My Thoughts on Sono Bello

I have seen a few patients in my office who have had experiences with Sono Bello. I know that they spend a huge amount of money on marketing directly to the public.
What is Sono Bello? From what I can gather from their website, they operate over 200 centers, where they perform minimally invasive liposuction (the TriSculpt system), some laser around the face to decrease wrinkles, cellulite reduction and also non-invasive Venus Freeze to reduce fat. I have never been to one of their centers, nor have I worked for them, so my comments are largely based on an internet search.
They do offer free consults. However, what is very strange to me is that the consult is done with a salesperson and NOT the surgeon. For me that sets up a HUGE RED FLAG. The salesperson is almost certainly paid on a commission basis and many reviews suggest that they are extremely pushy. Their only interest is getting surgeries booked. I saw one patient that was treated at Sono Bello. I feel she should never have been treated by liposuction. She was hugely overweight, with a lot of intra-abdominal fat (which is not amenable to any type of liposuction and needs dieting and exercising). She had NO IMPROVEMENT. She spent a huge amount of money. I know the prices they list on their website are very low. However, some of their patients that I have seen, have paid far more than their web site suggests.  Moreover, since those selling the service are not the surgeon, I doubt they can be sued since it is not them that is performing the surgery. When you have a consult regarding a surgical procedure (and even Botox or fillers), I will give you an honest opinion if you are a good candidate and what type of realistic results you can expect. I will also go over the risks and benefits. Moreover, it is me that does both the consult and the surgery.
From what I understand, these clinics employ a number of different surgeons, and which one you get is really luck of the draw. The website for Sono Bello says they have many Board certified plastic surgeons, but I wonder if ALL of their physicians are Board certified plastic surgeons? I am sure they have some good plastic surgeons, but like any place with a number of physicians, some will be better than others. I don’t believe that you don’t get to choose your surgeon. If you come to my office, you know that the only person that is going to perform your surgery is ME!
Their website displays a photo of a woman, Kellie, which I find extremely misleading since she has clearly lost a very large amount of weight in addition to her procedure. From both my experience and expertise, there is simply no way that this result was obtained by their liposuction technique.
The website also states that TriSculpt can be good for gynecomastia. Based on my many years of experience, I rarely do any type of liposuction alone for gynecomastia. The men who are self conscious about their breasts need to have a very aggressive treatment which should include an open excision in most cases. Anything less than this will leave the men dissatisfied with their final result.
It is not clear that there is any real follow up with their patients. I follow my SmartLipo patients for 6 months, if they live within driving distance.
I personally believe that the Sculpsure technology, which works on a heat basis, offers much better technology than the freezing methods, such as Venus Freeze or Coolsculpt. On their web site, they claim that the Venus Freeze will help cellulite, but I suspect it will not be very effective. The Cellulaze treatment is a far more aggressive treatment for cellulite and is much more likely to obtain a long lasting improvement (even this treatment is not always effective in every women). The only other treatment that may have benefit is Cellfina.
I realize that you cannot make everyone happy. I do my very best, but it is just a fact of life that some patients will be disappointed. However, a quick look at the negative comments on Sono Bello should make one wary of them.
This is not to say that they are not a reputable business. However, I would suggest that lowest price should not be your top consideration. It is surgery and there are risks. There is also a professional relationship with the plastic surgeon. I believe in a holistic approach and I strongly encourage most of my patients to work towards a healthier diet and better exercise to continue seeing improvements in their results. In general, you don’t want to have your surgery at a surgery factory whose only goal is to get as many patients in and through as possible. I’d advise candidates for these procedures to find a practice – and surgeon – whom they feel are truly invested in their surgery outcome.

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 Plastic Surgery and Health + Wellness Can Go Hand in Hand

To most people, “plastic surgery” and “health and wellness” are polar opposites. We tend to think of someone ill who has to have surgery. We realize of course that many people electively choose plastic surgery, but the idea that this could somehow connect with — and even facilitate — wellness seems like a far stretch. However, they truly really compliment each other.

Wondering how? 

I have very much been into healthy eating since I was a teenager (my early childhood years were a different story, as I consumed far too much soda, candy, etc) I have always been reasonably fit, but I definitely took it up several notches in 2000 when I started martial arts and then moved to marathons, triathlons, Ironmans (two of them) and then yoga and core exercises.

I personally believe that about 90% of all of our health problems would be resolved if people ate in a healthier manner and fit in exercise most days of the week. Just imagine how much money and time would be saved, rather than wasted on doctors, investigations, feeling lousy and heartache due to serious illness. All of this is preventable. More and more evidence is accumulating each year about how food affects the bacteria in your gut, which in turn leads to things like leaky gut syndrome, which probably plays a major role in autoimmune diseases. We are just learning that a similar phenomena is happening between the blood/brain barrier. We are finding lower incidences of cancer in people that exercise,  and a lower recurrence rate in those individuals that do get cancer who also exercise.

How does this tie in with plastic surgery? There are a number of procedures that can get the quick results needed to motivate a person to change up their life through diet and exercise. Of course, plastic surgery does not directly lead to lower cancer or better health. We all know that switching up your diet is not easy. If it were, there would be no obesity, rather than the current rate of obesity skyrocketing. It can be difficult to switch your diet, and when you do, it is human nature to expect a change in either how your look or in what you weigh, fairly quickly. Everyone who has dieted has had the experience of trying out a new diet, doing it religiously for several weeks and then weighing themselves to see no change. This often creates frustration leading to binge eating… and the cycle repeats.

I am a huge fan of either SmartLipo or SculpSure being done at the same time as a new diet/exercise routine.Both have the ability to decrease fat in the treated areas due to the laser melting of fat. This will oftentimes fast track your seeing results in how you look when you diet (however it still takes time to see the effect from these, and you will keep improving for months after the treatment). This quick shift in appearance can give you encouragement and help you persevere. There is also the added benefit that when you undergo these procedures, you have devoted effort and money and some mild discomfort, which will further increase your resolve to stick with your diet.

I make it very clear at all of my consults for the above that it is a partnership. I can, using technology, decrease fat in specific areas. But if you want your best results, you need to decrease your total body fat and this can only be accomplished by better eating and to a lesser extent, exercise – though doing both exercise and diet is strongly preferred.

So, which diet is best?

Clearly the one that you stick with! I am not a fan of any diet that gives you fake food for weeks/months because once you go back into the real world, there is a high relapse rate from these kinds of diet plans.

For most people, I endorse a combination of intermittent fasting, Ketone supplements  (which make fasting easier) and a low carb/high fat and protein diet that is largely organic with little processed food. And good news, you can still have dry white and red wine and see results. Here are my favorite supplements, which I use to put myself into ketosis quickly and daily.

 

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 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!

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 Kind of Results Can One Expect from SmartLipo?

I often spend time answering answering questions on RealSelf from users considering plastic surgery, or recent surgery patients sharing their results on the website. I do this for several reasons. Obviously, it’s a great way to connect with potential patients. It has also helped me to stay connected to what people’s biggest concerns are, the results they’re seeking and what they are wanting from their experience.

I recently came across a post from a woman who felt that her surgeon was “cold” when she discussed not feeling she had experienced much of a change after her SmartLipo treatment, and I feel compelled to share my response here for those considering SmartLipo:

“It is important to understand that almost certainly your doctor is not trying to be cold. He is just not sure what to say. On your front view, it does appear that you have improved. The side view seems to show less change. You note that two liters came out – which is a lot. I do feel that many patients are very focused on how much comes out, but there are other factors to consider, such as how much is left behind and how many pulses were given to an area, since this will melt fat that may not get sucked out immediately. Some doctors put in a lot of fluid, which means that they will remove far more fluid but that does not mean you will get a better result.

All doctors want to do a good job. He did remove fat but he cannot control how much that will impact your looks and appearance. You could ask him to do some of those areas again, but you should expect to pay and not expect it to be free. Many plastic surgeons, myself included, would give you a discount. There is significant cost to the surgeon each time we perform SmartLipo. The fibers are not reusable, so a new one has to be used for each case and they are expensive.

He, no doubt, does feel bad and wishes you had a more dramatic change. He just does not know the right words.

All of us who perform a lot of Smartlipo treatments have had this experience. I warn all of my patients that I will be taking out fat, but it is impossible to predict how much improvement you will get. The best analogy I use is: you can lose 4 lbs and still feel fat and feel your clothes are still tight. You can then lose 0.5-1.0 lb more and all of a sudden, your clothes fit better. It is not that the first 4 lbs did not do anything, but it did not reach that “tipping point” (to borrow a phrase from Malcolm Gladwell) to make your fat loss visible. Any surgeon who says all of his patients are thrilled with his results is simply not being honest or does very, very few cases.

We try our best for every patient, but some patients will always get better results than others.”

 

Thinking about cosmetic surgery? Please do not hesitate to contact my office at 703-406-2444 to schedule a private, complimentary consultation with me.

 

Tanning After SmartLipo: What You Need To Know - Berman Cosmetic Surgery and Skin Care Center Blog

The Best Time to Get Your Body Ready for Summer? Now!

A very common question I get is when to get cosmetic procedures done in order to look great for bathing suit season.

There are 4 operations/procedures that are going to be extremely popular in preparation for getting your body ready for summer:

  1. Breast Augmentation
  2. Smartlipo
  3. Tummy Tuck
  4. Sculpsure

Let’s discuss briefly the time frame for improvement for each of these procedures.

Breast Augmentation
After a Breast Augmentation (BA), there of course is an immediate improvement in your appearance. From day one, you will have a much better figure, both in and out of clothes. However, there is usually some upper pole swelling (more pronounced with saline implants) that is more noticeable if you are without any clothes. This can be easily hidden with clothing. You need to allow 3 months for your implants to drop into place. In general, the swelling is much milder with silicone and this allows you to look more natural sooner.

SmartLipo
I stress to my patients that after Smartlipo, you will continue to improve for 6 months. Of course, you can enhance the results by also exercising and by dieting, so as to decrease your total body fat. Smartlipo will reduce the fat in the treated areas. Multiple areas can be treated and you can generally return to work the next day. Only one treatment is required per area.

SculpSure
Sculpsure is done in the office and no sedation is required. You can even do this on a lunch break. I went to the gym immediately after I treated my love handles! A treatment session only takes 25 minutes and you can return to work immediately. You can treat multiple areas one after another during a single office visit. However, you should treat each area at least twice, usually with 6 weeks between sessions (it can be reduced to 4 weeks however). Once again, you will get more dramatic changes if you can also reduce your total body fat (through diet and exercise), as we reduce fat in the treated areas.

Tummy Tuck
A Tummy Tuck will show a dramatic change immediately after surgery. You can return to work after 10-14 days and usually to more intense workouts by 6 weeks. You can usually start exercising gently after about 3 weeks (sometimes even sooner). Your scars will continue to improve and fade with time. Your appearance will also improve with time so it is good to have some time between your TT and donning your bikini. If you know which bathing suit you want to wear, you can bring it along at the time I mark you for surgery, so I can do my best to try and design the incision scars to be hidden by your swimsuit.

Want to know more about cosmetic procedures and what might be right for you? Please call my office at 703-406-2444 to schedule a complimentary, private consultation with me.

How to Maintain your Results after SmartLipo or Liposuction

This is a very easy question to answer. The most important thing you can do to maintain your results from Smartlipo is not to put on weight. Many of my patients have read online that you cannot gain fat after doing liposuction. This is patently untrue! There are plenty of misleading articles online suggesting this, but the truth is that there are fat cells left behind after any type of liposuction. If you put weight on, those fat cells can swell and make you look larger in the treated area. It is possible that with less fat cells in the area (since fat cells are destroyed by the laser in Smartlipo) that you may not enlarge in the treated area, but there is no guarantee of this.

You can absolutely enhance your results by dropping your total body fat through better eating (see our Paleo meal replacement planLose Weight with our Paleo Meal Replacement Program for a simple way to do so). Smartlipo reduces fat in the treated areas, but because is also part of your total body fat, it is helpful to work to further reduce total body fat. Exercising allows you to both decrease your body fat and tones your body. There are of course a multitude of health benefits to exercising as well.

Want to further discuss SmartLipo and what results you can expect from this procedure? Please call my office at 703-406-2444 to schedule a complimentary, private consultation with me.