Can I Repair Multiple Earlobe Repairs in One Visit?

It is not that uncommon today that a woman will have several tears, usually two, in the same earlobe.

Of course, the question I always get is whether or not they can they be repaired at the same time in the office or is it better to do these on different days.

It has hard to answer this definitely without actually seeing the exact situation. As a guideline, if the tears are quite far apart on the earlobe and there is a considerable amount of healthy earlobe tissue between them, it is possible to fix them at the same time. However, if they are close in proximity or there is not a lot of tissue, it is better to repair one and then wait several months before repairing the other. It should be possible to still get a new piercing 6 weeks after the repair, even if the other tear has not yet been repaired.

As always, these repairs are just done in the office under local anesthetic.

If you’d like to discuss earlobe repair, please contact my office at 703-406-2444 to schedule a complimentary consultation with me. 

Will I get better results with a more invasive procedure?

This is a complicated question – with a perhaps complicated answer! Of course, if you can get the same results with a non-invasive procedure as you can with a minimally invasive or totally invasive procedure, then by all means, you should choose the non-invasive procedure (non-invasive being a procedure that requires no incision).

There is no question that we are seeing a strong trend towards the minimally and non-invasive procedure as the technology is getting better and better. As procedures are getting less and less invasive, it is allowing us to perform these procedures earlier and stave off having to do the more invasive procedures for many years – perhaps forever. This is a great trend. There will still be those patients who will get the best results for their situation with a more invasive procedure. As your surgeon, I’d be able to explain why this may be the case for you after seeing you for a complimentary consultation.

There are some amazing non-invasive and minimally-invasive procedures that my clients are seeing great results with. Having said that, are there any things a patient should be cautious about? Most definitely! First and foremost, know that the results are equipment-dependent. It actually drives me a bit nuts when I am using a Cellulaze laser from Cynosure to help cellulite and I hear ads on the radio for topical creams that promise even more than I would ever dare to suggest I can accomplish. We can accomplish a lot with technology, but I would never suggest I can completely eliminate the problem. The new technology is expensive for the doctor to buy, and you get what you pay for. For example, many spas are now offering similar treatments, but with much lesser equipment. Oftentimes, the lasers used are of inferior quality and the results are not permanent. One area I see this in quite often is laser hair removal. The laser used matters, and you simply won’t get the same result with a lower-grade piece of equipment.

For improvement in hyper-pigmentation, acne scarring and fine lines, the Picosure laser is the gold standard. However, it is a very expensive laser to buy and it takes skills to operate it. You simply will not find this in a spa and therefore you will need get the benefits of a Picosure laser if you want to be treated in a spa.

Minimally invasive fat removal systems, such as Smartlipo and Body-Tite, are expensive. However, there will be knock-offs that will be less expensive – and also less effective. This is also true of the Sculpsure laser, which can non-invasively decrease fat, but will likely not be as aggressive as Smartlipo or Body-Tite for those that want or need something more aggressive.

The best advice I can give prospective patients is to insist on a board certified surgeon, preferably a plastic surgeon (there is no such thing as a board certified “cosmetic surgeon”). Meet the surgeon in advance to discuss the procedure and your desired results. Although it is reasonable to be aware of costs, do not select the least expensive option. You are paying for both the quality of the equipment and the experience of the surgeon.

If you’d like to discuss your concerns or potential treatments, please contact my office at 703-406-2444 to schedule a complimentary consultation with me. 

Increasing Belly Fat Loss - Berman Blog

Increasing Belly Fat Loss

The first consideration is whether this fat is external or internal. If it is external, it is in the subcutaneous tissue and is usually pinchable. If it is internal or visceral fat, it is located behind the muscles and is deep in the belly, around the stomach and intestines.

If the fat is external, you do have some treatment options, both invasive an non-invasive, that can help. External fat is amenable to the various types of liposuction, such as Smartlipo (my preferred technique), and non-invasive techniques such as Sculpsure (my preferred technique) and Coolsculpt. A tummy tuck can remove the spare tire, provided the fat is external. A tummy tuck can also tighten the abdominal muscle wall, which makes the stomach flatter. Of course, you will get a better result if you combine these treatments with the methods below which will decrease your overall body fat, in addition to these spot treatments.

If the fat is internal, none of the above techniques will truly work, and it will come down to diet and exercise. Dieting is even more important than exercise, but clearly, both are complimentary. There are a multitude of diets. The common theme for all the sensible ones is stopping all sodas, including diet sodas (many studies have shown that diet drinks actually lead to weight gain, plus they are very unhealthy) and eliminating processed foods and refined sugars (as much as possible all sugars including alcohol). We have had great results with my patients with the Paleo Meal Replacement, but it is certainly not the only way to achieve great results.

What form of exercise is the best? The one that you enjoy most so that you will continue to do it! Numerous studies are showing that High Intensity Interval Training (HIIT) is one of the more effective ways to train (there are lots of free videos on Youtube – I have done many of these myself). The form of training can give you the most improvement in the least amount of time. I’d recommend that you exercise 4-5 times per week if possible. I am a big fan of the classes in a gym since it is hard to slack off when everyone around you is working out. Also, if it’s in your budget, personal trainers are a great investment. They hold you accountable and can give you some interesting, creative training workouts.

If you’d like to discuss your personal concerns or potential treatments, please contact my office at 703-406-2444 to schedule a complimentary consultation with me. 

How much downtime and pain come with an earlobe repair - Berman Cosmetic Surgery Blog

How much downtime and pain come with an earlobe repair?

The very short answer is that you should be in and out of my office in 30 minutes for a single torn or stretched earlobe repair (45 minutes for two stretched earlobes). It is very common to have this problem on both earlobes. I almost always use dissolving sutures so you don’t have to return for a follow up unless you want to.

How painful is this procedure? I inject local into the earlobe but I use a very, very tiny needle and the earlobe gets numb very quickly. The numbing should last hours and you can return to work immediately after you have the repair if you’d like. You can shower the next morning. There should be little to no discomfort and it should not require anything more than Tylenol for pain management. You can exercise as hard as you want the day after the repair.

Want to get your ear re-pierced? You can safely do so six weeks following the repair.


If you’d like to discuss earlobe repair, please contact my office at 703-406-2444 to schedule a complimentary consultation with me. 

Non-Surgical Mommy Makeover Options - Berman Cosmetic Surgery Blog

Non-Surgical Mommy Makeover Options

What is a “Non-surgical mommy makeover”? Although there is no dictionary definition, I define this as methods used to help restore mothers to their pre-child state, using either non-invasive or minimally invasive techniques. Most women, I’d imagine, are expecting this to be done in an office setting, without general anesthesia. It is important to be realistic (your plastic surgeon can guide you on this) in your expectations. Some women can get closer than others to their pre-pregnancy state.

For most women who come in for a consultation with me after having children, their focus is on their abdomen, flanks, bra fat, breasts and thighs. this is going to generally mean decreasing fat and possibly tightening the skin or improving the cellulite.

What are your options?
For starters to reduce fat, the completely non-invasive procedures available are Sculpsure (which is newer technology, faster, more comfortable and I believe more effective) and Coolsculpt (which has been around for more than 6 years). Both techniques are done in the office without any anesthesia, which means you can do the procedure and then return to the office or go out for dinner. Both techniques should be done at least twice for best results. There are no incisions and you can expect some definite improvement in most cases (but people will respond differently). These techniques reduce fat in the treated area and multiple areas can be treated in one session. If you want the maximum improvement, you are going to want to decrease your overall body fat, as well as have specific  sites treated. Diet is even more important than exercise, but ideally both should be focused on. There are a lot of healthy diets which share similar concepts such as eliminating processed foods, all sodas (including diet sodas) and refined sugars. My patients have had very good success with our Paleo Meal Replacement, which emphasizes reducing carbs.

For those willing to have a very small incisions, Smartlipo, which can done in the office with 2-3 mm incisions, for most women, is going to be more aggressive than Sculpsure and certainly more than Coolsculpt. It is also only done once. For most women, I prefer to give some oral sedation which means a driver is required. However, you can return to work the very next day.

For those women with cellulite, there are two generally helpful options: Cellulaze (which I offer) and Cellfina. Certainly there are presently no creams or massages or wraps or fascia blasters that I believe really work. You also get some skin tightening with Cellulaze but neither technique can totally eliminate cellulite. The key is to focus on improvement, not near perfection.

Many women develop hyperpigmentation or melasma on their face after their pregnancy (many women just develop this with natural aging). The Picosure laser with no downtime, has really revolutionized the treatment for this common problem. You should plan 3 treatments, each done one month apart. You can return to work or social activities the same day as your treatment. Facials and skin creams can be helpful after treatment, to prevent the hyperpigmentation from returning. Sunblocks are crucial if you are out in the bright sun. Older techniques such as Fraxel and CO2 lasers can be effective but cause a lot of redness. They can also make the problem worse on those women who are not Caucasian. The Picosure laser is safe on skin types 1-4.

Other changes in the face can include a loss of fat and thinning of the lips and lipstick bleed lines. These can be effectively improved by many of the fillers on the market and in select cases with fat transfers.

If you’d like to discuss non-surgical mommy makeover options, please contact my office at 703-406-2444 to schedule a complimentary consultation with me. 

Berman Blog - Why Our SculpSure Pricing is So Much Lower than Other Providers

Why Our SculpSure Pricing is So Much Lower than Other Providers

Most places are charging between $1,500-2,000 per session for SculpSure fat melting sessions, while my office only charges $1,000/session. Why? Because you truly need 2 seasons to get the best results, ideally spaced 6 weeks apart. I find that many providers push clients to purchase one session only, at that higher rate. However, I feel that everyone should plan on 2 sessions to maximize your success.

It is important to know that you can do multiple sessions in different areas of the body, one after another, since each session is only 25 minutes and you are not sore after the treatment. I have had patients complete a session on their abdomen and immediately afterwards, move the 4 paddles to their love-handles, then to their bra fat and then to their thighs. I insist patients purchase a minimum of 2 sessions to see a noticeable reduction in body fat. Studies done by Cynosure have demonstrated an average reduction of fat of 24% when done on the abdomen or flanks. However, the paddles for Sculpsure can be placed almost anywhere on the body including: thighs, upper arms, knees, bra fat, male breasts,etc. If you are on the fuller side, you should consider doing 3-4 sessions per area.

I also offer Smartlipo, Bodytite and Facetite, as other options, in addition to the Sculpsure. However, Sculpsure is the only one that offers fat reduction with NO incision – meaning, NO DOWNTIME for you.

Have questions about SculpSure? Please call my office at 703-406-2444 to schedule a complimentary consultation with me.


Dr. David Berman -Board Certified Plastic Surgeon

Do I ever Recommend Against Plastic Surgery?

The quick answer is quite often. There can be countless reasons for this, but they can probably best be grouped into two main categories:

  1. Risk outweighs benefits
  2. Unrealistic expectations.

Exploring the first option, “risk outweighs benefits,” there are endless possibilities here. Someone in less than good health should not be receiving elective cosmetic, plastic surgery in my opinion. Fortunately, almost all of the patients that I see are in good health. However, every once in while, someone comes to me with a load of medical issues and I will tell them that they should not be getting these procedures. I am also quick to point out that I don’t make any money by sending them away and that if they shop around, someone will probably perform their surgery, but I have to share my honest medical opinion. Of course, there are many procedures that can performed in the office with just local anesthetic – meaning they involve less risk. However, this does not mean that everyone is a candidate for a particular procedure. There are still risks. Sometimes it is obvious that someone should not be doing a procedure. Other times, it takes surgical judgement and experience to know this.

With regards to the second category, “unrealistic expectations,” I sometimes find that while the procedure can be carried out safely, there is a reasonably high possibility that even if the procedure goes as planned, the expectation of the patient is greater than what I can achieve on average. This is why the initial consultation is so important. It lets the surgeon explain what he/she can achieve on average and to confirm that this is commensurate with what the patient is expecting. Even if the patient gets the best result that has ever been obtained, if they wanted even more, they will be dissatisfied.

Along the same lines, it is important to discover if there are secondary, hidden goals. As an example, a woman came to me many years ago for a breast augmentation (BA). It became clear to me during the consultation that she was satisfied with her breast size and shape. What truly brought her was that her husband was having an affair and she hoped that the augmentation would solve her marriage issue. I don’t think she was aware of this at the time of her consult. I told her that I would not perform the procedure on her because what she really wanted was a repaired marriage and that was NOT going to be fixed by altering her breasts. She would inevitably been dissatisfied with the results of her surgery since it would not have achieved what she wanted from the procedure. Sometimes, patients are aware of these hidden goals and sometimes not.  We have to discern them from our consultation.

If you’d like to discuss any concerns you have, please do contact my office to schedule a private consultation with me.

Who is a Good Candidate for Male Breast Reduction

Those who are not affected by having “man boobs” (larger breasts than typically), do not realize how much emotional distress this can cause a man. Most of the men that I see in my office for this reason refuse to take off their shirts in public, even when they are at the pool or beach. I am a sun-loving plastic surgeon, so I can certainly imagine how miserable this could be!

Most of the men that I see for this procedure have fullness in their breast area, but overall their breast shape is good. It is just larger and fuller than they desire. For these men, I can do their male breast reduction in the operating room with just an incision that only goes along the bottom half of their areola. They go home the same day and can usually return to work in 4-5 days. They can shower the very next day. I usually place drains in the area for excess fluid, which will be removed in my office 5-7 days later.

If there is mostly fatty tissue, rather than fibrous tissue, as well as a good shape, I can perform either SculpSure or SmartLipo to decrease the fat in the chest area instead of a traditional gynecomastia procedure. This has the advantage of no incisions with Sculpsure (and only very tiny incisions with SmartLipo) and a return to work either the same day (with SculpSure) or the next day (with SmartLipo).

Men who have lost a great deal of weight sometimes have large hanging breasts, and their surgical repair is more complicated and involves larger incisions.  These are more challenging cases, but the men that feel they need this surgery are usually more than willing to accept the greater scarring involved in order to get a better breast shape.

Ultimately, a good candidate for a male breast reduction is a man who is realistic in his expectations and is troubled by the appearance of his breasts.

Laser Hair Removal for Asian and Olive Skin

When it comes to laser hair removal and skin color, not all lasers are created equally. Someone with white or Caucasian skin has much less to  worry about when it comes to getting a burn from laser hair removal.

The lasers work for hair removal because the laser light gets selectively absorbed by the hair, compared to the surrounding skin. This is why laser hair removal systems do not work on white or grey hair. This lighter colored hair cannot absorb the laser energy.

With skin that is darker, including olive skin or that of those of Asian descent, it can absorb too much of the laser energy and thus sustain a burn. The YAG laser is much safer for those with non-white skin. This is a 1064 wavelength laser, in contrast to the Alexandrite laser, which is a 755 wavelength. The YAG laser has a different absorption frequency, providing a safer laser experience (though the skin should still not be tanned when getting a treatment). For those with light olive skin, the Alexandrite laser can likely still be used. But again, the skin should be very light in color.

We can increase the energy setting with the YAG laser and still get an effective permanent hair removal. However, it may require a few more treatments than with the Alexandrite laser. It is also less uncomfortable for most people, because the skin absorbs less of the energy. I still recommend that you apply the numbing cream 45-60 minutes before and cover with Saran wrap. We  always use the cooler during the treatment, which helps to make it more comfortable.

The advantage of our Cynosure Elite Laser is that it is actually an Alexandrite and also a Yag laser, housed in the same unit. With the push of we can switch from YAG to Alexandrite.

Berman Cosmetic Surgery - Can you remove fat without surgery

Can You Remove Fat Without Surgery?

The short answer is YES, you can remove fat without surgery.

SculpSure is the newest and best way to remove permanently subcutaneous fat (the fat under the skin) – though it will not attack the internal or visceral fat deep (deep within your belly, as an example).

I have been really impressed with the SculpSure laser, and my patients have seen really great results. And what’s also great is that SculpSure is a quick 25 minute treatment. Four  paddles are placed anywhere on your body that has pinchable fat (not the face or neck), which then conduct a laser beam which travels through your skin and melts the underlying fat. This laser is safe for all skin tones, by the way. Your body then breaks down the fat gradually over 3 months, and it is metabolized away. I recommend that patients plan two treatments, spaced 6  weeks apart – though they can be done at 4 weeks intervals as well. You will continue to improve for 3 months after the second session. According to Cynosure, patients can see up to a  24% reduction in fat in the areas targeted. After a session, you can do whatever you want. I went directly to the gym immediately after both of my sessions for a workout!

This is a far superior to Coolsculpt, which has greater name recognition because they were the first one to the market with a non-invasive fat reduction system by about six years. That time, however, allowed Cynosure to learn from their shortcomings and design a better system. From what I have seen, Coolsculpt has a lower patient satisfaction rate, takes longer, is more painful, has occasional issues with unevenness, and in a small percentage of patients, there has been reports of long term nerve pain. We have not seen this with SculpSure.

Of course, modifying your diet and getting rid of junk food, processed foods and soft drinks, cutting your carbs and incorporating more exercise are  excellent ways to reduce your overall body fat – as well as improve your health.