Both procedures offer excellent results in the right candidates. A board certified plastic surgeon may have a personal preference, based on his or her personal experience and outcomes. Because there is an artistic component to plastic surgery, you may hear various recommendations from plastic surgeons. It is important to view before and after pictures of a surgeons's work to ensure that you admire expected results.

I prefer an endoscopic or subperiosteal approach in the right candidate, as I find it minimally invasive, relatively easy to recover from, predictable, and I like the natural look it achieves.

Facelift

There is no point in exchanging your implant to a smaller size. If you want to be smaller breasted, you should remove your implant. Implants are chosen to fill an individual's breast dimension. You need to provide a certain diameter of implant to allow appreciable fullness at the periphery of a breast mound. Think of roughly 200 cc as a cup size. Downsizing your implant to say 100-150 cc will not provide you any shape, and the smaller diameter implant will fall to the outer aspect of your pocket. Think of this like a golf ball floating around in your pre-exisiting pocket dimensions. In removing your implant, expect more apparent sagginess to your breast, especially once your contracture is released and your capsule is removed. To re-contour your breast, a breast lift is usually the best option. I would not necessarily expect a 'B' cup after explantation. If you are a DD, and simply the 320 cc implant is removed, you may have a considerable amount of overlying breast tissue to maintain a full cup breast. 23 years have passed, and your body changes. Certainly, this can all be estimated at the time of your surgical consultation.

Breast Augmentation

Recovery and rest are important to successful outcomes after plastic surgery.  Compliance with post-operative instructions decreases risks for complications.  Abdominoplasty is a major surgical procedure which requires at least 2-3 weeks of limited activity, and 6 weeks or longer of no strenuous activity such as heavy lifting and fitness activities.  I would include with this list forceful activities such as carnival rides, horseback riding, etc.  Using good judgment and some common sense are also key to a non-complicated recovery process and a good result after cosmetic surgery.  You need to see your physician for evaluation after experiencing symptoms after a carnival ride.  Non-compliance with post-operative activity restrictions can lead to complications such as bleeding, swelling, seromas (fluid collections), and wound or muscle separation, with a less than optimal surgical result.

Tummy Tuck

Liposuction removes fat - do not think of it as a skin-tightening procedure.  Even the laser liposuction does not provide a consistent skin tightening effect.  Patients will have a variable degree of skin tightening, subtle, related more to inherent skin elasticity versus technique used.  Each pregnancy with associated weight gain stretches the skin, and decreases elasticity.  Elasticity also decreases with increasing age.  So there is always a chance of skin looseness as your body changes with time.  Some patients get lucky and the skin looseness is not apparent most of the time, perhaps becoming more visible in the sitting or bending over position.  Usually results of liposuction hold up fairly well if your body snaps back to your pre-pregnancy weight, and you are in good shape, which it sounds like you are.  So if you are a good candidate for the procedure now, I would go ahead with it.  You never know what the future may bring, and worse case scenario, if you end up with skin excess after your next pregnancy, a skin-tightening procedure, such as a mini or full abdominoplasty, can always be performed.

Laser Surgery

It is quite simple to perform an earlobe reduction.  A wedge of redundant earlobe can be removed and the remainder rotated together and closed.  A small scar will result, but it is hardly perceptible.

Ear Reshaping