1 I do not want to have the skin that look too tight like some actresses on TV.

First of all, a first surgery on somebody whose aging is not severe won’t entail this kind of deformation.  After many surgeries, there is a risk of certain rigidity in the facial expression because this skin is more scarred and there is a lack of flexibility.  The facial muscles during the mimes will less manage to pull the skin so giving an aspect of mask.


2 Finally, I would just like to look rested and I do not want my friends to notice it too much.

If you appear to be in the mid-forties and if the signs of aging are not too much marked, a new hairstyle can mystify some of your friends who will find you rested.  However, if there is rather visible chops and that the fold between the superior lip and the cheek is marked, creating a groove, that the skin of the neck is withered, loosened, or that we can see some vertical strips on each side of the Adam’s apple, even if the surgery is a success, you won’t be able to hide it.  You will have to accept the fact you cannot hide the surgery, and not to feel guilty of having it.


3 Like many I smoked for a long time and I present smoker’s wrinkles to the superior lip.  What is the best treatment and is it durable?

Since the wrinkles are pronounced, it is needed to find the best treatment.  If we choose to do a gritting, a laser or a chemical peeling, the treatment can be rather deep, enough to create the formation of a crust in some patients.  The area will be pinkish like an oven burn on your forearm.  We can hide it with some foundation cream (makeup) for a month or two.  The result is lasting.  This procedure won’t make 100% of the wrinkles disappear, but it is really worth it.


4 How long before I can go back to work?

If it is a complete facelift (eyelids, face and neck) usually three weeks of rest are enough.  In the case of a facelift or a neck lift, usually two weeks is sufficient.


5 One of my friends had a lift a couple of months ago; it became loose since that time, is it because the surgeon did not tighten it enough?

Having released the skin, the surgeon puts it under stress to determine what has to be removed.  Since he does not have any device telling him how much can be removed, his experience will tell him what tension limit he can apply to secure the stitches.  Afterwards, depending on the elasticity of the skin, a certain relaxation will occur in the months post-operatively.  If the patient wishes to go further, it is sometimes useful to do a small lifting under local anesthesia of the region to optimize the result.

1 I heard that the implant has to be changed every ten years, is it true?

The estimated duration of an implant is from 15 to 20 years. There is no reason to replace an implant if it is not ruptured. In the case of a saline water implant, the breast is going to diminish in a couple of days. The water which will drain through the perforation will be reabsorbed by the body and be eliminated. In the case of a silicone implant, the breaking won’t be noticeable by a loss of volume. The diagnosis if often put during a mammography or an ultrasound.


2 Is it complicated to replace an implant?

For a saline water implant, the replacement is usually done under local anesthesia. Even though the implant has been emptying itself for a couple of days, the space created to put it years ago does not close rapidly. Then, we only have to do an incision at the site of the scar under local anesthesia, reach the broken implant, remove it and replace it by a new one. The post-operative pain will be limited to the incision site. There will be no pain in the breast area.


3 And to replace a silicone implant, is it that easy?

Silicone implants having a higher rate of stiff scar envelope will require removing the scar envelope and the implant inside. It is a surgery mastered well by the plastic surgeons since they have been inserting implants since 1963.

The scar envelope made by the body to isolate the foreign body varies from a person to another. In most cases, it will have the appearance of an elastic "saran wrap" and the breast will be supple. In approximately 15 to 20% of cases, the envelope will squeeze more and more the implant. If the implant is almost all the breast, we will obtain a breast that is fixed and that does not spread out naturally on the thorax. In patients that gained some weight during the year’s post-implants, you won’t be able to see the deformation but by palpation, you will feel a firm mass inside the breast.

The old stiff envelope tends to develop deposits of calcium that can annoy the radiologists during the screening mammograms because certain tumours contain microcalcifications. We will then start by extracting in one piece the implant and the scar envelope (fibrous shell and fibrous capsule). Although it is easy for a surgeon to install a supple implant through a short incision, it is almost impossible to remove a stiff object the size of an orange from an incision so short. He will then have to make a longer incision that will be located on the natural fold under the breast. When people say that it is necessary for the surgeon to scratch, we easily can imagine the surgeon scraping the ribs. The reality is a lot less dramatic, the surgeon uses an electric pen which allows him to melt the fibres that stick to the orange skin (scar capsule), when he is done, he can remove the implant.

Many implants are located in front of the pectoral muscle. Unless otherwise indicated, the plastic surgeon will lift the pectoral muscle and install the new implant under it. Since it is located in a space that was empty before and since it will benefit from the continual effect of massage by the numerous movements of the everyday life, the implant so positioned will have better chances to develop a flexible scar envelope and thus give a breast that will look natural.


4 Are the implants guaranteed?

The two producers Mentor and Inamed (previously McGhan) will replace the saline implants for life. The patient will only have to pay for the surgery. You have to remember that those fees usually do not appear before 15 to 20 years post-implants for the average patient. A study made by Mentor estimated that there was only a 3% chance for a ruptured implant with the water saline smooth edge implant (the most used ones).


5 What is the difference between a smooth and a textured implant?

The smooth implant looks like a transparent plastic bag and the textured one looks like frosted glass. This is done by a surface with thousands of spicules. Their purpose is to make it more difficult for the body to form a too active scar envelope. It is a question still debated between plastic surgeons and in medical newspaper, some believe it, others don’t.


6 I heard that there is various forms, moderate profile, high profile, droplet, etc… how can I choose?

It is your plastic surgeon, following your exam and by taking into accounts your needs that is the best person to help you choose which implant is the best for you. In 90% of the cases, we use the implant MP (moderate profile). A woman with a narrow thorax who desires an implant with a good volume will be better of with the implant HP (high profile) which has a narrow base; it will prevent the breast to go to the sides. As for the implant in droplet, it is not commonly used. The majority of patients wish a curve at the top of the breast; in the healing process the implant can turn on itself and as a result, if you have the implant in droplet, it can result as having the drop upside down.


7 I am afraid that my breasts will be too big after the surgery.

Our philosophy is to respect your demands. The patient has to make the evaluation of her needs in the privacy of her home. To do so, we recommend getting a thin bra with a complete cap of the desired size. Then using two thin plastic bags (like the ones at the grocery store for fruits and veggies), start by putting 250ml of non-cooked rice in the bag, close it loosely, put it in the bra and shape it to obtain a curvature of the breast. Put an adjusted sweater and look at yourself in a mirror. You can add or remove rice until obtaining the right size. Put the rice that is left in the bags in a measure cup. Bring that to your plastic surgeon and he will help you decide which size of implants is best for you before the surgery. This way, since you have tested the breast size, you do not risk to have an unexpected result.


8 Apparently, there is a different kind of incisions; is it true that we can go in by the navel?

In about 70% of the cases, the incision is under the breast. In 10% of the cases it is semi-circular under the areola and finally, in 20% of the cases, we go in through the armpit. Personally, we do not use the approach by the armpit. The choice of the areola or the zone of the natural fold takes into account the patient’s requests and the technical considerations. In the case where we have to move the areola upward to center it on the new breast, it will be more relevant to limit the sections to the circumference of the areola than to add a second incision in the natural fold under the breast.


9 On the muscle or under the muscle why?

From 1991 until quite recently, the water saline implant was our only option; when a patient bends over to the side, the water moves temporarily to the lateral side of the body and the bag is then containing less water in the sternum region. If the implant was placed only under the breast, we would risk seeing the folds of the temporarily empty implant. The pectoral muscle that goes from the sternum to the shoulder is useful to hide these transitions in a low neckline. It was also demonstrated that there is less hardening phenomena whatsoever for the saline water or silicone implant because this area is constantly massaged by each arm gesture.


10 Am I going to be able to do sports?

After 6 weeks we consider that you can do all your normal activities without limitations.


11 How about going back to work?

The majority of people with office work will be back after 10 days. Physical jobs require a little more (hairdressers, housekeepers, cooks, patient’s care, etc…)


12 I have been hearing that the silicone is dangerous for our health, is it still true?

No, a lot of scientific studies done during the last 15 years all came to the same conclusion. There was no more risks to have silicone implants than to develop chronic fatigue, arthritis, cancer, etc…


13 I am hesitating between saline water and silicone implants?

In the majority of cases where there is a layer of sub-cutaneous fat and mammary tissue, the cushion made by these elements will make the water saline implant less palpable. Recent studies conclude that the rate of hardening ( capsular contracture) is similar between saline and silicone with the actual generation of silicone implants when placed behind the pectoralis muscle ( around 3%). If the patient is very thin and has almost no breast, we will have a good chance to feel the contour of the saline water implant. In that case, the silicone implant is a better.


14 My breast is falling and I do not want to have many incisions on it, is it possible?

When the nipple is at the same height or over the natural fold under the breast, the inflation produced by the implant is going to raise the nipple at the same time. However, if the nipple is lower then the inflation will not be sufficient to lift it and it will be necessary to move the areola and center it when the nipple is of 1 or 2cm.

Ideally, a nipple above the fold under the breast is located 20-21cm of the collarbone or the hollow of the sternum at the base of the neck. A nipple that is located less than 24cm can be re-positioned by removing a crescent of skin to mode it in an ideal position. This lifting technique described by Dr Benelli leaves only a line which makes the circumference of the areola.

In the case where the nipple is lower, it is the breast tissue that needs to be raised upward to be centered in front of the implant; it is then that we will have to perform techniques that leave more scars, like a boat anchor.

In the case of a breast too low and with a certain density it might be necessary to proceed in two steps, the first one being the lifting followed by the augmentation.


15 Do I risk to loose sensibility?

The majority of the patients are going to preserve the erogenous sensibility of the nipple and the areola, but it is not 100% of the patients.

It remains that it is a surgery where we need to create a space to deposit the implant. The sensation is coming especially from the 4th intercostals nerve; under every rib there is a nerve coming from the vertebral column with branches that detect the sensations. The nerve under the 4th rib has a branch that leaves the thorax side and goes up to the tissues near the areola and to the breast skin. It is logical to think that the bigger the implant, the bigger will be the zone where the surgeon will have to unstuck the side tissues; it is in this zone that pass the nervous fibres and most of the time it is impossible for the surgeon to see them and protect them during surgery.

It is normal after the surgery to have a loss of sensibility, particularly in the bottom half of the breast. The sensation will return gradually. Before considering a permanent loss in sensibility, it is recommended to wait at least 18 months post-surgery.

1 1. Doctor can the cellulites which I have on my thighs can be treated by liposuction?

Liposuction is a procedure that is used to eliminate greasy reserves in localized zones. You cannot loose weight using only liposuction. The cellulites which we can see on your legs is more than loosen flesh and to suck up the underlying fat would only worsen the problem.

In the superior and lateral region of your thigh, the "culotte de cheval" (nothing to do with the horse but more with the riding breeches), there is some fat that tends to accumulate in woman. If you have firm flesh, we can suction the fat and the skin will be able to contract itself without any irregularity. It is what your plastic surgeon has to determine while examining you.

On the inside of the thigh, the upper part will be less easy to work with since the skin is very thin (like on the top of your hand). If your skin is loos, a liposuction can cause skin waves, therefore we have to consider the possibility of removing some skin. Sometimes the skin is so loose that not only an edge of skin on the border of the underwear has to be excised, but also a vertical border on the inside of the thigh. The liposuction will make the skin too big for your thigh and it needs to be adjusted.


2 My weight is 180 pounds, I fell like having a nice waist will give me confidence, am I a good candidate?

You have to realize that being overweight means that you have an accumulation of fat, not only under your skin, but also inside your belly and around all your organs and intestine. If your abdomen is 18 inches seen aside, to remove 1 1/2 inch of fat will not make a radical change. If you wish to obtain more comfort when sitting down, a liposuction can have its profits. If the skin is loosened by such a process, the surgeon will probably recommend to remove a crescent of skin in the bottom part of your belly which makes an apron. Making it, he will make sure that there is sufficient tension to avoid waves.

1Is there a surgery which can make stretchmarks disappear?

A stretchmark is a fracture of the elastic fibre of the skin when the tension exceeds the critical point determined by your genetic. For some, it will be a weight gain of 30 pounds, while for others it will be 70 pounds. Some techniques used in dermatology, such as the microdermabrasion or some lasers can ease the redness of the marks, but they are there to stay.

During an abdominoplasty a wide ellipse of lax skin, located between the navel and the pubis in the longitudinal side and from one hip to the other, is removed. The stretchmarks present in this skin will be removed. It is the skin located at the navel height that will be released and pull down to the pubis.


2 If I become pregnant again, what will happen?

Since your belly was returned to the tension it had when you were 18 years old, it will again be capable to distend to allow the growth of the baby.


3 I heard that a surgeon can repair muscles, what does that means?

When examining a muscular man, you can see a line from the breastbone to the pubis that separate the abdomen. During the pregnancy, the tension can stretch this line creating a space that can be up to 2 to 3 inches. The surgeon will bring closer these muscles to the midline.


4 Will the surgery give me a nice waist?

The abdominoplasty has especially a vertical effect, like pulling a blind downwards. The merger of the muscles will help to decrease the relaxation of the stomach at the end of the day, but it will not sculpt your waist.