Breast implants have an outer shell that is warrantied for 10 years. After 10 years the shell has a higher risk for rupture. If sagging is an issue for you, it would make the most logical sense at this point in time to change out the implant, or remove it, and have a breast lift for a youthful looking perky breast that will be long- lasting. I am often surprised at how attractive and full a breast can look after implants are removed with simulatanous breast lift so that as you continue to age you don't have the burden of another surgery to remove or replace the implant.

Plastic surgeons should always have the best interest of the patient at heart. Goals of plastic surgery are to improve physical characteristics to enhance natural beauty and quality of life. I feel the best plastic surgery is when it doesn't look like you've had a procedure. Too much plastic surgery tends to look unnatural and can make you look older than your stated age, distorting your features. It is our responsibility to say "no" to patients who have unrealistic expectations, or to patients who lose the perception of reality after reaping physical and emotional benefits of previous procedures and "want more". We have an ethical and moral responsibility to take care of our patients and guide them into making realistic decisions about procedures. We also have to think about long-term consequences of repeated operations and uncorrectable deformities that can occur when too many procedures are performed. So yes, we should always interfere and turn away patients who go too far with cosmetic surgery. H. A. Brown, MD

There are a number of reasons for people to have puffy eyes. Some are genetic and anatomical, while other reasons can be related to other factors such as allergies, poor sleep, intermittent swelling from fluid retention, and crying. Eyelid surgery, also called blepharoplasty, works well when there is a true excess of skin and/or fat around the upper and lower eyelids. Essentially, the skin and fat bulges in front of the lid itself. Other factors which may cause this look include eye brow descent, where the eyebrows start to drop and create heaviness on the upper eyelid, or upper eyelid ptosis (drooping), which means that the upper eyelid muscles are weak and the resting upper eyelid position is lower than ideal. For the lower lid, many patients complain of puffy lower eyelids or dark circles in the situation of hollowness. This means that rather than a redundancy of skin and fat of the lower eyelid, the situation is quite the opposite. In these cases, the orbit is noticed from loss of facial volume, genetics, or cheek tissue descent, unmasking the orbital structures and looking like a dark circle or sometimes a puffy lower lid. Darkening of the lower lid can occur from pigmentation, or color changes can occur from the robust capillaries in this thinned-skin area. In the situation of hollowness, sometimes fillers can be used to fill the depth of the depressions, which can improve the look of the orbit. Consulting with a board certified plastic surgeon will be the best way to establish what is causing your puffy eyelids so that a treatment plan can be recommended. H.A. Brown, MD

This is a controversial issue and every case is handled individually, depending upon the symptoms of the condition and the maturation of the individual. At 13, most teenagers are still in the growing phase, and I would not advise surgery in this age group. First of all, I would suggest that she is evaluated by her pediatrician to rule out other benign causes of macromastia (large breasts). Always try conservative measures first if she is having symptoms such as back pain, neck pain, or limitations on activity from her large breasts. Her appearance will continue to change as she goes through puberty and experiences hormone fluctuations. If the condition persists and she is suffering physical symptoms or issues with self esteem, I would consider consultation at or around age 16, or when she is physically and emotionally mature. Hayley A. Brown, MD