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.

Skin Necrosis after a Tummy Tuck (TT)

I answer a lot of questions on Realself.com 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.

How Botox and Fillers are Different for Men vs. Women

While women have historically dominated in use of Botox and Fillers, this has been changing rapidly over the past 5 years, with more and more men now taking advantage of these procedures.

Botox and facial fillers are the most common non-invasive procedures for both men and women. However, how many units I typically use for men is different than how many I use for women. The most common place to place the Botox for both men and women is still the glabellar area (the area between the medial eyebrows — the 11’s). Because men have larger muscles here, I will place 25 units, in this area rather than the 20 units I place for women.

Both men and women will treat the crow’s feet with Botox. While I usually place 10 units per side for women (this is only a general number, sometimes, I will place 5-12.5 units per side), I will often place 12-15 units per side for men.

The forehead is treated very differently for men versus women. Women often want a small amount placed over the lateral third of the eyebrow to try and elevate the lateral third and give them a nice arch. Men will not want this since this tends to produce a more traditionally “feminine” look. Men will typically ask for a more horizontal eyebrow, so I will avoid Botox over the eyebrow or I will put it  in equally medially and laterally above the eyebrow.

The most common place for a man to place fillers is the nasolabial fold. They will generally not request that fillers be placed along their zygomatic arch since this is a feature more commonly desired by women rather than men. In women, this will both soften their nasolabial folds and emphasize their zygomatic arch. Men will place fillers in the pre-jowl area, which help make the jowl area be much less noticeable.

Want to know more about Botox and Fillers? Please call my office at 703-406-2444 to schedule a complimentary, private consultation with me.

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.

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.

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.

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.

Bridal Makeover: Plastic Surgery for the Bride-to-Be

It is almost universal that a woman would like to look her very best on her wedding day. However, from a plastic surgeon’s perspective, it takes careful planning. I’ve seen women who have requested fillers and Botox within a few days of their wedding. I’ve even seen women who have requested an upper lid blepharoplasty within 2 weeks of their wedding. And ditto for a breast augmentation. Quite frankly, all of these are terrible ideas. This topic covers a broad age group: many women are having their first marriages in their 20’s and 30’s and oftentimes a second or third in their 50’s. I’m also discussing others in the wedding party in the information below.  

Of course, each woman and her wedding situation can be different. However, I think as a general principle you should ideally do fillers and Botox six weeks before your wedding. I am being conservative here… 3-4 weeks before is probably fine, but I would lean towards six weeks to be certain. This allows any bruising that may occur to completely resolve and for any fine tuning that needs to be done. Even if you “never bruise,” there is always a first time, so I recommend allowing time for that possibility. A more minor point is to be careful using Botox on your forehead before your wedding. Although getting rid of all lines and wrinkles on your forehead is appealing, those same muscles allow your brow to elevate. Anyone who has Botox injected in their forehead (this does NOT include the glabella area or crows feet), can experience eyebrow descent. This is only correctable with time!

I personally would not do a breast augmentation closer than 4-6 weeks before a wedding, and perhaps much longer if a complicated lift is required at the same time. Three months before the wedding is a better timeframe. As I said previously, I have had women request a breast augmentation the week before their wedding. I’ve told them to enjoy their wedding and honeymoon and then get their augmentation. Remember it takes up to three months for your implants to drop fully into position – and sometimes longer with a vertical mastopexy. I would recommend the same minimum three-month timeframe for a tummy tuck as well. 

SmartLipo is fine three weeks before their wedding, though the more time in advance, the better, as improvements continue to take place over a six month time frame.  

Remember, you are likely your own worst critic. While the thought of looking your very best for your big day is appealing, you want to be sure you allow plenty of time to prevent having any issues or complications on your wedding day. 

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.