It is difficult to determine the cause of breast asymmetry without an in-person exam, however, the firmer side may be developing a capsular contracture (tightening of scar tissue surrounding the implant). I recommend following up with your original surgeon if possible or seeking out a local plastic surgeon for an exam.
You may be a great candidate for a mastopexy to lift the breasts and create more symmetry in the areolas. In addition, a patient may be a candidate for auto-augmentation or fat transfer instead of breast implants.
Yes, fat transfer to the temples is an option if you are happy with the result of filler. You may need to wait until the filler is mostly dissolved before having fat transfer so the surgeon can see the true volume deficit.
You are too young/ not a candidate for a surgical facelift, but may be a candidate for lower face PDO threads and dermal filler to the chin. mental crease, and marionette areas.
You appear to be a better non-surgical candidate based on your photos. You ideally on want two surgical facelifts in your lifetime. There are many non-surgical methods and devices used to treat your concerns. Ultherapy, RF microneedling, Botox, dermal filler, PDO threads, etc.
A good facelift should not alter your facial expressions in any way. While nerve damage can rarely occur with facelift procedures, they are usually temporary. Good results should make you look like a younger more rested version of yourself!
I do not think a breast lift is necessary in this case. In my opinion, you have pseudoptosis, which describes a breast in which the nipples themselves are in a proper position but a significant portion of the breast tissue has dropped inferiorly. I have a great experience with performing a dual-plane dissection in which through an incision in the fold under the breast, dissection is first performed on top of the muscle up to the areola, then the remainder of the dissection of the breast implant pocket is created under the muscle. In this way, the implant is 1/2 to 2/3 covered by muscle and the lower portion by breast tissue. By separating the lower portion of the breast from the muscle, the nipple gets a little lift. I would also use a higher profile implant which provides more projection and contributes to a more elevated nipple position. Since you don’t have true ptosis, I don’t feel a breast lift is needed.
You can definitely have a tummy tuck after liposuction. There are increased risks for skin loss if you combine liposuction of the central abdomen with a simultaneous tummy tuck but as long as the tummy tuck is performed at least six months after the liposuction procedure it is totally safe. It is very common to benefit from a tummy tuck after having children since this procedure removes the extra lower abdominal skin and tightens the abdominal wall which has been stretched out from pregnancy. You should have no risk of additional complications because of your previous liposuction and should be able to obtain satisfying results.
Thank you for your question. The ideal placement for breast implants is under the muscle.
Thanks so much for submitting your question and photos. From the pictures, it looks as though the rippling is only seen when you are leaning forward/downward and only in the medial aspect of the breasts. Otherwise, it does look like you have a good result. Fat transfer can help solve the problem of rippling as well as implant placement below the muscle, but do not always work to prevent rippling depending on your body habitus (thin breast tissue, etc). Using a more cohesive style breast implant such as an Inspira SSF or SCF can help prevent rippling. An SSF (soft touch) implant is considered more cohesive than a normal SRF Inspira implant, but still retains its softness – an SCF (cohesive) implant has the most cohesivity and will be most firm but will help most to prevent rippling. I hope this helps answer your question. Best of luck with your recovery and enjoy your new look!
You will need a lift. The choice of augmentation or not is a person one so you will have to speak to your surgeon and decide what is best for you and your body.
It has been a while since we spoke but you might try Dr. Paul Ruff. He is well trained and has a great deal of experience.
It does appear the implants have at least one side bottomed out again. This is not an unusual problem with implants this large or tissue that has lost its elasticity. It is very possible that your tissues have lost a great deal of their elasticity with your significant weight loss. In that scenario, larger implants will tend to bottom out more because those larger implants weigh more. Activity level can also play a role. Finally, the type of repair may play a role. It appears you had a circumareolar mastopexy as well. You will almost certainly need a revision of the capsule. This could be done with the cautery technique or a combination of cautery and suture or even the use of an acellular dermal matrix as a support sling. If there is still an issue of skin laxity then you will need a revision mastopexy. You might consider a vertical mastopexy or an inverted T mastopexy.
It appears that you would benefit from waiting for a total of about three months until the scar tissue has had a chance to mature.
I agree, you appear to have implant malposition with vertical excess. You would benefit from some internal modification of the pocket with cautery, sutures….