Menopausal Makeover Series: Part 1 – What is this Exactly?

You probably have never heard the term “Menopausal Makeover” before. I had never heard of it either. I give credit to my wife’s friend, Chris, who is struggling with menopausal issues, for bringing this concept and term  to my attention. A quick Google search did return this term from another excellent plastic surgeon, Dr. Robert Gartside, though we have different approaches to this concept.

What Chris recognized is that for women struggling with menopause, which can occur uncommonly in your 30’s, but more commonly in your 40’s and early 50’s, there are a host of hormonal changes, which contribute to all aspects of a woman’s life both emotionally and physically. I am not going to touch on areas outside of the area of plastic surgery. I would like to add that many of these women still feel young at heart and want to re-capture some or all of their youth. They realize that they cannot stay totally youthful but want to retain as much as they can – i.e. slow down and even reverse some of the changes of aging and menopause.

It goes without saying that no one can fully turn back the clock. regardless of how much money and effort you expend. Most everyone realizes that at 48 years old, you cannot look 28 years old. However, you can almost always be improved. Many of my patients in this position come in requesting a natural look that compliments you and is does not look “fake.” I don’t think I’m alone is not personally liking the overly-operated upon and overly Botoxed look that aging (and even non-aging) Hollywood stars have now made famous!

The problem is that as we age, there are a multitude of changes that all occur simultaneously. In general, each of our “solutions” can only address generally 1-2 aspects of this aging – thus there is no one simple fix. In the subsequent blogs in this series, I will discuss some of the aspects of a “menopausal makeover”.

The Top 5 Questions Plastic Surgeons Wish You Would Ask - Berman Cosmetic Surgery

The Top 5 Questions Plastic Surgeons Wish You Would Ask

  1. Are you Board-Certified as a plastic surgeon by the American Board of Plastic Surgeons?
    I think if i were to name one thing that drives plastic surgeons crazy, it is the plethora of “wannabe plastic surgeons” who mislead the public that they are plastic surgeons when they are not. Specifically, there is no such thing as a board-certified Cosmetic Surgeon! That is just a made-up name by a fringe society with much lower standards (or no standards) than a true American Board Certification.Additionally, Facial Plastic Surgeons are NOT Plastic Surgeons. They are Ear, Nose and Throat doctors who call themselves Facial Plastic Surgeons, again to mislead you. Otherwise, they would be stating that they are ENT surgeons.
  2. What type of after-hours support do you offer after surgery?
    I give all of my surgical patients my cell phone number and tell them to text me if they have any concerns. This is certainly not required but it should be fairly easy to reach your plastic surgeon if you have questions or concerns.
  3. What is the proper attitude and expectation I should have if I decide to move forward with this procedure or surgery?
    The public sometimes has the wrong impression of what can be achieved with a particular treatment (e.g. a peel, Botox, filler or laser, etc.) or surgery. They see ads in magazines or online with some truly challenging problems and then in the follow-up pictures, totally transformation to model-good looks. This is rarely possible. A good, experienced plastic surgeon, can help explain to you what you can expect on average from a procedure, and what it can and cannot do. For example, I go to great lengths to explain to my patients that Smartlipo and Sculpsure are very good tools to help reduce fat in almost any area. However, for almost everyone, you will get an even better result if you can also modify your diet and increase your exercising in order to help drop your overall total body fat. Thus, it is really a partnership, similar to that of you and a personal trainer. They can train you for an hour at the gym, but if you are not putting in a good effort the other 23 hours of the day, your results will vary significantly. Be honest about your expectation. I can tell you if you are being realistic or overly optimistic.
  4. What is not included in your fee?
    When I provide a price quote for surgery, I will also include any associated fees (excluding things like prescriptions or garments since they can vary greatly). I also include all the follow-up visits. If a surgicenter or anesthesiologist is used, you need to know what their charges are as well. This will impact your total cost, so be sure you are asking your surgeon for all of that information up-front.
  5. In your professional option, should I have this procedure? 
    I think this is a great screening tool to decide on your doctor. I personally think a good doctor will never push you into any procedure or surgery. They should realize that everyone is different and even though plastic surgery is more affordable than ever, it is still not cheap. A good doctor will be concerned about your comfort, and will not be stressed if you decide to wait on a procedure or rule it out entirely.

If you have any other questions, please call my office at 703-406-2444 to schedule a private, complimentary consultation with me. I’d be happy to discuss any concerns you have!

Surgical Facelift Alternatives - Berman Cosmetic Surgery

Surgical Facelift Alternatives

People mistakenly believe that a facelift fixes your face and makes it perfect and instantly takes many years of aging off of your face. A facelift does certain things very well, but does not address many other aspects of aging.

What does a facelift do, exactly? A facelift is primarily designed to tighten the skin and underlying muscle of the neck and face. The most dramatic change occurs in those with a lot of loose neck skin. There is some improvement in the pre-jowl area and even less improvement in the naso-labial folds. Of course, one can add things like laser resurfacing, fillers or fat transfer and Botox, and a blepharoplasty. However, you can do these other things in the office, without paying for anesthesia or in an operating room facility.

So what are some surgical facelift alternatives?
Aging is multifactorial. This means that there is not one aspect of our face that shows our age. Just a few of the many things one can do to improve your face and delay for many, many years a facelift include:

  • Picosure laser:
    almost every women over the age of 35 will develop areas of irregular pigmentation – areas that are darker and lighter than the rest of the skin. The Picosure laser, with break-through technology, fires 1,000 times faster than any other laser. This means that you can get your face (and neck and chest and hands) resurfaced, with NO DOWN TIME! You need to plan for 3 treatments, each spaced a month apart. The Picosure laser can also help with fine lines and soften your skin. It can even help with acne scarring (although this will typically require 6 treatments). It will also dramatically improve age spots on the face.
  • Chemical Peels:
    We also offer an array of chemical peels such as the ViPeel, megapeels, and pharmaceutical skin grade products to further assist in this area.
  • Smartlipo to the submental area:
    Most people develop fullness and slight sagginess to the upper central neck area (submental area). This area usually responds very nicely to Smartlipo. This area is quite small and does not require any oral sedation, meaning you can be in and out of my office in just 30 minutes and can return to work the very next day.
  • Facial Fillers:
    As we age, we lose fat in our face and experience a deepening of the nasolabial folds. These respond very nicely to fillers such as Juvaderm, Voluma and Volbella.
  • Botox:
    Crowsfeet, glabellar and forehead lines in particular respond nicely to Botox. These lines are a result of movement.
  • Upper and Lower Blepharoplasty:
    The upper blepharoplasty is designed to decrease the redundant upper eyelid skin, while the lower lid blepharoplasty can help decrease the bulging and/or the redundant skin.

If you have any questions, please do not hesitate to call my office at 703-406-2444 to schedule a complimentary, private consultation with me.

Dr. David Berman -Board Certified Plastic Surgeon

Plastic Surgery Myths

There are, of course, a large number of myths about plastic surgery and each procedure has its own myths and misconceptions. Below, I’m highlighting a few of the top misconceptions I hear from patients. This barely touches the surface, but I have to start somewhere!

1) Plastic Surgery is too expensive.

It is true that plastic surgery is not cheap, but there now are many new elements of “plastic surgery,” ranging from general skin care,  facials and Megapeels to torn earlobe repair, Botox and fillers. You can sometimes even get a Megapeels or a tattoo removal session for less than $100, if we your surgeon is running a special. What I have always found is that, in general, people find the money for what is important to them. I would also add that women will often spend large amounts of money on their hair, an expense that often recurs every 4-6 weeks, and yet, a filler can last 18 months. Something like a breast augmentation can last 10-20 years! If we factor the cost/benefit over 15 years, it is suddenly not so expensive. In addition, almost all plastic surgeon’s office will offer Care Credit financing. My office also offers Alpheon financing.|

2) The scars are terrible.

This is usually not true. We can never 100% predict scarring, but many procedures do not cause scarring at all. The Picosure laser is a great way to improve your facial skin with no downtime and no incisions. There are no scars with the Picosure and in fact, we can often improve acne scarring with the Picosure laser. The scars for a breast augmentation are usually very small and get very hard to see with time. Scars resulting from Smartlipo are only about 3 mm in size, which is very tiny. They are usually very difficult to see after they heal and some time has elapsed. Even with more invasive surgery, such as a tummy tuck, these scars are usually not readily visible and they can fade very nicely over the years (and sometimes much sooner).


3) How much weight will I lose from Smartlipo or Sculpsure?

Both of these procedures are designed to decrease fat in specific areas to make you look better. They will not significantly change your weight but they may change your dress size and how your clothes fit. Of course, there is a reduction of fat, so by definition, your weight is being reduced. However, there is no shortcut for losing weight – you need to make better food choices (see our Paleo Meal Replacement for one great example of how to lose weight) and increase your exercising.


4) I don’t need or want to look 20 years old or “perfect.”

We plastic surgeons can take years off a person. However, aging is multifactorial – meaning that as we age, lots of lots of things change in our bodies and on our faces. We tend to focus on the most glaring changes but there are really a ton of changes that are occurring. However, if you are in your 40’s or older, unless you have fantastic genetics, plastic surgeons can often make you look better or much better, but it is very unlikely you can look like a 20 year old, no matter how much money and effort you expend. The problem too, if someone tries too hard and their surgeon does not know their own limits, then the person will look unnatural and fake, which is a look that I personally do not want to create.

Also a similar line of thinking – not all problems are equally solveable. A tummy tuck can often transform a spare tire into a very nice abdomen but someone with poor skin tone and very thick thighs can probably never achieve a look of thin thighs with wonderful skin tone. A good plastic surgeon know what is achievable and what needs to be accepted.


If you have any other questions about cosmetic surgery, please do to hesitate to call my office at 703-406-2444 to schedule a complimentary consultation with me. 

Tummy Tuck Scars: What to Expect - Berman Cosmetic Surgery Blog

Tummy Tuck Scars: What to Expect

A lot of women (and some men), upon seeing a tummy tuck (TT) scar posted on the internet, will be put off by the appearance and rule out the surgery. The intent of this post is not to try and change your mind but to rather offer some things for you to consider before ruling out a tummy tuck, if scarring is your primary concern.

First of all, it is important to note that I think there is a tendency for people who self post to select very atypical situations to dramatize their results and their lives. This is not to say that they did not occur but it is like that show Botched (which I confess, I have never watched but I get asked about by my patients). I am sure that these things occurred but it is not a typical result, but rather, a very rare one.

The scars from a TT, by definition will be long and generally are from hip to hip. However, they are usually placed low and can be concealed by clothing. Also, the TT scars usually fade really nicely, but it takes time. I did a TT on my office manager, Cheryl, and her scar is extremely hard to see now. I have had some patients put tattoos over their TT scars and that renders them almost invisible.

Some patients will have their scars fade much sooner. I just performed a TT on a woman, less than 3 weeks ago, and we have already posted her results (with a side view photograph of her before and after) on my website, because her scar is so faint. It looks like the operation occurred years ago!!! However, that has more to do with genetics, than the skill of the surgeon.

We carry a cream in our office which can help mature the scar sooner and help it fade more quickly. There are also other products from silicone sheeting to Mederma that can also be effective.

Sometimes, patients will get a dog ear after surgery, which is just a small amount of fullness at the edge of the incision. This can easily be refined in the office under local anesthetic and is quite a small bit of fine tuning which is sometimes necessary. You can return to work the next day.

The name of the game is patience, as scars will continue to fade month after month and year after year. If you have any questions about scarring or tummy tucks in general. please contact my office at 703-406-2444 to schedule a complimentary, private consultation with me.

What is Microneedling, Exactly? 

Have you ever fallen and scraped your knee? Once it heals and there is new skin, do you find that it looks softer and smoother than before? Microneedling is the same concept. With this treatment, we use a device that has tiny little needles which causes controlled micro-injuries. These send a signal to your body to produce more collagen and elastin. Therefore, it is great for people with fine lines and wrinkles, acne scars, larger pores, and stretch marks. It is safe for ALL skin types and you’ll experience little to no downtime!

Before your treatment, a topical numbing cream is applied to help reduce any pain you may feel. Typically, our patients say they don’t feel any pain, just the vibration from the device. Microneedling is awesome for your face but it can also be done on your hands, thighs, stomach, etc.

The healing time depends on each individual. Most patients generally look like they have a mild sunburn afterwards with redness and swelling. This can last up to two to four days following the procedure, but generally people see their skin go back its typical color in about 24 hours. It is recommended that you get between 3-6 treatments, and sometimes more, depending on how severe your condition is.

In order to achieve optimal results you must have a good at home care regimen and be consistent with that plan. And of course, our estheticians can help you build a great regimen tailored to your needs!

If you’d like to speak to our estheticians about ways to love the skin you’re in, call our office at 703-406-2444 to schedule a complimentary private consultation!

Do I Really Need to Wear Sunscreen in the Winter?

Simply put, YES! Now that it’s getting cooler outside many people ditch their SPF, which is a big no no. Wearing daily SPF protection is critical to helping prevent aging. In fact, the rays from the sun are the #1 cause of aging. Even though it’s no longer summertime, you are still being exposed to UVA rays on a daily basis.

There are two kinds of UV (ultraviolet) rays to be concerned about: UVB rays, which cause sunburns, and UVA rays, which cause aging (fine lines and wrinkles). Even when it’s cloudy or rainy out, 70% of UV rays are able to penetrate through the skin. Even if you spend more of the day indoors, the fluorescent lights are emitting UV rays. And those UVA rays are actually stronger when coming through glass, meaning everytime you get in your car you should be wearing SPF!

If you plan on being outdoors for a long period of time, remember to reapply every 2 hours. When purchasing sunscreen, make sure that is says “broad spectrum”, meaning it has both UVB and UVA protection.

If you’d like to speak to our estheticians about great SPF products to add to your skincare regimen, call our office at 703-406-2444 to schedule a complimentary private consultation!

The Many Benefits of Retinol

Written by Nicole Hackett, Master Esthetician
When considering what products to use in your skin care regimen, Retinol, a form of Vitamin A, should be at the top of your list! This ingredient is the gold standard for anti-aging. Essentially, it increases the cell turnover rate, which starts slowing down the older we get.  Retinol comes in many different forms, including  creams, serums, moisturizers and gels.  You can also get prescription-strength retinol. When you begin using Retinol, start slowly (1-2 times per week) and gradually work your way up to using it daily if your skin can handle it.  Sometimes it can cause your skin to feel dry and you may experience some flaking. This is a sign to cut back the usage and to also apply a good hydrating moisturizer. It is highly recommended that you use products that contain Retinol at night, because it makes your skin sensitive to sun light, and be sure that you are using your SPF daily!
The top benefits of Retinol for your skin: 
  • Diminishes the look of fine lines and wrinkles
  • Fights acne
  • Increases skin firmness
  • Improves uneven skin tone
  • Increases collagen production
  • Fights free radicals

If you’d like to speak to our estheticians about ways to love the skin you’re in, call our office at 703-406-2444 to schedule a complimentary private consultation!

How to Get Rid of Age Spots

We we all might not enjoy getting older physically, I think we can agree that it’s great to be getting wiser… and not having to sweat the small stuff like we may have done in our younger years! Having said that, it can be shocking to look in the mirror and think, “I am starting to look like my mother/father!” One of the things we tend to notice most are those pesky age spots.

Most people would define age spots as those darker spots that seem to appear out of nowhere on our face, hands and arms. They usually look like freckles but sometimes can be darker. They are completely benign. Of course, sometimes they appear differently, in which case it is worth having them looked at by a plastic surgeon or dermatologist to make sure they are not pre-malignant. There is also a common lesion which occurs as we age, called a “seborrheic keratosis,” which is darker and appears to be a small stuck on patch. These are completely benign and can be cut or shaved off.

What’s the best way to get rid of age spots?

Most women have several of these and the best thing to do is to treat the entire area, i.e. the face or back of the hands or arms, with the Picosure laser. This is a revolutionary laser, firing 1,000 faster than other lasers. This means the area can be treated with no down time. You may experience absolutely zero redness or just some temporary pinkness that lasts a few minutes. You can put on make-up and return to work immediately following the procedure. You should plan for 3 treatments, each done a month apart. Some women, if they have a lot of sun damage, may need up to 6 treatments. This will also help with fine lines and the texture of the skin and will make the skin softer. My estheticians will also recommend a great post laser skin care regime to help these improvements last.

If you just have 1-2 age spots, then just these spots can be treated by my estheticians with the Cynosure Elite laser. This will cause some redness in the spot that is treated. You may need more than one session. However, most women are going to want to use the Picosure and treat the entire area at the same time.

Have questions about your skin? Please call my office at 703-406-2444 to set up a complimentary consultation with our Master Esthetician!

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.