Breast implant removal with Perkylift™

Are you thinking about getting your implants taken out?  Implant removal without replacement has become more popular, due in part to the change in lifestyles and values post-Covid. For many, life has become more casual and authentic, and large breasts are no longer needed to make a statement or to create a certain look.

What happens after implants are removed?

If no remedial surgery is done, the implant pocket shrinks up, leaving the remaining skin and breast tissue misshapen and irregular. What once looked decent can turn into a real problem. Lots of ladies don’t want scars, though, and the thought of replacing the mostly scarless breast with a patchwork of incisions is daunting.

In 2009, Dr. Diane Duncan came up with the concept of nearly scarless breast lifting by combining tumescent infusion of the breast with subcutaneous radiofrequency tissue tightening. She has trademarked the name “PerkyLift”, which remains exclusive to her practice. The PerkyLift process also uses internal  PDO suspension threads in most cases to generate more lift and to hold the tissue securely while new collagen ingrowth takes place. These lifts have been used in combination with breast augmentation, breast reduction without scars, breast lifts in small to medium-sized cases, and for patients who have uneven breasts.

Recently, Dr. Duncan has devised a way to incorporate a PerkyLift with implant removal for qualifying patients. The old augmentation incision (usually inframammary) is used to remove the implant and capsule or implant pocket. The internal space is closed, and tissue is stitched internally so that drooping is corrected as much as possible. RF energy is used to stimulate collagen growth within the adipose tissue so that a new support scaffold is created. Then PDO suspension threads are placed.

Because the remaining skin and breast tissue are stretched out after implant removal, healing generally takes a bit longer than other variations of the PerkyLift. Three types of support are needed because there is no skin excision. Internally, sutures are used to fasten the tissue together in a lifted position. Suspension sutures also hold the tissue in place. External kinesiology tape is used to support the skin, and the patient wears a support bra in order to mold and shape the breasts while healing.

The shape “sets” over a 3-4 month period of time, and the final result can take up to a year to become fully defined.  This is not a quick and easy process, but the long-term outcome is worth it for those who want as much restoration of their youthful shape without new scars.


Before and After of Perkylift after breast implant removal example 1
38-year-old 20 years after breast implant placement 4 months following implant removal and PerkyLift


Before and After of Perkylift after breast implant removal example 2
51-year-old with saline implant deflation, right 4 months following implant removal and PerkyLift

Please give a warm welcome….

To our AMAZING new Physician’s Assistant, Adrien!

Photo fo Adrien at Yale University

Adrien Chan is a board-certified and Colorado-licensed Surgical Physician Assistant who recently moved from New England to join the Plastic Surgical Associates family. She is a native-born New Hampshirite who moved to Connecticut to pursue her dream of becoming a physician assistant. She completed her Bachelor of Health Sciences with a Biochemistry Minor in the Dual-Degree Entry Level Masters Physician Assistant Program at Quinnipiac University in 2019. She continued at Quinnipiac University where she completed her Master of Health Sciences in Physician Assistant Studies in 2021. With her profound interest in surgery, she decided to further her training in the Norwalk Hospital/Yale School of Medicine PA Surgical Residency Program.

During her rigorous training, she had the opportunity to work in various surgical specialties including: general surgery, plastic and reconstructive surgery, neurosurgery, cardiac surgery, colorectal surgery, surgical ICU, pediatric surgery, bariatric surgery, and vascular surgery. With a profound interest in plastic surgery, she chose to complete an additional elective in this field of medicine during her residency training. She believes in establishing a team-based approach towards finding a treatment that is most suitable for a patient’s desired outcomes, along with their ideal timeline of recovery.

Some of her interests include cooking, hiking, skiing, snuggling with her Siberian Husky, Teddy, and enjoying the beautiful outdoors, a perfect fit to settle into her new home in Colorado!

PatientFi (Our Newest Financing Partnership)

We are excited to announce a new partnership with PatientFi!

Considered the friendly way to pay, PatientFi can approve you in under a minute with no hidden fees, no hard pull on your credit history (thereby not affecting your credit score) and multiple monthly payment plans to fit your budget!

PatientFi offers a revolving line for use at our office, and you get to choose the terms from 6 months with 0% interest if paid in full, to fixed terms of 12, 24, and 36 months (APR ranging from 6.99-24.99% (dependent on your credit score)). Their handy payment calculator allows you to find the best option for you.

PatientFi ad

What’s the deal with exosomes?

Animated diagram of Exosomes

These little guys are hot the aesthetic buzz; but what are they and how do they work? When you look at a cell, all have an intracellular structure called an endosome (meaning that the vesicle is inside the cell). These tiny compartments contain smaller nanoparticulate containers measuring 20-100 nanometers – smaller than the diameter of the human hair. Initially, these were considered to be the ‘trash cans’ of the cell, but now we know that these endosomal particles contain valuable cell signaling biomarkers such as cytokines, chemokines, mRNA, miRNA, and genetic messengers. Their job is to influence neighboring cells to change their behavior.

Exosomes are formed when these endosomes fuse with the plasma membrane of the outer cell wall. A gap in the cell wall is created, and the tiny particles are released into extracellular fluid (ECF). These newly extracellular vesicles were initially associated (a little over 30 years ago) with cell to cell signaling. More recently, they are exploding onto the aesthetic scene as the better-than-stem-cell alternative as stem cells have the potential to become a variety of things ‘at will’ whereas exosomes can be programmed to be more specific and targeted. They are lipid vesicles that shuttle various proteins and genetic informatics between cells (including distant cells – they don’t need direct cell to cell contact!). Messages from exosomes can include rapid healing sequences, tissue repair promoters, and reparative biomarkers that improve tissue quality. Interestingly, about 91% of the effects of stem cells are transmitted in exosomes through a process known as paracrine cell signaling.

So exosomes or stem cells? Stem cells are unprogrammed, transformative cells that encourage regeneration in damaged or diminished tissues. Dr. Duncan frequently combines autologous stem cells into her fat grafting procedures as a way to brighten the skin, remove lining and creasing from underneath, and ensure optimal graft take. Exosomes are naturally present messengers for stem cells that encourage unhealthy cells to begin improving. According to Scientific Reports Journal, “exosome secreted by human adipose mesenchymal stem cells promote scarless cutaneous repair by regulating extracellular matrix” remodeling. The human adipose mesenchymal stem cells are what Dr. Duncan targets when refining fat for fat grafting, and supplement grafted fat with extracted stem cells.
However, not all patients want something as invasive as fat grafting in order to obtain autologous stem cells or exosomes. Currently about 15% of people wanting to improve their appearance choose surgery while the other 85% opt for minimally or noninvasive options. The logic is simple. No one will choose a procedure that creates a significant temporary deformity unless the payoff (8 to 10 years’ worth of improvement) is guaranteed. Instead of destructive procedures, most are interested in restoration of their own existing tissue. What does the field look like for those patients? Stem cell serums from cryopreserved human umbilical cord MSCs are entering the market (check into InfiniViveMD Stem Cell Serum) and lab-grown exosomes (see Benev products) are also becoming available. Exosomes are cultured from stem cells in conditioned media. They are not FDA regulated if applied topically, but they are not FDA-approved for injection.

At PSA, we use exosomes primarily to accelerate healing following a resurfacing treatment such as Neogen or Erbium laser. Stem cell and exosome facials are also available at Dr. Duncan’s office here in Fort Collins; give us a call to see how these non-invasive modalities might glow up your game!

Wang, Lu, et al. “Author Correction: Exosomes Secreted by Human Adipose Mesenchymal Stem Cells Promote Scarless Cutaneous Repair by Regulating Extracellular Matrix Remodelling.” Scientific Reports, vol. 8, no. 1, Jan. 2018, doi:10.1038/s41598-018-24991-y.

Diane Duncan, M.D., FACS

Award-winning plastic and reconstructive surgeon, Diane Duncan, MD, FACS has been recognized both regionally and globally for over 30 years. Read More