Now the implant is going to be placed underneath this which is going to make it bigger and its going to do the opposite of reducing the breast so we are kinda using two different approaches here when we combine a breast lift and an implant. A breast lift reduces the skin enveloped an implant expands the skin envelope so there’s a fine balance here. Personally I like to do the breast lift first and then place the implant at the end. I will trim the skin if necessary to achieve my final result.

I am back – I have done a slight reduction on this left side – we’re pretty close – there’s still a little bit of difference and I think it has to do as much with position and the overall difference in the natural breast. Volume wise I think we’re pretty close. I took off about the equivalent of two implants which is a decent amount – she certainly could have elected to just use two different implants and not do this and that is usually the most common approach to doing this.

I’ve done the lift – base width here is a little wider than this one – position wise it will equal out, vertical height on this is longer than here and all these little things add up – her chest is different between one side and the other and these are significant issues that come into play when we perform surgery because most patients don’t even realize that they are different – until we start looking at and evaluating their breasts, so its important that I spend a lot of time discussing all these nuances with patients so there are no surprises.

So we’re here in surgery and both sides are done enough actually in the process of creating a pocket under the muscle – the muscle lays on the chest and I virtually always go under this because it allows a little bit more protection over the implant. So here’s that main muscle to the chest and I’ve actually started to dissect it and when I go underneath here you can actually start to see the ribs and the pocket – so that’s the pocket that I’m going to create and where to put the implant in will be done with them.

Alright we are back. The sizers are placed on both sides, they are temporary implants to allow me to get close. We have got 100 cc’s in this sizer here which I think is a very nice breast – its a full B Cup and obviously she wants to be more of a C Cup so we are going to be put in another 50, that’s 150, here’s 200, heres’s 250, and this is going to be close to 270. So as we increase the volume we round out the breast, we get more fullness up here and actually starts to distort the natural appearance in the breast and bigger is not always better. A lot of women like this look but it clearly is not a natural look. I’ll also is fighting against this portion of the breast and in her particular case Ive had to release down here just to make sure that I can make this fold as low as this one. This is our implant Ive got a 270 here – it’s a silicone implant silicone gel wonderful devices and I think that for her it’s going to be a nice. Its going to match her base width and so we are just going to go ahead and insert this relatively straightforward to put in – good — perfect… Ive got some anesthetic medicine – Ive got the implant over here – the implant over here – you got to see it inserted we’re gonna go ahead and close and then we’ll update you one more time.

Alright so what Ive done here is Ive internally closed everything and the final closure in this we call a circum- vertical breast lift this does not have the upside down T so that’s not what we want but when we do this I can take the sharp needle and go all the way around with this per minute stitch call gore-tex and what that allows me to do is that. And this is beautiful and there is a little bit gathering here this almost always goes away but this permanent stitch tends to keep the areola from widening up again the other thing I’d like to show you is that here’s the areola and nipple you can see this is where skin used to be and I just kind of peeled of the outer layer of skin and kept all this attached this has never been removed nipples nice and pink and there’s nothing about this that is at all concerning and so they keep their sensation and they keep their the whole nipple and we don’t disconnect it and so what this is basically done the lift occurs by removing the excess skin above the level of the nipple and this ends up moving up and so when we do that that’s how that looks and you can see this sides been done over here and that’s the final look at we trim that extra skin and bring it through and we will be done.

Alright welcome back to the end of the case we are done and we all agree she looks really really good Ive used dissolving stitches for everything all the incisions are sealed with a topical adhesive so the patients can take the dressings off the next day – they can shower the next day they wear a support bra – for 5 to 6 weeks – I see them at one week, six weeks, six months a year, I like to follow up with my patients. And everything is healthy. These minor gathers virtually disappear as the months go by. Implant height it looks good. The volume symmetry is I think very good Ive expanded the lower pull of this breast a little bit to match this one. Nipple height looks good. So I think that’s it’ll be exciting to see her back as the weeks and months go by. So thank you for being with us”

Image By Design Plastic Surgery
29167 Jefferson Ave
St Clair Shores, Michigan 48081
Phone: (586) 776-3223

Non-invasive aesthetic procedures have come a long way in the last ten years. The American Society of Plastic Surgery’s yearly statistics continue to demonstrate strong demand for procedures such as neuromodulators (Botox and Dysport), and hyaluronic acid filler agents (Juvederm, Voluma, Restalyn). Recently, non-invasive contouring systems that perform the techniques of cryolipolysis, such as Cool Sculpting and radiofrequency skin-tightening Ultherapy, have emerged in the marketplace. Now Allergan has added Kybella to the mix as a non-invasive injectable material to dissolve fat under the chin.

Before and After

Before and After

The key to success with these treatments is consulting a comprehensive center that offers a full array of non-invasive and surgical options, and will direct you to the ideal treatment modality for your unique circumstances. Just as with any medical and surgical procedure, there are appropriate candidates and patients with contraindications.

The most important step to avoid dissatisfaction is to be evaluated by a physician who is properly trained to perform comprehensive evaluation and care for all patients with a particular aesthetic concern.

Board-certified plastic surgeons have the most comprehensive education and background experience to correctly evaluate your anatomy and determine which treatments will yield the best outcomes. The statement “if all you have is a hammer the whole world is a nail” rings true for medical spas and dermatologist offices which only have one option, such as Cool Sculpting or Kybella. Just because a treatment option is non-invasive does not mean it is inexpensive. If you factor in the cost of multiple treatments, it may be as expensive as surgery and still fall short of expectations.

When is Kybella the right choice?

With the current status of the injectable form of deoxycholic acid (Kybella) the ideal candidate must have reasonably tight skin with only mild to moderate adipose excess in the submittal and chin neck angle. The patient should not have a significant mandibular jaw discrepancy with the midface or have a particularly steep mandibular plain angle.

When is Kybella the wrong choice?

Any patient with lax skin of the neck or a significant deflation of the neck related to weight loss with demarcated platysmal bands is not a candidate. Taking away fat in this circumstance only worsens the deformity. Any patient with a deep underbite and a small chin with a very oblique chin-neck angle should also avoid Kybella. Deoxycholic acid is mostly created to dissolve fat but does produce some inflammation with the caustic material to encourage collagen production and skin retraction. Skin excess with an oblique chin neck angle and recessed chin will not yield overwhelming positive results.

Instead of Kybella, the better option is placement of a chin implant (genioplasty) with aggressive liposuction to encourage skin retraction. A middle facial third with significant skin excess and deflation combined with loose-hanging skin with platysmal bands is best treated with a corset platysmaplasty in conjunction with a neck/face lift.

Non-invasive aesthetic procedures can be a wonderful adjunct to helping people age gracefully with limited down time. Kybella in the right situation may improve necks and make people happy with the results.

Avoid being pushed into this option without a thorough three-dimensional analysis of your face to determine if it’s right for you. Nothing is more frustrating than spending a great deal of money and not realizing your desired results. Even with surgery, some deformities may not be able to be corrected. Take advice from a board-certified plastic surgeon to maximize your goals and to feel good in your own skin.


Consider custom solutions for a sagging neckline

Necklines for both men and women can be a focal point of self-consciousness. However, the etiology of an unattractive neckline can be diverse, so treatment options must be tailored to the underlying cause. There is no one solution for everybody. Careful three-dimensional analysis of the soft tissue and underlying bony structure of the midface, lower jaw and neck are imperative to choosing the correct modality to improve your neckline.

Some common underlying causes of poor aesthetic necklines:

Small lower jaw – If you have a deep underbite despite orthodontics and a short chin, this leads to less bone support of the soft tissues of the jawline and submental region. People with this type of lower jaw may have a very obtuse chin-neck angle leading to redundant skin. An ideal treatment for this situation is bony chin advancement (genioplasty).

If your chin is horizontally too short, then an augmentation with a chin implant is an excellent choice. I prefer the Medpore implant, which is carvable, and screw fixated and becomes an extension of the bone.

Both genioplasty and chin implants can easily incorporate the technique of liposuction as a means of sculpting the soft tissues of the neckline by removing unwanted fat. Liposuction induces collagen production and facilities skin shrinkage and redistribution yielding a pleasing result. This combination therapy can produce a wonderful outcome that makes you look more facially balanced. However, if your skin is too loose and hanging, a more formal neck lift may be preferable to liposuction.

Mid face descent of soft tissues – Aging can affect facial fat compartments leading to decreased volume, which results in the midface falling over time. This sagging increases nasolabial folds and causes lower facial soft tissue to drape over the jawline. A crisper jawline can be restored by replacing missing soft tissue volume in the fat compartments of the midface with filler agents like Voluma and Sculptra or via fat grafting. Subtle volume enhancements can create a nice effect on the jawline without looking like you’ve undergone a surgical procedure.

Gravitational changes to the soft tissue of the neck – Gravity affects all of us. The skin and muscles of the anterior neck begin to pull away over time. The appearance of the platysma muscle medial bellies becomes apparent leading to unsightly banding. In the early stages of gravity-induced changes, treatments such as chemical peels, micro-needling and radio frequency can yield improvements and delay the inevitable soft-tissue sagging.

Ultimately the best treatment option is a face/neck lift. A well performed facelift by an experienced board-certified plastic surgeon will yield excellent results with longevity of up to ten years depending on how well you age forward and take care of your skin, avoiding further sun damage.

Obesity: People with elevated body mass indices will accumulate increased fat throughout the body. The neck is no exception. Very mild amounts of fat excess with firm, good quality skin may realize improved contours with Kithera (an injectable product that dissolves fat in the neck). However, in my experience, few patients I evaluate are ideal candidates for this treatment. The injection results in inflammation, which can cause collagen production and skin remodeling, but most people need bigger guns to fight the battle. The price of several rounds of injections is as much as a true liposuction with less effective results.

If you have significant fat in the submental region and reasonable skin quality, liposuction can be a great treatment option to uncover a more normal neckline without a lot of expense or downtime. However, a face/neck lift with a corset platysmaplasty is the tried and true corrective option that works very predictably.

If you’re obese and undergo bariatric surgery or make lifestyle changes to produce massive weight loss, you’ll likely develop excess deflated skin that hangs off your face and neck creating an aesthetic deformity. Modifications of standard face and neck lifts must be incorporated to achieve a pleasing result.

The takeaway is that if you’re unhappy with your jaw and neckline, you can improve your appearance and boost your self-confidence by seeking out proper consultation with an experienced plastic surgeon. During the consult, a detailed facial analysis should be performed. Treatment options can be formulated to yield the best results by addressing your unique issues as presented during the interview. No need to hide your neck behind scarves and turtlenecks any longer.

According to many websites gives an option to standard breast inserts for many women. There are two types of Natural Breast enlargement procedures; Fat transfer breast augmentation and Stem-cell breast augmentation. As the name suggests “fat transfer”, the process involves removing of fat cells from any other part of the body (thighs or buttocks) and transferring it into the breasts. On the other hand, mature stem-cells from excess fat in the client’s own body can be collected, and then injected into the breasts to be augmented, where they can generate more excess fat to enhance the breast naturally. Traditional breast augmentation isn’t completely successful, while natural augmentation has many benefits such as, less complication and threats. Also, the recovery time of naturally augmented breasts will be shorter than standard augmentation.


Saline or silicone implants are trending for decades, as they are safe. However, we cannot ignore the drawbacks of traditional breast implants; No natural look, looks lethargic for some women, and non real feel. And, if the body is not responding to the implants, then the healing process will take much longer time. Some women experience deformation due to the implants, as they can slip out of the correct place. Most of the women desire naturally augmented breast; however, due to the unavailability or costlier process, they tends to choose traditional breast implants.


Natural breast augmentation has the least recovery time; Only 2 days, as there are no implants involved in the process. Naturally breast augmentation surgery carries fat or stem cells from the patient’s body. Therefore, there are no risks associated with this type of surgery. This type of surgery is also helps in reducing unwanted fat from the thighs or buttocks, which is directly proportional to losing weight. This methodology doesn’t influence the women’s potential to get mammograms, not at all like traditional breast augmentation

Natural breast augmentation has many benefits but has a major drawback; Limited increase in breast size! Yes, Natural breast augmentation doesn’t support the massive increase in size, so for those women who are looking for massive increase should not go with this type of surgery. However, one cup size can be easily increased with this procedure. This is the ideal surgery for women who are looking to restore their breast dull appearance due to aging, nursing, or pregnancy. The fat transfer process or stem cell augmentation can easily make breasts considerably rounder & firmer. Some women prefer a firmer as well as the rounder breasts instead of the breast size. Cosmetic surgeons like will not reject any type of breast augmentation surgery, so it is up to you; deciding which one is the best for your appearance and desire.


Fraxel repair is a revolutionary laser treatment to correct deeper wrinkles, tighten skin and remove years from your appearance. It is a safer, more effective and more comfortable alternative to surgical procedures.

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Expires 1/30/16

Spring Cleaning! Getting Rid of Your Old Makeup

Most beauty products are designed to stay fresh for a specified period of time then they start to break down. Hanging on to your skincare or makeup past its expiration date, might be causing skin problems. Using a product beyond its expiration date may seem harmless, but expired beauty products can carry a range of bacteria.

In a 2013 study published in the International Journal of Cosmetic Science evaluated the makeup routines and habits of 44 women ranging in ages 18 to 28, and the results showed 70% of women in the study used some type of expired product, mostly eye makeup mascara, eyeliner, and eye shadow.

Products that contain water as one of the first ingredients have the shortest shelf life after opening because water encourages the growth of bacteria and products made up of almost no water (such as powders) last the longest. Also products are susceptible to bacterial contamination and breakdown from exposure to air. If you have a product that is discolored, runny or lumpy, has separated, developed a strange odor, or feels different on the skin than it once did, then by all means throw it away.

Here is what you need to know on the shelf life of your favorite makeup and skincare products, and how to spot those that are past their prime.

Lotions and Perfume
Recommended replacement: 3-4 years
Body lotion and perfumes typically tend to last longer than most. Although, at times it is hard to remember how long you’ve actually had that scented body lotion. So, if it has changed color from a bright white to an unappealing yellow that seems thinner or more watery than when you initially purchased it, replace it.
As for perfume, alcohol is a natural preserver, keep it in a cool, dark place, and it should last for a few of years. When the scent of the perfume smells different, you should toss it.

Skincare Products
Recommended replacement: 1 year
Typically, you shouldn’t hold onto skin-care products for more than. Products that fight wrinkles, or acne are typically only formulated to be active for a year.

Recommended replacement: 1 year
Sunscreen should be replaced every year, however, if your formula comes out runny or has turned from white to yellow, this could mean the active ingredients might be compromised and most likely will not protect you from the sun’s harmful UV rays. Be sure to always pay attention to the way the products looks.

Recommended replacement: Loose compact powder last for about 1 to 2 years
Recommended replacement: Powder blush last for about 1 to 2 years
Recommended replacement: Foundations 6 months to 1 year
Powdered beauty products contain the least amount of water, making it harder for bacteria to grow. However, the brushes you use to apply the powder may carry dangerous bacteria. Invest in a brush sanitizer and clean your brushes regularly to prevent breakouts and bacteria growth. Within just months, foundation can start to grow bacteria that present health risks to your skin. Every time you touch your makeup, you transfer germs to them and ultimately to your face. Try to keep your fingers out of products. As oils rise to the top, and the consistency thickens, the odds of bacterial growth increase. This can lead to breakouts or irritation, even infection.

Recommended replacement: 3 months
A mascara tube is a dark, wet environment which is the perfect breeding ground for bacteria. Also, every time you re-insert the brush into the tube you double dip, all of which increases the risk of an eye infection.Pumping the wand pushes air into the tube, causing it to dry out faster. Try slowly draw out and twist the brush instead.

Eyeliner and Eye Shadow
Recommended replacement: Liquid eyeliners, 3 months
Recommended replacement: cream eye shadows, 6 months
Recommended replacement: pencil eyeliners and powder eye shadows, 2 years
Eye makeup is especially vulnerable to bacteria, so start reviewing your makeup collection for expiration dates. Pencil eyeliners can be renewed by sharpening after each use. Expired powdered eye shadows tend to be more flaky and dry.

Lipstick and Lip liner
Recommended replacement: Lipstick and gloss, 2 years
Recommended replacement: Lip liner 2 years or more
The water content in lipstick makes them potential mini reservoirs of bacteria so avoid sharing it with others. Also, if you get a cold sore, throw out all lip products you are using.
Another way to tell that lip gloss has passed its expiration date is if it you notice color changes or you see mold, get rid of them.

Here are some easy tips for prolonging the shelf life of your products:

Things to remember:

Store your products in a cabinet or drawer
Wash your hands before using products
Tighten/secure the cap after each use
Toss out eye/lip products after you’ve had an eye infection or cold sore

Things to avoid:

Storing your products in direct sunlight
Sharing your products with others
Adding water or saliva to thin out or remoisten your products
Pumping your mascara