Stay still but pay attention - If you are afraid of needles, don't make yourself writhe with discomfort by thinking about them. Set your mind on something random, like monkeys juggling pineapples. The Botox will be over before you know it. Stay still but pay attention and follow your doctor's instructions. He/she will tell you to smile, relax, frown, etc. during the injection process.
A great question that comes up often.  A breast reduction will both reduce the breast size and improve the shape of the breast while lifting it.  During this surgery, breast tissue is removed while preserving the tissue around the nipple.  The breast is then shaped and nipple placed in a higher, more ideal position.  This is essentially the breast lift component of this surgery.  With the reduction, we are accomplishing both. Hope this helps. 
The correction of capsular contracture might require an open capsulotomy (surgical release) of the collagen-fiber capsule, or the removal, and possible replacement, of the breast implant. Furthermore, in treating capsular contracture, the closed capsulotomy (disruption via external manipulation) once was a common maneuver for treating hard capsules, but now is a discouraged technique, because it can rupture the breast implant. Non-surgical treatments for collagen-fiber capsules include massage, external ultrasonic therapy, leukotriene pathway inhibitors such as zafirlukast (Accolate) or montelukast (Singulair), and pulsed electromagnetic field therapy (PEMFT).[60][61][62][63]
The saline breast implant—filled with saline solution (biological-concentration salt water 0.90% w/v of NaCl, ca. 300 mOsm/L.)—was first manufactured by the Laboratoires Arion company, in France, and was introduced for use as a prosthetic medical device in 1964. The contemporary models of saline breast implant are manufactured with thicker, room-temperature vulcanized (RTV) shells made of a silicone elastomer. The study In vitro Deflation of Pre-filled Saline Breast Implants (2006) reported that the rates of deflation (filler leakage) of the pre-filled saline breast implant made it a second-choice prosthesis for corrective breast surgery.[88] Nonetheless, in the 1990s, the saline breast implant was the prosthesis most common device used for breast augmentation surgery in the United States, because of the U.S. FDA's restriction against the implantation of silicone-filled breast implants outside of clinical studies. Saline breast implants have enjoyed little popularity in the rest of the world, possessing negligible market share.

Constance Chen, MD, board-certified plastic surgeon and breast reconstruction specialist, adds that the FDA is currently looking into fat grafting to see if there’s a risk of breast cancer associated with it. Other nonsurgical augmentations with saline or injectable fillers are extremely dangerous and not recommended, says Lara Devgan, MD, board-certified plastic surgeon and RealSelf Chief Medical Officer. “We do not understand how injectable fillers interact with breast tissue in the long run,” she explains.
It is certainly possible to lift a breast without changing the volume or removing any tissue, however, the breast will sometimes appear smaller after this procedure due to its position. It is also possible to reduce breast volume without lifting the tissue (usually via liposuction) but all reductions that are performed by making incisions will also include a lift.

Both anesthesiologists and registered nurse anesthetists can administer anesthesia. An anesthesiologist is a specially trained physician who will administer anesthesia and monitor your vital signs during surgery. A registered nurse anesthetist has specialized training to do the same.  However, while a registered nurse's services can cost about $300 per hour, an anesthesiologist's services can cost closer to $500 per hour.


Transaxillary: an incision made to the axilla (armpit), from which the dissection tunnels medially, to emplace the implants, either bluntly or with an endoscope (illuminated video microcamera), without producing visible scars on the breast proper; yet, it is likelier to produce inferior asymmetry of the implant-device position. Therefore, surgical revision of transaxillary emplaced breast implants usually requires either an IMF incision or a periareolar incision.
Both anesthesiologists and registered nurse anesthetists can administer anesthesia. An anesthesiologist is a specially trained physician who will administer anesthesia and monitor your vital signs during surgery. A registered nurse anesthetist has specialized training to do the same.  However, while a registered nurse's services can cost about $300 per hour, an anesthesiologist's services can cost closer to $500 per hour.
Textured implants were designed to lessen the risk of capsular contracture, which is an excessive contraction of the scar capsule that surrounds the implant, by preventing scar tissue from forming around the implant in a uniform manner. However, studies have proven inconclusive and no firm evidence exists to support the theory that textured implants reduce the risk of capsular contracture. If a patient requires implant removal due to capsular contracture or another complication, it may be more difficult for the surgeon to remove the implant because of the adherence of tissue to the textured surface.
It has been shown that the rates of capsular contraction are much lower when the breast implant is placed below the muscle. Also, with the implant below the muscle, there is that extra layer of tissue between the visible part of the breast and the implant, therefore making it more difficult to be detected by touch and maintain the natural feeling of the breast. The breast will look more natural with this method as you will not be able to visibly see the edges of the implant.

Breast implants are available in a variety of sizes. You should decide the cup size you want if you are considering breast augmentation. It is also important to make sure that you are not opting for a size that will be too large for your breasts. Breast implants are inserted by making an incision under the breast. So make sure you don’t opt for a size that is too big for your body and chest.

In the mid-twentieth century, Morton I. Berson, in 1945, and Jacques Maliniac, in 1950, each performed flap-based breast augmentations by rotating the patient's chest wall tissue into the breast to increase its volume. Furthermore, throughout the 1950s and the 1960s, plastic surgeons used synthetic fillers—including silicone injections received by some 50,000 women, from which developed silicone granulomas and breast hardening that required treatment by mastectomy.[112] In 1961, the American plastic surgeons Thomas Cronin and Frank Gerow, and the Dow Corning Corporation, developed the first silicone breast prosthesis, filled with silicone gel; in due course, the first augmentation mammoplasty was performed in 1962 using the Cronin–Gerow Implant, prosthesis model 1963. In 1964, the French company Laboratoires Arion developed and manufactured the saline breast implant, filled with saline solution, and then introduced for use as a medical device in 1964.[88]


One advantage of liposuction is that it won’t give you scars or loss of nipple sensation. Women who are in their menopausal years are the best candidates for liposuction because the fat content of the breasts increases during these years. Your skin has to have excellent elasticity for liposuction to work well. You also have to have a normally positioned nipple.

Saline-filled Breast Implants. Saline-filled breast implants are filled with sterile saline (salt water). They come in both smooth and textured shells and can be round or anatomically (tear-drop) shaped. Saline breast implants are also available in low and high profiles, and in many sizes. A saline-filled breast implant is usually empty before implantation. The doctor moves it into place during your surgery, and then fills it. The saline is administered via a process that ensures the implants remain sterile.

Private surgical suites, usually located in the surgeon's office, carry the least expensive facility fees. Usually ranging in cost from $1,000 to $3,000 per procedure, a private surgical facility can offer many advantages. The doctor is very familiar with the facility, and is likely working with the same staff members who have assisted in many previous surgeries. I operate in a certified private surgical facility where my patients enjoy the ultimate privacy and personalized care. In this setting, I am able to hand-pick each of my staff members personally, from nurses to anesthesiologists.
The correction of capsular contracture might require an open capsulotomy (surgical release) of the collagen-fiber capsule, or the removal, and possible replacement, of the breast implant. Furthermore, in treating capsular contracture, the closed capsulotomy (disruption via external manipulation) once was a common maneuver for treating hard capsules, but now is a discouraged technique, because it can rupture the breast implant. Non-surgical treatments for collagen-fiber capsules include massage, external ultrasonic therapy, leukotriene pathway inhibitors such as zafirlukast (Accolate) or montelukast (Singulair), and pulsed electromagnetic field therapy (PEMFT).[60][61][62][63]
Your plastic surgeon will give you instructions on how to prevent these complications. If you have a high temperature, it’s a sign of an infection. If you monitor your temperature daily, you’ll be able to head off an infection in the early stages. Darkening of the skin is another red flag sign and your surgeon should be notified almost immediately. Vomiting, convulsions and loss of consciousness are signs that something needs to be checked medically – quickly.
While you can read about all of this online, it's best to hear it straight from your doctor's mouth. Also, ask about what your doctor will do on the off chance that something goes wrong with your Botox treatment. If you have significant bruising, will he give you a discounted v-beam laser treatment to minimize the bruising? If you end up with Spock brows, will he fix them free of charge? What if your Botox wears off in a week, will he give you an additional touch-up for free? Do not be afraid to ask questions! It's better to have answers before than after.
The current lifetime risk of BIA-ALCL in the U.S. is unknown, but estimates have ranged between estimated to be between 1 in 70,000 to 1 in 500,000 women with breast implants according to MD Anderson.[73] Certain geographic locations have demonstrated variable risks. For instance, a December 2016 update from the Therapeutic Goods Administration of Australia and New Zealand reported a risk of 1:1,000 to 1:10,000 for textured implants.".[71] To date (2017), there has not been a case of BIAL reported where the patient had only implantation of smooth shell breast implants or a textured tissue expander that was exchanged for a smooth implant. The paucity of cases reported in Asian populations has raised the possibility that there may be a range of genetic susceptibility to the phenomena, or alternatively merely reflect differences in how cases are identified and reported.
Women who are experiencing mild sagging, yet still will benefit from a breast lift, are often good candidates for a peri-areolar lift. This involves a circular incision running around the edge of the areola, and like the crescent lift, is commonly performed in conjunction with breast augmentation. This lift can also be effective in helping reduce areola size. The resulting scar traces the edge of the areola.
At the initial consultation, your plastic surgeon will discuss his or her ideas on how the procedure will be done as well as what type of results you can expect. He or she should have a large book of before and after photos that you can spend time looking at. When looking at these, consider the height, weight and build of the person in the photos and whether it matches yours or not. If it matches your specs, then it’s more likely you could have similar results.
Furthermore, The Effect of Study design Biases on the Diagnostic Accuracy of Magnetic Resonance Imaging for Detecting Silicone Breast Implant Ruptures: a Meta-analysis (2011) reported that the breast-screening MRIs of asymptomatic women might overestimate the incidence of breast implant rupture.[53] In the event, the U.S. Food and Drug Administration emphasised that “breast implants are not lifetime devices. The longer a woman has silicone gel-filled breast implants, the more likely she is to experience complications.”[54]
All patients experience some pain in their breasts, chest and/or back after surgery. Most patients take only plain acetaminophen  (Tylenol) and Celebrex as prescribed for pain control. If you are unable to take Celebrex, acetaminophen  alone may be sufficient. Begin taking acetaminophen elixir (liquid) or tablets for pain as soon as possible after surgery.  If this is not sufficient to control your pain, begin taking any prescribed narcotic(Vicodin, Percocet, Darvocet, Tylenol  #3) pain pills as directed. If you did not receive a prescription for narcotic pain medication and you feel you need something  stronger for pain control, please contact us as directed below. Prescribed narcotic pain medications can make you sick to your stomach. Take them only after you have had something to eat. I recommend you take a dose of either  acetaminophen or narcotic pain medication before you go to bed the first night or evening after surgery. Set an  alarm clock to wake yourself up 4 hours after you go to bed. Take a second dose of the same pain medication then  resume your rest until morning.  Ice application during the first 24 hours after surgery will also reduce pain and swelling. Apply ice bags to  your breasts for 20 minutes at a time followed by 10 minutes of rest. In other words, apply ice to your  breasts for 20 minutes of every half an hour. When applying the ice bags make sure there is a small amount  of water in with the ice at all times. Your skin should feel cool to the touch. Do not use frozen gel packs.  It is not necessary to apply ice while you are sleeping at night.
A breast implant is a prosthesis used to change the size, shape, and contour of a person's breast. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast mound for post–mastectomy breast reconstruction patients or to correct congenital defects and deformities of the chest wall. They are also used cosmetically to enhance or enlarge the appearance of the breast through breast augmentation surgery.
Breast augmentation with implants is the surgical way to make your breasts fuller and perkier immediately. There are a lot of choices that are available. No specific choice is the best when it comes to breast implants. Every types of breast augmentation has its own pros and cons which needs to be considered. All women have different bodies, with different needs. The best way to choose the perfect implants is to understand the factors and your needs. Then go through your options. Always opt for the safest option and try to give your health the greatest priority while choosing breast implants and make sure you can select the option with the help of your chosen surgeon.
There are cases where some patients are wanting a very unnatural or obviously augmented look. This can be created by placing the implant over the muscle, as it allows you to really define the sharp edges of the implant, which in turn will create a very obviously implanted look. Aside from that, the advantages of going over the muscle can come in terms of the fact that you are preserving the strength of the pectoralis muscle. Some patients who are athletes or weight lifters, may want to ensure that they are maintaining 100% of their power and strength, therefore if the breast implant is placed over the muscle it allows them to maintain their ability to bench press at their highest weight. Furthermore, there are some patients which due to their anatomy, it is required to place the implant over the muscle. For example, if they had a previous breast augmentation where the breast implants was placed under the muscle that left significant scarring or if they had a severe capsular contraction, it would be recommended that they switch the location of the implant. Another benefit to having the breast implant placed about the muscle is that it can offer a more defined round shape if the patient’s breast has tissue that takes on a different shape.
When it comes to determining the prominence and size to utilize for the breast augmentation, the first step is to determine what are your goals/desires for the end result. Once you have decided on what you would like the final result to look like, the surgeon will make recommendations and suggestions based on your body type and build as to what they know will be able to achieve your goal, or get you as close to them as safely possible. An individual may want a specific size, but the surgeon will be able to tell if that is a realistic option for that individual or not. For example, if the patient’s chest is small and the breast tissue is tight, it will not be recommended to use a large implant as it will not fit. This is why a surgeon with clinical experience is beneficial, because they will be able to help you understand and guide you towards the best implant for your body. It is not uncommon for patients to become focused on details such as the actual volume of CC’s, however, you need to keep in mind that there are many varying factors that have to be considered by the surgeon when recommending the best implant for your body so try not to get too caught up in those details and trust your surgeon.
Most experts agree that Botox can also be a preventative measure for some younger clients, ‘It preserves the skin and stops lines developing,’ explains Spyrou. ‘Botox softens and temporarily freezes the muscles, which means the treated area will stay flat. If you can’t physically frown, then over time, the line will smooth out.’ That being said, there's a lack information about the long term effects of starting botox at a younger age. "The long term safety data in these treatments is usually focussed on older individuals." Says Dr. Justine Hextall, Consultant Dermatologist on behalf of The Harley Medical Group. So as with most cosmetic procedures, there are risks.
A breast reduction with lift surgery combines two procedures to improve the size and shape of the breasts. A reduction involves decreasing the size of overly large breasts by removing excess tissue and skin. A breast lift is done in order to raise and reshape the breasts. The breast reduction and lift procedure helps to alleviate problems caused by overly large, sagging breasts, including:
Ambulatory surgical centers are more expensive than private offices. These venues are owned by a third party, and provide everything your surgeon needs to safely perform rhinoplasty and other cosmetic surgery procedures. They typically charge by the hour. Ambulatory surgical center fees are usually around $3,000 or more for a single rhinoplasty procedure.

When the patient is unsatisfied with the outcome of the augmentation mammoplasty; or when technical or medical complications occur; or because of the breast implants’ limited product life, it is likely she might require replacing the breast implants. Common revision surgery indications include major and minor medical complications, capsular contracture, shell rupture, and device deflation.[44] Revision incidence rates were greater for breast reconstruction patients, because of the post-mastectomy changes to the soft-tissues and to the skin envelope of the breast, and to the anatomical borders of the breast, especially in women who received adjuvant external radiation therapy.[44] Moreover, besides breast reconstruction, breast cancer patients usually undergo revision surgery of the nipple-areola complex (NAC), and symmetry procedures upon the opposite breast, to create a bust of natural appearance, size, form, and feel. Carefully matching the type and size of the breast implants to the patient's pectoral soft-tissue characteristics reduces the incidence of revision surgery. Appropriate tissue matching, implant selection, and proper implantation technique, the re-operation rate was 3 percent at the 7-year-mark, compared with the re-operation rate of 20 per cent at the 3-year-mark, as reported by the U.S. Food and Drug Administration.[64][65]
The breast cancer studies Cancer in the Augmented Breast: Diagnosis and Prognosis (1993) and Breast Cancer after Augmentation Mammoplasty (2001) of women with breast implant prostheses reported no significant differences in disease-stage at the time of the diagnosis of cancer; prognoses are similar in both groups of women, with augmented patients at a lower risk for subsequent cancer recurrence or death.[103][104] Conversely, the use of implants for breast reconstruction after breast cancer mastectomy appears to have no negative effect upon the incidence of cancer-related death.[105] That patients with breast implants are more often diagnosed with palpable—but not larger—tumors indicates that equal-sized tumors might be more readily palpated in augmented patients, which might compensate for the impaired mammogram images.[106] The ready palpability of the breast-cancer tumor(s) is consequent to breast tissue thinning by compression, innately in smaller breasts a priori (because they have lesser tissue volumes), and that the implant serves as a radio-opaque base against which a cancerous tumor can be differentiated.[107]
Breast reduction surgery, or reduction mammoplasty, can instantly and effectively reduce breast size through the removal of excess breast tissue. Breast reduction is a surgical procedure that involves the removal of excess skin, fat, and glandular tissue to reduce breast size, eliminating the negative issues associated with breasts that are larger than the patient desires.  Usually, the breast is lifted significantly and enlarged areolas are reduced.  The tissue removed can also be sent to a pathologist for breast cancer screening if the patient desires.
Subfascial: the breast implant is emplaced beneath the fascia of the pectoralis major muscle; the subfascial position is a variant of the subglandular position for the breast implant.[77] The technical advantages of the subfascial implant-pocket technique are debated; proponent surgeons report that the layer of fascial tissue provides greater implant coverage and better sustains its position.[78]

The ASPS and the Plastic Surgery Foundation (PSF) have partnered with the FDA to study this condition and in doing so created the Patient Registry and Outcomes For breast Implants and anaplastic large cell Lymphoma Etiology and epidemiology (PROFILE). The United States FDA strongly encourages all physicians to report cases to PROFILE in an effort to better understand the role of breast implants in ALCL and the management of this disease.[74]


Rhinoplasty can be performed in one of three places: private surgical suites, ambulatory surgical centers, or hospitals. You should speak with your surgeon and make certain that their chosen venue has been accredited by an organization such as the American Association for Accreditation of Ambulatory Surgical Facilities (AAAA), the Accreditation Association for Ambulatory Health Care (AAAHC), or the Joint Commission for Accreditation of Healthcare Organizations (JCAHO).
Traveling long distances or for long periods of time can be problematic after surgery. Generally, I do not recommend traveling longer than one hour for one week after surgery. When you do travel you must have help at all times with your baggage (do not lift more than five pounds for three weeks) and you must get out of your seat and walk for five minutes every hour. Remember, even small vibrations during travel can increase the amount of pain you experience. Finally, you will not have the same energy level as you did immediately before your surgery.

There are cases where some patients are wanting a very unnatural or obviously augmented look. This can be created by placing the implant over the muscle, as it allows you to really define the sharp edges of the implant, which in turn will create a very obviously implanted look. Aside from that, the advantages of going over the muscle can come in terms of the fact that you are preserving the strength of the pectoralis muscle. Some patients who are athletes or weight lifters, may want to ensure that they are maintaining 100% of their power and strength, therefore if the breast implant is placed over the muscle it allows them to maintain their ability to bench press at their highest weight. Furthermore, there are some patients which due to their anatomy, it is required to place the implant over the muscle. For example, if they had a previous breast augmentation where the breast implants was placed under the muscle that left significant scarring or if they had a severe capsular contraction, it would be recommended that they switch the location of the implant. Another benefit to having the breast implant placed about the muscle is that it can offer a more defined round shape if the patient’s breast has tissue that takes on a different shape.
In 1999, the Institute of Medicine published the Safety of Silicone Breast Implants (1999) study that reported no evidence that saline-filled and silicone-gel filled breast implant devices caused systemic health problems; that their use posed no new health or safety risks; and that local complications are “the primary safety issue with silicone breast implants”, in distinguishing among routine and local medical complications and systemic health concerns.”[113][114][115]
Breast reduction involves reducing the size of the breast. A breast lift involves lifting the nipple-areolar complex and reducing the excess skin of the breast. Breast reductions can involve just liposuction in patients who have more fatty tissue than glandular breast tissue. Liposuction alone indeed does reduce the volume of the breasts. However, sagging of the breast can result and liposuction alone is therefore performed usually in highly selected patients.
The first step toward finding out if you are a candidate is a thorough consultation with a board-certified plastic surgeon who has extensive experience performing breast augmentation. He or she will examine your breasts, your skin tone and the rest of your anatomy to help determine if you are an appropriate candidate. You also may have the option of viewing plastic surgery photos from past patients to better gauge expectations. Other factors, including breast augmentation cost and whether your lifestyle and commitments will allow you to take enough time off to recuperate properly, also play a role in determining your candidacy.
The selection of a particular shape of implant is based on the look that the client is seeking to achieve. Feedback from patient tends to indicate that gel breast implants offer the most realistic feel. Silicone implants are filled prior to surgery, therefore require a slightly larger incision for insertion than saline. Smooth and textured shells of saline implants provide a beautiful shape to the breast.
Don't be afraid to ask questions. Make a list of questions you want to ask your physician and bring it with you to your Botox consultation. That way you won't forget what you want to ask. Ask how much the treatment will cost, how many units of Botox you will need, how long the he/she has been giving Botox injections, etc. Ask about side effects, risks, and how you should take care of your skin after Botox and how often someone with your skin condition should get Botox.
Breast implants are available in a variety of sizes. You should decide the cup size you want if you are considering breast augmentation. It is also important to make sure that you are not opting for a size that will be too large for your breasts. Breast implants are inserted by making an incision under the breast. So make sure you don’t opt for a size that is too big for your body and chest.
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