Recommended Reading: The Obesity Code

I highly recommend The Obesity Code by Jason Fung, MD, a bestseller and in line which what I too am advocating for a anyone wanting to lose weight, particularly fat. Although a 304 page book, it is easy to read and packed with information. I  want to highlight some of the main points that he makes that are relevant to those wanting to lose fat. I feel it is a great support to my suggestion of intermittent fasting and ketone supplements (see my previous blogs on this topic).

Dr. Fung does a great job destroying the constantly cited theory that all you have to do in order to lose weight is decrease your calorie intake. This is ubiquitously advocated by almost all “experts”. They support this falsehood by laws of thermodynamics – if more calories are taken in than out, you will gain weight and if you take in few calories, you will lose weight. He points out a huge number of studies showing how this does not work. It sounds like it should make sense and we are constantly told that – take in less calories and you will lose weight.

Why does the calorie in and calorie out theory not work? It is because what really determines if we store the food as fat or burn/eliminate the food (and drink!!) is our insulin levels. What happens is that we have all sorts of internal hormonally regulated systems in our bodies that adjust our basal metabolic rate (how many calories are used up), how much of what we eat that we actually absorb (the rest will go out in our stools), and how much energy is converted to fat and stored.

What Dr. Fung shows very clearly is that insulin is the key hormone in deterring whether we store or use up fat. The main problem today is that because of both constant eating (this is a relatively new phenomenon that in between meals we constantly snack) and the high intake of sugars and refined foods, we end up with high insulin levels in our blood. This causes the insulin receptors in our cells to be LESS sensitive to the insulin. This causes our bodies to produce even more insulin, which we become less sensitive to over time – and the negative feedback loop continues. High insulin levels tell the body to store fat.

The way to restore our insulin sensitivity is through both intermittent fasting (I think intermittent fasting is easier with the ketone supplements) and decreasing the stimulation to produce insulin which comes from both sugars and refined foods. An intermittent fast is defined as at least 14 hours without anything that will cause insulin to be produced (so unsweetened tea or coffee and water are fine). This has absolutely been proven to work and is a lot of the rationale behind the ketogenic diets.

There are lots of studies proving that refined foods and almost all sugars will raise insulin levels. It is important to note that I am stating “raise insulin levels,” as there are items like fructose and many other sweeteners used by the food and beverage industry that raise insulin levels but not your blood sugar level. This is why using the commonly referenced “Glycemic Index” is not effective.

I know sometimes people get overwhelmed and feel there are conflicting reports and lots of experts weighting in. It is really quite simple. Work up gradually to going 14 hours between dinner and when you eat your next meal (things like water, tea, coffee with unsweetened almond/coconut milk are fine). This is even easier if you can eat a relatively early dinner – if you finish dinner by 7 pm, you just have to delay eating until 9 am. I believe ketone supplements are very helpful when delaying your eating, as they decrease your appetite (especially helpful for people like me who end up eating late, even though I would prefer not to).

To find out what ketone supplement I am using for myself click here. The supplements will also raise your ketone levels which tells your body to breakdown fat for energy. The food you eat should be as unprocessed as possible – think lots of veggies, as organic as is reasonable, as unpoisoned as possible – salmon is great, and grass fed, free range beef etc. Absolutely avoid all sodas and diet drinks (they raise insulin levels and cause weight gain). It is common sense that you want to avoid farm raised fish and mass farming, as they use lots of antibiotics/hormones etc. You don’t have to be perfect at every meal, but you want to make at least some extra effort to select healthier choices. Realize it takes time for you to get used to this new routine, so expect some slip ups – but persevere and you can expect to be much healthier for it.

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!

How to Exfoliate Your Skin

Written by Nicole Hackett, Master Esthetician

 

Exfoliating is crucial to having nice skin and slowing down the aging process. By exfoliating your skin, you are removing the top layer of dead skin cells and this will help to speed up your cell turnover which slows down as you age. This will let your new skin come in. Exfoliating your skin also allows your other skin care products to penetrate deeper and will help lighten and brighten your complexion.

Ideally, you want to exfoliate 2-3x week, but this can be varied, depending on your skin type. If you over exfoliate, you can cause more oil production, so it’s important to see your esthetician to know exactly how and when you should be exfoliating.

There are two types of exfoliation, mechanical and chemical. Mechanical can use either a tool, like the Clarisonic brush, or a face scrub with beads that physically removes the dead skin.

Chemicals, on the other hand, use ingredients to shed the dead skin. Common chemical exfoliant ingredients are salicylic acid, glycolic acid, and lactic acid. You can find chemical exfoliants in different products like face washes, peel pads, serums, etc.

Mechanical exfoliants can be a bit harsh on the skin, so if you have sensitive skin, I would stay clear of mechanical exfoliators, but it really depends on your preferences and skin type. You can also combine both mechanical and chemical exfoliators.

 

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!

How is High Definition SmartLipo for the Arms Different from Regular Liposuction?

There are a number of things that make High Definition SmartLipo (HDS) to the upper arms different from regular liposuction to the arms.

First, I almost always use Smartlipo, which is liposuction with the additional step  of using a small fiber-optic laser which is inserted directly into the subcutaneous fat. This both melts fat directly and also heats up the skin, so that there is greater skin tightening. This is always done in the office. I am able to do this in a very comfortable fashion for the patient. There are no IV’s, only oral medication.

Typically, when I perform Smartlipo to the upper arms, I use one small incision to the back of the upper arm. This is where most of the fat is located and I can almost always reduce the fat in this area and get some nice skin tightening to the area as well.

When I perform HDS, I will use 6-8 very small incisions per arm, and these will be located on the back towards the posterior shoulder, often on the lower arm, just below the elbow. After marking the upper arm, I will fully numb the area. Thereafter, I will use progressively smaller cannulas to sculpt the upper arms, including around the muscles of the upper arms, to greater highlight them.  I may even have you contract your muscles to help highlight your muscle definition, or even stand up, to see if things change with gravity. In the final step, I will use the Smartlipo to further refine the arms – the laser will both melt fat and tighten the skin. These additional incisions, allow me to access areas around the entire arm that I would not normally be able to reach.

At the conclusion of the procedure, we will place you in a comfortable, snug upper arm garment. You can take it off to shower the next evening and daily. However, I want it worn the rest of the time, for at least 4-6 weeks and sometimes longer. It would be wise to get 2 arm garments since you will need to wash it daily. You will continue improve for 6 months.

 

WHO IS THE IDEAL CANDIDATE FOR SMARTLIPO TO THE UPPER ARMS?

The ideal person for this procedure will have good skin tone in the upper arms, which usually means they are less than 52 years old (of course, this will vary from person to person, so this is a guideline). They will do best if they are within 20% of their ideal weight, though heavier individuals should still benefit significantly. Of course, you should be in reasonable health and not a smoker. Smoking interferes with wound healing – you should quit all nicotine products for 4 weeks before and after surgery

 

IS THERE A COST DIFFERENCE BETWEEN HDS AND REGULAR SMARTLIPO?

HDS takes me a lot more time than regular Smartlipo and requires both greater expertise and specialized equipment.

 

Have questions about High Definition SmartLipo or other cosmetic procedures? Call us at 703-406-2444 to schedule your complimentary, private consultation with me. I’d be happy to answer any questions you may have!

How is High Definition SmartLipo for the Calves Different from Traditional Liposuction?

There are a number of things that make High Definition SmartLipo (HDS) to the calves different from regular liposuction to the calves.

First, I almost always use SmartLipo, which is liposuction with the additional step  of using a small fiber-optic laser which is inserted directly into the subcutaneous fat. This both melts fat directly and also heats up the skin, so that there is greater skin tightening. This is always done in the office. I am able to do this in a very comfortable fashion for the patient. There are no IVs involved, only oral medication.

CAN THE CALVES ALWAYS BE IMPROVED?
The answer is yes, fat can usually be reduced. However, many women have larger muscles and larger bones than they want and the amount of fat that contributes to this can sometimes be significant and sometimes very little. You can usually tell by feeling the upper and lower calves whether there is a significant amount of fat contributing to the fullness.

WHAT MAKES HDS TO THE CALVED DIFFERENT FROM REGULAR SMARTLIPO?
Normally, when I do Smartlipo to the calves, I use one small incision to the in the posterior, superior medial aspect. This is where most of the fat is located and I can almost always reduce the fat in this area and get some nice skin tightening to this area as well.

When I perform HDS, I will use several very small incisions lower leg and usually medial knee area. After marking the lower leg carefully, I will fully numb the area. Thereafter, I will use progressively smaller cannulas to sculpt the calves and lower legs, including around the muscles of the lower leg, to greater highlight them. I may even have you contract your muscles to help highlight your muscle definition, or even stand up, to see if things change with gravity. In the final step, I will use SmartLipo to further refine the calves – the laser will both melt fat and tighten the skin. These additional incisions allow me to access areas around the entire lower leg, that I would not normally be able to reach.

At the conclusion of the procedure, we will place you in a comfortable, snug lower body garment that needs to extend to the ankles. You can take it off to shower the next evening and daily. However, I want it worn the rest of the time, for at least 4-6 weeks and sometimes longer. It would be wise to get 2 garments since you will need to wash it daily.

You will continue improve for 6 months. The lower legs, because of the gravity, are more likely to swell. For the next several weeks, when you sit down, it is best if you also elevate your legs on a chair. When you go to sleep, try and elevate your feet in 2-4 pillows. When you are relaxing on the couch, do the same thing. You ideally want your legs elevated above your heart.

WHO IS THE IDEAL CANDIDATE FOR SMARTLIPO TO THE  CALVES?
The ideal candidate will have good skin tone, which usually means they are less than 55 years old (of course, this will vary from person to person, so this is a guideline). They will do best if they are within 20% of their ideal weight, though heavier individuals should still benefit significantly. Of course, you should be in reasonable health and not a smoker. Smoking interferes with wound healing – you should quit all nicotine products for 4 weeks before and after surgery

IS THERE A COST DIFFERENCE BETWEEN HDS AND TRADITIONAL SMARTLIPO?
HDS takes me a lot more time than traditional Smartlipo and requires both greater expertise and specialized equipment. Therefore, there will be a higher charge.

 

Have other questions about High Definition SmartLipo or other cosmetic procedures? Call us at 703-406-2444 to schedule your complimentary, private consultation with me. I’d be happy to answer any questions you may have!

What is High Definition SmartLipo?

WHAT IS HIGH DEFINITION SMARTLIPO?
This is a special variation of SmartLipo that seeks to give much higher definition of the underlying muscles and is particularly applicable to upper arms and calves, though it can be applied to any body part.

WHAT MAKES HIGH DEFINITION SMARTLIPO DIFFERENT?
There are several things that make High Definition Smartlipo (HDS) different. The goal is to decrease the fat in the treated area with a much more aggressive treatment. For starters, it will take much more time to do in the operating room. Secondly, it will require additional incisions, which are very small (about 3 mm), which the patient has to accept. It will generally be necessary to wear the body garment longer (several weeks but will vary from patient to patient) while the body reshapes.With regular Smartlipo, the vast majority of patients will return to work the next day. With HDS, I recommend that they take an extra day or two from work.

HOW LONG DOES IT TAKE TO GET YOUR FINAL SHAPE?
This is similar to Smartlipo in that your body will continue to improve for 6 months.

WHICH AREAS ARE TREATED BY HDS?
Any areas of the body can potentially be treated, but the areas that will yield the greatest difference are the upper arms and calves.

WHO IS THE BEST CANDIDATE FOR HDS?
You need to have satisfactory skin tone, which I can judge when I see you for your free consultation. In addition, the treated body part is part of the rest of your body — meaning that if you have more body fat than is ideal, you are still going to look better if you decrease your total body fat through better dieting and exercise.

IS THIS STILL DONE UNDER LOCAL ANESTHESIA IN THE OFFICE?
Yes, I am still doing this under local anesthesia in the office. I will have to you take a pain killer about 90 minutes before the procedure to keep you more comfortable. I may have you stand at the of the procedure, so that i can fine-tune any areas.

WHAT ARE THE MAIN RISKS?
The main risks are the same as traditional SmartLipo performed under local anesthesia with oral sedation. There is always a risk of uneven skin and wrinkling. There is a remote chance of a skin burn – however I have now performed over 840 SmartLipo cases without any burns. There can always be unevenness. Of course, there is the risk of not being as  good as you hoped you would be – a risk with all cosmetic procedures. The risk of an infection is very low. I have only had one, and she responded to oral antibiotics. The risk of blood clots and fat clots is very low, since you are not being put to sleep.

 

Have other questions about High Definition SmartLipo? Call us at 703-406-2444 to schedule your complimentary, private consultation with me. I’d be happy to answer any questions you may have!

Is Snapchat Causing Image Dysmorphia?

This new “condition” has recently been brought to my attention. It is when a patient shows up for a consult and has brought along a picture of themselves that has been altered with a Snapchat filter or altered in some specific way with Photoshop-style editing.

The situation has to be assessed on its individual merits .If someone (usually a woman) comes into my office with a picture showing her lips slightly fuller, what do I think? I have resisted the marketing tool which allows the surgeon to computer program the final result of the patient. The reason that I have strongly resisted this marketing tool is because surgery and cosmetic changes are not an exact science and not 100% totally predictable. I feel that if I give or show the patient a photograph of the final result — even if I tell them that this is just an educated guess — then any shortcoming from that final result will greatly distress the patient, even if they get a very good final result.

The exception to this rule is if someone comes in with a before picture of what their breasts look like now, and also brings along a final result, which states the implant size. This is very helpful, since if I just copy the implant size, the patient should get almost the same result.

However, with facial procedures – whether it is surgery or fillers and Botox – it really depends on the degree of changes they are expecting and how realistic their expectations are. Fillers allow us to build up definite areas of the face. This can also give some tightening to the face (example placing fillers along the zygomatic arch/cheekbone can help minimize the nasolabial folds) or help improve depressed areas or make areas that are too prominent be less prominent, if the areas around them are filled in.

What I look at are the degree of changes the person wants and the intensity of what they want. It is also important to try and discern their motivation for wanting the changes. Sometimes, patients will be quite open with a bit of questioning (my life coaching background is helpful here), that they expect these changes to get their previous boyfriend or girlfriend back or will make them popular, etc. Someone who has seen and been treated by numerous specialists and feels they all have done a poor job is unlikely to be happy with me. Of course, if there are questionable cases, it is best to turn them down or perhaps, refer them to a mental health professional.

In general, I think the Snapchat generation tends to be much too focused on what they want and are owed and much less focused on service and responsibility – but perhaps I am just showing my age!

 

Have other questions about your cosmetic procedure? Call us at 703-406-2444 to schedule your complimentary, private consultation with me. I’d be happy to answer any questions you may have!

What Can Growth Factors Do For Your Skin?

In case you didn’t know, growth factors are the next big thing in the skincare industry and they are taking anti-aging products to a whole new level. Growth factors occur in our body naturally but as we age, we start to decrease our production of growth factors.

But not to worry, there are now products available that will help replenish growth factors. They are one of the best active ingredients you can add to your skincare routine for total skin rejuvenation because they promote collagen and elastin growth at the cellular level. They take care of all your skin care concerns at once, from fine lines and wrinkles, to lack of firmness and pigmentation. You can add growth factors to any skin care routine and really boost your results. Plus, they are great for all skin types!

Since they are working with your cells to create more collagen and elastin, they help to maintain and enhance your results from any cosmetic procedures you may have done and keep your skin smooth and firm. If you want a healthy, youthful complexion don’t wait and start adding growth factors into your regimen!

One of our favorite skincare products with growth factors is the TNS Recovery Complex from SkinMedica. It has the highest concentration of a patented growth factor blend, with over 380 growth factors and is also formulated with antioxidants, soluble collagen, cytokines and matrix proteins.

We also offer the HydraFacial at our office which has different booster options depending on your skin care concerns including the CTGF (Connective Tissue Growth Factor) booster that we can add to any of our treatments. The unique tips on the HydraFacial allows the serums to penetrate deeper into your skin. You will leave the office glowing – trust us!

Have other questions about your skincare routine? Call us at 703-406-2444 to schedule your complimentary, private consultation with our estheticians. We’d be happy to answer any questions you may have!

VI Peel Combination Therapies - Berman Cosmetic Surgery

VI Peel Combination Therapies

Written by Nicole Hackett, Master Esthetician

 

VI Peel is an excellent chemical peel that is suitable for ALL skin types! Many people fear chemical peels because of how painful they think it might be… however, the VI Peel is virtually pain free because it has powerful numbing agents in the solution. These are specifically designed treatments to target concerns including anti-aging, hyperpigmentation, acne prone skin and acne scarring. After you receive your VI Peel, we give you detailed at-home care instructions — and you will see your results in as little as 7 days!

How and when should  you incorporate VI Peel with other skin care treatments?

  • Botox: you can get your Botox the day after you get your VI Peel
  • Fillers: you can get dermal fillers the same day as the VI Peel just be sure to get the fillers first
  • Mega Peel Microdermabrasion: same day beforeyour VI Peel
  • HydraFacial: 1-2 weeks before or after your VI Peel
  • SkinPen Microneedling: 2-4 weeks before or after your VI Peel
  • PicoSure Laser Facial: 4-8 weeks afteryour VI Peel (FYI- a VI Peel prior to your PicoSure treatment preps your skin to get you the best results)

Now that Fall is around the corner, it’s a great time to start booking your appointments and get your peel on!

If you have any questions regarding your skin concerns or you’re not sure what route you should go, call us at 703-406-2444 to schedule your complimentary, private consultation with one of our Master Estheticians!

Can I Fly After Surgery?

This is a question I receive from a number of patients. Unfortunately, my answer is not going to be an answer that applies to every surgery. There are really two categories of surgery – general and local surgery with oral sedation. The latter category would include procedures such as Smartlipo and  Blepharoplasty. I believe it is fine to fly the next day after Smartlipo, but I would want you to remain in the area for 3 days, generally, after a blepharoplasty.

  • For general anesthesia cases, I believe it is fine to fly out 48-72 hours after a straightforward Breast Augmentation (BA). Of course, it would be nice if you could stay longer, but I don’t think this is absolutely necessary.
  • If there was a vertical lift performed with the BA, I would want you stick around in the area closer to 5-7 days.
  • After a Breast Reduction, it would be best to stay in the area for 5 days or more, but again, there could be reasons to leave earlier.
  • For a Tummy Tuck, it would be best to stay in the area for 10-14 days, but again, depending on circumstances, this could change.
  • For a Gynecomastia surgery, it would be best to remain in the area for a week.
  • For a Facelift, 10-14 days.

These are, of course, just rough guidelines and each case would be individually determined. If your surgery lasted more than 3 hours, and your flight is more than a few hours, I may recommend that you take a baby aspirin before you fly.


Have other questions about your cosmetic procedure? Call us at 703-406-2444 to schedule your complimentary, private consultation with me. I’d be happy to answer any questions you may have!

More on Intermittent Fasting, Ketogenic Supplements and the Ketogenic Diet - Berman Cosmetic Surgery - Blog

More on Intermittent Fasting, Ketogenic Supplements and the Ketogenic Diet

As most of you know, I have been very enthusiastic these past 4 months about combining 2 concepts into one diet plan. The first concept is intermittent fasting and the second concept is ketogenic diets and supplements. You’ve surely seen quite a bit about these topics on the news and in social media. Many celebrities are touting these dieting strategies, including Halle Berry and Jenna Jameson.

These have both become very hot topics in 2018. I get Google articles on my phone about both of these daily. I just read a blog by a Dr. Pedre who has “created” what I have already been advocating for months – his “Cyclitarian Diet”. This is my intermittent fasting combined with being ketogenic. The only difference is that I did not give my diet a name!

Let’s explore the logic behind my diet. There are a huge number of benefits to intermittent fasting. Intermittent fasting basically means no food or calories for between 12 and 18 hours.

What are the benefits of intermittent fasting?

  • Burn fat
  • Live longer
  • Increased brain health
  • Reverse Type 2 diabetes and restore insulin sensitivity.
  • Decreased side effects from chemotherapy

And the benefits of a Ketogenic diet?

The list keeps growing and there is good scientific evidence to support all of these claims. By the way, I recommend the Ketogenic Bible, which you can buy through Amazon, if you want to read a great book on this topic. I read it and I learned a great deal. It is scientific but very easy to read.

  • Increased brain function – increased memory, cognition, clarity, better seizure control, fewer migraines
  • Possibly fights some cancers – brain cancers namely
  • Prevent heart disease – decreased blood pressure, lower TG, better cholesterol profiles (increased HDL
  • Also changes your LDL cholesterol from small (which is the bad form) to large LDL (which is benign). I personally would suggest that it is better to try and get more of your healthy proteins and fats from plant sources and wild caught fish eg salmon, rather than animal sources.
  • Improved acne, arthritis, psoriasis, eczema, IBS, etc
  • Increased energy and sleep
  • Decreased uric acid levels – helps gouts and kidney function
  • Better GI and gallbladder health
  • Helps with a large number of neurologic diseases eg seizures and also metabolic disorders
  • Stabilizes hormones for women and increased fertility.
  • Helps prevent cataracts
  • Increased muscle and better endurance
  • Increased insulin sensitivity, decreased and potentially curing type 2 diabetes, helps with Type 1 diabetes control
  • Increase fat burning especially visceral fat. So weight loss due to fat loss and muscle preservation
  • Decreased appetite

Why the ketogenic supplements?

Simply put, they allow you to enter ketosis immediately, without having to do a ketogenic diet for the 4-5 days normally required to enter ketosis. The ketogenic supplements immediately put ketone bodies into your bloodstream.

My diet essentials:

  • A 12-16 hour fast (drink water or herbal tea or coffee, no sugars added)
  • Take a ketone supplement after you wake up and then ideally another ketone supplement 3-5 hours later, if your budget and personal plan allows
  • Eat your first meal and stay ketogenic at least until dinner. At dinner, eat healthy and try and be as close to ketogenic as you can. You don’t have to be perfect every meal. The amount of weight you want to lose will determine how strict you need to be.
  • When you take a leniency from the diet, use common sense. It is one thing to occasionally have some sushi with rice or a whole wheat roll. It is quite another thing to have a high sugar dessert like donuts etc, which you should try hard to avoid, at least most of the time.
  • One final word of caution: all “diet sodas” are terrible for you so avoid them even though they have no carbs or calories!
  • Exercise, specifically high intensity exercise, will increase your state of ketosis and your fat loss.

To find out what ketone supplement I am using for myself click here.

 

Want to discuss the Ketogenic diet in greater detail or other 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!