Q & A

Dr. Tutela is a Board Certified Plastic Surgeon that is dedicated to superb results. He creates custom treatment plans to help you look and feel your best, while achieving the most natural look for you.

DO BREAST ENLARGEMENT CREAMS WORK?

At amazon.com you can see lots of breast enhancement creams and pills for sale. So, i figured if amazon carries them, they must have some benefit. I’d like to go up one or 2 cup sizes without surgery. The top reviewed breast enhancer that seems to do this is the Breast Actives. The Breast Actives program is called a natural Breast Enhancement Program with exercise, supplements and cream that give you nutrients that you don’t get in your diet. Is there truth that certain nutrients missing in your diet can lead to poor breast development?  If so, wouldn’t these products *work* to some degree if that’s the case. I mean, you do get bigger breasts when you gain weight, so it seems like theres a relationship between breast size and diet.

Thanks for the question. Unfortunately the answer is a short one. No.

There are many products out there with deceptive marketing and false claims.  For the most part, if it sounds to good to be true than it probably is.  Luckily there are many forums such as this one where you can go and get opinions for experts.  And you are obviously a very smart consumer who does their research before commuting to a treatment.

I hope this helps 🙂

– John Paul Tutela, MD

HOW TO MAKE YOUR BOOBS BIGGER – PILLS OR CREAMS?

I have very small breasts, and really want to make them larger. I have been looking at different options, breast augmentation being one of my top choices, but also looking at breast enhancing pills. I’m afraid the hormones and estrogen in them might be dangerous, but of course the websites won’t tell you that! I don’t have a lot of extra money for surgery, but I really feel like I want this not only for my self confidence, but overall for my personal happiness. Thanks!

Thanks for the question. There are no creams or pills that can safely and effectively make your breasts bigger.

There are many products out there with deceptive marketing and false claims. For the most part, if it sounds to good to be true than it probably is. Luckily there are many forums such as this one where you can go and get opinions for experts. And you are obviously a very smart consumer who does their research before commuting to a treatment.

I understand that committing to surgery is a big financial burden, but breast augmentation is one of the highest rated plastic surgery procedures in terms of satisfaction.  There are many financing options that can help you obtain what you are looking for while fitting in your budget.

I hope this helps 🙂

– John Paul Tutela, MD

I’M 38 YEARS OLD AND I HAVE HIGH CHOLESTEROL. CAN I HAVE A TT, BBL, AND LIPO?

I want to know, can I have done a tt, bbl, lipo being that I have high cholesterol?

Thanks for the question.  High cholesterol is not a contraindication to your proposed procedures.  It looks like you would be a good candidate from the photos provided.

I hope this helps 🙂

– John Paul Tutela, MD

LOOKING FOR A PLASTIC SURGEON THAT SPECIALIZES ON LOW SCAR TUMMY TUCK.

Looking for a plastic surgeon that specializes on low scar tummy tucks. either in Tijuana Mx or Orange County CA. I’m not sure if Ineed a full or partial TT. I had my third kid 7 months a go and I’m closing the factory. Any suggestions and input would be truly appreciate it.

Thanks great question.  Your photos look great and it seems that you are in good health.  It is hard to tell for sure if you need a full or mini tummy tuck.  A physical exam by a board certified plastic surgeon will be the best way to determine it.  Luckily you are in a part of the country where there are some great surgeons.  I will message you with some suggestions.

– John Paul Tutela, MD

MY QUESTION IS… IF YOUR DOING A LIPO, TT, AND A BBL, HOW DO YOU SLEEP?

To me sleeping on your back can kill the volume of your BBL, but is it safe to sleep on your belly after a TT? Also sleeping on your side can also kill your new hips… How do you sleep?

Great question.  The sleeping position after this type of combination surgery is creative.  In regards to the tummy tuck your positioning needs to be slightly flexed at the hip, which translates to slightly hunched foward when standing.  This leaves laying on your stomach out of your options.  In regards to your BBL you don’t want to lay or sit with your weight on your new fat grafts.  So this takes out flat in your back or even in a reclined position.  So what is created is a position on your back with pillows under your legs and back that keep your weight on your waist and thighs, while maintaining a slight flexed hip.  Also laying on your sides can be an option is there was not much augmentation to your hips.

I hope this helps 🙂

– John Paul Tutela, MD

HOW CAN I GET KIM KARDASHIAN’S BUTT?

I want my tush to look like Kim Kardashian’s and everyone says she had a Brazilian butt lift.  Can someone tell me what is a Brazilian butt lift?

Thanks for the question.  A Brazilian Butt Lift is a procedure where fat is harvested from different parts of your body, processed, then injected into your butt.  At least half of your gluteal aesthetics come from how your tea end is “framed” by the rest of your body. If you have a thick lower back and thicker, wider legs your buttocks will have less definition. The first part of a Brazilian butt lift is liposuction. This has 2 purposes. The first is that it sculpts the parts of your body that surround your rear end. That includes your lower back, hips and thighs. The second is that the fat obtained from the liposuction is then processed and injected into your buttocks to add volume, definition and projection, making your butt more shapely, and lifted.

I hope this helps 🙂

– John Paul Tutela, MD

WOULD IT BE POSSIBLE TO GET MY WAIST LOOKING SMALLER LIKE THE PICTURE ENCLOSED?

Hello! My name is Victoria I am 18 years old and currently 5’5″ and 190 pounds my main problem is my thighs being so large it looks like my but is small, my butt is not formed right nf the amount of cellulite it unbearable! I trenches 2 pictures of me currently and a pictur of my dream body. I’m not sure what procedure I need done, or if it’s even realistic for me to be that size.

Thanks for the question.  The procedure you are looking for is a Brazilian Butt Lift.  You are absolutely right in pointing out that your legs affect your the shape of your butt.  In fact at least half of your gluteal aesthetics come from how your tea end if “framed” by the rest of your body.  If you have a thick lower back and thicker, wider legs your buttocks will have less definition.  The first part of a Brazilian butt lift is liposuction. This has 2 purposes.  The first is that it sculpts the parts of your body that surround your rear end. That includes your lower back, hips and thighs.  The second is that the fat obtained from the liposuction is then processed and injected into your buttocks to add volume, definition and projection, making your butt more shapely, and lifted.

I think you are a good candidate for a Brazilian Butt Lift.  Most of your results would depend on the sculpting of your legs. And that really depends on whether the have much fat or are very muscular.  It doesn’t look like you have much fat in the rest of your body to add a tremendous amount of volume.  But by seeing a board certified plastic surgeon he or she will be able to develop a plan to get you closer to your goals.

I hope this helps 🙂

– John Paul Tutela, MD

17 DAYS POST OP BREAST REDUCTION, I WOKE UP WITH MY RIGHT BREAST REALLY HARD, RED, AND SWOLLEN. VERY PAINFUL. SUGGESTIONS?

I called my dr he said its normal, told me take Motrin and put warm compress. I have no fever and no drainage from incisions. Has anyone else experienced this?

Common things that can cause swelling and tenderness after a breast reduction are normal swelling, a seroma, hematoma, fat necrosis or an infection.  It is unlikely that a hematoma would present this far out from your surgery.  A seroma is a fluid collection that you might be able to feel though your skin.  A seroma could get infected as well as the skin itself.  I think your doctor did the correct treatment.  If it is just localized swelling the warm compress and motrin may soften things up and help with your discomfort.  If it is an infection, then it will “declare” itself and begin to get worse, in which case you have your diagnosis.

Fat necrosis is a small piece of fat that didn’t survive the operation, and can also present as localized firmness after Breast reduction.  For the most part that is not dangerous.  It can partially resorb over time.  Uncommonly it is removed surgically.

I hope this helps 🙂

– John Paul Tutela, MD

ARE THERE ANY SERIOUS ISSUES WITH BEING A SMOKER AND HAVING A BREAST AUG? IF SO, WHAT ARE THEY?

Absolutely.  Smoking has many issues associated with it.  With Breast Augmentation in particular smoking causes an increase in the incidence of Capsular Contracture.  Consular Contracture is when the scar tissue that forms around your implant begins to stiffen up.  This happens on a spectrum from just a little firmer and perkier to totally deformed and painful.  Smoking makes your chances of this happening worse.

Smoking also compromises your bloods circulation.  This can lead to wound healing problems and even necrosis of your incision line.  That is usually not a problem with a primary Breast Augmentation, but could prove to be an issue with more complicated breast surgery such as a Mastopexy (Breast Lift) or a Breast Reduction.

You can reduce the risks of poor circulation by stopping all nicotine products 6-8 weeks prior to surgery.

In order to mitigate the risk of capsular contracture I would recommend quitting prior to surgery and keeping away from smoking for the first year after surgery.  At that point you are better off not starting again.  For many people it takes an event in their life to stop smoking, and getting an aesthetic procedure is a perfect excuse to change your lifestyle as well.  In my practice we offer a “Road to Wellness” that puts patients in contact with specialized providers to address overall wellness and how to incorporate that into their lives with nutrition, training and even a wellness coach.

I hope this helps 🙂

– John Paul Tutela, MD

HOW MUCH DOES EYELID SURGERY COST?

How much does a blepharoplasty cost?  Are the prices different for blepharoplasty on the upper eyelids vs. the lower eyelids?

It depends on a few things. Across the country prices tend to increase near major metropolitan areas and decrease in more rural areas.  Also upper lid blepharoplasty is usually cheaper.  In northern New Jersey eyelid surgery usually ranges from $2,000-3,000 for upper lids $4,000-$5,0000 for lower lids and $5,000-$8,000 for all four lids.

I hope this helps 🙂

– John Paul Tutela, MD

DROOPY EYELIDS – ALTERNATIVES TO EYELIFT SURGERY?

I know an eyelift would work for my sagging eye lids…but what about non surgical ways to improve eye lids?

Thanks for the question.  There are in fact a few options to rejuvenate your eyes without surgery.  The first of which is Botox.  This will help keep wrinkles from around your eyes from getting worse and keep your wrinkles from piling up when you smile.  The next important step in non surgical eye rejuvenation is skin care. By using a retinol base product the collagen in your skin will be reorganized and give a more youthful look.  Using a filler under your eyes can decrease your lid cheek junction and fill in any year trough deformity. Finally facial resurfacing with a laser or chemical peel can tighten up some loose skin and smooth out any fine lines and wrinkles.

I hope this helps 🙂

– John Paul Tutela, MD

WONDERING IF THE DENT / HOLE UNDER MY BOOBS WILL GO AWAY EVENTUALLY

Dent under breast, had surgery 2 weeks ago, had tape removed today. Forgot to ask ps about the dent.

Thanks for the question.  I think it is too early to comment on final results.  A good portion of your breast will descend over the next coming weeks and that may change the “dent” that you are looking at.  If it doesn’t go a way it can be fixed with a minor revision.

I hope this helps 🙂

– John Paul Tutela, MD

HOW LONG IS THE RECOVERY TIME FOR RHINOPLASTY? FROM MY PIC, WHAT WOULD I NEED DONE TO HAVE A MORE NARROW & SMALLER NOSE?

I am twenty one and this year I’ve been looking into Rhinoplasty. Ive always wanted this procedure done because I hate my nose but I was always to scared to go through with it. Recently I went to a consultation and I decided that I really want one. I would love to know more about rhinoplasty and meet more surgeons, to get more experienced before I go under the knife. My biggest fear would be hating my nose even more after surgery.

Great question. It is hard to say for sure without a detailed exam.  It looks like you would benefit from a modest dorsal hump reduction, cephalic alar trim, and some further tip work to narrow your tip slightly.

Typically the nose is very swollen and may even be bruised for the first week after rhinoplasty. The swelling in the nose takes a very long time to resolve. It will probably take around 3-4 weeks for you to see what the bulk of the work has provided to your facial aesthetics. However all of the swelling can take anywhere from 6-12 months to completely resolve. So there may be small contour abnormalities that go away over time. Also sometimes scar tissue may develop in a way that may also cause a contour abnormality.

Most people take a week off of work. I instruct my patients not to engage in any cardiovascular exercise for 2 weeks.

I hope this helps 🙂

– John Paul Tutela, MD

RHINOPLASTY RECOVERY TIME?

What is the average rhinoplasty recovery time? When should I expect to be able to go out in public after a nose job, and when will the bandages come off?

Great question. Typically the nose is very swollen and may even be bruised for the first week after rhinoplasty. The swelling in the nose takes a very long time to resolve. It will probably take around 3-4 weeks for you to see what the bulk of the work has provided to your facial aesthetics. However all of the swelling can take anywhere from 6-12 months to completely resolve. So there may be small contour abnormalities that go away over time. Also sometimes scar tissue may develop in a way that may also cause a contour abnormality.

Most people take a week off of work. I instruct my patients not to engage in any cardiovascular exercise for 2 weeks.

I hope this helps 🙂

– John Paul Tutela, MD

I WAS JUST WONDERING HOW MUCH OF NOSE HAS HEALED AFTER 6 MONTHS POST OP RHINOPLASTY.

Hello, I was just wondering how much % of the nose has healed 6 months post op rhinoplasty? Thank you so much!

Thanks for the question.  Typically the nose is very swollen and may even be bruised for the first week after rhinoplasty.  The swelling in the nose takes a very long time to resolve.  It will probably take around 3-4 weeks for you to see what the bulk of the work has provided to your facial aesthetics.  However all of the swelling can take anywhere from 6-12 months to completely resolve. So there may be small contour abnormalities that go away over time.  Also sometimes scar tissue may develop in a way that may also cause a contour abnormality.  If you have any specific questions about your results you should definitely go back to your surgeon or you can even upload your before and after photos to this site.  If you are not comfortable with either of those options you can always seek out another opinion.  There are many surgeons in Northern NJ that provide FREE consultations.

I hope this helps 🙂

– John Paul Tutela, MD

THIN BREAST SKIN AT INCISION AFTER RECONSTRUCTION SURGERY. WHAT CAN BE DONE TO CORRECT IT?

Great question. It is common for skin flaps to be thin after mastectomy.  A great adjunct to breast cancer reconstruction has been fat grafting.  Fat grafting is when liposuction is performed on another part of your body. The fat that is removed is then processed and injected under the mastectomy skin flaps to thicken the flaps and smooth out any contour abnormalities.  It is a rather short procedure and you can go home the same day.

I hope this helps 🙂

– John Paul Tutela, MD

CAN DIEP WITH IMMEDIATE PLACEMENT OF IMPLANTS BE SUCESSFULLY DONE WITH GOOD RESULTS?

I am scheduled for a bi-lateral mastectomy followed by DIEP with immediate implant augmentation. My surgery will take place at a well respected university hospital. My Plastic Surgeon suggested the immediate placement of an implant to bring me to the size I am currently as I do not have enough abdominal fat. He said that he has had very good results and that it cuts down on the need for additional surgery.

Thanks for your question. It is hard to determine what is the best treatment option for you without an exam and consultation.  It is unusual to have an implant placed at the same time as a DIEP flap.  But certainly if your surgeon has experience with this it can be done.  There is still a chance that you will need an additional small surgery to improve the shape.

Good luck in your upcoming surgery.

I hope this helps 🙂

– John Paul Tutela, MD

IS THERE A WAY TO TELL THE WEIGHT AND VOLUME OF A BREAST FROM THE PICTURE PROVIDED?

My right breast had cancer and it was removed and an implant was put in. Right from day 1 I told the surgeon the implant was too big (first 2 pics) but the surgeon did not agree. Eventually, my skin died (next 2 pics) and the implant was removed (last pic). Can you tell from the pictures the actual size of the implant? How heavy it is? And the volume of my left breast and how heavy it is. The doctor said he removed 430g of right breast tissues and implanted me with a 410cc implant. Thank you.

It is hard to tell from the photos only but it does look like that breast is about 500cc all together.  If you are looking for the actual implant that was used during surgery there is always a record of it, so you can request your record from the hospital that your surgery was performed.

I hope this helps 🙂

– John Paul Tutela, MD

ALREADY SAGGING AFTER BREAST LIFT AND SILICONE IMPLANTS

I finally had a Breast lift and Breast augmentation this Jan. I have 2 kids, 34, 5’7″, 160lbs, 38C prior to surgery. I had 550cc Mentor round, moderate profile silicone implants. I feel that they are already sagging and I am unhappy with the lack of roundness on the top and lack of cleavage, and disproportionate nipples. I don’t care if they look natural I want them to look perfect in a bathing suit. What are my options?

Thanks for your question.  It looks like you are bottoming out.  This is when the breast implant continues to migrate down past the ideal position.  I would wait until at least 6 months after surgery to make any decisions, but you may need to have a revision to get them even and back into place.  550 cc implants are large and heavy and they exert a big force in a downward direction.  Sometimes using a textured implant helps resist this force.

I hope this helps 🙂

– John Paul Tutela, MD

WOULD A SMALL IMPLANT WITH A BENNELI LIFT BE MOST SUITABLE FOR MY BREASTS? FIRST TIME BREAST AUGMENTATION, HELP!

I am 19 and am looking to improve my breast shape due to what appears to be sagging caused by weight loss when I was younger. I’ve been to one surgeon so far, who’s advised me I don’t need a lift, but an implant to create shape in the upper portions of my breast. I like my size, though I wouldn’t mind a minor implant if it fixed my problem. I just want round, but subtle, perky breasts. I would also like to minimize my nipple size. I would appreciate as much advice as possible, thanks!

Thanks for the question.  It is hard to say without an exam, but it does not look like you need a lift.  An implant alone will likely get you a more shapely breast and fill out your upper pole and give nice cleavage.

I hope this helps 🙂

– John Paul Tutela, MD

DO I NEED A CRESCENT LIFT WITH MY BREAST AUGMENTATION?

I’m 33 and a mother of three. I nursed all three. I recently had a consultation for a breast augmentation and was told I needed Crescent left. I prefer not to have the scars, but I’m also worried about my nipples pointing downward under my implants. I wish him and result to be a natural, full perky breast. Perhaps a full 32c up. I was a 32D when I was nursing.

Thanks for the question.  With the amount of deflation that is apparent in your photos in is likely you will need a relatively large implant in order to fill out your overlying breast tissue.  A periareolar lift will give you a scar around your areola which is an easy place to hide the scar.  It will have the added benefit of reducing the size of your areola.

I hope this helps 🙂

– John Paul Tutela, MD

SIGNS OF A CAPSULAR CONTRACTURE AFTER BREAST AUGMENTATION?

My breast implants are now 10 years old and stick out more.  When older breast implants feel somewhat harder and seem to stick out more is it capsular contracture?  How does a doctor determine if a patient has this problem?

Capsular contracture is when the scar tissue around your implant begins to stiffen up.  It occurs across a spectrum and can be a little stiff or very stiff, deforming and painful.  It can happen early or late and may be a sign of implant rupture.  Saline implant rupture is easy to see because the implant deflates quickly and the size of your breasts will be different.  Silicone implant rupture is more difficult to detect and may require an MRI.

Sometimes the earliest sign of capsular contracture can be when laying on your back one implant falls to the side and the other remains stiff and pointing straight up.

Capsular contracture can be treated in a variety of ways, from a pill you take by mouth to revisional surgery.

A careful exam by a board certified plastic surgery should be the first step in creating and diagnosis and setting up a plan of action.

I hope this helps 🙂

– John Paul Tutela, MD

ADVICE FOR EXERCISE AFTER BREAST AUGMENTATION?

I work out everyday and am getting breast implants ASAP. I know it will be hard to run or do the elliptical, but can I do stationary bike at the gym, since it only involves moving the legs? I heard getting the blood rushing isn’t good for healing but I need to stick to my routine and cannot possibly take the 3 weeks off from working out that they say you must do to heal right. Any advice?

Thanks for the question.   I usually advise my patients to keep from cardio exercise for 2 weeks and can resume full contact sports after 6 weeks.

I hope this helps 🙂

– John Paul Tutela, MD

WILL HIGH PROFILE IMPLANTS GIVE “NATURAL-LOOKING” BREASTS?

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 profiles give me large, full, and natural-looking breasts with nice cleavage?

Thanks for the question.  The profile of an implant determines how far off the chest they project.  So for a given diameter of an implant a low profile implant projects very little and are more on the flat side and a high profile implant projects very much and are more rounded(like a ball).  They both have the same diameter but have different projections.  The implants that you have picked are on the larger side and for that diameter would likely have a sharp takeoff from your upper pole, creating a more “augmented” look.  You will definitely have large full breasts with plenty of cleavage.  Whether or not they look natural all depends on what your breasts look like prior to surgery.  If you are very flat chested then those implants would not yield a very natural result.  But if you already have some breast tissue those implants could yield a favorable result.  It all comes down to a detailed exam, and a custom fit and unique plan.  I use a predictive approach when analyzing and planing breast surgery.  I take into account many measurements which include your base diameter and the distance from your nipple to your fold with and without stretch.  Then the patient’s own personal goals to get the desired look.

I hope this helps 🙂

– John Paul Tutela, MD

WHICH BREAST IMPLANT PLACEMENT GIVES A MORE NATURAL APPEARANCE?

When getting breast implants, what gives a more natural appearance, going under or over the muscle?

Thanks for the question.  Going over the muscle is not really indicated for every patient.  You must have at least 2 cm of breast tissue at your upper pole to qualify.  This is because if you go over the muscle on a thin breasted woman the outline of the implant will be too noticeable.  Sometimes placing implants over the muscle can help breast that have a little sag to them.  Going over the muscle however has its drawbacks.  It has a much increased rate of capsular contracture.  That is when the scar tissue that forms around the implant begins to stiffen up.  This can be severe enough to cause deformity or pain.

I typically perform a dual plane which gets the best of both worlds.  The upper portion of the implants are covered by the muscle.  The lower portion is separated slightly to allow greater contact between the implant and the breast tissue itself.  This gets the benefit of a lower rate of capsular contracture and still has the ability to provide some lift to a woman’s lower pole.  It is important to be seen by a board certified plastic surgeon to come up with the best analysis and plan for your body.

I hope this helps 🙂

– John Paul Tutela, MD

SIGNS OF LEAKING BREAST IMPLANTS

I’ve had my breast implants for about 4 years.  When I lie down my implants sometimes feel like a misshapen, hard lump.  I can also feel the implants and some soreness. Are these signs my breast implants are leaking?  How can I tell?

Thanks for the question.  Deformity of you implants can be a sign of rupture or more commonly of capsular contracture.  Capsular contracture is when the scar tissue around your implants stiffen up and can be deforming or even painful.  This is what you are most likely experiencing.  There are many treatments for capsular contracture that range from medication you take by mouth to revision surgery.  It is very important that you are seen by a Board Certified Plastic Surgeon to properly analyze the lump in your breast.  It could always be a symptom of a bigger problem and you should be seen as soon as possible.

I hope this helps 🙂

– John Paul Tutela, MD

HOW LONG IS BREAST IMPLANTS RECOVERY TIME?

I am a phys ed teacher and would like to get breast implants. I want a very natural look and do not want anyone to know. I am afraid that if I take additional vacation time either before or after winter or spring break, everyone will notice. Is it possible to be back to work after only a week of recovery?

Thanks for the question.  Recovery for Breast Implants is typically about a week.  That being said I have had patients who had surgery Friday and returned to work on Monday.  A lot of it has to do with the individual patients pain tolerance and what they do for work.  Desk jobs will be easier to back to right away where more physical jobs should be avoided for 1-2 weeks. I tell my patients to avoid any cardiovascular exercise for 2 weeks, and they can resume full contact sports in 6 weeks.

I hope this helps 🙂

– John Paul Tutela, MD

WILL BREASTS LOOK LARGER AS BREAST IMPLANTS DROP?

I had a full Breast lift and Breast implant surgery 4 days ago. I requested to go to a full C or small D. My results have been great. My nipples are now where they should be, and I no longer have droopy breasts. My breasts however, do not look as large as I would have hoped. My PS put in 450cc’s memory gel silicone under the muscle. I started off as a B cup. Will my breasts look larger as the implants drop, or should I have gone for a larger size?

Thanks for the great question. It is hard to say without photos or an exam but 450cc’s after a lift is pretty aggressive.  I don’t think going any bigger would be a better option.  If your breast were prone to sag without implants they are only more likely to do so again with large heavy implants exerting pressure on your breast.  Also size and preference changes depending on how old you are.  I find that my younger patients are typically looking for larger breasts while women in their 40’s are not trying to look too big.  So it is important to keep this in mind when choosing your implants.  I feel tat the goal is something you are going to be happy with for a long time, not just the next few years.

I hope this helps 🙂

– John Paul Tutela, MD

SPORTS BRA AND TIGHTER BRA AFTER BREAST IMPLANTS?

I’m post-op breast augmentation from a 34AA to full C (400cc). I want to know how long do you wear a sports bra and would a tighter one be best apposed to a comfortable bra?

Thanks for the question.  While no uniform answer is well documented in the literature, I believe a few things to be true from a common sense perspective.  I think that a supportive bra that has no underwire but is not too tight is simply the most comfortable thing to be in.  I also think that gentle pressure may help provide compression and limit any post operative fluid collection or blood pooling.  Again since there is no definitive science to support or undermine this practice it is best left up to your surgeon as to what post operative protocol works best in his or her experience.

I typically have my patients wear a snug but no too tight sports bra for 4-6 weeks.  I also advise against re-outfitting their entire bra collection until at least 3 months post op.

I hope this helps 🙂

– John Paul Tutela, MD

TEAR DROP VS ROUND BREAST IMPLANTS FOR PETITE BUILD?

Hi! I’m a 19 year old girl who is petite build, short about 150cm (4’9″), breast size about an A cup and is going to get Breast implants but I’m not sure which style to go for. I was told the tear drop as it is more natural and due to my petite built. I just wanted to know if I were to get round implants would it look that bad?

Great question.  It is hard to say for sure without an exam.  But likely a round implant will look great.  Breast implants have close to the highest satisfaction rating of any plastic surgery procedure.  That being said by far round implants are the most commonly used implants. But your question point out a great difference between round and shaped implants.  The shaped implants deliver a very natural shape to the breast, not only because if there shape, but because they typically have more form stable silicone gel inside.  In fact once a round implant is placed, the forces of gravity and the forces of the breast and muscle change the shape of the round implant to more of a tear drop shape.

I use a predictive approach when outlining a plan for implant selection.  By using precise calculations based on each patients individual measurement I come up with a unique plan for each patient.  This not only includes implant selection, but what is done surgically to your existing breast tissue to deliver the optimal outcome.

I use both round and shaped implants for my patients depending on their physical exam and their own personal aesthetic goals.

Shaped implants provide a great option for delivering shape when there is no shape that exists.   I also use shaped implants a lot for breast reconstruction after breast cancer surgery because these women have had their breast removed and the shaped implant does very well in this circumstance as well.

Thanks again for the question.

I hope this helps 🙂

– John Paul Tutela, MD

HOW MUCH TEAR TROUGH FILLER?

I had 2 treatments of tear trough fillers (Juvederm) and I’m several unhappy with the results – I still have the indentations AND under my eyes still seems as dark as before. Could this be because it was done incorrectly or is some other filler/procedure necessary? I am so disappointed after paying $1,000.

Thanks for the great question.  It is hard to comment on whether or not the injection was done correctly without seeing a before picture.  It appears that I can see some filler in the tear trough nearer to your nose but it doesn’t look evenly distributed.  Even though most of deformity is in that area, it is important to treat most of the the under eye area to get the best result.  It also looks like your cheeks can use some definition.  By treating all of these areas it will decrease your lid cheek junction and lift your cheek mass closer to you eye.  This will help with the darkness seen under your eyes.

I think Juvéderm is a fine product for that area.  I like to also use Restylane there because it is easier to spread around.

In addition to fillers I would suggest an uplifting eye serum.  Skin care is a great adjunct to non surgical facial rejuvenation. So I would definitely be sure to be on a consistent regimen.

I would be sure to consult with a Board Certified Plastic Surgeon to ensure that you have the proper analysis and plan of treatment for yourself not only now but who can follow you as you age. While there are many providers that now have started entering the cosmetic arena and many are very good at what they do it is hard to determine when you progress to benefiting from surgery without the proper training.  I think you are a long way from any surgical correction but it is nice to establish a good relationship with a Plastic Surgeon you trust.

Thanks again for the question.

I hope this helps 🙂

– John Paul Tutela, MD

CAN YOUR BREAST SAG IS YOU HAD A BREAST LIFT AND GOT PREGNANT AFTER?

I want to have a breast lift with a tummy tuck but I am unsure if I want more children in the future. So I’ve decided on holding off on the tummy tuck and I’m not sure yet if I should go on with the breast life for now.

Thanks for the question.  It is not necessarily try that pregnancy will destroy your lift, but there is a good chance depending on how much weight is gained and how engorged your breast get during pregnancy or breastfeeding that you would need a revision after your body settles down.

I hope this helps 🙂

– John Paul Tutela, MD

3 WEEKS POST OP. WOUND NOT HEALING PROPERLY… ANY SUGGESTIONS?

Hi Doctors! I am now 3 weeks post op and loved my surgeon and am happy with the results. One concern I have is a wound behind my ear that’s not healing properly. My Dr. said the skin died? And he removed the dead skin leaving it open and instructed me to clean it twice a day with dove soap and keep bacitracin on it…I trust my Dr. But would like to think what others think. Also would like your opinions on the results of my facelift/lower bleph and lateral brow lift!??

Thanks for the question.  Your doctor is correct, part of the skin behind the ear has died and scabbed up.  And your are absolutely being treated corrected with local wound care.  It will likely heal with a wide or raised scar in that area that can be revised in a few months or a year.

I hope this helps 🙂

– John Paul Tutela, MD

198 LBS, 5’2″. I’M SCHEDULES FOR A TT IN 4 WEEKS. SHOULD I LOSE FIRST? IS IT UNHEALTHY TO HAVE SUCH A SURGERY AT MY HEAVIEST?

I currently weight 198 at 5’2 and I’m scheduled for Tummy Tuck in 4 weeks, March 19 2016. Should I lose weight first and I ask because they keep insisting that I can get it done now and I won’t have any problems after the TT. When I continue to lose weight. I’m just nervous because I don’t want to pay $9000 and 20 pounds down I start to get a little saggy tummy. And would I have the bulge on the top still? Also is it even healthy at that weight? He’s been doing cosmetics surgery for 30+ years.

Thanks for the question.  It is smart to think about losing weight.  By doing so your results will improve and you will have a lower complication rate.  However your weight and further more your BMI (Body Mass Index) is not a contraindication to surgery.  If you feel like you have given it an earnest effort and you can’t seem to lose the weight getting the surgery would be ok, only if you don’t have any other health issues.  Being examined by a board certified plastic surgeon will get you an appropriate plan for treatment.

I hope this helps 🙂

– John Paul Tutela, MD

HOW DANGEROUS IS A TUMMY TUCK FOR A PERSON WITH NERVOUS PROBLEMS?

I want to get an abdominoplasty but I’m wondering if it’s dangerous for a person with nervous problems because everybody is telling me that I can die from it but I really want to do it!

Thanks for your question.  I think it is really important that both physical and mental health concerns are addressed prior to embarking upon any major surgery.  I have developed a Road to Wellness where I work closely with a group of providers such as a nutritionist, trainer, wellness coach and even a psychiatrist to make sure all of my patients concerns are evaluated completely.  If you have untreated anxiety disorder I would definitely make sure to be seen and evaluated by a board certified psychiatrist and get that under control prior to surgery.  That being said, having anxiety is not a contraindication to surgery.

I hope this helps 🙂

– John Paul Tutela, MD

GOT LABIAPLASTY DONE ON FEB. 22, IS THIS LOOKING GOOD SO FAR? DID HE CUT TOO MUCH OFF OR AM I OVER-THINKING THINGS?

Was wondering if it’s looking okay so far?

Thanks for the question.  It is hard to tell at this point because you are too close to your surgery date.  There is still a lot of swelling, but it looks like it is healing fine.  Definitely follow up with your surgeon to make sure everything heals as expected.

I hope this helps 🙂

– John Paul Tutela, MD

WILL I HAVE FULL USE OF MY ARMS AFTER BREAST IMPLANT SURGERY?

Great question.  Most people are a little stiff after surgery.  But by doing some simple range of motion exercises you can stay loose and comfortable.  I usually prescribe a muscle relaxer along with a pain killer that helps fight any muscle spasms or tightness.  I instruct that patients to not go back to heavy lifting for 6 weeks.

I hope this helps 🙂

– John Paul Tutela, MD

IS IT EVEN POSSIBLE TO CORRECT TUBEROUS BREASTS AND GET A NATURAL LOOKING RESULT?

Heya docs! I have small tuberous breasts (not self diagnosing- you all told me this over a year ago). I’ve been on the hunt for a good doctor. My concern is that every before and after pic I see of tuberous breast correction looks so very fake. It makes me cringe every time I see an after pic with the implant bulging out from the top, but the lower pole still looks like a struggle. Whats the deal? Can tuberous breasts just not ever look natural after correction?

Thanks for the question.  In order to gain a more natural result after breast augmentation there are a few surgical maneuvers that must be addressed.  One of the defining characteristics of tuberous breast is a contracted lower pole.  So you are absolutely correct in in noticing that the lower pole looks like it is struggling.  That is because that is where most of the anatomic deformity is.  By scoring the tissue in a radial fashion your surgeon allows this tissue to release and redrape over the implant in a more natural way.  This will also help balance the shape between the upper and lower poles.  Sometimes the inframammary fold (the crease under your breast) needs to be lowered to give the lower pole more room.

Scheduling a consult with a Board Certified Plastic Surgeon will allow you to identify the specifics about your breast and help target a custom treatment plan that is just right for you.

I hope this helps 🙂

– John Paul Tutela, MD

WILL PREGNANCY RUIN MY BREAST IMPLANTS?

I had breast enlargement surgery 15 months ago, I am pregnant again and am wondering if  this will ruin my breast implants? I had the implant under the muscle but I am worried I will regain that saggy look again.

Thanks for the great question.  The biggest thing that is a concern with breast implants too close to pregnancy is stretch marks.  I usually recommend not getting pregnancy for 6-12 months after implants to avoid stretch marks.  The is not much that can be done if stretch marks occur.  It is true that your breast can sag after they have been engorged with pregnancy and lose volume afterwards.  But it is not definitely going to happen, so you may not have anything to worry about.  Fortunately, sagging or ptosis can be corrected surgically.

I hope this helps 🙂

– John Paul Tutela, MD

ANY SUGGESTIONS FOR MY EYES SHAPE AND UNDER EYES?

I feel that my eyes shape and look is strange. Do I have crosseyed or not can eye shape be changed as I don’t like my eye shape. Do the areas around my eyes are hollow and if I fix it that would make my eyes look better?

Thanks for the question.  It is hard to tell for sure with out an exam.  But you have increased lid show, which means you can see more of your upper lid skin than you can in lost people.  One of the reasons for this is you may have a dehiscence of you levator muscle.  This is the muscle that helps keep your eyes open. A dehiscence is when it is disrupted and it falls a little.  This can be repaired surgically.  It is best to be evaluated by a board certified plastic surgeon to figure out the next best course of action.

I hope this helps 🙂

– John Paul Tutela, MD

LIPOSUCTION TECHNIQUE FOR LOVE HANDLES

1. What is the best liposuction technique for love handles? 2. I am normal weight and I work out, but my love handles are stubborn and don´t respond to any workout I have tried. (I am 47 years old and female). If this area is not a toned one does liposuction make this area lax and loose or does it respond well to liposuction even if this area is not a muscular one? Or with other words: Do I risk “flabbyness” after liposuction or loose tissue?

Liposuction is a great option for targeted and spot treatments of areas of fat that are resistant to diet and exercise.  If you are young and workout your skin will likely snap back well, but it is hard to determine without an exam.   You are likely to do well with liposuction for your love handles.

I hope this helps 🙂

– John Paul Tutela, MD

TUMMY TUCK VS LASER SKIN TIGHTENING FOR NIMIMAL LOOSE SKIN AFTER PREGNANCY

I feel that laser skin tightening works best for small areas like your face and neck.  If you have excess skin in your abdomen from child birth, it is likely that only a skin excision will help with this.  A physical exam by your plastic surgeon will be able to best determine your options.

I hope this helps 🙂

– John Paul Tutela, MD

40 DAYS POST OP, HOW LONG WILL A SEROMA LAST AFTER TUMMY TUCK AND LIPOSUCTION?

I had tummy tuck surgery combined with liposuction 40 days ago, and although I am pleased with how I look as I have got my body back to what it used to be, I have also developed a seroma.

One week after surgery my doctor determined I had a seroma and for the two weeks following he has been taking this fluid away by syringe every day. It has now been three weeks since he took the last syringe of fluid and my doctor has now advised me that my body will remove the small amount of remaining fluid itself.

It’s now been six weeks since my surgery and although I feel well I am still worried that there may be some remaining fluid, which could be harmful to me. Can anyone tell me how long a seroma should last and how I should examine myself to ensure there is no remaining fluid?

Great question.  A seroma alone is not dangerous.  It may however compromise you final result.  They can last up to months.  The problem with them lasting a long time is that the area that surrounds them can form a capsule making them harder to resort back into your body.  Some times another drain may need to be placed under ultrasound guidance. The only time a seroma can get dangerous is it the seroma itself gets infected.  Everytime it is accesses with a needle it has the potential of introducing bacteria into the seroma cavity.  Signs of infection would be redness, warmth and tenderness.

When you tap on the area where the seroma is you can typically see a “fluid wave”.

I hope this helps 🙂

– John Paul Tutela, MD

CAN YOU HAVE A BABY AFTER A TUMMY TUCK?

How long after a tummy tuck and body sculpting can another baby be planned? I am a single mom who is scheduled on June 23rd for a tummy tuck and body sculpting. I would like to know how long I should wait till it’s safe, in case I decide to remarry and have another child.

That’s a great question that I get asked a lot by my patients. For the most part, it is best to wait until after you are done having babies to have a tummy tuck.  The results from your tummy tuck would likely become undone.  However that is can always be revised.  From a safety point of view I would give it at least a year.  But if it is part of a plan I would wait for the TT.

I hope this helps 🙂

– John Paul Tutela, MD

HOW LONG IS THE RECOVERY PERIOD FOR A FULL TUMMY TUCK?

I’m 43 years old and had Full Tummy Tuck around seven weeks ago. I could not stand upright for 5 weeks post-op. When do you stop feeling tugs, pulling and tightness?

Thanks for the question.  Most people take one week off of work.  I tell my patients to stay away from cardio exercise for 2 weeks and no lifting more than 5-10 lbs for 6 weeks.

I hope this helps 🙂

– John Paul Tutela, MD

WHAT KIND OF SURGERY(S) WOULD BE IDEAL FOR MY BREASTS?

I am in the process of saving up money to get surgery on my breasts one day. I want to have an idea of what kind of surgeries I will want to get, so I can have a estimate of how much to save. let me know what kind you think I will need. I want to have at least somewhat regular shaped, round, full breasts. I probably want them a bit bigger, maybe a lot bigger but my main objective is about the shape. I wear a 36 E although I feel they do not look this size. My areolas are extremely large.

Thanks for the question. In order to change the shape of your breast and reverse their sagging a Mastopexy or Breast Lift can be done.  If you want to increase their size at the same time a gel implant can be added.  Mastopexy Augmentation are more expensive then just breast implants alone or a breast lift alone.  In Northern NJ the price can range from $10,000- $20,000.

I hope this helps 🙂

– John Paul Tutela, MD

HELLO, I HAVE QUESTIONS REGARDING TUMMY TUCK WITH MUSCLE REPAR AND LIPO VERSUS JUST LIPO. ANY SUGGESTIONS?

Hello, Can you tell me the recovery period for a tummy tuck with muscle repair and lipo? I am only allowed to take one week off and not sure if that will be long enough. How long to you gave to wear the garments after surgery. Also if you needed the about but opted to just get lipo what would the result be and are all lipos the same?

Thanks for the question.  Tummy Tuck with or without lipo usually requires about 1 week off from work.  After that I continue to instruct my patients not to lift anything heavier than 5-10 lbs x 6 weeks.  So if your job includes heavy lifting you would need more time off work or to be put on “light duty”.  My patients wear a compression garment x 2 weeks for Tummy tuck alone and 6 weeks if liposuction is added.

In regards to liposuction alone the result really depends on the quality of your skin and the likelihood of good “snap back”. Some people’s skin snaps back well while others do not.  You can always obtain liposuction first and see if your results warrant a Tummy Tuck.  However if you have excess “saggy” skin to start with, then only an excision of that skin will get you the shape you are looking for.

There are a variety of tools you can use in conjunction with liposuction.  the 2 most common are the Vaser or Laser lipo.  They are both good for aggressive liposuction but in the end I don’t think they provide much more than liposuction alone.

I hope this helps 🙂

– John Paul Tutela, MD

HOW LONG SHOULD YOU WEAR YOUR BINDER / GARMENT FOR AFTER A TUMMY TUCK?

I typically have my patients wear compression garments for about 2 weeks.  If liposuction is used as well, then I have them maintain compression for about 6 weeks.

I hope this helps 🙂

– John Paul Tutela, MD

TUMMY TUCK RECOVERY

What is tummy tuck recovery generally like? If I get it done, what can I expect post-op care, checkups, pain? How long does complete recovery from a tummy tuck take?

Thanks for the question.  You can expect to be sore the first week, and probably not really want to leave the house much. However you should not be in bed most of the day.  I instruct my patient to take frequent walks around the house 5-10x a day and combine sitting, laying down and standing slightly hunched over.  The second week you should start feeling much better.  My patients are instructed to abstain from cardio exercise for 2 weeks and no heavy lifting more than 5-10 lbs for 6 weeks.  Most people are back to work after 1 week.

I hope this helps 🙂

– John Paul Tutela, MD

SHOULD I COVER THE SPLITTING SUTURES FROM MY TUMMY TUCK?

I have 2 small holes and then it is sealed between them. If I leave the wound uncovered the oozing seems to dry up but then it starts splitting into the sealed skin. Should I keep the holes covered? When I do this the wound seems to start oozing again.

Thanks for the question.  Spiting sutures is common in Tummy Tuck surgery. In fact it is common whenever you have a long incision (like in a breast reduction too).  It can be treated in a number of ways, from excision to observation.  It is best to show you plastic surgeon and let he or she decide the best plan. Until then I would put bacitracin on it and cover it.

I hope this helps 🙂

– John Paul Tutela, MD

MENTOR VS NATRELLE BREAST IMPLANTS

The only brand of breast implants I’ve heard of are Mentor.  Are these the best kind of breast implants to get and do lots of surgeons recommend them?

There are many choices right now in regards to implants.  Size, shape, texture, brand.  Mentor is a great choice.  Allergan has great choices too, and right now you and a friend can get a free bottle of Botox when you choose Allergan implants.  I tend to have many patients that like to sign up for that deal.

I hope this helps 🙂

– John Paul Tutela, MD

MOMMY MAKEOVER. QUESTION ABOUT BEING A GOOD MINI TUMMY TUCK CANDIDATE

5’10’, 136 lbs(lost 40 recently& quickly), 3 kids. Am told am good candidate for a mini tt and I really would like to avoid a full. Stomach is only displeasing sitting or bending over. Looking at 425 cc implants as well. Since gotten a hernia and might as well get my tubes tied while at it. Need to make the right decision. I know a full tt always gives the best results. Do you think I can get a mini to take care of what I mentioned? Would lypo along with it help with the belly fat?

Wow!!! You are in incredible shape. Congratulations on your discipline and hard work.  You case illustrates a great point.  Even with a trainer level physique you make still experience excess skin or a dimple from prior surgery.  This is truly a surgical issue as only an excision of skin can give you the results you are looking for.

It is hard to say for sure if a mini or full tummy tuck will be sufficient.  But it looks like your excess skin goes fairly wide, in which case a full tummy tuck would be best.  Also a full TT will also make repairing the hernia much easier.

I hope this helps 🙂

– John Paul Tutela, MD

HOW MUCH WEIGHT CAN I LOSE FROM A TUMMY TUCK SURGERY?

How much weight (in loose skin/tissue) will I lose from a tummy tuck?

A tummy tuck is not intended as a method of weight loss.  You will in fact discard skin and fat which can weigh anywhere from 1-15 lbs. however the tummy tuck is used truly for shaping.  It is ideal to begin a weight loss program if you are overweight prior to tummy tuck surgery.

I hope this helps 🙂

– John Paul Tutela, MD

TUMMY TUCK – CAN A DOCTOR TELL IF YOUR ABDOMINAL MUSCLES NEED TO BE TIGHTENED FROM JUST A PHYSICAL EXAM?

Can a doctor tell if your abdominal muscles need tightened from just a physical exam? Ty.

Absolutely.  When you lay flat on your back your plastic surgeon will feel your abdominal wall when you strain.  This will flex your abdominal muscles and he or she should be able to tell how far your muscles are separated.

I hope this helps 🙂

– John Paul Tutela, MD

MY RIGHT IMPLANT SMALLER THAN LEFT. WHY?

My right saline implant has 620 cc while left has 560cc Why does left look bigger and feel firmer? And why can I feel the bottom of implant on right and feel the saline bubble and move it around? Please help me understand 3 months post op.

It seems from your story that you had some degree of breast asymmetry before your surgery.  Often times this will remain to some degree even after trying to correct it by using different size implants.  Other reasons for breast asymmetry include a hematoma or capsular contracture.  Be sure to see your surgeon so he or she can diagnose the issue.

I hope this helps 🙂

– John Paul Tutela, MD

TUMMY TUCK SCARS

I imagine that you can have tummy tuck scars hidden below your underpants but is this true? can i wear a bikini 1 year after tummy tuck?

Your scars will depend on how much skin needs to be removed.  Typically I have patients bring in their bikini or underwear so I can be sure to make the marks where they will be hidden.

I hope this helps 🙂

– John Paul Tutela, MD

HOW LONG DOES TUMMY TUCK SURGERY SWELLING LAST?

I had a tummy tuck about 3 weeks ago.  How long should I expect the swelling to last?

Your scars will depend on how much skin needs to be removed.  Typically I have patients bring in their bikini or underwear so I can be sure to make the marks where they will be hidden.

I hope this helps 🙂

– John Paul Tutela, MD

HOW MUCH DOES A TUMMY TUCK COST?

I had 3 c-sections and planning to have a tummy tuck (abdominoplasty) done, but I’m not sure how much a tummy tuck costs.  What are average tummy tuck prices? 

The cost depends on a few things. Cost tends to be a little lower in more rural areas and tend to increase in major metropolitan areas.  Part of what will determine the final cost is whether or not you need muscle plication.  This is when your abdominal muscles are tightened.  This adds a little more time to your surgery and likely will increase the price.  It also depends on whether your surgery falls in a category known as a mini-tummy tuck.  This is when only a small amount of skin needs to be excised, and your belly button does not need to be altered.

That being said the price range for a tummy tuck could range from $5,000-$18,000.

I hope this helps 🙂

– John Paul Tutela, MD

WHAT IS HEMOSIDERIN STAINING AND HOW LONG DOES IT LAST?

I had a mommy makeover March 1st, 2010. This included tummy tuck, breast lift, breast augmentation, hernia repair, and liposuction of the hips. I recently noticed that I have discoloration (bruising) in the area where I had liposuction. The bruising is almost symmetrical on both hips. Is there anything I can do to get rid of the bruising? My doctor has diagnosed me with hemosiderin staining. Will it be permanent? Can someone explain this condition to me?

This is a byproduct of bruising.  It is a breakdown product of red blood cells.  It may last quite a while.   Two widely available products help bruising resolve faster. The first is Bromoline and the other is Arnica.  They can cut bruising time to less than half.

I hope this helps 🙂

– John Paul Tutela, MD

I AM ALLERGIC TO CODEINE. ANY SUGGESTIONS FOR PAIN CONTROL AFTER MOMMY MAKEOVER?

Great Question.  Be sure to talk this over with your Plastic Surgeon before surgery.   This was he or she can be sure to provide you with adequate long acting local anesthesia, such as Exparel or a pain pump.  For the most part extra strength Tylenol and high dose ibuprofen can help a great deal. There is a synthetic narcotic called Ultram, that often does not cross react with those people who suffer from Codeine allergies.

I hope this helps 🙂

– John Paul Tutela, MD

MOMMY MAKEOVER PRICE

What is the Price of a Mommy Makeover?

Great Question. The cost depends on a few things. Cost tends to be a little lower in more rural areas and tend to increase in major metropolitan areas. It also greatly depends on what exactly needs to be done surgically in order to obtain the results you are looking for. A “Mommy Makeover” typically includes A breast lift and a tummy tuck. Sometimes people would benefit to adding an implant to their breast lift. In regards to their abdomen, they may or may not need muscle tightening, and the same goes for liposuction. For these reasons the price range of a Mommy Makeover can vary quite drastically.

That being said, the price range for a Mommy Makeover can range from $12,000-$30,000

The most important thing you can do is to make sure you are seeing a Board Certified Plastic Surgeon to ensure you will get an appropriate work up and plan.

I hope this helps 🙂

– John Paul Tutela, MD

HOW MUCH DOES A MOMMY MAKEOVER COST?

How much does a mommy makeover cost? Please tell me the difference in mommy makeover prices for breast lift with augmentation and breast lift without augmentation.

Great Question. The cost depends on a few things. Cost tends to be a little lower in more rural areas and tend to increase in major metropolitan areas. It also greatly depends on what exactly needs to be done surgically in order to obtain the results you are looking for.  A “Mommy Makeover” typically includes A breast lift and a tummy tuck.  Sometimes people would benefit to adding an implant to their breast lift.  In regards to their abdomen, they may or may not need muscle tightening, and the same goes for liposuction. For these reasons the price range of a Mommy Makeover can vary quite drastically.

That being said, the price range for a Mommy Makeover can range from $12,000-$30,000

The most important thing you can do is to make sure you are seeing a Board Certified Plastic Surgeon to ensure you will get an appropriate work up and plan.

I hope this helps 🙂

– John Paul Tutela, MD

BREAST IMPLANT SIZES

I’m worried that if I get breast implants they will give me a top heavy look (my friend calls it the stripper look!), so, I’m trying to figure out what size breast implants should I get.  Is there a rule of thumb or tips for choosing breast augmentation sizes? What are my options in breast implant size?

That’s a great question.  I use a predictive approach when it comes to choosing breast implants.  The very most important thing is what the patient desires.  I use that as a starting point.  I then use a series of measurements that I use to narrow down the large field of implants that are available. First is your base diameter (which is a measurement of the width of the footprint of your breast).  Next is the measurement from your nipple to the fold under your breast, with and without stretch.  This gives me an idea of how much volume your skin envelope can handle without looking distorted.  Then I take into considerations any asymmetries in your native breasts and chest wall.  I prefer a natural look that doesn’t look “fake”.  I feel that it is truly hard to see good plastic surgery, because it is hidden behind precise technique.

A board certified plastic surgeon will be able to guide you through all of your choices and by using biodimensuonal planing will be able to customize a unique plan that is just right for you.

I hope this helps 🙂

– John Paul Tutela, MD

I HAVE HAD BREAST IMPLANTS FOR 14 YEARS. HOW LONG DO BREAST IMPLANTS LAST?

I have had breast implants for 14 years and I am now developing a large rash under my left breast, and it hurts and I feel a lot of air pockets. One doctor told me to replace them every 10 years and another told me you never have to replace them

There is no definitive life span of the actual implanted device.  It is not like a timing belt in your car that should be replaced at 100,000 miles.  Your implants can last a very long time without any problems.  They only need to be replaced if you experience a problem such as capsular contracture or rupture.  Often times as you age your breast will sag, and you may elect to get a lift and change your implants at that time.

I hope this helps 🙂

– John Paul Tutela, MD

HOW MUCH DO BREAST IMPLANTS COST?

I would like to get breast implants but before I do I would like to know about breast augmentation prices.  How much do breast implants cost?

The cost depends on a few things. Cost tends to be a little lower in more rural areas and tend to increase in major metropolitan areas. The breast implants themselves range between $500-750 per implant.  The next two things that are considered into the final price that a patient would pay is the rate the anesthesiologist gets paid and then the facility fees.  In addition to all of the above comes the surgeons fee.  All together in New Jersey total patient responsibility could be anywhere from $4,000-10,000.

I hope this helps 🙂

– John Paul Tutela, MD

IS TRAVELING TO CALI, COLOMBIA SAFE FOR SURGERY?

So I was planning on traveling to Cali, Colombia for a BBL with either Dr. Luis Eduardo Plazas or Dr. William Jimenez. I was dead set on Plazas but he doesn’t have as many reviews as Jimenez. My family has been telling me Colombia is very dangerous (which I know but would be staying at a recovery house). I don’t speak Spanish and am worried about the overall safety but I love their results. I don’t care for a huge butt just the hourglass figure. Thoughts?

My greatest concern about your question is safety.  Not only of the actual geographic location that you are traveling to but of having surgery there.  The standards that are set for operating facilities are much more rigorous in the United States.  Also being so far from your operating surgeon concerns me for reasons of follow up and of taking care of you through any potential complications. While I understand the appeal that comes with health tourism, I do not recommend it.  There are many Board Certified Plastic Surgeons in your area.  If price is a concern feel free to see a few surgeons and compare not just the price but your comfort with each surgeon.  There are also many finance options available to help spread out your payments. Stay safe.

I hope this helps 🙂

– John Paul Tutela, MD

I’M THINKING ABOUT GETTING A TUMMY TUCK AND A BREAST LIFT SOON. ANY SUGGESTIONS?

I have two little kids and I’m 31 yrs old. What should i expect the following days post surgery? WOULD I BE ABLE TO STILL TAKE CARE OF THEIR NEEDS?

Thanks for the question. The answer really lies in whether or not you need a fascial plication.  That is part of a tummy tuck where your abdominal muscles are sewn together tighter. I would say 85-90% of tummy tucks are done with fascial plication.  Sometimes there is no weakening of the muscles and all that is needed is a skin excision.  That being said I would say 6 weeks of no heavy lifting over 10 pounds is a safe post-operative plan if you need a fascial plication and 2-3 weeks if it is only a skin excision.

In regards to childcare duties that depends on how heavy your children are.  But to be safe I would arrange for some good help after surgery.

I hope this helps 🙂

– John Paul Tutela, MD

DO KOREAN PLASTIC SURGERY CLINICS DO RHINOPLASTIES ON CAUCASIAN WOMEN?

My bridge starts really low then forms up into a bump & kind of gets bulbous at the tip. I’d like to get rid of the bump (make the bridge level/ lower/ a little sloped) & make my nose look more feminine & cute (maybe make tip less bulbous). Will Korean clinics operate on Caucasian women for a rhinoplasty? Any imputs on improvements to my nose you think it needs?

I have never heard of a Korean plastic surgery clinic.  If you are referring to getting your surgery done overseas, I do not recommend that.

I hope this helps 🙂

– John Paul Tutela, MD

WRINKLING ON LEFT BREAST OR JUST SETTLING?

My left breast seems to be trying to wrinkle (it almost looks like a slight indent about half way between the nipple and the incision, I am 5 weeks post op and am just wondering if thus could be the breast settling in and it might go away, or if I could have early signs of permanent rippling? It just seems high up to be rippling from what I’ve seen, but I figured I should ask. Thank you in advance!

Great question. It is hard to tell from the pictures, but you should definitely ask your plastic surgeon and he or she can determine what is going on from an exam.  On another note your right breast looks  like it is dropping too much (bottoming out).  These are all important things that should be discussed with your plastic surgeon, so he or she can address them appropriately and in a time fashion.

I hope this helps 🙂

– John Paul Tutela, MD

PRICING FOR LABIAPLASTY?

I’ve seen that usually for the procedure, it is done to both inner lips. And can cost around $4000. What if you just need it done to one lip? Is pricing the same ?

The cost depends on a few things.  Cost tends to be a little lower in more rural areas and tend to increase in major metropolitan areas.  That being said the range for labiaplasty is anywhere from about $3,000-$7,000.

On the web link below, we describe a new method for labiaplasty.

I hope this helps 🙂

– John Paul Tutela, MD

I AM 5FT 7IN, 226LBS AND BMI 35. WILL I BE ABLE TO GET A TUMMY TUCK AND LIPO? I LOVE IN NJ.

One of the most important things is that your weight is stable.  If you are in the middle is a weight gain it weight loss it is better to wait.  It is more difficult to achieve an ideal result if you are trying to hit a moving target.  Your BMI is not a contraindication to surgery but you must know that it does increase your likelihood of wound healing problems.

I hope this helps 🙂

– John Paul Tutela, MD

IS AN IMPLANT JUST FINE FOR ME OR WILL I NEED A LIFT TOO? ALSO WHAT WILL THE SCARS LOOK LIKE?

I am currently a 32D with two kids, one who was breastfeed. Although my breast seemed to sag before my pregnancies, weight loss has made them worse. I want perkier natural looking breast and nothing too big for my petite frame. I am not looking to be exaggerated. I also want my areolas smaller.

The best option to give you fuller, perkier breasts would be a breast lift.  If you would like to add volume to your lift you can also add an implant.  The scars would include a scar around your areola and likely down the center of your breast to your fold. The horizontal scar across your fold may or may not be needed as well.

In terms of scar most people scar very well.  In most of plastic surgery I have found that shape is valued higher than scars.  I think you are a great candidate for a lift with or without an implant, and very likely to have a fantastic result.

I hope this helps 🙂

– John Paul Tutela, MD

WHAT DOES A RECONSTRUCTED BREAST LOOK LIKE?

How close can breast reconstruction get to creating a breast that looks real? Does it largely depend on how much tissue has been removed?

That is a very good question.  There are many variables to answer that.  Much of how well a breast can be reconstructed is dependent on what tissue is left over after mastectomy.  The more aggressive the mastectomy the more difficult reconstruction can be.  Depending on what is expected you Plastic Surgeon may elect to use a tissue expander and implant based reconstruction or Autologous tissue.  Autologous tissue is using part of your own body to recreate a breast.  This is typically from your abdomen or your back.  You can really have great results with either form of reconstruction from an experienced surgeon.  What’s great is that there has been more and more focus on bringing concepts from aesthetic breast surgery to reconstructive surgery, and patients have benefiting greatly from this.

I hope this helps 🙂

– John Paul Tutela, MD

DO BREAST RECONSTRUCTION TISSUE EXPANDERS CAUSE PAIN AS THEY EXPAND?

Great question.  After mastectomy Tissue expanders are placed under the pectorals muscle to give them more protection and cover than just the skin would provide.  After you get through the initial discomfort from surgery you will likely begin your expansion process on the 2nd postoperative week.  Depending on the amount expanding you could experience increased discomfort for 1-2 days after the expansion.  Much of this is caused by the pectorals muscle spasming against the expander.  For the most part this has been well tolerated with the use of Valium as a muscle relaxer and other pain medicine as needed.  You can always slow down the expansion process and fill the expanders less at each visit to minimize discomfort.

I hope this helps 🙂

– John Paul Tutela, MD

BRAZILIAN BUTT LIFT RECOVERY

I want to go for the Brazilian Butt Lift in March. Can someone tell me what is the usual recovery time for this type of procedure?

Great Question.  The expected recovery for Brazilian Butt Lift is similar to the recovery for Liposuction, but the restrictions are a little different.  The first week after surgery you can expect bruising in the areas that the fat was harvested from.  You will be required to wear a compression garment for at least six weeks.  The difference is that for BBL the compression will not included the buttocks.  You will also be instructed to keep from putting pressure on your buttocks for 2-3 weeks while the fat graft builds its new blood supply.  This will include, sleeping on your stomach and keeping from sitting too long for any one period.  The first week after BBL you will be sore and likely want to take off from work or school, but after that you may start incorporating more normal activity.

I hope this helps 🙂

– John Paul Tutela, MD

FAT TRANSFER TO BUTTOCKS

I am 198 lbs 5’4. How much fat can I have transfered to my buttocks? I want a big butt – knowing I will lose some fat transfer, it makes feel more is better than less. I been saving for this surgery for so long, I dont want to be disappointed.

Great question.  The amount of fat transferred depends on a few things.  The most limiting factor is how much fat exists to be harvested.  Some women can actually be too thin for fat transfer.  If there is ample amount of fat to be harvested for the transfer, then the next factor is your unique body shape and what appropriate proportions would be.  But you are right that up to 50% of injected fat resorbs over the first year, so often we overfill, knowing that it won’t all stay.  Typical amounts range from 200cc-1000cc per side.

I hope this helps 🙂

– John Paul Tutela, MD

HOW MUCH DOES A BRAZILIAN BUTT LIFT COST?

My hips are about 40 inches. I would love my dimensions to read 36-30-46. That’s what I would love… would this be achieveable this with a Brazilian butt lift?  How much does the procedure cost?

The cost of brazilian butt lift varies depending on a few factors.  The first is geography.  Throughout the country most prices trend higher near major metropolitan centers and may be lower in more suburban or rural areas.  The second and most important factor that affects price is very unique to each patient.  Each patient has a different body with different amounts of fat deposits in different areas.  Much of your gluteal aesthetics come not just from your buttocks but from the areas that immediately surround your buttocks, such as your lower back, your hips and your posterior thighs.  The more fatty tissue that you have to be sculpted the more work is done and may have an effect on final pricing.  In general Brazilian butt lift can cost anywhere from $7,500 to $15,000, with most cases being done on the lower side of that range.

I hope this helps 🙂

– John Paul Tutela, MD

WHEN DO YOU SEE THE FINAL RESULT FROM AN UPPER AND LOWER LIP BLEPHAROPLASTY?

When should I judge the final result after my upper and lower blepharoplasty?

Bruising typically lasts 7-10 days and swelling goes away by three weeks.  The final results should be seen by three months.  This is especially true if you have had canthoplasty.

I hope this helps 🙂

– John Paul Tutela, MD

WHY DO SOME IMPLANTS RESULT WITH DEFINED UPPER POLE ROUNDNESS AND OTHERS DO NOT?

I’ve noticed that some girls have results of very contoured upper pole roundness with lower cc amounts and others have a gradual slope with no definition even with a large implant. Is this as a result of implant profile, technique, or how close implant diameter is to bwd? Is it the closer or over the measurement of implant to bwd the more defined upper roundness? Photo below of someone with defined upper pole roundness and one with just cleavage Incase my terminology is wrong. Thank you!

That’s a great question.  There are many ways to control what type of upper pole definition you obtain.  That should be based on an informed conversation with your plastic surgeon that takes into account your own personal desires and the specific dimensions of your body.

One reason for differences in upper pole fullness is the characteristic of the implant itself.  A high profile implant will have more upper pole fullness for a given base diameter than a low profile implant.  Saline implants tend to have more upper pole fullness.  As the breast tissue pushes down on the implant, it displaces the saline upward.  Having your implants placed over the muscle will also give you more upper pole fullness as the muscle is out of the picture.  However, an  implant placed over the muscle has an increased rate of capsular contracture.  There is a new line of silicone gel implants from Allergan called Inspira that is slightly over filled with gel that provides more upper pole fullness.

Another reason for differences in upper pole fullness can be the thickness of fat and muscle of the upper breast prior to the operation.

The simplest reason can be a difference in the bra that a woman wears.  Some bras push the breast upward and together which drives tissue to the upper pole.

A board certified plastic surgeon will be able to guide you through all of your choices and by using biodimensuonal planing will be able to customize a unique plan that is just right for you.

I hope this helps 🙂

– John Paul Tutela, MD

I’M 2 WEEKS POST BREAST REDUCTION. IS IT NORMAL TO HAVE UNEVEN BREASTS AT THIS STAGE?

I was a size H and went down to a full size C. I’ve had uneven, saggy breast before surgery my left side always bigger than my right. Its been two weeks since the surgery and my left side is noticeably fuller than my right. Is this normal? And what can i expect during my healing process?

There are many reasons to be slightly asymmetric after breast reduction.  From the pictures it is hard to tell what is going on.  You appear to be tilting your body. It is best to be examined ink person by your plastic surgeon.  He or she can account for what you are experiencing.

– John Paul Tutela, MD

DO I NEED A BREAST LIFT AND A BREAST AUGMENTATION FOR THE RESULTS I WANT OR WILL A BREAST AUGMENTATION ALONE WORK?

I’ve seen two board certified surgeons and one told me I was borderline needing a lift while the other said I definitely needed one. I don’t want full sagging breast but if I can avoid the scars from a lift it would be great. Thanks in advanced.

It looks like from the pictures you will be most happy with your final result if you add a lift to your augmentation.  There is a chance that if your implant size was very large it may fill your skin envelope adequately.  The problem with that is two fold.  First, the size implant required to adequately fill your skin envelope would be too big to ensure a natural looking result.  This may be your goal, but I always guide my patients to a natural looking result in terms of size and shape.  I feel that you can’t see good plastic surgery. Second, the size implant that would be required to fill your breast envelope would likely become ptotic (sag) in a short period of time.

I hope this helps 🙂

– John Paul Tutela, MD

I GAVE BIRTH ALMOST 5 MONTHS AGO. HOW LONG WOULD I HAVE TO WAIT TO GET A BBL AND LIPOSCULPTURE?

The short answer is I would wait at least 6-9 months.  I think that amount of time gives your body a chance to snap back the stretched out skin from pregnancy so you can accurately analyze any problem areas.  There is a chance that after pregnancy you may return to you goal weight but you skin has become stretched out to the point that would require a skin excision (Tummy Tuck) to achieve your desired shape.

A caveat to that time line is whether or not you are breast feeding and whether or not you have in fact reached your goal weight.

Breast feeding alters the circulating hormones in your body.  When you stop, your body is likely to go thru variations in your fatty depositions.  When doing any sort of cosmetic surgery it is easier to achieve your goal if your target isn’t moving.

You are welcome to stop by anytime for a FREE consultation.

I hope this helps 🙂

– John Paul Tutela, MD

IS A DRAINLESS TUMMY TUCK A SAFE PROCEDURE?

My surgery is scheduled for January 26, 2016 and I just find out that my surgeon does not use the drainage. I’m a little bit scared now and begin to wonder if this is safe. Please help me. Thank you!

I don’t think it is really a matter of safety more than of complications.  Typically drains are used in an area of the body that has been dissected aggressively (such as in a tummy tuck).  After an area has been dissected the body reacts by forming fluid to try to fill in the space.  For the most part your body does a good job at resorbing the fluid that it creates, but an abdominoplasty typically creates more fluid than you body can keep up with.  Drains keep this fluid from building up and causing a seroma.  Theoretically if you close all of the space created during surgery your body won’t create as much fluid.  I also use progressive tension sutures to close this space, but I feel that leaving a drain as well helps lower the risk of a seroma.  While a seroma is not necessarily dangerous it can negatively affect your final cosmetic result and cause a contour abnormality and require repeated needle aspirations in the office.

I hope this helps 🙂

– John Paul Tutela, MD

WHEN DO STEROID INJECTIONS START WORKING?

I had a Rhinoplasty done 3 weeks ago and visited my doctor for a follow up yesterday. He injected steroids to reduce some swelling in my bump that was a bit visible due to swelling. I read somewhere that if the bump doesn’t go down after steroids were injected then the bump is most likely not going to go away. I still have that same tiny bump I had before the injections & I’m just hoping that its JUST swelling and it will go away. Is what I read true? & when do the injections actually go in effect?

The amount of time for a steroid injection to work depends on what is being used for.  Itchiness will resolve in just more than a day.  But as in your case I would give the steroids 1-2 weeks to take effect.  However even if the swelling doesn’t go away with the steroids, that does not mean it won’t go away.  Your nose tends to hold on to edema (swelling) for a long time.  Some people think that complete resolution can take up to a year.  That may seem like too long to wait but I certainly would not recommend revision surgery until at least 6 months have passed.

I hope this helps 🙂

– John Paul Tutela, MD

REMOVAL OF STITCHES AFTER BBL

Just got my stitches removed from bbl and she asked that I lay on the doctor’s table to do so for the incisions on my stomach etc. which took all of 2 minutes Would the laying and sitting up have caused some damage to the fat on my buttocks? Thank you!

Although in general you want to limit the pressure on your buttocks after BBL, that short amount of time should not affect your final result.

– John Paul Tutela, MD

WHAT CAN BE USED FOR BREAST ENLARGEMENT WITH NO SIDE EFFECTS ON BREAST FEEDING?

For the most part primary breast augmentation should not effect breast feeding.  If a periareolar approach is used there is a theoretical chance to affect breast feeding.  If that is very important to you and there is no other reason for a periareolar approach (i.e. Tuberous breast or needing a lift) I would suggest a inframammary incision.

It is important to note that if you get pregnant within 6 months of breast augmentation you have a much increased chance of stretch marks in your breasts.  So if you are planning on getting pregnant soon, it is better to wait for your augmentation.

I hope this helps 🙂

– John Paul Tutela, MD

IS IT POSSIBLE FOR MY TUBEROUS BREASTS TO FIT 500CC SALINE IMPLANTS?

Hello I am 20 years old, 5ft. 2 and 110 pounds. I suffer from tuberous breasts. I am currently a 32b cup. I was wondering if 500 cc saline implants, would fit? or would the implant size(500cc) be unreasonable and too big for me since I have tuberous breasts?

You can fit 500cc implants, but the real question is will that look good.  The answer to that depends on a variety of factors, but from the photos a smaller implant will probably be a better choice.

I use a predictive approach when it comes to breast surgery.  It is important the the implant that is chosen fits your body, not just a random number.  By measuring the width of your chest and assessing the laxity on your skin and soft tissue the best plan can be created.

The most important thing regarding your breast is that you have tuberous breasts.  SO the approach to you augmentation will also be critical.  An areolar reduction will help keep your areola from stretching even wider after augmentation.  Scoring the breast tissue in a radial fashion near you areola will also address the tubular form that can be seen on profile.  Sometimes with tuberous breasts your Inframammary fold needs to be lowered, however that is not obvious from you photos.

I think you will not be happy with a breast augmentation alone without addressing the unique features of a tuberous breast.

I hope this helps 🙂

– John Paul Tutela, MD

WHAT CHANGES WOULD MY NOSE NEED AND WHAT WOULD BE A ROUGH ESTIMATE OF COSTS FOR THESE CHANGES?

My nose has bothered me for quite some time, especially the way that the bridge is lower than the rest of the nose and the transition isn’t very smooth. I wouldn’t mind a bit more definition from the frontal view. I don’t necessarily mind how far my nose extends out in my profile, but would like to fix the bridge into the nose. I know that each case is different along with doctors in regards to pricing, but what would be a fair estimate for these changes? Also, what changes would you recommend?

You are right, pricing differs from region to region and from surgeon to surgeon.  Prices tend to be increased in major metropolitan areas like New York City, Los Angeles and Miami.  I imagine that the prices in Wisconsin are on the lower side of the spectrum.

It is hard to say exactly what you need without an exam, but from your pictures it looks you would benefit from a Dorsal Hump reduction.  That will help with the bridge of your nose. After that typically your tip will appear to be more downwardly projecting.  A cephalic alar trim, which trims part of your lower lateral cartilages helps turn the tip up slightly.  It also looks like you have a bulbous tip.  Delicate tip work with either interdomal or intradomal sutures or both will help create definition to your tip.

I would say that anywhere from $8000-$12,000 is a fair price for all of that work.

I hope this helps 🙂

– John Paul Tutela, MD

BREAST REDUCTION T-JUNCTION SCARS. ANY SUGGESTIONS?

I had my breast reduction about five months ago. The healing has been great but now I found my t junction scars to be very thick and lumpy. I’ve looked at many different scars and found one similar but mine is very saw and red and I wonder what could be wrong.

There are multiple reasons why a an unfavorable scar may occur. One of the most common reasons is a person’s own predisposition to form a keloid or hypertrophic scar. If you have many other keloids on your body, from other scars or from getting your ears pierced, you will have a higher chance of forming another keloid. If you have many other scars all of which have healed well, then you will likely continue to scar well. Another reason of unfavorable scaring comes from tension at the incision site. If the incision is not closed properly there may be undue stress on the incision and may result in a widened raised scar. More serious complications with your surgical site such as an infection or necrosis will also negatively affect your final scar.

In particular with many plastic surgery procedures the blood supply to the skin at the incision site could be compromised.  This can be due to tension at the wound, overly aggressive dissection or most importantly smoking.  Are you a smoker?

It looks like you experienced delayed wound healing at the junction of your scars.  Early on this can be treated with anything from pressure massage, silicone sheeting, steroid injection, laser or an excision and closure.

I would not recommend excising this scar for closure until at least 1 year after surgery.  At that time it would best be assessed by a board certified plastic surgeon to see if this would be possible.  The last thing that you would want is to undergo an excision and not have enough laxity for closure and be left with an open wound.

I hope this helps 🙂

– John Paul Tutela, MD