What Can PicoSure Do For Your Skin?

The PicoSure laser helps remove wrinkles, dark spots, acne scarring, and tattoos. It is the first of a new generation of lasers, with its cutting-edge technology allowing for optimal results with very little downtime. Other laser resurfacing treatments like the Fractional CO2 laser and IPL can be  extremely uncomfortable and have significant downtime for the patient.


What’s especially nice about the PicoSure laser is that it doesn’t rely solely on heat to burn unwanted tattoo ink or pigmentation (dark spots in your skin). Instead, it delivers energy so rapidly that tiny particles that make up pigment and tattoo ink shatter without burning the surrounding tissue. Less heat means less damage and discomfort.  It also sends a signal to your body activating your skins cells to respond, which then produces new collagen and elastin for healthier, younger looking skin.  This breakthrough technology is perfect for anyone over the age of 35 looking to slow down the aging process, anyone with pigmentation issues or suffering from acne scarring.



When you come in for your treatment our esthetician will apply a topical numbing cream to help minimize any discomfort. After approximately 30 minutes of numbing, the treatment will begin – and it takes only 10-15 minutes! Another great thing about PicoSure is the minimal downtime,. Typically, patients have mild redness for only a few hours after the procedure and can return to work and their regular activities. With other lasers, the downtime can last up to a week!  We require that you get a minimum of 3 PicoSure treatments, though it should be noted that more may be needed depending on the condition being treated. Once you have reached the results you want, we highly recommend that you get another treatment every 6 months to help prevent accumulation of pigment and slow the appearance of wrinkles.


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

How Young Is Too Young for Plastic Surgery - Berman Cosmetic Surgery

How Young Is Too Young for Plastic Surgery?

It is important to point out that much of plastic surgery is not cosmetic surgery, but rather, reconstructive surgery. For example, children born with cleft lip and palates, and fingers that are joined together (syndactyly). No one would argue that these surgeries should be postponed until much later in life. So the question is really, when is cosmetic surgery appropriate? As is true with all good questions, there is often no simple answer. There is no magic age, but many considerations to take into account for various procedures.

One of the more common plastic surgery procedures done for children is otoplasty. This in simple terms means that the child’s ears stick out and the otoplasty corrects this problem. Everyone knows that children can be cruel and be mean. I have had young children brought to me by their parents, wanting to know when they should have the surgery. What I tell the parents is the following: “I would wait until the child begs for the surgery.” Many times when I ask the child, they are not concerned. It is the parents who worry about the possibility of their child being teased. It is my personal belief that if the surgery is done before any teasing begins, the child will be given the impression that there is something wrong with them, that the parents are forcing them to correct. Clearly, this is not an ideal situation. I explain to the parents that their child may never encounter any problems from their ears, in which case, there is no reason to undergo the surgery. It is best to wait until the child requests it to begin the consultation process.

Breast Reduction:
Most professionals would agree the young woman’s breasts should have stopped increasing in size for at least six months before considering options. The youngest woman I have completed a breast reduction for was 17 years old, but I had been in discussion with her and her parents for over a year. As a surgeon, I want to make sure that the patient fully understands and has the maturity to deal with the surgery and the potential scarring, etc.

Breast Augmentation:
I have completed breast augmentation on several young women who were graduating high school, who had their parents’ full support. Currently, the FDA has only approved silicone breast augmentation for women over 22 years of age. Thus, I use saline implants only for these young women. There clearly has to be a maturity level and emotional stability for these young women, but I personally think it is fine for them to have this procedure when they are graduating from high school.

I don’t believe there is a magic age for this surgery. It would really depend on the level of anxiety one’s labial appearance is causing them, how realistic their expectations are for the surgery and a gut feeling about her reasons for the surgery. Years ago, I saw a young woman in her very early 20’s who wanted a labiaplasty. After talking with her, she told me that she had been sexually assaulted and her labia reminded her of the incident. I strongly encouraged her to get counseling and she agreed. She has never returned for surgery which tells me that the solution was likely therapy and not surgery. In general, I think most women should be at least in their 20’s.

SmartLipo & Lid Blepharoplasty:
I have seen a few women in their early 20’s who have had congenital fullness in the neck area, who did great after I did Smartlipo on her neck. I have also had a young woman in her early 20’s who congenial bags under her lower lids that did very well with the lower lid blepharoplasty that I did for her.

Botox & Fillers:
There is absolutely no role for putting in Botox and fillers in advance of needing them. It is extremely unlikely that a woman in her teens would need these, and I’d say the same for those  in their early 20’s. I have put lip fillers (Volbella is a one) in women in their 20’s. I believe this should be done gradually, and the goal should be a natural look. I always caution these young women, and older woman too, to go gradual and aim for a natural look – and not to emulate some of the Hollywood stars, who I feel have gone way overboard.

I think that in the society we live in, there will be a push for teenagers to have more and more cosmetic surgery, earlier and earlier, which I personally do not think will be a good thing. There should always be careful consideration given to cosmetic procedures.

If you have questions about any procedures you are considering, please call my office at 703-406-2444 to schedule a private, complimentary consultation with me.

Menopausal Makeover Series: Part 1 - Berman Cosmetic Surgery Blog

Menopausal Makeover Series: Part 2 – Botox

Botox is definitely your friend as you try to minimize the effects of aging. We all know men and women who have those permanent “11’s” – vertical lines running upwards between their eyebrows. These stem from years of contracting those “glabellar muscles” from such activities as staring at a computer screen or squinting in the bright sunlight. The good news is that those deep lines do not have to be permanent! If you get 20-25 units of Botox every 3.5-4 months for a year, those lines will soften tremendously. If you want to fast track this, you could also get a small amount of filler injected when you get your Botox.

There is another difference with getting Botox when you are post-menopausal. As you age, those transverse forehead lines that you may not be in love with are caused by the same muscles that hold up your eyebrows. This means that you will be much more prone to getting a descent of your eyebrows, particularly if Botox is injected into the lines extending directly above your eyebrows, all the way up to your forehead hairline. Sometimes it is better to accept the transverse forehead lines above your eyebrows, rather than to also get a descent in your eyebrows. It can be impossible to predict if this will occur for you. Therefore, if you elect to inject Botox into your forehead, it is always better to start with a low dose and see how you respond. If there are no concerns, you can always add more after two weeks.

The crow’s feet often become deeper as you age and frequently, I like to increase the amount of Botox I inject into the crow’s feet from 20 units total for both sides to 25 units total per side, along with 3 small injections per side.This will help with the dynamic lines of movement, as with smiling for example. If you want to decrease those lines when your face is static, you could also do a series of 3 Picosure Laser Facials.

Stay tuned for additional topics in my Menopausal Makeover Series, designed to address the special considerations of women in this time in their life.

If you have any questions, or would like to talk about your specific concerns, please call my office at 703-406-2444 to schedule a private, complimentary consultation with me!

Berman Cosmetic Surgery & Skin Care Center - Facial Surgical Procedures

Manual vs. Chemical Exfoliants

Exfoliating is a very important step in your skin care regimen if you want to improve the appearance of your complexion. Not only does exfoliating help your skin to look brighter, clearer, smoother, and overall healthier, it also allows for your other products to penetrate more deeply into the skin, making them more effective. When you exfoliate, you are sloughing off dead skin cells which helps to stimulate your cell turnover rate (which decreases the older we get). Exfoliants fall under two categories, manual and chemical.

Manual exfoliants tend to have a gritty texture with microbeads and typically come in the form of scrubs. Microdermabrasion is another type of manual exfoliant, and you can either use diamond tips or crystals to exfoliate the skin. When you are using manual exfoliants, you are literally scrubbing off dead skin cells. Because they are abrasive, it is very important not to over exfoliate because it can actually cause damage to your skin. A good rule of thumb when using scrubs to exfoliate is to use them only 1-3 times per week!

Chemical exfoliants use chemical solutions to exfoliate and stimulate collagen and elastin to the skin. The solutions are known as either AHAs or BHAs. AHAs are “water” loving meaning that they attract and hold moisture close to the skin’s surface and they work from the bottom of the epidermis to the top. The different AHAs are good for certain things, but in general they are preferred for those who struggle with dryness. The most common AHAs are Glycolic, Lactic, and Citric. BHAs on the other hand are “oil”-loving meaning they work to “de-gunk” pores and they work from the top of epidermis to the bottom. BHAs are great for people with oily, acne-prone skin. Salicylic Acid is the main BHA…which is also a main ingredient found in aspirin. If you are allergic to aspirin, you will want to avoid BHA products. Oftentimes a combination of AHA and BHA products can be very beneficial for combating skin issues and having a superior outcome!

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

Menopausal Makeover Series: Part 1 - Berman Cosmetic Surgery Blog

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”.

Stay tuned: In the next article in this series,  I will discuss Botox for the post-menopausal patient.

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!