Malia - Berman Cosmetic Surgery & Skin Care Center Blog

What Is Milia?

Written by Nicole Hackett, Master Esthetician

Do you have little white bumps on your face that look like whiteheads, but nothing comes out when you try to pop them? If that is the case, you probably have Milia. These tiny white or yellow cysts occur when keratin becomes trapped beneath the surface of the skin and then hardens.

Milia is not painful and doesn’t cause any long-term damage. However, Milia cannot be popped and you should see your esthetician to have them extracted. If you are experiencing Milia around your eyes, you may be using a cream or lotion that is too heavy for your skin, which is causing sebum and dead skin to get trapped under the skin.

As we age our skin starts to lose its natural ability to exfoliate. In order to prevent Milia from forming, you should regularly exfoliate your skin and use a retinol serum. A chemical exfoliant will help to remove dead skin from the surface and retinol will encourage your cell turnover rate and bring new skin to the surface.

If you have questions or need your Milia extracted, call us at 703-406-2444 to schedule your complimentary, private consultation with one of our Master Estheticians! 

Podcast: The Truth Beneath the Surface - Berman Cosmetic Surgery Blog

Podcast: The Truth Beneath the Surface

As I hope my patients all know, I consider my business to be less about plastic surgery and more about “improving people’s lives.” I have even been known to refuse surgery requests if I believe a procedure will negatively impact a patient’s self-esteem. I recently spoke to Northern VA Advice Givers about my practice, what I attribute my success to, the psychiatry of plastic surgery and what’s on the horizon for aestheticians.

If you are considering a cosmetic procedure, I am happy to talk with you about your goals and possible ways to achieve them. Please call my office at 703-406-2444 to schedule a complimentary, private consultation with me.

Skin Necrosis after a Tummy Tuck (TT)

I answer a lot of questions on Realself.com and a question I have seen many times concerns skin necrosis, the dying of live skin cells, following a tummy tuck. It is very important to know that this complication occurs occasionally to every plastic surgeon, no matter how careful he is. As I was once taught and it is very true: the only surgeons who do not get complications with this don’t operate or they lie (courtesy of Dr. John Guy, one of the better surgeons that I trained with many years ago).

 

First of all, why do some patients get skin necrosis after a TT ?

This is always due to an insufficient blood supply. It is much more common in smokers or nicotine users. I insist all of my patients refrain from all nicotine products (including cigarettes, patches, gum etc) for 3 weeks before and after surgery. Diabetics are also more likely to have decreased circulation after a TT to the distal flaps of tissue. An extremely tight garment that interferes with the blood supply can contribute to this.

However, most of the time when it occurs, it just happens, and there is no obvious reason. I had a female patients many years ago who placed a very hot pad on her abdomen for menstrual cramps and gave herself a 3rd degree burn, which caused skin loss – but this is a very unusual case.

 

Where does the skin loss occur?

Almost always, the skin loss occurs at the farthest point of the flap, where the blood supply is the weakest. This is at the lower abdominal incision, usually close to the middle of the incision or at the T-junction if there is a small vertical part of the scar.

 

What is the treatment for skin necrosis?

This will depend on the size of the area and how it looks. This will require frequent visits to the plastic surgeon or a wound healing center. If the area is fairly small, local wound care is usually all that is needed, plus lots of patience. The area will usually go black, lift off and then heal fine. Sometimes the scar will need to be revised in the office at a much later date. The final result is usually excellent but you need to have a lot of patience since you cannot rush the process.

In some cases, you may need to pack the wound or use special vacuum suction to speed up the healing.

 

Have more questions or concerns about the tummy tuck procedure? Please call my office at 703-406-2444 to schedule a complimentary, private consultation with me.

How to Take Care of Your Skin After a Facial

Written by Nicole Hackett, Master Esthetician

Maintenance and consistency are critical after you get a facial, or any other treatment for your skin such as lasers, peels, microneedling, Botox, fillers, etc. If you truly want to be preventative and have good skin health, you need to have a good at-home regimen. One facial a year is just not going to cut it. You can have great products, but to see results you need to use them on a regular basis. Miracles don’t happen overnight. Getting on a good skincare routine can be hard at first, but it’s important to make time and add it into your daily routine. Once you get in the swing of things, it just becomes habit.

These are the essentials that I believe everyone should be using:

  • First, you want to be using a good cleanser and ideally not something you can find at the drugstore. You want something with high-quality ingredients that is going to clean your skin, get rid of makeup/dirt and not strip your skin – which can make it dry and flaky. You should be cleaning you face 2x day, but if that’s too much for you, then I recommend cleansing at night.
  • Second, I recommend exfoliating at least 1-3x week. There are different ways to exfoliate the skin, either mechanical exfoliation or chemical exfoliation. Exfoliating your skin is going to remove the dead skin cells on the surface of your skin and help to increase your cell turnover rate, which slows down the older we get. It will help prevent fine lines and wrinkles from forming and help to control blackheads.
  • In addition, everyone can benefit from a good quality vitamin C serum. Vitamin C helps to lighten and brighten your skin tone, it also helps to protect skin from the visible impacts of pollution, promotes collagen production, improves hydration and keeps your skin looking younger, longer!
  • Keeping your skin moisturized is very important for anti-aging, as the drier our skin is, the more noticeable fine lines and wrinkles are. There are tons of different moisturizers out there, but hyaluronic acid is an ingredient that all skin types can benefit from. Hyaluronic acid is extremely moisturizing, holding 1000 x its weight in water and locking in moisture from the air. It is best used after you apply your serums because it is made with larger molecules and it will help to penetrate your serums deeper into your skin.
  • Now the number one anti-aging product you should be using is SPF, and you should be using it EVERYDAY, even if its cloudy and rainy outside. The sun is the number one cause of aging and we are constantly being exposed to UVB and UVA rays. Even indoors, the fluorescent lights are emitting rays and when we are driving the rays are penetrating even stronger through the glass. If you are going to be outdoors for long periods of time it is important to reapply every two hours. Use a good sun screen with SPF 30 or higher and make sure it says broad spectrum.

To maximize your results from skin care treatments, it is vital to be using good skin care products at home and that you use them consistently.

Want to chat more about our options for healthy, glowing skin? Call us at 703-406-2444 to schedule your complimentary, private consultation with one of our Master Estheticians – we’d be happy to help you find the right products for your skin!

Do I Really Need to Wear Sunscreen Everyday?

Written by Nicole Hackett, Master Esthetician

Most people only think about putting on sunscreen when they are on vacation at the beach or out by the pool, but really you should be applying sunscreen Every. Single. Day. Rain or shine. If you want to protect yourself from skin cancer (which is the most common type of cancer), sun damage and overall aging, you need to be wearing SPF daily.

The sun is the number one cause of aging… it causes fine lines and wrinkles, pigmentation issues, and uneven tone and texture to the skin. Everyone likes to have a nice tan color to their skin, but in the long run you will regret it. Plus, nowadays there are so many different ways to get a nice glow, including spray tanning, tanning lotions, gels, sprays, etc. It is very easy to tell when someone has spent their life out in the sun with no protection. Their skin tends to have a leathery texture, and they often appear older than they truly are.

Wondering about the winter months? The same rule still applies! There are two kinds of ultraviolet rays that are emitted by the sun, UVB and UVA rays. UVB rays cause sunburns and are obviously more intense in the summer months. However, when you are in areas with snow, sand and water, you are increasing your chance of getting a sunburn because they reflect the rays from the sun. UVA rays cause aging of the skin penetrate deeper into your skin, and they have the same intensity year-round. Whenever you are out in daylight, you are being exposed to UVA rays, and they penetrate even stronger through glass – meaning every time you are in your car, you should be wearing SPF. And even while indoors, florescent lights are emitting rays!

Sunscreen is the number one anti-aging product you can own. We recommend that you use a broad-spectrum SPF that protects from both UVB and UVA rays, SPF 30 or higher, water resistant (especially if you will be outdoors) and reapply every 2 hours if you will be outside for long periods of time. Not only should you be wearing SPF when outside, but you should try to stay in the shade when possible, wear sunglasses with UV protection, and hats to protect your face from the sun.

Dr. Berman’s skincare line has a great tinted sunscreen that we highly recommend. It has SPF 50, UVB and UVA protection, a light coverage tint that blends with almost all skin tones for a healthy touch of color, and can be worn alone or as a makeup primer. Not only does it protect your skin from the sun, it also provides hydration and antioxidant benefits to the skin including green tea polyphenols, vitamins C + E, and CoQ10 which are great ingredients post-procedure for laser facials and chemical peels as it will help to bring down any redness and heal the skin faster. Our clients rave about this sunscreen and how creamy and smooth it goes on to their skin. This sunscreen is by far one of our best sellers!

There is truly no safe way to tan. Every time you tan, you are damaging your skin. As this damage builds, you are speeding up the fine lines, wrinkles and pigmentation in your skin and increasing your risk for all types of skin cancer. So, it’s time to ditch all of the tanning oils and tanning beds and time to get on board with SPF. If there is one skin care product we could recommend it would be sunscreen — 100%!

Want to chat more about our options for healthy, glowing skin? Call us at 703-406-2444 to schedule your complimentary, private consultation with one of our Master Estheticians – we’d be happy to help you find the right products for your skin!

How Botox and Fillers are Different for Men vs. Women

While women have historically dominated in use of Botox and Fillers, this has been changing rapidly over the past 5 years, with more and more men now taking advantage of these procedures.

Botox and facial fillers are the most common non-invasive procedures for both men and women. However, how many units I typically use for men is different than how many I use for women. The most common place to place the Botox for both men and women is still the glabellar area (the area between the medial eyebrows — the 11’s). Because men have larger muscles here, I will place 25 units, in this area rather than the 20 units I place for women.

Both men and women will treat the crow’s feet with Botox. While I usually place 10 units per side for women (this is only a general number, sometimes, I will place 5-12.5 units per side), I will often place 12-15 units per side for men.

The forehead is treated very differently for men versus women. Women often want a small amount placed over the lateral third of the eyebrow to try and elevate the lateral third and give them a nice arch. Men will not want this since this tends to produce a more traditionally “feminine” look. Men will typically ask for a more horizontal eyebrow, so I will avoid Botox over the eyebrow or I will put it  in equally medially and laterally above the eyebrow.

The most common place for a man to place fillers is the nasolabial fold. They will generally not request that fillers be placed along their zygomatic arch since this is a feature more commonly desired by women rather than men. In women, this will both soften their nasolabial folds and emphasize their zygomatic arch. Men will place fillers in the pre-jowl area, which help make the jowl area be much less noticeable.

Want to know more about Botox and Fillers? Please call my office at 703-406-2444 to schedule a complimentary, private consultation with me.

Do Men Get Liposuction Too? And How Does it Differ from Treatments for Women?

The quick answer is yes, men definitely get liposuction. SmartLipo is the most common surgical procedure for men in my practice. I have performed a very large number of SmartLipo procedures on men (more than 815 cases as of May 2018), though the areas of the body it is performed on tends to differ from women.

What areas do men accumulate fat and get SmartLipo? The submental area (upper neck), lower abdomen, flanks and often upper abdomen. Almost all men, even if very fit, will have more fullness in their flanks than they want. Even when I was doing Ironman races, it was rare to see men competing alongside me with perfectly flat flanks.

Most men will accumulate fat intra-abdominally, often much more so than women. Frequently, I will see men with very large protruding stomachs who want SmartLipo, but all of their fat is intra-abdominal (visceral) with no external fat. There is no role for liposuction of any kind in these cases. These men can only improve with dieting (I now recommend the a low carb/high protein diet with intermittent fasting, Ketogenic supplements and exercising.

As is the case with all Smartlipo patients, I can reduce fat in the specifically-treated areas, but it is always a partnership – men can significantly improve the final result with better eating habits and increased exercisin,g which should lead to decreased total body fat.

Want to know more about SmartLipo? Please call my office at 703-406-2444 to schedule a complimentary, private consultation with me.

Tanning After SmartLipo: What You Need To Know

I get a lot of my ideas for my blogging from Realself.com, since people often raise questions that I would not have thought of.

Several people have asked about tanning after SmartLipo. It’s not that simple though – we have to discuss the difference between regular tanning and spray tanning. Spray tanning after about 3 days should not be a problem. The very small incisions are sutured and then covered with a steristrip. It is very unlikely that after 3 days the spray tan would enter the small incisions and cause a problem.

But what about suntanning after SmartLipo? You do need to be careful for a few reasons.

  1. First, it is very common for skin to me numb in the treated areas. This means you can get a sunburn and not feel it.
  2. Also — and this is very important — the circulation to the skin can be somewhat decreased (this will vary from person to person and will depend on how aggressive the SmartLipo was and how superficial it was done). It should not be decreased very much since the small blood vessels are largely spared and definitely the larger vessels are spared. However, there can be some decrease, which theoretically could increase the risk of a sunburn. There are no studies on this, so it is largely opinion only.

I would suggest a good sunblock (good advice for all the time) after a day or two if you plan to be out in the sun. However, I would avoid laying out in the sun to sunbathe for hours, until about 10 days following your SmartLipo procedure. Even then, you should reapply your sunblock frequently and go indoors to check your skin to see how you are doing. I am not as fanatical as many dermatologists about being out in the sun. I think a light tan is great but clearly you don’t want to be baking your skin in the sun and you always want to protect your face if you want to minimize hyperpigmentation. It’s important to not that being tanned will also prevent you from getting our PicoSure facial, but you could get a Hydrafacial if desired.

Want to know more about SmartLipo? Please call my office at 703-406-2444 to schedule a complimentary, private consultation with me.

What I Noticed When I Stopped Taking Ketone Supplements

As I think many of you know, I generally eat very healthy, exercise regularly, and I am not overweight. However, I had heard many positive things about the ketogenic diet and supplements and was curious about what they could do for me. Many celebrities are touting these dieting strategies, including Halle Berry and Jenna Jameson.

For 2 weeks, I followed  a ketogenic diet during the day, and took a ketogenic supplement first thing in the morning. I did not follow a ketogenic or even a paleo diet for dinner. On this pretty easy routine, I lost 4 pounds in 2 weeks. The Jewish holiday of Passover arrived and I stopped all of this. I then resumed the diet for a week and lost another pound. I was down to 139 pounds, which is very low for me. Because I had a four-day conference in New York City, I decided to take a break and not follow any specific diet.

The Result of Taking a Break:
Interestingly enough, I noticed over the 4 days at the conference that I was not waking up as alert. When I was on the above-mentioned ketogenic routine, I woke up very alert and almost immediately. I started to feel aches and pains in the morning, which were almost completely non-existent when I was taking the supplements. I was also naturally eating more. By contrast, the ketogenic supplements suppressed my appetite naturally, so I ate less without consciously trying to do so.

For me, this little experiment confirmed the following benefits of the Pruvit ketogenic supplements:

  1. More energy and waking up very alert, as opposed to the typical tired, groggy feeling for 30 minutes or more.
  2. Much less achiness in the early morning.
  3. Fat loss of 2 pounds/week. My wife even says that I have greater muscle definition.

If you are looking for a way to decrease body fat, I highly recommend trying ketone supplements. They are available for purchase online or stop buy our office to purchase a 10-day supply.

I believe that most people who try it and follow my diet plan will notice a significant difference in just 10 days.

 

Want to discuss available options for decreasing body fat? 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!

Lotions Vs. Creams - Which is Better for Your Skin - Berman Cosmetic Surgery Blog

Lotions Vs. Creams – Which is Better for Your Skin?

Written by Nicole Hackett, Master Esthetician

 

There are a plethora of moisturizers on the market, but how do you know which one is best for your skin? Well, we have the answer!

The difference between lotions and creams is the way they are made. Lotions tend to be water-based and creams are more oil-rich, which makes them thicker.

Lotions absorb quickly, are light on the skin and hydrate without feeling heavy. Lotions are great for daily use and for those who have normal to oily skin. In the summer, if you’re feeling especially oily or if you live in a humid area, lotions would be best for your skin because they are water-based and won’t clog your pores.

Creams, on the other hand, are heavier and best for those who have dry skin. In addition, if you are getting chemical peels or laser treatments done, you should be using a cream post-treatment to protect the barrier of the skin and help lock in moisture. In the winter months, our skin tends to become drier, so adding in a nightly cream can definitely help.

In short, people that have dry skin would benefit from a cream and people with normal or oily skin should opt for a lotion. However, you should always  listen to what your skin is telling you. If you are feeling extra dry, that’s your body telling you it needs more moisture and vice versa.

We have everything from Dr.Berman’s Ultra Lite Cream to Obagi’s Moisture Rich-Cream. Call us at 703-406-2444 to schedule your complimentary, private consultation with one of our Master Estheticians – we’d be happy to help you find the right products for your skin!