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    Decoding Tummy Tuck: Liposuction vs. Abdominoplasty

    Decoding Tummy Tuck: Liposuction vs. Abdominoplasty

    Dr. Sam Rhee: Hello and welcome to Three Plastic Surgeons and a Microphone, as always joined by my fellow colleagues, Dr. Sal Pacella in La Jolla, California. His Instagram handle is San Diego, the plastic surgeon. Dr. Sam Jejurikar is in Dallas, TX; his Instagram handle is Dr. Sam Jejurikar, and I am Dr. Sam Rhee in Amos, New Jersey. And my Instagram handle is at Bergen Cosmetic. 

    Today we are going to be talking about abdominoplasty. Our last episode was almost a year ago, and it was one of our most popular episodes. And it’s one of those topics that many people have a lot of interest and questions about. So we’re definitely going to take a deeper dive into it today and talk a little bit more about it. But first, as always, we have our disclaimer.

    Dr. Salvatore Pacella: This show is not a substitute for professional medical advice, diagnosis, or treatment. This show is for informational purposes only. Treatment and results may vary based on the circumstances, situation, and medical judgment. After appropriate discussion, always seek the advice of your surgeon or other qualified health provider with any questions you may have regarding medical care. Never disregard professional medical advice or delay seeking advice because of something in this show.


    Understanding Tummy Tuck Options: Liposuction vs. Abdominoplasty

    Dr. Sam Jejurikar: And I will lead the discussion today, gentlemen. As Sam had mentioned, our last episode on tummy tuck was one I had gotten the most questions and comments about from viewers, so we thought we would revisit it. I generally have found, and tell me if you disagree with me. Most people don’t want a tummy tuck. That’s not a thing that anybody ever comes in and says, Dr., I really want a tummy tuck. But it’s a thing that people are generally reconciled towards. 

    So I thought the way we would lead the discussion today was I would show you a case and then ask you a bunch of questions. So this lovely woman is in her mid-30s and has three kids. She says she’s a little overweight. She wants to lose about 20 or 25 pounds. She doesn’t like the way her tummy looks. We also talked about her breast and did some stuff on her breast. But we’ll leave that out of today’s discussion. But just wants to know, Dr. Pacella, do I have to have a tummy tug? Can you just do liposuction on me and make me look better?

    Dr. Salvatore Pacella: It’s a very common question we get, and what I tell patients is, well, two things. Number one is there are different two different positions where the fat could be on your belly. There’s external fat, and then there’s internal fat. Right? And so that, wow, perfect set up here. Wow! It’s like… 

    Dr. Sam Jejurikar: If we coordinated this.

    Dr. Salvatore Pacella: And often patients, I think, sometimes have some difficulty articulating or understanding this. Those patients have a lot of intra-abdominal fat, and they are probably at least moderately overweight to start with. A tummy tuck will have a very challenging result to look good because that intra-abdominal fat cannot be compressed, one thinks. And so the protuberance of this fat oftentimes just doesn’t create a very nice, natural hourglass shape. 

    So patients who are more amenable to getting their cosmetic results from a tummy tuck oftentimes have a lot of external fat and skin compared to internal fat. The second most important thing that I tell patients is that skin consistency with that external fat is very important. So let’s go back to your previous patient here. 

    So, looking at her now, obviously, without doing a physical exam on her, her belly is not massively perturbed by any means, and she does have some adiposity or some fatty tissue on her love handle area. And centrally, I think with this patient, I certainly would have a discussion about potentially just using liposuction, particularly over the front and sides of the belly. 

    But I will qualify that by saying it’s not going to do much for your skin. Your skin has decent consistency and elasticity; it may contract a bit, but if you want the tightest look possible, a tummy tuck will do it.

    Dr. Sam Jejurikar: What about you, Dr. Rhee?

    Dr. Sam Rhee: I think Sal hit the nail on the head, and you said it too, Sam. People don’t come in saying, give me a large incision right down there on my belly. You’re right; nobody actually comes in. Very few actually come in asking for that. So when you have a patient, and I’ve had patients very similar to ones that look like this, who say, you know what, I don’t want that cut. Can you just do liposuction for me? I don’t want anything else. 

    I’ll have that discussion that Sal just had with that patient, and it’s really about trying to accommodate that patient but also letting them know what the potential consequences are as well. I think that’s a give-and-a-take that you always have with every patient, and you sort of have to work with them. Liposuction only removes fat. If you have to remove the skin, you’re going to have to make a cut somewhere on the body. That’s just the physical truth, and you have to talk to the patient about that.

    Dr. Salvatore Pacella: Yeah, I would say in this particular patient, again, it’s not super detailed; there’s a little pixelation. But suppose that skin has decent elasticity and stretches a bit. In that case, I might consider simply doing liposuction with maybe what I call a mini tummy tuck, which is removing a small amount of skin inferiorly. And I think if the patient is not keen on the idea of a big, massive incision or the big recovery associated with a tummy tuck, and she realizes that it’s not going to get nearly as tight, that may be a decent option, a little mini abdominoplasty with some anterior liposuction.

    Dr. Sam Jejurikar: So in that scenario, Sal, which I think is very reasonable. What would you do with her muscles? Because when you look at this, particularly the lower portion of her tummy, there’s a little poop. Would you placate the muscle, which tightens the muscle? The people don’t know what that word means, or would you just leave it alone?

    Dr. Salvatore Pacella: Yeah, so good question. It’s obviously hard to see just on the photograph, but that will be one thing I’m going to be absolutely looking for on my physical exam. So in this particular patient, to me, this almost looks like that’s a fatty deposit versus a rectus diet.

    Dr. Sam Jejurikar: I’ll tell you, it’s rectus. {Crosstalk}

    Dr. Salvatore Pacella: Got it. Okay. Alright. So if that area was simply fat, it’s amenable to liposuction. But if we’ve got some pooch and some muscle in a mini tummy tuck, there’s only a limit to the amount of placation you can do, and you can only really do it on the lower portion. So I would be very conservative on that. And it begs the question if we’re going to tighten up the abdominal wall muscles anyway, why not just do the full monty? That’s where the recovery comes in. The recovery comes in and sewing the muscles.

    Dr. Sam Rhee: I was just going to add that if you do the plication of the lower part of the belly, you can make the upper part look worse. So I agree with Sal. You got to sort of be careful with that.

    Dr. Sam Jejurikar: Well, I’ll jump ahead a bit here. So she told me, Dr. J, I want my tummy to be as flat as possible, and I want to lose some weight. I want to lose, like, 25 pounds, 30 pounds. Should I lose that weight before or after I have the procedure? What would your guy’s answer to that question be? How much do I have to lose at all?

    Dr. Sam Rhee: For me, I don’t think I’ve seen very many patients. They all have goals of losing 20 to 30 pounds. It’s always a little aggressive. I don’t know if I’ve ever actually seen it. I’ve seen very few, maybe a few, but not that many actually lose that weight beforehand. I usually ask them what their happy weight is. If it’s 20 or 30 pounds below whatever they are now, I’ll say, you know what? We’re good if you get to within five to ten of that happy weight.

    Dr. Sam Jejurikar: What about you, Sal?

    Dr. Salvatore Pacella: I would say it’s always best to lose as much weight as you can prior to surgery. But like Sam, I think it’s rare that anyone can achieve a consistent goal of losing the 20 pounds they put out to. And if I can get half of that, I’d be happy.


    Effective Scar Management Techniques for Tummy Tuck Patients

    Dr. Sam Jejurikar: I typically tell people something very similar to what you guys just said: to get within 10 to 15 pounds of your goal weight. That’s pretty good. If you can do that. I think there’s a hypermetabolic state that happens with surgery. You lose some weight with surgery, and all is said and done. And I think when you settle out, you’ll be pretty good. So she did lose a little bit of weight before you see these postop pictures, but about 15 pounds probably, and it loosened up the skin more. 

    So the conversation about a mini tummy tuck became less of an issue. So then the next thing we had a conversation about, because she had a bunch of concerns, was a scar. As both of you have said, nobody wants that scar, but eventually, if you’re bothered enough by the appearance of your tummy, you’re reconciled to it. But she said I want to do everything I can about the scar. Tell me what your protocol is to make my scar look as cosmetically acceptable as possible. How would you answer that question? Is either one of you?

    Dr. Sam Rhee: Go ahead, Sal.

    Dr. Salvatore Pacella: I would usually say so. The first thing is really on me: when I repair this in the operating room, I want to repair the skin under minimal tension, if any. I want to close this in multiple layers. I want to make sure that we’re not getting an infection. We will use monofilament sutures so that we don’t have spitting incisions, etc. And then, after surgery, the things that patients can do is I tend to use a lot of silicone ointments and a lot of adjuvant scar treatments, such as laser if needed. 

    So there are multiple things we can do afterward to improve the scar. And I think the key is patient expectations and education that the scar will probably look the worst in about three months. This sort of second phase of wound healing causes a lot of redness, but that slowly fades after about eight to twelve months. So I think patients’ expectation is just as important.

    Dr. Sam Jejurikar: And Sam.

    Dr. Sam Rhee: Yeah, I can’t remember who said maybe it was Kuzan at Michigan who said scars. The appearance of scars is a combination of a couple of things. One is genetics, the second is how the scar is made, and the third is how you manage the scar afterward. And so all those three things do play a role. As Sal said, the one that we control is the actual incision and how we put it together and close it. And any plastic surgeon who’s worth their salt is going to do a good job with that, or at least the best that they know how. 

    And then, you talk to the patient based on who they are. I have a lot of patients who are Latinx or African American, who have a lot of concerns about scarring, so we’re really vigilant afterward. We do the same things that Sal talks about. I’ll start with silicone gels really quickly. We monitor very diligently, and we intervene early if we have to. Those are the things that help minimize scarring in most patients.

    Dr. Sam Jejurikar: Yeah, what I would say is the last time we did this, Sal made a point, which he didn’t make this time, but is so true, which is the meticulous closure that you do. One of the things that Sal mentioned that he did last time is that he does running closures of the deeper layers to offload tension. Wasn’t that you, Sal, that said that you actually do a running scarf as fascia closure? 

    Until that episode, I have largely been doing an interrupted closure. But I adopted that after we did that episode, and it’s made a huge difference. It has actually made the consistency of the scars actually better. So I want to thank you for that. That’s a huge point, though; surgeons should be doing everything they can to offload tension on the closure to make the scars look as good. 

    The other thing that both of you said, which I 100% agree with, was you both mentioned silicone. I think silicone, and there are other adjuncts that I want to ask you about in a second. But I think silicone, either in the form of strips or gels, is the gold standard for scar care. How long do you tell your patients they should be using it after surgery? Because I’ll typically get people that will use it for a few weeks and say it doesn’t work and then just stop using it. What do you tell them upfront about how long they need to be taking care of their scars?

    Dr. Salvatore Pacella: Six months.

    Dr. Sam Rhee: I said six months. Yes, exactly six months. But honestly, I’ll be lucky if I get half that in a lot of patients.

    Dr. Sam Jejurikar: Yeah, I tell them a year. I tell them they need to be babying their scar and obsessing over it for over a year. Let’s say you have them doing silicone, and their scars are looking okay, but they’re still a little bit thicker and a few months out. What other things do you tell people are useful for their scars? Postoperatively? Do you think micro-needling, for instance, is useful for scars? Do you think lasers are useful for scars? Do you do steroid injections?

    Dr. Salvatore Pacella: I definitely think the laser is a key component. I work very closely with a cosmetic dermatologist, and the blade of lasers can really tremendously help with the appearance of scars early on. Throughout my career, I’ve really gotten away from injecting scars with silicone. I’m sorry. Kenalog or Steroid. And I have just found that it is so inconsistent and doesn’t distribute through the scar very easily. 

    There are oftentimes pockets of white material when you try to inject it. It’s just very challenging. I will say, though, I know this discussion is about abdominal plastic, but in the face, I’ve been starting to use a lot of five FU injections, particularly around the eyelid, which I find much easier to inject. It can be very effective in breaking up scars. I haven’t done it in a larger scar, though.

    Dr. Sam Rhee: We all have our preferences. If I see any sort of scar or hypertrophy, I do a combination of topical and Kenalog injections. For me, it works pretty well. I mean, it’s not that often that I have to get to that point, but that’s something that I’ve sort of done for a while, and I’m okay with it. I agree that it is a little inconsistent. 

    I will probably have to see the patient back in about six weeks and see how they’re doing with it. When I first started doing that, maybe 10 or 15 years ago, I don’t know what I was doing back then. I don’t remember. But I overdid it. I way overdid it, and I had issues with that. Now I don’t know. I guess it’s experienced for me that just doing it, I tend to know what I can do with it, and just sort of it seems to work for me as long as I keep a close eye on it.

    Dr. Sam Jejurikar: It’s very interesting listening to the two of you because I couldn’t agree more. I think that less is more where Kenalog is concerned. I use it a bit, but I have realized it’s a dilution, and the amount needs to be much less than I did earlier. I also think there’s a role for micro needling for scars that are thick. It’s actually easy to do. I’ve seen it lead to some remodeling of thicker scars in darker-pigmented patients. 

    I like bleaching creams a lot, hydroquinone creams. I think they help a lot with some of the dark brown discoloration that you see in lighter skin patients. I like broadband light treatment discoloration, but I think there are a lot of things that you can do. I think the great thing is seeing how you guys have relationships with people that are cosmetic dermatologists. We have a skincare center. 

    Finding someone who is passionate about treating that and having the right amount of time can lead to some good results with scars. The next question, though, that she had for me is, Dr. J. I want to know if you’re going to do any liposuction at the same time you do my tummy tuck. And how would you guys answer that question? And if so, where would you do liposuction on this patient? I’ll go back to her pictures.

    Dr. Salvatore Pacella: Yeah, absolutely. I think for every single abdominal plastic I do; I add liposuction to at least the love handle, kind of lower back, flank area, and many times along the hip. I think that is crucial when I think about abdominal rejuvenation. We really want to do a 360-degree rejuvenation. If you tighten up the tummy muscles, tighten up the skin, and then you got this kind of muffin top on the side, nobody’s happy with that, right? 

    Definitely add some liposuction. Now the question becomes, how do we incorporate liposuction into the actual procedure on the front of the tummy? And that’s something that I think has evolved tremendously in my practice over the last several years. For example, another beautiful segue here.

    Dr. Sam Rhee: I know.

    Dr. Sam Jejurikar: Hand drawn by me this morning. Thank you very much. Yeah.


    Liposuction and Swelling Management in Tummy Tuck Procedures

    Dr. Salvatore Pacella: So traditionally, in plastic surgery, it was a serious faux PA to liposuction. Anything on the abdominal plastic skin flap, and I think philosophy is changing as long as you’re not super aggressive. So, for example, at the upper portion of the chest on the upper abdomen, many patients have some fatty rolls here, right up above the rib cage area, and that can sometimes be problematic if we don’t hit that a little bit with some liposuction. The other place I like to do it is centrally in the abdomen. Oftentimes a beautiful abdomen has a little bit of a central dip, so I think that’s a nice place to do it.

    Dr. Sam Rhee: I agree 100% with Sal. I do way more liposuction with my tummy tucks now than I ever have in the past. I think we talked about it before. The 360 is super important. The flanks, as Sal said, the back. And yeah, they used to scare us about the upper abdomen when we were learning about this stuff, that you would revascularize the flap. And I guess it’s with the experience again now; I just feel like I can do a much more aggressive job in that area than I used to without having to worry about that sort of devascularization.

    Dr. Sam Jejurikar: So this picture that Sal referred to as a nice segue is a modification of the kind of a classic picture that Steve Wallach and Alan Monterosa, both of whom are mentors of mine, did to sort of help define the blood flow to the abdominal wall with liposuction. And so green, basically the love handle area, and you can incorporate the back into it as well, is a safe zone for us to do and feel pretty good about. 

    You can obviously do as much liposuction as you want to under the skin flap as well that you’re going to take off unless I’m doing fat grafting and I need fat for some reason; I don’t typically do that. But the question sort of becomes a central portion of the abdomen. Yellow is what we kind of view to be a zone of extreme caution around. It’s a little bit less, but we worry about the blood flow. 

    And so what I’ll often pose to the question is, do you want me to try to hit a home run on your case, or do you want me to hit a single or a double? And what I mean by that is they’re going to look great with the tummy tuck, but to get a sculpted look on the upper abdomen, you have to do some aggressive liposuction. And the potential risk of that is some healing issues. 

    The healing issues typically happen in the lower portion of the abdomen; it heals. It can be messy for a few weeks and a little disconcerting to people if they get healing issues. But I have found as I have gotten much more aggressive with my liposuction, which I definitely have, the incidence of getting some minor wound healing complications is not insignificant. Have you guys seen that as well?

    Dr. Salvatore Pacella: I just haven’t been overly aggressive. I really just limit my liposuction to the upper pole a bit, and then centrally, I rarely go into the areas that are kind of along the central column.

    Dr. Sam Jejurikar: Yeah.

    Dr. Sam Rhee: For me, it depends if the patient has any comorbidities. I’m pretty conservative, and then I’ll tell the patient sometimes we may have to do a little bit more in the future if there’s an issue; it’s patient-specific. For me, it really just depends on the individual and how much fat there is, to begin with as well.

    Dr. Sam Jejurikar: Yeah, it’s the rare patient that I will liposuction the entire upper flap on, don’t get me wrong, but sometimes people are very demanding in terms of what they want and see, they have to understand the risk that goes along with it. I’m not trying to say that everyone should get aggressive lipo at all, but I’m saying it’s worth having that conversation, which I do with everyone, about the amount of liposuction you can do in that upper abdomen and what the potential consequences are. 

    So the next thing she wanted to talk about, just to kind of move along for the issue of time, is swelling. What can I expect for swelling? How long am I going to look big? How would you guys answer the questions? And what sort of things do you try to do to help with swelling after surgery?

    Dr. Salvatore Pacella: Yeah, I think the swelling is a huge part of the postoperative recovery. I routinely tell patients to expect to be swollen for six months to a year afterward, in particular the distance or the anatomy or real estate between the belly button and the upper waistline area. That area is markedly swollen for months and months and months afterward, and it can also be numb. 

    And patients just really need the expectation of that. So oftentimes, for a good four to five weeks, I use an abdominal binder and compress that relatively snug and tight, and then after that time, I usually have them stay into some sort of compression garment for about three months that could be Spanx or really snug yoga pants that go all the way just below the bra line.

    Dr. Sam Jejurikar: Sam, what about you?

    Dr. Sam Rhee: Yeah, there’s a lot of swelling for a while, and I caution patients because I’ve had a couple of patients that went and saw a therapist without asking me and getting some sort of ultrasonic treatment or some other treatment and actually causing skin necrosis in the abdominal flap as a result of it. 

    And they’re just so hell-bent on dealing with the swelling on their own, what they want to do with it. And I just tell them, listen, you have to take your time with this. This is not a super-fast process like some other procedures are. So yeah, compression, that’s important, but also avoiding things that can actually be detrimental as well.

    Dr. Sam Jejurikar: I have two questions for you guys. One, do you think drains are helpful in the minimization of swelling? And two, is there any point in time after surgery where you do feel comfortable with either Lymphatic massage or entomology or any other form of external treatment to help with swelling?


    The Importance of Drains and Pain Management in Abdominoplasty

    Dr. Salvatore Pacella: There has been a big push in plastic surgery to avoid drains and abdominoplasty, and I will say I just have not bought into that. A small patient with minimal fat, minimal dissection, thin amount of skin maybe could tolerate not having a drain, but it’s just such a large surface area to collect fluid, particularly the fact that you often get some of this exudate from the liposuction fluid that’s coming into the wound or the abdominal plastic subcutaneous space. 

    So I routinely use drains in everybody, and sometimes they’re in for weeks on end. It’s a challenge. I would usually say that for Lymphatic massage, I would probably give it a good six weeks before any of that kind of aggressive another manual Lymphatic massage I would recommend.

    Dr. Sam Jejurikar: What about you?

    Dr. Sam Rhee: I’m with Sal. I do quilting sutures and all that. But even with that, I still use drains on all my patients. I agree. The liposuction having all of that liposuction pubescence still there can play a role, especially for the initial. And I’m just conservative with it. 

    I don’t like being overly aggressive when I feel like the long-term consequences can be of issue. I’m also conservative. As I said, I’ve had a couple of bad experiences with patients going to see therapists for some sort of massage-type treatment, so I just tell them to hold off for about six weeks. 

    I think if you have a provider that you trust that you can work with, then as we’ve talked about with scar management, that’s one thing, but if you’re working with a variety of different people or you don’t know what they’re doing on my end, I will just be very conservative with it.

    Dr. Sam Jejurikar: I really agree with that last point that you just made. Going to providers that you know and work with and can communicate with, I think, helps a lot. I’ll answer the second question for my first. I am a big fan of Lymphatic massage or entomology. I think the sooner they start it beyond the first ten days or so, I like it. 

    Personally, I think that the name of the game for me is getting this one to go away as quickly as possible. I feel like the less they can be stretched out afterward. When you’re dealing with patients that have poor skin elasticity, which is by definition a tummy tuck patient, I think the better the results are, so typically; I’ll start it; we do it through our center about ten or 14 days after surgery. 

    And I’m very happy with it. I haven’t noticed any wound healing complications that I would attribute to that relative to other factors. But yeah, I definitely would be on the lookout for that. And I agree with both of you guys on drains. I’ve kind of used drains at the beginning of my career. I went through a couple of years span where I tried not to use them at all. And I just thought the patients looked swollen and didn’t look as good. 

    Personally, I know there are people that get good results not using drains, but for me, because I’m so focused on swelling going down as quickly as possible, just like you guys, I like the drains. So she had one more concern, and that concern was, am I going to hurt after surgery? How long am I going to hurt for? And what are you going to do to try to make my pain better? How would you guys treat pain? What’s your standard protocol?

    Dr. Salvatore Pacella: Well, just like we talked about several episodes ago, abdominoplasty…my prediction pain. It can be a painful operation, particularly when we’re talking about placation of the musculature. There are various options for treating pain at a local level. I think one of the most common things surgeons use is EXPAREL, which is an injectable Marcaine and injectable long-acting anesthetic. 

    Unfortunately, we don’t have it on the formulary at my health system. So instead, I use something a little bit more unique. It’s called a pain pump. It is two little tiny catheters that get sewn into the muscle repair. So I actually sew these catheters right at the level underneath the muscle repair, and they slip in and out very easily. 

    And then, at the end of the case, I hook this up to a big bulb, which the patient will carry around with them for about four days. And it’s got about 400 CCS of this long-acting anesthetic, which is just constantly being injected. And I have found that to be really nice because I think it really can do a huge job of taking the edge off the pain.

    Dr. Sam Rhee: For me, I don’t use pain pumps, although I have in the past. It’s just one of those things that I found personally. They work. They definitely work. I just found them to try to encumber them. Yeah, just for me, as a solo practice guy to incorporate into my practice, just managing that. I have been experimenting with gabapentin, which I think has been very helpful for a lot of patients. 

    And that’s thanks to Sam. In our last episode, we were talking about postoperative pain management, and I do offer EXPAREL. I am of mixed feelings about it. I don’t know if you’re a big believer. I think you are, but you’ll tell me about it in a second. I’ve been pretty happy with injecting a lot of Marcaine at the end of the case and just sort of getting them by for the first couple of days. 

    They generally tend to do okay. It’s an up-charge for me for EXPAREL, and I’m okay with it. Maybe it’s just my own experience, or it’s like I said, it’s in my hands. It wasn’t something that I told every patient, listen, this is something that’s a game changer, but maybe I have to revisit it. I know you and a couple of other people have told me this is something that’s super helpful.

    Dr. Sam Jejurikar: I think it’s helpful. I just think a pain pump is helpful. It seems to work great in some people and maybe not so great in others. I think we’ve had a lot of conversations about this sort of multimodal approach to treating pain. It’s another tool that you can use. I think gabapentin is a nice narcotic thing that we can use. 

    I’ve been using Celebrex More, which is and which is a non-steroidal anti-inflammatory, which is nice. I think our goal is to make people comfortable while minimizing the number of muscle relaxants and narcotic pain medications they’re on. But ultimately, it is going to hurt no matter what you throw at them. There is just no way to get rid of the pain. 

    And so those were her big concerns. Here are her postop results. I actually don’t have any pictures of the scar, which is ironic, given that we talked about it. So sorry about that, guys, but she had some pretty aggressive liposuction of the upper abdomen. I tightened her muscles all the way from stem to stern. Yeah, this is her about six months out.

    Dr. Salvatore Pacella: Go back to the obliques if you can there, Sam. So I think a takeaway point here is just to look at the hourglass improvement he’s achieved here. I mean, that’s really substantial. It almost looks like you removed a couple of ribs.

    Dr. Sam Jejurikar: No ribs were harmed during this case.

    Dr. Salvatore Pacella: No, but I mean, that’s just a testament to really the placation and extra liposuction done on the lower back. Really good result.

    Dr. Sam Rhee: Yeah, that’s what Sal said about that central portion of the abdomen making that sort of Holloway sort of look. That looks really nice. That looks natural. It looks really aesthetic.

    Dr. Sam Jejurikar: Well, I think unless you guys have any other closing thoughts, I will continue to learn from you guys. And I just love going over these cases and seeing your guys approach things because I think if you’re doing general surgery, there’s really one way to take out a gallbladder. 

    But in plastic surgery, there are so many different ways to handle the same case, and so many different plastic surgeons get good results doing things differently that I continue to love talking to you guys and learning from you guys.

    Dr. Sam Rhee: Exactly the same.

    Dr. Sam Jejurikar: Well, thanks. Yeah, thanks, viewers, for watching yet another podcast. And until next time, have a great Sunday!

    Exploring HD Liposuction with Dr. Christopher Costa

    High definition Liposuction

    Unpacking the Art of Liposuction: A Conversation with Dr. Christopher Costa

    Welcome to our podcast where we bring you the minds that are moving and shaking the world of plastic surgery. As always, I’m your host Dr. Sam Jejurikar, accompanied by my esteemed colleagues, Dr. Sam Rhee from Paramus, New Jersey, and Dr. Sal Pacella, who joins us from sunny La Jolla, California. Today, we have an exciting episode in store for you. We’re thrilled to be joined by a special guest, Dr. Christopher Costa, a leading aesthetic surgeon hailing from the bright lights of Las Vegas. Today, we’ll delve into the fascinating and transformative realm of high-definition liposuction. So, buckle up and let’s get started. But first, let’s pause for our obligatory medical disclaimer with Dr. Pacella.

     Dr. Sam Jejurikar: Well, good morning, everyone. Welcome to another edition of Three Plastic Surgeons and a Microphone. As always, I am joined by Doctor Sam Rhee and Bergen County, New Jersey. Got him. Paramus, New Jersey. Sorry. Doctor Sal Pacella in La Jolla, California, who’s at San Diego Plastic Surgeon, and today, we have the great fortune of being joined by Doctor Chris Costa, who’s an incredibly busy aesthetic surgeon in Las Vegas. Before we get into the program meeting and introduce Doctor Costa, we’ll just do the necessary disclaimer. Pacella.

    Dr. Sal Pacella: Alright, here we go. This show is not a substitute for professional medical advice, diagnosis, or treatment. This show is for informational purposes only. Treatment of results may vary based on the circumstances and situation of medical judgment. After appropriate discussion, always seek the advice of your surgeon or other qualified health provider with any questions you may have regarding medical care. Never disregard professional medical advice or delay seeking advice because of something.

    Discussing Dr. Costa’s Expertise in High-Definition Liposuction

    Dr. Sam Jejurikar: Great. So, for our listeners, I’ve had the great pleasure of knowing Doctor Costa for many years as a Doctor Pacella. I’ve seen Chris since he was a resident of Southwestern; back then, it was clear that he had a great eye and mind for all things aesthetic surgery. I kept in touch with him over the years, and he shared his philosophy with me. I’ve really been struck by one; the results I see online are fantastic in many different procedures, whether plastic, liposuction, body contouring, or breast surgery. He seems to do a great job with all of that stuff. But he’s had an evolution. He’s done some things that are philosophies of what I do and many others. But his results speak for themselves; they are so awesome to sort of keep up. So, what we’ve decided would be a great topic for today is high-definition liposuction because every time I go onto Chris’s social media, I see yet another amazing result after another amazing result. And so, Chris, I guess for our listeners out there, first of all, love the show.

    Dr. Christopher Costa: Yeah, thanks.

    Dr. Sam Jejurikar: Second, what is high-definition liposuction? The next term is being banded around a lot.

    Dr. Christopher Costa: Right, I know that’s like all the buzz on social media now. I think no matter where you turn; everyone is saying high def, high def, high def. What I classify as high-definition liposuction is, it’s we’re doing more than removing. So, from the traditional sense of liposuction, where your mom’s liposuction from 10, 20 years ago or whatever, it’s just like the focus really was on volume, right? Just get the vote, and then you fit into your genes, and there’s nothing wrong with that. The term high-def kind of comes into play is where we look more at your natural anatomy and the contours that you already have and just kind of bring them out and tell the story that you’re trying to tell people on the outside, right? So, like all plastic surgeries, but like the people who do really, really well are obviously it’s like the people who are in the gym 3 to 6 days a week, and they’re just like, man, I just can’t get any sort of like result just because of genetics or whatever it is. So, just try and help bring that out for me.

    So, there are varying degrees, right? Because, like, the person who maybe has a BMI of like 20 and works out all the time. They’re going to be coming to me with different expectations than somebody who had two kids and they just want their old form back. You know what I mean? So, it’s always a conversation, and there are varying degrees. Most of my patients come to me ironically, saying, hey, I just don’t want a six-pack or anything crazy like that, right? Like they just, people just want to look natural, right? So, I think we use high def because, like, people know now what’s out there, and they know what that term means. But it’s just about like all necessary whether you’re doing rhinoplasty or breast augmentation. Like the goal is to make people’s heads turn and be like, whoa, they look awesome, right? Not necessarily like, whoa, that’s some plastic surgery. Like that’s always the goal whether we’re doing body contouring or tummy tuck or breast or nose, face, for all of us, right?

    Dr. Sam Jejurikar: Right. I think you get on a couple of really good topics. One is natural. Sounds like more of your patients are interested in looking natural and fit as opposed to looking like they have crazy six-packs. I assume you’re talking predominantly about women when you say that.

    Enhancing Body Contouring Through Improved Patient-Surgeon Dialogue

    Dr. Christopher Costa: Yeah. Exactly. It definitely is different in the male population but to a certain extent, right? Like I did a man in his 60s actually last week, and he was a physician. He bikes. He’s an avid biker, and he had two orthopedic injuries last year where he was basically, you know, immobilized and not able to like to get into shape, and now, he was like, man, like, I’m 60, whatever. I can’t, no matter what I do, like I just can’t get any definition back that I had before. And he’s like, I’m not trying to like to look like Captain America. I just want kind of my own old form back and somebody who can kind of make it look without making it look kind of like that Van Gogh painting where it’s kind of amorphous.

    Dr. Sam Jejurikar: Yeah.

    Dr. Christopher Costa: Something like that. So, for the most part, you probably like the same thing you guys see in your offices. Like anytime someone comes in for a breast augmentation. Well, I’m in Vegas, so maybe my patients are a little different than your guys’, right? As I know, my average size breast implant, maybe a little bit larger in Dallas. But the patients that come to me are all like; I love your results, just don’t make me look like I got two volleyballs in my chest. Like, don’t give me that plastic surgery look. So, it’s the same thing with lipo and all that stuff. So, I think that something when you’re trying to learn a technique in a new procedure, the pendulum can shift too far the other way, too, right? When you give the patient something, it crosses the line of natural-looking results, and now, they look over-operated or just over-resected or that kind of thing. So, it’s definitely tough. It’s definitely a balance. It’s taken a lot. Totally different from what I learned in training.

    Dr. Sam Jejurikar: So, let’s walk through the process of a patient coming in for a high-definition liposuction consult. Guys, interject, as he has questions as well. So, let’s say you have three patients that are coming to you. One has a BMI of 20, one has a BMI of 25, and one has a BMI of 30, and they all tell me, Doctor Costa, I want to look athletic and natural. Does your conversation differ with those patients in terms of what the results might look like? Or is it the same conversation with all patients?

    Dr. Christopher Costa: Yeah, I know. I think that’s really interesting because the way you’re asking that question kind of puts a lot in the context of, I think, the way a lot of plastic surgeons think about this and maybe even patients of like, oh well, if my BMI is this versus this. That’s a very structural way to think about patients. The way I have every single one of my body contouring consoles is, I say the equation to getting you the result you want has three different factors, okay? X, Y, and Z, alright? The first factor is muscle diastasis; if you have pregnancies, if all that is stretched out, I got to fix it. The second part is going to be your subcutaneous skin. If you’ve got, or I’m sorry, subcutaneous fat. If you’ve got a lot of fat, that’s where we make the little incisions, and I can suck it out. Then the third part, which I say is the most critical part of this whole thing, is your skin quality. If you have excess skin quality, skin damage, age of the skin itself, all that kind of stuff, and I tell people I’m like, of all of these factors, your skin is that’s the loose cannon. Like, that’s the one I can’t predict. That’s the one that I really define, like what type of result we can get you and that kind of thing.

    Now luckily, most people are really reasonable, right? Like regular plastic surgery, the patient is just a regular person. It’s not somebody who likes what we see on TV unboxed and all this kind of stuff. It’s just like people who want to look better, like they just whatever. So, a lot of people get that. So, my conversation about whether Your BMI is 20 or 30 really comes down to me doing an exam and looking at your skin, right? Because I have had patients with BMIs of thirty for who I can get phenomenal results. And I’ve had patients with BMIs of 20 who have three kids, and I just tell them, like, look like we have to do a skin removal procedure. I think patients really get it when I kind of present it that way. Because if I just say like the liposuctions to treat fat. It doesn’t do anything for that third part of the equation. It doesn’t do anything for your extra skin, so we got to do a skin procedure if we’re going to treat your extra skin.

    Now I have. I think one of the things that has really, really helped me move forward is I have a very low threshold to do some sort of skin excision. Like, I have a lot of tools in my tool belt where skin doesn’t necessarily have to mean it’s a full tummy tuck, right? It’s not like zero to a hundred. It’s maybe we’re just doing a little mini-C-section scar size-like skin removal to pull that skin tight and help distribute that fat nice and nice and evenly, right? One analogy I like is when we do liposuction, we leave the fat behind, right? And that’s the way it should be done. That’s the way you keep the tissue nice and healthy, but it’s kind of like taking a big bowl, a big heaping bowl of potato salad, okay? So, if you just scoop a bunch of potato salad in a bowl, it’s all chunky, and it looks like whatever, but if you get some saran wrap nice and tight and you just you stretch it over that top of the potato salad, it looks nice and smooth and contoured, right? So, I explain that to patients.

    Decoding High-Definition Liposuction

    Dr. Sam Jejurikar: It’s heavy-duty saran wrap you have here. Well, I’m just kidding.

    Dr. Christopher Costa: It just flattens everything out of it. So, I’m open to suggestions if you got a better idea of how to do it.

    Dr. Sam Jejurikar: No, I like that. I think that’s a great analogy. I’m just, you know. I am saran-wrapped potato salad. It never looks that smooth in my refrigerator. But anyway.

    Dr. Christopher Costa: But I don’t even like potato salad. So, macaroni salad. I don’t.

    Dr. Sam Jejurikar: But actually, I do want to follow up if that’s okay.

    Dr. Christopher Costa: Yeah.

    Dr. Sam Jejurikar: So yeah, I think you’re; I totally agree with your analogy, by the way. It makes total sense in terms of the skin losses. So, I get it. Someone that’s got really bad skin elasticity can talk him easily into doing a skin excision. I get if someone has really good skin elasticity, really that worried about being a plastic surgeon. What if someone’s kind of in that middle ground? They’re sort of, you can kind of tell their skin can loosen up a little bit, but they’re coming to you, and their skin’s not that loose yet until it. Is there any rolling for things short of doing a skin excision to tighten the skin, whether it’s radio frequency or any other sort of antibodies?

    Dr. Christopher Costa: Yes, so and then, so I think, as I said, it all comes down to the skin. So, if I even have that premonition of the loose skin, I don’t; I’m not really sure. It says, right, like yeah, exactly like you said, Sam. There’re people on both sides, but most people are in the middle. Most people have had a kit. Most people have some degree of laxity, and so first of all, it’s just about like patient counseling, where I just tell people what like looks like. And to answer, as I promise you, I’m going to answer your question, but I really believe it’s not a one-way conversation of like this is how I decide it. It’s totally a two-way conversation. That is how you get happy patients for sure if you say, alright, here’s the deal. You got a little bit of skin. It’s kind of loose after I suck your fat, I think you may have a little bit of loose skin, but I don’t know because I don’t know, like everybody’s different. Your genetics, your things. I’m giving you my best guess.

    If it were me, I would rather do a little bit of skin excision. Pull that skin tight so I make sure that we get a nice smooth contour. But if you are like just totally against that, and you’re okay with having a little bit of loose skin, and maybe the contour doesn’t look the same, or maybe you’ve got a little bit of that kind of thing. Then I’m okay doing that too. And I think, well, that is one thing that I was not taught in my training, and I don’t know if other programs do teach that or not. But like the way I was taught was like you really only do liposuction only on people with really, really good skin quality. Because those are the only people that are going to have really good results, and you, someone with a BMI of 32, should never really do liposuction because like they’re not going to have a good result. They’re going to end up with whatever.

    I think that that is something that is just totally wrong because there are so many people out there who they’re not necessarily looking for these amazing sculpted super results, right? They just want to look better, and if you tell them like hey, you may have a little bit of loose skin. How do you feel about that? Oh, by the way, like, if you do like it, we can always come back and cut it off later if it really, really bugs you. A lot of people are like yeah, that sounds good, let’s do that, like, and then when they’re in my office, I say, it’s 50% get it, 50% end up healing really well. That’s why I say like I can’t even predict it because, like, sometimes I’m like, there’s this patient’s definitely going to need a mini tummy tuck, or a modified tummy tuck like with umbilical transposition, and then their skin just heals really well. So, I love radio frequency micro-needling; I’ll say that for those patients where I’m like, hey, I don’t know, so there’s a little insurance policy that we can do at the same time that will help us maybe get a little bit of skin retraction. I like incorporating that for those patients if they’re interested in it. But again, I just leave it up to the patient. I say like or/don’t. It’s really up to you.

    Now if it’s very, very obvious the patient needs a tummy tuck, I’m going to, like, still tell them I’m going to still give them the same option. I think that’s also something that’s maybe kind of controversial, maybe not. But again, like, I can think of a patient with a BMI plus 35, and she just was like, listen, I can’t take the time off. I can’t. I just want to debulk, you know, and that’s the word I use. I say this is going to be more of a debulking procedure, right? And I’ll tell you, man, some of my happiest patients. They really are, and you know we can, we can still highlight, give them some contour, give them some of that shape back, and then those girls like love the results. Because they have always maybe been kind of like a larger woman, but now they’re like a really, really sexy larger woman, and then maybe they come back in a year, and they have the time to do the tummy tuck or whatever.

    So, I really do think it’s like this sliding dynamic, and it’s hard to, like, create some algorithm in a paper of like, oh yeah, well BMI here do this procedure. BMI here does this procedure because it’s really not like it’s really not. It’s really like trying to figure it out. I know we always like, well, what are your goals? We tell we just ask the patient what’s your goals like, and we try to meet that, but like, I don’t know how much of us actually, really, really listen to that, right? Because, and the reason I point out is when I first started, like, got out on my own, I worked for Evol Corporate Plastic Surgery, okay? One of those places that do like liposuction on, okay? And when all you have is a hammer, everything’s a nail, right? So, everyone that walks through the door liposuction. That’s all they do. I was told like, hey, you got to do liposuction on this guy. Hey, you got to do liposuction on this woman. And I was like, man, this is totally different than what I was trained. This is a really bad thing. This goes against everything I’ve been taught that I’m supposed to do. This patient totally needs a big, extended tummy tuck with possibly whatever. But we would do these liposuction procedures, and again, if you talk to the patients and you kind of tell them what to expect down the road, they’re extremely happy. It’s way happier than I could have ever expected. I was like, oh my God, they’re going to hate me. They’re like, oh.

    I also think that if you’re not somebody who doesn’t personally care about the feelings of others and stuff, you’re probably not going to be a good plastic trainer. But, like, you know what I mean? Like, you got to let your own conscious kind of guide you right like, and I’m like, look, I’m just going to lay it out for you, right? Like you still can be big after this, you’re still going to have loose skin like this is not like some crazy procedure, and they’re like, “Dude, I don’t care, I just want to like fit into my pants.” That was a bit like opening eye kind of thing for me when I did that because it really did show me that, like, we spend so much time saying, this is the right thing for you. Our science says this is the right procedure, and obviously, we have to present that to people like I’ve done this for a really long time, and I can tell you that this is probably not going to be the best result. But if that person also comes to you and says like, look, well, I can’t get three weeks off or two weeks off for a big mommy makeover procedure, and like, I just really want to get some of this off, so I can like to start walking again or start doing some exercises like that. Like, sometimes it’s just that’s the catalyst, right? I like to really get that going.

    Dr. Sam Rhee: Well, I think that’s really important. I appreciate the fact that a lot of plastic surgeons impose their viewpoint or their opinions on what the aesthetic standard should be as opposed to presenting the options and letting the patient understand what those options would result in and then letting them choose what they know themselves to be their best result. Which I think sometimes a lot of plastic surgeons overlook in terms of always trying to achieve what we think would be appropriate. One of the questions I had for you, Chris, was about defining high-definition liposuction. So, as opposed to saying, like you said, your mother’s liposuction. What is it that makes it high definition?

    Dr. Sam Jejurikar: Why do you guys keep talking about Pacella’s mom’s liposuction?

    Dr. Sam Rhee: Dude. I was.

    Dr. Sal Pacella: Oh, we’re going to start with the mom’s joke.

    Dr. Sam Rhee: Dude.

    Dr. Sam Jejurikar: Sorry.

    Dr. Sal Pacella: Your mom…

    Dr. Sam Rhee: So, if we could get on point, guys, the question is, is it picking the right patient, as you said, like a fit 60-year-old who’s looking to try to get back into shape? Is it doing more aggressive liposuctioning? So, you’re actually seeing the underlying musculature, or is it more of an etching where you’re sort of working a technique to highlight the anatomy better by a specific technique of liposuction?

    Dr. Christopher Costa: Absolutely, all the above. So, when you’re saying like, well, what is, like, if someone comes in and says, am I a candidate for high-depth liposuction? I think that is kind of another way to rephrase it.

    Dr. Sam Jejurikar: Like, how are you doing it? How do you?

    Dr. Christopher Costa: Yeah.

    The Interplay of Communication, Expertise, and Technology in High-Definition Liposuction

    Dr. Sam Rhee: What makes it high definition regularly?

    Dr. Christopher Costa: So, Hoyos wrote a paper a year or two ago, and he just came out with another one that’s like kind of similar where he basically kind of defines like the different degrees of definition. The way he kind of structured that paper, I think, is the way that I kind of talk to a lot of my patients. I don’t call people endomorphs or ectomorphs. What I just say, like number one, everybody is coming into my office for liposuction. I’m assuming they’re coming in because they’ve like seen my results and that they’re coming in because they want some degree of definition. So, it doesn’t matter if I’m doing a very obese person; I’m still going to try and get them some highlights in the linear Alba and the semi-linear lines, right? Like, I’m still the key, though, like, you can’t just draw them on, okay? You’ve got to look at the patient’s torso because someone who’s got a 40-inch circumference chest, their rectus muscles are just going to be wider. So, if you try and paint them on there, you would for a 5-foot-two petite Asian woman or something like it’s going to, it’s not going to work, right?

    So again, like highlighting their natural anatomy, I have them literally stand and flex as I tell them I’m like flex like you’re trying to show me your abs, and I just push on them, and I try and feel where that is. So, it’s not like a stencil where you can just like to stick it on there and then like draw inside the lines, right? So, I think I can do these techniques in every single patient. Now if to that degree, if a patient who is, let’s just say, overweight with some loose skin comes to me and says, I’m looking for a high deaf result. I’m going to say, well, number one, like, what do you mean by that? Right? And have them show me some pictures and again, like when they show me those pictures, a lot of them are they’re showing me natural results. They’re not showing me the true high deaf etched out six pack, eight pack with serratus definition, and the external obliques coming off of the rib cage. That’s like an extremely high-def right, and that type of patient tends to be, yeah., it’s kind of self-selecting, right? Like that tends to be somebody who’s already in shape.

    Dr. Sam Jejurikar: Can I ask you a question? Are you using traditional lipo and energy modality is power-assisted? Like how are you doing? How are you achieving different degrees of definition?

    Dr. Christopher Costa: Alright. All the industry people hate me. Because I don’t believe that this, and I think this is super important for your audience to hear. Do not associate a result with a device. Okay? Whatever that device is out there like we get called old. At least a few times a week, asking, hey, do you guys have, oh, I saw Doctor Costa’s liposuction? Does he use the X for whatever device he is for? Does he do X? I’m not saying any names. You know what I mean? And that I’ve literally had to have hours of conversation coaching my staff on how to navigate that because your result is based on proximal to the instrument, right? So, if you put me in a pair of Air Jordans and make me play basketball against Michael Jordan in flip-flops, he’s still with me, pretty hard, right? Like it’s not the device. It’s not the shoe. It’s the surgeon.

    Dr. Sam Rhee: It’s always the surgeon.

    Dr. Christopher Costa: And from the surgeon’s standpoint, it’s again, like if you’re a surgeon, there are so many people who, like I saw during training, and I’ve seen just out in the community who they go through the steps, and then they’re done and never sit there and like critically analyze their own result on the table. Like it’s just like, well, I did it, the fats in the canister, we’re done. Like yeah, I got three liters of fat out, like what, that’s a great endpoint. And at no point are they actually looking at the patient, feeling the patient doing a skin pitches test like feeling to make sure that that contour is nice and even, right? So, do we have those devices? The answer is yes, and I do use them when appropriate, but I don’t necessarily think that any device actually makes the surgeon. Ironically, so like I have two micro heirs in my office because I do a lot of awake liposuctions. And the reason I have two micro heirs is that the pieces interchange; you can take the tip-off, right? And I can fit it in my tabletop autoclave. That’s the only reason I have it.

    Dr. Sam Jejurikar: Okay.

    Dr. Christopher Costa: That’s not because I feel like it’s a better thing.

    Dr. Sal Pacella: Oh yeah. Just a question. Okay, so you mentioned very eloquently how you would talk to a patient. Your conversation is very two-sided, and you mutually decide on a procedure. So, let’s say, for example, you think the patient needs a more advanced procedure. Full tummy tuck liposuction, etcetera. The patient says, no, I can’t take the time off. I’m just going to do a little bit of skin incision. I’m not going to tighten up the rectus muscle; I want to do something that you feel is not necessarily the best. You do the procedure, and then they’re unhappy. How do you handle that?

    Dr. Christopher Costa: So again, my experience has been that most people are reasonable and normal. Like most people are normal, right? So, I can have an unhappy patient, but if I sit with them and I say like yeah, remember we talked about all this? Like, that’s the loose skin that I was talking about, and remember how you said you couldn’t take two weeks off work? Oh yeah, okay, okay. Like most people get it. Like people are not dumb. Yes, you are there, the people out there who are just mean, angry people when they’re going to be met. Yeah, we try not to operate on those people. You know what I mean? And I think that’s a big key part if it’s not, if in that two-way, part of that two-way conversation is the patient interviewing me, but me interviewing the patient too is like does this person like get it, right? Like if they do not get it, the way I can tell a patient doesn’t get it is because they start trying to negotiate with me, right? Like, they start saying like, well, it’s like it’s one or the other. It’s either we cut the skin off, and I get you the best result, and we pull it tight, or we just do more of like a debulking procedure, and we try and get you smaller and just one step along the way.

    Well, can’t you do that, Ian, get me the result that I, and like when I have that conversation, I’m like, we lay it out very, very clearly? No, it’s one or the other. It’s not both. And if I feel like they’re not getting it, I will then say, I don’t think it is probably the right procedure for you, or I don’t think I can get you the results that you want. You should maybe go see somebody else, but the advantage is I don’t know how long your guy’s consults are. I know you guys all do really, really good work, but there is that that is part of the advantages. I get to interview the patient also and make sure that they’re somebody who when they do come back, and they have that result at like we’re like 100% clear about what the goals and expectations were, and like I said, like no, most people aren’t going to like come after you because most people get it.

    So, when that does happen, let’s just say it does happen. We’ve laid all the groundwork now to kind of lay that out to them, and the other thing that’s really nice is, like, I have lots of really, really great results on my website. But I have some results on my website that I kind of like hide at the bottom, okay? And the reason I hide them at the bottom is that they’re not the ones I really want to highlight, but they’re there in case I have somebody who, like, I feel like isn’t getting it. Because then I can show them, hey, this is somebody who should have gotten a tummy tuck, and I really recommended it to him. But they decided that they just want to do liposuction, and here they are, and you can see that they’re smaller, and they have that crepe-looking skin now, and this is their result. But they are super, super happy because I gave them like we had that conversation and we talked to them. And I said, so are you going to be happy if you get a result like this? Like, and that’s how I truly love, yeah.

    Dr. Sam Rhee: You know what I love about that, Chris? The first thing is I think it is obvious for all of us as experienced plastic surgeons. It’s not about figuring out who to operate on. It’s figuring out what not to operate on, and the farther along you go, you figure that out, and you avoid these situations as best you can to make sure you’re a good match with the patient. The second thing I love about your answer is that you’re honest. You don’t just put everything that looks glam and awesome on there. You’re putting others.

    Dr. Christopher Costa: All body shapes. Yeah.

    Dr. Sam Rhee: Other results are that. Right, and to me, that’s the mark of a real Plastic surgeon, someone who’s very honest, who can show a variety of results and is not sitting there insecure about, like, oh, I only have to like to pretend that everyone is like a model an Instagram model that comes out of my practice. I think that honesty is something that I just thought about myself. Like, you know what? That I could probably take some lessons away from that myself.

    Dr. Sal Pacella: And I think that brings.

    Dr. Christopher Costa: I can’t tell you. Yeah.

    Dr. Sal Pacella: I think that brings us to our last question, Chris. A very important question or no answer, okay? Okay. Does what happens in Vegas always stay in Vegas?

    Dr. Christopher Costa: No. Yeah, really, not.

    Dr. Sal Pacella: Yes, or no?

    Dr. Christopher Costa: It definitely doesn’t, but I promise you if you come out, we’ll have a good time. We’ll have a good time for sure.

    Dr. Sam Jejurikar: Chris, we really want to thank you for your time. I think you’ve hit some real points for our viewer’s high-definition liposuction is not one catch-all operation. It’s the surgeon that determines it. It’s not really how big you are. All of the various anatomic factors determine how great of a result you’ll get. So, thanks for illustrating those points and super, super instruct. We appreciate that.

    Dr. Sal Pacella: Good seeing you guys.

    Dr. Christopher Costa: Yeah, thanks. Hopefully, my perspective was refreshing a little bit. Just a reminder, yeah, I’m in Las Vegas Platinum Plastic Surgery. We just opened our new office with our new surgery center too. So, if you’re around, come check us out and see our new place, Sam.

    Dr. Sam Jejurikar: Next time, I’m there for sure.

    Dr. Christopher Costa: Yeah. Very cool.

    Dr. Sam Jejurikar: Alright. Thanks again, gents.

    Dr. Christopher Costa: Alright.

    Dr. Sam Jejurikar: Take care. Thanks, Chris.

    Dr. Christopher Costa: See you guys.

    Dr. Sam Rhee: Thank you, Chris.


    Dallas Surgeon Dr. Sam Jejurikar: How to get Rid of Male Gynecomastia

    Fans of classic sitcoms might still be amused by the Season 6 Seinfeld episode in which Frank Costanza and Cosmo Kramer debate the dubious marketing merits of naming their prototype of a bra for men the bro or the manssiere. However, as Dallas cosmetic surgeon Dr. Sam Jejurikar can tell you, for men who suffer from gynecomastia — the abnormal development of nonmalignant breast tissue — the condition is no laughing matter.

    The word gynecomastia — Greek for “woman breast” — was introduced in the second century by the notable Greek physician, surgeon, and philosopher Galen. The condition is characterized by the development of excess localized fat, excess glandular tissue, and sometimes, excess skin in one or both breasts. The first surgical attempt to alleviate the condition is thought to have been performed by seventh-century Byzantine physician Paulus of Aegineta — known for his pioneering work in the field as “the father of cosmetic surgery” — who describes the procedure in the sixth volume of his groundbreaking encyclopedia, Medical Compendium in Seven Books.

    While we’re worlds away from the cosmetic procedures performed in ancient times, Dr. Jejurikar acknowledges the problem of overabundant male breast tissue hasn’t gone away, and he adds that with the advent of increasingly advanced surgical techniques in recent years, the demand for male Gynecomastia (breast reduction) has been on the rise. In a Feb. 25, 2016, report by the American Society of Plastic Surgeons, it was revealed male breast reductions accounted for more than 40% of all breast-reduction surgeries in the U.S. According to Aesthetic Plastic Surgery National Data Bank figures, there were 28,689 male breast-reduction procedures performed nationwide in 2021.

    The Causes of Male Gynecomastia: Nature or Nurture?

    The generally accepted cause of male gynecomastia is an imbalance of testosterone and estrogen linked to an oversensitivity of androgen receptors in male breast tissue. Due to hormonal changes during adolescence, early onset gynecomastia may disappear on its own or respond favorably to treatment with hormone-blocking medications — which unfortunately, is not always the case for adults.

    Some medical practitioners point to the overconsumption of phytoestrogens (isoflavones) found in soy products and certain herbal supplements as a contributing factor to abnormal male breast tissue growth. However, recent studies suggest the soy connection is a myth. Steroid abuse and obesity have also been associated with the condition. The debate in the scientific community may be ongoing, but no matter gynecomastia’s underlying cause, Dr. Sam Jejurikar says weight loss and exercise will not eliminate its effects in adult patients. The only viable solution to achieve male breast reduction in such cases is surgery.

    Dr. Jejurikar on What Modern Male Breast-Reduction Surgery Looks Like

    “Male breast-reduction surgery is usually performed under general anesthesia and takes one to three hours,” Dr. Sam Jejurikar explains on his website. While this time frame is typical, extreme cases may take longer and require more complex surgical intervention.
    “In severe cases of gynecomastia, the weight of excess breast tissue may cause the breasts to sag and stretch the areola (the dark skin surrounding the nipple),” the American Society of Plastic Surgeons noted. “In these cases, the position and size of the areola can be surgically improved and excess skin may be reduced.”
    An initial consultation with a cosmetic surgeon will reveal the extent of an individual patient’s condition. Dr. Jejurikar explains that once a doctor has ascertained the kind and amount of tissue to be removed, they can formulate a personalized surgical plan for the patient.
    For those whose gynecomastia is composed mostly of adipose (fat) deposits, liposuction alone may suffice to remove it. Patients presenting with excess skin and glandular tissue in addition to adipose tissue will likely require a combination of surgical excision and liposuction. Again, in only the most extreme cases, cosmetic reconstruction may also be required to create the desired aesthetic outcome.


    Dr. Sam Jejurikar Answers Your Male Gynecomastia FAQs

    What’s the reason most men get breast-reduction surgery?

    Male breast reduction can strengthen self-esteem and make those who undergo the procedure feel more attractive overall. The most commonly cited reason men get male breast reduction is to enhance their appearance: when clothed, to improve how a shirt or other garment drapes on their body; and when not clothed, to attain a more toned appearance.

    Am I a good candidate for male breast reduction?

    You’re a good candidate for male breast reduction if you’ve already ascertained your case can’t be corrected without surgical intervention. You should be in good general health and not have any condition(s) or be taking medications that inhibit blood clotting or healing. Ideally, you don’t drink, smoke, or take nonprescription drugs. Your outlook should be positive and your goals realistic. Your weight should fall within a normal range and your breast development should be stabilized. If you’re currently in the process of losing a substantial amount of weight, it would be best to postpone Gynecomastia or other cosmetic skin-tightening procedures until you’ve reached your goal weight and your weight is stable.

    Is the procedure covered by insurance?

    Generally speaking, cosmetic procedures are not covered by insurance. However, some carriers may offer compensation on a case-by-case basis. Check with your provider to see what, if any, coverage they offer.

    What should I do to prepare prior to surgery?

    The first thing you must do before surgery is to be totally honest with your doctor during your consultation with regard to both your health and lifestyle. Undisclosed conditions can lead to surgical complications. It’s up to you to share all pertinent information in order to ensure the best possible outcome.

    Most doctors will give you a thorough medical evaluation, which may include laboratory tests, before surgery. Depending on the results, you may be required to adjust any current medications you take, and if you do smoke, your surgeon may ask you to stop for a period both before and after the procedure. You should also avoid taking aspirin, ibuprofen, and other anti-inflammatory drugs or herbal supplements before surgery because they can increase the risk of bleeding.

    Since the procedure will be performed under anesthesia, you’ll need to arrange for someone to bring you home and purchase any necessary postoperative supplies in advance. It’s also a good idea to stock up on groceries. You won’t be able to go to work for a few days post-op, so make sure to arrange time off with your employer.

    It’s also a good idea to put together a proactive postoperative plan with your surgeon. Find out which medication(s) will be prescribed for your recovery, make a schedule for when your dressings must be changed or removed, and if you have stitches, when they should be removed. Find out when it’s safe to return to your regular physical routine (including exercise) and when you need to schedule a follow-up visit.

    What does postsurgical recovery entail for male Gynecomastia?

    The most important part of your recovery is getting enough rest. During the first 48 hours of your convalescence, it’s best to have someone stay with you, both to help you get around and in the event of an emergency. You should also make arrangements to get help with chores and cooking for a few days.

    Your doctor will give you specific instructions for postoperative care and it’s imperative that you follow those instructions to the letter. If you have incisions, you must avoid the use of excessive force or abrasive motion as you heal. (Get immediate medical attention if you experience any of the following: shortness of breath, chest pains, irregular heartbeat, unusual swelling.)

    Will my breasts come back after the surgery?

    Dr. Jejurikar says the results of male breast-reduction surgery are permanent in most cases. However, he cautions that if causative factors — including the use of certain prescription medications, steroids, and weight gain — are still in play, some excess tissue may return. Likewise, incorporating healthier lifestyle choices such as exercising, eating healthily, and moderating alcohol consumption will contribute to an improved overall outcome.

    How can I find a local plastic surgeon experienced in male Gynecomastia?

    If you’re in the Dallas area, you can reach out to Dr. Sam Jejurikar’s office to set up a consultation for breast-reduction surgery. Otherwise, look for a board-certified cosmetic surgeon who has experience in the procedure. Ask to see the doctor’s “before and after” patient photos. The American Society of Plastic Surgeons has an extensive online directory to help you find a qualified cosmetic surgeon near you. Also, check out reviews to see what others are saying.

    Dallas Texas Surgeon Dr. Sam Jejurikar on Surgical Hair Restoration

    Dallas Dr Sam Jejurikar Hair RestorationKids who grew up in the ’80s are likely familiar with candy buttons — row after row of tiny candy dots stuck to a roll of paper you chewed off one at a time. Back in the day, that’s pretty much what hair transplants looked like, too — row after row of hairy, suspect-looking punctuation marks gathered in a dubious runway formation with embarrassing sections of scalp peeking through. While hair plugs were standard operating procedure in the last century, Dallas-based cosmetic surgeon Dr. Sam Jejurikar is happy to report that was then and this is now. 

    Dr. Jejurikar explains that while hair restoration is still a medical procedure that should only be performed by a specially trained surgeon, the science of hair transplant technology has evolved over the years into an art form. In the hands of a competent hair restoration surgeon, the results, once painfully obvious, are now nearly undetectable.

    Am I a Good Candidate for a Hair Transplant Procedure?

    In the Oct. 2021 Indian Journal of Plastic Surgery, Robert H. True, M.D., wrote: “A hair transplant can be performed for any person with sufficient hair loss, good donor area hair, a healthy scalp, in good general health, and who has reasonable expectations. When the hair transplant is done by a well-qualified, trained, and experienced surgeon, results are natural and enduring.”

    Historically, men have sought out hair restoration surgery more often than women. According to studies conducted by the International Society of Hair Restoration Surgery for its ISHRS 2022 Practice Census, of all hair restoration surgeries the prior year, 87% were performed on men and 13% were performed on women. However, as surgical techniques continue to advance, an increasing number of women suffering from hair loss are opting for surgical solutions.

    The most commonly cited cause leading people of all genders to opt for hair restoration surgery is patterned hair loss (alopecia) — male pattern hair loss or androgenic alopecia, and female pattern hair loss, although not every person who suffers from one of these conditions is a viable candidate for hair restoration surgery. Candidates who are precluded from hair restoration surgery have been identified as having one or more of the following physical conditions: diffuse unpatterned alopecia, cicatricial alopecia, unstable hair loss, or insufficient hair loss. 

    Additionally, patients deemed either too young or medically unfit for surgery will generally not be given the OK for the procedure until such time as their bodies have sufficiently matured or upon recovering their health and receiving the go-ahead from a physician. Likewise, people who harbor unrealistic expectations — and those with psychological issues, including body dysmorphic disorder or trichotillomania — are not considered appropriate candidates for hair restoration surgery.

    Dr. Sam Jejurikar Explains What To Expect From a Hair Restoration Consultation

    Hair restoration surgery is never a one-size-fits-all procedure. That’s why a patient’s initial consultation with a prospective surgeon is so important. If a doctor is only trained in one method of hair restoration surgery, be cautious. There are several surgical options available, and some are better suited to individual hair loss conditions than others.

    During your initial consultation, a surgeon should examine your scalp to determine the type and extent of your hair loss as well as your individual hair growth patterns. They should also gather information on your family hair loss history and obtain a thorough medical history background from you that includes information on any prior hair replacement treatments or surgery, any health conditions such as uncontrolled high blood pressure, blood clotting deficiencies, propensity for scarring, and any medications you’re taking (such as blood thinners) that might have adverse effects on surgery. Lifestyle factors, such as smoking and alcohol consumption, will likely also be taken into account.

    Finally, expect a prospective surgeon to discuss your recovery goals and expectations for your final hair restoration outcome. Dr. Jejurikar cautions that while there’s every reason to expect excellent results, you should be wary of surgeons who overpromise.

    The ‘Before’ and ‘After’ of Hair Restoration Surgery

    They say a picture is worth a thousand words, and when it comes to hair restoration surgery, that’s certainly the case. During your initial consultation with a prospective hair restoration professional, ask to see a gallery of before-and-after photos of their actual patients. Dr. Jejurikar says a reputable cosmetic surgeon will be only too happy to show you examples of their satisfied clientele. After all, pictures of positive outcomes speak for themselves.

    So You’ve Decided To Get Hair Restoration Surgery. What’s Next?

    Once you’re comfortable with a prospective surgeon, ask them to explain the planned procedure in detail. Find out which form of anesthesia will be used, and don’t be afraid to ask about any potential risks. Get an idea of how long your surgery will take and where it will be performed. Also, be clear about the cost of the procedure, including surgical personnel and facility costs, associated medications and dressings/bandages, and follow-up visits.

    And again, don’t be afraid to discuss your expectations to make sure that you and your surgeon are on the same page regarding your results.

    Dr. Sam Jejurikar on ‘Cutting Edge’ SmartGraft Technology

    Thanks to advanced technology, an alternative nonsurgical hair restoration solution called SmartGraft is now available for many patients for whom traditional surgery was once the only option. SmartGraft is a precise, minimally invasive procedure employing a special grafting device that extracts grafts from the donor site. The procedure can be performed in an outpatient setting in one office visit with very minor discomfort (although the length of the procedure will be governed by the extent of each patient’s hair loss and the desired thickness of new growth).

    Dr. Jejurikar reports other benefits of SmartGraft include little to no downtime, faster recovery, and quicker hair growth results. “Hair regrowth typically occurs in phases and your hair will likely shed during the first few weeks,” Dr. Jejurikar explained. “Most patients see a noticeable improvement within six months and full growth within 12 months of treatment.”

    Recovery From Traditional Hair Restoration Surgery

    After a traditional hair restoration operation, most patients report tenderness and pain in the scalp area. Surgeons generally prescribe pain medications to be taken for several days (or more) following surgery, and the affected area will be bandaged as well. Although most patients are able to return to work two to five days after the procedure, your doctor may also prescribe an antibiotic or anti-inflammatory medication to be taken over the course of several days and up to a week.

    While it’s disconcerting, be aware that two to three weeks post-op, your transplanted hair is going to fall out. Dr. Jejurikar says this is part of the normal shedding cycle and is no cause for concern. New hair growth is going to take a few months, so be patient. 

    What Makes a Qualified Hair Restoration Surgeon?

    In a statement on its website, the ISHRS has warned consumers to be wary of “the use of unlicensed technicians to perform aspects of hair restoration surgery, which should only be performed by a properly trained and licensed physician” because it “places patients at risk of: misdiagnosis; failure to diagnose hair disorders and related systemic diseases; and performance of unnecessary or ill-advised surgery, all of which jeopardizes patient safety and outcomes. There may also be a risk that unlicensed technicians may not be covered by malpractice insurance.”

    That’s why, first and foremost, Dr. Sam Jejurikar stresses that the hair restoration surgeon you select should be board-certified by the American Society of Plastic Surgeons (or in Canada by the Royal College of Physicians and Surgeons of Canada). Per the ASPS website, for a surgeon to obtain board certification they must: complete at least six years of surgical training following medical school, with a minimum of three years of plastic surgery residency training; pass comprehensive oral and written exams; graduate from an accredited medical school; complete continuing medical education, including patient safety, each year; and perform surgery in accredited, state-licensed or Medicare-certified surgical facilities.

    If a prospective surgeon doesn’t meet these qualifications and have the credential certificates to back up their claims, don’t risk putting your health and safety in their hands.

    Cosmetic Nose Surgeon Dr. Sam Jejurikar Knows Rhinoplasty ‘Inside and Out’

    rhinoplasty Dr. Sam Jejurikar

    While some people not be happy with the way their noses look, according to Texas-based cosmetic surgeon Dr. Sam Jejurikar — ranked by Newsweek as one of 2022’s Best Plastic Surgeons in America and respected as one of the finest “nose doctors” in Dallas — there’s a lot more to the human nose than appearance alone. 

    Rhinoplasty — more commonly known as a “nose job”— is a cosmetic surgical procedure that aims to enhance the appearance of the nose. However, many people don’t truly understand what it entails. Dr. Jejurikar notes there are quite a few misconceptions about rhinoplasty that he hopes to clear up for anyone considering getting one — and for those who might benefit from nose surgery who are unaware of some of its proven health benefits.

    Dr. Sam Jejurikar has made it his life’s mission to help anyone seeking cosmetic surgery. “It is intensely gratifying to help patients achieve their goals,” he told Inspirery. “Although every patient’s story is different, the impact of his or her life is dramatic and significant. Being able to help patients experience moments like this will never cease to be immensely satisfying.” 

    Dr. Sam Jejurikar’s Nose Surgery 101: Common Rhinoplasty Techniques

    Rhinoplasty is often performed as an outpatient procedure during which the patient is under general anesthesia. However, whether IV or general is used, it’s always performed in conjunction with a local anesthetic (a lidocaine/epinephrine mixture) to numb the area and reduce potential bleeding.

    There are two standard techniques for the procedure: open rhinoplasty and closed rhinoplasty. A closed (endonasal) rhinoplasty is performed entirely inside the patient’s nose via incisions made in the nostrils. The components requiring modification are pulled out and reshaped, then returned to the nasal bed. The internal incisions are closed with absorbable sutures, so there is no need to remove stitches at a later time and no external scarring.

    Open (external) rhinoplasty is needed when more visualization is required within the nose. To perform it, the surgeon makes a small trans-columellar (bridging) incision connecting incisions made to the right and left nostrils. The skin is then lifted to expose the internal nasal framework.

    Seeing directly inside the nose without disturbing its natural internal alignment (as happens with closed rhinoplasty) allows the surgeon to evaluate its individual structural components with a higher degree of accuracy. While some very limited scarring may result from open rhinoplasty, it greatly improves access and visibility, which may result in more symmetrical final results.

    “At your consultation appointment, you and Dr. Jejurikar will decide which of the two techniques is appropriate for your surgery,” states his website. “Either way, Dr. Jejurikar will gently lift the soft tissues covering the nose and sculpt the bone and cartilage into the desired shape, close the incision and apply a sterile dressing.”

    Dr. Sam Jejurikar Explains Some Unexpected Health Benefits of Rhinoplasty

    Aesthetics is the main reason people get nose jobs — but it’s certainly not the only reason. There’s no question looking good can boost self-esteem, which often goes a long way to making a patient feel better about themselves in general. However, nose surgery can also correct birth anomalies and damage caused by injuries that lead to breathing difficulties.

    The nose working in conjunction with the mouth is an essential part of the human respiratory system. Patients with narrow nasal passages or obstructions may experience restricted breathing, resulting in snoring/sleep apnea, shortness of breath, and other sinus issues. 

    Nose surgery that alleviates or even eliminates sinus problems (septoplasty) is often performed as an adjunct to traditional rhinoplasty. When successful, the result is improved breathing and better sleep quality, an essential component of overall good health that impacts everything from hypertension, cardiovascular disease, diabetes, stroke, and weight gain to fatigue and depression.

    Dr. Sam Jejurikar’s Nose Surgery Q&A

    Before considering a “nose job,” ask the following four questions:

    1. Won’t everyone know I’ve had a nose job? No. Those who know you best may notice a difference in your appearance, but a competent cosmetic surgeon will make your features appear natural. The only way people will know you’ve had a nose job is if you tell them.
    2. Is having a “Kardashian” nose guaranteed to make me beautiful? No. Cosmetic rhinoplasty is all about balance and symmetry. Balanced, symmetrical features are the benchmarks against which beauty standards are measured. While a Kardashian nose might look great on a Kardashian face, it’s not going to be the best fit for everyone. Dr. Jejurikar cautions that patients must have realistic expectations.
    3. Will getting a nose job change my voice? Strange but sometimes true: Rhinoplasty can actually alter the human voice. While such changes are not usually significant, they can be noticeable. It’s speculated this is the reason why singers with distinctive vocal stylings whose appearance might be enhanced by rhinoplasty may elect to forgo the procedure. 

    Dr. Sam Jejurikar Goes Post-Op: Need-to-Know Nose Surgery Recovery Facts

    According to Jejurikar’s website, after a procedure, “You may experience puffiness, nose ache or a dull headache, some swelling and bruising, bleeding or stuffiness. Most patients feel like themselves within two or three days and return to work within about a week.” It’s totally normal. 

    Swelling is treated with the application of ice per your surgeon’s instructions, and over-the-counter pain medications should offer adequate pain relief. However, common nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, diclofenac, and aspirin that may interfere with blood clotting should be avoided. The swelling usually subsides after about two weeks, although some residual puffiness may linger for up to six months. How much bruising a patient experiences is dependent on their skin sensitivity and the extent of the procedure. Look for bruising to last for up to 10 days. While not usually a cause for concern, Dr. Sam Jejurikar says if swelling or bruising seems abnormal, it’s always a good idea to check with your doctor to head off any potential complications and make sure the healing process is proceeding as it should.

    In general terms, rhinoplasty recovery is achieved at the six-month mark, although it can take up to a year for the underlying facial structure to recover its full strength and integrity. In the immediate aftermath of nose surgery, patients are advised to avoid strenuous activities, including exercise and sex. Blowing your nose, showering, wearing glasses, staying out in the sun, consuming alcohol, and smoking can all hinder recovery. To ensure optimum recovery, it’s always best to talk with your surgeon to establish a postoperative time line.

    Dr. Jejurikar’s No. 1 tip for post-nose-surgery recovery is to avoid situations where your nose might be injured. While it’s okay to fly a week after nose surgery, stay in your seat to avoid getting bumped and have someone else put your luggage in the overhead.

    How to Find a Great Nose Surgeon

    When selecting a surgeon to perform any cosmetic procedure — including rhinoplasty — it’s wise to heed the advice given by the American Board of Plastic Surgery (insert link). Always look for an experienced, board-certified surgeon who specializes in the procedure. Once you’ve established that, be sure to ask how long they’ve been a practicing plastic surgeon, and how many rhinoplasties have they performed. Question if they’ve ever been disciplined by the board or by the state. Check to see if there’s any reason you wouldn’t be a good candidate for a rhinoplasty and ask about their policy on revisions if you’re not happy with the results.

    Query where the surgery is going to take place — a hospital or surgery center, and if that location is accredited. Inquire about any hidden costs like lab work, postoperative care, or additional medications.

    A reputable surgeon will answer your questions freely and will willingly show you a portfolio of their before and after nose-surgery patients’ photos. Before any procedure, your surgeon must thoroughly check your medical history, including any medications you take, to avoid surgical complications. Dr. Sam Jejurikar says you should never let a doctor pressure you into something you’re not comfortable with. If something doesn’t feel right, find another surgeon.

    Texas Surgeon Dr. Sam Jejurikar’s Best Tips on How To Prepare for Your Mommy Makeover

    Are you thinking about getting a mommy makeover in Dallas, Texas? This rejuvenating plastic surgery procedure targets areas of the body affected by pregnancy to restore your pre-baby look and confidence. But not all mommy makeovers are the same. Mommy makeovers are composed of numerous and varying procedures, and not all of them deliver the same results. 

    To help you get the results you want, we’ve asked top surgeon Dr. Sam Jejurikar to answer a few key questions about the process, including how to prepare for the procedure and tips for a fast recovery. Dr. Jejurikar is a board-certified plastic surgeon who has been performing mommy makeovers in Dallas, Texas for over 25 years.

    What Is a Mommy Makeover?

    A mommy makeover is a combination of cosmetic surgery procedures that aim to restore a mom’s post-baby body to its pre-baby appearance. A mommy makeover may include a tummy tuck, a breast augmentation/reduction, or liposuction to reshape the areas of the body impacted by pregnancy. While there are multiple procedures involved, a mommy makeover can usually be performed in one surgery. That means just one day in the operating room and one recovery period, making it convenient for busy moms. 

    What Procedures Are Included in a Mommy Makeover?

    No two mommy makeovers are exactly alike because every mom’s body is different. Your mommy makeover may include two, three, or four different procedures, depending on your body, your needs, and your budget. The procedures usually included in a mommy makeover are a breast augmentation or reduction, a breast lift, a tummy tuck, and liposuction.

    How do you know which procedures you’ll need for your mommy makeover in Dallas? Your plastic surgeon will help you build the right mommy makeover for your body during a consultation.

    How To Prepare for Your Mommy Makeover

    What can you do to make your mommy makeover surgery go as smoothly as possible? Your doctor will do everything they can to turn back the clock on your body. But if you want to get the best results possible, there are a few things you should do in the weeks and months leading up to your procedure. 

    Follow a Pre-Makeover Diet

    Your body will require lots of healthy nutrients to fuel your postsurgical recovery, so you’ll need to build a foundation of nutrition before your mommy makeover. If you’ve been dieting, stop cutting calories and eat more protein, iron, healthy fats, and vegetables. If your diet consists of fast or processed foods, cut back on those unhealthy options and eat more real, whole foods like lean meat, fruit, vegetables, and whole grains.

    Stop Drinking Alcohol 

    This is an important one! Don’t consume any alcohol for two weeks before (and two weeks after) your mommy makeover surgery. Alcohol thins your blood, and even traces of it can cause bruising and bleeding during surgery. That could lead to a longer recovery, which nobody wants.

    Exercise Regularly  

    A mommy makeover is intended to go hand in hand with healthy lifestyle choices, the most important of these being to exercise regularly. Strengthening your core muscles, such as your abs, can help a tummy tuck show off your definition. Plus, losing some extra fat will make you appear much tighter and more toned after surgery. Don’t worry: You don’t have to do intense workouts before your mommy makeover in Dallas, Texas. It’s good enough to maintain a moderate exercise routine. 

    Quit Smoking

    Smoking — and all nicotine use — affects oxygen levels in the blood. Oxygen-rich blood flow is critical for recovery, and because a mommy makeover involves multiple procedures, it’s highly recommended to stop using nicotine for at least a month before surgery. If you use tobacco or nicotine products (including vapes), tell your doctor during your consultation. They’ll help you discuss quitting options. 

    Make a Recovery Plan

    You’ll need at least four weeks of rest after your surgery. During this time, you must be very careful in order to heal property. Too much stress or physical exertion can affect your results. Prepare your home and work life to accommodate your limited mobility. For example, you may want to set up the sofa bed in the living room to prevent having to take the stairs to the bedroom. Also, stock up on medication, entertainment (books, movies, etc.), and snacks that you can keep at arm’s reach. 

    Tips for a Faster Recovery Post-Mommy Makeover

    Recovery is the least appealing part of any surgery, but if you follow your doctor’s orders (and some of the tips below), you may recover a bit faster than expected. 

    • Take time off work: Most women take two to three weeks off work after surgery. 
    • Don’t do housework: Even simple chores will be too demanding for at least seven to 10 days.
    • Get someone to look after the kids: Make sure your children know you can’t pick them up or play for a few weeks.
    • Maintain a healthy diet: Stay hydrated and eat lots of recovery-friendly foods like fruit, vegetables, and lean protein. Avoid pro-inflammatory fried and processed foods.
    • Take short walks: Regularly stroll around the house to promote healthy circulation. 
    • Sleep on your back: After breast and tummy work, sleeping on your back is a must.
    • Get a toilet booster seat: This makes it easier to sit and stand after surgeries like lifts and tucks. 
    • Take all medication as advised: You might not like the idea of taking multiple medications, but each plays an important role in your recovery. 
    • Never miss a follow-up appointment: These appointments allow your doctor to gauge your recovery and update your recovery plan.

    Dallas Texas Surgeon Dr. Sam Jejurikar’s Career in Review 

    Dr. Sam Jejurikar is a plastic surgeon who specializes in reconstructive and aesthetic procedures. He’s well known for his mommy makeovers, which he has been performing for over 25 years from his practice at the renowned Dallas Plastic Surgery Institute.

    Dr. Jejurikar has been honored three consecutive years in D Magazine’s annual “Best Doctors and Pediatric Specialists in Dallas” list, and he was recently named among the Best Plastic Surgeons in America in 2022 by Newsweek and Statista. When he’s not in the operating room, he trades the scalpel for a microphone as the co-host of the popular medical podcast “3 Plastic Surgeons and a Microphone.” 

    Dr. Sam Jejurikar Answers Patients’ Top 10 Tummy Tuck Questions

    tummy tuck surgery 

    It’s part and parcel of mommy makeovers and is more in demand than ever, thanks to the pressures of social media and the washboard abs streaming on our TVs, but tummy tuck surgery, also known as abdominoplasty, is nothing new. The procedure — which is elective and aimed at improving the shape and appearance of the abdomen — was first performed in France in 1890. In 1899, Baltimore surgeon Dr. Kelly performed the first tummy tuck in the U.S. Since then, advances in medicine have transformed this surgery into a safe, streamlined procedure that, according to Dallas-based cosmetic surgeon Dr. Sam Jejurikar, has given the term “cutting edge” a whole new meaning. 

    What should I expect from tummy tuck surgery?

    According to the Mayo Clinic, people with excess fat and/or skin in the navel area, or those with a weakness in the lower abdominal wall, are common candidates for abdominoplasty. The surgery removes excess skin and fat from the abdomen. Using permanent sutures, the connective tissues in the abdomen are tightened as well. 

    Tummy tuck procedures generally take two to three hours and are performed in a hospital or outpatient surgical facility setting under general anesthesia. During the procedure, the plastic surgeon makes a horizontal, oval, or elliptical incision, depending on the amount of tissue to be removed, just above the pubic line. When the incision heals, the resulting scar runs along the natural skin crease of the bikini line. In addition to removing excess skin and fat and tightening the connective tissues, the surgeon pulls the belly button through a small incision, anchors it into its normal position with sutures, and then judiciously repositions the surrounding skin to achieve a firmer, more toned aesthetic.

    What are the benefits of tummy tuck surgery?

    The main reasons for undergoing a tummy tuck procedure are enhancing body image and boosting self-esteem. Feeling good about how we look has a definite correlation with our mental health.

    While body image concerns are relatively common and are not considered mental health issues per se, according to the U.K.’s Mental Health Foundation, such worries can signal risk factors for potential mental health problems. It reports: “Research has found that higher body dissatisfaction is associated with a poorer quality of life, psychological distress, and the risk of unhealthy eating behaviors and eating disorders.”

    In addition to improving self-esteem, tummy tucks also afford patients a host of other valuable health benefits.

    A tummy tuck can strengthen your abdominal muscles. Having a stronger core can improve flexibility, help alleviate lower back pain, improve posture, and ward off hernias.

    A tummy tuck may reduce the risk for certain medical conditions, including sleep apnea, diabetes, heart disease, and gallbladder disease.

    A tummy tuck can increase bodily function control and decrease urinary stress incontinence occurrences. Many factors lead to the loss of bowel or bladder control. Aging, multiple pregnancies, and significant weight loss can be all factors. These issues can be exacerbated by the presence of excess fat and skin in the abdomen. Removing extra skin and fat and tightening connective tissue in the abdomen can improve control over bodily functions and lessen involuntary urinary leaks.

    How long after a tummy tuck can I sleep on my stomach?

    The accepted rule of thumb is to avoid sleeping on your stomach for six weeks after undergoing tummy tuck surgery. This hiatus from stomach sleeping ensures the skin and muscles have adequate time to heal. However, each patient is different, and some may need to stay off their tummies longer than six weeks. It is highly recommended you discuss a postsurgical sleeping protocol with your doctor prior to the procedure. 

    What’s the best way to recuperate from a tummy tuck procedure?

    Recuperating from a tummy tuck takes time and proper care of the body. To facilitate a speedy recovery, I recommend the following: 

    Eat right and keep hydrated. High-protein foods benefit healing by boosting energy and promoting muscle growth. Conversely, foods with high sugar and sodium content can have a negative impact on the healing process and should be avoided. While patients who’ve undergone abdominoplasty experience swelling, drinking adequate amounts of water (eight glasses per day is recommended) reduces retention by flushing fluids from your system.

    Don’t overdo it. People are eager to dive back into their everyday routines after surgery, but this can be a mistake. Instead, ease gradually into daily activities, and if your body is giving you the warning to stop doing something, listen to it. In general, tummy tuck patients should refrain from pulling, pushing, bending, and lifting heavy objects for a minimum of six weeks after surgery.

    Look into lymphatic drainage massage. As the name implies, lymphatic drainage massage stimulates the body’s lymphatic system. This enhances its efficiency, speeding the removal of toxins, boosting immune response, and aiding in the overall healing process.

    What’s the difference between a tummy tuck and liposuction?

    As mentioned above, a tummy tuck is a surgical procedure performed under general anesthesia in a hospital or outpatient surgical setting. Liposuction is a much less invasive procedure that does not require a surgical incision and can be performed under a local anesthetic (although general is preferred). Abdominoplasty is strictly abdominal surgery, while liposuction can be performed on any area of the body where stubborn fatty deposits that resist traditional weight loss protocols occur, including the neck, thighs, back, and arms.

    During liposuction, no skin is removed, nor is fat surgically excised. Instead, a saline, water, and anesthesia solution is injected into the target area. A cannula is then inserted, and the fat is sucked out. Those considering either procedure should consult with a reputable cosmetic surgeon before proceeding to better understand which one best meets their needs.

    How soon is it safe to get a tummy tuck after pregnancy?

    Due to significant changes in the body, one of the most prevalent times women choose to get a tummy tuck is after pregnancy. It’s only natural to want to get back to your pre-baby body as soon as you can. However, some guidelines must be adhered to in order to safeguard a woman’s health and achieve the maximum benefits from the procedure. 

    Six months after giving birth is the earliest patients should schedule a tummy tuck. Moms who’ve undergone a C-section may have to wait longer (up to a year) and should discuss any potential surgery with their doctor. There are other factors that may make postponing a tummy tuck a good idea as well:

    Are you still breastfeeding? Breastfeeding influences hormonal changes in the body that can impact the healing process and influence weight fluctuations. It’s recommended to wait until three months after you finish breastfeeding before getting a tummy tuck.

    Has your weight stabilized? Weight gain during pregnancy is normal. Getting back or close to pre-baby weight can take time, and many moms experience postpartum weight fluctuations. While a tummy tuck will improve physical appearance, it’s not strictly intended to be a weight loss procedure. Tummy tucks are most effective when patients are at or near their ideal weight. 

    Do you plan to get pregnant again? The logic of this is pretty simple: Every pregnancy can result in additional stretching of tissues and added fat to the midsection, all of which can undo the good your tummy tuck has done. If you think there might be more kids in your future, putting off tummy tuck surgery is best until after welcoming your last blessed event.

    Can men get a tummy tuck?

    The simple answer to this question is, yes. Men can and do get tummy tucks — and are doing so in increasing numbers. That said, when it comes to tummy tucks, not all men are created equal. Some men make better candidates for this surgery than others. Dr. Jejurikar advises men interested in the procedure to discuss their expectations with a certified cosmetic surgeon to ensure their desired outcome is realistic.

    Can a tummy tuck be combined with other surgery?

    Yes. One of the most popular cosmetic procedures currently performed is what’s known as the “mommy makeover,” which can combine a tummy tuck with breast enhancement and/or liposuction. The upside of combined surgeries is that they require only one recovery period. However, that recovery period will likely be longer than that of a single procedure. Your overall health is the biggest factor in determining whether multiple procedures are viable and must be determined by a doctor on a case-by-case basis.

    Who should not get a tummy tuck?

    Tummy tucks work wonders for some — but they’re not for everyone. The Mayo Clinic cautions that prior to embarking on the procedure, potential patients should thoroughly discuss any of the following conditions or concerns they have with their surgeon:

    You plan to lose a significant amount of weight. A major weight loss can result in excess skin on the abdomen. It’s better to wait until weight goals are met before undertaking tummy tuck surgery.

    You have a severe chronic condition, such as heart disease or diabetes. While abdominoplasty may lessen these conditions, if you already have them, they can put you at greater risk during surgery, especially when a general anesthetic is involved. 

    You have a body mass index greater than 30. Again, while tummy tucks do result in weight loss, it is not considered weight loss surgery. Patients who fare best are at or close to their ideal body weight.

    You smoke. In general, smoking increases surgical risks. It’s not a hard-and-fast rule, but nonsmokers generally enjoy better surgical outcomes.

    You’ve had previous abdominal surgery that resulted in significant scar tissue. Excessive scar tissue can be a side effect of any abdominal surgical procedure. Some patients are more prone to it than others. If prior surgery indicates that’s the case, further procedures might not be in your best interest.

    How do I find a good tummy tuck surgeon in Dallas or elsewhere?

     The qualities that make a good tummy tuck surgeon in Dallas are the same no matter where the procedure is being performed. A good tummy tuck surgeon combines thorough medical knowledge with technical artistry. A good tummy tuck surgeon truly cares about their patients, listens to their concerns, and helps them arrive at realistic goals and expectations. A good tummy tuck surgeon always makes the health of their patients their highest priority — even if that sometimes means saying no to a procedure.

    First and foremost, those considering cosmetic surgery should seek out a doctor who, like me, is board-certified in plastic surgery by the American Society of Plastic Surgeons (ASPS). Only board-certified plastic surgeons have the education, training, and certification to perform cosmetic surgeries on the face, breasts, and body. Always verify your surgeon’s credentials and make sure they have experience in the procedure you’re interested in.

    Male Facelifts – a New Normal in Dallas Plastic Surgery

    Dr Sam Jejurikar Men's facelift

    Once strictly a woman’s privilege, plastic surgery for men is on the rise. More men than ever are seeking facial rejuvenation procedures, according to Dr. Sam Jejurikar, touted as one of the best plastic surgeons in Dallas.

    One of the most significant changes that have taken place in this area is that men are now talking to one another about their issues with aging. In the not-too-distant past, aging and how it can impact men was not something most men would openly discuss, and therefore, many options have not been available.

    As social mores have changed so much in recent years, the facts have become clear, with men being encouraged to open up and talk about the physical changes that occur with aging. Men care about how they look and want options to combat the physical changes of aging.

    The commonly accepted idea that the more rugged and weather-beaten a man appeared, the more manly he is, is now a thing of the past. Many men who want to look younger and feel better about themselves are seeking facelifts at an increasing rate.

    What Happens During a Facelift for Men?

    Men's facelift Dr. Sam Jejurikar

    As men age, the tissues which control facial expression, the SMAS (Superficial Muscular Aponeurotic System), become lax and weak, beginning to sag. This sagging causes jowls to form, cheeks to hollow and deep creases to appear along the corners of the mouth and down the side of the nose. A SMAS facelift adjusts and mends this wear and tear, correcting sagging jowls and filling out hollow cheeks and deep creases.

    The procedure is performed under general anesthesia or with IV sedation.

    During the operation, incisions are made through all three facial and neck skin layers. The layers are then lifted in an upwards motion, with tension being placed on the underlying SMAS layer. Any excess fat is trimmed, and the SMAS is then sutured.

    A highly skilled surgeon, such as Dallas-based Dr. Sam Jejurikar, understands the minute differences in facial anatomy present in various patients. No two candidates are the same, and all patients are treated as individual cases, demonstrated by the excellent results he is famed for.

    Are Men’s Facelifts Different From Women’s?

    men and women facelift

    Absolutely. The male anatomy is different from that of the female, so the procedure must be approached distinctively for it to succeed.

    Men have thicker skin and muscle than women, which needs to be accounted for during surgery so that the overall appearance of the face is as natural as possible.

    The incisions made during surgery on a male are also different, mainly due to the fact that men have beard growth. In women, the main incision passes behind the ear’s tragus to conceal the scar. In men, the incision is positioned in front of the tragus so that any skin with hair on it won’t be drawn over the tragus and inside the ear.

    Can Men’s Facelifts Have Practical Benefits?

    The effects of a good facelift aren’t just aesthetic; a facelift can also greatly improve self-confidence and eliminate or lessen debilitating feelings of low self-esteem.

    This, in turn, can bring about genuine change in the lives of men who have undergone surgery. Relationships improve, and romantic social and professional opportunities may also increase as self-confidence is directly linked to how others perceive us.

    What About Post-Operative Care?

    The recovery from a procedure like this will generally take around 2- 3 weeks.

    • Some swelling, bruising, and numbness are completely normal and to be expected.
    • Bruising can last a little longer but, in general, should be completely resolved after around three weeks.
    • Patients need to rest and take things easy after their operation.

    Are There Any Complications to Consider?

    Facelift surgery for men is usually safe, but as with all surgery, it is important to understand the possible risks. The best candidates are men over 50 who are in good health and do not smoke.

    Smoking can increase the risk of infection in postoperative patients and slow healing. To ensure the best possible recovery, patients must listen carefully to the advice given by their surgeon.

    Seeking the Best To Achieve the Finest Results

    A facelift can easily knock a decade or more off a person’s face, especially if the procedure is performed by an experienced doctor who has been touted as one of the best plastic surgeons by Newsweek and D Magazine. Dr. Sam Jejurikar, of Dallas, Texas, has been practicing for over 20 years, is board-certified by the American Board of Plastic Surgery, and is a member of the renowned Dallas Plastic Surgery Institute.

    About Dr. Sam Jejurikar

    Discover Dallas Best Plastic Surgeon | Sam Jejurikar MD

    Dr. Sam Jejurikar has twice been named in D Magazine’s annual “Best Doctors and Pediatric Specialists in Dallas” list, and in August of this year, he was honored as a top plastic surgeon in Newsweek’s rankings of America’s Best Plastic Surgeons.

    After earning his undergraduate degree at the University of Michigan as a member of the Alpha Omega Alpha Honor Society, Dr. Jejurikar undertook a residency in plastic surgery at the University of Michigan Hospitals and Health Centers.

    Further training at the renowned Manhattan Eye, Ear, and Throat Hospital with a sub-speciality in aesthetic surgery followed, and more recently, Dr. Jejurikar earned his Executive MBA from SMU Cox School of Business.

    Dr. Sam Jejurikar currently serves as an active member of the American Society of Plastic Surgeons, the American Society for Aesthetic Plastic Surgery, the Dallas Society of Plastic Surgeons, and the American Medical Association.

    With philanthropic beliefs strongly informing his work, Dr. Sam Jejurikar regularly participates in medical missions. This includes an annual trip to treat impoverished children with Smile Bangladesh.

    If you want to hear the latest from Dr. Sam Jejurikar himself, he runs a podcast where he discusses the latest in plastic surgery, media trends, and what being an actual plastic surgeon is like. Hear the latest below:

    [podcastplayer feed_url=’’]

    What’s new in breast augmentation?

    Much like everything else in life, technology and techniques are constantly changing in plastic surgery. With the advent of new products, plastic surgeons can refine and improve the procedures they offer patients. This is particularly true with breast augmentation, which has evolved considerably in the past few years. So, what’s new you ask?

    The biggest changes involve improvements in breast implant gel and breast implant shells. Although silicone implants have been around for years, not all silicone implants are the same. The earliest silicone implants consisted of a mostly liquid silicone covered by a relatively wispy shell. Not surprisingly, these implants tended to leak, either from the breast implant shell rupturing or from silicone gel bleed, which occurred when silicone gel would leak through the breast implant shell to the surrounding tissue. When this happened, patients were plagued with severe pain, not to mention hard and deformed breasts. The problems were so bad that the Food and Drug Administration (FDA) removed silicone breast implants from the United States market in 1992. The implants remained available elsewhere in the world, however, and scientists and plastic surgeons worked diligently to improve them. The first change consisted of making the silicone gel material within the implant more cohesive, meaning the gel became stickier and thicker. The other substantial change involved improving the implant shell so that the implants were less likely to rupture and less likely to leak. The results of these changes were an improving safety profile throughout the world. Because of this, as well as numerous clinical trials conducted in the U.S., The FDA allowed silicone gel implants back on the market in 2006.

    Since then, breast implant technology has continued to improve. In 2013, the FDA approved the first of the cohesive gel implants that are most commonly used today. These are commonly called gummy bear implants, because they feel remarkably like the candy. Safety data from these implants are promising because, not only do these implants give the best aesthetic results for patients, but they are less likely to result in capsular contracture than other commonly used silicone and saline implants. Depending on the feel desired by patients, implants manufactures have even varied the cohesivity of implants. Allergan, for instance, offers a relaxed, soft touch (intermediate) and more cohesive implants. These options not only allow plastic surgeons to get better results than ever before, but to customize these results more than ever before to the preference of their patients.

    Other big advancements have come in the fight to prevent capsular contracture, which is one of the worst complications that can happen with breast augmentation. Capsular contracture essentially is pathologic scar tissue build up around a breast implant, resulting in painful, hard and deformed breasts. Usually, surgery is required to fix this problem when it develops, so prevention is obviously of paramount importance. It’s thought that capsular contracture is the result of subacute bacterial infection.

    The Keller Funnel is a device most plastic surgeons believe will reduce the incidence of capsular contracture. The Keller funnel essentially functions as a condom for breast implants; the implant is completely sheathed in the funnel as it passes through the skin into the breast pocket. Once in the appropriate location, the breast implant can be squeezed out of the funnel into the breast, never having touched the patient’s skin. With no skin contact, the chances of contaminating the implant with even a small number of bacteria is reduced, theoretically diminishing the likelihood of capsular contracture.

    Another way to reduce the incidence of capsular contracture is through antibiotic solutions which bathe the breast pocket and the implant prior to insertion into the patient. Compelling data has demonstrated that the combination of three antibiotics (cefazolin, bacitracin, gentamycin), with the addition of an iodine containing solution markedly reduce bacterial biofilm around implants. This should also lessen the likelihood for bacterial colonization of a breast implant, thereby lessening the likelihood of capsular contracture.

    Finally, preoperative doctor-patient communication has been significantly improved with the advent of three-dimensional imaging. Dr. Jejurikar finds that it’s relatively simple to create an accurate 3D rendering of a patient and then use that rendering to point out relevant anatomy to patients. Patients can see differences in size and symmetry from all angles and then better understand the rationale behind using different sized implants or recommending a breast lift. In addition, it is possible to simulate a breast augmentation on these 3D models with varying sized implants, tremendously helping with the process of preoperative implant selection.

    Obviously, innovative technology and implants must be used in concert with good surgical judgment and technique. If you’d like to learn more about breast augmentation consult with Dr. Jejurikar, please do not hesitate to contact our office to set up a consultation. If you’d like to submit photos prior to your consultation to create your every own 3D rendering, follow this link.


    Skin lightening without hydroquinone

    Recently, the state of Texas banned the dispensing of hydroquinone, the most popular skin bleaching cream, in concentrations of 4% of more, because of safety concerns. Hydroquinone had been used by many patients in pre-surgical and post-surgical therapy, as well as by many patients as part of their skin care reigmen. So what are patient’s to do?

    Elure™ Advanced Skin Lightening Technology ( is a new topical cosmetic product available at EpiCentre Park Lane and EpiCentre Legacy. The appearance improvement provided by elure is based on a patented natural enzyme, known as Melanozyme™, which temporarily reduces the dark-colored pigment in your skin. In several clinical studies, elure produced a brighter and more even toned skin appearance for most subjects in just 28 days. Elure™ does not contain hydroquinone. Early results with this product have been quite promising.

    To learn more, contact Dr. Jejurikar’s office at 214-827-2814.



    Our Location Dallas Plastic Surgery Institute

    9101 N. Central Expwy.
    Suite 600, Dallas, TX 75231
    Tel: 214.827.2814
    Dallas | Dr. Jejurikar

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