When Should You Consider Plastic Surgery - Berman Cosmetic Surgery Blog

When Should You Consider Plastic Surgery?

There are, as you can imagine, numerous considerations to take into account when deciding if you are ready for plastic surgery.

Check out my video below for the questions I always ask my patients before considering plastic surgery. It needs to feel right for you. If you’d like to chat in greater detail, please do not hesitate to schedule a complimentary, private consultation with me calling our office at 703-406-2444.

Dr. David Berman -Board Certified Plastic Surgeon

Do I ever Recommend Against Plastic Surgery?

The quick answer is quite often. There can be countless reasons for this, but they can probably best be grouped into two main categories:

  1. Risk outweighs benefits
  2. Unrealistic expectations.

Exploring the first option, “risk outweighs benefits,” there are endless possibilities here. Someone in less than good health should not be receiving elective cosmetic, plastic surgery in my opinion. Fortunately, almost all of the patients that I see are in good health. However, every once in while, someone comes to me with a load of medical issues and I will tell them that they should not be getting these procedures. I am also quick to point out that I don’t make any money by sending them away and that if they shop around, someone will probably perform their surgery, but I have to share my honest medical opinion. Of course, there are many procedures that can performed in the office with just local anesthetic – meaning they involve less risk. However, this does not mean that everyone is a candidate for a particular procedure. There are still risks. Sometimes it is obvious that someone should not be doing a procedure. Other times, it takes surgical judgement and experience to know this.

With regards to the second category, “unrealistic expectations,” I sometimes find that while the procedure can be carried out safely, there is a reasonably high possibility that even if the procedure goes as planned, the expectation of the patient is greater than what I can achieve on average. This is why the initial consultation is so important. It lets the surgeon explain what he/she can achieve on average and to confirm that this is commensurate with what the patient is expecting. Even if the patient gets the best result that has ever been obtained, if they wanted even more, they will be dissatisfied.

Along the same lines, it is important to discover if there are secondary, hidden goals. As an example, a woman came to me many years ago for a breast augmentation (BA). It became clear to me during the consultation that she was satisfied with her breast size and shape. What truly brought her was that her husband was having an affair and she hoped that the augmentation would solve her marriage issue. I don’t think she was aware of this at the time of her consult. I told her that I would not perform the procedure on her because what she really wanted was a repaired marriage and that was NOT going to be fixed by altering her breasts. She would inevitably been dissatisfied with the results of her surgery since it would not have achieved what she wanted from the procedure. Sometimes, patients are aware of these hidden goals and sometimes not.  We have to discern them from our consultation.

If you’d like to discuss any concerns you have, please do contact my office to schedule a private consultation with me.

A Day in the Life of a Plastic Surgeon


One of the better things about being a plastic surgeon is that no two days are ever alike.

I thought it would be fun to share with you what a day in my life looks like. May 10, 2017 began off with a SmartLipo case for a female client from Baltimore. She had previously came in for a complimentary consultation with her sister. Like many couples who come in to my office for a similar treatment, one will complete theirs first so the other can hear how easy or tough it was. Of course my hope is that they always think of it as easy! As is the case with almost all of my SmartLipo cases, she took some Ativan beforehand to help her feel more relaxed and comfortable (and open). Although some plastic surgeons may be bored while performing SmartLipo, since it is repetitive motions, I really enjoy doing these cases. For me, it is a great chance to chat with my patients and learn about their lives. I have heard incredible stories, both disheartening (sexual abuse, financially helping their families even when they had little money of their own, and so on), as well as truly inspiring (coming to the U.S. with less than $50 in their pockets and succeeding). Whatever the subject matter, it is truly a privilege to be able to connect to people in this way. We are all so busy in this hectic world that this is truly committed time to talk with another person (neither one of us can leave!)

I worked on two of her areas of concern. She currently does not exercise and I had a chance to stress the importance of healthy eating and also exercising. I personally like the Paleo meal replacement product that I currently sell in my office, as it takes most of the planning and thinking out of following a strict diet – and it definitely does work. I also stressed that everyone will get a more dramatic change from SmartLipo if they decrease their total body fat. With both SmartLipo and SculpSure, spot areas of fat are being reduced, but it is still important to decrease the total body fat.

I actually had a second Smartlipo case immediately following this one. This time, it was a former professional athlete who over the last year had found himself super busy with work – to the point where he had stopped all exercising and his diet had gotten worse. The two places guys tend to get fat is in the lower abdomen and flanks. He had already turned around his diet and was starting to exercise. The SmartLipo was to get him jumpstarted so that he could see changes more quickly. He was very, very committed to this and I know he will be successful and will get buff again. It is definitely taking a toll psychologically on him to go from a super-cut 6 pack to his self-proclaimed “doughboy” status.

I followed these procedures with several Botox patients. I like my Botox patients to come back in every 3.5 months. Unlike most plastic surgeons, I do my own injections – and enjoy it! I particularly enjoy hearing if they have any new vacation plans coming up and what is new in their lives. I often have known these patients for years. Some days, I only have a couple of minutes to catch up and other times, I have more time to get into the details – but it is always great to see them again. Two of the women on this day were over 40 years old. It was also an opportunity to tell them about the new Picosure laser that I had just recently purchased for my practice. It is truly an amazing laser, as it allows women to dramatically even out the coloration of their skin and eliminate brown spots and pigmentation on their face, neck, chest and hands – with no downtime. They need to do at least 3 treatments about 1 month apart. We are all amazed by how much improvement the patients are getting already. We are just starting to post some of our results online.

Next up were a few patients wanting fillers. The fillers usually last 12-18 months, so I don’t see them quite as often. However, many of the filler patients also get Botox. Today, as is often the case, I saw a woman who I told should hold off on fillers as she looked great, and that perhaps we should re-evaluate in 4-6 months. Sadly, many doctors will always do something if they can. However, I prefer a more natural look and also personally do not want to encourage treatments that aren’t necessary in my professional opinion.

I then saw a few follow-up patients: a Smartlipo case, a labiaplasty case (done with her breast augmentation) and a breast augmentation case. It is nice to see how they are progressing, and with each visit ,getting a more natural and improved look. After most cosmetic procedures, with time, things look better and better.

I then had a SculpSure consult. I have known this woman for several years, and she has been troubled by stubborn fat that just won’t go away. I was able to offer her insight on both SculpSure and SmartLipo, as they would both be helpful to her. SculpSure is a new laser that I recently purchased which will melt up to 24% of the fat in an area, with no incisions and just 4 small paddles applied to the skin. The treatment only takes 25 minutes, and there is absolutely no downtime. You must do two treatments 4-6 weeks apart to get the best results. It is the only treatment that I have ever had done to myself – so I can tell you with 100% absolute certainty that the results are amazing and what the actual procedure feels like) After explaining both procedures to her and giving her the prices, she left to think about which one makes the most sense for her right now.

My last consult of the day was a woman who wanted a tummy tuck. However, in her case I thought that while a tummy tuck could be beneficial, her skin tone was good enough that if she would work on losing a bit of weight, she would probably do fine with a less invasive procedure such as SmartLipo.

It was a busy day. I never schedule a lunch break. However, I always find time to grab some food that I brought from home between patients and to drink lots of water.

Tomorrow, I will be going the surgicenter to exchange breast implants in a woman who received saline implants over 15 years ago and who now wants to go larger and have silicone implants placed.

Every day brings new patients and former patients back into my world. And every day, i get an opportunity to help boost someone’s self esteem both by what I can do for them and also what I can say to them. If we feel good about ourselves, and feel empowered, then almost anything is possible.