Q.  I had a breast augmentation in New Jersey 8 years ago and have since moved to the Triad.  I have had 2 children since my surgery and now my breasts are sagging below my implants.  Can my breasts be lifted even though I have implants already in place?

A.  Yes, they can. As a matter of fact, it makes the surgery a little easier since most women who have a lift require the placement of implants to help restore lost volume from pregnancy.  Breast lift surgery is a frequently performed operation in my practice; it takes about 3-4 hours and will keep you out of work for about a week and out of the gym for about a month.

The one question that might be considered in your case is whether you should replace your implants at the time of surgery due to their finite lifespan (possible leakage).  You did not tell me whether you had saline or silicone gel implants, but typically saline lasts about 15-20 years before leaking.  Silicone gel implants are recommended to be changed every 12-14 years.  Changing silicone gel implants early is recommended in order to avoid leaking silicone into the breast.

If you decide to replace your implants at the time of your lift, you avoid giving them the opportunity to fail.  Since you will be undergoing general anesthesia during the lift, changing the implants adds very little in terms of complexity of the surgery and recovery.  The early replacement of your implants may save you from having to have another surgery in 4 to 6 years to change a leaking implant.  It is something to consider and something you should discuss with your board certified plastic surgeon.

Q. I am almost 40 and have noticed some unwanted changes in my skin, specifically some light brown spots and fine lines beginning in my cheeks.  I try to take care of my skin, but occasionally enjoy getting in the sun.  I wear sunscreen most of the time.  Is there anything that I can do to slow the aging process of my skin?

A.  Most importantly you need to be as diligent as possible with sunscreen when you plan to be in the sun for more than about 30 minutes.  The UV radiation from the sun is very damaging to the face, and will with time, add to the unwanted changes that you are beginning to see.  As for slowing the aging process, that requires a comprehensive approach using a combination of products.  To be clear, genetics often plays the biggest role in how you will age, but environmental damage certainly accelerates the aging process.  However, a good skincare program can reduce or correct some of the unwanted effects of environmental damage.

There are many skincare programs on the market, from over the counter that you can purchase at the store to those which are only available under the care of a physician.  What I can offer as a physician is more aggressive in its ability to correct skin damage and can be customized to your skin type.

The goal of any skincare program is to stimulate collagen to help soften fine lines, fade brown spots to even out pigmentation, and exfoliate to reduce the outer layer of lifeless skin.  The final step is to protect the skin from further damage by using a good broad spectrum sunscreen.

Some skincare programs are more protective, meaning they are designed to slow the changes associated with aging.  Other programs are corrective, meaning they are designed to reverse the effects of aging that have already taken place.

You should consider a consultation with a plastic surgeon or dermatologist who has interest and expertise in skincare, to come up with a customized plan to protect and improve your skin.

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William Byron Barber II, M.D.

has been practicing plastic surgery in Greensboro for 20 years and is certified by the American Board of Plastic Surgery.  He is Chief of Plastic Surgery for Moses Cone Health System, and is an active member of numerous local, regional and national plastic surgery associations.

Visit his website at: www.BarberPlasticSurgery.com or e-mail him at: AskDrBarber@BarberPlasticSurgery.com