Dr. Berman and the Bobbitt Case: 25 Years Later - Berman Blog

Dr. Berman and the Bobbitt Case: 25 Years Later

I often get asked about the infamous Bobbitt case that I took on in 1993. As most of you remember, John Bobbitt was that famous case where his wife decided she was upset with him and cut off his penis (at the base) and then threw it out of her car window into a field. I achieved significant fame from being the plastic surgeon who reattached it with microsurgery.

With the 25 year anniversary of this case that made national headlines, I was interviewed by Washingtonian magazine.

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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.

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. 

Berman Cosmetic Surgery - Will I get better results with a more invasive procedure?

Will I get better results with a more invasive procedure?

This is a complicated question – with a perhaps complicated answer! Of course, if you can get the same results with a non-invasive procedure as you can with a minimally invasive or totally invasive procedure, then by all means, you should choose the non-invasive procedure (non-invasive being a procedure that requires no incision).

There is no question that we are seeing a strong trend towards the minimally and non-invasive procedure as the technology is getting better and better. As procedures are getting less and less invasive, it is allowing us to perform these procedures earlier and stave off having to do the more invasive procedures for many years – perhaps forever. This is a great trend. There will still be those patients who will get the best results for their situation with a more invasive procedure. As your surgeon, I’d be able to explain why this may be the case for you after seeing you for a complimentary consultation.

There are some amazing non-invasive and minimally-invasive procedures that my clients are seeing great results with. Having said that, are there any things a patient should be cautious about? Most definitely! First and foremost, know that the results are equipment-dependent. It actually drives me a bit nuts when I am using a Cellulaze laser from Cynosure to help cellulite and I hear ads on the radio for topical creams that promise even more than I would ever dare to suggest I can accomplish. We can accomplish a lot with technology, but I would never suggest I can completely eliminate the problem. The new technology is expensive for the doctor to buy, and you get what you pay for. For example, many spas are now offering similar treatments, but with much lesser equipment. Oftentimes, the lasers used are of inferior quality and the results are not permanent. One area I see this in quite often is laser hair removal. The laser used matters, and you simply won’t get the same result with a lower-grade piece of equipment.

For improvement in hyper-pigmentation, acne scarring and fine lines, the Picosure laser is the gold standard. However, it is a very expensive laser to buy and it takes skills to operate it. You simply will not find this in a spa and therefore you will need get the benefits of a Picosure laser if you want to be treated in a spa.

Minimally invasive fat removal systems, such as Smartlipo and Body-Tite, are expensive. However, there will be knock-offs that will be less expensive – and also less effective. This is also true of the Sculpsure laser, which can non-invasively decrease fat, but will likely not be as aggressive as Smartlipo or Body-Tite for those that want or need something more aggressive.

The best advice I can give prospective patients is to insist on a board certified surgeon, preferably a plastic surgeon (there is no such thing as a board certified “cosmetic surgeon”). Meet the surgeon in advance to discuss the procedure and your desired results. Although it is reasonable to be aware of costs, do not select the least expensive option. You are paying for both the quality of the equipment and the experience of the surgeon.

If you’d like to discuss your concerns or potential treatments, please contact my office at 703-406-2444 to schedule a complimentary consultation with me. 

What’s New in Cosmetic Surgery for 2017

 

It’s amazing what advancements take place each year in cosmetic surgery. This part year has brought about two major breakthroughs, PicoSure and SculpSure

The PicoSure laser is a gamechanger in facial procedures. Almost all women over the age of 30 develop irregular areas of increased pigmentation on their face. As they continue to age, this will extend onto the neck and chest area and also the hands. This is often even more pronounced in the Asian population. Traditional laser treatments have included CO2, IPL and Fraxel lasers. These are very helpful with white skin but the problem is these treatments all cause a tremendous amount of redness and inflammation, requiring missing many days from work and other life activities. In addition, on Asian or light brown skin, they can cause hyperpigmentation.

The Picosure laser allows for dramatic improvement in hyperpigmentation on the face, neck, decollete  and hands, regardless of skin tone – and there is very little to NO downtime! I’d recommend planning on three treatments per area, spaces one month apart.

The other huge breakthrough, for the body, is SculpSure. This is the first treatment modality that lets you melt fat in just 25 minutes, using 4 paddles (cell phone size). You should plan at least two treatments, spaced six weeks apart. Studies by Cynosure show that up to 24% of fat can be reduced in the area. This is a very impressive amount, considering no incisions are needed and you can do this on your lunch break or on the way to the gym. I even did this on myself (see my photos here) to show that it really works. By using heat, it avoids many of the problems that occur with freezing (as with CoolSculpt – uneven fat removal, significant pain, ineffective in many patients, significant nerve damage – causalgia).

Another shift we are seeing is the greater recognition that excellent, pharmaceutical-grade skin care is an integral part of looking younger and healthier. These types of products are only going to be available from a physician’s office and can’t be purchased online or at high end stores. Even with the best laser treatments, you will need excellent skin care to maintain this result.

A few predictions:

  • I believe the Brazilian Butt Lift, which is usually achieved by fat transfers, will be found to have a higher complication rate than the public realizes. I have seen fat transfers performed in women with low body fat. The problem is that about 50% of the fat will often not survive (fat needs to acquire a blood supply to live or it just melts away). Therefore, these women will pay a lot of money but will have little to no change in the appearance of their buttocks. I also believe more women experience infections, oil cyst, and fat loss than is presently recognized.
  • I believe that the number of facelifts performed will decrease over time as more women choose to delay their facelifts by using fillers, botox and facial lasers like Picosure. Additionally, procedures like Smartlipo can decrease the fullness and tighten the neck/submental area in many of those women between the ages of 35-55 years old.  Ultimately, they may feel the need for a facelift to to tighten the neck, but this will likely be pushed off in many women to a much older age.

Cosmetic Surgery is more than just Breast Augmentation, Tummy Tucks and Facelifts

More than just Breast Augmentation

Cosmetic Surgery is more than just Breast Augmentation, Tummy Tucks and Facelifts.

Of course, the bulk of my major cases are Smartlipo, Breast Augmentation and Tummy Tuck. However, there are a number of other procedures that I do which may be beneficial to you. You can find additional information about these procedures in the appropriate section on my web site.

Torn or stretched earlobes

Many women have stretched or torn earlobes. This can be quite a nuisance for women who enjoy wearing earrings and don’t want to wear the old fashioned clip-on earrings. I can fix the torn or stretched earlobes in just 30 minutes in the office under local anesthetic. You can drive yourself home and you can return to work immediately. You can shower and exercise the very next day. You should wait 4-6 weeks before having them re-pierced.

Eyelid – Blepharoplasty

Many people after the age of 40 and sometimes before, develop under eyelid redundancy. This causes them to look tired or angry or serious. I do the upper eyelid blepharoplasties, just in the office, in one hour with local anesthetic plus an oral sedation. There are no IV’s. You must have someone drive you and you cannot do Uber or a taxi. You can return to work in just 2 days. There is usually very little bruising and no pain. The single suture slides out in 6 days.

Mole and Lesion Removal

I am always amazed that many people select a non- plastic surgeon, to remove the moles and lesions on their faces. There are many doctors, who give the impression that they are board certified plastic surgeons, when in fact they are neither board certified nor surgeons. Ask the specific question, “are you a board certified plastic surgeon?”

Botox

Many offices delegate their filler and Botox injections, but I do ALL of my own filler and Botox injections. Presently, my prices are very reasonable and much less than prices found in many dermatologist offices.

Labiaplasty

I am also able to do labiaplasties in the office under local anesthetic with oral sedation. You can return to work in just a few days and i have had a few patients, who have returned to work in 48 hours!!

 

What does a cosmetic surgeon do?

What does a cosmetic surgeon do? It’s not just breast augmentations.

Most of the public is aware of the mainstay of most plastic surgeons, which are facelifts, noses (which I don’t do), breast augmentation/lifts/reductions, tummy tuck and liposuction.

However there are many other things that I do that you may not be aware of.

Smartlipo or Laser lipo (see my other blogs and web site for more details) is my most popular procedure. As of May, 2016, I have done almost 600 of these cases in my office with the patients returning to work the next day. The incisions are very, very tiny and so far, I have had no complications. It is important to be aware that you will continue to improve for 6 months.

Another common surgery is the repair of torn or stretched earlobes. Many women stop wearing earrings because they don’t realize that this can be fixed in my office in just 30 minutes or less. You can return to work immediately. I have also fixed earlobes that have had gauges in them. This will be a bit more complicated than a stretched earlobe, but I frequently can give a much more normal appearance to the earlobe.

Cellulaze is the laser treatment that can smooth out the irregular skin of the thigh or buttock. It cannot make it go away but it is the only FDA approved treatment that actually helps this very, very common problem for women. This is also done in the office.

I do my blepharoplasties in the office with local anesthetic with some oral sedation. You can go back to work in 2 days after this procedure. My web site can give you more details on this.

Ears that stick out too far, are a source of embarrassment for many adults and I can correct this in the OR. In my practice, it is almost entirely adults that want to have this repaired.

Of course, I take off unsightly moles, growths, lipomas, and suspicious lesions. I can also revise scars.