Skin Necrosis after a Tummy Tuck (TT)

I answer a lot of questions on and a question I have seen many times concerns skin necrosis, the dying of live skin cells, following a tummy tuck. It is very important to know that this complication occurs occasionally to every plastic surgeon, no matter how careful he is. As I was once taught and it is very true: the only surgeons who do not get complications with this don’t operate or they lie (courtesy of Dr. John Guy, one of the better surgeons that I trained with many years ago).


First of all, why do some patients get skin necrosis after a TT ?

This is always due to an insufficient blood supply. It is much more common in smokers or nicotine users. I insist all of my patients refrain from all nicotine products (including cigarettes, patches, gum etc) for 3 weeks before and after surgery. Diabetics are also more likely to have decreased circulation after a TT to the distal flaps of tissue. An extremely tight garment that interferes with the blood supply can contribute to this.

However, most of the time when it occurs, it just happens, and there is no obvious reason. I had a female patients many years ago who placed a very hot pad on her abdomen for menstrual cramps and gave herself a 3rd degree burn, which caused skin loss – but this is a very unusual case.


Where does the skin loss occur?

Almost always, the skin loss occurs at the farthest point of the flap, where the blood supply is the weakest. This is at the lower abdominal incision, usually close to the middle of the incision or at the T-junction if there is a small vertical part of the scar.


What is the treatment for skin necrosis?

This will depend on the size of the area and how it looks. This will require frequent visits to the plastic surgeon or a wound healing center. If the area is fairly small, local wound care is usually all that is needed, plus lots of patience. The area will usually go black, lift off and then heal fine. Sometimes the scar will need to be revised in the office at a much later date. The final result is usually excellent but you need to have a lot of patience since you cannot rush the process.

In some cases, you may need to pack the wound or use special vacuum suction to speed up the healing.


Have more questions or concerns about the tummy tuck procedure? Please call my office at 703-406-2444 to schedule a complimentary, private 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.

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 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.

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.

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.

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.

Is a Mommy Makeover Right for You?

It’s important to understand that a Mommy Makeover is not a specific set of operative procedures. It refers to the surgery one might undergo after having a baby. Most commonly, it involves having a tummy tuck and a breast augmentation with or without a breast lift. However, it could refer to just one of these procedures or could include SmartLipo, a mini Tummy Tuck or a breast lift.

There is no way I can help you determine via a blog post whether or not a specific surgery is right for you. You really need to visit a board-certified plastic surgeon for a  personal consultation (note: a “cosmetic surgeon” is NOT a plastic surgeon – there is no Board certification for this).  

Having said that, there are some considerations you can take into account to determine if a Mommy Makeover might be right for you: 


If you are thinking of a Tummy Tuck:

  • Have you allowed enough time since delivery or C-section to see how much the skin will tighten on its own?
  • Have you lost all of the weight that you think you are going to lose? You don’t have to get down the very last pound, but all things being equal, it is better if you have lost most of the weight you are planning to lose.
  • Are you planning on having another child any time soon? If you know you are going to have another child in the next 1-2 years, you may want to hold off doing your TT until you are finished having babies and instead just go for SmartLipo. However, if having another child is just a remote possibility, then this is something that should be discussed with your plastic surgeon. Often in this case, I will perform the tummy tuck, but not tighten the fascia.


If you are thinking of a Breast Augmentation:

  • Are you still breast feeding? You should hold off until at least 3 months after you have stopped breastfeeding and your milk has dried up. You should also wait until your breast size has stabilized after you stop breastfeeding.
  • A breast augmentation will not prevent you from breastfeeding in the future, nor will it interfere with sensation.
  • Sometimes, only a breast lift is required – and depending on what type of lift, it may be able to be carried out in the office under local anesthetic with just oral sedation (i.e. a donut mastopexy).


What about doing the Breast Augmentation and Tummy Tuck in the same surgical procedure?

  • These procedures are often  done together in the same surgery and it works out very nicely. The advantage of this approach is that it allows you to recover from both at once, meaning less days off of work.  Most people should be able to return to work in 2 weeks (some will go back in 10 days). There are also cost savings when doing both at once. 
  • It should be noted that there is a higher risk of Deep vein thrombosis, or DVT. However, I put my patients that have both procedures on Lovenox after surgery and I get them up walking immediately, which significantly decreases any risk of DVT and pulmonary embolus.
  • It does take a few days longer to bounce back from the combined procedure than it would from either procedure alone.

If you have any questions, I highly recommend calling my office at 703-406-2444 to schedule a private consultation with me.

Tummy Tuck Post-Operation: Do’s and Don’ts

Many of my patients worry about doing too much following a tummy tuck and “hurting” the operation. This is harder to do than you think. Of course, life is a balance. I don’t want you over doing and washing your floors the day after surgery. It is important, however, to be up and walking. This will actually help with the discomfort and you will bounce back much quicker. It also helps prevent your muscles from getting stiff and tight. You need to be up walking and then resting.

You absolutely can walk up and downstairs immediately after surgery. (Once again use common sense. If you need someone to help you on the stairs then do so, but almost everyone can do the stairs, as soon as the anesthesia effect has worn off).

Eat all of your meals at the table and NOT in bed. Eating meals in bed psychologically makes you think you are sick and discourages movement.

When you walk, walk with the spine straight. It is totally erroneous that you will come apart if you walk straight. I know some people have been told that by other surgeons, but this is nonsense. You will just get a sore back!

I let all of my patients take a shower after surgery. You don’t need to cover the incisions with anything. Use whatever soap you want (no taking baths until I tell you that you can). Of course, remove any gauze on your incision but leave the steristrips.

After a few days, as soon as you are starting to feel better, get someone to take you out for a drive or go for a walk outside of the house. This will help you bounce back. Remember, you are not sick, you are just recovering from surgery.

Allow yourself to take naps and to rest up. You will recover quicker this way.


What do I have to clean?

There is no point in cleaning the steris. The only sutures without steris covering them (unless the steris fall off prematurely which is fine) are around your umbilicus (and in the rare case where I place a drain). Clean around and inside your umbilicus with dilute hydrogen peroxide and a thin coat of antibiotic ointment, twice per day.


What if there is a bit of bleeding or drainage from part of the incision after surgery?

It is normal to have some drainage after surgery, especially the first day and night, especially if you have had liposuction at the same time. It is also common to have some light oozing or bleeding from the incision or from the umbilicus, especially the first day or first night. Just put some extra gauze and hold pressure for ten minutes. If you are concerned, send me a text. It will stop and is rarely anything to be concerned about.


When can I have sex?

When you feel up to it. Again, use common sense and be cautious.


What should I do if I am concerned about something?

If it is during office hours, please call my office at 703-406-2444. If it is after hours or on the weekend, I give all of my post op patients my personal cell phone. Do not hesitate to text me with your questions. You are never bothering me – and it is easier for me to reply to a text than a phone call.