The Lift Chooses the Patient: Lollipop Lifts and Reusing Implants

Someone left me a comment asking two separate things at once: would I do a lollipop lift, and would I reuse her implants? Both are worth answering properly, because the honest answer to the first is "yes, all the time" and the honest answer to the second is "maybe."

I do lollipop lifts constantly. There is nothing second-tier about them.

But here's the framing I want you to walk away with, because it matters far more than any individual pattern:

You get the lift that works to achieve the goal. Sometimes that's a lollipop — a scar around the areola with a vertical line running down to the crease. Sometimes it's an anchor pattern lift, which adds a horizontal scar along the fold. Your anatomy and your goal decide which one you get. A preference for a shorter scar does not.

That's a different conversation than the one a lot of patients arrive wanting to have. People often come in having already picked their lift based on scar length alone. I understand the instinct completely — nobody wants more scar than they need. But choosing a pattern that can't do the job is how you end up back in the operating room, which is exactly why I'm so hard on donut and crescent lifts. If the pattern can't deliver the shape, the shorter scar isn't a win. It's a deferred problem.

If you're still at the stage of wondering whether you need a lift at all, I've written about how I actually grade ptosis and make that call.

First, something most patients have never been told: implants are off-label for reuse. They were never formally studied with the FDA in this manner. We do reuse them from time to time, and appropriately so — but you should know that's what's happening.

Here are my rules.

Recent surgery with a positioning problem. If you've had surgery within a short time period — a year or two — and the implant is simply misbehaving, that's a reasonable reuse. Maybe it's dropped too far to the side or sitting too low. If it's purely a positioning issue, I have no trouble using that implant again.

After a hematoma. If we're taking you back to evacuate a hematoma, I don't think you need a new implant. We clean things out and the same device goes back in.

Older implants. If the implant is a couple of years old or more, I don't love reusing it. We're already in there, and it's the right moment to place a fresh device.

Any contracture. Ever. So many contractures are caused by biofilm, and there is no way to clear biofilm from an implant in the operating room. I'm sorry, you just can't do it. In the setting of a contracture, you always need a fresh implant.

For a fuller breakdown of the reuse decision — including infection and implant exposure — I've written about that here.

The comment said "mild contracture," and I want to push back on that phrase directly.

Contractures are surgical problems. There's no version of one that gets managed into remission, and there's no version of one where reusing the implant becomes acceptable. Treating a contracture properly means an operation and a new device.

Here's the nuance that makes this worth saying out loud, though. Sometimes people describe a "mild contracture" and what they actually have is a little superior malposition — an implant riding high in a slightly tight space that isn't really a contracture at all. That's a genuinely different problem, and it has a different answer. In that situation, depending on the patient, I may consider using the same implant, as long as it meets the rules above.

So the label matters. Getting told you have a "mild contracture" and getting told you have superior malposition should lead you down two different paths.

One last thing that patients routinely miss. If you have a true contracture, you're usually covered under your implant's contracture warranty — unless the implant is very old, in which case we wouldn't be reusing it anyway.

So when we're heading back to the operating room for a contracture, your implant company should be paying for at least the implant itself. Depending on the manufacturer and the specifics of your warranty, you may also get some money toward the cost of the surgery.

That's a real reason the "let's just reuse it to save money" logic falls apart in contracture cases. The new implant is often already paid for.

Lollipop lifts are a legitimate, everyday tool, and the pattern you get should be dictated by your anatomy and your goal rather than by your scar preference. On implants: reuse is off-label but reasonable for a recent positioning issue or after a hematoma, and off the table for older implants or any contracture, because biofilm can't be cleaned off a device in the OR. And if someone tells you that you have a mild contracture, ask them what they actually mean — because a true contracture needs surgery and a new implant, and superior malposition is a different conversation entirely.