Berman Cosmetic Surgery & Skincare Center - Reversing Facial Fillers - Blog

Reversing Facial Fillers: Where, How and How Often?

There are a large number of facial fillers on the market and they are becoming immensely popular. Although, not quite as popular as Botox, they are quickly becoming the “next biggest thing.” Although there are millions of women and men doing this, for those that are newer to this, you are probably wondering the following:

Should I do do this? Who should I let do the injection? What are the risks? And if I hate it, can I reverse it?

Let me preface my comments by saying that I have always done all of my own injections for fillers and Botox for my patients. I know many places use estheticians and other doctors that are not plastic surgeons (even dentists). Most of the time, this is probably fine but there is a lot to be said for having an experienced plastic surgeon do your injections. But ultimately, that is your decision, based on your comfort level.

Not all facial fillers are reversible. Only those that are made from hyaluronic acid can be reversed. The good news is that all the facial fillers that I use are made from hyaluronic acid: namely Juvaderm and Voluma, and their associated families of products. This also applies to Restylane and Perlane and that entire family of fillers. This does not apply to Radiesse or Sculptra, which are made from a completely different material.

When a filler is injected, I always tell my patients to massage any firm areas that they may notice during the first week. You can certainly ice an area after an injection, but it is not required. Also, if you are happy with the look after the injection, it will almost certainly stay that way. Everyone gets some water absorption and slight swelling after the filler is injected. I strongly advise everyone to wait 2 weeks after the filler before considering making any changes. Since people sometimes examine the area injected very critically, it is important to realize that there may be subtle differences between the areas injected and along the areas injected (eg the two sides of the lip) that may be noticeable to you at day 2 or 3, but will be fine by day 14. The important thing to note here is to not be in a rush to make changes in the first two weeks!

I believe the main advantage of knowing that your filler is reversible is having peace of mind that you are not “stuck” for many months or years with the filler if you end up not really liking it. The practical side is that you are very unlikely to even need it reversed. You should also know that if you inject the reversing agent, it may dissolve ALL of the filler injected into that area, which you may not want. It is not an exact science and we cannot control exactly how much of the filler will melt away with the reversing agent.

Berman Cosmetic Surgery - 3 Summer Must Haves for your Skin

3 Summer Must Haves for your Skin

Written by Jacqueline Seabra, Master Esthetician

Summer is that time of the year when sweat glands and sebaceous glands are more active – meaning the skin clogs more easily. You need a good regimen to maintain your skin and keep it free of blemishes, while protecting it from harmful UV rays.

Seeing a need for a great skincare solution for our clients is what prompted Dr. Berman to create his own line of skincare products. As a master esthetician, I cannot say enough about our 3-step plan for gorgeous skin, which consists of a daily scrub, Vitamin C serum, and tinted moisturizer.

These 3 products are all you need to set the stage for beautiful summer skin: 

  • CLARIFYING BRIGHTENING POLISH
    This mild brightening scrub is environment friendly with micro-beads to gently and effectively polish the skin by removing excess oil, residues and impurities. As a brightening agent, it contains Arbutin, a natural brightener that inhibits melanin production, Glycolic and Salicylic Acids to assist with cell renewal, and Vitamins A, C, and E, which work as powerful antioxidants.
  • VITAMIN C SERUM
    This unique serum delivers the most stable form of ascorbic acid to the skin using a special liposome-encapsulated phyto stem cell and peptide delivery system. This powerful antioxidant can be applied both morning and night to combat free radicals.
  • PERFECT TINT -SPF 50 

    This luxurious tinted moisturizer, enhanced with green tea extract, is the perfect combination of an antioxidant moisturizer and sun protection, made with 16.2% Zinc Oxide. It will also block both UVA and UVB rays. Its’ unique Universal Pigment Technology provides a sheer, healthy touch of color for all skin tones.

In addition to these 3 must-haves, our Berman Cosmetic Surgery skincare line has everything else you need to customize your skincare regimen according to your individualized needs and concerns. View the complete line >

Great skin is just part of your skin care regime. If you have more serious concerns you’d like to address, including hyper pigmentation, acne scars and fine lines,  you may want to consider our Picosure laser facial, which gives great results with NO downtime, or one of our popular skin care facials or chemical peels.

If you have questions or need help finding the perfect skincare regime, please call us at 703-406-244 to schedule a complimentary consultation with me. Here’s to healthy, glowing summer skin! 

Berman Cosmetic Surgery - How to Improve your Results after a Tummy Tuck, SmartLipo or Sculpsure - Blog

How to Improve your Results after a Tummy Tuck, SmartLipo or Sculpsure

Whether it’s a tummy tuck, SmartLipo or SculpSure, you have invested considerable time, money and effort into your body contouring procedure and you surely want to get the maximum results. There are several things I recommend my patients do to optimize their procedure.

Almost of the people doing these body contouring procedures are trying to reduce fat in specific areas. Sometimes there is one area which has been treated, but more often, several areas have been treated. In a minority of the tummy tucks that I have performed, there was no extra fat at all – it was entirely a loose skin problem. If you have a bit more fat than is ideal, you can definitely enhance your results by decreasing your total body fat. I am decreasing fat in specific areas but if in addition to that, you can decrease your total body fat everywhere, you will look even more amazing.

There is no magic here. Modifying your diet is extremely helpful.It is almost impossible to out-exercise a poor diet. I believe that following a Paleo or Paleo-like diet works the best. It’s for that reason that I do offer my favorite Paleo meal replacement through my office. This makes it very easy to follow the Paleo diet if you can simply replace your regular breakfast and/or lunch with the powder. I realize that there are many different diets that can work. I am, however, not a fan of diet pills or anything artificial.

Maintaining or increasing your activity level is also key. More and more evidence is confirming that some variation of a high intensity workout done a few times per week gives you the greatest return on your time. Most gyms offer this and there are countless free videos on Youtube that you can do in the comfort of your own home with no equipment. I have a lot of opinions on exercising, and will be blogging about those in the future, but in short, it is my strong belief  that everyone should be doing core exercises as part of their routine. As we get older, this is even more important. For women especially, strength training for the upper body in women is critical.

Regarding the scarring from a tummy tuck or the small scars from Smartlipo (there are NO scars from SculpSure), we sell a scar cream that should help the scar fade and mature more quickly. I have many years experience and some people’s scars fade much quicker than others and this has little to do with the surgeon’s skills. Virtually every scar will continue to fade with time, but it should be noted that they will never completely disappear. They’ll be visible if you look hard enough for them! I have seen some women get tattoos over they TT scars and this does a great job hiding them. But of course this won’t be a desirable option for everyone.

It is important to recognize that there is plenty you can do to help you look and feel better overall. A tummy tuck, SmartLipo or SculpSure can help to eliminate fat and loose skin, but proper attention to your overall health, fitness and nutrition will help your skin look it’s absolute best.

Berman Cosmetic Surgery Blog - The Evolution of Breast Implants

The Evolution of Breast Implants

Let me first note that is  meant as a guide and not a historical thesis. However, I could not resist adding the paragraph below from Wikipedia:

From the first half of the twentieth century, physicians used other substances as breast implant fillers—ivory, glass balls, ground rubber, ox cartilage, Terylene wool, gutta-percha, Dicora, polyethylene chips, Ivalon (polyvinyl alcohol—formaldehyde polymer sponge), a polyethylene sac with Ivalon, polyether foam sponge (Etheron), polyethylene tape (Polystan) strips wound into a ball, polyester (polyurethane foam sponge) Silastic rubber, and teflon-silicone prostheses.

The first “breast filler” surgery took place in 1895, and involved fat being transferred to the breast.The main thing to note is that today, we largely have only saline and silicone implants. There has been a variety of different fill substances and coatings. but those have largely been discarded due to a variety of problems.

What has changed is that there are two basic coverings for the implants: smooth and textured (small spikes or velcro-like). Also, there now are options in the profile of the implant. This means that the base diameter gets smaller as the implant projects more forward. Over time, the options in this area have increased considerably. Although there are certainly instances where it is helpful to have a smaller base diameter and to have an implant that projects more prominently, I often feel that there are variations between each model. When it is only measured in millimeters, it is driven more by a marketing desire (so a woman can feel that she is more in control) than of any practical reasoning. In my opinion, one cannot possibly notice difference of this small amount.

The other big change is in the “cohesiveness” of the silicone implant. This means that the silicone implant gets firmer – and subsequently, more expensive. This could be beneficial for the woman with very thin skin and soft tissue so that it is less likely to show rippling. In general, the greater the cohesiveness and firmness, the more the company is charging for the implant. But again, depending on the skin condition, that may be the more desirable option, if you’re already taking the time and effort to improve your appearance in this area.

The good thing is that we now have implants that we believe to be both safe and effective, and with a variety of options, so that everyone should be able to find an implant that will be effective for them and give them their desired end result.

Ashley Black and the Fascia Blaster: My Thoughts on the War on Cellulite

Every woman knows what the term cellulite refers to: the cottage cheese certain areas, including your thighs, have with dimpling or waviness. While it doesn’t seem to affect men, it is estimated that 85% of women over the age of 35 years of age have it. It is quite ubiquitous. It is also very genetically-based. I have seen women who run marathons, who are very trim, with cellulite. There are currently two FDA-approved treatments for cellulite: Cellfina and Cellulaze.

Cellulaze is made by Cynosure and was the first FDA- approved treatment for cellulite. It is done in the office under local (in my case, only under local with oral sedation) or general anesthesia. It involves infiltrating the area to be treated with local anesthetic with epinephrine. A fiberoptic laser fiber is inserted under the skin which is used to lyse (cut with the laser) the fascial bands which are pulling the skin inwards. The laser can be directed up into the skin,  to both melt fat to decrease the fullness in the skin rolls (fat in the dermis) and also to laser heat the underside of the skin. This laser of the underside of the skin has been proven to  stimulate collagen and elastic production. The decreased collagen and elastic fibers are thought to be the principle cause for the cellulite. It is a single treatment and the patients will continue to improve for at least 6 months.

Cellfina has been more recently approved by the FDA. Rather than using a laser, it relies solely on cutting the fascial bands under the skin. It is also a single treatment with many advocates.

Ashley Black’s fascial blaster is essentially a roller with spikey projections that is rolled over warm, oiled skin for several minutes. The rolling continues until there is redness and often bruising. It sells online for about $89. She is getting a huge following on the internet and is getting featured in several women’s magazines. She has some very nice before and after pictures on her Facebook page. I’ve been asked if it works what I think about it. 

First, there are some some excellent transformation photos. Of course, if she did not have any pictures, no one would buy it or try it out. It seems that there have been a huge number  Fascia Blasters sold. Assuming these excellent pictures are legitimate, I still have some concerns. It can be difficult to demonstrate cellulite on photos and it is very dependent on lighting. I also wonder how soon after the rolling the pictures were taken. The kind of aggressive rolling that she is recommending will definitely cause swelling. If the skin is swollen, it will absorb water and this will temporarily make the skin look much better since it will mask the uneven surface of the skin. I wonder what these areas look like two weeks later, after the rolling has ceased?

Secondly, there is no question that the Cellulaze  treatment is a very aggressive way to break these adhesions from the skin. It also puts a significant amount of heat into the skin which stimulates collagen production. Even with this, I estimate in my hands only about 80% of women improve somewhat. (I would add that I cannot predict who is going to get a better or a poorer result).  However, even with this very aggressive treatment, it cannot make the cellulite disappear. Most women get a mild to moderate improvement. Almost no one will have their cellulite disappear. It is still worth doing since I don’t believe any treatment is as aggressive. It certainly should accomplish as much as Cellfina, since it incorporates the idea of cutting the fascial bands, and with a laser as opposed to a needle. I find it very hard to believe that rolling the skin can generate enough shearing force to actually tear these fascial bands to the skin – and that they will not simply reform, even if they were torn. If these two minimally-invasive techniques can only give some improvement, I question how likely is it that the Fascial Blaster can give a lasting improvement.

Lastly, even if these photographs are legitimate and not taken in close proximity to the treatment, how many people have photographs that show no difference whatsoever?  If 10,000 women have tried it and there are 30 good photographs, that is not a great ratio of success.

What I do find very interesting is that there are some parallels between this and Thai massage. Thai massage, like acupuncture, follows the thought that there are energy lines that run up and down our bodies. No doubt the Fascial Blaster stimulates these lines. Drinking plenty of water after these treatments, should help to detox the body and make the person feel better over several days. Also the massage of the warm oil will stimulate these lines. I think this accounts for the very positive experience many people are seeing with the Fascial Blaster”.

What would it take to better convince me that the Fascial Blaster works? It is impossible to do a rigorous double-blind medical study. However, it should be possible to get 100 consecutive women to use the Fascial Blaster for some set  period of time. Standardized photographs – with the same distance and lighting – would be done before the study starts. Then after stopping the rolling for 3 weeks, re-photograph the areas. These photos would then be sent to several judges who would not know which photos were taken before and which were taken after treatments and the judges could rate the results. It would be important to have many women who had no treatment but also had “before” and “after” photos to also be sent to the judges, to ensure that they were able to ascertain that the no treatment group did not improve.

Until this happens, I am reserving judgement. I am perhaps showing my years in the beauty world, but there have been endless “miracle treatments” that get rave reviews one year, and then  just 2-3 years later, completely disappear from the world.

Why Laser Hair Removal is Not Ideal in Summer Months

Many people do not consider laser hair removal until the weather gets a little warmer and they start baring more skin. However, by that point, I’d typically recommend against the procedure. The primary reason for this is that you should not be getting laser hair removal on skin that is tanned. You need to use a sunblock in the area for at least 3 weeks and maybe longer. Having said that though, areas such as the bikini area and  axillary area (armpit) are usually not tanned, and laser hair removal on those areas are fine for laser hair removal through the summer. Generally speaking, any area that does not get tanned, even though it is summer, if ok to get treated.

Now you may be wondering if you’ve wasted your money if you’ve already received a few treatments before the summer, and now  you want to hang out at the pool and tan during the summer. Absolutely not! The hair that was destroyed by the treatments (generally 15-20% of the hair treated in one session) remains gone and you can just resume your treatments in the Fall, or when your tan fades – whichever comes first!

Bridal Makeover: Plastic Surgery for the Bride-to-Be

It is almost universal that a woman would like to look her very best on her wedding day. However, from a plastic surgeon’s perspective, it takes careful planning. I’ve seen women who have requested fillers and Botox within a few days of their wedding. I’ve even seen women who have requested an upper lid blepharoplasty within 2 weeks of their wedding. And ditto for a breast augmentation. Quite frankly, all of these are terrible ideas. This topic covers a broad age group: many women are having their first marriages in their 20’s and 30’s and oftentimes a second or third in their 50’s. I’m also discussing others in the wedding party in the information below.  

Of course, each woman and her wedding situation can be different. However, I think as a general principle you should ideally do fillers and Botox six weeks before your wedding. I am being conservative here… 3-4 weeks before is probably fine, but I would lean towards six weeks to be certain. This allows any bruising that may occur to completely resolve and for any fine tuning that needs to be done. Even if you “never bruise,” there is always a first time, so I recommend allowing time for that possibility. A more minor point is to be careful using Botox on your forehead before your wedding. Although getting rid of all lines and wrinkles on your forehead is appealing, those same muscles allow your brow to elevate. Anyone who has Botox injected in their forehead (this does NOT include the glabella area or crows feet), can experience eyebrow descent. This is only correctable with time!

I personally would not do a breast augmentation closer than 4-6 weeks before a wedding, and perhaps much longer if a complicated lift is required at the same time. Three months before the wedding is a better timeframe. As I said previously, I have had women request a breast augmentation the week before their wedding. I’ve told them to enjoy their wedding and honeymoon and then get their augmentation. Remember it takes up to three months for your implants to drop fully into position – and sometimes longer with a vertical mastopexy. I would recommend the same minimum three-month timeframe for a tummy tuck as well. 

SmartLipo is fine three weeks before their wedding, though the more time in advance, the better, as improvements continue to take place over a six month time frame.  

Remember, you are likely your own worst critic. While the thought of looking your very best for your big day is appealing, you want to be sure you allow plenty of time to prevent having any issues or complications on your wedding day. 

Should I Have a Tummy Tuck Before Having Kids?

 

A high percentage of tummy tucks performed are after a woman is done having children. They often aren’t happy with the stretched out look that bearing children has created on their abdomen. There may be loose skin, stretch marks, and decreased muscle and fascial tone, causing the abdomen to bow outwards.

But what about those women who have not yet had children, but feel they could benefit aesthetically from having a tummy tuck? I often see patients who have experienced significant weight loss and have the same concerns that moms may have, with stretched out skin.

This definitely comes up in my practice from time to time. It is really not a problem. They can have a tummy tuck without issue, but if I know that they will likely have children,  I just avoid tightening their fascia, the the thin layer that overlies the abdominal muscle and helps to keep it flat. This allows me to excise the extra skin and fat and give them a tighter look. When and if they get pregnant, the skin and muscle will stretch. How it will look after their pregnancy is impossible to predict, but oftentimes it will be much better than if they did not have the tummy tuck, especially if they are careful to eat in a healthy, controlled fashion and maintain their workouts. I can, of course, still do liposuction to their flanks (love-handles) to help give them a more contoured look. Of course, if they know they are going to have a child soon (in the next 2 years or so), then it makes more sense to wait until after the pregnancy.

What happens to those women who think they will have no more children and have a TT and then find themselves pregnant? Ultimately, the child always wins. The abdominal wall will stretch and the internal sutures will stretch or break. This has obviously happened to women on numerous occasions. However, if i know of these plans in advance, I would simply not tighten the fascia for this reason.

A Day in the Life of a Plastic Surgeon

 

One of the better things about being a plastic surgeon is that no two days are ever alike.

I thought it would be fun to share with you what a day in my life looks like. May 10, 2017 began off with a SmartLipo case for a female client from Baltimore. She had previously came in for a complimentary consultation with her sister. Like many couples who come in to my office for a similar treatment, one will complete theirs first so the other can hear how easy or tough it was. Of course my hope is that they always think of it as easy! As is the case with almost all of my SmartLipo cases, she took some Ativan beforehand to help her feel more relaxed and comfortable (and open). Although some plastic surgeons may be bored while performing SmartLipo, since it is repetitive motions, I really enjoy doing these cases. For me, it is a great chance to chat with my patients and learn about their lives. I have heard incredible stories, both disheartening (sexual abuse, financially helping their families even when they had little money of their own, and so on), as well as truly inspiring (coming to the U.S. with less than $50 in their pockets and succeeding). Whatever the subject matter, it is truly a privilege to be able to connect to people in this way. We are all so busy in this hectic world that this is truly committed time to talk with another person (neither one of us can leave!)

I worked on two of her areas of concern. She currently does not exercise and I had a chance to stress the importance of healthy eating and also exercising. I personally like the Paleo meal replacement product that I currently sell in my office, as it takes most of the planning and thinking out of following a strict diet – and it definitely does work. I also stressed that everyone will get a more dramatic change from SmartLipo if they decrease their total body fat. With both SmartLipo and SculpSure, spot areas of fat are being reduced, but it is still important to decrease the total body fat.

I actually had a second Smartlipo case immediately following this one. This time, it was a former professional athlete who over the last year had found himself super busy with work – to the point where he had stopped all exercising and his diet had gotten worse. The two places guys tend to get fat is in the lower abdomen and flanks. He had already turned around his diet and was starting to exercise. The SmartLipo was to get him jumpstarted so that he could see changes more quickly. He was very, very committed to this and I know he will be successful and will get buff again. It is definitely taking a toll psychologically on him to go from a super-cut 6 pack to his self-proclaimed “doughboy” status.

I followed these procedures with several Botox patients. I like my Botox patients to come back in every 3.5 months. Unlike most plastic surgeons, I do my own injections – and enjoy it! I particularly enjoy hearing if they have any new vacation plans coming up and what is new in their lives. I often have known these patients for years. Some days, I only have a couple of minutes to catch up and other times, I have more time to get into the details – but it is always great to see them again. Two of the women on this day were over 40 years old. It was also an opportunity to tell them about the new Picosure laser that I had just recently purchased for my practice. It is truly an amazing laser, as it allows women to dramatically even out the coloration of their skin and eliminate brown spots and pigmentation on their face, neck, chest and hands – with no downtime. They need to do at least 3 treatments about 1 month apart. We are all amazed by how much improvement the patients are getting already. We are just starting to post some of our results online.

Next up were a few patients wanting fillers. The fillers usually last 12-18 months, so I don’t see them quite as often. However, many of the filler patients also get Botox. Today, as is often the case, I saw a woman who I told should hold off on fillers as she looked great, and that perhaps we should re-evaluate in 4-6 months. Sadly, many doctors will always do something if they can. However, I prefer a more natural look and also personally do not want to encourage treatments that aren’t necessary in my professional opinion.

I then saw a few follow-up patients: a Smartlipo case, a labiaplasty case (done with her breast augmentation) and a breast augmentation case. It is nice to see how they are progressing, and with each visit ,getting a more natural and improved look. After most cosmetic procedures, with time, things look better and better.

I then had a SculpSure consult. I have known this woman for several years, and she has been troubled by stubborn fat that just won’t go away. I was able to offer her insight on both SculpSure and SmartLipo, as they would both be helpful to her. SculpSure is a new laser that I recently purchased which will melt up to 24% of the fat in an area, with no incisions and just 4 small paddles applied to the skin. The treatment only takes 25 minutes, and there is absolutely no downtime. You must do two treatments 4-6 weeks apart to get the best results. It is the only treatment that I have ever had done to myself – so I can tell you with 100% absolute certainty that the results are amazing and what the actual procedure feels like) After explaining both procedures to her and giving her the prices, she left to think about which one makes the most sense for her right now.

My last consult of the day was a woman who wanted a tummy tuck. However, in her case I thought that while a tummy tuck could be beneficial, her skin tone was good enough that if she would work on losing a bit of weight, she would probably do fine with a less invasive procedure such as SmartLipo.

It was a busy day. I never schedule a lunch break. However, I always find time to grab some food that I brought from home between patients and to drink lots of water.

Tomorrow, I will be going the surgicenter to exchange breast implants in a woman who received saline implants over 15 years ago and who now wants to go larger and have silicone implants placed.

Every day brings new patients and former patients back into my world. And every day, i get an opportunity to help boost someone’s self esteem both by what I can do for them and also what I can say to them. If we feel good about ourselves, and feel empowered, then almost anything is possible.

My Experience with the PicoSure Laser Facial

[vc_row type=”in_container” scene_position=”center” text_color=”dark” text_align=”left” overlay_strength=”0.3″][vc_column column_padding=”no-extra-padding” column_padding_position=”all” background_color_opacity=”1″ background_hover_color_opacity=”1″ width=”2/3″][vc_column_text]Written by Jacqueline Seabra, Master Esthetician

As a Master Esthetician, I can truly say that I’m delighted with the results from PicoSure, which is a minimally invasive treatment. As I’m every defensive about what goes on my skin, I wanted to try the facial treatment without any numbing/ I was a little skeptical, but definitely willing to try.

I will note that I do have a high tolerance for pain and discomfort in general, but I found it to be minimally uncomfortable – a heat sensation that I’ll describe as intense but at the same time, it felt good. The PicoSure laser concept is about bringing heat to the skin to induce collagen production and thus resurface the skin. With that thought it mind, I can say it actually felt quite pleasant to me.

It’s a quick procedure, with no  redness or just a small amount, which can be easily covered up with makeup. After each of my two treatments (I will do a third in a months time), I kept working in the office and treating patients, and did not even apply any makeup because I experienced no redness. I found the PicoSure laser facial to truly be a no-downtime procedure with great results.

Even though I wanted to do the PicoSure treatment without applying the numbing cream, most people will want to apply the numbing cream 30 minutes prior to the treatment and cover the area with Saran wrap (for greater absorption), so it will be completely painless.

Remember, you should stop all active ingredients, such as Retin-A or other acids, on your face for 3 days prior to your Picosure laser treatment. You will likely need 3 treatments to see your desired results, each one month apart. You must use a sunblock between treatments when you are in the sun.

 

Jacquline is a Master Esthetician at Berman Cosmetic Surgery & Skincare Center. Learn more about Jacqueline and the rest of the team here.

Want to schedule a skin consultation with Jacqueline? Click here or call 703-406-2444 to schedule now![/vc_column_text][/vc_column][vc_column column_padding=”no-extra-padding” column_padding_position=”all” background_color_opacity=”1″ background_hover_color_opacity=”1″ width=”1/3″][image_with_animation image_url=”4607″ alignment=”” animation=”None” img_link_large=”yes”][vc_column_text]Master Esthetician, Jacqueline, one hour after her PicoSure facial. Notice the absence of redness – she was able to continue to work and see patients immediately! [/vc_column_text][/vc_column][/vc_row]