Richard Bosshardt

One of the first things I tell all young women seeking breast implants is this, and I emphasize that, if they remember nothing else from the consultation, they should remember it: it is not "normal" to have implants put into your breasts. The range in size and appearance of otherwise normal breasts is huge and there is no such thing as the "perfect" breast as this is in the eye of the owner or beholder of those breasts. Breast augmenation is an inherently unnatural thing to do and achieving a perfectly natural, i.e. normal result is a combination of good judgement, good surgery, a compliant patient, and, yes, a little bit of luck. Having said all of this, it is common for breasts to look a bit odd or visibly augmented early on. Putting implants into a small breasts will initially make them firm and tight, and the shape will often look unnatural, with too much fullness in the upper chest. I have patients do some simple things to encourage the implants to settle: regular breast massage, taking a daily vitamin E supplement, and wearing a snug sports bra for a few months. If the implants are really too high, I will use an elastic band (bandeau) for a few weeks to help them drop. In nearly all cases, the breasts will look as they should within 3 months, usually much less. If the implants are really big or the pockets have not been properly tailored, the breasts may never look normal. I can do everything just right and in a very few patients, the implants will simply not settle as they should. This is what keeps, or should keep, plastic surgeons humble. Sensitivity in the breasts, especially the nipples can be diminished after breast augmentation. This can be permanent to some degree in about 10% of women. It may take a year or more for normal sensitivity to return.
If a plastic surgeon does not inform prospective breast implants about everything that can go wrong with the surgery, either immediately or years later, they are not doing their job.  
Don't forget what I said at the top. An augmented breast is no longer normal. Normal was what you were trying to change. 
Best, R. Bosshardt

Richard T. Bosshardt, MD, FACSBosshardt & Marzek Plastic Surgery Associates1879 Nightingale Lane, Suite A-2Tavares, FL 32778Tel: 352-742-0079Fax: 352-742-0059

There are so many variations to facelifts that it is hard to keep track of them all. One universal goal is to obtain maximal results with minimal surgery. This reflects a disconnect with the reality of facial surgery. A properly done, traditional facelift is a major surgery that involves extensive, but very well hidden, incisions, wide release of the skin of the lower face and neck, and tightening of both the skin and underlying muscles of the face. It takes several hours, requires real anesthesia, and has a real downtime of 7-10 days with a total recovery time measured in months. Lesser procedures, often referred to as mini-facelifts, can produce OK results in carefully selected patients, but it is agreed that the results will either not be as good as for a full facelift, will not last as long, or both. What constitutes a mini-facelift is open to question. Some mini-procedures involve little more than a very small incision, a stitch or two to tighten the muscle, and that's about it. One should view these with some skepticism, especially if the surgeon is promising dramatic results. The best example of this is the now defunct LifeStyle Lift, which at one time was the largest provider of facelifts in the US. It was essentially a mini-facelift that promised incredible results with little surgery and just local anesthesia. Why is it defunct? There are several reasons. It did not work well as evidenced by over 50% unfavorable reviews online. The Lifestyle Lift stayed afloat as long as it did due to its saturation marketing but that caught up to it. It was fined in New York for false advertising and in Florida the Attorney General made it stop calling the surgery "revolutionary" and hyping it other ways. Eventually, the company went bankrupt from falling revenues and excessive costs of advertising. There is no single procedure called a "one stitch facelift" and I would be very skeptical of anyone doing such a thing and promising great results. 

Richard T. Bosshardt, MD, FACS

There is no single operation called a mini-face lift. A mini-facelift is anything less than a full facelift. A full facelift involves making extensive incisions on the face through which the skin is widely released, facial muscles can be tightened with stitches, and excess skin removed. The scars, while lengthy, are usually almost invisible if properly placed. It requires proper anesthesia, either local with intravenous sedation or general anesthesia. In my practice, nearly all patients are asleep for this. The healing time is 7-10 days and total recuperation is measured in months, not weeks. It can produce astounding results that look very natural and last a lifetime. The most well known "mini" facelift was the LifeStyle Lift which, at one time, provided the largest volume of facelifts in the US. Where is it today? The company went bankrupt for several reasons. Results were too often disappointing, with 50%+ negative reviews online. I saw many unhappy patients from this. It was also dishonest in its advertising and was subject to the largest fine in history by the state of New York for false advertising. In Florida, the Attorney General demanded it cease to call the procedure "revolutionary". Eventually, the company went under. Mini-facelifts can be offered to select patients who can accept modest results that won't last as long. I most often do these in combination with something else, like fat grafting to the fat.

Sure. The only reason to limit caffeinated beverages is if you are one of those woman whose breasts become more lumpy and/or tender if you drink anything with caffeine in it. It has no bearing on breast augmentation surgery.

Usually through incisions inside the mouth although sometimes they can be place via an incision in the eyelid or even through a facelift incision. I don't do this operation. Cheek implants can shift, can sometimes be seen or felt, and can get infected. A better way to enhance flat cheeks is by using your own fat, which is natural and, when successful, permanent.

There are a variety of ways to lift cheeks. A facelift will do this to some degree and some facelift variations target the mid cheek area. Barbed threads have been used but work poorly and I won't use them. Fat grafting is an excellent, permanent way to add volume to the cheeks and this can produce a "lift" effect as well.

I am not sure what you mean by "knuckle" surgery. I do a lot of hand surgery but do not what you are referring to with this description. Any hand surgery that involves joints can be quite painful initially and require an extended period of recuperation including, at time, hand therapy.

Of course, but this is rarely indicated. If you are overweight, the solution is not fat removal but weight loss. Some people have a fat pad in the middle of the cheek removed to make their face look thinner. I think that this is a bad idea more often than not. One of the inevitable accompaniments of aging, unless you are overweight, is loss of fat in the face, making you look gaunt. It is not a good look. More people are actually putting fat into the face these days than taking it out.

A rhinoplasty, the medical term for a nose job, can be done to improve breathing, to enhance the look of the nose, or both. When done for breathing problems, insurance may cover this. A cosmetic rhinoplasty must be paid for by the patient. Be sure you see an experienced surgeon and by all means, have them show enough before and after photos to insure they do the kind of work yoiu are looking for. I no longer perform rhinoplasties in my own practice. It is an operation you have to do a lot of to do well and I just don't see enough patients seeking this.

In most surveys, there is a bell-shape curve, meaning the most of the numbers fall somewhere in the middle. With respect to breast implants, the most common implant size is 350 cc. My practice pattern follows this. This size implants works well for the majority of women of normal stature. It will usually increase bra cup size anywhere from 1-2 cup sizes. Bra cup size is a very imprecise way to assess breast size because there is no standard for A, B, C, D, etc. cups. Every manufacturer uses different guidelines for their bras so comparisons are very difficult. Think of it this way: if you bought a bunch of different 12 inch rulers and each one was a different length, it would make inches a useless measurement. Bra cup size is useful as a guide, nothing more. The best you can do is wear the same style bra from the same manufacturer but even this will not be precise.

Botox is extremely safe when purchased from reliable sources and properly used. True reactions or allergies to it are extremely uncommon. The two most common adverse reactions are not satisfactorily accomplishing the goal of quieting the muscles that are injected and migration of the Botox to other muscles nearby. The first can occur because of mishandling Botox, which is a very delicate material and can be inactivated by jarring or excessive stirring. The second can result in things like a droopy eyelid. Fortunately, all Botox side effects are temporary because Botox is temporary. There is no antidote so all you can do is wait it out. Brusing from the injection can occur but is uncommon. I have not seen any other issues from Botox in over 15 years.

You are asking the wrong question. Properly done eyelid surgery lasts forever. The question is: how long before the ongoing process of aging might make another surgery desirable or necessary. That one is impossible to answer for any individual since many factors affect how we age, to mention that individual desires and expectation may change with time as well. You should look good after eyelid surgery for years.

Pain, like beauty, depends on who is judging. Facial plastic surgery in general is not regarded as a painful process. Most facelift patients, for example, have relatively little pain postoperatively. When I do a full facelift combined with a laser or chemical smoothing of the skin around the mouth, patients often tell me that the lesser procedure hurt more than than the major work. If your surgeon is experienced, he or she will will insure that you are as comfortable as possible after surgery. No surgeon wants their patients telling others that the operation was very painful. This is not the way to gain word of mouth referrals.

This is a general term to denote a non-surgical procedure intended to produce a visible rejuvenating effect. It may involve injection of any number of materials. There are various commercial fillers out there. There is one procedure using one's blood, the so-called "vampire" facelift to rejuvenate the face. All of these have in common that they produce very minimal to, at most, modest results, when they produce results at all. None have replaced a properly performed surgical facelift.

I do not believe lasers work for stretch marks. These are permanent scars produced by tearing of the underside of the skin from overstretching such as from growth spurts, weight gain, and pregnancy. There is probably a genetic tendency to stretch marks. I purchased the only FDA laser approved for scars several years ago. After using it on several patients for acne scars and stretch marks, I concluded that it was totally worthless. I quit using it altogether even though I paid for it over the next several years. Won't do that again!

Sure, but you won't want to mash on it or manipulate it in any way for a couple of weeks. Your surgeon will tell you what precautions to take.

I don't do them. Don't like them. They are nowhere near as popular as they once were due to problems like shifting out of position, becoming visible or palpable, and infection. If you need more volume in your cheeks, fat grafting using your own fat may be a wonderful option and is permanent. Best of all, it is your own fat so no rejection, etc.

In my opinion, liposuction is not a way to lose weight. A few surgeons do large volume liposuction, with removal of many liters of fat, but this is major surgery with significant, real risks, and some have died from this. If you are truly overweight, you should look at your diet, activity level, and lifestyle before turning to liposuction. A liter of fat weighs about 2 lbs. In Florida, no more than around 4 liters of fat, or about 8 lbs, can be removed in an office setting at one time.

All liposuction results are permanent, whether good or bad. They can be modified only with more surgery. Time and weight changes will definitely have an effect on the results.

There is no best age. Most patients will fall in the broad "middle-age" category. It is a matter of what you are trying to correct and what results you expect. This can only be determined in a face to face meeting with a plastic surgeon. I tell many propective patients to wait a few years and then return to revisit their situation. There is no upper limit. My oldest facelift patient was 95. It is more a matter of your desires and expectations and your overall health to withstand the rigors of anesthesia and surgery.