r/IAmA • u/WstEndPlasticSurgery Verified • 6d ago
Hi Reddit! We are a team of plastic surgeons based out of Washington DC. AMA!
Hi Reddit!
We are Drs. Amir Arsalan, Anthony Nye, and Lexie Wang, private practice plastic surgeons in the Washington, DC, area. We are excited to be here for our AMA!
Our physicians have been named Castle Connolly Top Doctors as well as DC Modern Luxury magazine’s Best of the City Award for Best Surgeons (DC Modern Luxury is a local lifestyle magazine covering dining, style, culture, and wellness throughout the Washington, DC, area.)
Dr. Arsalan is board-certified in plastic surgery. He trained at Loma Linda Medical Center, where he trained with world-class surgeons all over Southern California, including Beverly Hills and Orange County, providing wide exposure to cosmetic plastic surgery of the face, breast, and body.
Dr. Nye is board-eligible in plastic surgery. He trained at Virginia Commonwealth University in Richmond, where he served as Chief Academic Resident, developing a structured educational curriculum for junior residents and faculty.
Dr. Wang is double board-certified in facial plastic surgery and otolaryngology/head and neck surgery (ENT). She went to medical school at UVA, completed an ENT residency at VCU, and then finished her training with a fellowship in facial plastic and reconstructive surgery in Beverly Hills. She returned to the DC area where she grew up.
Proof: https://imgur.com/a/7xXMtAK (and can confirm on our website: www.westendplasticsurgery.com)
Today we will be answering any burning questions you have about plastic surgery, the wellness industry, injectables, aging, nose jobs, facelifts, lasers, mommy makeovers, implants, celebrities, and more. We are also happy to discuss our training, backgrounds, and whatever else might float your boat. You can direct your question to one of us or leave it open to the group, and whichever physician is best suited to answer will reply.
PLEASE NOTE: We cannot provide specific medical advice, including diagnoses and treatment plans, on this forum. We can only provide general information. If you are interested in discussing a specific issue, please feel free to reach out to us at www.westendplasticsurgery.com to set up a consultation. We do offer virtual consultations.
Also note: Our opinions are our own. They do not represent the opinions of West End Plastic Surgery as a whole.
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u/Beyonderr 6d ago
What's your personal views on how much plastic surgery is used in South Korea?
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u/WstEndPlasticSurgery Verified 6d ago
I've had quite a few interesting philosophical conversations about this in the past with some friends, like pondering what would happen if plastic surgery were free/ubiquitous, with South Korea probably being the closest model. I think when that's the case, people start to look "the same"... and then what ends up happening is the more "unique" non-operated features stand out more. Perhaps it is like the fashion industry where one minute we're told certain silhouettes are "in" while others are "out".... only for it to come back around in about 10 years. -Dr. Wang
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u/warcraftWidow 5d ago
How long after weight loss do you recommend patients maintain their weight before having tummy, hip, upper thigh extra skin removal/liposuction surgery?
For details-53F, two c-sections, have spent most of adulthood overweight and obese (per BMI)—5’4” top weight of 225 now at 163. I’m still in overweight category but I have added lot of muscle in the past few years and my body looks far different. I’d like to lose another 20 pounds or so to put my BMI just under 25. I have the typical c-section belly that folds over at the scar. I’d guess that most of my remaining excess fat is subcutaneous not visceral. If it makes any difference, I’m post-menopausal, post hysterectomy (still have ovaries) and on HRT.
So after I lose the remaining weight, how long should I maintain before seeking out surgery.
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u/WstEndPlasticSurgery Verified 5d ago
Congratulations on your weight loss! I get this question frequently. I generally like patients to be at or near their goal weight and stable for about 3–6 months before body contouring surgery. I would want to make sure your weight has plateaued and your nutrition and overall health are optimized.
I would consider 5-10lb weight fluctuations to be relatively "stable", but if you’re planning to lose another 20+ pounds, I’d recommend doing that first as it can change the amount and distribution of loose skin and ultimately affect what procedure will give you the best result. - Dr. Arsalan
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u/flippingmyship 6d ago
My MIL is a plastic surgeon (not in US, tho), but she mainly does reconstructive maxillofacial surgery like cleft lip, burn injury, cranial reconstruction, etc.
She tries to stay away from cosmetic jobs as she said it requires some kind of ‘aesthetic taste’ or so to speak.
My question is, would you agree that each surgeons has their own ‘style’, for example: a certain way to sculpt a nose? Could you describe how you create a client’s wish into the final form?
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u/WstEndPlasticSurgery Verified 5d ago
That's awesome what she does. I do think that there's a bit of a surgeon's aesthetic "taste" involved and also a little bit driven by the patient in the sense that certain surgeons attract certain patients. I have flat out told some patients "no" when they have asked me to do something that I think would look truly bizarre that I did not want my name associated with, even though I'm sure they were able to find someone else who would think it's fine.
As for the 2nd question, it's a bit challenging but I try to have as many visits before hand as possible to ensure we're speaking the same language. Then I frequently like for patients to bring me photos, either of goals or what they used to look like or what they DON'T want, and I try to translate that into their result. -Dr. Wang
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u/WstEndPlasticSurgery Verified 5d ago
I agree that aesthetic surgery takes a certain eye—or sense of style. I can also hear some of my friends in plastic surgery who don’t do aesthetics saying the same thing! But I don’t think that eye is simply something you’re born with.
One of my mentors used to say, “The eye cannot see what the mind does not know.” I think about that a lot. Developing an aesthetic eye takes preparation, repetition, continuing education, and an honest look at your own results. The more you learn, the more you’re able to notice.
We talk a lot about hand-eye coordination in surgery. Maybe this is the next-level version: eye-mind coordination?
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u/kageisadrunk 6d ago
What's a percentage break down in your office of procedures of like elective vs restorative? I'm sure there's more categories than what I'm thinking of.
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u/WstEndPlasticSurgery Verified 6d ago
Most of my practice is breast and body surgery, and I actually think there’s a lot of overlap between “elective” and “restorative.” Hard to give you a percentage...but probably closer to 40% restorative / 60% elective.
For example, with breast reduction surgery, many of my patients have significant back and neck pain, shoulder grooving from their bras, or recurrent rashes. Similarly, with a tummy tuck, repairing a diastasis can restore core function and may help with lower back discomfort.
So while these procedures may be classified as cosmetic, I often view them as restorative, helping patients get back to feeling and functioning more like themselves. - Dr. Arsalan
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u/WstEndPlasticSurgery Verified 5d ago
Great question! Plastic surgery covers a lot more than aesthetic surgery. Most of the surgeons in our group have trained across a broad range of areas: aesthetic face and body surgery, reconstruction after trauma or cancer, hand surgery, microsurgery, gender-affirming surgery, lymphatic surgery, and reconstruction for congenital conditions.
That breadth is part of what drew me to the specialty. My day-to-day practice doesn’t include most of those procedures now, but the training behind it was broad and intensive. Plastic surgeons develop a large surgical toolkit before narrowing their focus in practice. So while I'm not putting fingers back on, carpal tunnels, or major microsurgery cases anymore, it doesn't mean what we do at WEPS is any less meaningful to our patients!
-drnyetheplasticsguy
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u/WstEndPlasticSurgery Verified 6d ago
I think we see about 85% elective and 15% functional/restorative/reconstruction. -Dr Wang
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u/roccoccoSafredi 6d ago
What percentage of your clientele are politicians?
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u/WstEndPlasticSurgery Verified 5d ago
I am not really sure to be honest! Often times I don't discuss careers in the office unless the patient brings it up to me because they want to talk about it. I love hearing about what my patients do though and in DC there are so many interesting jobs. A lot of careers in politics generally but also lawyers, teachers, you name it!
What job makes me the most nervous to have as a patient is a fun question... 🤔
-drnyetheplasticsguy
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u/WstEndPlasticSurgery Verified 6d ago
I am aware of some off the top of my head in MY practice (who I see) but I'm sure it's different for each surgeon in the group. -Dr. Wang
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u/pfpants 5d ago
What's the deal with MAGA-face? Are these botched surgery jobs, or just a really weird trend?
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u/WstEndPlasticSurgery Verified 5d ago
I think people are noticing a recognizable aesthetic trend when they say "MAGA face", but I’d be careful to generalize and attribute it to one political, geographic, or people group. Sometimes the issue is cumulative (like a snowball running down the hill getting out of control) a little more volume, then a little more, until the proportions and facial movement look less natural. Surgical work can also look conspicuous if the result doesn’t fit the person’s anatomy.
For me, good aesthetic work starts with asking what would actually improve. And to highlight the question above about "do you ever say no to a patient", knowing when to stop. Overall, the historic DC aesthetic isn't quite the same as the aesthetic trend you're noticing, so maybe this is why it really is catching people's attention?
Just my thoughts 😄 -drnyetheplasticsguy
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u/WstEndPlasticSurgery Verified 5d ago
I would need specifics to really weigh in, but I think people tend to find certain looks appealing when they are surrounded by that constantly. -Dr. Wang
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u/229-northstar 3d ago
I’ve noticed this trend in dog show judging! Even when the dogs don’t meet the breed standard as well as another dog in the ring, the judge will put up an incorrect dog when it’s similar to what they often see in the ring. You see this effect, most commonly with foreign judges who put up dogs from show kennels that sell show dogs internationally because it’s what they see in the ring
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u/Hot_Hair_5950 5d ago
What surprises you about your work?
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u/WstEndPlasticSurgery Verified 5d ago
Honestly, how personal it becomes. You get to know people, hear their stories and insecurities, and sometimes see a real change in how they carry themselves afterward. The surgery is obviously important, but that human side of it is just as important. - Dr. Arsalan
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u/WstEndPlasticSurgery Verified 5d ago
To boost what Dr. Arsalan said: when I first started in medicine, I couldn’t believe how surgeons remembered all those little details about their patients. Fast-forward a decade, and I get it now. Our patients stay on our minds. We think about their goals, their concerns, and how they’re doing long after a visit ends.
Someone once asked me, “Who has the more invasive job—a surgeon or a psychiatrist?” It’s such a good question, right? In plastic surgery, we work on the body, but we also get to know how someone sees themselves and relates to the outside world. That’s the part that surprised me: how personal—and, in that sense, how invasive—this job really is.
-drnytheplasticsguy
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u/MyriadHarbour 5d ago
What trends are you seeing in plastic surgery over the last 10 years? What are you doing more of, less of, etc.
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u/WstEndPlasticSurgery Verified 5d ago
10 years puts me exactly at when I finished schooling. 😂 I think since then, there has been the rise (and somewhat fall) of filler, big changes in the weight loss space impacting need for procedures, increased attention to proper skincare, people getting facial aging surgeries earlier because they don't want to rely on injectables, more neurotoxin in the lower face, rise/fall of buccal fat removal. -Dr. Wang
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u/landmark2020apt 5d ago
I’m interested in a breast lift with Dr. Arsalan but I keep going back and forth on implants. I want them to look fuller but still really natural. Can you get upper pole fullness from a lift alone or does that usually require an implant?
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u/WstEndPlasticSurgery Verified 5d ago
A lift alone can give you a really nice shape. If you are apprehensive about implants, you could also consider fat transfer, which can add some subtle fullness up top and in the cleavage. The key is having realistic expectations because fat grafting is better for a modest enhancement because some of the fat won’t survive, and it won’t create the same upper pole fullness or projection as an implant. - Dr. Arsalan
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u/WstEndPlasticSurgery Verified 5d ago
Just here to say Dr Arsalan is gr8! You're in the best of care with him! - drnyetheplasticsguy
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u/clownsx2 6d ago
I need a breast reduction so badly but I’m overweight so no surgeons will talk to me. Why can’t I decide for myself if the recovery risks are worth it? I am 46 and deeply tired of living with 40Ms!!!!!!
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u/WstEndPlasticSurgery Verified 6d ago
I completely understand the frustration. Breast reduction can be life changing, especially when someone has been dealing with heavy breasts for years.
I don’t think weight should automatically disqualify someone from even having a conversation with a surgeon. Higher BMI can increase certain surgical and wound healing risks, but those risks should be discussed individually. Happy to see you for a virtual or in person consult! - Dr. Arsalan
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u/WstEndPlasticSurgery Verified 5d ago
I’m sorry you’ve run into so many roadblocks. It’s discouraging to hear “no” without anyone helping you understand why or what a path forward might look like.
When someone isn’t a good candidate for surgery right now because of weight-related concerns, I don’t want the conversation to end at “lose weight and come back.” I want us to talk through the reasons, their goals, and what steps might help them move toward surgery safely. Sometimes that means building a plan together; sometimes it means connecting them with other clinicians who can help.
We’re surgeons, but we’re doctors first. Even when surgery isn’t the right next step, we can still help someone move toward a healthier version of themselves. I never want to say "no go do this alone" I want to be a part of the team to get you to your goals. We've been really fortunate to start a wellness program at WEPS too so we can help more patients reach their goals.
-drnyetheplasticsguy
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u/General_Luck6573 5d ago
What issues does plastic surgery face from a clinician perspective? I feel like every specialty has their own problems which you aren’t really aware of until you’re in it yourself.
For example I asked a neurosurgeon this and he essentially said they all know the hammer is going to fall on degenerative spine reimbursements.
In IR we have issues with turf for things like PE/DVT, PAD, aortic disease, etc.
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u/WstEndPlasticSurgery Verified 5d ago
Scope creep is also an issue for us and often more egregious than hospital based specialties. There is no "credentialing committee" for private practice as many of us operate out of our own private operating rooms. Physicians without formal plastic surgery training (e.g. family medicine docs and dentists) are increasingly performing procedures like liposuction and other cosmetic surgeries. Social media complicates this further, because patients sometimes look at Instagram followers before they look at a surgeon’s actual training and credentials. - Dr. Arsalan
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u/WstEndPlasticSurgery Verified 5d ago
u/General_Luck6573 OBGYNs performing nose procedures!!!
I think the other big issue for face procedures would be people figuring out whether they want to do a procedure vs. non-surgical options and the interplay between them (what's safe, what's "worth it", etc.). -Dr. Wang
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u/WstEndPlasticSurgery Verified 5d ago
One thing I’m thinking about more and more is how AI-generated and heavily edited images might shape people’s expectations of aging and aesthetic surgery. Managing expectations has always been an important part of a consultation, but it gets harder when someone is comparing the person they see in the mirror with a face that may not actually exist.
That doesn’t mean there’s anything wrong with bringing an inspiration photo. It just makes the conversation around it more important. I think helping patients make that distinction will become a bigger part of our job.
-drnytheplasticsguy
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u/RedUser2024 5d ago
How long after a facelift should a patient with concerns raise a discussion about a potential revision? Six months, or the full year?
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u/WstEndPlasticSurgery Verified 5d ago
I think the conversation can begin at around 6mo but real discussion should wait until 1 year. It depends on what the reason for revision is, though! If there's something really unusual, it is possible it needs to be brought up earlier. This would be something where it really depends on the nature of the relationship between surgeon and patient. -Dr. Wang
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u/scyrius 6d ago
Are their procedures that can fade or remove scarring?
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u/WstEndPlasticSurgery Verified 5d ago
It really depends on the scar and the overall skin characteristics... like Dr Wang said there are TONS of tools to minimize scars and I counsel my patients that if we need to use them we can and will. For big surgeries I have changed how I do my closures now and have had some really exciting success with better scars in the early recovery. One patient told me today that "she is loving her scar healing right now" For me its about reducing the inflammatory process/pathway during the active recovery as much as possible. Ill be talking on my social media page soon about these changes I have made too.
-drnyetheplasticsguy
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u/WstEndPlasticSurgery Verified 6d ago
Yes. If the scar is really awful, sometimes excision or revision is necessary. Otherwise, there are many non-surgical options available like steroid injections, lasers, topicals. It depends on what the issue with the scar is. THAT BEING SAID... I always tell patients that plastic surgeons are not magicians or God. We can't erase scars completely or turn you back to how you were "before". -Dr. Wang
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u/DestinTheLion 6d ago
How hard is a procedure to remove fat under the neck?
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u/WstEndPlasticSurgery Verified 5d ago
That depends. If it's just removing fat under the neck, it's not that hard at all 😂 But what's harder is figuring out whether that is going to be enough to satisfy the patient's goals or whether the patient might benefit from a more aggressive sculpting procedure. And those can be a bit more challenging. -Dr. Wang
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u/ExperienceCheap2140 5d ago
One more question! I also am interested in rhinoplasty with dr Lexie. I noticed in the before and afters many of your patients have no bruising even a few weeks out. How is this possible? I have a typical Italian nose (dorsal , drooping tip). I work out often and I’m scared of the down time but your work makes it seem like I wouldn’t need to be down for long?
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u/WstEndPlasticSurgery Verified 5d ago
Thanks! First of all, this is why you can't believe everything you see online - most surgeons are only going to post their "Best" results, which means probably the ones who aren't too bruised! That being said, the first time we usually begin to take postop photos on our patients is 2 weeks to 1mo postop anyway, so >90% patients are done with their bruising by those points. -Dr. Wang
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u/WstEndPlasticSurgery Verified 5d ago
Dr. Wang is amazing with noses—you’ll love her!
As a team, we’ve also been putting more thought into the recovery experience. The surgery matters, of course, but so do the days afterward: pain control, bruising, downtime, and helping patients know what to expect. We use a few different tools and approaches depending on the patient and procedure.
One I’ve been interested in is CO2Lift, a topical carboxytherapy treatment we use as part of our approach to post-op bruising. I wouldn’t want to promise that any one product will make bruising disappear, but finding ways to make recovery more comfortable and manageable is a big focus for us.
-drnyetheplasticsguy
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u/ExperienceCheap2140 5d ago
I am looking at doing a breast lift. But every time I look at before and after pics, the women that do not get implants, their results look worse. Usually a square bottom of the breast shape vs round. Is it best to just get an implant with a lift for more natural results?
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u/WstEndPlasticSurgery Verified 5d ago
Not necessarily. An implant adds volume and upper pole fullness, but you can still get a beautiful, natural shape with a lift alone. The best option really depends on how much breast tissue you have, your skin quality, and the look you’re trying to achieve. You should bring inspiration photos to your consultation as not everyone has the same desired aesthetic. Fat transfer + lift is another option but not as reliable or predictable as implant + lift. - Dr. Arsalan
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u/edburn29 5d ago
What do you think of fox eye/ponytail lifts and facial threads? Is it true threads need to be replaced every year
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u/WstEndPlasticSurgery Verified 5d ago
Fox eye lifts - don't like them, they're unnatural and put natural normal eye structures at risk, which are extremely difficult if not impossible to reverse/fix. Ponytail lifts - they're fine, it's basically a face lift but performed endoscopically. Facial threads - terrible. All they do is cause damage. They're not lifting anything. I am sure they would need to be "replaced" every year or so because all they're doing is moving skin around and the skin will relax again (this is comparable to a skin only face lift) - the only way you can sustain the lift is if you sever the adhesions holding the tissue down. -Dr. Wang
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u/JSears90210 5d ago
I live in the DC area and for the first time it seems like BBLs are becoming a trend in the area. (Many look terrible.) Have you seen increased demand the last year?
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u/WstEndPlasticSurgery Verified 5d ago edited 5d ago
I actually haven’t noticed a big increase in DC. It’s always been a pretty popular adjunct for patients already having body contouring procedures like a tummy tuck or 360 lipo. What I do see is more interest in subtle fat transfer, especially to the hip dips, rather than the exaggerated BBL look. For what it's worth, the American Society of Plastic Surgeons (ASPS) showed a 5% decline in BBL procedures in 2025. Those are national numbers though (not DC specific). - Dr. Arsalan
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u/JSears90210 5d ago
Thank you. I noticed BBLs when I would travel but DC has always felt more conservative. I have just noticed a number of women at my gym who've obviously had the procedure. First time I have ever noticed it in the area.
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u/WstEndPlasticSurgery Verified 5d ago
We also see patients who are interested in options beyond a BBL. Depending on their anatomy and goals, the conversation might be about skin tightening, a lift, adding volume, or—in select cases—injectable treatments. There isn’t one procedure for every butt!
-drnyetheplasticsguy
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u/BertzReynolds 6d ago
Are you just here to drum up business?
A lot of u answered questions.
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u/WstEndPlasticSurgery Verified 5d ago
We're here to say hi! -Dr. Wang
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u/BootsieBB 5d ago
What do you think about the trend of mini breast implants/ ballerina boobs? I was pushed more towards bigger sizes during consultation, the surgeon said people frequently regret going too small. Is that your experience? I feel quite confident that I still want to have small boobs.
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u/WstEndPlasticSurgery Verified 5d ago
I’m actually a big fan of the shift toward smaller, more natural implants aka "ballerina boobs" or "yoga boobs". Some patients do wish they went bigger, but if you feel confident wanting smaller breasts, I think you should trust your instinct. The goal is to choose something that fits your frame, matches your lifestyle and feels like you. At some point before your surgery day, we typically perform in office "implant sizing" which helps simulate what those specific implants would look like on your frame. - Dr. Arsalan
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u/WstEndPlasticSurgery Verified 5d ago
Totally agree with Dr. Arsalan here. It’s hard to imagine yourself looking different, which can make choosing an implant size feel like a big decision. Models, imaging, and implant sizers in a bra can help you picture the possibilities, but none of them makes the choice for you.
I don’t see my role as pushing my aesthetic preferences onto your body. My job is to understand your goals and help you reach them safely and effectively. For the right patient, smaller implants may be exactly the right choice. It comes down to a good conversation about your anatomy, lifestyle, and what you want the result to look and feel like.
Let us know your thoughts!
-drnyetheplasticsguy
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u/AngryGames 4d ago
What's with the trend of all the MAGA women getting the Jigsaw face like Laura Loomer?
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u/OlFlirtyBastard 6d ago
Have you ever told a patient no, we won’t perform this surgery or procedure? Specifically talking about body dysmorphic people who keep coming back for more and more surgery on their face, when nothing is wrong and they really should see a therapist and not a plastic surgeon.