The Omnilux Mask: What It Does, The Science Behind It, and How I Use It

The Omnilux Mask: What It Does, The Science Behind It, and How I Use It

The Omnilux Mask has become a standout tool in skincare, offering an easy, effective way to rejuvenate skin, minimize fine lines, and promote overall skin health—all from the comfort of your home. As a plastic surgeon, I’m always on the lookout for non-invasive solutions that complement professional treatments, and the Omnilux Mask has become a personal favorite. Not only do I use it regularly, but I’ve also seen its benefits firsthand for my patients.

I got my Omnilux Mask, along with all my skincare products, from the expert team at EpiCentre Skin Care and Laser Center, where their knowledgeable aestheticians created a personalized skincare plan tailored just for me.


What is the Omnilux Mask?

The Omnilux Mask is an FDA-cleared light therapy device that uses LED light to improve skin quality, reduce inflammation, and promote healing. Designed for at-home use, the mask delivers specific wavelengths of light that target a variety of skin concerns.


How Does It Work?

The mask uses LED light therapy, a technology supported by extensive clinical research. Depending on the wavelengths, the Omnilux Mask delivers a variety of benefits:

  • Red Light (633nm): Boosts collagen production, reduces fine lines, and calms inflammation for smoother, more youthful-looking skin.
  • Near-Infrared Light (830nm): Penetrates deeply to accelerate tissue repair, making it particularly effective for post-surgical recovery or improving skin elasticity.
  • Blue Light (415nm, available in some versions): Targets acne-causing bacteria, improving clarity and reducing breakouts.

What Does the Science Say?

LED light therapy is backed by robust scientific evidence. Here’s what studies have shown:

  1. Improved Collagen Production: Red light stimulates fibroblasts, leading to increased collagen and elastin.
  2. Reduced Inflammation: Red and near-infrared light reduce redness and irritation, making it ideal for sensitive or healing skin.
  3. Enhanced Healing: Light therapy accelerates cell repair and regeneration, which is why it’s often used in post-surgical care.
  4. Acne Reduction: Blue light effectively kills acne-causing bacteria, reducing the frequency and severity of breakouts.

How I Use the Omnilux Mask

The Omnilux Mask has become a regular part of my skincare routine, as well as my wife’s. Here’s how we incorporate it:

  1. Regular Use: We use the mask 3-4 times a week to keep our skin healthy and radiant.
  2. Post-Treatment Recovery: After professional treatments or procedures, we use the mask to calm redness and speed up healing.
  3. Personalized Skincare Plan: Our skincare regimen—including the Omnilux Mask—was developed in collaboration with the skilled aestheticians at EpiCentre Skin Care and Laser Center. They recommended the mask and selected products that work perfectly for our differing skin’s needs.

Why EpiCentre Skin Care and Laser Center?

When it comes to skincare, there’s no one-size-fits-all solution. That’s why I trust the aestheticians at EpiCentre Skin Care and Laser Center. Their expertise ensures that every patient receives an individualized plan tailored to their specific goals. Whether you’re interested in the Omnilux Mask, professional treatments, or finding the right products, their team can guide you toward healthier, more radiant skin.

In fact, I purchased my Omnilux Mask and all my skincare products from EpiCentre Skin Care and Laser Center. Their personalized approach is unmatched, and I recommend them to anyone serious about achieving and maintaining great skin.


Interested in the Omnilux Mask?

If you’d like to learn more about the Omnilux Mask or are ready to create your own personalized skincare plan, I highly recommend reaching out to the team at EpiCentre Skin Care and Laser Center. Their expert guidance and professional-grade products can help you achieve your skincare goals.

Visit EpiCentre Skin Care and Laser Center’s website to explore their services and schedule a consultation today!


Final Thoughts

The Omnilux Mask is a fantastic addition to any skincare routine, whether you’re recovering from a procedure or simply looking to keep your skin glowing. Combined with a personalized plan from EpiCentre Skin Care and Laser Center, it’s an excellent way to optimize your skin health.

Let’s work together to keep your skin looking and feeling its best!

Motiva Implants: An Exciting New Option for Breast Augmentation in Dallas

Breast augmentation has advanced significantly in recent years, and for women seeking a natural look and feel, Motiva implants are among the most exciting options available. Recently approved by the FDA in late September, these implants combine cutting-edge technology, safety, and aesthetics, making them a fantastic choice for patients.

At our Dallas practice, we are proud to offer Motiva implants, bringing the latest advancements in implant technology to our patients. While new to the U.S. market, these implants have been used internationally for years, and our team has significant experience using them to deliver exceptional results.


What Sets Motiva Implants Apart?

Motiva implants are designed to provide both aesthetic and functional benefits, making them particularly appealing to women who desire a natural enhancement. Their innovative features, including Ergonomix technology and a unique surface design, help patients achieve their goals with confidence.


1. Ergonomix Technology for a Natural Look and Feel

Motiva’s Ergonomix implants use a special viscoelastic gel that mimics the movement and texture of natural breast tissue.

  • Natural Movement: The implants adapt to body position, creating a teardrop shape when standing and a rounder contour when lying down.
  • Soft and Supple Feel: The advanced gel provides a softness and pliability that closely resembles natural breast tissue.

For patients prioritizing a natural appearance, Motiva implants are a standout choice.


2. Low Capsular Contracture Rate

One of the most important benefits of Motiva implants is their low rate of capsular contracture. Capsular contracture occurs when scar tissue forms around the implant, causing it to harden or distort.

Motiva’s SilkSurface™ technology enhances biocompatibility, which:

  • Reduces the risk of capsular contracture.
  • Promotes smooth integration with the body’s tissues.

This advanced surface design not only improves safety but also opens the door to surgical techniques that may not be ideal for other implants.


3. Subfascial Augmentation: Quicker Recovery and Natural Results

Motiva implants are particularly well-suited for subfascial placement, a surgical technique where the implant is placed beneath the fascia (a thin layer of connective tissue) but above the chest muscle.

The Benefits of Subfascial Placement:

  1. Faster Recovery:
    Subfascial augmentation avoids disrupting the chest muscles, leading to less pain, swelling, and downtime compared to submuscular placement. Patients often return to their normal routines more quickly.
  2. Natural Appearance:
    The fascia layer provides a natural, supportive covering for the implant, allowing it to settle seamlessly within the breast. Combined with Motiva’s ergonomic properties, this placement creates a smooth, natural-looking contour.
  3. Preservation of Muscle Function:
    Because the chest muscles are left untouched, patients avoid muscle-related complications like distortion during arm movements or exercise, which can occur with submuscular placement.
  4. Reduced Animation Deformity:
    Unlike submuscular implants, which can move unnaturally with muscle contraction, subfascial implants remain stable, ensuring consistent results whether at rest or in motion.
  5. Safety and Durability:
    Motiva’s low capsular contracture rate makes subfascial placement a safe, durable option that reduces the risk of complications over time.

By combining Motiva implants with the subfascial technique, our practice is able to deliver results that are not only beautiful but also comfortable and long-lasting.


Motiva’s FDA Approval and Advanced Technology

While Motiva implants were only recently FDA-approved in the U.S., they have been widely used internationally with an excellent track record. Their advanced features, including the viscoelastic gel and SilkSurface™ technology, set a new standard for breast implant safety and aesthetics.

We are proud to offer these cutting-edge implants at our Dallas office, ensuring patients can benefit from the latest advancements in breast augmentation.


Why Choose Motiva Implants in Dallas?

At our practice, we prioritize delivering personalized care and exceptional results. Motiva implants allow us to provide patients with:

  • A natural look and feel that closely mimics natural breast tissue.
  • Faster recovery times thanks to subfascial augmentation.
  • The peace of mind that comes with advanced, FDA-approved technology.

Our team’s experience with Motiva implants and the subfascial technique ensures that each patient’s procedure is tailored to their unique anatomy and aesthetic goals. Whether you’re seeking a subtle enhancement or a more dramatic transformation, we’re here to guide you every step of the way.


Schedule Your Consultation

If you’re considering Motiva implants for your breast augmentation in Dallas, we invite you to schedule a consultation with our team. We’ll discuss your goals, explain your options, and develop a personalized treatment plan designed to help you look and feel your best.

Let’s achieve your aesthetic goals with the most advanced implants and techniques available today!

Optimizing Facelift Recovery with Hyperbaric Oxygen Therapy (HBOT)

Facelift recovery is as important as the surgery itself when it comes to achieving the refreshed, youthful look patients desire. Over the years, we’ve seen many patients inquiring about ways to enhance their recovery, and one trend we’ve noticed gaining traction is Hyperbaric Oxygen Therapy (HBOT). Many patients have started exploring this option on their own, and we’ve had the opportunity to witness the remarkable benefits it can bring to the healing process.

While HBOT isn’t a requirement for recovery, it can be an excellent way to optimize your results and make the recovery journey smoother and more comfortable.

What is Hyperbaric Oxygen Therapy?
For those who might be unfamiliar, HBOT involves breathing pure oxygen in a pressurized environment. This process delivers increased levels of oxygen to your bloodstream and tissues, which can help with healing, reducing inflammation, and enhancing overall recovery.

What We’ve Observed
Patients who’ve incorporated HBOT into their facelift recovery often report noticeable improvements, including:

  • Faster healing of incisions: Enhanced oxygen delivery promotes tissue repair, helping wounds close more quickly and cleanly.
  • Reduced swelling and bruising: Many patients tell us that their swelling subsides faster with HBOT, and bruises fade more quickly.
  • Improved skin health: Beyond the surgical results, patients often notice that their skin feels more vibrant and rejuvenated.
  • Enhanced overall recovery experience: Patients frequently describe feeling like their recovery process is more seamless and less uncomfortable.
  • We’ve personally seen these benefits in patients who choose to include HBOT in their recovery plan, and it’s been exciting to hear their positive feedback.

Why Consider HBOT?
While it’s not essential, HBOT can optimize your recovery in several ways:

  • It provides your healing tissues with the oxygen they need to repair and regenerate efficiently.
  • It helps with inflammation and fluid buildup, which can make your recovery feel smoother and help you get back to normal activities sooner.
  • It supports your overall skin health and may enhance the final look of your results.
  • For patients who are looking for ways to maximize their recovery and results, HBOT is a great option to explore.

A Recovery That Works for You
Every patient is different, and the recovery process is highly individualized. Whether you’re interested in exploring HBOT or prefer to stick to the basics, the most important thing is following the plan that works best for you. We’re here to help guide you every step of the way and ensure you feel confident in your recovery journey.

If you’d like to learn more about how HBOT could fit into your facelift recovery or have questions about optimizing your healing process, don’t hesitate to reach out to us. We’d be happy to share more about what we’ve seen and how it could benefit you.

Contact us if you want to know more!

We’re here to help you achieve the best results possible from your facelift—and enjoy every step of the journey!

Dr. Sam Jejurikar Appointed Contributing Editor of Plastic and Reconstructive Surgery

We are thrilled to announce that Dr. Sam Jejurikar has been named a contributing editor for Plastic and Reconstructive Surgery (PRS), the premier peer-reviewed journal in the field of plastic surgery. This prestigious appointment is a testament to Dr. Jejurikar’s dedication to advancing the art and science of plastic surgery, as well as his commitment to excellence in patient care, research, and education.

As the leading publication in the specialty, PRS serves as a critical platform for sharing groundbreaking research, innovative techniques, and thought leadership in plastic surgery. Becoming a contributing editor is a highly selective honor, reflecting Dr. Jejurikar’s expertise and his contributions to the field.

About Plastic and Reconstructive Surgery

Published by the American Society of Plastic Surgeons (ASPS), PRS is recognized globally as the authoritative source for information on plastic surgery, featuring original articles, reviews, and clinical updates that influence the practice of plastic surgeons worldwide. Contributing editors are entrusted with shaping the journal’s content by ensuring it meets the highest standards of accuracy, relevance, and scientific rigor.

Dr. Jejurikar’s Vision

Dr. Jejurikar’s appointment as a contributing editor represents an exciting opportunity to help steer the direction of plastic surgery advancements. His extensive clinical experience in both aesthetic and reconstructive surgery, combined with his passion for education, uniquely positions him to contribute valuable insights to the journal’s editorial process.

Reflecting on this honor, Dr. Jejurikar shared:
“It’s a privilege to contribute to Plastic and Reconstructive Surgery as part of its editorial team. This journal has been instrumental in shaping my career and the careers of countless surgeons around the world. I look forward to supporting its mission to elevate the practice of plastic surgery and inspire the next generation of surgeons.”

A Commitment to Excellence

Dr. Jejurikar’s patients and peers know him for his meticulous attention to detail, innovative approaches, and compassionate care. These same qualities will now guide his editorial contributions, helping to ensure that PRS continues to set the standard for plastic surgery research and education.

Please join us in congratulating Dr. Jejurikar on this remarkable achievement. His role as a contributing editor underscores his commitment to staying at the forefront of the specialty and advancing the practice of plastic surgery for the benefit of patients and practitioners alike.

Stay tuned for more updates as Dr. Jejurikar embarks on this exciting new chapter in his career!

Dr. Sam Jejurikar named among Newsweek’s best plastic surgeons in America for the third straight year

We Are Pleased to Announce: Dr. Sam Jejurikar Named Among America’s Best Plastic Surgeons

We are thrilled to announce that Dr. Sam Jejurikar has been included in Newsweek’s prestigious list of America’s Best Plastic Surgeons for the third consecutive year. This recognition highlights Dr. Jejurikar’s expertise in rhinoplasty and liposuction, as well as his unwavering commitment to delivering exceptional care and transformative results for his patients.

Compiled in collaboration with Statista, Newsweek’s rankings identify the top 150 plastic surgeons in the country across five categories: breast augmentation, liposuction, facelift, rhinoplasty, and eyelid surgery. Dr. Jejurikar’s inclusion in the top tier for rhinoplasty and liposuction underscores his skill in these highly specialized procedures and reflects the trust he has earned from patients and peers alike.

With the continued growth of elective plastic surgery, now more than ever, patients rely on trusted resources to find the best surgeons. Newsweek’s rankings aim to guide individuals in making informed decisions, and we are proud that Dr. Jejurikar has been recognized among the best in the field. You can view the full Newsweek America’s Best Plastic Surgeons list here.


Advancing Excellence in Plastic Surgery

Dr. Jejurikar’s expertise and dedication to patient care have made him a trusted name in Dallas and beyond. His meticulous approach to complex procedures, such as rhinoplasty and liposuction, ensures natural, transformative results that enhance both appearance and confidence.

This honor reaffirms his commitment to staying at the forefront of advancements in plastic surgery, combining technical skill with personalized care to deliver the highest standard of outcomes.


About Our Practice

At our practice, we are proud to offer cutting-edge procedures tailored to meet each patient’s unique goals. Dr. Jejurikar and our team prioritize patient safety, satisfaction, and innovation, ensuring that every individual receives the exceptional care they deserve.

If you are considering plastic surgery and want to learn more about our services, contact our office or schedule a consultation today. We look forward to helping you achieve your aesthetic goals with confidence.


We are honored to celebrate Dr. Jejurikar’s well-deserved recognition and look forward to continuing to provide unparalleled care for all our patients.

Exploring the New Motiva Implants: Natural Results and Advanced Safety

Exploring the New Motiva Implants: Natural Results and Advanced Safety

When it comes to breast augmentation, patients and surgeons alike are always looking for innovations that prioritize safety, aesthetics, and comfort. Motiva Implants are the latest advancement in breast implant technology, offering natural-looking results, reduced risk of complications, and groundbreaking designs like the Ergonomix implant. Here’s what makes Motiva Implants a game-changer in the world of breast aesthetics.


What Are Motiva Implants?

Motiva Implants are a next-generation line of silicone breast implants designed with cutting-edge technology to improve both aesthetic outcomes and patient safety. They feature a specialized silicone gel that mimics natural breast tissue and adapt to the body’s natural movement. This unique approach creates a soft, natural appearance while minimizing common complications associated with traditional implants.

Motiva offers various implant styles to cater to individual preferences and body types, with the Motiva Ergonomix implant being particularly noteworthy for its ability to achieve exceptionally natural results.


Why Surgeons and Patients Are Choosing Motiva Implants

1. Low Rates of Capsular Contracture

One of the most common complications in breast augmentation is capsular contracture, where scar tissue around the implant tightens, leading to discomfort and changes in breast appearance. Motiva’s advanced SmoothSilk®/SilkSurface® technology creates a uniquely smooth implant surface designed to reduce irritation and inflammation, significantly lowering the risk of capsular contracture.
Clinical studies have shown that Motiva Implants are associated with capsular contracture rates as low as 1%, compared to rates of 10% or more in traditional implants. This makes Motiva a compelling choice for patients focused on safety and long-term results.


2. Natural Results with Ergonomix

The Motiva Ergonomix implant is specifically engineered to mimic the look, feel, and movement of natural breast tissue. These implants feature a progressive gel that shifts with body positioning—appearing fuller when standing and more natural when lying down, similar to how real breast tissue behaves.

This dynamic behavior, combined with the implant’s soft texture, makes Ergonomix implants ideal for patients seeking subtle, natural-looking enhancements. Whether for primary breast augmentation or reconstruction, the Ergonomix line delivers results that seamlessly integrate with the patient’s natural anatomy.


3. Comprehensive Safety Features

Motiva Implants aren’t just about aesthetics—they prioritize patient safety with innovative features:

  • BluSeal® Technology: A visual indicator that ensures the implant shell is intact and minimizes silicone gel leakage risks.
  • TrueMonobloc® Design: Improves implant durability and strength without compromising softness.
  • Q Inside Safety Technology®: An optional feature that embeds a micro-transponder within the implant, allowing surgeons to access implant details safely and securely without invasive procedures.

Is Motiva Right for You?

Motiva Implants are an excellent option for patients seeking a natural, aesthetically pleasing result with reduced risks of complications like capsular contracture. The variety of implant sizes, shapes, and features—like Ergonomix—ensure a personalized fit for each patient’s needs and goals.

As with any procedure, it’s essential to consult with an experienced plastic surgeon to determine whether Motiva Implants are the best choice for you. Your surgeon will assess your goals, body type, and medical history to create a plan that delivers safe and beautiful results.


Final Thoughts

Motiva Implants represent a new era in breast augmentation, combining natural aesthetics with advanced safety features. With their low capsular contracture rates, dynamic movement, and cutting-edge technology, Motiva Implants provide a unique and innovative solution for patients looking to enhance their appearance with confidence.

If you’re considering breast augmentation and want to learn more about Motiva Implants, including the Ergonomix line, schedule a consultation with our office. We’re here to guide you every step of the way toward achieving your aesthetic goals.

Understanding Animation Deformity and How Subfascial Breast Augmentation and Motiva Implants Can Help

What Is Animation Deformity?

Animation deformity is a condition that can occur after breast augmentation surgery, specifically in cases where the implants are placed under the chest muscle, known as submuscular placement. This condition is characterized by an unnatural movement or distortion of the breasts when the chest muscles, particularly the pectorals, contract. For example, during activities such as flexing the pectoral muscles or engaging in physical exercise, the breasts may appear to shift or distort in an awkward way.

For many patients, animation deformity can be more than just a cosmetic concern. It may also cause physical discomfort, especially during activities that involve muscle contractions like lifting weights or other forms of intense exercise. This can be especially troubling for individuals who are physically active or those who engage in regular workouts.

Preventing Animation Deformity: The Role of Subfascial Breast Augmentation

One promising solution to prevent animation deformity is subfascial breast augmentation. This innovative surgical approach involves placing the breast implant beneath the fascia (a thin layer of connective tissue) that covers the chest muscle, but above the muscle itself. This method is distinct from traditional submuscular placement, where the implant is placed directly under the muscle.

Subfascial augmentation offers a number of important benefits, including:

  1. Natural Aesthetics: The implant’s position in the subfascial plane reduces the interference of the chest muscle, helping to preserve a smooth, natural contour of the breast. This placement minimizes the likelihood of the breasts looking distorted or moving unnaturally when the muscles contract.
  2. Reduced Risk of Animation Deformity: Because the implant is not placed directly under the muscle, there is no risk of it being pushed or distorted during muscle contractions. This makes subfascial placement an ideal option for those who are active and engage in exercises that involve significant muscle movement.
  3. Improved Comfort: Patients who have had submuscular implants sometimes experience discomfort during physical activity due to the pressure placed on the chest muscle. Subfascial placement, however, eliminates this discomfort, providing a more comfortable experience for the patient, especially during exercise.

The Advantages of Motiva Breast Implants

Motiva breast implants are a leading option in the world of breast augmentation, known for their advanced technology and high patient satisfaction. These implants have been increasingly popular around the globe, and their recent approval for use in the United States has made them an even more attractive choice for patients seeking breast augmentation with subfascial placement.

Here are some of the key features that make Motiva implants stand out:

  1. Advanced Silicone Gel: Motiva implants are filled with ProgressiveGel™ Plus or ProgressiveGel™ Ultima, which are designed to closely mimic the natural look and feel of breast tissue. These gels provide a soft, natural feel that enhances both the appearance and the tactile experience of the breasts.
  2. Dynamic Surface Technology: Motiva implants are equipped with a textured surface designed to improve tissue integration, helping the implant stay securely in place while reducing the risk of complications such as capsular contracture, a common issue where the scar tissue around the implant tightens and hardens.
  3. Ergonomic Shape: The ergonomic shape of Motiva implants allows them to adapt to the natural movements of the body, making them look and feel more natural. This dynamic design enhances both the aesthetic and functional benefits of breast augmentation, especially for patients who lead active lifestyles.
  4. Microchip Technology: Some Motiva implants are equipped with Q Inside Safety Technology™, a unique microchip embedded in the implant. This allows for non-invasive verification of the implant’s information, providing patients and surgeons with a higher level of safety and peace of mind.

Global Success and US Approval

Motiva implants have been used successfully in Europe, Latin America, and Asia for several years, gaining widespread trust among both surgeons and patients. Studies have shown that Motiva implants tend to have fewer complications and offer superior outcomes compared to traditional breast implants. The FDA’s recent approval of Motiva implants for use in the United States allows American patients to benefit from the same innovative design and excellent results that have made Motiva a trusted name in breast augmentation worldwide.

Why Consider Subfascial Augmentation with Motiva Implants?

For individuals concerned about animation deformity or those seeking a more natural and long-lasting result, subfascial breast augmentation with Motiva implants offers an excellent option. This combination provides:

  • Aesthetic enhancement with a natural appearance and minimal risk of distortion during muscle contractions.
  • Enhanced comfort during exercise and daily activities, as the subfascial placement eliminates discomfort associated with muscle pressure.
  • Access to cutting-edge implant technology, designed to offer superior results and fewer complications compared to traditional breast implants.

Conclusion

Animation deformity can be a major concern for individuals who have undergone breast augmentation with submuscular implants, particularly for those with active lifestyles. Subfascial breast augmentation offers a modern solution that minimizes the risk of this deformity while providing natural, aesthetically pleasing results. When combined with the advanced technology of Motiva implants, this approach ensures that patients not only achieve their desired look but also experience improved comfort and fewer complications.

If you’re considering breast augmentation and are concerned about animation deformity, consult with your surgeon to determine whether subfascial placement and Motiva implants are right for you. By working together with your medical professional, you can create a personalized plan that helps you achieve your aesthetic goals.

For more information or to schedule a consultation, don’t hesitate to contact our office. We’re here to help guide you through the process and provide the best options for your needs.

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.

Contact

Contact

Our Location Dallas Plastic Surgery Institute

9101 N. Central Expwy.
Suite 600, Dallas, TX 75231
Tel: 214-827-2814
Dallas | Dr. Jejurikar

Stay Connected

Ready to get started?
Request a Consult