Preservé™ by Manhattan plastic surgeon Dr. Darren Smith — a breast augmentation that preserves your natural tissue, performed under local anesthesia. Dr. Smith authored the textbook chapter on the technique.
Request More InformationBoard-Certified Plastic Surgeon · President, New York Regional Society of Plastic Surgeons · Dual Fellowship-Trained
Most surgeons learn a new technique from a textbook. Dr. Smith wrote the chapter on Preservé.
If you've been looking for a breast augmentation that doesn't require putting you fully under, doesn't cut through muscle, and lets you return to your life sooner — there's a name for it. It's called Preservé.
Preservé is a tissue-preserving approach to breast augmentation built around Motiva implants. Rather than relying on general anesthesia and broader tissue disruption, it is performed under local (tumescent) anesthesia — most often while you remain awake or lightly sedated — with the goal of preserving the surrounding muscle and tissue.
A traditional breast augmentation is typically performed under general anesthesia. The Preservé approach is designed to be performed awake, under local anesthesia, with attention to preserving the pectoral muscle.
Awake does not mean aware of pain. The area is thoroughly numbed with local anesthesia, so you can remain conscious and breathing on your own.
The technique uses the Motiva SmoothSilk® / Ergonomix® family of implants.
Local anesthesia with light oral relaxation. You're comfortable and conversational — most patients describe pressure at most, with music playing and the team talking you through it. The gentlest option, with the quickest return to feeling completely yourself.
IV sedation administered by a board-certified anesthesiologist. You drift through a light sleep — pleasantly dissociated, with little or no memory of the procedure. You breathe entirely on your own throughout. No breathing tube. You wake quickly and clearly.
For the few patients who would rather be completely asleep, full general anesthesia is available, administered by a board-certified anesthesiologist. It's rarely necessary — most choose to stay awake or opt for twilight sedation — but the choice is entirely yours, and you're monitored throughout and recovered with care before heading home.
Whichever option you choose, you're cared for by our elite team in our private surgical suite — and home shortly after.
Both your consultation and your procedure take place entirely within our private, discreet boutique surgical suite at the Ritz Tower on East 57th Street — a self-contained Manhattan setting designed for complete privacy, from arrival through recovery.
You choose your level of awareness — most patients stay fully awake with light relaxation or opt for twilight sedation administered by a board-certified anesthesiologist. Full general anesthesia is available if you'd prefer it, though it's rarely necessary.
Many patients return to light activity the same day, and most are back to their daily routine within a few days.
Nervous about being aware during surgery? That alone doesn't rule you out.
A consultation is the best way to determine whether Preservé is right for you.
No. Preservé is performed under local anesthesia — most patients stay fully awake or choose IV twilight sedation, drifting through a light sleep while breathing on their own, with little or no memory of the procedure. General anesthesia isn't required, but it's available if you'd prefer to be fully asleep.
With twilight sedation there is no breathing tube — you breathe on your own the entire time, with a board-certified anesthesiologist dedicated to your comfort, adjusting your sedation in real time. You wake within minutes of the procedure ending, clear-headed, without the grogginess and nausea that commonly follow general anesthesia.
No — the treatment area is thoroughly numbed, and you can choose the comfort option that fits you best: fully awake with light relaxation, or twilight sedation where you drift through a light sleep.
A standard augmentation is usually performed under general anesthesia. Preservé is designed to be performed awake, under local anesthesia, while preserving the pectoral muscle and surrounding tissue.
Most patients can return to light activity the same day. The majority can be back in the office in 48 hours.
The Motiva SmoothSilk / Ergonomix family of implants.
It requires specific training and experience. Dr. Smith authored the surgical chapter on the technique.
Our private practice is at the Ritz Tower on East 57th Street in Manhattan.
Consultations with Dr. Smith are $500, applied toward the cost of your procedure. For patients who prefer to preserve liquidity, tailored payment arrangements are available and discussed privately during your consultation.
“Dr. Darren Smith is truly in a class of his own. I’ve worked with several top, celebrity‑level plastic surgeons over the years, and none of them come close to the combination of artistry, precision, and genuine human warmth that Dr. Smith brings to his work.”
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During your consultation, we use VECTRA 3D imaging to simulate your potential result together, so you can refine the look before anything is scheduled.
What each panel shows:
VECTRA 3D simulations — illustrative, not a guarantee; individual results vary. Garments added with AI for modesty.
Share a few details and a member of our team will personally follow up by phone, text, or e-mail (your choice).
Consultations with Dr. Smith are $500, applied toward the cost of your procedure.
Private and no obligation — just a conversation about your goals.
