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Q&A with Dr. Levens

September 2016: Various

Q:  I am going to the Caribbean for Christmas week and am wondering if I would have time to fully recover from a breast augmentation and a tummy tuck?  Want to look great in my bikini!!!
A:  Good for you.  Sounds like a wonderful vacation.  With Christmas about 8 weeks away, you would have enough time to look "great" in your bikini but have to factor in the time to get the procedures scheduled.  Initial Recovery time for a breast augmentation is just 5-7 days with swelling remaining up to 8+ weeks.  Recovering from a tummy tuck is a longer time frame.  You should allow at 2 weeks to return to work and 6 weeks for full activity

Q:  Do facelifts and eyelid surgeries remove crow's feet?
A:  Generally not.  A toxin like Dysport or Botox along with in office skincare and laser treatments as well as take home products are usually the most effective ways to treat these fine lines.  Facelift and eyelid surgeries remove excess skin to address deeper wrinkles and saggy skin.

Q:  Are all injectable wrinkle fillers basically the same?
A:  No.  They are used for similar "filling" purposes but have different chemical makeup, duration of efficacy, and recommended uses.  Some can better address fine lines while others are better for adding volume to an aging face.  Depending on the facial areas of concern, your board certified plastic surgeon should have a variety available and will make his/her recommendations.

Q:  Does liposuction result in significant weight loss?
A:  No. Liposuction is not a weight loss procedure.   Weight loss is typically minimal from lipo alone but the resulting removal of diet resistant fat will create a slimmer appearance.  We advise our patients that they should be within 10-15% of their ideal weight for best results.

Q:  Can I have a breast lift without having implants?
A:  Yes.  A breast lift (mastopexy) can be done with or without implants and generally depends on the individual and the look you want to achieve.  A breast lift without implants will give you a natural and often smaller breast shape by raising the position of the nipple, reducing the size of your areola (if needed), and removing the excess skin.    If you want more fullness at the upper chest, then you will likely need implants in addition to the lift.

August 2016: All About Men

Q: Is Cosmetic Surgery just for women?
A: Absolutely not! Traditionally, women were the more common consumers of cosmetic and plastic surgery but with the increase in use and popularity of many non-invasive alternatives, men now make up a considerable portion of the cosmetic surgery market.

Q: What can I do about the crow's feet around my eyes and the laugh lines from my nose to my mouth. I think they make me look older than I feel?
A: Botox® and Dysport® are the most popular toxins that can be injected to reduce the appearance of crow's feet (as well as the "11"s between the brow and the horizontal forehead lines). The muscles around the eyes that cause the crow's feet are "relaxed" by the toxin, keeping the action from occurring and thus, the lines are diminished. The effect usually lasts about 4 months and can be repeated.

Your laugh lines can be treated with a number of fillers, including Juvederm®, Restylane®, and Radiesse®. The lines are softened and the effect lasts 6+ months. These non-invasive procedures offer minimal to no downtime and will give you a rested and rejuvenated look.

Q: This is a little embarrassing, but despite being fit and in shape, I seem to have enlarged breasts.
A: Don't be embarrassed. Your condition is called gynecomastia, a surprisingly common male condition that is easily treated. Depending on the severity of your condition, the procedure will include liposuction or excision or a combination of both. Downtime is minimal and the results are excellent.

Q: I don't like my neck. What can I do about it?
A: There are a number of options depending on your condition, whether caused mostly by skin laxity or excess fat or a combination of both. There are minimally invasive injections (Kybella®) to destroy fat cells and skin tightening treatments using Infrared or Radio Frequency energy for loose skin. If treatment beyond these methods is needed, a more traditional surgical neck lift might be necessary. Schedule a consultation with a board certified plastic surgeon to help sort out the best options for you.

July 2016: Mommy Makeover

Q: I've heard a lot of talk lately about a "Mommy Makeover". What exactly is that?
A: "Mommy Makeover" is a popular term used to generally describe plastic surgery procedures to address breast and abdominal changes resulting from pregnancy. For the breasts, it can involve augmentation (for women who have lost significant volume without droopiness), a lift/reduction (for those whose breast have more significant droopiness) or a combination of the two. For the abdomen, the procedures can be an abdominoplasty - addressing significant skin and muscle laxity, a mini-abdominoplasty if the problem is confined mostly to the lower abdomen and occasionally liposuction only for reshaping. A consultation with a board certified plastic surgeon will help to determine the best option for you.

Q:  Should I wait until I am done having children?  And what happens if I do get pregnant down the road?
A: It is best to wait until you are done having children as that is when most of your body changes occur.  Should you become pregnant after a "Mommy Makeover", you may lose some of the improvements that you achieved with surgery. A further procedure may be indicated should you desire improvement again.

Q:  Is it safe to do all that surgery at the same time?
A: If you are in good health, in the care of an experienced board certified plastic surgeon having the procedures done in an accredited facility, the combined procedures are quite safe.

Q:  I am "long past" my children's births, approaching 60 - but don't like the look of my breasts and tummy.  Am I too old for a "Mommy Makeover"?
A: That is a good question. Older Moms with grown children may now have more time and be more prepared to "take care" of themselves. Your concerns can still be addressed as long as you are in good health.

Q:  How long after my child is born should I wait to do a "Mommy Makeover" and how long is the recovery?
A:  It is best to be back closest to your pre-pregnancy weight, usually at least 6 months or more after childbirth before you proceed.  With a Mommy Makeover, if a tummy tuck is indicated, that is the longest recovery. You should be able to return to limited activities and "desk job" within 2 weeks but be prepared for a full 6 weeks for complete recovery.

June 2016: Lip Enhancement

Q: Lip enhancement seems to be the "in" thing these days. I am in high school. Am I too young?
A: While there is no specific age restriction, it is always best that you are old enough and mature enough to understand the risks and consequences. I generally do not advise this procedure for patients younger than 18 or 19 years.

Q: I have heard that there are the risks and consequences of lip enhancement? Can you explain?
A: Typically a soft tissue filler (hyaluronic acid HA) injection is used to enhance the lips. There is mild pain, swelling and bruising. Each patient is different and some bruise and swell more than others. Refraining from aspirin and aspirin-containing products 5-7 days prior to injection may reduce your likeliness of bruising. Bumpiness and unevenness can also result. If you are prone to cold sores let your physician know and an antiviral medication can be prescribed as the injection may provoke a breakout.

Q: I see people that look like ducks, I don’t want that!
A: Like all cosmetic procedures, an artistic eye and good judgement are essential to achieve the best results. There is a proper proportion for the upper and lower lip fullness. The lower lip should always be fuller. It is important to respect the normal lip anatomy and landmarks such as the cupid’s bow of the upper lip. The degree of enhancement is individual and should be discussed fully with your physician prior to the procedure.

Q: I'm afraid of putting something foreign into my lips. Can I use my own body fat?
A: Yes, fat injection can be utilized to enhance your lips but requires that fat be removed from another area such as your abdomen. Fat has the advantage that it may be longer lasting as it is living tissue that will pick up circulation. Typically the HA injections only last 4-6 months.

Q: Is there any other longer lasting option? Or even a permanent solution to thin lips?
A: There are soft silicone lip implants that can be easily implanted into the lips under local anesthesia. Some patients find them to be too stiff; if it becomes too bothersome, the implant can be removed.

May 2016: Safety First

Q:  I'm getting so nervous.  I've seen a lot in the news recently about deaths from plastic surgery.  Is cosmetic surgery safe?
A:  Yes, cosmetic surgery can be very safe.  However, as with any surgical procedure, there are potential risks and complications.  Since cosmetic surgery is elective (purely optional), minimizing risks should be the first priority for both you and your plastic surgeon. Who you choose to perform your procedure, where it is performed and your general health are three of the main components to ensure a safe and successful outcome.

Q:  How do I know if both the surgeon and the facility where he/she performs surgery are reputable and safe?  
A:  There are a few initial questions to ask or search for on the internet before your consultation.

  • Your surgeon should be fully trained in his/her specific area of expertise. For example, liposuction should be performed by a board certified plastic surgeon and not a medical doctor with a few weekend courses in cosmetic surgery.
  • Your surgeon should be Board Certified by one of the member boards of the American Board of Medical Specialties. A list of those boards can be found here:
  • The facility should be accredited by state and federal ambulatory and hospital accreditation standards.
  • Be sure that your surgeon is credentialed (has privileges) at a local hospital to perform the same procedure planned for you at an office or outpatient facility.

Q:  Why does my surgeon need to ask me so many personal questions about my history, including medicines, vitamins, herbal supplements, smoking and drug use?
A:  You should be glad that he/she asks all those questions because having a complete picture of your medical history and current health is vital prior to undergoing any surgical procedure.  YOU, along with your surgeon, are both responsible for minimizing risks and insuring a good outcome.  Being honest about your health, social history (drinking and smoking) and medications are paramount. Certain prescribed medications as well as vitamins and herbal supplements may need to be stopped before your procedure.

Q:  I am considering a Brazilian Butt Lift and everyone is telling me that it is a very dangerous surgery.  I've heard people die from that procedure.
A:  First off, a Brazilian Butt Lift is no more dangerous than any other cosmetic procedure as long as the precautions and guidelines outlined above are followed.  The procedure involves injecting fat removed by liposuction from other areas of your body to shape and enhance your derrière.  If your surgeon has good experience with the procedure and after thorough discussion and examination determines that you are a good candidate then the risks and complications from a Brazilian Butt lift can be minimized.

April 2016: Breast Enhancement and Gynecomastia

Q: I am confused. How do I know if I need a breast lift or just implants or both?
A: It can be a little confusing but there are a few basic guidelines - breast drooping, nipple position and your desired post-op breast size.

Generally, an augmentation with implants only would be appropriate if you are looking for enhancement in breast size and you have no drooping or only mild drooping of your breast and nipple (your nipple position is still straight ahead and not pointed down).

A lift (mastopexy) alone without implants is best if your drooping is more severe, your breasts are an adequate or overly full full size and you are comfortable with a slight reduction in volume.

A combination lift with implants is indicated if your drooping is severe and you desire larger breasts. Implants add upper breast fullness, something that cannot usually be achieved with a lift alone.

Q: I am a young man who works out regularly and is quite lean but I suffer from embarrassing breast "fullness" on my chest. In some shirts, I look like I have breasts! Can something be done about this?
A: The condition is called gynecomastia and is quite common. It actually is excess breast tissue and in the majority of men, there is no known cause. However, anabolic steroid use can sometimes cause this condition. The treatment is a very straight-forward, outpatient surgical procedure with a quick recovery and very satisfactory results.

Q: I am considering a breast augmentation. Are silicone implants safe?
A: Yes. They are an excellent option and the primary choice for the vast majority of breast augmentation patients. That said, saline implants are also a good option.

Q: I've heard that my breast implants have to be replaced every 10 years?
A: This is a common misconception. Although not lifetime devices, breast implants often last well beyond 10 years with continued good results and should only be replaced if there is a problem.

Q: I am considering a breast reduction. Will I lose nipple sensitivity and will I still be able to breast feed down the road?
A: Although temporary numbness/sensory changes can occur in the post-operative period, most patients regain normal sensation within the first year. As for breast feeding, the ability to nurse is most often not compromised yet not guaranteed.

March 2016: Sculptra® Aesthetic and Laser Treatment

Q:  I heard Sculptra® is a "natural filler"?  Can I have it injected for my facial wrinkles?
A:  Sculptra® is not actually a filler, but a product that stimulates your own collagen production.  The changes noted are more gradual but ultimately are longer-lasting than traditional fillers, such as Restylane® and Radiesse®.  Think of it as a "volumizer" that over time (and a number of sessions spread out over several months) restores your fullness and a more youthful appearance.

Q: I am 50 years old and have my daughter's wedding in 6 months.  I want to look "refreshed" without looking "done".  What would you suggest?
A:  First off, congratulations! Generally, for a 50-year-old we would address both volume and skin texture.  You could start with facial fillers and toxins (Botox® or Dysport®) to address lines and wrinkles.  Sculptra® could be a great product for you.  The results are gradual and the 6 month window would give you time to see changes.  For pigmentation and skin texture issues, I would have you consult with our Medical Aesthetician, Stacey, for her recommendations for peels and laser treatments.

Q:  How do I get rid of brown spots on my face and chest?
A:  We have a couple of options that will be helpful to you.  In our Med Spa, we offer Photo Facial Laser treatments, microneedling, peels and home care medical-grade products specifically designed for pigment issues.  A complimentary consultation is the best way to determine which option is best for you.

Q:  Can Laser Treatment be used to treat my son's acne?  It's not severe, just persistent.
A:  We offer a laser treatment for mild to moderate acne.  It does involve about 10-12 treatments over a period of a few months.  Results are optimized about one month after the last treatment.

Something on your mind?  Email us at and we will either answer you directly or feature your question in our monthly Q & A.

RealSelf Q&A with David J. Levens, MD