, and even lengthen the tip of the nose. After rhinoplasty surgery using spreader grafts, there is typically some post-op nasal swelling which makes the nose less 'soft'. Within a few months, this problem should improve. We frequently perform complex rhinoplasty in our Seattle plastic surgery clinic.

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How do rhinoplasty surgeons know the results they are creating during a surgery are the results that a patient wants.

Rhinoplasty surgery is an art. Good results come from careful pre-operative diagnosis of all cosmetic and functional issues, and then designing a plan with the patient to achieve those goals in a reliable fashion. Success in rhinoplasty surgery really comes down to attention to detail and experience in the operating room. Our Seattle plastic surgery practice performs rhinoplasty surgery frequently.

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Breast Augmentation

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I Was Recently Told I Needed a Lift As Well As Implants. I am 28, 135lbs and 5"3. I've always had size D breast, and after having 3 kids and nursing they are no longer full and big. I was told by the doctor I went to for a consult that I was borderline for a lift and he highly recommended a lift as well as implants in two separate surgeries. I would just like my big full breast back with out the lift. Do you think this obtainable?

In most cases, I am able to do breast lift and breast augmentation surgery simultaneously in my Seattle plastic surgery practice. I can typically  do a mastopexy augmentation procedure in a single stage. You certainly could do a simple breast augmentation, but you would have to accept that your breast tissue would continue to look 'saggy' relative to the implant. This issue worsens as the years go by. Doing a combined breast lift and breast implant will address both issues at the same cosmetic surgery procedure.

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I'd like to have a breast augmentation with gummy bear breast implants to feel more feminine. Can you tell me what breast implant surgery for constricted breasts is like ?

Breast augmentation for constricted breasts is a common procedure in my Seattle plastic surgery practice. Mild constricted breast anatomy is actually a good anatomic sub-type for form-stable gummy bear implants produced by Sientra, Allergan and Mentor. The implants are texturized to help prevent rotation. The breast implant incision using gummy bear implants is typically beneath the breast in the infra mammary fold. The scar is well concealed.

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Dr, Sattler, what breast implant size will get a Full C or D? I would like to use a shaped breast implant with an anatomical profile to be more natural, but would like a reasonable increase in my breast, something around full C or D. What then would be the size of anatomical implant used in my case? Thank you very much.

Breast implant sizing is best based on anatomic considerations. Shaped breast implant sizing is best when based on anatomic considerations. There are a variety of shaped breast implants on the market now, with form-stable silicone implants just recently available for cosmetic use. The gummy bear implants produced by Sientra, Allergan and Mentor are available in our Seattle and Bellevue area cosmetic surgery clinic.

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Arm Lift

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I gather that the incision for a brachioplasty can be on the inner arm or the back of the arm. If the latter, is the scar dead centre down the back of the arm or more to the side where the inner arm meets the back of the arm.

In plastic surgery- scars are least conspicuous when placed in natural border between aesthetic subunits. The best place for an arm lift scar (in my opinion) is in the groove between the biceps and triceps muscle on the inside of the arm. Scars on the back of the arm are very conspicuous.

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Is it Possible to Get a Second Arm Lift?

Brachioplasty surgery can be revised to improve arm contour and sometimes improve the scar quality. Achieving good scar quality with brachioplasty is challenging.

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Could a doctor please help me understand what it means to have a bilateral brachioplasty?

A bilateral brachioplasty is an arm lift procedure for both arms (bilateral)- its a great procedure for patients with arm laxity. It places a substantial scar on the arm, but offers excellent and long lasting arm contouring.

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Hello, I am a 45 yr old woman. I have never been very heavy. I have/had large arms since I was a little girl. I have/had excess fat & slightly sagging skin on the upper part of my arms & would not wear sleeveless tops. I went to 2 plastic surgeons seeking the limited incision barchioplasty. Both professed to be able to do the proceedure, however, that was not the case... I was left with no armpit, no/worse results & now have scars in addition. I am very depressed.I need help & reference in CA 2 revise them. Please help.

Brachioplasty is not a technically difficult operation, but getting good quality brachioplasty scars is a challenge for any surgeon. For this reason, there is a fair amount of collective experience revising brachioplasty procedures. It may be that you had the 'wrong' operation for the arm problem that you had- a limited incision brachioplasty is not a great operation for most patients. Most patients with any degree of arm laxity from armpit to elbow have better results with a 'full length' brachioplasty technique. Obviously, this is a long scar, but the 'trade off' is much improved arm contour. Seek out a good plastic surgeon in your area for some expert advice.

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Body Lift

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I'm 30, fit, and I look relatively good. As a teenager I lost 80 lbs and kept it off. I lucked out in the lax skin department, but my skin still does some crazy things. I realize I look like most LBL patient's after pictures and am also younger than the patients I've seen. Am I nuts to consider a LBL? I sure would like a higher, firmer, smoother butt and thighs in exchange for a scar. I am going to get a tummy tuck and it will lift my pubic mons (needed).

Only a in-person visit with a physical exam can answer this question. Looking at the photos you sent to our Seattle cosmetic surgery office, I think some well-planned thigh and flank liposuction would improve your figure and create the illusion of more buttock projection. Liposuction does very little to address skin laxity, which you do have.

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How Many Body Parts Are "Lifted" During a Body Lift Procedure? For someone who has lost a lot of weight and has sagging skin, what are the typical areas that are lifted during a body lift?

In my experience, the lower body lift (belt lipectomy) cosmetic surgery has the potential to lift and improve the appearance of the mons, abdomen, flanks, thighs and buttocks. There are a variety of types of lower body lift procedures. We offer consultations for body contouring surgery in our Seattle area cosmetic surgery office.

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Am I a Candidate for Lipo, or Do I Need Lower Body Lift? I exercise , mostly running. I have recently had a tummy tuck and breast augmentation. but I am so unhappy with there appearance of my butt and thighs. could this be fixed (made to have a smoother appearance) with plastic surgery or am I stuck with this butt?

Thank you for sending your photos to us. The buttock Lift is a great procedure. You have already had the 'front half' a lower body lift done. I would recommend completing your lower body rejuvenation with a buttock lift. This procedure will lift your sagging buttock and smooth the lines and folds that your photos demonstrate. We are happy to see you in our Seattle area plastic surgery clinic.

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Tummy Tuck vs. Body Lift: I am a 27 year old mother of 3. I'm 5'5" and 133 lbs. Have been planning my mommy makeover for a while now and have even had a couple of consults. I am having a breast lift and implants. I was also planning a tummy tuck and it was suggested to consider a medial thigh lift as this area drives me crazy. I don't have much fat on my body, just lots of stretch marks and some saggy skin. I am not at all excited about the scars in my groin, because I've heard that they always migrate down and show, so bathing suites would be an issue. I was looking at the pics of body lifts and wondering if this would be a better option? How well does the inner thigh area get lifted? Wouldn't mind a little boost in the booty anyway... I don't mind the scar from the body lift that goes all the way around, but I don't want to do this if the thigh results aren't substantial... Any suggestions?

Don't expect any lifting effect along the inside of your thighs after a circumferential body lift - you will get some lateral and posterior thigh lifting effect from this cosmetic surgical procedure. My advice is to do the circumferential body lift and wait several months. Come back and do the medial thigh lift. We are happy to see you in our Seattle area cosmetic surgery clinic.

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Lower Body Lift or Extended Abdominoplasty? I had a gastric band placed two years ago and now I'm ready to shed my excess midsection. What is the difference between lower body lift and extended or circumferential abdominoplasty? What would you recommend based on the attached photo?

Lower body lift for massive weight loss patients. Without the benefit of an exam, its difficult to say what type of circumferential body lift procedure you need. A circumferential abdominoplasty and a 'lower body lift' are basically synonymous. There are a couple of type of lower body lifts, each with its advantages and disadvantages and scar positions. Seek out a board certified plastic surgeon with a practice in post-weight loss body contouring surgery for an opinion.

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How Much Would a Lower Body Lift with Brazillian Butt Lift Cost? I am a woman in my early forties who's lost 40 lbs and am looking to lose 20-30 more. I I have a lot of sagging all over my body and flattening of the buttocks. I know that a Body lift is often employed to remedy such situations. I know a lot of these things are individual as to what surgeons charge and what people's unique anatomy requires, but would I be safe by estimating a ballpark figure $15-20k for Body lift and 10 more for Fat grafting? Or is there commonly a discount with so many combined procedures?

Combined procedures in plastic surgery save just a little money. There are some efficiency and therefore, some cost savings in having a lower body lift done in combination with fat transfer to the buttock- you won't save much compared to doing them independently- but you would save some. There are a couple of nice techniques using vascularized buttock tissue to augment the buttocks during a LBL- you probably would be able to avoid fat transfer using these procedures. Seek out a surgeon that does a lot of LBL work for an opinion. We are happy to see you in our Seattle area cosmetic surgery clinic.

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How Much Does Lower Body Lift Cost? I know my insurance isn't going to cover it, but I've lost a ton of weight (113 lbs so far!) and I know this surgery is on the horizon. I am saving up and will do some financing, but what is the range of price I need to shoot for?

A lower body lift is a truly transformative cosmetic operation and is one of the biggest that we do in cosmetic plastic surgery- expect to pay $12-20K for the procedure- which would include anesthesia and after-care visits. Some surgeons are doing the lower body lift in an outpatient setting with close RN monitoring at home and aggressive DVT protective measures- this can hold the cost down considerably- the hospital is an expensive venue to have this cosmetic surgery....

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Botox

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Which Muscle is Botox Injected into Correct Slightly Lopsided Smile? I had a midface procedure that has given me some nerve injury, its been almost 3 weeks, I can smile wide and force movement but if I smile naturally my lips cover my teeth more on the right side, would it be the levator labii superioris alaeque nasi that is injected with a few units of botox to regain symmetry on the other side? Can this give the look of a more prominant nasalabial fold? or would it be another area on the cheek that effects lifting the corner of the lip that should be weakened.

Botox for smile asymmetry is risky business. I think you are thinking along the right lines anatomically, injecting the 'uninjured' side to weaken your lip elevators (LLSAN and other muscles) innervated by the buccal branch of facial nerve would probably work - but may result in a new type of asymmetry. I personally would wait this one out - most facial nerve injuries recovery spontaneously and you should have full lip elevator function back in a few months. We offer cosmetic Botox treatments in our Seattle clinic to rejuvenate the face, soften line and wrinkles.

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I had botox on my forehead 4 times in my life in the last 2 years, the last time being in Aug 2012, all in a clinic in Seattle. In the last year I noticed one eyebrow is lower than the other. I looked at pictures of myself from 10 years ago, 2 and 3 years ago and I did not have this before. If I use my muscle to raise the eyebrow then it evens out but otherwise they are definitely uneven. Did botox give me permanent ptosis or is this something more serious and unrelated?

Sorry to hear that you had a drooping eyebrow after a Botox treatment. Brow asymmetry often represents natural variation is not Botox related. My guess is that you have natural asymmetry of your brow position. As you age, this may become more obvious. For patients with any hint of brow ptosis, I typically treat the 'brow depressor' muscles with Botox (glabella and lateral orbicularis muscles) and leave the frontalis muscles alone (brow elevators). We offer experienced and consistent Botox injections in our Seattle area cosmetic surgery clinic.

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Hi Dr. Sattler, I had my frown lines treated 3 weeks ago in a different clinic in Seattle and I still have a little vertical line left in between my eyebrows, can I have some more botox to try and get rid of that line altogether? Or do I need to wait 3 months until my next treatment?

Botox touch up treatments can be done safely. You could certainly have your Botox treatment 'touched up' to further weaken the glabellar muscle group. The other consideration for residual vertical lines is the use of a dermal filler such as Restylane or Juvederm to soften this line even further. We offer experienced Botox and Juvederm injections in our Seattle cosmetic surgery clinic.

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How is Botox used for Jaw Reduction? Thank you.

Botox is effective for jaw reduction. Injection of Botox into the masseter muscles can induce atrophy of this muscle and reduce the appearance of facial width. Botox dosing for jaw treatment varies, but is typically a relatively heavy dose, in the 50-80 unit range. Give our Seattle cosmetic surgery clinic a call and schedule a Botox consultation. 

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How Long Does Botox Remain in Your Body? Some plastic surgeons say that Botox leaves the body within 2 days of injecting it. And others say it wears off after 4 - 6 months. What is the truth? If it leaves the body quickly how can the effect last? As I understood the toxin has to remain to block the nerve communication? So how long does the toxin stay in the body and how does it REALLY work!?

The Botox mechanism of action is well understood. Botox is a protein that blocks the transmission of nerve signals to muscles. It temporarily weakens the muscle that it is injected into. The drug's effect is evident at about the 7-10 day point after injection and should last 4-5 months, based on the amount of toxin (the unit dose) injected and other factors. Our Seattle Botox clinic offers injections for facial wrinkle reduction.

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Brazillian Butt Lift

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Possible to Get Dramatic Results w/ Brazilian Butt Lift? I'm 5'9 and 182 pounds with a figure that resembles a cardboard box. I hope that a brazilian butt lift can give me the hourglass shape I desire. I want hips, I want butt and I want a smaller waist.

Brazilian Butt Lift results depend on the underlying pelvic anatomy. A BBL is a great procedure- but its not going to alter the shape and proportion of your pelvic skeletal and muscular anatomy- A 'boxy' shaped buttock will benefit from from liposuction to improve shaping, but if your flank anatomy is relatively 'boxy', liposuction is unlikely to give you the 'hourglass' shape you desire. A BBL will augment the soft tissues of your buttock, add projection- but it will not give an 'ideal' buttock shape unless that shape is there to start with.

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Brazilian Butt Lift - Safe for 40 Year Old, 3 C-Sections? I want a Brazilian butt lift and want to know how safe is it for a 40 year old woman who has had 3 c-sections.my last one was a year ago.i cant shake this belly fat and my butt is gone and i look misshaped with hips and thighs..big belly and no butt..help!!

Brazilian Butt lift will improve your figure. I think its reasonable to combine liposuction of the tummy, flanks and other areas with a Brazilian Butt lift. I would not recommend combining a BBL with a tummy tuck- the positioning during recovery would be challenging and would likely compromise the result of the BBL.

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Brazilian Butt Lift Revision w/ Stored Fat? if you have a bbl and a few months later want you butt bigger can tha doctor store your fat then you can later go get more injected?

Frozen fat for fat grafting is viable. We freeze fat for future touch-ups for our fat grafting patients - we have re-grafted fat into faces, breasts and body and have noted no significant difference in post-grafting viability and volume. I would say that 'fresh' fat is better than frozen fat for large volume touch ups.

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Incision Location for Brazilian Butt Lift: Is the incision for a Brazilian Butt Lift always all the way across at the top of the butt? Can it be in other locations such as underneath where the cheeks join the thighs or vertically down the middle where it can be more easily hidden? It is hard to tell from photos because thongs could be covering the incision. I am thin so I don't need anything done to my back or flanks, I just need help for a sagging backside. If an incision can be done at the bottom I am interested.

Brazilian Butt Lift is really an augmentation using fat. This is a poorly named procedure, but its popular enough that the name has stuck- a BBL is simply fat grafting and liposuction done to contour the buttocks, flanks and thighs. There is an excisional procedure called a Buttock Lift that involves removing lax tissues and lifting sagging buttocks- this leaves the scar that you describe.

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How to Lay Down After Multiple Surgeries? I'm having a Tummy Tuck, Brazilian Butt Lift, Liposuction, and Breast Implants all done in one surgery. How will I lay down?

Beware of combination plastic surgery. The combination of procedures that you list is not recommended. After fat grafting to the buttock, it is recommended that you keep pressure off of the treated area for several days. After a tummy tuck, it is difficult to lie flat in bed. After an augmentation, it is unwise to lie on your stomach.

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Breast Implant Removal

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How is Breast Implant Replacement Surgery Done? I have textured silicone implants in a subglandular placement and want to replace them with smooth silicone implants under the muscle. Will the new implants be placed in at the time of removal of the textured ones? Or will it have to be done in two separate procedures so I can heal from the first surgery first. I hate to have to walk around with deflated boobs for months.

Breast implant revision surgery is done in our Seattle area cosmetic surgery clinic. Sometimes silicone implants leak and need to be replaced. I typically recommend removal and replacement with smooth silicone implants in the submuscular position for patients that present with subglandular silicone implants. If you need a lift, it can be done at the time of surgery, or in a delayed fashion. I recommend up-sizing the implant about 75 cc when switching to the submuscular plane- this position tends to 'blunt' the volume of an implant.

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I recently had breast implants put in from my size A and went to a C. It has almost been one year and am looking to remove them because I am not satisfied and would like to go back to my previous looks. What would the outcome most likely be?

Breast implant removal will make breast look different. If most of your current augmented breast volume is composed of implant, then your breasts will have some laxity for a period of time after implant removal. If your tissues are youthful and elastic, some of this laxity may recover on its own. You might need a lift. We can discuss your breast implant removal and breast lift options in our Seattle area cosmetic surgery clinic. 

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Is It True That my Breast Will Look Better After Breast Implant Removal? I recently had breast implants put in from my size A and went to a C. It has almost been one year and am looking to remove them because I am not satisfied and would like to go back to my previous looks. What would the outcome most likely be?

Breast implant removal will make a breast look different. I guess it all depends on what your idea of 'better' is. Removing implants just a few weeks after augmentation will result in a breast that looks much like what you started with, with the addition of a new scar. Unless you are dealing with a substantial implant malposition issue, implant removal in the early post op phase will not improve your breast appearance. You'll have a brand new scar ! Depending on what you decide to do, we are here to help with breast implant removal or replacement in our Seattle area plastic surgery clinic.

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What Happens to the Pocket After Breast Implant Removal? If the capsule is not taken out? Can you feel it? What happens to the pocket when breast implants are removed?

Capsulectomy is often needed for complex revision breast surgery. If you are having a simple implant removal procedure, the capsule should be excised and the 'pocket' obliterated, in order to prevent a long-term fluid collection from forming. This procedure is called a capsulectomy. I generally remove the anterior capsule only (in a sub-muscular argumentation) and then place a drain in the space for a few days. You cannot feel the remnants of the capsule when it is handled in this manner. I perform breast implant removal, implant replacement and capsulectomy in my Seattle area cosmetic surgery clinic.

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Aesthetic Result After Breast Implant Removal? I had a silent breast implant rupture (no encapsulation). My breasts are both soft and jiggly. The implants are 10 years old, mushy, and soft, and I have at least a B cup of my own tissue (sub-dermal implants). They are not droopy. Will I be deformed after having my breast implants removed? I'm very scared, my aesthetic result is important to me. What will I look like after explantation? What should I expect? Will I need a breast lift? Will all my own tissue be removed, leaving me with concave "puppy dog ears"?

Breast implant removal - aesthetic outcome expectations. Without a photo- its difficult to judge how your breasts will look with the implants out- if you have a ruptured silicone implant- it should be removed. The appearance of your breast after removal will depend on how much native breast tissue you have, and its positioning on your chest wall. Your choices are three: remove implants, remove and replace implants, remove implants and get a breast lift. I perform breast implant revision surgery in our Seattle area breast plastic surgery clinic.

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Breast Implant Revision

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What Kind of Lift Do I Need with my Breast Revision? My implants are HP saline under the muscle done in 2005, a revision from my over the muscle saline implants from 2000. I am looking for more lower pole fullness. What lift is recommended? I am concerned about scars. Thank you!

Based on the photos that you sent to us, I'm guessing that you dislike the sagging lower pole of your breasts, but are otherwise happy with your augmentation. I would recommend a standard vertical breast lift with reduction of the lower pole tissues of each breast. This would leave a vertical scar on each breast, and a scar around the areola. Your areola are in good position, and don't need to be 'moved', but the skin should be tailored around each areola for the best possible result. I perform breast lift and breast implant revision surgery in my Seattle, Washington area plastic surgery clinic.

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What Kind of Lift Do I Need with my Breast Revision?My implants are HP saline under the muscle done in 2005, a revision from my over the muscle saline implants from 2000. I am looking for more lower pole fullness. What lift is recommended? I am weary of vertical scars due to my tendency to hyperpigment. Thank you!

Breast position on the chest is a determinant of augmentation result. Your breast footprint appears to start relatively low on your chest. You have quite a distance from your collar bone to the 'top' of your breast. I personally do not think a breast lift would improve upper pole fullness. A larger diameter implant would, but would create a 'fake' look with a very rounded upper pole.

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Will My Breast Even Out? Is It Too Early to See if I Need a Revision Done? (photo) My breast are uneven after Breast augmentation. I went from 32B to 34D and they are uneven. One is high and the other is low with some indentation. I read that they can change from 3 months to a year. Does it look like I need a revision? Please Help Me. Thank You.

Considerations prior to revision of breast augmentation. Impossible to answer this question without several key pieces of info : when was augmentation done, what do you look like prior to surgery etc. Wait a few months and keep in touch with your plastic surgeon.

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Bottomed Out... Should I Replace my Implants with Smaller Ones? (photo)I recently had a BA with 375cc silicone UHP unders. I have been unhappy with their placement since early on; they are too low and too far apart. My surgeon recommended a capsulorrhaphy at my 3 month follow up. I think my current implants may be too big for my frame and may have caused me to bottom out. My doctor says he thinks the size is okay, but I'm afraid to have the repair just to have it happen again. What is your opinion, should I downsize when I have a revision? Any other suggestions?

Revision of breast augmentation to improve 'bottoming out'. I'd recommend supporting the implants with a 'internal bra' composed of Strattice, a useful biomaterial used in breast reconstruction. This will help improve positioning - bottoming out and lateralization, in your case.

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What to Do About My Breasts With Implants After Breast Feeding? (photo)Im 22, 5'7'' 140 pnds. I b/f for over 2 yrs leaving my breast elastic. I previously had implants size 450cc saline and am not happy with the way they look 1 yr later compared to being DD cup throughout pregnancy. I just want a fuller/close together breast with high profile. What size is good for me? My doctor said to keep my same implant and just do a lift but i want larger implant to fill the excess sag like 800-900cc. I just liked the way my breasts were when pregnant and want that same size/look.

'Rock in the sock' deformity can be improved with revision breast surgery. You have a classic 'rock in the sock' deformity - heavy implants stretching and elongating the breast skin envelope. My recommendation would be to switch implants to sub-muscular plane, support with Strattice infra-mammary sling, and perhaps use a smaller implant. You may need a mastopexy to deal with skin excess. Good luck!

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Breast Implants

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My plastic surgeon has recommended silicone implants. I would like under muscle smooth moderate plus profile implants. About 375 cc? I am 5"3 112 lbs size 34 A. Is this a good size for me?

Its impossible to make implant sizing recommendations based on the limited information presented. Based on the photos that you sent to us, your tissues appear tight and you don't appear to have a wide breast width - be careful about using large implants. During an consultation in our Seattle Washington area cosmetic surgery clinic, I can give you reasonable implant sizing recommendation based on the dimensions of your chest and your aesthetic goals.

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I had breast implants placed in 1995. They are saline, over the muscle. They appear to be wrinkling and I would like them replaced.

Saline implants can be replaced with modern silicone implants into the sub muscular position. This often improves soft tissue coverage over the implants, especially important for patients with thin tissues. Implant support can be improved with Strattice to reinforce to create an 'internal bra' for the implant. This type of complex breast implant revision surgery is frequently done in our Seattle Washington plastic surgery practice.

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Can I Get Breast Implants WITHOUT Lift? I am a natural D cup with some sagging.I would like larger breasts, but am not sure I want a breast lift. I want to look as natural as possible.

Breast augmentation for 'full breasted' women is more challenging that it might seem. Based on the photos you provided, I'm not sure that breast augmentation is going to help you meet your cosmetic goals of looking completely un-augmented. A small implant could be used in your case to provide some upper pole roundness, but I'd worry that over time, you would develop breast sagging over the implant and would require a lift in that situation, later in life. Using a big implant is only going to create an augmented appearance in your situation. Our Seattle, Washington area clinic is a cosmetic breast augmentation center.

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I had breast augmentation done in California many years ago. My surgeon told me that one breast was slighlty bigger than the other so he decided to put 500 ccs on my right breast and 550 ccs on the left one to make them more symetrical. My breasts look more uneven to me than before.

Differential breast implant sizing sometimes creates a new assymetry. I think there are different philosophies on differential breast implant sizing. In most cases like yours, I'll use the same volume breast implant to establish a symmetric breast width and height. Using different sized implants in patients without a lot of breast tissue can create new asymmetries related to the implant diameter/height/projection etc.

I think there were some differences in your infra-mammary fold position and nipple/areolar position that make your case a little more challenging to achieve perfect symmetry.

I perform complex cosmetic breast augmentation surgery in my Seattle Washington plastic surgery practice.

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Breast Lift

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Hi, I'm planning on getting a breast augmentation and lift soon. I was hoping to get some opinions on the Benelli breast lift? I'm currently a 36C and want to get to a full D. I have a lot of breast tissue with minimal sagging but my nipples are lower than they should be. They don't point down but I don't have the natural fullness below them like I want. Do you think the Benelli lift will be efficient or would a different type of lift be worth the extra scars??

Benelli mastopexy is good for areolar reduction but not for breast lifting. My experience with a Benelli, or peri-areolar purse string mastopexy, is that the procedure is good for areolar diameter reduction, but does tend to flatten breast projection. It certainly does not have the 'lifting' capability of a vertical mastopexy. I think long-term breast shaping and scar quality  is much better with vertical mastopexy and breast implant combination surgery. I frequently perform breast lift surgery in my Seattle Washington cosmetic surgery practice.

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I had breast lift with augmentation 250cc 10d ago by a surgeon in Oregon. I'm wondering if they are healing as expected given the 10 day mark. I know it's still quite early & they are still "raw". I'm having some pain in my right breast near my armpit / along the outer edge of the breast - feels like a squeezing or pressing sensation, not constant. I'm a righty so I assume this is normal? Left feels good but both are irritated underneath. They still seem very swollen. I assume this is all normal but please confirm. thx

Based on your description, you sound like your are having a routine recovery after vertical mastopexy and breast augmentation. My patients are quite swollen after this surgery. This takes a few weeks to settle down. I frequently perform breast lift and augmentation surgery in our Seattle area cosmetic surgery practice.

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Breast Lift With Implants? (photo)Dear Surgeons I'm hoping you will be able to help with my question. I'm 34 years old with one child I breast fed. I have been confused please have a look , I have attached pictures so that you can be able. I have been to consultation with a few surgeons here in UK for breast lift and implants and they told me it will cost roughly £7000 pounds. My worry is what if I pay all that money and I'm left with horrible scaring and also not sure between Implants or Fat Transfer procedure. Thank u xx

Breast lift without implants is a powerful operation. You have severe nipple and parenchymal ptosis (sagging) and lack upper pole volume. This is a challenging situation to optimize. I would offer a vertical breast lift with a Graf flap which would move your sagging breast tissue beneath the central portion of your breast. This would vastly improve your breast shape.  You'll need to decide if you actually want larger breasts before deciding if a breast implant is right for you. A breast implant is the only reliable way to achieve volume in the upper pole of your breast.

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Will my Right Breast Require a Lift? (photo)I am wondering if my right breast will require a life to correct the asymmetry. I would like implants to make my breasts around the same size, but more importantly, correct the difference in the placement of my nipples. One is about an inch lower than the other and I don't know if a standard augmentation could correct this. I am going in next month for a consultation and would like something to compare his suggestions to. I would like to make the most informed decision possible. Thank you!

Breast asymmetry cases often require mastopexy. You appear to have substantial differences in breast volume, nipple position, breast footprint and shape - A breast lift on right side may be necessary to balance the position of your nipples. The type of photo that you posted is not helpful in making these assessments. Seek out a plastic surgeon with substantial cosmetic breast surgery experience and get an informed opinion on your unique situation.

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Do I Have Tuberous Breasts, and is There Any Way to Avoid Mastopexy? (photo)I'm quite confused about this issue. I don't know whether I have tuberous breasts - I suspect I do. If so, how difficult would it be to correct this? I would prefer to avoid mastopexy if possible, as I have not yet had children. My pictures aren't the clearest (the camera on my computer isn't great), but any information would be appreciated. Thank you.

Constricted breast anatomy can be improved with conservative augmentation. I don't think you have a tuberous breast anatomy - I would describe your breasts as 'constricted' - the breast footprint is narrow relative to the width of your chest and the fold beneath the breast is relatively high.

I think an areolar reduction would improve your aesthetic result - but if you wanted to avoid this, I would offer augmentation using a implant with a base width diameter  that is narrower than the width of your breast.

You could start with this basic cosmetic intervention, and then decide later if you wanted a mastopexy.

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