| Patient One -- 250cc silicone gel implants |
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Pre-Op
Front and Side View
Normal sized chest. Note that left nipple is lower than right and there is less white exposed on the under surface of the left breast. Collapse of upper pole of breast is common and can be corrected with proper placement of implants.
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Post-Op
250cc gel implants behind the muscle with a 1 cm left crescent mastopexy lift performed through top of left areola for better balance. Barely noticeable delicate scar.
See section on Breast Lift for more detailed information.
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| Patient Two -- 250cc filled to 275/285cc implants |
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Pre-Op
Front and Side View
Female - Age 29 - 5'4" -
130 lbs - Size 34B
No children. Left breast larger and more hang.
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Pre-Op Markings
Augmentation with Bilateral Asymmetric Crescent Mastopexy
Left Crescent = 2-1/2 cm
Right Crescent = 1-1/2 cm
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Post-Op
6 Weeks -
Front and Side View
250cc filled to 275cc on left and filled to 285cc on right - Size 36C Smooth, round, saline implants. Sub-pectoral. Incision: Inframammary.
See section on Breast Lift for more detailed information.
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| Patient Three -- 250cc filled to 280/290cc implant |
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Pre-Op
Front and Side View
Female - Age 35 - 5'4" -
130 lbs - Size 34A
1 child - Asymmetric -
Left shoulder higher. Right breast larger.
Lower Breast Deficiency (inadequate breast volume below the nipple, especially on the left).
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Post-Op
5 Months -
Front and Side View
250cc filled to 280cc on Right and 290cc on Left -
Size 36B-C
Smooth, round, saline implants. Sub-pectoral. Incision: Inframammary.
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| Patient Four -- 275cc filled to 330cc implants |
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Pre-Op
Front and Side View
Female - Age 26 - 5'4" -
117 lbs - Size 34A
Deficiency of upper pole of breast
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Post-Op
7 Weeks -
Front and Side View
275cc filled to 330cc
Smooth, round, saline implants. Sub-pectoral. Incision: Inframammary. Lowering of breast fold.
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| Patient Five -- 290cc implants |
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Pre-Op
Front and Side View
Female - Age 34 - 5'6" -
110 lbs
2 children, loss of breast volume
Right: Pre-op markings to lower the breast fold.
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Post-Op
10 Years - Front View
290cc final fill with Saline inflatable implants under muscle.
Note the proper balance above and below the nipple as a result of lowering the breast fold. If this is not done, there would be too much implant projecting above the nipple.
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| Patient Six -- 300cc filled to 350cc implants |
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Pre-Op
Front and Side View
Female - Age 38 - 5'7" -
125 lbs - Size 36AA
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Post-Op
6 Weeks -
Front and Side View
300cc filled to 350cc --
Size 36C
Smooth, round, saline implants. Sub-pectoral. Incision: Inframammary.
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| Patient Seven -- 275cc and 300cc implants |
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Pre-Op
Front and Side View
Female - Age 29 - 5'6" -
130 lbs - Size 34B
Left breast smaller and constricted (shortened diameter)
Right breast some constriction with hang.
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Post-Op
3-1/2 Months -
Front and Side View
300cc filled to 375cc on left; 275cc filled to 300cc on right -- Size 36C
Smooth, round, saline implants. Sub-pectoral. Incision: Inframammary. Right breast lift performed within the elongated brown area of areola.
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| Patient One -- 310cc implants |
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Pre-Op
Front and Side View
Female - Age 32
Because of the hang, a breast lift is required.
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Post-Op
6 months -
Front and Side View
310cc inflatable implants under muscle with crescent breast lifts on both sides.
Note: A crescent mastopexy (breast lift) performed through the top of the areola usually results in a delicate scar. See section Breast Lift for detailed information.
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| Patient Two -- 325cc filled to 400cc implants |
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Pre-Op
Front and Side View
Female - Age 25 - 5'9" -
148 lbs - Size 34B
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Post-Op
3 Months -
Front and Side View
325cc filled to 400cc -
Size 36D
Smooth, round, saline implants. Sub-pectoral.
Incision: Inframammary.
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Patient Testimonial
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| Patient Three -- 325cc filled to 400cc implants |
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Pre-Op
Front and Side View - 1990
Female -- Age 20
Polaroid photograph submitted by previous surgeon.
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Post-Op First Surgery
Front and Side View - 1999
Female - Age 28 - 5'6" -
130 lbs.
Had 195cc textured Replicon implants above the muscle. Surgery performed elsewhere.
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Post-Op Second Surgery
Patient desired larger implants
1 Month -
Front and Side View
325cc implants filled to 400cc
Smooth, round, saline implants. Sub-pectoral. Incision: Inframammary.
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| Patient Four -- 360cc silicone gel implants |
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Pre-Op
Front and Side View
Female - 5'8"
Virginal type breasts and a large chest diameter.
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Post-Op
3 weeks -
Front and Side View
360cc gel implants under muscle. Note that the breast folds were lowered for proper balance and nipples riding on the summit of the breast (side view).
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| Patient Five -- 410cc implants |
It is helpful to see different sized implants in the same patient.
Additional Notes:
(1) I have stopped using the lower areolar incision because of the increased potential for capsular contracture due to contamination when cutting through the breast ducts.
(2) Often one shoulder is higher than the other creating asymmetry of the breasts. This is often due to a handbag or pack carried on one side only. The weight should be shifted during the day to avoid stresses on the neck and spine which can cause chronic discomfort. |
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Pre-Op (1979)
Front and Side View
Age 28 - 5' 4" - 110 lbs - Note: Minimal breast volume; Areolar area is lower on left side.
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Upper Middle - First Surgery 1992
13 Years post-op -
Front and Side View
200cc Gel Above Muscle
Age 41. Incision - lower areola. Note: Left lower areola has an overhanging scar as a result of breast mass removal done elsewhere 3 years after her 1979 surgery.
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Lower Middle - Second Surgery 1994
12 days post-op - Front View
275cc inflatable below muscle.
Age 43, 130 lbs.
No 3/4 view available.
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Bottom - Third Surgery 1998
8 Months post-op -
Front and Side View
410cc inflatable below muscle - Age 47.
Additional Surgery:
(1) Left breast lift (scar left superior areolar area).
(2) Revision of scar left lower areola.
(3) Lowering of both breast folds to accommodate larger implants.
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| Patient Six -- 500cc and 520cc implants |
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Pre-Op
Front and Side View
Female - Age 25 - 5'3" -
144 lbs - Size 36B
Large volume implants requested by patient
Note: Pre-op asymmetry
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Post-Op
1 Month -
Front and Side View
500cc on left and 520cc on right - Size 36D
Smooth, round, saline implants. Sub-pectoral. Incision: Inframammary.
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| Face and Neck Lift |
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Pre-Op
Age 72
Note jowls, lower face wrinkling and poor neckline.
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One Month Post-Op
One month after face lift and defatting of the neck. Wrinkles around the mouth would require other approaches. Note change in neckline and overall rejuvenated appearance.
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| Face Lift and Resurfacing |
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Pre and Post-Op
Left: 44 year old female with thickened skin due to 30 year history of scratching (neurodermatitis).
Right: 2 years and 8 operations later, including face lift, facial shaving, reconstruction of pulled down eyelids and ear lobe reduction and defatting of the nose.
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Patient Testimonial
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| Face, Neck, Forehead Lift, Grafting of Frown Lines |
This patient had facial aging, droopy eyebrows, and deep frown lines. A face, neck and coronal forehead lift was performed. The removed skin was grafted under the frown lines to smooth this area. There was also an improvement of the upper eyelids, although no surgery was done in this area. This improvement is due to the elevation of the brows from the forehead lift.
The deeper tissues involving the lower checks and jowls were elevated to the check bones to enhance the upper 1/3 of the face.
Often the nasolabial folds respond poorly or not at all to face lifting surgery. At times, they are excised or treated with facial fillers at the time of surgery or at a later time.
Face lift scars blend well in front of the ear and are barely noticeable. The fold below the ear was present pre-op and is not part of the scar.
This patient had a facelift many years ago before we had Botox and facial fillers. At the time, the results were pleasing and the patient was happy. Currently, there is considerably more that can be done to further rejuvenate a patient such as this. The midface (inner face) shows volume deficiency and incomplete correction of the nasolabial folds. By using facial fillers, such as Restylane, Radiesse and fat grafting, volume can be restored to the inner face, which at the same time, has a lifting effect on the nasolabial folds. The nasolabial folds are also injected to help smooth the area. |
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Pre-Op
Age 44
Facial aging, droopy eyebrows, and deep frown lines.The low set eyebrows give her an "angry" appearance, belying the kind, gentle person that she is.
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1-1/2 month follow-up
Note the overall rejuvenation of the face and the more pleasant appearance post-op and the elimination of the tired, angry look.
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| Face/Neck/Forehead Lift. Scalplifting for Baldness |
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Pre-Op
Age 58
A stressful job left its marks and the patient requested rejuvenation.
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2 year follow-up
Face, neck and forehead lift and staged scalp lifting for baldness.
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| Patient One |
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Upper Eyelid Surgery
Left: Pre-op Female Age 49
Overhang of upper eyelids
Right: Post-op 5 Months
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Post-Op
4 Years
Continued deepening of lid folds with time.
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Patient Testimonial
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| Patient Two |
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Upper and Lower Eyelid Surgery
Left: Pre-op Female Age 51
Note pocket of fat inner upper lid and 3 fat compartments lower lid.
Right: 3 Weeks Post-op
Upper and lower blepharoplasty with lateral wedge excision (bottom lid tightening)
Note: Delicate scar (below eyelashes) lower lid.
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| Patient Three |
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Upper & Lower Eyelid Surgery
Pre-Op
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Post-Op
Left: Scars fall into natural crease with eyes open and are barely visible when the eyes are closed.
Right: Eight years after operation. Note deepening of upper eyelid crease.
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Post-Op
23 years after operation. Continues to look better than pre-operation.
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| Patient Four |
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Upper Eyelid Surgery
Our Surgical Nurse, Kay.
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Post-Op
8 months after upper eyelid surgery.
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| Patient Five |
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Upper & Lower Eyelid Surgery
72 year old female with upper eyelid excess, wrinkling and fat protusion.
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Post-Op
5 years after surgery. Gives appearance of having had a face lift (not done).
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Post-Op
Continued improvement 13 years after operation.
Dr. Pacik's Mom - had to do a good job!
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Post-Op
Year 2002, 92 years old
20 years Post-Op
Still looking great!
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| Patient Six |
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Upper & Lower Eyelid Surgery
Pre-op
Male Age 50
Overhang of upper eyelids; fat inner corners of upper eyelids; wrinkling of lower lids.
Right: Note the reduced distance from the new eyelid fold to the bottom of the eyebrow.
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3 Month Post-Op
Patient very happy with the results of the surgery. Lower eyelid skin quality still needs further improvement with advanced skincare (MD Forte Skin Rejuventation Eye Cream).
Left: Eyelid closed showing delicate scar in natural skin fold upper eyelids.
Right: Close up showing healing lower lid scar just below eyelashes.
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| Patient Seven |
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Upper Eyelid Surgery
Left: 48 year old male - impending loss of lateral (outer) vision due to hooding of upper lids.
Right: 3 weeks after surgery. Note rejuvenation.
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| Patient Eight |
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Upper Eyelid Surgery
Female -- Age 39
Pre-Op. Family history of heavy upper eyelids
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Post-Op
Left: 9 days after removing l cm wedge of tissue and upper eyelid fat.
Right: Post-op 5 months
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| Patient Nine |
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Upper & Lower Eyelid Surgery; Botox forehead & frown lines
Female -- Age 49
Left: Pre-op. Excessive upper eyelid skin, more overhang on right upper lid due to lower right eyebrow.
Right: Post-op 6 weeks. Pleasing contour upper & lower eyelids and improved lower lid functioning due to lower lid tightening (lateral wedge resection)
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Forehead Wrinkles
Left: Pre Botox. Eyes looking up. Dots indicate sites of Botox injections.
Right: Post Botox. 1 month after Botox injections. Patient unable to elevate eyebrows.
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Frown Lines
Left: Pre Botox. Injection markings.
Right: Post Botox. 1 month after Botox injections. Patient unable to frown.
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| Patient Ten |
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Upper Eyelid Surgery
Female -- Age 46
Left: Pre-op. Asymmetrical upper eyelid overhang
Right: Post-op 7 months
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Restoration
Left: Picture of patient at 17. 3/4 view showing minimal exposure of upper eyelid.
Right: 7 months Post-Op showing enhanced upper eyelids.
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| Neck Liposuction |
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Pre and Post-op
Left: Pre-op - The bulging fat in the neck resulting in a poor neckline are unattractive and make this patient appear heavier than she is.
Right: Post-op
One of our early liposuctions done in the 1980's with excellent results.
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| Neck Liposuction |
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Pre-Op
Female, Age 42
Fatty neck and poor definition between the cheek and side of the neck. Liposuction of the neck and liposculpture to enhance jaw line. Upper surgical markings along jaw line represent the area for liposculpture. Two moles removed from lower neck, used as entry points for the liposuction as well as an entry point below chin.
Liposuction of the neck and liposculpture to enhance jaw line. 2 moles removed from lower neck, used as entry points for the liposuction as well as an entry point below chin.
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1 day follow-up
Front and Side View
Often, patients note immediate post-op improvement despite swelling and bruising, giving the appearance of weight loss. Pain is usually minimal.
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| Neck Liposuction & Upper Eyelid Surgery |
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Pre-Op
Neck Liposuction, Upper Eyelid Surgery
Front and Side View
Female, Age 50
5'8" , 165 lbs
Poor neckline due to fat accumulation and sagging skin and heavy hanging upper eyelids.
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5 year follow-up
Front and Side View
Improved, more attractive, neckline. These long-term photographs show the lasting results of liposuction. Patients who gain weight after liposuction, generally gain their weight elsewhere.
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5 year follow-up
Close-up of upper eyelids showing more pleasing, youthful eyes. Rejuvenation of the eyes and neck gave proper overall harmony to the face.
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| Neck Liposuction & Upper Eyelid Surgery |
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Pre-Op
Front and Side View
Female, Age 29
Fatty neck, poor neckline and excess skin of upper eyelids.
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13 year follow-up
Stable result of neck and eyelid rejuvenation. The patient continues to be very happy with her appearance.
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| Neck Liposuction and Upper Eyelid Surgery |
| The excess skin and fat in the eyelids and fat accumulation of the neck together with poor neck angle, accentuate the full face, giving this youthful person the appearance of being heavy set. In some patients such as this, more of a right angle to the neck is not possible because of the location of certain neck muscles that cannot be altered. |
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Pre-Op
Front and Side View
Female, Age 48
Heavy appearance upper eyelids, jowls and neck. Lack of delineation between cheeks and neck.
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2 month follow-up
Front and Side View
Neck and jowl liposuction, liposculpture along the jaw line and upper eyelid surgery.
Note improved delineation between the cheeks and neck as shown in right photo. A shadow now appears under the jawline as would be expected in a patient with proper balance between the cheek and neck. Appearance of weight loss, even though weight remained stable.
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3/4 View Pre-Op and Post-Op
Left Photo: Pre-op surgical markings of eyelids, jowls and neck.
Right Photo: Post-op photo showing improved, graceful appearance. Facial fillers (Restylane, Radiesse) were not available at the time of her surgery, but nowadays would be used to fill out the marionette lines.
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| Neck Liposuction and Chin Implant |
| A poor angle of the neckline is often associated with an under-developed chin. The combinatioin of a chin implant with liposuction of the neck at the same time can yield dramatic results. |
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Pre and Post-op
Left: Pre-op
Poor neckline, underdeveloped chin.
Right: 8 week follow-up
Notice how the chin implant enhances a more attractive neck.
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| Neck Rejuvenation |
| It is fortunate that numerous techniques are available for neck rejuvenation. At times, additional surgical manipulation beyond liposuction is needed. One of the more common procedures for neck rejuvenation is a corset platysmaplasty. Here, the plastic surgeon tightens the platysma muscles along the midline to enhance the angle of the neck. During this maneuver, the area deep to the muscle is checked to remove bulging fat. This, together with proper dissection of the neck skin, and liposuction of the neck, will result in a more youthful appearing neck. |
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1989 Consult
Fatty neck. No Surgery performed at this time.
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Pre-Op 1997
20 lb. weight loss since 1989 consult. Markings for liposuction of neck and jowls.
Additional Procedures
1998 - Corset platysmaplasty (tightening of neck muscles).
2002 - Botox residual neck cords
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Post-Op 2003
6 years post liposuction
5 years post corset platysmaplasty
Additional surgery planned for recurrent right neck cord. Note: Patient's improved skin tone from the Obagi Nu-Derm Advanced Skincare Program.
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| Neck Rejuvenation |
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Pre-Op
Front and Side View
Female, Age 55
Neck laxity and visible platysma cords following 60 lb. weight loss.
Tightening of neck muscles (corset platysmaplasty); excision of deep neck fat under platysma muscle; liposculpture of jaw line.
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Old Photograph
Patient at age 25 with well defined neck.
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Pre-Op Surgical Markings
Surgical markings showing 1 inch planned incision under chin, outline of platysma cords for corset platysmaplasty. Jaw line marked for liposculpture and jowls and lower neck marked for liposuction.
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11 Weeks Post-Op
Slight residual swelling and wrinkling of area under chin. Expected to improve with time. Patient on the Obagi NuDerm Advanced Skincare System for 11 weeks.
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| Neck Rejuvenation |
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Pre-Op
Front and Side View
Female, Age 60
Poor neckline, fat accumulation of neck and jowls and neck sag.
Liposuction of neck, jowls; liposculpture of jaw line; tightening of neck muscles (corset platysmaplasty).
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4 month follow-up
Note refinement of neck and jowls. The improved draping of skin gives the appearance of a face lift, though this was not done. Skin tones improved with advanced skincare products.
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| Neck Rejuvenation & Chin Implant |
| Sometimes a patient simply does not want a face lift. Try as I might, and knowing that a combined face and neck lift would give her a much better result for total facial rejuvenation, she always smiled at me and said "No, | |
During our initial consultation before surgery, we do everything possible to make our patients and their significant others comfortable. Each patient is very important to us. We never consider any operation "minor" or "routine" and make every effort to ensure a comfortable, safe and successful surgery. While no surgery achieves "perfect" results, we strive to come as close to perfection as humanly possible.
