How Much Does Lifestyle Affect the Outcome of Plastic Surgery Procedures?

This is an interesting question that I was asked to blog about. There is both a superficial and a deeper answer to this question.
The superficial answer is: it depends on the type of plastic surgery performed and what type of lifestyle changes have occurred.
Certain surgeries are going to be more affected by lifestyle than others. If you have Smartlipo with me (my most popular procedure) and then put on a significant amount of weight afterwards, it will obviously detract from how good you look. You may still get a significant benefit from the Smartlipo because if the Smartlipo brought a better balance to the shape of your body, even if you put on weight, you will likely still have a better overall shape.
A tummy tuck is even less sensitive to minor weight gain, since you will have a much flatter abdomen after a tummy tuck than before. Even if you gain weight, you should still look much better than before surgery. The weight gain, if not too excessive, will generally not lead to loose skin, so the benefits of a tummy tuck will remain. The muscle tightening that is usually done with a tummy tuck will still remain if a few pounds are added after surgery. Of course, if you put on a lot of weight, some of the weight will be belly fat and this could cause your abdomen to protrude.
Procedures such a blepharoplasty or fillers or botox are not going to be affected very much by mild weight gain. Similarly, minor weight gain after a breast reduction will not have much affect.
On a deeper level — and this is where my certified life coaching training comes in — cosmetic procedures can be a stepping stone for transformation. If we look better, we feel better about ourselves. We realize that if we feel better about ourselves, we feel empowered, have more energy, treat those around us better etc. Those of you who have seen me in consultation for a body procedure know that I almost will discuss modification to your diet and exercise. If after doing a tummy tuck or Smartlipo you can be motivated to eat a healthier diet and increase your exercise, these benefits will far surpass anything that i can do for your surgically – especially if you keep those habits for life. So often, I see my patients alter their dieting and exercising and then drop 10-25 pounds, looking and feeling so much better. My concern with putting on weight after a procedure is that the procedure has not fulfilled its potential for being a stepping stone for transformation.
Want to discuss available options for decreasing body fat or cosmetic procedures in general? Call us at 703-406-2444 to schedule your complimentary, private consultation with me – I’d be happy to help you find the right solution for you!

What is the Process for Tattoo Removal with PicoSure?

Tattoo removal using the PicoSure laser is actually a rather straightforward process:
  1. Come in for a consult (at no charge!)
  2. Do not tan or spray tan the area that you plan on doing the tattoo removal for. You can tan other areas of your body; just not immediately around the tattoo.
  3. Apply numbing cream over the tattoo and cover with Saran wrap 30-45 minutes before your appointment. The Saran wrap increases the absorption of the cream and also prevents it from getting all over your clothes.
  4. Arrive 5 minutes early to wipe off the numbing cream and any sunblock, lotions or oils that you have on your skin over the tattoo.
  5. Your Master Esthetician will clean the area.
  6. The laser treatment begins! Tattoo removal with the Picosure laser is very fast. We use a special cooler that blows cold air onto the area being treated. This greatly decreases any discomfort. For those with a lower tolerance for discomfort, we offer a nitrous oxide inhalation (you can still drive following this), which should make this much easier for you.
  7. Following the laser treatment, you will need to protect the treated area from the sun. If there is some blistering, which can happen on occasion, simply apply a light dressing to the area if you are out in the sun. Once the area is healed, it should be fine to use sunblock on the area.
  8. You will want to schedule your next treatment for 6 weeks later. Occasionally, we will alter the interval between treatments, depending on your skin’s response.

It should be noted that it is impossible to predict how many sessions you will need. The fastest tattoo removal that I have seen in my practice is 3 sessions to fully remove a large block tattoo on the forearm. The Picosure laser requires half as many treatments as a regular tattoo removal laser. Generally speaking, a black tattoo will be removed faster than a colored tattoo, and there is a much lower risk of ghosting with the Picosure laser.


Want to discuss options for your skin concerns? Call our office at 703-406-2444 to schedule a private, complimentary consultation!

Your Top Questions About Upper Eyelid Blepharoplasty Answered

Upper Lid Blepharoplasty is an extremely common procedure that I do in the office in just one hour. I have done this procedure on many of my staff as well as patients.
Why is it such a popular procedure?
As we get older, for almost all of us, our upper eyelid skin stretches and creates an overhang of extra skin. This gives us a tired look and heavy feeling to the upper eyelids. In some cases, if not corrected, it can interfere with your upper field of vision. However, for those younger than 70 or 80 years old, it is typically just a cosmetic concern.
How is this problem corrected?
Despite advertisement to the contrary, no skin cream is going to make the loose skin magically tighten up. We need to excise the redundant skin.
Is there scarring and if so, what do the scars look like?
You cannot be cut and NOT have a scar, as that is how the body heals. However, the scar is usually very difficult to see (no scar is ever invisible). If you don’t have too much extra skin, the scar is completely hidden in the upper eyelid fold. If you have more skin, then the scar may continue laterally and extend into a crows feet line. This will be discussed at the time of your consult. These are some of the hardest scars to detect, which is one reason it is such a popular procedure.
How long does the procedure take and where is it performed? Do I need to be put to sleep?
I do all of my upper lid blepharoplasties in my office under local anesthetic, with a pill to help you relax. It literally takes one hour. You do need someone to drive you home from my office, as you absolutely cannot drive yourself following the procedure.
How sore will I be after the procedure and when can I go back to work? 
You should have virtually no pain. While I will prescribe you painkillers, it is very unlikely you will need anything stronger than Tylenol.
You will likely need to take 2 days off from work and apply lots of ice for these 2 days. You should sleep with 3-5 pillows for a week, so that your head is elevated above your heart.
Will there be bruising?
Bruising is hard to predict. I have done many upper lid blepharoplasties with no bruising, but I certainly have had some patients bruise considerably. Everyone has to avoid aspirin, Bufferin and Excedrin etc for 10 days prior to surgery. We sell an Arnica supplement that you would start before surgery that may help with post-procedure bruising. However there is nothing that can guarantee you will not bruise. If you get bruises, it will last 2-3 weeks to subside, and will gradually track down your cheek. You can cover it with makeup. Everyone gets some swelling so it will keep looking better and better for months.
How many sutures are placed and when do they come out?
There is only one suture per side, weaved through the skin. It is secured at each end with a steristrip. It will be removed in 6-7 days.
How soon can I shower or exercise?.
You can shower the evening following the procedure. You can wash your hair and get your face wet. I usually allow you to exercise after one week. You can be up walking around immediately.
What does an upper blepharoplasty not address?
It does not correct or change your eyebrow position. It also does not correct upper lid ptosis – meaning it does not help the eyelid position, but rather decreases the upper eyelid skin above it.
Want to discuss this further? Call my at 703-406-2444 to schedule your complimentary, private consultation with me – I’d be happy to help you find the right solution for you!

Dr. Berman’s Favorite Procedures for Getting Your Body Ready for Summer

The best procedure for getting your body ready for summer? That is a tough question for me to answer. It is really a toss up between a breast augmentation and Smartlipo. On the one hand, a breast augmentation is very transformative and of course, there is little you can do as a patient on your own in this area. If you want larger breasts, there is only one way that is completely predictable and that is to place breast implants under the muscle. It, of course, is done in an outpatient setting and you can return to work in 4-5 days. It does take about 3-4 months for them to settle into position, but in clothes, you will look great right away.

Smartlipo is also one of my very favorite procedures. Almost every man and woman wishes they had less fat in certain areas. I can almost always decrease the amount of fat in the treated area. I can never make you perfect but I can almost always improve you. There is very little risk (though it should be noted that everything has some risk) since it is being done under local with oral sedation. The results are more gradual, compared to a BA. With Smartlipo, you will continue to see improvements for up to six months. What can be very exciting for me is how many people, after getting Smartlipo, will then get stricter with their dieting and exercise, which further enhances their final results. Even more importantly, this sets up healthier habits which will positively impact the rest of their lives.


Want to discuss available options for decreasing body fat or cosmetic procedures in general? Call us at 703-406-2444 to schedule your complimentary, private consultation with me – I’d be happy to help you find the right solution for you!

Best Ways to Replenish Your Skin

Written by Sophia Seligmann and Nicole Hackett

We all know that using good quality skin care products is important to keep your skin healthy and hydrated, and to slow down the aging process. It’s important to have the right products for your skin type, be consistent, and of course use them properly. Our favorite ingredient to help get that glow back is Hylauronic acid. It’s certainly a game changer, and  great for all skin types. We repeat – ALL skin types! It is water-based so it won’t clog pores and it locks in the moisture in your skin. I promise you will wake up and your skin will be looking and feeling amazing, super soft and hydrated. You can use it 1-2 times/day – or more, if you have very dry or dehydrated skin and it just needs that extra quench. Dr. Berman has his very own skincare line and sells a pure Hylauronic serum called “ultra hydrating serum.” This product is excellent for hydrating and bringing your skin’s moisture barrier back to health. It nourishes and quenches dehydrated skin to impart a supple, smooth complexion and instant correction. This universal booster provides all day moisture retention and visibly reduces the signs of aging with a nourishing blend of antioxidants and humectants. With each drop, skin appears brighter, firmer and rejuvenated.

It’s important to note that skin care products can only penetrate so deep into your skin. It’s also very important to have healthy skin at a cellular level, improving it from the inside out. Having a healthy diet and lifestyle will help your skin tremendously. Drinking plenty of water, eating your fruits and veggies and staying active are a few ways to achieve that.
Be sure to add these fruits and veggies to your diet to get the benefits:
  • Avocados can help reduce redness in the skin; grapefruits, oranges, and mangos are all packed with powerful antioxidants that help protect against UV rays, improve blood circulation and distribute nutrients and oxygen to the skin and help protect the collagen in the skin.
  • Kale is an extremely nutrient dense food and is amazing for your skin. It’s the ultimate skin replenisher, it encourages healthy cell growth producing collagen, and helps keep your skin firm and radiant.

A few extra tips for amazing skin:

  • We recommend cutting back on your alcohol intake, as alcohol dehydrates your skin and deprives it of vital vitamins and nutrients and causes your face to look bloated and puffy.
  • You also want to make sure that you are getting your beauty rest. Getting a sufficient amount of sleep is essential for healthy skin. It’s recommended to get 6-8 hours of sleep, so aim for 8 hours so you can look and feel great the next day.
  • Studies have shown that high stress levels can be detrimental for your overall health, including that of your skin. People who have high stress levels tend to produce more oil, causing bad breakouts – and no one wants a big zit, especially when they have a special event to attend. Try meditating, doing yoga daily, listen to relaxing music or sounds (which will also help you have a better nights sleep; there are free apps on your phones available).

These are just a few recommendations to help you replenish your skin and get it looking better than ever. If you can make these changes to your lifestyle, along with proper skin care products and treatments, your skin will truly thank you for it! Trust us.

If you have any questions regarding your skin concerns, call us at 703-406-2444 to schedule your complimentary, private consultation with one of our Master Estheticians!

Your Top Spider Vein Questions Answered

Where are spider veins typically located?
Both men and women can develop spider veins on the face, thighs and lower legs. Spider veins can also occur on the chest.
Why do people get spider veins?
There clearly is a genetic component to spider veins. They do not arise from crossing your legs or exercising, as many people believe. Like everything in life, there can be a hormonal linkage.
What is the best way to treat spider veins on the face and chest?
I believe that the very best way to eliminate spider veins on the face and chest is with a laser that targets the red in the blood vessels. Our Cynosure Elite laser does a great job. Oftentimes you can treat all of them with just one session. It does not cause bruising, unlike some of the older lasers. The treated area can be red afterwards for a few hours but can be effectively covered by make-up . The only challenging area is the juncture where the nose meets the cheek. Sometimes this area will not respond to any treatments, even if it is repeated. There is no role for injections on the face, and there are also no skin creams that I’ve found that are useful to eliminate spider veins.
What is the best way to treat spider veins on the thigh or lower leg?
Sometimes I will do an injection, but most of the time, I prefer using the Cynosure laser. If I perform an injection, I typically recommend at least one follow-up laser session to be completed at least 6-8 weeks later.
What can I do to prevent developing more spider veins in the future?
You will want to eliminate excessive sun exposure, as this can definitely lead to more sun damage and spider veins. Beyond this, I don’t believe that anything plays a role, except perhaps not getting pregnant. Things like wearing support stockings (this may be helpful for varicose veins, which are different) and avoiding spicy foods are old wives tales.
Want to discuss available options for removing spider veins? Call us at 703-406-2444 to schedule your complimentary, private consultation with me – I’d be happy to help you find the right solution for you!

Last Minute Treatments Before Summer

Summer is right around the corner and you know what that means… bikini season! Have you been working out and eating right all winter long trying to get bikini body ready, but still have stubborn areas of fat that just don’t seem to go away? We have the perfect treatment for you… SculpSure.

SculpSure is a non-surgical body contouring laser that targets stubborn areas of fat that are resistant to diet and exercise. It only takes 25 minutes to treat with minimal discomfort and no downtime! Stop in during your lunch break or go back to your normal daily activities, including working out, immediately after. This is the perfect treatment to get you bikini body ready!

We recommend at least 2 treatments spaced 6 weeks apart – so give us a call today to get your treatments in before summertime! In addition, we highly recommend our Keto dietary supplements to give you optimal results. These supplements will help curb your appetite and put your body into ketosis. You can take them 1-2 times/day and we have different flavors to suite your taste buds.

Want to discuss available options for decreasing body fat or cosmetic procedures in general? Call us at 703-406-2444 to schedule your complimentary, private consultation with me – I’d be happy to help you find the right solution for you!

Non-Invasive Ways to Prepare for Spring and Summer

In the DC area, our weather has been crazy this winter: warmth then snow then warmth and more snow. However, I believe it is a safe bet that before too long we will be getting outside in shorts and T-shirts – at least I certainly hope so!

Below, I will briefly discuss two techniques – one for your body and one for your face – to help get you warm-weather ready.


  • Sculpsure
    This is the newest technology to reduce stubborn fat anywhere on your body. This technology came out years after Coolsculpting, and I believe it to be radically different and better. I could have bought either machine 2.5 years ago, but I intentionally selected the Sculpsure machine.Sculpsure uses 4 paddles (size of about a small cell phone), which can be placed just about anywhere there is fat. They send out laser light which penetrates the skin and heats and destroys the underlying fat (amazingly, it is safe for any skin color). The melted fat is then safely absorbed by your body.You do need to treat the area at least twice, 4-6 weeks apart. You can treat several different body parts on the same day since each treatment session only takes 25 minutes. For thicker areas of fat, you will want to do more than 2 sessions. I have even had my own flanks/love handles treated with a nice improvement (according to my wife!)

    How does this compare to more invasive procedures such as Smartlipo? Smartlipo is going to be more aggressive than any non-invasive technique, as it does require small incisions and more time at the office. However, SmartLipo involved just a single treatment.


  • Picosure Laser Facial
    This is one of the most incredible new pieces of technology that I have seen in many, many years, yet so few people know about it. This laser facial (though my wife and others have used it on the neck, chest, back of hands, etc) is able to radically improve irregular pigmentation due to sun and aging, and melasma due to pregnancy and hormones — and with little to no downtime.More importantly, it is the safest laser for those with any natural color in their skin. In fact, it is hugely popular in Asia for this reason. It will also help with acne scarring and fine lines.You need to plan 3 sessions, each spaced one month apart. You can reapply makeup  immediately after your session and return to work. There is no significant redness or peeling. My wife had incredible results with this laser!

    For now, we are offering 3 laser Picosure facials for only $1,500. However, you need to act soon, since I suspect we will be increasing this fee soon. Because I have three Master Estheticians working for me, we are able to offer this treatment six days per week. We cannot use the Picosure laser on a tanned area, so you want to start your sessions while the weather is a bit colder, before you start getting a tan on your face.

My Recommended Keto Meal Eating Plan

Doing an intermittent fast and then keeping your carbs low during the day is super easy, as long as you focus on what you can eat and do not focus on what you should not eat.

If you are looking to follow this eating lifestyle, I suggest that you go ideally 14-16 hours without eating as part of your intermittent fasting strategy. This means that you don’t eat food, but you can have water, coffee or tea (black or with half and half or unsweetened coconut or almond milk) with cinnamon or any spice but NO sugar or diet sweetners. I am a huge fan of drinking the Pruvit ketone supplements (see my previous blogs on the topic or visit to order them) to put you in a ketogenic state quickly. Of course, this means the earlier you finish eating the night before, the sooner you can eat food the following day. I certainly find that the ketogenic supplements decrease my appetite, making it much easier for me to an intermittent fast. I tend to eat late dinners so this means that most days, I don’t eat any food until the afternoon. Sometimes, I will take a second ketone drink in the late morning to make the fasting last longer or sometimes, I will take my second ketone to use while I exercise. I find them to be an excellent energy source. I never carbo load before or during my workouts anymore.

Once I start eating, either late afternoon or dinner, I try to keep my carbs low.

People have asked me what they can eat?  Below are my top suggestions, though a Google search can generate thousands of ideas as well. I would caution you that since the word “ketogenic” has become very trendy, it behooves you to still read the ingredients. They should be natural and ideally organic, free of sugars or fake sugars (stevia and monk fruit are ok) and free of dyes, chemicals, bad fats etc. You should confirm that the carbs are truly low, as well.

My go-to ideas:

  • I am a big fan of celery with organic peanut butter/almond butter with sunflower seeds on it.
  • Any type of eggs – if fried, use healthy oils like olive oil, coconut or avocado oil
  • Any type of vegetable salad. Avocados are especially good because they are a good source of both protein and healthy fats. You want to watch commercial salad dressings, as they are usually filled with sugar or high fructose syrup and unhealthy fats etc. it is very easy to just add olive oil and either vinegar  or lemon juice plus whatever herbs you like.
  • You can also add tuna or salmon or meat or turkey or seafood (get organic and i would definitely only get wild caught fish, never farm raised) and you can add seeds and/or nuts.
  • I do not personally eat any pork or seafood, but they are very keto-friendly.
  • Most soups will be keto-friendly, but definitely double-check the ingredients.
  • Regarding potatoes: I am more lenient on these. I believe that since you are going to be in a ketogenic state quickly due to the keto supplements, eating these baked, especially with olive oil, is probably perfectly fine. I have seen results with them in my diet, but of course, listen to your body – and your results
  • Cheese is keto-friendly, but i would not eat a ton if you are dairy sensitive or if you are trying to lose a lot of weight.
  • Nuts are great, but again, even though you technically don’t have to count calories, common-sense would suggest not to eat tons of them daily if you are trying to lose a lot of weight, as they are very calorie-dense.
  • I often make wraps with rice paper, as they are very low carb. I will put scrambled egg and avocado in them, or other veggies with cheese. Sometimes, I will just use a very low carb wrap, but rice paper wraps are better in my opinion.

There are a plethora of recipes for keto desserts and keto breads, but I would suggest that you pay attention to the ingredients since some people are very liberal with what they are calling “keto”.

I don’t regularly check my ketone levels, but if you are a “keto-purist”, then go ahead and check them periodically. I personally believe only the blood ketone levels make sense (you can get the meters on Amazon and they use a finger prick). The urine tests are not accurate since once you get efficient using the ketones in your blood, you will stop spilling these in your urine.

As you can probably tell, I love discussing the Keto diet! Feel free to email me with your questions at

To order your ketone supplements, visit I suggest the monthly reorder for a savings of 30%).


The Differences between SculpSure and EmSculpt

SculpSure has been around for 3-4 years now, and we have had our machine for about 2 years. Each treatment consists of 4 paddles (about the size of a small cell phone) that send laser light through the skin, which heats the fat (this is safe for all skin types, by the way). It works because fat has a poor blood supply and is sensitive to heat. The melted fat gets reabsorbed by the body. We recommend treating each area at least twice, with 4-6 weeks between treatments. It has been our experiences that heavier set individuals should plan on more than 2 sessions to get their desired result.

Cynosure demonstrated in one of their studies a 24% reduction in fat in the treated area. Whenever there is a study with a number stating a reduction as high as 24%, it is important to understand that this number is a bell curve with some people getting more and some getting less. I do not believe it is possible to know who is going to get the higher or lower reductions. For many people, the results will be real but will be subtle, so it is important that you take great before and after photos — and I recommend waiting about 12 weeks after the last treatment for the after photos, as you will continue to see improvement following treatment. I always stress with my patients that they can enhance their final result by working on better eating habits. I am a huge fan of intermittent fasting with a low carb diet and ketogenic supplements. This change in diet will often produce life changing prolonged results.

EmSculpt is a newer technology that uses focused electromagnetic energy to stimulate muscle contraction, which is supposed to increase muscle tone, decrease fat and give you a butt lift — all at the same time. Their website recommends 30 minute sessions, performed 2-3 days apart, with a minimum of 4 sessions total.  They claim results are visible in 2-4 weeks. I am extremely skeptical. First of all, we can go the gym and work out for 2 hours for four sessions every other day and most of us will not show any difference in our bodies that quickly. It just takes more time than that. I am even more dubious that for someone who is not already very lean, even if by some miracle the muscle size did increase with just 4 sessions, that it would be remotely visible with a layer of fat overlying it. I am also very reluctant to believe that the butt area will actually lift just because the muscle contracts. As a previous endurance athlete and longtime fitness buff, I am extraordinarily weary of any claim of building up muscle while you do nothing at all. Perhaps I will be proven wrong. There is rampant obesity in America today. There are also a lot of wealthy people in America today. If getting buff were as easy as paying a few thousand dollars, with no incisions and no physical effort, we would be seeing far more in-shape men and women than we do. The reason the 6-pack is so rare is because it is so hard to get. I think it will be many, many years before we have a machine that can do this work for us.

Want to discuss available options for decreasing body fat or cosmetic procedures in general? Call us at 703-406-2444 to schedule your complimentary, private consultation with me – I’d be happy to help you find the right solution for you!