Ask Dr. Cooper

-Swelling after an arm lift (brachioplasty) is expected, with most of the swelling resolving by 3 months after the procedure. 

-However, some patients, such as yourself, will have continued swelling beyond 3 months that can be annoying. 

-It is likely that over the course of another 3-6 months, this swelling will resolve completely.  I realize it's hard to be patient for the swelling to resolve, but time, more than any other therapy, will allow the swelling to improve.

• After a couple weeks you'll be "healed" from the brachioplasty operation, but it takes months for all of the swelling to go down. And, you won't see your final scar results for about one year.
• If you are expecting your arm scars to look presentable, and you'd like most of the swelling to have gone away, then you probably will want to wait 3 months or so before your wedding.  However, I recently had a patient get married 1 month after her brachioplasties, and she couldn't have been happier!
• Best of luck to you!

Unfortunately, no lotions or any amount of liposuction will treat the excess skin that you have been left with.  Only an operation to remove this excess skin is an option.  Arm lifts (brachioplasty), breast lifts (mastopexy), tummy tucks (abdominoplasty), and lower body lifts or thigh lifts help treat this excess skin that you may have. 

• Losing almost half of your weight is quite an accomplishment!
• It is very common after losing so much weight to notice excess skin of the arms, chest, abdomen, back, and thighs. 
• Unfortunately, no amount of exercise will improve this, but you may be a good candidate to undergo an arm lift, chest contouring, tummy tuck or lower body lift, as well as thigh lifts. 
• Prices differ from surgeon to surgeon and may be dependent to some extent on where you live.  Definitely meet with a board certified plastic surgeon to find out what operations could benefit you and what the costs would be. 
• Best of luck to you!

• Botox will definitely improve, or possibly make disappear altogether, the furrows of your brow. 
• 20 units usually is enough, as you mention. 
• Botox is becoming more common in our practice among men and women in their twenties and thirties. 
• Botox will help erase that "angry" looking appearance from your face. 
• Definitely meet with a board certified plastic surgeon to find out more!

• I'm fairly conservative with Botox injections into the forehead for the horizontal lines that you are concerned about.  I usually begin with 12 units.  We can always add more later, but I want to make sure that we don't cause ptosis (sagging) of your brows. 
• As far as the glabella region (the lines between your eyebrows) I usually use 20 units. 

• Botox can take effect within 24 hours, and sometimes it can take as long as 2 weeks to take full effect. 
• Some of my patients notice that Botox takes effect very quickly, while others don't notice much of an effect for a week or so.  You may just fall into that latter category....
• In your case, I would not be overly concerned.  With time you'll likely be very happy with the results. 
• If after 2 weeks you have not observed the results that your Botox injector told you to expect, then definitely contact him/her to be evaluated.

-Both saline and silicone implants are safe for breast augmentation.  There are some differences between the two, however. 

-Saline implants may show more rippling compared to silicone implants, and they may not feel quite as natural as silicone implants.  Saline implants are also less expensive than silicone implants. 

-Most women I see today request silicone implants, and I think they are a good choice based on feel and their less likelihood of rippling.  However, the ultimate decision is yours. 

-Another difference to keep in mind concerns implant leakage.  If a saline implant leaks, your body will reabsorb the saline, and when you look in the mirror, you'll notice that the affected breast is smaller than the other.  However, when silicone leaks, you may have a "silent leak."  This refers to the fact that the scar tissue around the silicone implant usually holds the implant in place, AND, unlike saline, your body will not reabsorb the silicone.  Hence, the FDA advises getting MRI scans periodically to look for silent leaks.  (Definitely, discuss this FDA recommendation with your plastic surgeon to learn more about this recommendation.)

-Thanks for your question, and best of luck to you!

- I use general anesthesia, and some local anesthetic, when performing breast augmentations.

- I do not know of any plastic surgeons who use epidural anesthetics for this procedure.

- Occasionally, I will use IV sedation, but generally speaking, I have found that general anesthesia is best for breast augmentations. 

• Most of our breast augmentation patients return to work around 3 days after their procedure.  Some women who have the procedure on a Friday may even return to work part time on Monday. 
• This doesn't mean all of your discomfort will be completely resolved, but it should be very manageable by that time.
• If your "normal office duties" don't involve a lot of lifting, I imagine you too would be fine going back to work a few days after your procedure. 
• For patients whose jobs are quite physical (such as law enforcement, for example) we'd recommend light duty for the first couple weeks back at work. 
• After your breast augmentation you'll likely take some prescribed narcotic medication for a couple days, and then Ibuprofen and Tylenol are usually best. 

• The internet can be a very scary place!  Unfortunately, you can find a lot of misinformation on the web, especially concerning silicone implants. 
• The overwhelming majority of women are very happy with their silicone implants, otherwise I wouldn't place them!  For many women, their quality of life has been improved, rather than "ruined," as you may have read in some internet posts...
• Silicone implants do not cause any systemic diseases or health problems. Interestingly, silicone implants are one of the most studied "medical devices" out there! From 1992-2006, due to health concerns, the FDA decided that silicone implants could not be used for cosmetic breast augmentation surgery, and only patients undergoing breast reconstruction for cancer could have silicone implants placed. 
• During this time, thousands of women in the U.S. who had silicone implants were studied. Numerous advisory panels concluded that silicone implants do not cause health issues such as rheumatoid arthritis or autoimmune disorders, and they were indeed safe to use for breast augmentation. Thus, in 2006 the FDA granted permission to bring silicone implants back on the market for cosmetic breast augmentation use. 
• Silicone implants usually feel more natural than saline implants, and they are less likely to show rippling through the skin. 

• It is common to still have nipple sensitivity and some swelling 4 weeks after breast augmentation
• With time, over the course of a few months, the tightness will resolve, and most likely the nipple sensitivity will resolve as well. 
• The good news is that you still have nipple sensation, although hypersensitivity of the nipples can definitely be annoying. 
• Thanks for sharing your concerns, and hang in there!

• Recovery after breast implant and capsular contracture removal is usually much quicker and less painful than the original placement of your breast implants. 
• As a massage therapist, I would estimate that you'll probably want to take a week to 10 days off of work. 
• Best of luck to you!

• Removal of breast implants is usually a less painful than the primary breast augmentation. 
• Depending on what kind of work you do, you'll probably feel fine going back to work after just several days to 1 week. 
• Best of luck to you!

• Natrelle implants, manufactured by Allergan, and Mentor implants are both safe.  
• I have used both types of implants, and neither is "better" than the other. 
• Rather than being concerned about the implant manufacturer, I would recommend spending more time understanding which approximate size implant you are interested in, and make sure that your plastic surgeon understands your goals and expectations for your new breast shape and size. 
• Best of luck to you!

• It is very unlikely that you have  an implant rupture 4 weeks after your breast augmentation from swinging your arms a lot during a fight. 
• If your discomfort doesn't get better over the course of the next couple weeks, and perhaps after taking some Ibuprofen,  then I'd recommend you meet with your plastic surgeon.  He or she will be able to examine you, and likely will be able to reassure you that everything is okay. 
• Thanks for sharing!

• I think you will have a very nice result from a breast augmentation. 
• You can expect a breast augmentation to help restore the breast fullness that you have lost. 
• As far as improving your cleavage with breast augmentation, you may notice a modest difference.  Bras help increase cleavage more than implants.  Cleavage is really based on each patient's anatomy.  If your breasts are set apart widely to begin with, then breast augmentation is unlikely to improve your cleavage very much.
• Definitely meet with a board certified plastic surgeon to find out more!

-The answer to your question is "yes," however, this is rarely performed because the overwhelming majority of women would like their nipples/areolas to look as normal as possible after their breast reductions.

-I have had two patients, both quite a bit older than you, who had extreme breast ptosis (sagginess of the breasts) along with very large breasts, and these patients wanted their breasts to be very small AND they desired to not have free nipple grafts (whereby the nipples/areolas are removed and sewn back on in the appropriate position as skin grafts.)

-They both did great, were happy with the outcome of their operations, consented to undergoing complete removal of their nipples/areolas, and did not miss this portion of their breasts postoperatively.

-HOWEVER, this is uncommonly performed (less than .5% of my breast reduction practice) and breasts without nipples/areolas do look somewhat strange!

-In 99% of breast reductions I perform, the nipples/areolas are moved to the appropriate position based on the blood supply from a superio-medially based pedicle.

-I recommend you meet with a board certified plastic surgeon to discuss your concerns. Thanks for your question!

-You have an interesting question, and I suppose it may differ from surgeon to surgeon.

-I meet with all breast reduction patients, and all cosmetic surgery patients, at least twice before their operation.  The first time is the initial consultation, and then once again at a preoperative visit to go over consents, answer any final questions, examine the patient again prior to the operation, and review their medical history to make sure that nothing has changed.

-If you would like to meet with your surgeon again prior to your operation, I would recommend calling his/her office and requesting another visit.

-Best of luck to you!

• Earlobe repair is performed under local anesthesia in the office setting.  General anesthesia is uncommonly used.  
• After the procedure, pain is minimal, and sutures are removed 1 week later. 
• Meet with a board certified plastic surgeon to find out more!

- As a plastic surgeon who closes gauged earlobes, I recommend that you have this procedure performed by someone who has some experience with this particular procedure. 

-The procedure itself is performed under a local anesthetic and in the office setting.  Pain is minimal and recovery is quick.  

-I recommend meeting with  a board certified plastic surgeon in your area to find out more about the procedure, including cost. 

-Best of luck to you!

• Occasionally absorbable sutures may be "spit" out by the body before they are fully absorbed.  Your plastic surgeon should be able to remove this without much difficulty. Additionally, if it is a permanent suture protruding through the skin, this too will need to be removed.  
• Definitely, contact your surgeon so he/she may evaluate this. 

• Due to normal postoperative swelling and bruising, it is not possible at this time to determine what your final results will look like months down the road.  It is not uncommon to have  more swelling on one side of the face than the other during the first week, and this can make your appearance look asymmetric . 
• As for the tight skin under your chin, this will likely loosen up with time.
• Please contact your plastic surgeon as he/she can evaluate you in person and reassure you about what to expect during this very early post-operative recovery period.
• Best of luck to you!

• Occasionally, after a facelift there can be some slight separation of skin edges, and it sounds like your plastic surgeon's recommendation to keep these areas clean and moist with antibiotic ointment is appropriate. 
• Do keep in close contact with your plastic surgeon so that he/she may evaluate you and make sure that you go on to heal as quickly as possible. 
• Likely, within a couple weeks these areas will be healed.

• Definitely consider meeting with a board certified plastic surgeon to have this evaluated. 
• Plastic surgeons are specially trained to provide their patients with great results when operating on the face. 
• By taking care to close incisions on the face in multiple layers, we can achieve excellent scar results. 

• When there is less than 30cc/day coming out of drain for two days in a row, I will remove the drain.
• Definitely, give your plastic surgeon a call, and see if he/she agrees that it is time for you to be drain free!
• Best of luck to you!

• This question is commonly asked, and unfortunately, in my experience, insurance companies never cover repair of diastasis.
• Definitely meet with a board certified plastic surgeon to make sure that you might not have a hernia, because insurance companies may cover the hernia repair.
• Best of luck to you!

• It is very common to be left with an abundance of loose skin of the neck after massive weight loss. In many cases a neck lift can dramatically help patients such as yourself improve the contour and overall appearance of the neck. 
• I definitely recommend meeting with a board certified plastic surgeon to find out exactly how the operation is performed and what sort of recovery period you may expect. 

• If you trust your plastic surgeon and you are happy with the results from your prior procedure(s), I would give stong consideration to undergoing the thigh lift with him. 
• However, you may always get second opinions from other plastic surgeons, and you may find a price that is more affordable, either here in the U.S. or abroad. 
• I would caution you to make sure that whomever you ultimately choose to perform your operation has a good reputation and has experience with the operation. 
• Also, with thigh lifts, drains are almost always left in place to prevent seromas, so it is important that you remain in the vicinity of whereever the operation is performed so that your surgeon may manage these drains, and address any possible complications that might arise. 
• Best of luck to you!

-It is very common to notice that you actually weigh more after a tummy tuck than you did before, but this is not permanent!  We note this to be more common in patients who have lost a lot of weight prior to their tummy tuck.  (I'm not sure if you fall into this category or not.)

-There are a couple reasons that this may occur.  After a tummy tuck (and additionally, after liposuction) your body simply swells in reaction to the procedure.  This swelling is just the body's response to the huge operation that you underwent.  Additionally, some of the lymphatic channels of your abdomen have been disrupted, and it takes time for your body to redirect the fluid that the lymphatics used to take care of. 

-This process of your body getting rid of excess fluid can take MONTHS, occasionally as long as a year, so even at 9 weeks you still may weigh more than you did before your procedure.  It is not uncommon in fact to hear patients (especially those who have lost a lot of weight prior to their tummy tuck) say that they can't fit into the clothes they were wearing pre-operatively for months after their operation.

-It's difficult, but try to remain patient as your body adjusts to the major operation you underwent.  It can take months to see the final results!

• It is common to still have some occasional discomfort, for up to a few months, after a tummy tuck.  
• Likely the discomfort you are feeling is just part of the healing process, or perhaps you "overdid" it recently, or strained a muscle. 
• If your pain continues, or if you are still concerned, definitely make an appointment with your plastic surgeon, as he/she will be able to examine you and should be able to reassure you that everything is okay.