Skin Tightening Q&A: Do “Non-Surgical” Lasers and Ultrasound Work?

Question – Can you offer some insight into all the non-surgical procedures that are inundating the market for skin tightening, for instance, lasers and soundwave technologies? Many are saying they were featured on shows like Dr. Oz to lend credibility to their claims…. I suspect it is just another “too good to be true” story, but your thoughts on the subject would be most welcome. – Debra

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Answer – Excellent questions, Debra. Regarding the latest generation of “non-ablative” lasers for skin tightening and sound-wave technologies, the short answer is that, as with most things in life, “there are no shortcuts” and “if it’s too good to be true, it usually is” (for more on the high cost of smartly marketed, less invasive and/or expensive treatments and technologies, please see slides 14-17 from my ‘What to Look For in a Plastic Surgeon‘ presentation.

That said, if a new product, technique or technology is shown to be both safe and superior to the current treatment standard (through peer-reviewed, double blind studies by other plastic surgeons), my approach has always been to assimilate/incorporate it into my practice. Even then, however, I try to never be among the first wave of users. This helps ensure not only the safety of my patients, but also their satisfaction with the results as well.

Case in point, for years, laser liposuction companies and MDs claimed that the machines not only suctioned fat, but were also a method of non-surgical skin tightening. The technology was promoted featured on promoted featured on Oprah, GMA, The Today Show, People Magazine (‘The New Lipo: Has Fat Met Its Match?‘) and hundreds of other publications. But since its introduction, no studies have confirmed its superiority to traditional tumescent liposuction methods. What has been confirmed, though, is laser liposuction’s potential to burn skin. More on that here.

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Breast Q&A: To Breast Lift or Not to Breast Lift, With or Without Implants?

Perhaps the two most frequently asked questions I receive from women interested in breast enhancement surgery are:

1. “Do I need a breast lift with or without implants?”
2. “Can I get an ideal result with just breast implants?”

As with most operations, it’s always best to get things right the first time around. And when it comes to breasts, getting it right doesn’t typically mean looking great for only a few short years before the effects of gravity and time undue all the good work that was done.

So when I advise my mastopexy (breast lift) patients on what their options are for achieving the best and most youthful looking breast possible, I always make sure that they have a crystal clear understanding of what their surgery options are and how each option will look and feel over time (re: 1 year, 5 years, 10 years etc.) rather than just what they can expect to look like during the immediate post-operative period.

9 times out of 10, the best path forward is clear and the patient is in full agreement that the procedure’s pros outweigh any cons that may inherently be involved (e.g. a slightly longer incision in return for a stronger, more longer lasting lift).

Of course, not every breast fits perfectly into one of the the breast types described below, but most do, so hopefully readers will find the following example photos and procedure recommendations helpful and/or informative , especially if they are considering their options for a breast lift with or without implants/augmentation.
 

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Face Q&A: For Sunken Hollow Cheeks, Fillers, Fat Injections or Facelift?

Question – Below my cheekbone a hollow channel is inching towards the center of my face. I had a facelift two years ago and cannot figure out what is causing this. What can be done to correct this?

The facelift was two years ago. On one cheek, just below my cheekbone and along the path of the lift, a hollow channel has been inching toward the center of my face. The doctor has assured me that this was not a thread lift. The hollow is about 1.25″ in width. The skin above it is taut and looks lifeless. The hollow keeps lengthening and it looks awful. What could be happening? And can anything be done to stop it and/or correct it? – via RealSelf

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Answer – Given that your facelift was two years ago, there are a couple possible reasons for why your cheeks now appear hollow/sunken based on the details you provided in your question: One possibility is that your surgeon did more ‘pulling’ & ‘tightening’ of your skin and not enough/any fat or tissue reposition. Another possibility is that you’ve experienced some fat re-absorption within the cheek area in the 2 years since your facelift as a result of weight loss, changes in diet, and/or BMI. The good new is that there are a few ways to replace the volume you’ve lost, which I’ll detail below.

 
How an overly tight facelift can cause hollow cheeks

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Mommy Makeover Q&A: What Will My Mommy Makeover Recovery Time Be?

Question – How long is the down time during a mommy makeover recovery? How much pain will I be in after surgery?

What is recovery like with a mommy makeover? I have scheduled both a breast augmentation with lift and a tummy tuck and am pretty scared. I am worried that the pain will be unbearable.

I know medication will be provided but I do not want to be comatose. I have 2 small children and a wonderful husband that will be taking 100% care of all 3 of us but I also want to be coherent. Will I be alert and will I be in so much pain as to scare my children? I have had 2 c sections and the pain was completely bearable.

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Answer – Both procedures, breast augmentation and tummy tuck, come with a certain degree of pain and discomfort; that said, every patient’s pain tolerance is different. Most patients feel “uncomfortable” for the first few days, but after about a week, begin to feel reasonably well. By the 2nd or 3rd week, you should be back to performing most of your normal, day-to-day activities.

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Breast Q&A: What’s the Best Way to Correct Grade 1 Breast Ptosis (Sagging)? Implant, Lift or Both?

Question – What is the best way to correct breast ptosis, high or moderate profile implants, a breast lift or both?

I am 36 years old, breastfed 2 kids, and have lost volume in my breasts. I have some sagging but my nipple is still over the fold. I weigh 130 pounds and am very fit and toned.

I am 5″4″ and my breast size is a 34B. Before my kids I was a 34C cup. When I was breastfeeding I was a 34D cup. I would like to be a D cup and wonder what type of procedure would be best to correct my ptosis?

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Answer – Since you have a small amount of glandular ptosis (pseudoptosis), you not only want to fill-OUT, but lift-UP a little as well. Therefore, my approach would be a dual plane breast augmentation, which would fill out the inferior/lower pole nicely, give you muscle coverage across the upper two thirds of the breast and a nice, slightly lifted appearance.

More specifically, given your body measurements and photo (which shows pseudoptosis with mild Grade 1 ptosis), I suspect that 450cc moderate plus profile implants are needed to give you both the breast size (D cup) and breast lift you desire.

How To Classify/Grade Breast Ptosis

Simply put, grade 1, 2 or 3 glandular ptosis, which refers to how far the areola is sagging below the inframammary fold beneath the breast, the lower attachment point of the breast to the chest wall.

• Grade 1: Mild Ptosis – The nipple is at the level of the inframammary fold, but most of the breast tissue is below the nipple.
• Grade 2: Moderate Ptosis – The nipple is located below the inframammary fold and below the majority of the bottom breast tissue.
• Grade 3: Advanced Ptosis – The nipple is far below the inframammary fold and points towards the floor.
• Pseudoptosis – The nipple lies above or at the level of the inframammary fold while the majority of the breast has descended below the level of the fold. This is not true ptosis, or sagging.

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Botox Q&A: How Long Does Botox Last and What Makes the Effects Last Longer?

Question – How long does Botox last? What determines how long it will work for me?

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Answer – In most patients, Botox lasts between 3-4 months. However, there’s quite a bit of anecdotal evidence suggesting that it’s possible for patients to achieve results that last up to 6, 9 or even 12 months after consistent, long-term and properly-administered use of the Botox product.

In other words, what determines how long the effects of Botox lasts is:

1. the dosage (and whether or not it’s been properly diluted)
2. the duration & consistency of use
3. the skill/experience of the injector or surgeon who administers the injection

The x factor within the “consistent, long-term and properly-administered” conditional I included is, of course, “properly administered”. After all, consistent treatments over several years will matter very little if the wrong amount of Botox has been injected imprecisely/incorrectly. That’s why 2 of the 3 factors explored in this post address it (re: ‘dosage’ and ‘skill/experience of the Botox injector‘).
 

1. Dosage: Why injecting & diluting the proper amount of Botox = key

The first factor that impacts the longevity of Botox’s winkle-reducing effects is the dosage. Botox is diluted for safe use regardless of the injection site, so the impact it has on the surface is largely dependent upon the amount of injections. The site of injection will determine the amount of injections you receive.
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Breast Q&A: Will High Profile Breast Implants or Moderate Plus Give Me Natural Looking Breasts?

Question – Will High Profile breast implants give me natural looking breasts vs Moderate or Moderate Plus?

I am 5’4″ 125lbs, 31″ ribcage, 34C (wanting at least a DD) and my breast measures 13cm wide. I told my PS I wanted large, very nice looking (not high and ball-looking) breasts. He told me he will use a smooth, round, High Profile, 500cc silicone implant and it will look “very nice” with a “nice downward slope”. Everywhere on the internet says that high profiles don’t give a really nice natural look, and that moderate profiles do. Will high profile breast implants give me large, full, and natural-looking breasts with nice cleavage?

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Answer – Although I use Moderate Plus or Moderate Profile prosthesis in the vast majority of cases, given your base width dimension of 13.0cm and your wanting a 500cc implant, a High Profile implant would be appropriate.

In answer to your question, it is not so much the size of the prosthesis that results in a ‘natural’ or ‘unnatural’ look but rather the surgical technique used in relationship to the pre-operative breast appearance.

If, on examination, your nipple to inframammary fold distance is 5.0cm – 6.0cm (meaning that the fold does not need to be lowered excessively), then a high profile implant can be placed in a position that provides adequate inferior/lower pole projection and avoids creating an overly round upper half of the breast (i.e. the “high, ball-looking” and ‘unnatural’ look you don’t like).

That said, there are many women who like the look of round, projecting breasts with upper pole fullness (high cleavage) – neither look is ‘right’ or ‘wrong’ so to speak, they’re just different. Every plastic surgeon has a certain aesthetic style they prefer (re: some aim for the most natural looking shape and size possible while other find the ‘high and round’ look more attractive), but at the end of the day, if the patient is clear about the way they want their breast to look after surgery, it’s my job as their surgeon to achieve it (within reason of course).

Before diving into a few specific recommendations given the measurements you provided, here are my general thoughts on each of the 3 Mentor breast implant profile types:

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Breast Q&A: Undecided – Lift vs Implants for Deflated Breasts

Question – Undecided, Lift or Implants. Surgery in 3 Weeks, Opinions Please

Hello. I have my breast surgery scheduled in June, however, am still undecided which route I should take. Would 500cc saline implants be sufficent to give me some volume, or will I end up with large, saggy breasts? If I decided to go just for a lift, my boobs will be tiny and scared. Hence, I’d rather go for implants even if I will have to get a lift 10 years down the road. I don’t want both surgeries, so it will be either tiny or big. What to do? I’m 40, 1 child. Thank you.
– via RealSelf.com

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Answer – For the best result possible, a vertical breast lift + submuscular, moderately sized implant is needed

In response to your question and based on your photos, this is not really a one or the other type of situation. You really need to have both a lift and an augmentation. If you do them separately you will probably not be satisfied with the eventual outcome. You have significant loss of volume, and if you were to only proceed with skin tightening all that would be accomplished is a higher position of the nipple areola complex. There would be no superior fill and an even smaller appearing breast mound.

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Breast Q&A: Is a Perfect Breast Augmentation Result Possible in My Case?

Question – I think my “goal” photo = a perfect breast augmentation. Is it possible for my breasts to look similar after implants? Am I being realistic about what’s possible for me?

My plastic surgeon wants me to bring in pictures of what I want to look like after breast augmentation so he can be sure that he understands what “look” I like best. We’ve discussed this at my consultation; however I did not bring any pictures with me. My surgery is on the 5/26/2011. At my pre-op appointment, we will go into the specifics of the look/result I am hoping for. The first two pictures are “before photos” of my breasts and the third is what I believe is a perfect breast augmentation. The measurement from my collar bone to my nipple is 21 cm on both breasts. Am I being realistic? Thank you!

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Answer – For a similar result to the “perfect breast augmentation” look you like, a lift is needed.

I agree with my colleagues that it is difficult to compare apples to oranges since every breast has its own unique characteristics, but since the photo you chose as an example of your ideal postoperative outcome is mine, I will give you my thoughts on the situation. (n.b. here’s a link to the ‘perfect breast augmentation’ case you cited as an ideal result).

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