James C. Grotting, M.D., FACS
I am interested in having my breasts enlarged. Which is better—implants under the pectoral muscle or over it? It seems to me that if they are over the muscle, the implants could sag over time due to their weight and the elastic property of skin. Also, is it possible to have a facelift and breast lift done at the same time?
There are a variety of factors that influence the decision of whether implants should be placed above or behind the pectoral muscle. In women who are relatively thin with minimal breast tissue above the nipple, saline implants are better concealed behind the muscle and the appearance may be more natural. On the other hand, women who have some drooping of the breast gland and thicker fat above the nipple often will get a better lifting effect from placing the implant on top of the muscle. The larger and heavier the implant is, the more gradual stretching of the skin and breast you will have over time. You will want to discuss these and other factors – such as how implant placement may affect mammography -- with an ASAPS-member plastic surgeon. In healthy patients, breast and facial surgery can be safely done at the same time.
I've heard about a Deep Plane Facelift that is performed deep under the facial muscles. Is this better than the standard facelift and more long lasting? Are there more complications, and is this a fairly common procedure among surgeons?
Since we now know that all the layers of the face gradually droop with aging, most facelift techniques are designed to restore all these layers -- the skin, muscle, and fatty tissue -- to a more youthful position. The deep plane facelift refers to the lifting of the various layers of the
face as a single unit rather than separating and lifting them individually. Many surgeons prefer the deep plane approach when performing a secondary facelift (a facelift on a patient who has had a lift in the past) in order to avoid the scar tissue from the previous operation. In the right hands, most facelift techniques give excellent and long-lasting results with low complication rates. The deep plane facelift is probably less common than some of the other methods, but those surgeons who use it often advocate its use for all facial rejuvenation candidates.
Can a tummy tuck be performed on a 33-year-old woman who has not yet had children but is planning to do so? If so, will I have any problems during/after birth?
An abdominoplasty (tummy tuck) can be performed on a 33-year-old woman who is planning to have children. If you are considering this, however, you should be aware of the following: 1) Abdominoplasty involves not only removing loose skin, but also muscle plication (tightening), both of which will be exposed to the stretching/expanding forces of pregnancy. Therefore, there is no guarantee that you will be able to maintain the results of the abdominoplasty after your pregnancy. You might need to undergo additional procedures, including a revision of your muscle plication/abdominoplasty. 2) While the muscle plication will be stressed during pregnancy, labor may be easier because the abdominoplasty will have improved the function of the rectus muscles (the vertical muscles in the abdomen). The pregnancy should not be any more difficult: your skin will stretch regardless. The muscles also may also stretch, however, which might require the revision mentioned above.