The Austin-Weston Center For Cosmetic Surgery

Yes. There are people who feel they have an area of excess, and as a surgeon you’ll look at it and say “No, I can’t make that be better." So you really have to have enough that the contour of the area is not ideal. The patients who come in and say they’re fat and they’re not really are probably not candidates for any cosmetic surgery. Doing small areas of liposuction is actually very nice because then you’re doing finesse work as opposed to someone who comes in and has a large volume, which we then start to think of as de-bulking. For some people that’s actually OK because it’s helping them get rid of a very troubled spot and they maybe will get the motivation to do a bit more on their own and take it even further but ideally we’d like people to be near their ideal weight or at a weight they can maintain easily.

Vaser utilizes ultrasonic energy and it takes fat cells and the tissue that binds them, the fat cells are held in a structure kind of like a honeycomb, when all the honey’s gone you’ve still got the comb left behind so there’s the structure around fat cells that holds them in place but when the fat’s gone that structure’s still there. Vaser utilizes these peak sound waves to shape the fat cells loose and kind of loosen the area, then they become much easier to suction out of the body. It makes it easier for the surgeon to perform the reduction. And so often it helps improve the result. It’s ideal for people who’ve had previous liposuction and now have some scar tissue that’s in there around those fat cells. It’s one more thing we can do to shake them free. I think the utility is that it allows us to get a bit more out.

Is that voice in your head bugging you about this every day. Are you so concerned about looking like your mother that you can’t get this voice to shut up? Talk to a plastic surgeon and see what they think. I can’t tell you the answer to that question without feeling your neck. My experience is that you can get long lasting excellent results. It’s always going to look different if you liposuction the neck than if you don’t. And it’s going age well if you do the appropriate surgical procedure at an early age so you’ll never look like your mother. So it’s probably better to do a smaller procedure early than it is to do a bigger procedure late.

Fat grafting in the butt is better. I don’t like hard implants in the butt. To do a Brazilian butt lift I suck fat out to the tune of a liter’s worth at least, prepare it, then put anywhere from 300ccs into each cheek of the buttocks. I suck it from wherever I can get it. Some people have it over their abdomen, some people have it over their flanks and hips, outer thighs. The problem is that if you have no butt you have no fat either. To recover you should try to stay off your butt for 3 weeks. The fat removal part is regular liposuction, so it’s not that big of a deal. It’s maybe a week’s recovery, maybe less, depending on how aggressive you are. It’s a great two-in-one procedure, instead of throwing the fat away after liposuction it gets processed, purified and reinjected into the buttocks.

If you have good skin elasticity and good muscle tone and you just have a little bit of extra subcutaneous fat on your tummy then you can get away with just liposuction because the skin will shrink back and you’ll have a nice shape. If, however, you have loose muscle or loose skin which commonly comes from pregnancy or from gaining and losing a lot of weight, liposuction alone will not treat that. There are three things that make an abdomen protrude: fat, loose skin and loose muscle. Liposuction will only treat one of those and if you’re very loose and you get lipo it you can make your skin looser because you’re deflating it, kind of like letting the air of out a balloon. So you have to be careful in thinking that the minimal procedure will do it for you. We believe that all of cosmetic surgery is custom designed so we have to design an operation for what your anatomy needs and allows.

Yes, people have different terminologies for facelifts, facial rejuvenations or necklifts. Most commonly when people say facelift they’re talking about a rejuvenation of the cheeks, chin jowls and neck. When I am performing a facelift I am reducing the neck fat, or neck skin laxity or tightening the muscles of the neck as part of that procedure.

Is that voice in your head bugging you about this every day. Are you so concerned about looking like your mother that you can’t get this voice to shut up? Talk to a plastic surgeon and see what they think. I can’t tell you the answer to that question without feeling your neck. My experience is that you can get long lasting excellent results. It’s always going to look different if you liposuction the neck than if you don’t. And it’s going age well if you do the appropriate surgical procedure at an early age so you’ll never look like your mother. So it’s probably better to do a smaller procedure early than it is to do a bigger procedure late.

You have to wait until you age enough to have enough of a flaw or defect that it can be treated and improved. So you can’t do a preventative necklift, you have to wait until there’s something there to lift or tighten. I do believe that for instance if you have a full neck when you’re young and you have liposuction of it early rather than waiting for 10 or 20 years for it to get loose, in that sense you might prevent a larger procedure like a facelift or necklift by doing some lipo earlier. I also believe that to be true with arm liposuction. If you have a full upper arm with good skin elasticity you can lipo that early whereas if you wait for years the wait is going to make it get looser and you’re going to have to get a more significant procedure like an arm lift.

It’s all separate because each person is so unique that not everybody having a facelift or a rejuvenation of their cheeks and jowls needs to have their brows addressed or needs to have their upper eyelids done. Whether it’s also doing their nose as part of a rhinoplasty at the same time or adding fat to different areas of the face we call that a facial rejuvenation.

Absolutely yes. The conversation starts with the patient and the surgeon and finding somebody that listens to your desires of what you want done. In the 70s there were doctors who just cranked out the same nose and they could get away with it because cosmetic surgery was different at that time. Now we have a lot better tools for people to figure out what they want and what looks best on them for rhinoplasty. There are a ton of variations of rhinoplasty, It’s finding a surgeon who actually listens to the patient and can meld their ideas with what he knows is possible.

We commonly do them together and it’s gotten the term mommy makeover these days when you have breast surgery at the same time as an abdominoplasty, whether it’s a breast lift or a breast augmentation. The most important thing is the timing of the tummy tuck because it’s rare for breast augmentation surgery to take over an hour to perform. Breast surgeries are relatively short operations, so add it on to the tummy tuck, which typically is only going to take about two hours and having three hours worth of surgery versus two is really not a big deal. If somebody has to have a very extensive tummy tuck and maybe that tummy tuck is going to take five or six hours then perhaps doing the additional procedure at the same time is not quite desirable.

Generally if you have droopy breasts and you want them perkier it will require a breast lift. I tell my patients that breast implants do not lift breasts they simply give you a bigger version of what you have. If you are happy with the volume of your breasts in a bra you should not have an implant because what breast implants do is simply make you bigger, they don’t give you a breast lift. So don’t do a breast implant thinking you’re going to get a breast lift out of it.

We use fillers such as Juvéderm very commonly in the lip and that can be done in the office with a little bit of local anesthetic in a procedure that takes 15 to30 minutes. We can do it with a patient’s own fat as well. That can be either done with a local anesthesia or during the time of surgery. Things that fill the lips like fat or Juvéderm or Restylane, move with the lips in a much more natural fashion so those are really the preferable ways of dealing with lip volume.

We use fillers such as Juvéderm very commonly in the lip and that can be done in the office with a little bit of local anesthetic in a procedure that takes 15 to30 minutes. We can do it with a patient’s own fat as well. That can be either done with a local anesthesia or during the time of surgery. Things that fill the lips like fat or Juvéderm or Restylane, move with the lips in a much more natural fashion so those are really the preferable ways of dealing with lip volume.

If you have good skin elasticity and good muscle tone and you just have a little bit of extra subcutaneous fat on your tummy then you can get away with just liposuction because the skin will shrink back and you’ll have a nice shape. If, however, you have loose muscle or loose skin which commonly comes from pregnancy or from gaining and losing a lot of weight, liposuction alone will not treat that. There are three things that make an abdomen protrude: fat, loose skin and loose muscle. Liposuction will only treat one of those and if you’re very loose and you get lipo it you can make your skin looser because you’re deflating it, kind of like letting the air of out a balloon. So you have to be careful in thinking that the minimal procedure will do it for you. We believe that all of cosmetic surgery is custom designed so we have to design an operation for what your anatomy needs and allows.

It makes it harder for the mammographer and the radiologist to read the mammogram but there’s no good evidence to show it prevents or delays the detection of breast cancer.

The breasts can be very similar but there’s always going to be small differences and sometimes they’re very significant differences. Usually when we’re operating we’re operating on both but you can operate on just one. Sometimes you’ll get one that’s just larger and it just needs to be reduced. But if you decide to augment one breast because you have one that’s smaller, it’s really hard to make the other breast match it because an augmented small breast looks odd compared to the natural breast on the other side. So a breast lift or a smaller breast augmentation would be best. Just reducing one to make it look like the other breast is easier than augmenting one to make it look like the other breast.

We commonly do them together and it’s gotten the term mommy makeover these days when you have breast surgery at the same time as an abdominoplasty, whether it’s a breast lift or a breast augmentation. The most important thing is the timing of the tummy tuck because it’s rare for breast augmentation surgery to take over an hour to perform. Breast surgeries are relatively short operations, so add it on to the tummy tuck, which typically is only going to take about two hours and having three hours worth of surgery versus two is really not a big deal. If somebody has to have a very extensive tummy tuck and maybe that tummy tuck is going to take five or six hours then perhaps doing the additional procedure at the same time is not quite desirable.

It’s all separate because each person is so unique that not everybody having a facelift or a rejuvenation of their cheeks and jowls needs to have their brows addressed or needs to have their upper eyelids done. Whether it’s also doing their nose as part of a rhinoplasty at the same time or adding fat to different areas of the face we call that a facial rejuvenation.

To actually open up the eyes with a browlift you sometimes have to overdo it and that’s where people start to look funny and overdone and not rejuvenated. So I never want to overdo something unless someone asks me to be overdone.

That’s actually an extremely difficult area because people have different causes for the dark circles and some of them are really not correctable because of pigmentation issues within the skin. Some of the dark circles are actually because there’s a bulging fat area above the dark area and for that the best thing to do is to move some of that fat down to the mouth.

The answer is both. It’s a separate procedure done in conjunction with an eyelift.

Successful cosmetic surgery quiets that voice in your head that’s bothering you about something. That’s the secret about cosmetic surgery. It allows you to get your attention off of your appearance and back into your life again. You know you’ve had successful surgery when your voice goes away. Some people’s voice will go away when you inject a little Juvéderm in the orbital rim, some people’s voice is still going to be there and then they have to come back and do something else. And it’s got to be a pretty strong voice because surgery is not without its risks, recovery, expense and stigma about the whole thing.

We commonly do them together and it’s gotten the term mommy makeover these days when you have breast surgery at the same time as an abdominoplasty, whether it’s a breast lift or a breast augmentation. The most important thing is the timing of the tummy tuck because it’s rare for breast augmentation surgery to take over an hour to perform. Breast surgeries are relatively short operations, so add it on to the tummy tuck, which typically is only going to take about two hours and having three hours worth of surgery versus two is really not a big deal. If somebody has to have a very extensive tummy tuck and maybe that tummy tuck is going to take five or six hours then perhaps doing the additional procedure at the same time is not quite desirable.

If you have good skin elasticity and good muscle tone and you just have a little bit of extra subcutaneous fat on your tummy then you can get away with just liposuction because the skin will shrink back and you’ll have a nice shape. If, however, you have loose muscle or loose skin which commonly comes from pregnancy or from gaining and losing a lot of weight, liposuction alone will not treat that. There are three things that make an abdomen protrude: fat, loose skin and loose muscle. Liposuction will only treat one of those and if you’re very loose and you get lipo it you can make your skin looser because you’re deflating it, kind of like letting the air of out a balloon. So you have to be careful in thinking that the minimal procedure will do it for you. We believe that all of cosmetic surgery is custom designed so we have to design an operation for what your anatomy needs and allows.

Fraxel is a laser that is just a hose that sprays light out and depending on the source of that light the light will be absorbed by any specific thing or color. Usually what we use for resurfacing the skin is a light wave that comes out that’s absorbed by water which is in UV range. Now every skin cell that you have has water in it and so when you spray the light on skin every cell gets heated up and explodes. That’s good and bad. You can make some lasers strong and some weak and choose to heat the skin a lot or not that much, but you’re going to heat all of the skin basically with a laser. The problem is, to really affect changes in the collagen what you have to do is heat the skin to the point that you’re going to end up killing the pigment producing cells, or melanocytes. And so what Fraxel did was come up with a nozzle that you can put on the hose that converts the spray into little teeny drill holes and you control the depth and the spacing of the drill holes.

Yes. But it’s the drooping or sagging tissues that a facelift addresses best.

Everybody ages very differently and I think that a lot of people will decide to do something perhaps late 40s or early 50s and they're catching things very early and in a subtle phase in which people are not going to notice that they’ve had something done. I also see some people who have really aged wonderfully and they’re 58 years old and they really don’t even need a full facelift, they just need small tweaks here and there.

I don’t think facelifts are for wrinkles at all because wrinkles to me are sort of defects in the skin, in a sense, as opposed to drooping of the tissues which is really what “lifting” corrects—drooping tissues. The wrinkles between your eyebrows, as they scowl and get older, you can’t fix that with a facelift, you really need a brow lift. So you can correct drooping tissues but you can’t really get, especially fine wrinkles, out of the skin. Fine wrinkles have to come out a different way. They have to come out, depending on where they are, either with good skin care, and you can address that either with creams and light chemical peels and things like that, like Retin A, you can do those sorts of things for a long period of time or you can do something more powerful, like a strong peel or a laser and then recover for a shorter period of time.

Fraxel is a laser that is just a hose that sprays light out and depending on the source of that light the light will be absorbed by any specific thing or color. Usually what we use for resurfacing the skin is a light wave that comes out that’s absorbed by water which is in UV range. Now every skin cell that you have has water in it and so when you spray the light on skin every cell gets heated up and explodes. That’s good and bad. You can make some lasers strong and some weak and choose to heat the skin a lot or not that much, but you’re going to heat all of the skin basically with a laser. The problem is, to really affect changes in the collagen what you have to do is heat the skin to the point that you’re going to end up killing the pigment producing cells, or melanocytes. And so what Fraxel did was come up with a nozzle that you can put on the hose that converts the spray into little teeny drill holes and you control the depth and the spacing of the drill holes.

Yes. But it’s the drooping or sagging tissues that a facelift addresses best.

Is that voice in your head bugging you about this every day. Are you so concerned about looking like your mother that you can’t get this voice to shut up? Talk to a plastic surgeon and see what they think. I can’t tell you the answer to that question without feeling your neck. My experience is that you can get long lasting excellent results. It’s always going to look different if you liposuction the neck than if you don’t. And it’s going age well if you do the appropriate surgical procedure at an early age so you’ll never look like your mother. So it’s probably better to do a smaller procedure early than it is to do a bigger procedure late.

It’s all separate because each person is so unique that not everybody having a facelift or a rejuvenation of their cheeks and jowls needs to have their brows addressed or needs to have their upper eyelids done. Whether it’s also doing their nose as part of a rhinoplasty at the same time or adding fat to different areas of the face we call that a facial rejuvenation.

Yes, people have different terminologies for facelifts, facial rejuvenations or necklifts. Most commonly when people say facelift they’re talking about a rejuvenation of the cheeks, chin jowls and neck. When I am performing a facelift I am reducing the neck fat, or neck skin laxity or tightening the muscles of the neck as part of that procedure.

Everybody ages very differently and I think that a lot of people will decide to do something perhaps late 40s or early 50s and they're catching things very early and in a subtle phase in which people are not going to notice that they’ve had something done. I also see some people who have really aged wonderfully and they’re 58 years old and they really don’t even need a full facelift, they just need small tweaks here and there.

We use a facelift in a few different areas. Sometimes I’ll actually do a facelift or the upper portion of the cheek for people who have scarring from acne. If somebody looks in a mirror and they put a finger by their cheekbone and one down below their ear and they pull backward and it makes their skin look better and it makes some of the acne scarring look better, a facelift might be useful to improve that to another degree. It’s not just wrinkling. It’s mostly useful for people who have just started to droop. You’ve got that heaviness of jowls and extra fatty deposits where you don’t want them, you’re starting to get the puppet folds down around the mouth, what we call marionette lines.

Generally not from conversational distance but up close, yes. They are in an area just in front of the ear, up toward the sideburn area and typically underneath the sideburn. Then they’re behind the ear in the grooves. And for a number of people there’s also an incision just underneath the chin. One of the ways you can tell on people who have had facelifts if the surgeon has not done it perhaps to the latest skill that we know now, is that they raise that sideburn up. People lose that natural hair where their sideburn is and you can see that scar or you can tell because it looks odd. People should have that wispy hair coming down. Some people take the incision right up there behind that hair and end up cutting out some of that hair-bearing skin.

Yes, generally that’s the preferable thing to do.

It definitely does. A mini is usually just a minimalistic or small version of a cheek lift that improves some of the nasolabial jowl region to a modest degree. For some people that’s absolutely all they need. It does have less downtime because the incision area and the surgical area is smaller and so there’s less bruising and swelling. They still have incisions that are going to have stitches for over a week and they’ll have to do something to camouflage that area.

That’s actually an extremely difficult area because people have different causes for the dark circles and some of them are really not correctable because of pigmentation issues within the skin. Some of the dark circles are actually because there’s a bulging fat area above the dark area and for that the best thing to do is to move some of that fat down to the mouth.

A limited incision facelift is a mini facelift. There are some surgeons who will do more through a minimum incision facelift and make it slightly more extensive than a mini facelift but it’s generally not going to be as effective as a full-length incision facelift, or what’s considered a traditional facelift. A lot of those things, whether called mini or limited incision, are just marketing terms.

I don’t think facelifts are for wrinkles at all because wrinkles to me are sort of defects in the skin, in a sense, as opposed to drooping of the tissues which is really what “lifting” corrects—drooping tissues. The wrinkles between your eyebrows, as they scowl and get older, you can’t fix that with a facelift, you really need a brow lift. So you can correct drooping tissues but you can’t really get, especially fine wrinkles, out of the skin. Fine wrinkles have to come out a different way. They have to come out, depending on where they are, either with good skin care, and you can address that either with creams and light chemical peels and things like that, like Retin A, you can do those sorts of things for a long period of time or you can do something more powerful, like a strong peel or a laser and then recover for a shorter period of time.

Yes. But it’s the drooping or sagging tissues that a facelift addresses best.

You can divide the face in thirds. Go through the pupils and everything above that line is the upper third. Draw a line at the bottom of your nose, everything below that including the neck is the lower face. Everything between that is your mid-face. A facelift for the lower face, it handles the jowl and neck. Think about it, they should have called it a jowl neck lift. A facelift has nothing to do with the nose, mouth and eyes.

That mid face is one of the areas that we address first. One of the very cool things that I’m loving more and more is to inject Juvéderm along the orbital rim, it is great if you do it right, it seems to almost lift the tissues so the bulges underneath the eyes almost go back in; it cleans up that hollow. You can do it under local anesthesia, it’s a quick and easy fix that keeps you out of surgery for a long time. For a malar groove, the groove that opens up between your cheek bone and the cheek fat that kind of drips down over your mouth as you get older, I like to add fat.

When you rejuvenate the face a facelift is just a portion of it. It’s really just a jowl and neck issue that you’re handling with that procedure and that’s really not the full issue for many.

The answer is both. It’s a separate procedure done in conjunction with an eyelift.

The answer is no. If you have drooping tissues and you need to have them lifted, you need to have them lifted. That doesn’t mean that you can’t get a rejuvenative effect by using fillers like Juvéderm on the orbital rim, fat grafts to various areas of the face, some good skin care or maybe some Fraxel. You can get a rejuvenative effect but it’s not going to be the same as surgical results but it’s not as risky, not as scary, not as expensive and doesn’t have as much of a recovery time.

Successful cosmetic surgery quiets that voice in your head that’s bothering you about something. That’s the secret about cosmetic surgery. It allows you to get your attention off of your appearance and back into your life again. You know you’ve had successful surgery when your voice goes away. Some people’s voice will go away when you inject a little Juvéderm in the orbital rim, some people’s voice is still going to be there and then they have to come back and do something else. And it’s got to be a pretty strong voice because surgery is not without its risks, recovery, expense and stigma about the whole thing.

Is that voice in your head bugging you about this every day. Are you so concerned about looking like your mother that you can’t get this voice to shut up? Talk to a plastic surgeon and see what they think. I can’t tell you the answer to that question without feeling your neck. My experience is that you can get long lasting excellent results. It’s always going to look different if you liposuction the neck than if you don’t. And it’s going age well if you do the appropriate surgical procedure at an early age so you’ll never look like your mother. So it’s probably better to do a smaller procedure early than it is to do a bigger procedure late.

I just saw a guy come back who is 75 and I did his facelift in his early 60s. I would not treat him now with a facelift. I’m thinking what he needs now is a little grafting because his face has gotten thinner. As we get older that’s the third aspect of aging. The first is wrinkling, the second is the drooping or the sagging and the third is the thinning of the tissues, or gaunting, or whatever you want to call it. It becomes about adding volume. So you do adjunctive procedures. Every once in a while you do the facelift again. Some people hold lifts beautifully and never do it again. If you can take your thumb and bend it back and touch your forearm, that’s an informal test for how loose your tissues are. The odds are if you can do that and touch your forearm you’re not going to hold your lifts very well because the tissues in your thumb are the same as they are in your face.

When you inject fat into diff areas of the face more is going to live in certain places and less is going to live in certain places. It’s going to live very well when you inject it into looser tissue like the cheek, where you already have fat, and there are trophic factors, or growth factors, keeping the fat of the cheek alive that this new injected fat is going to like. So fat when injected into the cheek does very well. Fat does well injected into vascular areas like the temporal areas, like the muscle over your cheek which gets hollow over time, where you can put 3 or 4 ccs of fat and it does beautifully. Fat in the lips is a little trickier. It’s a tight area and even though it’s very vascular it’s moving all the time and so fat there doesn’t do as well.

There are different kinds of tummy tucks and generally the thing that makes a tummy tuck more painful and that will delay your healing process is a full tummy tuck with tightening of the muscles which makes it more painful. Generally, in my practice we suggest that the patients plan on taking two weeks off for that. That doesn’t mean you’re in the bed for that time, we don’t use drains in our practice and our patients are up and about and in the shower getting it soapy and wet the first day after, regardless of what procedure they have done. A mini tummy tuck generally doesn’t have the tightening of the muscles and it’s an easy thing to go through. That doesn’t mean you should be exercising at full speed but most patients would take a week off rather than two weeks off for that procedure.

You have to wait until you age enough to have enough of a flaw or defect that it can be treated and improved. So you can’t do a preventative necklift, you have to wait until there’s something there to lift or tighten. I do believe that for instance if you have a full neck when you’re young and you have liposuction of it early rather than waiting for 10 or 20 years for it to get loose, in that sense you might prevent a larger procedure like a facelift or necklift by doing some lipo earlier. I also believe that to be true with arm liposuction. If you have a full upper arm with good skin elasticity you can lipo that early whereas if you wait for years the wait is going to make it get looser and you’re going to have to get a more significant procedure like an arm lift.

Sometimes with younger patients you can get away with treating just part of the face. You can do a necklift or a cheek lift that doesn’t include the neck. Generally a facelift includes both the cheeks and the neck, we call it a face-neck lift in our practice. But you have to be careful in treating just part of the face. You can do it when you’re young when the first thing shows up that’s aging, like maybe the eyes, and just treat the eyes and not the whole face. But generally by the time you’re 50 or so the aging is a little bit of everywhere, it’s not just in one place. So the paradox of cosmetic surgery of the face is that the more you have done at one time the less done it will look.

The face ages in three ways. As we get older we get loose or we sag, we wrinkle when our skin gets thinner and less elastic. The last thing that happens is that we tend to get gaunt, or the fat in the face tends to melt away and you see it be more angular. So a facelift can treat all three of those. You add volume by adding fat back to the face in someone who’s gaunt (facelift with fat transfer). The lifting procedures are better at treating sagging than wrinkling although part of the treating of the sagging also helps with the wrinkling. But there are resurfacing procedures such as lasers and fat injections and fillers that will help with wrinkling. In general, plastic surgery is less good at treating wrinkling than at sagging. And gaunting is more difficult to treat with fat injections. So the easiest and best results are when you have good skin elasticity and when your skin sags but doesn’t wrinkle.

As they get older people with full faces tend to look younger. Teenagers have full round faces, and I’m not suggesting that you get fat to treat that. What you can do is have some liposuction which can kill two birds with one stone. You can lipo some bulges on other parts of your body and use it to re-inject it into the face and you’ll get the benefit of both the liposuction and the face volume. That’s the facelift with a fat transfer.

It’s all separate because each person is so unique that not everybody having a facelift or a rejuvenation of their cheeks and jowls needs to have their brows addressed or needs to have their upper eyelids done. Whether it’s also doing their nose as part of a rhinoplasty at the same time or adding fat to different areas of the face we call that a facial rejuvenation.

To actually open up the eyes with a browlift you sometimes have to overdo it and that’s where people start to look funny and overdone and not rejuvenated. So I never want to overdo something unless someone asks me to be overdone.

I don’t think facelifts are for wrinkles at all because wrinkles to me are sort of defects in the skin, in a sense, as opposed to drooping of the tissues which is really what “lifting” corrects—drooping tissues. The wrinkles between your eyebrows, as they scowl and get older, you can’t fix that with a facelift, you really need a brow lift. So you can correct drooping tissues but you can’t really get, especially fine wrinkles, out of the skin. Fine wrinkles have to come out a different way. They have to come out, depending on where they are, either with good skin care, and you can address that either with creams and light chemical peels and things like that, like Retin A, you can do those sorts of things for a long period of time or you can do something more powerful, like a strong peel or a laser and then recover for a shorter period of time.

Successful cosmetic surgery quiets that voice in your head that’s bothering you about something. That’s the secret about cosmetic surgery. It allows you to get your attention off of your appearance and back into your life again. You know you’ve had successful surgery when your voice goes away. Some people’s voice will go away when you inject a little Juvéderm in the orbital rim, some people’s voice is still going to be there and then they have to come back and do something else. And it’s got to be a pretty strong voice because surgery is not without its risks, recovery, expense and stigma about the whole thing.

The breasts can be very similar but there’s always going to be small differences and sometimes they’re very significant differences. Usually when we’re operating we’re operating on both but you can operate on just one. Sometimes you’ll get one that’s just larger and it just needs to be reduced. But if you decide to augment one breast because you have one that’s smaller, it’s really hard to make the other breast match it because an augmented small breast looks odd compared to the natural breast on the other side. So a breast lift or a smaller breast augmentation would be best. Just reducing one to make it look like the other breast is easier than augmenting one to make it look like the other breast.

A buttock augmentation can be done with implants. An incision is made near the crease area and you have to have an incision on each side of the buttock crease region. The implant needs to be placed within the buttock muscle area as opposed to the breast implant with which there’s a really easy place to put it and they settle in pretty nicely without a lot of complications. I’ve seen only a very few people who have had them. This is not an operation that I do. A Brazilian butt lift is not as much lifting the butt as propping it up using the patient’s own fat. In that case you could liposuction from an area where there’s too much fat and you take it and inject it in the area of the buttocks and the buttocks is already composed of a lot of fat and by increasing the volume of the buttocks you get a more rounded and perhaps a more lifted looking buttocks. I think it would be better called a Brazilian buttock blow up as opposed to a lift.