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.



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.”


Have questions about SmartLipo? Please do not hesitate to contact my office at 703-406-2444 to schedule a private, complimentary consultation.


Which is Better: SmartLipo or Liposuction - Berman Cosmetic Surgery Blog

Which is Better: SmartLipo or Liposuction?

This is a very common question that I often get asked.

SmartLipo is actually a form of liposuction, but it includes the additional step of using a fiberoptic laser to melt the fat and cause some skin tightening

How Does Liposuction Work?
With regular liposuction there are basically two steps. After you have the areas for liposuction marked, the surgeon will numb up a few small areas for the incisions. He will then infiltrate local anesthetic into those areas. After a few minutes to let it work, he will then carry out liposuction, often under general anesthesia.

How is SmartLipo different?
Smartlipo is always done by me in my office under local anesthetic, frequently with oral sedation. The main difference is that after the area has been made numb but before the liposuction is carried out, I insert a small fiberoptic laser fiber into the subcutaneous fat. Every time I step on the peddle, 2 laser beams are emitted into the fat and this both melts the fat and also gives heat to the skin, to cause it to tighten. After this middle step is done, then the melted fat is liposuctioned away.

Which one is more highly recommended? 
I believe Smartlipo allows more to remove more fat. In addition, there are going to be fat cells that do not immediately get melted and which come out in the liposuction but these fat cells will later die from the effect of the heat and your body will resorb them. This means the effect of the Smartlipo will be greater than what is initially removed. In addition, the laser creates small tracts throughout the fat, which will over the next 2 months, get healed with newly formed collagen. After 2 months, this collagen will mature and start to tighten and contract, making the area tighter.

With Smartlipo, you will continue to improve for 6 months after the procedure.

With all liposuction procedures, you can enhance the final result by also working on your dieting and exercising to decrease your total body fat.

Check our my video below for additional considerations. If you’d like to talk more about SmartLipo or liposuction, please do not hesitate to schedule a complimentary, private consultation with me calling our office at 703-406-2444.

Advantages of Sculpsure over Liposuction or a Tummy Tuck - Berman Cosmetic Surgery Blog

Advantages of Sculpsure over Liposuction or a Tummy Tuck

There are several of advantages to getting a SculpSure treatment over Smartlipo (which I love), liposuction or more invasive surgery such as a tummy tuck or arm lift. This popular procedure melts up to 24% of stubborn fat with highly advanced laser technology.No Downtime:
The biggest advantage with Sculpsure is that it is totally non-invasive. There are absolutely no incisions or downtime. I had my love-handles treated twice, and both times, I went immediately to the gym from my office. SculpSure is so convenient you can do it on your lunch break or on your way home for dinner. Treating an area only takes 25 minutes and you can treat several areas, one right after another.Low on Risk & Side Effects:
There are very few risks and side-effects from the treatment. The laser light can travel through any skin color and only penetrates into the subcutaneous fat. It is safe to use even if you have had a hip replacement (as I have) or abdominal surgery (we don’t, however, want to place the paddles directly over scar tissue). I do tell all of my patients to make sure they eat something and drink lots of water before they do their treatment.

Sculpsure is a great addition to your diet and workouts to maximize your chance of improvement. I always stress to my patients, that there are no magic treatments. If you want maximum improvement, you will want to increase your exercise and improve your eating.

Sculpsure has been shown to decrease your truncal fat up to 24% (this result will vary from person to person) but this still means you will have 76% of your fat left behind. Sculpsure is a great start and a great addition to a workout routine. Combining this with your new diet makes it more likely that you will see results sooner.

It is important to know that doing Sculpsure now does not prevent you from doing more invasive procedures, such as a Smartlipo (laser lipo) or a tummy tuck later on if you feel you need a more invasive procedure to get your desired look.

Questions about SculpSure? Please call my office at 703-406-2444 to schedule a private, complimentary consultation.

Increasing Belly Fat Loss - Berman Blog

Increasing Belly Fat Loss

The first consideration is whether this fat is external or internal. If it is external, it is in the subcutaneous tissue and is usually pinchable. If it is internal or visceral fat, it is located behind the muscles and is deep in the belly, around the stomach and intestines.

If the fat is external, you do have some treatment options, both invasive an non-invasive, that can help. External fat is amenable to the various types of liposuction, such as Smartlipo (my preferred technique), and non-invasive techniques such as Sculpsure (my preferred technique) and Coolsculpt. A tummy tuck can remove the spare tire, provided the fat is external. A tummy tuck can also tighten the abdominal muscle wall, which makes the stomach flatter. Of course, you will get a better result if you combine these treatments with the methods below which will decrease your overall body fat, in addition to these spot treatments.

If the fat is internal, none of the above techniques will truly work, and it will come down to diet and exercise. Dieting is even more important than exercise, but clearly, both are complimentary. There are a multitude of diets. The common theme for all the sensible ones is stopping all sodas, including diet sodas (many studies have shown that diet drinks actually lead to weight gain, plus they are very unhealthy) and eliminating processed foods and refined sugars (as much as possible all sugars including alcohol). We have had great results with my patients with the Paleo Meal Replacement, but it is certainly not the only way to achieve great results.

What form of exercise is the best? The one that you enjoy most so that you will continue to do it! Numerous studies are showing that High Intensity Interval Training (HIIT) is one of the more effective ways to train (there are lots of free videos on Youtube – I have done many of these myself). The form of training can give you the most improvement in the least amount of time. I’d recommend that you exercise 4-5 times per week if possible. I am a big fan of the classes in a gym since it is hard to slack off when everyone around you is working out. Also, if it’s in your budget, personal trainers are a great investment. They hold you accountable and can give you some interesting, creative training workouts.

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

Berman Cosmetic Surgery - How to Improve your Results after a Tummy Tuck, SmartLipo or Sculpsure - Blog

How to Improve your Results after a Tummy Tuck, SmartLipo or Sculpsure

Whether it’s a tummy tuck, SmartLipo or SculpSure, you have invested considerable time, money and effort into your body contouring procedure and you surely want to get the maximum results. There are several things I recommend my patients do to optimize their procedure.

Almost of the people doing these body contouring procedures are trying to reduce fat in specific areas. Sometimes there is one area which has been treated, but more often, several areas have been treated. In a minority of the tummy tucks that I have performed, there was no extra fat at all – it was entirely a loose skin problem. If you have a bit more fat than is ideal, you can definitely enhance your results by decreasing your total body fat. I am decreasing fat in specific areas but if in addition to that, you can decrease your total body fat everywhere, you will look even more amazing.

There is no magic here. Modifying your diet is extremely helpful.It is almost impossible to out-exercise a poor diet. I believe that following a Paleo or Paleo-like diet works the best. It’s for that reason that I do offer my favorite Paleo meal replacement through my office. This makes it very easy to follow the Paleo diet if you can simply replace your regular breakfast and/or lunch with the powder. I realize that there are many different diets that can work. I am, however, not a fan of diet pills or anything artificial.

Maintaining or increasing your activity level is also key. More and more evidence is confirming that some variation of a high intensity workout done a few times per week gives you the greatest return on your time. Most gyms offer this and there are countless free videos on Youtube that you can do in the comfort of your own home with no equipment. I have a lot of opinions on exercising, and will be blogging about those in the future, but in short, it is my strong belief  that everyone should be doing core exercises as part of their routine. As we get older, this is even more important. For women especially, strength training for the upper body in women is critical.

Regarding the scarring from a tummy tuck or the small scars from Smartlipo (there are NO scars from SculpSure), we sell a scar cream that should help the scar fade and mature more quickly. I have many years experience and some people’s scars fade much quicker than others and this has little to do with the surgeon’s skills. Virtually every scar will continue to fade with time, but it should be noted that they will never completely disappear. They’ll be visible if you look hard enough for them! I have seen some women get tattoos over they TT scars and this does a great job hiding them. But of course this won’t be a desirable option for everyone.

It is important to recognize that there is plenty you can do to help you look and feel better overall. A tummy tuck, SmartLipo or SculpSure can help to eliminate fat and loose skin, but proper attention to your overall health, fitness and nutrition will help your skin look it’s absolute best.

SmartLipo Versus Traditional Liposuction

One of the most frequently asked questions I receive is how do SmartLipo and regular liposuction differ and which is better.

Traditional liposuction involves infiltrating a wetting solution, typically a combination of saline with lidocaine and epinephrine).  In most cases, this is done in the operating room under general anesthesia. Most patients will need to take about 4-6 days off of work to recover. Since it is done under general anesthesia, you have to pay for the operating room and the anesthesiologist. You also need to fast beforehand and have someone with you to drive you home. Most patients are quite sore for several  days. It does work – and until SmartLipo and ultrasonic liposuction came along, it was the only game in town.

SmartLipo on the other hand is done in my office under local anesthesia. I prefer to give an oral sedation (Ativan), which means you do need to have a driver with you. Unlike traditional liposuction, there are no IVs involved and I do insist you eat and drink before your procedure. You can return to work the next day and to your regular workouts within 5 days. First, I will numb up the areas to be treated. What makes this procedure unique is the second step. I pass a fiberoptic laser back and forth in the subcutaneous fat, which melts the fat. The heat damages and destroys much more fat (similar principle as with the SculpSure laser that we also own) than what will come out in the liposuction. The laser helps stimulate collagen and elastic fiber production in the skin, leading to some skin tightening. The last step involves liposuction’ing out the fat. There is less pain after the procedure compared to regular liposuction because smaller, more delicate instruments are used. Also, there is less risk of unevenness. There is usually less bruising as well because the laser coagulates small blood vessels. And you will continue to see improvements for 6 months!

SmartLipo offers all of the benefits of traditional liposuction, but also has several important additional benefits. Where traditional liposuction always comes into play, however, is if you are already in the operating room for another procedure with me. This is for two reasons – 1) SmartLipo equipment is not portable and 2) SmartLipo takes longer than traditional liposuction. If you are under general anesthesia, it is better to get it done as quickly as possible. But if SmartLipo is the only procedure you need, I’d recommend getting that done in my office – no general anesthesia needed, saving you recovery time and the cost of anesthesia and facility fees. 


SmartLipo versus SculpSure – Which is Better?

This is an interesting question, especially since they are both designed to be spot treatments for areas of unwanted fat.

First, let’s look how these two treatments work to eliminate fat. Fat has a poor blood supply compared to muscle or organs. This means that when fat is heated to 47 degrees Celsius, it will die. Both Smartlipo and SculpSure work on this principle.

SculpSure requires no anesthetic. Essentially 4 cell phone size attachments are secured to the area where you want to decrease the fat. (a belt holds them in place against your body). These attachments allow a laser to send wavelengths through your skin to heat the underlying fat. These attachments also cool the skin. The skin is not damaged but the underlying fat is heated to the necessary 47 degrees. It definitely gets warm and is somewhat uncomfortable. However, I had no problems treating my flanks. The entire treatment only takes 25 minutes. I was able to go to the gym immediately afterward with no problem. The company’s research revealed that 24% of the fat will be removed (the body just breaks down the killed fat cells with no problems). Most people should do a second treatment 6 weeks later. A person with more fat may want to do additional sessions and can expect further improvement (though not likely 24% each time). They will continue to improve for 3 months after the treatment.

Smartlipo is done in the office with local anesthetic and usually some oral sedation (if you take oral sedation you need to have a driver). I make small incisions (only 2-3 mm) which allow me to infiltrate the local anesthetic. I then insert a fiber-optic laser fiber directly into the fatty layer and significantly heat the fat (there is a temperature probe in the fiber so that the area is not over-heated). It also heats the underside of the skin which causes the skin to tighten. I then liposuction out the melted fat. You can return to work the next day and resume exercising after 5 days. You will continue to improve for 6 months.

So which is better, Dr. Berman?


Clearly, SculpSure is the easiest. You can do this on your lunch break or on your way to the gym. You do need to repeat this at least twice. There is no bruising and little to no swelling. There may be some minor tenderness but you should not require any painkillers afterward. This is the clear winner for ease of treatment.

Smartlipo is definitely more involved. You can expect to lose a day from work. You should expect some discomfort the next day and many people require painkillers, at least at for a few nights. Many people will get some bruising. The improvement will continue for 6 months. However, if you think about it: The laser fiber is in direct contact with the fat, gets very hot, and the fiber is  continuously moved to contact multiple fat cells. Liposuction is then carried out after the laser is removed. Except in very thin people, you can expect more fat to be removed with Smartlipo and more skin tightening to take place. This should be considered a more aggressive treatment.

Ultimately they are both great tools to help get you closer to the body you want. It depends on what you want to achieve, and how easy you want the treatment to be.

It is best when going for a consult, to see a board certified plastic surgeon, who offers both of these treatments, to help you decide which is best for you.

What does SmartLipo Cost?

What is the Cost of SmartLipo Compared with Traditional Liposuction?

It is very normal for people to wonder, what is the cost of Smartlipo and how does that compare to the cost of regular liposuction.

First of all, it is important to be clear about the difference in procedures. Regular liposuction involves infiltrating the area (usually associated with the word, “tumescent” which just means a lot of fluid is infiltrated into the area) which contains some local anesthetic (lidocaine) with some epinephrine to minimize bleeding. After this, the fat is liposuctioned out. This is usually done under general anesthesia in an operating room.

Smartlipo (or laser-lipo) is a major advance in this technique and involves a middle step of inserting a fiber-optic laser fiber into the fatty layer (uses the same very small incision which was used to infiltrate the subcutaneous tissue with the local anesthetic). The laser fiber heats up and kills the fat cells. It also heats up the skin so that it causes the skin to tighten. There is a built-in temperature sensing device in the laser fiber, so the fat and skin are heated but not burned.  Smartlipo is almost always done in the surgeon’s office under local anesthesia with oral sedation. Some surgeons will use IV sedation.

As one might expect, costs are going to vary across the United States. Invariably, large urban centers, with a higher cost of living, are probably going to cost somewhat more. I would strongly caution against using a Groupon or accepting a very out of proportion low fee. This is safe surgery but it is surgery and the person should know what they are doing and know anatomy. I would strongly recommend a board certified surgeon, especially a plastic surgeon. No decent surgeon will use Groupon.

Regular liposuction, since it is being done under general anesthesia in an operating room, is generally going to be more expensive.  You are paying, not only for the surgeons time but also for the anesthesiologist (or nurse anesthesiologist) and the operating room (even if the surgeon happens to have one in his office).  

In general, if you treat multiple body areas (eg a common combination is upper and lower abdomen and love handles/flanks) at one time, you will pay less than if you came in for 3 separate treatments.

A rough idea of costs would be about $3,600 for one area, $5,600 for two areas and $6,500 for 3 areas – though we are currently running a 30% special discount at the moment.

Common Smartlipo Areas

Common Smartlipo Areas

The best areas to get Smartlipo are the areas that you find hardest to trim down. For most people, the love handles (flanks) are a notoriously difficult area to trim down. I have done both marathons and full Ironmans and it is rare to see someone who does not have some extra bulge there especially if they are older than 18 years old! Some women have saddlebags (lateral thighs) that even when they get thin refuse to reduce in prominence. This can be a real problem since it forces them to wear a larger pants size which is out of proportion to the rest of their body. It is noticeable in most types of clothes.

So what would I say, are the top 5 areas for Smartlipo?


For men, really there are only 3 top areas: lower abdomen, love handles (flanks) and sometimes upper abdomen. Occasionally a very trim man, may only need the periumbilical area which is more like doing just the middle abdomen.


For women, the 5 commonest areas would be: lower and upper abdomen, flanks and inner/outer thighs. This is followed closely by neck, medial knees and bra line and upper arms. Much less common but still doable are the lateral breast area and calves.