Raymond Goh

Hi. I am sorry to hear of the trauma that you are going through. The surgical incision/scar seems a little high for a standard tummy tuck, but there may have been a particular reason for that decision. Now that we are faced with an open wound, the goals are to promote healing and to prevent infection and further tissue necrosis. One method that may be considered is a negative pressure dressing, which sucks on an enclosed wound and promotes tissue ingrowth. Without seeing you in person, it’s hard to give specific advice. Make sure you see a qualified and experienced specialist plastic surgeon who can help you get the best possible outcome. All the very best.Dr Ray Goh

Hi. Thanks for posting your question regarding an augmentation after breast lift.Although there may be some extra internal scarring present, we would approach you scenario as we would a primary breast augmentation case. If your breasts are in a good shape and the nipples sit in a good position, you will do well with implant augmentation.All the very best.
Dr Ray Goh

Hi. Thanks for your photos and questions.
It looks from the limited facial photo that you have a deficient chin. Augmenting this, either through an implant or an genioplasty (where the bone itself it advanced forward), will balance out the face and reduce the "double chin" appearance. Adjunctive liposuction to the submental region may further define the lower face. Neither procedures will change he sagging of the lower lip and mouth area. 
An eyelid procedure, if not complicated, can certainly be done at the same time, with the understanding of course, that this will impact upon the recovery.
All the very best.
Dr Ray Goh

Hi E1098.
You have excellent breast symmetry and shape to start with to get a good result from breast augmentation. You will do well with either round or anatomical (tear-drop) implants. My preference for you would be a round implant, as I believe this will give a natural result, provide upper pole fullness, and negate some of the potential down sides of anatomical implants (such as rotation). The implants should be placed sub-muscle/dual plane for better long term result. In terms of size and shape, this will be determined by your breast anatomy and goals. I think that an implant in the high 300's will give you at least a full C if not more. All the very best.
Dr Ray GohValley Plastic Surgery

Hi EmmaG1993.
Cup size can be quite variable, depending on the size/shape of your breasts as well as your chest, and should not be the ONLY outcome factor when working out the type and size of breast implants you're going to have. For example, a similar volume of breast tissue in two persons with different body types and builds can equate to different cup sizes. Remember also that computer imaging can only provide an approximate indication, and cannot guarantee direct correlation with eventual results. 
The important factors in assessing and determining the type and size of breast implants that is right for you are your breast dimensions and the volume you are desiring. I find it helpful for the patient to "try" on different implant sizes under the bra to get an approximate feel of what volume they are happy with. Sure, one can accommodate a larger dimension implant by lowering the inframammary fold; however, you must remember that lowering the inframammary fold does carry its risks, including implant displacement or "bottoming out".
If you are unsure or anxious, I would suggest that you consult with your surgeon to discuss further and to clarify plans.
All the best.
Dr Ray GohValley Plastic Surgery

Hi Newgirl1234567,
It is quite normal to be nervous before any surgical procedure, no matter how large or small, and be it reconstructive or cosmetic in nature. If you are anxious about your procedure, you should be in contact with your surgeon and their staff to make sure all your questions and concerns are addressed. It is important that you have established trust in your surgeon and their team, that you both have mutual goals in mind, that you are aware of the potential risks and complications, and that you are well prepared for your recovery. 
All the very best.
Dr Ray GohValley Plastic Surgery

Hi Sheba. 
It is very common for the native breast tissue to droop over existing breast implants in women who have breast fed. The picture you have uploaded don't seem to appear for some reason. If you can try to upload them again, perhaps I  can give you a better idea of what needs to be done to improve the shape of your breasts. In general however, the option is to either improve the position of the nipple and shape of the breasts with a mastopexy (breast lift) alone over existing implants, or to replace the implants together at the same time as the breast lift. To achieve symmetry, one may consider removing a bit more breast tissue from the larger breast. I would suggest a thorough examination and discussion with a qualified and experienced plastic surgeon. 
All the very best.
Dr Ray GohValley Plastic Surgery

Hi FEEGEE.
Thank you for posting your questions and photos.

What is it that you are wishing to achieve? A change in size? An improvement in the shape of your breasts? Or both? The photos show a degree of ptosis (droopiness) to your breasts. In order to improve the overall shape of your breasts (tightness of breast tissue, and position of nipple), I think that the only option you have is a mastopexy, which will likely involve an anchor scar. Keep in mind that although the scars will still be visible, over time, they usually fade away to become quite inconspicuous.
All the very best.
Dr Ray GohValley Plastic Surgery

Hi Michelle.
Thank you for posting your questions. When it comes to breast implants, there is no absolute need to replace implants after a certain time if there is nothing wrong with them or if you have not had any problems with them (eg. capsular contracture, ruptured implant, displacement etc). Having said that, implants made 25 years ago are unlike the quality and longevity of modern implants, and there is a high possibility that they may have leaked/ruptured. I would first of all assess the integrity of the implant with an ultrasound scan, followed by a review with a plastic surgeon to discuss your options.
All the very best.
Dr Ray GohValley Plastic Surgeon

Hi there Abfab.
Thank you for posting your photos and questions. 
It would be helpful to see a front-on photo as well as a photo that shows the relation of your nose to your chin. However, from what I can see, you may be deficient in the projection of your chin. This can often reduce the overall masculinity of the face, and make the lower face blend onto the neck. 
Liposuction can certainly be considered to reduce fullness of the submental region; however, the balance of your face and definition of your jaw may never be ideal without addressing the underlying bony architecture, 
Hope this information helps.
Dr Ray GohValley Plastic Surgery

Hi Juliaanna1701.
Thank you for posting your questions. Without photographs, it is very difficult to give accurate advice. 
The difference between 185 and 215 is very small (30cc), and in general should not make a significant difference in the overall cup size, unless of course your frame is very small (which you may be). Additionally, size is a very subjective matter. As long as the dimensions of the implant fits the patient's frame, the final judge on what is too big or small in general lies with the patient. They type of implant also plays a role in how they feel. As far as the pain and aches are concerned, I would seek the assessment of a plastic surgeon to see what may be causing this.
All the very best.
Dr Ray GohValley Plastic Surgery

Hi Theloveofa.
Thank you for posting your enquiry.
From the photo provided, it seems that your breasts are fairly symmetrical and of good shape to begin with, so a breast augmentation alone should give you the desired natural look. Selecting the right implant type and size is a process undertaken during the consultation, based on your body dimensions and the desired volume increase. Many patients also find it advantageous to "try" on the implant to see and feel if it's what you are looking for.
Please feel free to contact my office on (07)34888118 or email info@valleyplasticsurgery.com.au, and one of my friendly staff members can discuss this further with you or arrange a consultation.
Best regards,Dr Ray GohValley Plastic Surgery

Hi Rachrach.
Thank you for posting your enquiry and photos.
You have quite marked breast asymmetry and a degree of ptosis (droopy). You will not get a satisfactory result in my mind with implants alone, even if using implants of different volumes. Your breasts will need both volume equalization as well as reshaping. Improving the shape of the breasts will involve adjustments of the nipple position and breast tissue, and this will incur scars on the breasts. I think the best approach for you will involve both implants as well as a lift, whether this be done in one stage or separated into two.
All the very best.
Dr Ray GohValley Plastic Surgery

Hi Sylve.
Thank you for posting your photos and questions. Your photos reveal current asymmetry between your left and right breasts, likely due to the ruptured implant which has been documented. You do not display significant ptosis that will require a lift, especially if you wish to up-size. You have to bear in mind however, that there may be some degree of residual asymmetry after a remove and replace with capsulectomy. The other factor to keep in mind is that a high volume implant (700cc) will take a strain on the breast supportive tissue and can have negative long term consequences. 
All the very best.
Dr Ray GohValley Plastic Surgery

Hi there Sissy2016.
It is apparent from your photo that the caudal (lower) part of your septum is deviated and protruding into the left nostril. This may in some people cause nasal dorsum and tip deviation and occasionally breathing obstruction. A septoplasty to straighten the deviated portion of the septum would be my initial thought. A thorough clinical review is of course required to figure out functional as well as cosmetic aspects of your nose that you would like corrected.
All the very best.
Dr Ray GohValley Plastic Surgery

Hi Net84.
Thank you for posting your photo and questions. During consultation, discussion will be focused on your goals and clinical findings. Obviously, trying to achieve (as close to) symmetry will be one of those goals. You also have to think about what size and shape breasts you wish to achieve. Are you happy with your current volume, but just want to lift the breasts up? Or are you looking for increased cup size as well? 
Looking at your photo, you have a significant degree of ptosis (droop). Therefore, I do not think you will be able to get away without some kind of lift procedure, which will entail external scars. This comes as an inevitable compromise toward getting good breast shape control. Most scars however, tend to fade with time, and patients are generally happy with their new breast shape despite having external scars.

Hope this information helps.
Best regards,Dr Ray GohValley Plastic Surgery

Hi Jane2712.
Thank you for posting your questions. The attached photo certainly demonstrate the lower facial jowls that you speak of.
It is true that terminology circulating in popular media about facelift procedures can be very confusing (mini lift, S-lift, SMAS lift, deep-plane lift etc etc). Even amongst experienced facelift surgeons, there are variability as to which technique each surgeon would consider "mini". In general, I think the term "mini" facelift would entail a more limited incision (scar), a more limited extent of dissection into the face, and with or without some tightening of the underlying fascial layer. A full (or more extensive) facelift is certainly more invasive, and naturally, would carry more recovery time and risks. I would often warn patients that a more limited facelift surgery may not get as much improvement or that the improvement may not last as long. Which procedure that is best suited for you often comes down to a trade-off of pros and cons, and so the risks and benefits or each method have to be discussed and considered.
I hope this information is of help.
Best regards,Dr Ray Goh Valley Plastic Surgery

Hi TT@99.
What you have been advised is fine. It shouldn't have any significant implication toward your BA surgery.
All the very best.
Dr Ray GohValley Plastic Surgery

Hi Indiana01.
Thank you for your post. Looking at your photos, you should be able to get a good result with implant augmentation alone. The type of implant, pocket/plane, and technique will be determined by the type of result you're wishing to achieve.
All the very best.
Dr Ray GohValley Plastic Surgery

Hi Honeycakes.
It's best to check with your surgeon and also anaesthetist. 
The impact any recent illness has on surgery is particularly relevant toward the anaesthesia risks. A respiratory infection affects your lungs' oxygenation capability, and therefore can increase the risks of complications and prolong recovery. Whether you will be fit enough to undergo elective surgery safely will largely depend on the assessment and comfort level of your surgeon and anaesthetist. 
I hope this helps.
Dr Ray GohValley Plastic Surgery

Hi Shannonmummy. Thank you for your post.
Without photographs, it's hard to advise specifically. If you are 16J to begin with, my immediate thoughts would be a breast reduction alone. Breast reductions performed well can achieve not only a functional improvement, but also be aesthetically pleasing. You certainly will not be able to achieve an "augmented" or "fake" look with a breast reduction alone, and there is often deficiency in the upper pole. Keep in mind that the result from an implant with a reduction/lift performed at the same time can often be less predictable than a lift/reduction alone, as you are introducing the extra factor of an implant, and where it eventually settles will somewhat influence the final shape of the breast and the position of the nipples. Sometimes, to achieve a more predictable result, we may choose to perform a reduction/lift first, followed by implants at a second stage.
I hope this information is of help.
Best regards,Dr Ray GohValley Plastic Surgery

Hi Melrihani.
Thanks for posting your photos and questions. 
Have you had breast reduction, breast lift (mastopexy), or breast implants with a lift (augmentation mastopexy) procedure? This is important to know, as it can indicate different risk factors and healing potential. It seems from the photo that you have a small area of wound dehiscence. This may also represent a little suture abscess. These will usually heal well with simple conservative management through dressings. However, if you have silicone implants in place, an open wound does place an increased risk of infection to the implants, and antibiotic cover should be at least considered.
You should continue regular follow up with your surgeon to ensure you're progressing ok.
All the best.
Dr Ray GohValley Plastic Surgery

Hi Twinkltoes.
It is difficult to assess your nose without a full set of photographs taken from several angles. What I can see from the provided photos however is that you may be dissatisfied with the length of the nose, a possibly droopy tip, and the flared nasal alars.
In any rhinoplasty consultation, it is important to have a frank discussion with your surgeon to narrow down what areas of your nose you are not happy with and your desired outcome, and to know if techniques can be utilised to reasonably achieve this outcome. Equally as important in any rhinoplasty is the presence of any functional or breathing issues that you may have. Costs for a rhinoplasty will vary widely depending on what needs to be done. It will also depend on whether it is purely for cosmetic reasons or if there is a functional aspect involved as well.
All the very best.
Dr Ray GohValley Plastic Surgery 

Hi Macas08.
Thanks for posting your photo and question. It would be helpful in your assessment if a frontal photograph was available; however, judging by the available photo, your nipple position and glandular distribution don't seem too bad. You may be able to achieve a good result with implants alone. It would be best to seek a specialist opinion though to make a definitive assessment.
Best regards,
Dr Ray GohValley Plastic Surgery

Hi Pande13.
Thank you for posting your question on breast reduction.
Although mainly a functional procedure (reducing the weight of breasts in order to help with back/neck aches), the aesthetic outcome is equally as important in breast reduction surgery. Your plastic surgeon needs to know what your desired size is. No one can absolutely guarantee the eventual size, since various factors such as scarring, fat atrophy, and leaving enough tissue to keep the nipple complex viable, can impact upon this. Having a mutually agreed goal in size however, will help toward achieving your desired result.
All the very best.
Dr Ray GohValley Plastic Surgery

Hi there Funsun.
Scarring post any elective surgical procedure is determined in general by two categories of factors:1. Patient factors: genetic predisposition to adverse scarring (keloid or hypertrophic). This is often related to racial predisposition to adverse scarring. Other patient factors include smoking and general healing ability.2. Surgical factors: these include tissue handling and the way the wound was closed and supported. 
If a patient was prone to adverse scarring, then all measures to prevent this from occurring are employed. These can include but not limited to: internal sutures to take the tension away from the skin surface, skin taping for additional support, and topical creams and gels. Despite all measures, some patients will still have a scar that is less than ideal. You do however need to give scars time to mature and fade. 
The location of the incision (inframammary crease, around the nipple areola, or in the axilla) should not determine whether you are going to get a better scar or not. 
I hope this is of help. 
All the very best.
Dr Ray GohValley Plastic Surgery

Hi Rach8. Thank you for posting your question and photo. 
I can see that you have a hairless area on your forehead and anterior scalp (alopecia). This can occur when some of the hair follicles do not survive the surgical trauma and scarring process. Scars can certainly be revised and improved. How this is done is decided upon assessing what the scar and the quality of the surrounding tissue is like. The aim would be to make it a less conspicuous scar. 
All the very best.
Dr Ray GohValley Plastic Surgery

Hi Sammay.
Thank you for posting your photos and questions.
Looking at your photos, I believe that if you have implants alone, you are at very high risk of early recurrent ptosis, where the native breast tissue droops over the implant. If you are ok with the restoration of volume but less-than-ideal shape of the breasts, then implants alone may be considered. You can always return secondarily to perform a lift procedure if you are dissatisfied with the eventual breast shape. Doing a breast lift secondarily may also produce a more predictable result. 
The other option is obviously an implant with a lift (mastopexy); however, as you know, this comes at the expense of scarring. Most scars will fade away in time though.
Weighing up the pros and cons and deciding on the best procedure to achieve your desired goals is all part of the consultation process. A thorough assessment and good communication with your surgeon will ensure the right procedure is chosen for your particular situation.
All the very best.
Dr Ray GohValley Plastic Surgery

Hi Sammy-Jo. Thank you for posting your questions and photos.
A question you have to ask yourself is what your desired outcome is: is it an improvement in breast shape alone or improved breast shape AND volume. If you are happy with your current volume but just wish to have the ptosis (droopiness) improved, then a breast lift (mastopexy) is all that is required. 
The other option if you wish to have more volume in addition to correction of the droop is a lift with an implant. Your degree of ptosis will not deliver a good result with implants alone. The type of implant used in a lift with implant will be dependent on your existing chest anatomy as well as surgeon choice.
All the very best.
Dr Ray GohValley Plastic Surgery

Hi Closer. Thank you for posting your question.
The only thing that can be offered for a sub-optimal scar this far down the tract post surgery is a scar revision. Steps can be taken to make the new scar less visible, such as taping, massage, and topical applications. There is however no guarantee that the new scar will not be visible.
I would suggest seeing your plastic surgeon to discuss if this could be an option.
All the very best.
Dr Ray GohValley Plastic Surgery