If you’re dreading putting on a bikini because you’re too big in some spots and too little in others, check with a good plastic surgeon. You might be surprised to discover the possible solutions. Often it’s a matter of proportion: small breasts can make full hips look too big, and overly large breasts can make you appear bigger in every way than you actually are. Experts say after a breast enhancement or reduction, you should be completely recovered and ready to hit the beach within four to six weeks.
[better breasts for summer]
go big, or not
Women have more options than ever when it comes to breast implants. While some still request very firm, full, forever-21 breasts, the trend right now is to opt for a more natural-looking implant. “We can help women get the look they are after. In my 
practice, I have fewer women wanting that very ‘augmented’ look and more wanting an enhancement with a natural augmentation,” says Dr. Marissa Tenenbaum, director of plastic and reconstructive surgery at Washington University School of Medicine.
“As women live longer and healthier lives, their desire to look better no matter what their age also increases,” says Dr. Michele Koo, plastic surgeon with Aesthetic & Hand Surgery Institute. “The sizes requested are as varied as the number of women who request them. But the age for first-time breast augmentation is increasing significantly. The age and lifestyle of the patient tends to determine the requested size rather than popular trends or what is in social media.”
choose carefully
In addition to the traditional round silicone and saline implants, there now are teardrop-shaped gel implants that have been available in Europe for the past few years. Fat grafting is another option for women wanting a modest enhancement, although Tenenbaum says the practice is controversial in terms of safety and results.
Choosing the right size and shape has been made easier by advancements in preoperative planning, where surgeons can use 3-D simulations to help patients actually see what they would be getting. “Honoring your body’s dimensions when choosing shape and size is critical to a natural outcome,” Tenenbaum says.
lifts
A breast-lift removes excess skin and repositions the nipple-areolar complex to the middle of the breast mound, Koo explains. Lifts need to be done in conjunction with breast reductions, but they also are a popular choice in other circumstances, like for women whose breasts are altered significantly after multiple childbirths or after losing large amounts of weight.
risk v. reward
According to Koo, breast reductions get ever safer as the understanding of the blood supply in the breast is better understood. “The scars have changed, and rarely do patients need to spend an overnight stay or require drains.”
Tenenbaum says patients commonly ask how long implants will last. It’s also one of the most difficult questions to answer. Implants can last anywhere from 10 to 30 or more years. The newer gel implants seem to be sturdier and last longer, too, she says. Even beyond 30 years, if a woman is doing well and there is no rupture, there is no reason to return to surgery. Signs of implant rupture include hardening (capsular contractures) and breast distortion.
The most important thing for getting the best results is do your homework, advises Koo. She recommends asking for before and after photos, talking to previous patients and looking at patient reviews. You also want to find a surgeon who listens to you and truly cares about what you’re looking for.
[do you dare to bare?]
Underarm sagging is a common problem that occurs with the natural aging of skin, decreased muscle tone and weight fluctuation. But unlike other parts of your body, you can’t always just diet or exercise your way to toned arms. If you’ve done more pushups than you care to count and still don’t like the way your arms look in a sleeveless top, it may be time for a more aggressive approach.
the joys of coolsculpting
For individuals who have good muscle tone and just a little extra weight on their arms, liposuction and the nonsurgical alternative, CoolSculpting, are two options to consider.
“CoolSculpting is a great alternative for busy people who cannot or will not undergo surgery,” says Molly DuBro, a physician assistant at Nayak Plastic Surgery. “With CoolSculpting, we can freeze away stubborn fat in many areas, such as the underarms, abdomen, love handles, and thighs. CoolSculpting alone can offer a 30 percent reduction of fat without the invasive procedure of an upper arm-lift and absolutely no downtime. Clients are able to leave that day and resume their normal activities.”
DuBro says the best candidates for CoolSculpting are those within 20 or 30 pounds of their goal weight who want to improve areas with ‘pinchable’ fat. The procedure is not painful and requires no downtime or recovery, but it will take four weeks to begin seeing results.
how about lipo?
Liposuction offers more dramatic and rapid results, but it is a surgery and comes with all that entails: cutting, general anesthesia, scars and a recovery period. Following liposuction, patients wear compression garments for four to six weeks and generally have some bruising, according to Dr. Sumesh Kaswan, a SLUCare plastic surgeon.
And if the problem is flabby skin, neither liposuction nor CoolSculpting will tighten loose skin. Interest in upper arm-lift (brachioplasty), which excises loose, sagging skin, has grown exponentially over the last 10 to 15 years, Kaswan reports. He credits its popularity to the increase in people losing extreme amounts of weight through diet, exercise and/or gastric bypass surgery. Some patients also like to have an arm-lift with their liposuction.
“The patients who get the best results from upper arm-lifts are those who have done their work beforehand—who have gotten to their ideal weight, or at least as close as they can get on their own—and exercised to build muscle tone. If you regain weight or continue to lose weight after the procedure, you’ll compromise the results,” Kaswan says.
the pros/cons of arm-lift
For people who have lost an extreme amount of weight, upper arm-lifts can be the final step in their weight loss transformation. But it does not come without its drawbacks. Patients can expect to have pain and swelling for the first week and will not be able to return to a normal activity level for four to six weeks, the experts say. Patients also will have a scar, typically underneath their arm, from the arm pit (axilla) to the elbow. “Among all other cosmetic procedures, scars on the arms stay thick and red a lot longer,” Kaswan says. “It may take a year to a year-and-a-half to get to the final scar, and that has nothing to do with technique or the surgeon.” While there are things your doctor can do to modestly improve the scar, ultimately it is a trade-off—flabby skin or a scar.
[laser skin resurfacing]
If you want to improve the quality of your skin by doing more than applying expensive creams and serums, laser treatments could be the answer. To get appreciable results, you might need a series of treatments, and with most of these, you need to avoid sun for a period of time afterward. So to get in shape before that big summer vacation or family reunion, now’s the time to start.
the power of lasers
Laser skin resurfacing can reverse the signs of aging, sun damage and acne. It works by targeting the light energy of a specific wavelength to create controlled, precise injury to the skin, says Dr. Brock Ridenour, a facial plastic surgeon at Ridenour Plastic Surgery. “The injury stimulates the body’s natural healing process to make new collagen and elastin fibers, important in the thickness and elasticity of skin. Resurfacing also destroys old skin cells, which are replaced by the body’s progenitor cells (similar to stem cells).”
Lasers come in two main forms: non-ablative and ablative. “Non-ablative devices do not cause significant injury to the surface layers of the skin and therefore recovery is quick and easy,” says Ridenour. “They pass through the upper layers to target problems below the surface, such as age spots, broken capillaries and unwanted hair. They also stimulate new collagen and tighten the skin.” They’re popular because they’re safe and easy and require limited or no downtime. “Patients may experience mild swelling, redness and the occasional light bruise,” Ridenour adds. Frequently, patients undergo multiple treatments to get the desired result.
less is more
Ablative lasers, on the other hand, are intentionally more aggressive but will solve the problem with fewer treatments. Patients may experience light scabbing, crusting and/or oozing that can require ointments, bandages and a longer healing process. “These more aggressive devices are used to treat more advanced aging such as extensive loss of elasticity and deep lines and wrinkles. Most produce maximum results with a single treatment,” Ridenour says. Healing takes one to two weeks, but the patient’s face can stay red for months. Other potential risks include scarring and changes in pigment, he explains.
There also is a newer option, the CO2 fractional laser, which combines the effectiveness of the traditional ablative laser without the harsh side effects. “Instead of targeting the entire surface of the face, the fractional lasers take a fraction of the skin away,” says Dr. Joe Muccini, a dermatologist at Midamerica Skin, Health & Vitality Center. “It punches holes in the skin like an aerated golf course. Because some of the skin is left behind, the recovery is faster, about four days, and potential for scarring is less. You also can consider doing it again to end up with the same results of the traditional lasers.”
the ipl
Intensive Pulse Light (IPL) devices often get grouped with lasers, but are not lasers, Muccini points out. Lasers use a specific wavelength of light, but IPL devices employ broadband light to treat a variety of skin conditions and abnormalities, including photoaging, age spots, freckles, pigment and broken capillaries, as well as unwanted hair and tattoos. They’re also sometimes used to treat fine lines and varicose veins. The treatments require no downtime and are much less expensive than laser treatments.
what’s right for you?
When you look in the mirror, what bothers you? Muccini says people often come into his office and ask what he thinks they need done. “Nobody ‘needs’ this. We do it because we want to look like the most fabulous version of ourselves,” he says. He advises patients to prioritize their desires and consider the cost, downtime and what they can tolerate.
