Breast Implant Location: Above or Below the Muscle

Breast augmentation with implants is one of the most commonly performed cosmetic procedures in the United States.  Not only does augmentation surgery increase breast size and fullness, it also enhances self image.  Patient satisfaction is extremely high after augmentation surgery.  The results are noticeable immediately!!


During the consultation, the surgeon and the patient discuss expectations, implant types, and select implant sizes.  Most importantly, a physical exam is performed and measurements are obtained.  The surgical plan is customized for each patient. 


I frequently encounter the question regarding implant location: subpectoral (under the muscle) versus submammary (above the muscle).  In the subpectoral position, the implant is placed partially or completely under the pectoralis major muscle.  In the submammary position, the implant is placed completely above the pectoralis muscle but below the glandular breast tissue.


Neither position is universally the best!! Implant location is based on each patient’s breast anatomy. Factors that play a role include:


  • skin quality (thick vs thin)
  • current breast size
  • desired breast size
  • breast shape
  • breast ptosis
  • nipple position


Measurements of nipple position that were obtained during the consultation are important when selecting implant location.  When the nipple remains centrally located on the chest wall without a significant amount of breast ‘droop’ or ptosis a sub-muscular position is best.  However, once your nipples have descended and there is moderate to severe ‘drooping’, implant position above the muscle is best.  This avoids what is called a waterfall deformity or what some refer to as a “snoopy dog breast deformity”.


If you are interested in breast augmentation, I recommend you schedule a consultation so that we can discuss the best options for you.


Dr. Jefferson

Labiaplasty vs Vaginoplasty

Labiaplasty and Vaginoplasty are the two most commonly performed procedures within the scope of female genital cosmetic surgery, also known as cosmetic gynecology. Although these procedures are very different, I have noticed that they can cause some confusion with patients. For example, these separate procedures are often mistaken for one inclusive surgery or are mistaken for an entirely different type of surgery such as a prolapse or incontinence surgeries. My goal is clear up this confusion and hopefully help my patients make a more informed decision whether they are suitable candidates for either, both, or none of these procedures.


There are many reasons why patients may elect to have either of these procedures. One reason can be strictly cosmetic, meaning that the patient views part of her genital area to be aesthetically displeasing and wishes to improve the appearance.  Other reasons include functionality purposes such as discomfort in clothes or while participating in activities such as running or walking. Lastly, these procedures can be performed to help improve sexual satisfaction or function.


Labiaplasty focuses on the external part of the vagina and vulva. The goal of this procedure is to reduce the size of labia minora or less frequently labia majora. This is done by surgically removing any excess skin on the outside of the vagina. The incision is then closed with absorbable suture.


Vaginoplasty focuses on the internal part of the vagina. The goal of this procedure is to restore the vagina in women who suffer from decreased vaginal sensation or feelings of a loose or wide vagina which can affect their sexual lifestyle. Vaginal relaxation whether it’s due to aging, prior vaginal births, or trauma is improved by decreasing the diameter of the internal vaginal canal. This is accomplished by surgically removing excess vaginal tissue and tightening the underlying muscle layers with absorbable suture.


I hope this information was helpful. Please contact our office to schedule a free consultation where I can answer any additional questions and discuss which treatment option would be best for you!


By Dr. Noah

Cosmetic Surgery Procedures To Consider This Winter!


Now that the seasons are changing, I’ve had lots of patients asking me: “What time of year is best for cosmetic surgery?” That’s an especially good question this year, because COVID has everyone’s holiday plans up in the air, and since everyone is wearing masks all the time.

The Winter is always a good time for any kind of surgery since it’s cooler, and you can wear baggy/bulky clothes to conceal your swelling and bruising. But some procedures are especially good to do in the winter.

This year, eyelid surgery is great any time of year. Everyone is wearing masks, so their eyes are all that most other people see.

Upper eyelid surgery is a quick procedure with very little downtime – Reagan at our Spring Hill office had hers done yesterday (Thursday) and has a full day scheduled next Tuesday. Since it’s cool outside, she’ll have less bruising and swelling than if she had her surgery in the summer, and she won’t miss any fun outdoor activities since the days are so short now. Chin implants, lip lifts (check out this excellent article – ), and facelifts are also great procedures to do now, because your mask will hide your swelling while you recuperate!

Any kind of body contouring surgery (liposuction, breast lift, breast augmentation, tummy tuck, and BBL) is great to have during the Winter. First of all your recovery will be a little easier because of the cool weather and your ability to hide your swelling under sweats. Second, most people are a bit more sedentary in the Winter, so resting during your recovery is a little easier. Finally, and maybe most importantly, November through February are a great time to have breast augmentation, tummy tuck, liposuction, and BBL, since you’ll be totally recovered and ready to wear your swimsuit when the pools open in April!

by Dr. Ingram

Brazilian Butt Lift

The Brazilian Butt Lift, or BBL, is one of the fastest growing cosmetic procedures in the country. Just in 2012, only about 8,500 such procedures were done in the US, compared to over 34,000 in 2019. More than any other procedure, its growth has been fueled by the rise of social media. However, along with its exponential growth, there have been concerns over its safety, with some preliminary studies labeling it as having “the highest mortality among cosmetic surgical procedures.” 


Although there have indeed been cases of mortality related to the BBL in the US and the rest of the world, newer studies have demonstrated that using proper technique significantly reduces the risk to levels comparable to other cosmetic procedures. If you are interested in a BBL, in addition to asking about board certification, you should have a frank discussion with your surgeon about his or her training and experience doing the procedure, their assessment of the risks and mortality associated with it, and the measures they will take to minimize these risks.


The most important one of these measures includes injecting the fat over the gluteus muscles, but there are many others, such as those proposed by the Multi-Society Gluteal Fat Grafting Task Force or the World Association of Gluteal Surgeons. Just like with any other consultation, your surgeon should instill confidence not only in his or her ability to provide you with a great cosmetic result, but also with performing the procedure as safely as possible. 


By Dr. Morales

My Favorite Procedure


As a cosmetic surgeon in practice for nearly 30 years, I have found rhinoplasty to be my favorite operation.  Hardly any surgery gives patients more satisfaction than a well planned and executed rhinoplasty procedure.

This procedure is something they and everyone else sees every day for the rest of their lives.  So the stakes are high.  Sometimes the slightest alterations, which are preferable to drastic changes,  can make the biggest impact and produce safer more reliable results.  My favorite cases in particular are young female patients who are very attractive but feel self- conscious about their nose.  One frequent comment I get a lot is “I got my daddy’s nose!”  Often times they do not have a feminine nose to match their face.  When the nose fits in harmony to the face one can appreciate the overall beauty of the face, rather than the eye being drawn to a flawed feature like a large nasal hump.  From the surgeons stand-point, the rhinoplasty procedure is a life-long learning procedure.  It is the most difficult surgery to master.  When I get the result that I am striving for, and have a happy patient, then it makes all the hard work and years of study worth it all.

By Dr. Marvel

Tummy Tuck FAQs

Tummy tucks – also known as abdominoplasties – are one of the most common procedures performed by cosmetic surgeons. Tummy tucks have become more popular not only because of the dramatic results most patients show but also because of our focus on health and fitness. Recent advances in the operation offer better pain control and a smoother recovery. Here are a few of our patients’ most common questions about this operation.

“Do I need a full tummy tuck, or can I have a smaller scar – for example, with a “mini” tummy tuck or just liposuction?”


Every tummy tuck is slightly different, since everyone’s problem areas are different. Some patients have too much loose skin, some have lots of stretch marks, some have too much fat, and some people’s muscles been stretched or separated by pregnancy. People with tight skin can benefit from procedures which result in reduced scarring approach, such as liposuction, an endoscopic abdominoplasty, or a mini-abdominoplasty. If there is a lot of loose skin that needs tightening, you will require a longer scar. We always try to keep scars as short as possible, but what matters most is how your skin and waist look after surgery, since tummy tuck scars are hidden under shorts and a bathing suit.

Will a tummy tuck help my stretch marks?”

Absolutely. After pregnancy, most women’s stretch marks are below their belly buttons, and this is the skin that is removed in a tummy tuck. Unlike lasers and creams (which I don’t think I have ever seen help anyone at all, once they’re a year out from having their last baby), an abdominoplasty completely removes this skin, making your entire abdomen look like the much less damaged skin between your ribcage and your belly button – but even better, since even that undamaged skin is stretched and looks better than before!

“How much discomfort will I have after a tummy tuck?”

Years ago, tummy tucks were frequently performed in hospitals, and many patients could not stand straight up for a week or two. We perform all of our tummy tucks in one of our two outpatient surgery centers, so our patients are up and walking on the first night after surgery. Most patients need 3 or 4 days of a mild narcotic pain reliever and are back to their normal light activities about two days after they stop taking pain medicine. People who had had a prior C-section say that the discomfort is a 2-3 if the C-section pain was a 10.

“How long is the recovery after a tummy tuck?”

The answer to this question depends on what you mean by “recovery.” All our patients are walking around their homes on the first day after surgery. Most people are able to get out of the house for light exercise and shopping (but NO HEAVY LIFTING) on the third or fourth day after surgery. You can drive a car about a week after surgery, and you can start lower body aerobic exercise (a recumbent stationary bike is the best at this stage) at ten days after surgery. After that, it is up to you and how you feel, but you can’t lift anything heavier than 30 pounds until a month after surgery because we don’t want anything to mess up the muscle tightening you’ve gotten.

“Will the results last?”

Absolutely! As long as your weight remains fairly stable, abdominoplasties are usually a ‘one and done’ procedure, which does not need to be repeated. Of course, your skin will continue to age after surgery, but it almost never gets back to the looseness that you had before surgery.

“After pregnancy, my tummy needs help, but my breasts do, too. Can you work on both at the same time?”

Absolutely. Lots of patients have changes to both their abdomen and their breasts after childbirth and nursing. Combining abdominal and breast contouring after pregnancy is so common that it has a name – “mommy makeover.” Combining these procedures makes a lot of sense, because you save a little money on the operations and can combine your recovery times, making it easier to fit both operations into your hectic schedule.

By Dr. Ingram


Top Surgeries To Enhance The Profile


A facial profile is the outline of a face when viewed from one side. Whether realized or not, most people find a well-balanced profile to be more attractive, youthful, and likable. However, many people feel they only have one “good side,” the side they always show the camera, and are unhappy with a specific part of their profile.

Many procedures can help patients achieve a more balanced and attractive profile. Below are the top surgeries that help patients enhance their facial profile while minimizing the signs of aging.

Lip Augmentation

Lips are one of the most prominent features of the face. Lips start out full and smooth, but over time, they may develop wrinkles and thin out. As lips become thinner with age, some individuals wish to enhance them to appear more youthful. Others may be dissatisfied with their naturally thin or flat lips and want to correct them.

Lip augmentation can improve the appearance of the lips and mouth by adding volume and fullness, eliminating wrinkles, and making them more youthful and balanced with the face. Options include fillers, implants, or possibly a lip lift.

However, if the lips are naturally oversized, a lip reduction will reduce the size of the lips, creating balance, so that the mouth is more proportionate with the profile.

Facial Implants

Many people don’t realize that facial structure can naturally change shape with age or weight fluctuation. So, what began as a nicely balanced profile might change over time. Facial implants can make a profound impact on the appearance of the face, as they restore lost facial contours due to aging or injury.

Facial implants can correct an undefined jaw, a weak chin, or sunken cheekbones. They can add definition, restore volume, and improve the overall balance of a face. The results are subtle and natural, yet patients receive dramatic improvement.

Chin Augmentation

One of the most popular procedures to enhance a facial profile is chin augmentation. This procedure can dramatically improve the profile by altering the facial shape, specifically the jawline. For example, if a patient has a rounded face and neck, a chin implant will help create a more angular face shape, improving the balance between the cheekbones, nose, and chin.

A successful procedure will dramatically improve the overall balance of the face. Chin implant surgery creates a small incision on the inside of the mouth or under the chin, so any scarring is minimal and hidden. Results are subtle and natural, yet they provide dramatic improvement, a stronger profile, and overall, a more proportional look.


Rhinoplasty, commonly known as a nose job, is designed for those wishing to refine and reshape their nose. Some patients feel that their nose is the most prominent or flawed feature on their face and want to correct the size, shape, width, or bump on the tip of the nose. Rhinoplasty works to improve the appearance of the nose and balance it with the rest of the face, allowing it to blend in and not stand out.

Rhinoplasty can be a life-changing procedure for patients. Many people report increased confidence, improved self-esteem, and even easier breathing.

Neck Lift

A sculpted jawline and a wrinkle-free, firm neck are associated with youthfulness and health. But over time, skin in the cheeks, jaw, and neck loses its elasticity and sags. This loss of contours in the face and neck may be the result of genetics, gravity, stress, and environmental conditions. By tightening the skin around the neck and removing excess fat, patients can dramatically improve their profile.

However, not everyone that’s unhappy with their neck needs neck lift surgery. For example, if a patient is only concerned with excess fat under the chin, this can be addressed with liposuction. But if the neck has loose, excess skin or muscle banding, then a neck lift may be the most appropriate choice.

Marvel Cosmetic Surgery offers a full range of procedures to enhance a facial profile. Contact us today or call 615-538-0399 to schedule your free consultation. Let the Marvel team find the perfect procedure for you!


Bounce Into Spring With A Mommy Makeover


Childbearing can take a significant toll on a woman’s body. Most women notice changes to their bodies right after pregnancy, and many wish to get their shape back to what it was before giving birth. A Mommy Makeover describes the process when women undergo several cosmetic procedures at once to restore their bodies after childbirth and child-rearing. A Mommy Makeover is a well-deserved gift to any mother.

The most common procedures grouped together for a Mommy Makeover are breast augmentation or breast lift, a tummy tuck, liposuction, buttock augmentation, botox, and vaginal rejuvenation.

A Mommy Makeover helps reverse some of the effects that childbearing and breastfeeding has on the body. However, it doesn’t replace a healthy diet or exercise program or constitutes a weight-loss solution.

Should You Consider A Mommy Makeover?

Mothers who have given birth and have breastfed multiple children are highly likely to be physically altered, even if they exercise and maintain a balanced diet. These changes are lasting and sometimes not able to be corrected with workouts or diets.

A great candidate for a Mommy Makeover will have realistic expectations, be at a stable weight, and be physically healthy. Some patient concerns might be extra tummy fat that doesn’t respond to exercise or diet, droopy or loose skin around the stomach, and lost volume in the breasts or sagging breasts.

A Mommy Makeover should only take place after a woman has decided not to have any more children. Those planning to have more children should wait, since pregnancy, childbirth, and breastfeeding will alter the results of the procedure. The best time for a Mommy Makeover is at least four to six months after the birth of the last child.


A Mommy Makeover combines several procedures tailored to address the needs of the patient. These will allow the patient to undergo liposuction, a tummy tuck, and a breast lift simultaneously. Your doctor will help you choose the correct procedures to ensure a youthful appearance, rejuvenated skin, and redefined body contours.

Many women also opt to have either a breast lift or breast augmentation with implants. In some cases, women choose both the breast lift and the implants. They can also rejuvenate and restore the tone of the vaginal region following childbearing. Stretch marks, a belly pouch, and loss of breast tissue and elasticity can also be addressed and corrected.

During a tummy tuck, the excess skin is removed, and the abdominal walls are joined back together as needed. After that, the remaining skin around the midsection is tightened, and most of the stretch marks can be removed as well. Liposuction is an excellent option for removing fatty deposits throughout the body where needed. This process is especially helpful for eliminating isolated areas of fat from the thighs, tummy, hips, and other trouble spots.

Benefits of a Mommy Makeover

There are many benefits of a Mommy Makeover. From a mental standpoint, most mothers feel frustrated, self-conscious, or even depressed from the long-lasting changes motherhood brings. This makeover can help restore a woman’s self-image and self-confidence by addressing her specific concerns.

Don’t forget about the face when thinking about these procedures. Enhancing the facial skin tone and texture, and making aging skin look and feel young once again helps the mom feel amazing. Another benefit is the reduction or elimination of stretch marks. Since pregnancy can cause the skin to stretch rapidly, stretch marks can appear no matter how much lotion is applied. They often remain even when the baby weight is lost.

The results of a Mommy Makeover won’t be drawn out over several months or years since everything can be done all at once. This is a quick way to help moms get back to their pre-baby wardrobe easier and faster.

Spring is the perfect time to choose a Mommy Makeover and showcase your newfound body confidence in the summer. Marvel Cosmetic Surgery offers a full range of procedures that can help. Contact us today or call 615-538-0399 to schedule your free consultation. Let the Marvel team design the perfect makeover for you!

What Can Be Done About Uneven Breasts?

Uneven Breast

Very few women have perfectly symmetrical breasts. In fact, it’s rare for breasts to be entirely identical. Although for most women, the differences are unnoticeable. Some women do have asymmetry that is more noticeable and even severe.

Having asymmetrical breasts can make it difficult to find bras that fit or to wear clothing comfortably. Many women even feel discomfort with the way their breasts look side-by-side. If having asymmetrical breasts is worrying you, rest assured there are many things you can do to give your breasts a more even appearance.

Causes of Breast Asymmetry

Breast tissue is made up of milk ducts, lobes, fatty tissue, and other matter. Because breast tissue is continuously changing due to hormones, weight gain/loss, and even age, it’s extremely common for breasts and nipples to be uneven in appearance. Breasts may also appear more asymmetrical at some times than others.

A variety of factors can cause breast asymmetry. Some include weight gain or loss, uneven development during adolescence, pregnancy, breastfeeding, uneven shrinkage while aging, medical conditions, breast infections, breast cancer, or poor results from a prior breast augmentation procedure.

As many women are electing for cosmetic procedures to fix noticeable asymmetry, breast augmentations have now become one of the most requested cosmetic procedures. Below are a few options for those interested in correcting the asymmetry of their breasts.

Breast Reduction

Smaller breasts may fit your frame better or give the perkier appearance you want. If your breasts are slightly uneven but you enjoy your current cup size, then a breast reduction in the larger of your two breasts may be the option for you. This procedure is optimal if you have more than a cup size difference in your breasts and wish to keep the size of your smaller breast.

Keep in mind that the more reduction in a breast, the more likely that breast will need to have a lift done to make the tissue firm and perkier. Ask your doctor to explain the pros and cons of breast reduction in your initial consultation.

Breast Lift

A common problem with women as they age, have children, or breastfeed is sagging of the breast tissue. In some cases, breasts begin to sag away from one another, so even if they are similar in size, the breasts will appear asymmetrical.

In a breast lift, the sagging tissue is removed, and the breast is lifted to a higher point on the chest, placing the nipples in a more natural place. Your breast lift will not make your breasts appear larger unless you are getting breast implants, but it will give you a more symmetrical placement and a perkier appearance.

Breast Augmentation

Breast asymmetry can be corrected easily through breast augmentation. Depending on the severity of your asymmetry and desired results, the surgeon may recommend placing breast implants in one or both of your breasts.

If your breasts differ in more than a cup size or you want larger breasts than you currently have, then an augmentation might be your best option. Your doctor will show you different breast implant sizes to choose from. If augmenting both breasts, the implant sizes will differ to make the final results more symmetrical.

Breast Augmentation Results

While breast augmentation will instantly increase breast size, they will not look their best immediately after surgery. It takes time for breast tissue and chest muscles to adjust to having implants present.

There are a few parts of the healing process that is normal and should not cause worry. At first, the breasts will seem too high on the chest. The swelling will also cause the breasts to appear distorted or feel firmer than usual for some time. The majority of swelling resolves in two to three weeks, and after about three months, the implants will soften and settle into the more natural position.

At your initial consultation, your surgeon will discuss all of this with you in great detail and help you arrive at the ideal method to achieve your unique goals. Together, you will also review the different breast implant options available, as both saline and silicone implants can deliver exceptional results when correcting breast asymmetry.

Contact us today or call 615-538-0399 to speak with a member of our helpful staff. Our team will answer all of your questions and help you make the most informed decision on breast augmentation possible.

Body Contouring After Significant Weight Loss

Body Contouring

Weight loss, however big or small, is a major accomplishment. However, those who achieve substantial weight loss may be disappointed by excessive skin folds or loose skin that cover up their well-earned results.

To combat this, many now elect for a body contouring procedure following significant weight loss. After this procedure, patients finally achieve what they hoped to with their dramatic weight loss, a better-proportioned appearance with smoother contours.

What is Body Contouring?

Body contouring is a procedure that eliminates or reduces the remaining excess skin and fat after individuals have lost a significant amount of weight. This procedure also improves the tone of the underlying tissue.

This procedure is not just for vanity. It is often necessary for a patient’s quality of life, as excess skin can make getting dressed or bathing a chore. It may also limit mobility and cause hygiene and medical problems. Chronic skin-on-skin contact can also result in rashes and other sores that can lead to infection. Many times, the only way to remove excess skin is through body-contouring.

Body contouring is not a substitute for exercise and a healthy diet. Individuals receiving body contouring should be willing to adopt a healthy lifestyle to maintain long-term results.

Who is a Good Candidate for Body Contouring?

The best candidate for body contouring is a nonsmoking, healthy individual without a medical condition that could impair healing or increase the risk of surgery. The right candidate has also reached his or her goal weight and is committed to keeping it off with a healthy lifestyle and proper nutrition and fitness. Patients will benefit the most if they have excess skin in certain areas but minimal excess fat.

The ideal candidate also has realistic expectations for his or her results. While surgery can improve the overall appearance, every patient heals differently with varying results. During your initial consultation, it is important to talk to your doctor about the results you can expect.

Body Contouring Areas

Below are the areas most often treated through body contouring.

  • An arm lift removes excess skin and gives a tighter, more defined contour.
  • Buttock Augmentation transfers fat, uses buttock implants, fat grafting, or a combination of these methods to change the size of the buttocks.
  • Labiaplasty reduces the length of the labia minora.
  • Liposuction removes excess fat deposits between the skin and muscle.
  • A mini tummy tuck flattens the look of the belly and primarily focuses on excess skin and abdominal wall laxity below the belly button.
  • A “Mommy Makeover” is a set of procedures custom-designed for each patient to restore and invigorate a woman’s body after the physical effects of childbirth or weight loss.
  • A tummy tuck removes excess fat and skin from the waist, and in most cases restores weakened or separated muscles creating an abdominal profile that is more smooth and firm.

A combination of surgeries may take place at the same time. For example, an “upper body lift” may include surgery to the arms, back, and breasts. A “lower body lift” will focus on the hips, thighs, abdomen, and buttocks.

Procedure & Recovery

Most body contouring procedures are performed under general anesthesia. After surgery, tubes are usually placed in the wound to drain excess fluid, and patients are given medications to control pain and discomfort.

For the next two to four weeks after surgery, soreness, swelling, and bruising is normal. Most people can return to work after two to four weeks, but people with physically demanding jobs need to wait longer. During this recovery period, you will follow up at your doctor’s office regularly to monitor your progress.

Specific instructions may include avoiding bending, straining, or lifting for several days to weeks. Some patients may also need to avoid standing fully upright and stressing any internal sutures as they heal, and to sleep with pillows elevating the knees. To minimize the risk of blood clots, patients need to be up and walking as soon as possible and need to drink plenty of fluids.

Results After Body Contouring

Body contouring results are visible almost immediately; however, it can take a while to see the final results. The results are generally long-lasting, provided that the patient maintains a stable weight and general fitness. As your body ages, it is natural to lose some firmness. However, most of your initial improvements should remain.

Marvel Cosmetic Surgery offers a full range of body contouring procedures providing a more proportionate figure. Contact us today or call 615-538-0399 to schedule your free consultation. Let the Marvel team find the perfect procedure for you!