I would need to know how long ago you had the procedure and what the procedure was. In general if this is a surgical scar between one and three weeks and there is no infection , a fresh surgical wound should heal without problems. Again, it depends on the location of the scar and what procedure was performed and what if any deep sutures were placed and how long ago it was performed .

James Fernau, MD

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You have a condition called plagiocephaly and you should be evaluated by a plastic surgeon who specializes in craniofacial surgery. Best wishes.

James Fernau, MD

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It is very important to have this problem corrected the first time. Revision surgery can correct any problems from the first surgery and it is very important to have this problem corrected the first time. Revision surgery can correct any problems from the first surgery however revision surgery is more difficult than primary surgery. It is very important you seek a board-certified plastic surgeon. And preferably a plastic surgeon who specializes in facial plastic surgery and more specifically nose surgery or rhinoplasty. Best wishes.

James Fernau, MD

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We use the quick recovery method for breast augmentation. Patients start walking the day of surgery and increase to a mile by the end of the first week. Two miles after the second week and add a mile to each week up to 4 weeks. We have them gently raise their arms above their head 4 times increasing four times per day for 4 weeks. At 4 weeks they start gentle lightweight upper body workouts. At 6 weeks they return to unrestricted activity.

James Fernau, MD

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Consult with a board-certified plastic surgeon who specializes in Brazilian buttock lift. Appropriate testing may include ultrasound, CAT scan and possible MRI. It would be helpful if you could provide the name of the material which was injected. Best wishes.

James Fernau, MD

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Stop 10 days before and 4 days after.
Make sure with pharmacy there are no interactions wth alcohol and antibiotics in general.

James Fernau, MD

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Nasal valve surgery swelling usually subsides at three months. If it does not you may need to have surgical correction

James Fernau, MD

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You may have collapse of the external nasal valve which can happen after rhinoplasty. Your best option is to go back to your surgical team and inform them of this possibility and they can asses the external nasal valve. This problem can be corrected. And remember you still have normal postoperative swelling which could be contributing to your breathing problem. Best wishes.

James Fernau, MD

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I suggest you research the American Academy of Orthopaedic Surgeons ( AAOS ) and check their physician roster near your location and you can make the appropriate inquiries. Best wishes

James Fernau, MD

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Scars such as this usually improve with time. Scars reach full maturity at 9-12 months. Early scar treatment therapy is important and includes topical silicone gel and topical silcone sheeting, scar massage and various forms of laser therapy including erbium laser resurfacing and fractionated laser resurfacing and a ND:YAG laser to name a few. Best wishes.

James Fernau, MD

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The general signs of infection include fever, increasing pain at the surgical site, redness and swelling at the surgical site, drainage from the incision line , possible nausea and vomiting and possible general feeling of "just not feeling well"

James Fernau, MD

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Although the photographic quality is not good in this picture, I think a combination of fractionated laser resurfacing and erbium laser resurfacing would be quite beneficial. These treatments could be performed every 3 to 4 weeks for 6 to 8 sessions and you could achieve a good result. For any remaining Contor depressions cosmetic filler would be beneficial, as well. As a last resort you could then try surgical excision followed by postoperative laser resurfacing. Best of luck to you.

James Fernau, MD

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Many implants in the body are titanium and there are no cases of poisoning. There are very rare allergic reactions. Your signs and symptoms should be evaluated by an internal medicine specialist.

James Fernau, MD

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Enlarged turbinates are a major cause of nasal obstruction. On physical examination if they fail to decongest and remain enlarged then surgical manipulation is indicated. Surgery for the turbinates includes crushing and out fracture, excision and out fracture, cauterization, and submucous resection with out fracture. Cauterization leads to a foul odor and I would not recommend this. I also avoid crushing the turbinate because it still remains as an obstruction. My preferred method is a meticulous submucous resection with partial excision of the bone and leaving mucosa for continued humidification leaving at least 40% of the turbinate so it can still function in a dry climate and eliminate the nasal obstruction. Best of luck!

James Fernau, MD

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A deep playing facelift is safe in the hands of a board-certified plastic surgeon who has extensive experience in this procedure. Most board-certified plastic surgeon's perform a facelift technique called a SMAS facelift and during this procedure the dissection is above the level of the facial nerve. A deep plane facelift is dissected below the level of the facial nerve and there is a higher incidence of facial nerve injury and in some studies a longer recovery period. A consultation with a board-certified plastic surgeon is essential.

James Fernau, MD

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In my opinion it is best to wait at least six months after pregnancy to start initiating surgical procedures such as liposuction. Keep in mind, many women also require a tummy tuck or abdominoplasty, as well. Every patient is different and you have to take into account breast-feeding and it may take up to 12 months to initiate any surgical procedures. Overall, it is best to be conservative and consider the health of the mother and the baby first.
There are many procedures for stretch marks including an abdominoplasty to remove excess skin and unsightly stretch marks, erbium laser resurfacing with or without Fraxel laser resurfacing, retinal compounds such as Refissa combined with growth hormone compounds such as Regenica. Silicone tape is also beneficial. It is important to remember a stretch mark is nothing more than a scar and many of the same treatments we do for scars work for stretch marks. In general, stretch marks are too numerous to treat with fillers.

James Fernau, MD

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If you have nasal obstruction and your nasal septum is blocking your airway then a nasal septoplasty is indicated. Nasal airflow studies and CAT scans are very helpful. There are anatomical structures which can block the nasal breathing including the inferior nasal turbinates and the internal nasal valve. All of these should be evaluated with a 0° and 30° rigid sinus endoscope. If you have any doubts, seek a second opinion and consider nasal airflow studies and a CAT scan of your sinuses as well. Make sure you seek the opinion of a board-certified otolaryngologist and or a board-certified plastic surgeon.

James Fernau, MD

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Embrace has scientific data showing improvement in scars. We are very aggressive with our postoperative scar treatment regimen and our abdominoplasty scars are very acceptable to minimal. We have used the Embrace therapy starting 2 weeks after surgery for a total of 8 weeks and I have seen excellent results. Thus far, I have not seen a bad result. Postoperative silicone sheeting may cost from one to $200 while the Embrace therapy costs approximately $400.

James Fernau, MD

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Most commonly the condition you described is either a lipoma (benign fatty tumor) or a sebaceous cyst. Both can be easily be removed surgically by a board-certified plastic surgeon or a board-certified facial plastic surgeon.

James Fernau, MD

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The quality of the scar is very important to evaluate to determine the appropriate therapy. Since I do not have a picture I will explain how we generally treat scars in our practice. Most of the time scars are treated with a retinol product and hydroquinone and growth hormone and undergo serial laser resurfacing with an erbium laser and a Fraxel laser until the scar is diminished. In between laser therapy we use sunblock with zinc oxide and titanium dioxide and silicone scar gel therapy. If a scar needs a surgical scar revision we do the same process I just described to obtain an optimal result. More often, we are using topical growth hormone immediately after laser treatments and in between laser treatment as well.

James Fernau, MD

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90% of premature aging is due to sun damage.. Therefore, it makes sense to start using sunblock in children as early as possible and make sure the sunblock contains zinc oxide and titanium dioxide. Retin-A can be used as early as the late teens ; however, if overused or improperly used it can lead to skin sensativity and even sun damage. There are new topical growth hormone products showing early promising results. Most importantly , avoid tanning beds and use good sunblock.

James Fernau, MD

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The majority of board-certified plastic surgeon perform some type of facelift referred to as a SMAS facelift which allows the surgeon to manipulate the skin in both the face and the neck and manipulate the structure called the SMAS which is continuous with the platysma muscle in the neck and therefore a facelift and a necklift can simultaneously be performed using this popular technique. A deep plane facelift is performed over the periosteum of the facial structures and can be effective in the hands of experience and skilled surgeons in this procedure. Overall there is a higher incidence of nerve damage with this procedure. A modified deep plane facelift is somewhere between the SMAS and the periosteum. There are many variations of this technique and it is important to thoroughly discuss this with your surgeon. Make sure he has extensive experience with this technique. Consultation with a board-certified plastic surgeon is imperative.

James Fernau, MD

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Saline breast implants are still used today. They can be placed through the transumbilical approach; whereas, silicone gel breast implants cannot be placed through this approach
Most board-certified plastic surgeon use silicone gel breast implants including myself. There are three approaches including transaxillary, periareolar and inframmamary . The inframammary approach allows for the Quick Recovery technique. The periareolar approach is very good for simultaneous breast lifting or mastopexy. I use silicone gel implants almost exclusively in my practice. Consultation with a board-certified plastic surgeon is very important.

James Fernau, MD

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Laser hair reduction has been around for a long time and there are many devices. The best devices well show a reduction of at least 80% and the highest percentage of laser hair reduction quoted by a company is 92%. Laser hair reduction is best accomplished in a patient with light skin and dark hair. Thus far, laser hair reduction does not work very well if your hair is blonde or red or gray and if you are a very darkly pigmented individual. It usually takes at least six treatments spaced apart every six weeks to achieve optimal results. Please note, laser hair reduction is not stated as permanent by the FDA.

James Fernau, MD

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Both of these are excellent products and I believe each one has a specific role in every part of the face. Juvederm is preferred in the lips because it last longer and Juvederm Ultraplus is very good in the nasolabial folds for a more long-lasting effect. Juvederm Voluma is an excellent product to provide extra long lasting volume to the cheekbone region and hollowing of the face just below the cheekbone region. Juvederm is not suited for the tear trough region because it causes too much swelling. Restylane is an excellent filler for the tear trough region and the nose. Many patients achieve long-lasting results when Restylane is placed along the nasal dorsum and the nasal tip. The parentheses lines are tricky to fill and either of the aforementioned fillers can work however I prefer a filler called Bellafill which can be conservatively placed to avoid a large bubble deformity. Other fillers to consider include Radiesse and fat. Blunt cannulae needles decrease the possible complication of an intravascular injection. Simultaneous treatment with Botox or Dysport can enhance the effectiveness of the filler. Glabella lines and brow Lines and temporal hollowing can all be treated with the aforementioned fillers with meticulous injection principles and techniques.

James Fernau, MD

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In my previous response to upper eyelid rejuvenation and sagging upper eyelids one must also consider a condition called ptosis. Most commonly we see a condition called senile ptosis which is dehiscence of the Levator muscle aponeurosis and this can be repaired while simultaneously performing upper eyelid blepharoplasty. It is very important to evaluate the presence of ptosis preoperatively before undergoing an upper eyelid blepharoplasty.

James Fernau, MD

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Bedsores or pressure sores are a serious problem. Patients need to be turned every two hours and placed in a special air bed. The sacrum and the heels need to be watched vigilantly and padded appropriately. High-protein diets and proper nutrition are essential.
Consultation with your orthopedic surgeon and the earliest possible ambulation should be initiated. If a bedsore develops consultation with a board-certified plastic surgeon is mandatory.

James Fernau, MD

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Addressing your questions regarding what are the risks of local anesthesia. Some people are allergic to local anesthesia and this is quite rare. Overall it is considered quite safe. Epinephrine has to be used during rhinoplasty to minimize bleeding so the surgeon can visualize what he is doing and sometimes the epinephrine reaction to the patient is overwhelming and they become quite anxious and it becomes difficult to do the surgery unless they have taken something like Valium orally. In my experience, in the vast majority of cases patients do quite well with oral sedation such as Valium and or versed using local anesthesia with epinephrine. Patient selection is crucial and the surgeon and the patient must be on the same page as far as the type of experience they are willing to undergo during surgery. If a patient is really frightened then either intravenous sedation or general anesthesia is preferred. In some cases patients have such a dramatic reaction to epinephrine that general anesthesia and or intravenous sedation is required to minimize the effects of epinephrine.
Sometimes the gases in general anesthesia cause more bleeding therefore. Intravenous sedation is the preferred method or a procedure called total intravenous general anesthesia is preferred.
I think one of the most important issues is your surgeon feeling comfortable during the procedure and you feeling comfortable with your surgeon.
30% of the general population has a fear of general anesthesia. In reality, studies have shown for healthy patients undergoing a planned operation, general anesthesia is about as dangerous as pregnancy in a healthy woman.
When considering all ages and all illnesses and a group of 100,000 persons, the chance of dying is less than 13 deaths per 100,000 persons.
Remember, the majority of these deaths occur in patients over 70 years of age with multiple illnesses. Local anesthesia does have its risks however the general consensus is it is safer than general anesthesia although finding exact statistics on this matter is difficult.

James Fernau, MD

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First of all, it is important to remember liposuction does nothing to improve cellulite. Options include topical RetinA combined with growth hormone topical application, Ultherapy, Thermage, Velashape, Zeltiq, Vanquish, Cellulaze, Endermologie, ThermiRF and SmoothShapes, Realize the fact that there are so many treatments no individual treatment is better than the other or a guarantee of success. Most treatments require serial repeated treatments. Consult a board-certified plastic surgeon who has laser experience and preferably a member of The American Society of Laser Medicine and Surgery ( ACLMS ). Best of luck in your endeavors.

James Fernau, MD

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This scar is too immature at this point for surgical scar revision. I would not inject corticosteroids because they can cause skin atrophy. 5FU Is too early at this point. Hyaluronidase is also too early because it too can cause wound breakdown. Options include massage with vitamin E oil, silicon gel application, always sunblock with zinc oxide and titanium and avoid PABA , Microdermabrasion's, erbium laser resurfacing, fractionated laser resurfacing or a combination of both erbium and Fraxel. My personal preference is the aforementioned laser combination of erbium and fractional laser resurfacing every month. Spot focus laser resurfacing on the bumps can help diminish the size of the bumps and bring them down to the surface level. After each laser treatment antibiotic ointment is usually applied for 1 to 2 weeks followed by silicone gel therapy until the next laser treatment. Sunblock is imperative. Scars are not fully mature until 8 to 12 months. Best of luck in your endeavors.

James Fernau, MD

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I would recommend a consultation with a urologist. Some urologist physicians specialize in this disorder. There are many factors to consider the cause of this complex problem. Treatment, for example, can range from taking oral medication such as Cialis or Viagra or may consist of surgery such as implanting an inflatable pump to achieve an erection. The success rate of Viagra varies from 48 to 81% in the population. Inflatable pumps have a success rate of 70 to 80% in the population. Best of luck in your endeavors.

James Fernau, MD

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Four major open rhinoplasty general anesthesia is preferred because any bleeding which goes down the back of the throat may cause coughing and make it impossible for the surgeon to perform such meticulous and delicate surgery. For major open rhinoplasty using intravenous sedation, the surgery is more challenging for the rhinoplasty surgeon and a small carefully placed sponge near the back or posterior nasal passage can control bleeding and simultaneously provide local anesthesia. I have done this quite successfully however I only felt comfortable after performing hundreds of open rhinoplasties. For minor open rhinoplasty usually performed for nasal tip problems local anesthesia with oral sedation such as Valium is quite acceptable and tolerated by the patient and the surgeon. In my opinion, rhinoplasty should be performed by a board-certified plastic surgeon or a board-certified facial plastic surgeon, and preferably a member of the Rhinoplasty Society with many years of experience and a very good photographic gallery. I cannot speak for the young surgeon you mentioned. His comment may be due to inexperience or it may be due to a very high level of training and surgical excellence. Best of luck in your endeavors.

James Fernau, MD

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In all cases of gynecomastia we use power assisted liposuction (PAL) using the principles of SAFE liposuction. Incisions are usually in the axilla. Specially designed disposable cannulas are used with the PAL system. Then, if needed we make a small periareolar incision and remove any glandular tissue which remains. In the rare cases of skin which is severely sagging a complete incision is made around the areola and directed down to reposition the nipple areolar complex and shape the breast to normal. Postoperative Topifoam compression and custom garments are used to decrease bruising and lessen the recovery period. Best of luck.

James Fernau, MD

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At 90 days it is probably too early for a surgical revision of a scar. Most scars are revised surgically at 9 to 12 months. After surgical scar revision Botox has been shown to help improve scars. Also after surgical scar revision we use anti-tension taping for a minimum of two weeks and start erbium and fractionated laser resurfacing within 6 to 12 weeks or as soon as the redness of the scar has diminished. We like to use silicone gel to the scar after the anti-tension taping as this helps lessen the redness and we can start the laser resurfacing at an earlier date. We have also found intense pulsed light therapy is beneficial in darker or pigmented scars. Very conservative fractionated laser resurfacing is beneficial in darkly pigmented patients. In these patients it may require 20 treatments total instead of 10 treatments in lighter pigmented patients. Postoperative sunblock with zinc oxide and titanium is crucial.
If your scar is only 90 days then surgical revision would not be an option and Botox would not be an option. At this point silicone gel application and either erbium or fractionated laser resurfacing or intense pulsed light therapy are all beneficial. Again, sunblock with zinc oxide and titanium is crucial.
Depressed scars can respond to either temporary fillers like Restylane or more permanent fillers such as Bellafill.
Raised scars also known as hypertrophic scars or keloid scars can respond to Kenalog injections, Vitrase injections and /or 5 FU injections. In my opinion, laser resurfacing will improve these scars after they respond to the injections. In particular, scars which are wide and neither raised or depressed respond quite well to our regimen of laser resurfacing. A typical regimen of laser resurfacing is once a month until the scar has diminished.
Best of luck in your endeavors.

James Fernau, MD

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The incidence of metastasis to the Perifacial or buccinator lymph nodes is 35% in carcinoma of the oral cavity and 8% in carcinoma of the oropharynx. Therefore, it is imperative that carcinoma be ruled out. You need a very detailed history and physical examination and possibly a magnetic resonance image to make sure there are no suspicious lesions present and to differentiate the lymph node from the parotid gland. I would suggest you consult with a board-certified otolaryngologist who specializes in head and neck cancer. I have experience in this area since I am a board-certified otolaryngologist and a board-certified plastic and reconstructive surgeon. A magnetic resonance image may be required to make sure the mass is not part of the parotid gland. It has been a long time since you have had the mass and if it does start to grow I believe it would be mandatory to have it removed. After the aforementioned meticulous physical examination and radiological work up either needle biopsy or surgical biopsy may be warranted after observing the mass for a period of time. Lymph nodes less than 1 cm are difficult to needle biopsy. If this node grows to the size of 1 cm I would definitely have it needle biopsied. In my personal opinion I would not wait too long and I would want to know what the lymph node represents sooner than later. Best of luck in your endeavors.

James Fernau, MD

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Several large studies at major institutions revealed that breast implants placed in the sub muscular position did not make it more difficult to detect breast cancer. However, breast implants placed in the submammary position i.e. above the muscle, did make it more difficult to detect breast cancer. Remember, breast self-examination and appropriate age and timing of mammograms and frequent examination of your breasts by your OB/GYN are imperative. Also, knowing your family history is important and you may want to know your BRCA Status if there is a positive family history of breast cancer. One in eight women develop breast cancer. Personally, I have perform breast augmentation in the sub muscular position and two of my patients developed breast and since the breast implants were under the muscle they did not have to be removed and the women retained the shape of their breast even after the modified mastectomy. Breast augmentation is an important decision and should be discussed in detail with your plastic surgeon cooperating with your OB/GYN surgeon. Best of luck in your endeavors.

James Fernau, MD

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Procedures to correct nasal breathing problems include septoplasty and repair of nasal vestibular stenosis and reduction of the inferior turbinates. These can be billed to insurance. The septoplasty can be performed with an incision inside the nose. The repair of the nasal vestibular stenosis most often requires an incision under the nose and lifting the skin to visualize the nasal dorsum. Turbinate excision is done inside the nose. It takes about 15 minutes. The septoplasty alone takes 30 minutes. The repair of the nasal vestibular stenosis requires harvesting from the septum which is a septoplasty and takes approximately 1 1/2 hours. Again, these can be billed to insurance. If a patient desires simultaneous correction to make the nose look better such as filing down the dorsum or making the tip look smaller this is considered cosmetic surgery and cannot be billed to insurance. In my hands, the cosmetic portion of the procedure is most easily accomplished with an open incision under the nose which allows me to visualize the entire nasal dorsum and the nasal tip for meticulous cartilage grafting and meticulous suturing to refine the nasal dorsum and the nasal tip. My cosmetic rhinoplasties generally take three hours and require septoplasty for cartilage harvesting and grafting. The services must be strictly recorded during surgery and the cosmetic portion paid out-of-pocket by the patient. Otherwise, it would be considered fraud. A good rhinoplasty surgeon will exam the nose with a nasal speculum and brilliant headlight illumination and also use a rigid 0° and 30° endoscope. Nasal endoscopy will determine the angle of the internal nasal valve and determine if you are a candidate for repairing nasal vestibular stenosis and evaluate the full extent of the nasal septum and evaluate the full extent of the inferior turbinates. Remember the surgeon cannot do the cosmetic portion of the procedure and try to get insurance to cover it. Again, this would be considered fraud. Best of luck in your endeavors.

James Fernau, MD

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If your nasal breathing is normal then a septoplasty is not indicated. If you are seeking cosmetic improvement then a septoplasty is performed to harvest cartilage to improve the contour of the nose and maintain nasal shape.I see that you were on allergy medication and this is the most likely cause of your inability to equalize your air pressure since allergies can cause inflammation of the eustachian tube orifice, the eustachian tube proper and the lining of the middle ear. A board-certified ear nose and throat specialist who also specializes in allergy would be the optimal consult for this problem. Best of luck in your endeavors.

James Fernau, MD

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This problem is not an emergency and you can wait until your insurance begins. Until you see a board-certified plastic surgeon you can request records from your old surgeon which will reveal where the implants were placed in relationship to the pectoralis muscle and what type of implants were used. The board-certified plastic surgeon and his staff will communicate with your insurance plan and see what can be covered. A magnetic resonance image is the gold standard to detect a ruptured silicone implant. If your plastic surgeon makes a determination the implant is ruptured on physical examination and you want new implants you can avoid the magnetic resonance image and your surgeon can proceed directly to removing your implants and placing new implants. Remember, the cost of an emergency room visit without insurance could easily be the equivalent of a plastic surgery procedure which would remove your implants and replace new implants. Best of luck in your endeavors.

James Fernau, MD

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Your choice of a rhinoplasty surgeon should not be based on imaging technology. Rather, it should be based on the skill and expertise of the rhinoplasty surgeon based on his preoperative and postoperative photograph, posted reviews and the number of rhinoplasties they have performed. It is imperative they are a board-certified plastic surgeon or a board-certified facial plastic surgeon and preferably a member of the
Rhinoplasty Society. Imaging can be helpful however it does not replace the skill and experience of an accomplished rhinoplasty surgeon. Best of luck in your endeavors.

James Fernau, MD

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This is an inherited deformity and can easily be corrected with a spacer between the affected toes and taping. You should see a pediatric podiatrist. If a problem develops surgery may be required and is straightforward for a board-certified pediatric podiatrist. Best of luck.

James Fernau, MD

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If there is a chance you are pregnant you must delay the surgery. You must consult your OB/GYN and your primary care doctor as well. Taking the morning after pill greatly increases your chance of a deep venous thrombosis which could lead to a fatal pulmonary embolism. Safety is the number one priority in plastic surgery and it should be your priority for your body. Remember, plastic surgery is elective and in the meantime you can do vigorous workouts to enhance the buttock musculature. Best wishes.

James Fernau, MD

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An average cost to expect is between $4000 and $8000. You definitely want a board-certified plastic surgeon, or facial plastic surgeon, or oculoplastic surgeon to make sure your procedure is performed correctly and safely. The reason for the price range is because different procedures may need to be done depending upon the condition of your lower eyelids. Here are a few things to consider and ask your surgeon what you might need:
1. Pinch blepharoplasty only
2. Fat pad removal or fat pad repositioning
3. Release of the arcus marginalis
4. Fat grafting to the tear trough region
5. Partial excision of the orbicularis muscle
6. Tightening of the orbicularis muscle
7. Lateral canthoplasty or lateral retinacular canthoplasty
8. Skin excision
9. Simultaneous chemical peel or laser resurfacing
10. Skin only or skin muscle flap or trans conjunctival approach
And remember prices vary with each surgeon, Geographic location, office-based surgery, surgical center, or hospital-based surgery. Usually, office-based surgery is less expensive.
Patient safety is of utmost importance. Good luck in your endeavors.

James Fernau, MD

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Scientific research has excellent data on the efficacy of Embrace Therapy. In my practice we have a philosophy of anti-tension taping for 6 weeks followed by erbium laser resurfacing over the scars until they are diminished. We have had excellent results with this process. For high-risk patients who have formed keloid scars, wide scars or hypertropic scars we have found Embrace Therapy quite useful and have seen dramatic results. Embrace is used for approximately eight weeks postoperatively and it is tolerated quite well by the patients and thus far we have 100% satisfaction from patient using this treatment.

James Fernau, MD

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From your description it sounds as if you have a capsular contracture causing the breasts to raise to a higher position secondary to the capsular contracture. Since your implants are over 30 years old you probably have a leak which is causing the capsular contracture . A magnetic resonance imaging would be helpful but not absolutely necessary. The old implants need to be removed with a complete capsulectomy and new fifth-generation silicone gel implants placed into a new pocket and you may need a breast lift which would require incisions around the areola or incisions around the areola and extending inferiorly in the shape of a lollipop. These can be complicated reconstructions and you may require acellular dermal matrix such as Alloderm. What you need specifically can only be determined by a physical examination conducted by a board-certified plastic surgeon who is well-trained in breast surgery. Best of luck in your endeavors.

James Fernau, MD

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In my opinion waiting only four weeks for recovery after a rhinoplasty is unwise. Although many rhinoplasties do look good at four weeks there is always a chance of residual swelling and bruising which would be a distraction for your wedding and your wedding pictures which you would see for a lifetime. I think it would be best to have the rhinoplasty performed three months before a wedding to allow sufficient time for swelling to resolve especially in the nasal tip region. I perform open rhinoplasty because I have better visualization and more control.
If you have a receding chin, a chin implant is a good option. However, without photographs it is difficult to give an opinion.

James Fernau, MD

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I would consult with a board-certified plastic surgeon who is a member of the Rhinoplasty Society and specializes in rhinoplasty. Your postoperative result is not uncommon and it can be corrected with structural cartilage grafting. The sources of the cartilage are either from the remaining nasal septal cartilage, ear cartilage or rib cartilage. The type of grafts are referred to as spreader grafts or alar batten grafts or lateral crural strut grafts. Various other grafts may also need to be used during your procedure. Best of luck in your endeavors.

James Fernau, MD

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The best cartilage to use for rhinoplasty is the nasal septal cartilage. The surgeon does not have to make an extra incision in order to harvest this cartilage and it has the best qualities for grafting. The second source of cartilage is from the ear and the incision is minimal. The third source of cartilage is from the rib and this is the most visible incision with the most postoperative pain. The rib graft is typically used in complex secondary rhinoplasties. In a primary rhinoplasty where a septoplasty has not been performed I always prefer harvesting the nasal septal cartilage. On every patient I perform cartilage grafting for two reasons. First for cosmetic refinement of the nasal dorsum referred to as the dorsal aesthetic lines and for cosmetic refinement of the nasal tip. Second for structural support of the nasal dorsum and the nasal tip to improve the nasal airway and prevent postoperative deformities. Cartilage grafting is an essential component of any rhinoplasty. Furthermore, harvesting temporalis fascia can be quite helpful in certain circumstances. I think it is important to use the patients own tissue grafts and avoid synthetic grafts and or grafts harvested from non-human sources. In my personal opinion silicone grafting in the nose is prohibited. Additionally, in certain cases Restylane can be used postoperatively to correct minor imperfections. Best of luck in your endeavors.

James Fernau, MD

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The scar tissue on the upper lip requires sharp excision and a meticulous closure. After approximately six weeks using either an erbium laser or a fractional laser the incision scar can be further diminished. In my practice, we have found postoperative laser resurfacing to be incredibly effective in erasing scars. We include this in the price of the scar revision. Of course every scar revision cost will vary from surgeon to surgeon; however, I believe your scarring looks to be quite minimal from the photograph and the cost would vary from $500-$1500. The final cost would depend on a complete examination of the inside of the mouth and of the exterior of the lips and evaluating the movement of both the upper and the lower lips. As always, please seek the consultation of a board-certified plastic surgeon. Best of luck in your endeavors.

James Fernau, MD

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A septoplasty is a method of harvesting cartilage from the nose and this Cartlidge is the optimal cartilage to reconstruct the nasal tip. Other sources of cartilage which require another incision on another body part include your cartilage harvest and rib cartilage harvest. The vast majority of rhinoplasty surgeons

James Fernau, MD

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All insurance work which is legitimately found on physical exam and documented in the note with the proper codes and submitted to insurance with the proper codes can certainly be billed to insurance if it is pre-certified and found medically necessary. If there is additional cosmetic work which needs to be done this can be performed simultaneously and the cosmetic fee paid to the surgeon. Best of luck in your endeavors.

James Fernau, MD

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I recommend this particular regimen to a lot of my rhinoplasty patients; however, as always you must consult with your pharmacist and go over any allergic reactions to medication to make sure the regimen is safe.

James Fernau, MD

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Something Doctoers offer revisions for one year. The international Society of aesthetic plastic surgery offers revisions for up to two years.

James Fernau, MD

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If your anesthesiologist is a board-certified physician you will be in good hands. General anesthesia is usually preferred by the rhinoplasty surgeon sense your airway will be protected from any bloody secretions draining down the back of your throat during the procedure. A build up of this material in your stomach can make you vomit after surgery. There are some very good medications to prevent nausea vomiting after surgery and this includes the use of Decadron and it Zofran and occasionally Iran the plastic surgeon can request he had a seizure to be totally intravenous general with no use of inhalation agents.

James Fernau, MD

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I have 22 years of experience with my liposuction. The first 10 years are used ultrasonic Liposuction.I found this technique to have many complications and painful scar formation and therefore I abandoned it. My experience with i lipo is limited because of the limited nature of the results. We have had many demonstrations of this type of noninvasive liposuction in our office and none of them have proven fruitful.
We have performed over 20,000 areas of wiper fortune using the super work power assisted technique which gives superior results and we can simultaneously perform abdominal etching to delineate there precise anatomy of the abdominal wall. In my opinion this would be your best treatment option. The recovery is quick with minimal bruising and minimal downtime and most patients have it performed on a Friday and return to work on Monday.
Furthermore, you must be congratulated on your weight-loss and your exercise regimen.I would recommend focusing on super wet liposuction using a power assisted device abbreviated PAL. Also make sure the surgeon is board certified in plastic surgery and he performs the technique called SAFE liposuction using autografting. The aforementioned procedure provides the safest and most consistent results. Good luck.

James Fernau, MD

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There are several procedures which address your question. Performing SAFE liposuction with auto grafting is an excellent choice. This can be combined with a small incision underneath the chin and performing a plication of the platysma muscle and/or modifications of the platysma muscle which reduces the banding underneath the neck. There is also a neck lift procedure which is a more extensive procedure requiring an incision behind the neck and extending down the hairline approximately 7 to 8 cm behind the ear. This can provide excellent contour of the neck. This is usually combined with liposuction of the neck and a small incision underneath the chin, as well.

James Fernau, MD

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Yes, you would be able to have it done. It is best to look for a board-certified plastic surgeon who preferably performs mostly cosmetic surgery. Members of the American Society of aesthetic plastic surgery are excellent. Also, remember to obtain a really nice tapered waist it is important to liposuction the hip rolls and cross tunnel the abdomen with the hip rolls to obtain the shape you want.

James Fernau, MD

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Lipomas are usually removed because they are causing symptoms. If they are not removed they can grow larger and be more difficult to remove in the future. If the lipoma his near a structure such as a nerve or a blood vessel and it is causing symptoms or problems it should be removed so it does not grow and cause problems at a later date. Alternatively, if the lipoma is located on the abdomen and is not causing symptoms it can be observed.

James Fernau, MD

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Some doctors do not take any insurance and charge only a cosmetic fee. Some insurance plans will cover a portion of the surgery which usually allows better breathing through the nasal airway. This can offset some of the cost. You can ask your doctor if they accept insurance plans for this purpose. Please note, rhinoplasty surgery ranges from $5000-$20,000. Best of luck in your endeavors!

James Fernau, MD

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Secondary liposuction deformities our best corrected with a technique called autografting supplemented with fat grafting. Autografting involves using specialized equipment called power assisted liposuction ( PAL ) , which is used to free up the scar tissue without suction applied . Then appropriate fat grafting can be performed and other areas of residual fat deposits can be meticulously suctioned. The proper Brazilian butt lift involves fat grafting directly into the gluteus maximus muscle where there is a greater blood supply than the overline subcutaneous tissue. The percentage of fat grafting success using this method should range between 60% and 80%. Make sure to consult a board-certified plastic surgeon and preferably a member of the American Society of aesthetic plastic surgery who has a good track record of Brazilian buttock lifting and fat grafting. Best of luck.

James Fernau, MD

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Lawn prescription medications include Lamisil, Miactin, and Tinactin. These can be used for 1 to 6 weeks. If there are blisters present use Burrows solution for three days followed by the aforementioned non-prescription antifungal cream medication. Also, on a Google search there is a list of the top 25 homemade remedies as well. Best of luck.

James Fernau, MD

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For the swelling on your back I would recommend a board-certified plastic surgeon. Especially if the swelling or tumor is to be removed for cosmetic purposes the board-certified plastic surgeon will make every effort to make the scar as least noticeable as possible. Then it is also possible to treat this scar with laser treatments to further improve it over time.

For the swelling on the hand and wrist area you could also consult the same plastic surgeon. Sometimes swellings or tumors on the hand and wrist area are best treated by a plastic surgeon or orthopedic surgeon who is further specialized in hand surgery. They are certified by the American Society of hand surgeons.

James Fernau, MD

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Residual pain in the wrist after any wrist surgery is not uncommon. If the pain becomes excruciating the radius may be putting to much pressure on the lunate and the radius may need to be shortened by 2-5 mm. If the pain continues and you reach stage 3 the lunate begins to break apart from the surrounding pressure of the other wrist bones producing sharp fragments of floating bone which becomes excruciatingly painful. Treatment may require a proximal row carpectomy which involves removing the lunate and the scaphoid and the triquetrum. This diminishes wrist motion and relieves the wrist pain. Make sure you see a board certified hand surgeon . Good luck

James Fernau, MD

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Earlobe repair is easily done in the doctors office to avoid costly surgical facility fees. This surgery generally requires a simple anesthetic into the earlobe followed by surgical excision of the edges of the deformity to be repaired. This is followed by meticulous and delicate suturing on the anterior and posterior edges of the defect to create a normal appearing earlobe. The sutures remain in place for 5 to 7 days. At approximately 6-8 weeks a new earring post can then be placed just above the superior aspect of the newly created surgical scar. By placing the earring post in this position it will prevent further tearing. The scar serves as a buttress to prevent migration of the earring . The average cost of earlobe repair ranges from $500-$900 per side. In some instances, insurance may cover the surgery.

James Fernau, MD

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