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Q) My ideal weight of 105, age 54, height 5' and a very petite frame. I have always been plagued by cellulite and plan on lipo for lower body and possible tummy tuck and thigh lift. My consult is set for 5/2 and was wondering if it’s better to lose the weight before. I have read opposing opinions. My weight lose is now moving along after months of being in a stall, I'm at 123 so 18 pounds to go which is coming off nicely in just the last couple of days.

B.S.

A) I would suggest that you consult with your plastic surgeon and let him/her guide you in those decisions.  I always suggest to my patients that they lose as much weight as they possibly can before undertaking any surgery, and I generally see them intermittently throughout the process, so that both I and the patient have a good understanding of the patient’s psychological and body health, contour and symmetry.  

Jonathan Ross Berman, M.D. , F.A.C.S.

Q) I just had liposuction on my upper and lower abdomen and my doctor told me I have to wear the compression girdle for 3 MONTHS. I've read on-line that typically compression garments should be worn for up to a month. Why does my doctor insist on 3 months? My procedure wasn't intense as I was fairly thin before (couldn't get rid of my pouch) and I seem to be recovering well. After a month, would it be okay if I were to wear the garment at night only?

W.M.

A) I certainly cannot advise against what your surgeon has instructed. I can only tell you that generally speaking, depending on the area of liposuction, and the amount of fat aspirated, my patients are usually in a compression garment for approximately 6 weeks.  However, this is very individualized, and I make determinations on a case by case basis, as everyone heals differently, and at a different time rate.  I have had patients wear compression garments for more than 6 weeks, and some less, but this is the general rule for most of my patients.  

Jonathan Ross Berman, M.D. , F.A.C.S.

Q) I had liposuction along the jawline and jowls about four years ago but either the skin didn't tightened or laxed again over time, not along the jawline but further back. I would like to try lipo again to remove the remaining tissue but is it safe to use lipo in the same area as one previously did. Does scar tissue from the previous procedure make doing the procedure again more risky or problematic?

A.I.

A) There is certainly no contraindication to performing liposuction in the same area, as long as it’s indicated.  Many factors are at work here, including your skin tone, elasticity and possible environmental skin damage, all of this needs to be taken into consideration before proceeding.

Jonathan Ross Berman, M.D. , F.A.C.S.

Q) The past couple years my cheeks have fallen, leaving my under eyes partially hallowed and folds around my mouth. My cheeks are now beginning to rest around my mouth and jowl area. I feel much older. I decided to get filler (radiesse) in my cheeks, which I fell helped 20%. Radiesse only attempted to fill in my upper face but ignores the new mass that is my lower face. Is a midface lift is what I need? It puts the pad (my cheeks) back on my cheekbones and out of my lower face. Am I a candidate?

B.K.

A) It’s very difficult to definitively answer your question without seeing you, or at the very least seeing a photo. Depending on the patient and the areas to be treated, I prefer autologous fat grafting, which lasts longer than the fillers.  I often use fat grafting in conjunction with facelift; however, I also have performed full face autologous fat grafting if the patient is a good candidate. 

Jonathan Ross Berman, M.D. , F.A.C.S.

Q) With all the questions I've seen by Realselfers with regards to age and facelifts, many of the plastic surgeons seem to evade the question of why PRACTICALLY facelifts on a young person are a bad idea. Many simply seem to sidestep it by responding with what young people should do instead. Technically, not ethically, why is a facelift on a young person a bad idea? Scarring? Aesthetically looking too "done"? Why?

Thanks.

E.B.

A) On the other hand, are you too old to have a facelift?  Technically, one must put aside thinking about age and consider many factors, including the psychological health of the patient, the skin tone, elasticity and environmental skin damage if any.  I have performed facelift on a patient as young as 38, as she was psychologically healthy, but through heredity and life style, she presented with jowling and deep lines and wrinkles to her face, as well as sagging skin.  This is unusual in someone of this age, but certainly not unheard of.  When I first started out in plastic surgery more than 20 years ago, the general consensus was not to perform facelifts on patients of this age; however, if the individual is a good candidate and is healthy, I feel there is no reason not to proceed. 

Jonathan Ross Berman, M.D. , F.A.C.S.

Q) 3 months ago I had a septoplasty, face/neck lift, endoscopic brow lift, lower bleph, fat grafting under the eyes and in nasal folds, and C02 laser work arond my mouth. I am still quite swollen and look unnatural under the eyes and through my cheeks, and am still pink around the mouth. I am getting concerned that I am just not going to have a good aesthetic result from the surgery. Is the swelling and distortion after three months to be expected or how long should I expect it to persist?

H.F.

A) Swelling after nasal/facelift surgery does, indeed, last a considerable length of time; however, at 3 months you should see dramatic diminishment, although possibly not complete resolution.  If you haven’t done so, you really must sit and speak with your surgeon about this. 

Jonathan Ross Berman, M.D. , F.A.C.S.

Q) I had a full neck lift in conjunction with a face lift and fat implants.It looks worse than it did before surgery. It has been 10 months since my surgery. I also have lines on the sides of my mouth. What can I do? The PS says he is not responsible.

N.H

A) It’s very difficult to definitively answer your question without seeing you, or at the very least seeing a photo. Full face and neck lift with autologous fat grafting certainly should have taken care of your “turkey neck”.  As to the “lines at the side of my mouth”, these most likely should be correctable with the autologous fat grafting.  Any qualified board certified plastic surgeon will explain how he/she performed neck lift, along with facelift, which should give you a smooth, symmetrical and well contoured neck.  Jonathan Ross Berman,

M.D. , F.A.C.S.

Q) I had a face lift in the past, and felt for the most part, just fine. I had absolutely no depression or mood changes. However, some docs are not telling me it is normal to expect a depression after such surgery. Could you please explain why this might be.and how long it can last.

A.K.

A) Some (but not all)  patients do go through a period of depression after major cosmetic surgery of any kind.  I think that this is due to a combination of factors i.e., postop medications and the fact that the patient is confined for a period of time without seeing dramatic results.  In all my years of performing cosmetic surgery, I suspect probably half of my patients experience depression after facelift surgery, lasting just a few days. 

Jonathan Ross Berman, M.D. ,F.A.C.S.

Q) My present physician , to my surprise, told me i must be entirely off all hrt for both 2 weeks post and pre op to achieve significant results. i have not heard this before ever, from all the doctors i have consulted with.. my condition is closely monitored and hrt is well within normal limits and helps me greatly, my condition is stable.. my pcp or hormone sees no justifiable medical reason to warrent d/c hormones, as they pose an insignificant risk. What are the consensue of opinion out here?

M.L.

A) I have never asked my patients to discontinue their HRT before or after facelift, and am unsure of the general consensus in the medical community.  I suspect that if there was strong opposition to this, it would be generally accepted. 

Jonathan Ross Berman, M.D. , F.A.C.S.

Q) The whole left side is lower than the right side. from the eyes nostrols to the lips even. I have used fillers to try to even out my lips. I am considering a nose job but what about the rest?

J.S.

A) It’s very difficult to definitively answer your question without seeing you, or at the very least seeing a photo.  Generally speaking, asymmetries of the face may be corrected with combinations of procedures i.e., autologous fat grafting, other fillers, implants and surgery. 

Jonathan Ross Berman, M.D. , F.A.C.S.