Welcome to another exciting episode of 3 Plastic Surgeons and a Microphone! Today, we’re thrilled to chat with the friendly and talented Dr. Reza Kordestani, who has become a go-to expert for body contouring procedures. With a genuine passion for post-operative care and innovative techniques, Dr. Kordestani has earned a reputation for helping his patients achieve stunning results in tummy tucks, breast surgery, liposuction, and Brazilian butt lifts. In this down-to-earth conversation, we’ll dive into the secrets behind his patients’ rapid recovery and fantastic outcomes. Don’t miss your chance to learn from one of the industry’s best, while feeling like you’re catching up with an old friend!
Dr. Sam Jejurikar: Alright. Well, welcome everyone to yet another edition of 3 Plastic Surgeons and a Microphone. As always, I’m joined by my two co-hosts, Doctor Sam Rhee in Paramos, New Jersey, who’s at Birkin Cosmetic, and Doctor Salvatore Pacella in La Jolla, California, who’s at San Diego Plastic Surgeon. I’m Dr. Sam Jejurikar. Today, we are very lucky to be joined by one of the busiest Body contouring surgeries in the Northeast, Reza Kordestani, who’s in the Washington, DC, area and actually practicing in McLean, Virginia. I’ve known Reza for years, the time that he was in Dallas, and I’ll get into his introduction a little bit more. But before we get into the meat of the program, let’s do the nitty gritty and do our usual disclaimer. Gents, take it away.
Dr. Sam Rhee: Got it. Thank you. This show is not a substitute for professional medical advice, diagnosis, or treatment. This is for informational purposes only. Treatments and results may vary based on circumstances, situations, and medical judgment after appropriate discussion. Always seek the advice of your surgeon or other qualified healthcare 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.
Dr. Kordestani and Body Contouring
Dr. Sam Jejurikar: Perfect. So, for our viewers who don’t know Doctor Kordestani, here is a little bit about him. He did his undergraduate studies at Duke, much like Doctor Rhee. So, I’m sure Doctor Pacella has an opportunity. Not a great time to be saying that gentlemen with the NC double A tournament having gone away did for y’all. Michigan didn’t even make a tournament, so I can’t say much. Then Reza went to Dartmouth Medical School, and then I got to know Reza when he trained at what some say is the best plastic surgery residency in America, UT Southwestern. Of course, the three of us would say Michigan, but it’s controversial. But got to know him well, recognized from early on that he’s an exceptional talent, not only surgically, not only through his thought processes but through his sense of humor.
One of my favorite moments was when he was near the end of his training when I saw an epic boomerang where he was wearing teal scrubs with another famous plastic surgeon. Rod Rorick, and they were boomeranging a high five back and forth. It was one of my favorite things I’ve ever seen on social media. Resume his way out there. Oh, those are good times. Yeah. Man, still talk about you all the time, by the way. So, Reza’s made his way out to DC, where he rapidly has built a reputation for himself doing all things body contouring. Tummy tucks, breast surgery, liposuction, Brazilian butt lifts, and I felt like there’s been some similarities in my practice and Reza’s practice, and I’ve seen a lot of his results and was blown away by the results. So, we asked him to be on this program so he could kind of discuss his philosophy towards Body contouring surgery.
So, I guess where I’ll start, Reza is we’ve had a lot of these podcasts talking about body contouring, but things that I’ve noticed are sort of different about your practice and your results. First, I noticed that you spend a lot of time talking about post-operative care. Specifically, lymphatic massage and compression garments, and you show results just a few weeks out from surgery that is really good. So, can you share with our sort of what you think is sort of the main states where it’s getting a great result, whether it’s liposuction, BBL, or a tummy tuck?
Dr. Reza: Yeah. I think, and this wasn’t particularly discussed with us in residency either, but it seemed to me when I got started some of the patients were asking me about these lymphatic massages and contouring massages, and that kind of caused me to look into them and speak with some of these a multi massage service, or they call them post-op care therapists. So different names for them.
Dr. Sam Rhee: Yes.
Dr. Reza: They’re not really licensed in the board but on anything of that nature, but they spent a lot of time trying to get the fluid out. Like sort of the same as fluid from liposuction cases through open drain holes. Speaking with them and kind of looking into things that, for instance, Alfredo Julio’s does, it became very evident to me that there were a lot of things that I needed to learn about. So usually, I think it all varies on the aggressiveness of your liposuction. If the liposuction is very aggressive, there are more chances for scar tissue to form abnormal adhesions to form. And much like hand therapy, we’re very accepting of that where right after surgery, in order to prevent abnormal adhesions and scar tissue from forming and stiffness, we have somebody start a hand therapy very quickly. And I think the post-op care from what I initially heard about Alfredo Julio’s is he has them right after surgery. He puts in drains, which I’ve started to do with the liposuction, and I leave them in; this is second-hand knowledge from someone speaking with his main therapist.
Ten days, he leaves the drains in. Every day they come in, they give gentle lymphatic massage to drain all that fluid out. They do some amount of taping of the skin, too, with KT tape, which I haven’t actually ventured into because there’s, of course, a risk of blistering them. And there is compression. He uses 360-wraparound foam. I’m told two of them on top of each other and then the FNAC garment on top. And then, in order to drain the trolls open, they use Vaseline. I just use bass trace and ointment, which give a similar result. To keep that area from healing up so that they can continue.
Dr. Pacella: So, Reza, quick question for you. So, you’re talking about putting drains in just doing standard liposuction. How do you? How long does it drain? How do you put it in? You sort of put it in with a blender. What instrument? Because for viewers out there, oftentimes, when we use drains, it’s with a larger open surgery. It’s fairly easy to place. We place it through or right next to the incision. So, it can be a little bit of a challenge to put what drain in for liposuction. Correct.
Dr. Reza: Yeah, absolutely. For the back, I use an access incision right at the top of the gluteal crease, and in that area, it’s a short drain, and that’s mainly to keep that area open. I only leave that one way.
Dr. Pacella: And is that sorry to interrupt? Is that close?
Dr. Reza: Yeah, it’s a close suction? I used to use close. I used to use close suction in that area and the tugging in the top of the gluteal crease from that stitch. It’s incredibly uncomfortable anytime you want to sit, etcetera. So, now I actually take a JP drain and cut the end of it that is still open. Like at the very tip, and I insert that portion and sew it in, and that negates a kind of tug in. It is quite messy because then it’s an open drain that’s draining out, but patients were really miserable with that closed suction drain. So, I switched to an open drain that’s not. In the abdomen, I also basically use a drain about put five-ish centimeters long. I try to use an instrument that has its like a laparoscopic needle holder. So, I think one of those laparoscopic needle holders grabs the drain and then pushes it, and that pencil works pretty well.
Dr. Sam Jejurikar: I actually do something a little bit different with my drains in the abdominal wall, but I put drains in 100% of the abdomen as well, guys. But I’ll take the sort of end of the drain that you would normally hook up to the bulb, and I’ll feed it over a four-millimeter basket cannula, and I’ll use an access side either in the umbilicus or the inflammatory fold. I’ll feed that end through the entire abdominal wall to my pubic access, so I’ll basically feed that in, and then I have a drain. That’s like this long; that’s basically the entire length between those two incisions. It makes a huge difference in the drain after liposuction, and it’s kind of interesting. I already pretty much know where I think Reza stands on this, but when it comes to drainless tummy tucks, which is a huge thing that people want. I’ve just gotten the complete opposite extreme. Like, I’ve gone drains for minimal access incisions almost 100% of the time unless people just strongly don’t want it, and I’ll consequence, but I don’t think the results are as good. Would you agree with that, Reza?
Dr. Reza: Yeah, I’ve tried to get some patients to come back to me because they want a little more contouring of their abdomen after having had a tummy tuck, whether with me or elsewhere. And I find that when I’m liposuction someone who has had a drainless tummy tuck. It’s much harder to push the cane through their sink. The result looks beautiful to me. There’s nothing abnormal about the result. It just is it’s harder to push the tango through. So, I presume when there are interstitial areas between the adipocytes because their Body has to absorb that fluid and produce some more inflammation, it looks to me or, and it feels to me, like a little additional scar tissue that they form underneath. That’s not necessarily visible, which I think that’s what’s led to the popularity of general stem types, but it does make it hard to do additional liposuction.
Dr. Pacella: So, Sammy J, let’s go back to what you were saying about your drains. So, when you that you’re in, are you suturing it to the skin? Are you putting it on a bulb, or you’re just letting it sort of drain like a pen rose, if you will, into the wound?
Dr. Sam Jejurikar: I’m using a closed suction drain for the abdominal wall. Because it’s a long length, I hook it up to a bulb. I don’t find it to be that troublesome in the front of the Body, but I 100% agree with Reza that when you’re doing that sort of presacral diamond, the area right above the gluteal crease. It can be really uncomfortable if there’s any sort of traction in that area. I don’t always put a drain in that area. I sometimes do. I sometimes don’t. I only really do it if there’s an excessive amount of energy modality being used or just a ton of suction in the back, but in the front, I use a close suction drain, and I seal it in.
Comparing Microair and Vaser Liposuction Techniques: Dr. Reza’s Experience and Insights
Dr. Sam Rhee: What kind of system do you use Reza for your liposuction like your machine?
Dr. Reza: I recently used to just use Microair, and now I’ve started using a Vaser that I got at the beginning of the year about three months ago. I have both. Both work well. I don’t think there’s necessarily a major difference that I see between them besides the fact that I do get fewer collagen fibers on clogging while I’m suctioning after Vaser, which I have to do with it just shaking out those fat cells and sparing the collagen fibers. I don’t think I’ve necessarily seen any like skin shrinking effect from that little bit of heat that the Vaser has. If anything, I have seen less swelling. I don’t understand why I presume it’s scaring some of the lymphatics. I don’t know. There’s no way for me to tell, but I think the skin trending effect that people may see has to do with it preserving more of those kinds of cobwebs of collagen underneath. Like, I mean, when I Vaser the stomach, and I do lift up the tummy tuck flap, I do see more of those preserved for sure compared to traditional Microair without Vaser.
Dr. Sam Jejurikar: Does your decision about what technology you’re going to use for liposuction is it impacted by whether or not you’re going to do fat crafting?
Dr. Reza: I’ve started actually using it on everyone, the Vaser, mainly because I found that with the, when I was doing fat grafting, would they, and I was using the Wells Johnson eqp system. I noticed that if I was injecting the fat with a four-millimeter basket, it would tend to clog, and the alarm would come on for the pressure being too high. And it wasn’t the amount that was injected into the buttock that was causing there. It was just that it was clogging a four-millimeter basket, and it’s just those collagen fibers that were coming out before I was using Vaser, But now I’m able to use the smaller one just like a four-millimeter Mercedes after using the Vaser, and it goes in very smoothly. It’s much smaller fat. They’re still intact fat. I mean, I’ve taken them out, and they’re no major oil layer that I see. And it goes in very smoothly without all those fibers clogging the injection.
Dr. Sam Jejurikar: What about you guys? Do you guys like Phaser, or do you guys use any? What is your thought in terms of using energy modalities and then fat crafting? Pacella, Rhee, any thoughts on this? You’re muted.
Dr. Pacella: So, I’m not usually doing massive amounts of liposuction cases. I’m usually doing this in the setting of an abdominoplasty or something like that. So, I found in my practice the most efficient way to do that is just simple power-assisted liposuction. Vaser, when I’ve used it before, it almost takes a significant amount of time. You have to pass the Vaser first and then do the liposuction, and I’ve found that I’ve gotten equally, if not better, results with just simple Power, just a tool I’ve used for many years. I don’t really do anything differently if I’m using that for fat transfer either because I hook up the Power Assisted lipo to my fat grafting reservoir, and it seems to hold. It seems to do well, and I’m doing fat transfer not only for cosmetic breast surgery but also for facial surgery and breast cancer Construction as a second or third stage. I’ve found the FAT to be very viable and useful in the setting of Power-assisted.
Dr. Sam Rhee: I’ve stuck with Power Assist, but it’s not for any other reason than that’s the system I’ve had, and it’s worked pretty well for me. I know you like Vaser, Sam. So, I just can’t really comment on it. I’ve always stuck with Power Assist too. But I think, oh, I almost forgot that, but Reza is right. There is a fair amount of collagen fiber and stuff that you do have that does collect with Power Assist when you are doing fat grafting, and so it’s just interesting that you don’t see that in Vaser. Maybe it’s just more macerated, or it’s more of clean-cut. I’m not sure about that.
Dr. Sam Jejurikar: Yeah. Well, yeah, I totally agree with Resident’s observation because it’s really interesting because years ago, we were sort of led to believe that if you used energy with fat grafting, that fat wouldn’t be viable. And now, I actually think it might be better because maybe it’s less bloody when the fats come out. I mean, I don’t know, but I find that my fat grafting results probably are better with Vaser. So, I use it on almost 100% of cases at this point. I rarely, I really don’t use Power Assisted much, but I really like Vaser. I also saw Reza. You were talking about your use of Renuvion a little bit too. So, do you use a lot of radio frequency in your cases?
Dr. Reza: There is some cost to it, but I do feel like it wasn’t working well for me. I had the Renuvion before I had the Vaser. To be honest with you, it really wasn’t working that well for me without the use of Vaser. I think because as soon as I’d be done with the liposuction, there would be it was some, a fair amount of blood just because of the aggressiveness of the lipo, and that blood tended to clog the so very easily. So, once I started using the Vaser along with it where there was less subcutaneous blood after that. It doesn’t; it barely clogs that many on the system. In my hands, it looking back, I would only use Renuvion if I had the Vaser.
Dr. Sam Jejurikar: Okay. Do you guys, and you guys don’t really use a lot of either Body Tight or Renuvion?
Dr. Sam Rhee: What are your experiences?
Vaser, Body Tight, and Renuvion: Optimizing Skin Tightening & Contouring
Dr. Sam Jejurikar: Well yeah, I’ve never. I’ve never had a Renuvion, but we use Body Tight, which I think is similar. I think they’re both just generating heat more superficially, so it’s kind of geared; for a listener is Vaser, the energy is directed sort of in a mid-fatty layer, and it makes it a little bit easier, I think to withdraw the fat. Maybe a little bit of translation of heat to the skin, but not a ton. So, you don’t tend to see a ton of skin tightening, whereas Renuvion and Body Tighter heat a lot more superficially. So, you tend to see skin tightening more with these systems. Yeah, I use Vaser in combination with Body Tighten, but my main reason for doing it is just a lot faster. Like, I mean, Body tight used to take me forever for the skin to heat up, and now when I use Vaser and Body Tight, that Body Tight works pretty quickly.
Dr. Reza: There was an area where I started noticing when Renuvion making a distinct difference was the super umbilical area, so right above the abdomen. Beforehand when I saw somebody with kind of more of a horizontally shaped umbilicus and I would liposuction that. The skin tended to fall a little bit and maintain that horizontal gern. Once I started using Renuvion afterward, I did ask the rep about it. They suggested the inframammary increase access sites that I use. And using the Renuvion upwards turned people’s notice into a more youthful lean kind of vertical element. That’s the place where I really noticed, and it started convincing me, okay, the Renuvion may have some effect, at least early on.
Dr. Sam Jejurikar: Okay. Well, the kind of the next topic I wanted to touch on is I know you’ve built a really big reputation for doing Body contouring surgery, and you’ve got a huge waitlist. So, as a result, I imagine you’re seeing a lot of just revision surgery as well where people are coming to you, whether it’s been their tummy tuck that’s gone awry or their liposuction. What are the things that you see the most when people come to you for revision procedures?
Dr. Reza: I think a lot of it has been people coming in after having had aggressive 360 liposuctions and wanting to have a tummy tuck done. I’ve actually seen the aggressiveness of liposuction over the past. I would say you guys would know better than me, but the ones that I saw right out of practice, especially from Miami, where they do a fair amount of them. The aggressiveness was just to the degree where the amount of scar tissue underneath and the amount that scarphs has shrunk up, and it does not pull-down works. It’s made it very difficult to even offer a tummy tuck to those individuals. So, it’s kind of, I saw a fair amount of those, and I did actually decide to stop doing tummy tucks on those patients. Because I didn’t want, I wasn’t ever able to pull the skin down as much as I wanted to. The scar tissue was higher. They would get some hypertrophic scarring, and I would always have to have like a T at the very final portion where I can pull the incision down. And, of course, I would give like about a centimeter of the scheme process in that area they’ll have to deal with secondarily.
Dr. Pacella: So, Reza, I think for our viewers and listeners here, what you said was very pertinent. I’ve seen that as well, too, a really big uptick tick in the amount of aggression that’s done with this procedure, and I think this real relates to what’s happening in plastic surgery education in the last ten years. So, obviously, there’s a very talented surgeon out of Columbia, Doctor Hoyas, correct, and he does a lot of high-definition liposuction. So, really assertive high detailed abdominal etching, really sort of going underneath the skin to create adhesions to create a really chiseled look, and he is a master at it. But I think he’s also been very expansive in teaching. He does a lot of conferences. He does a lot of professional education sessions, and I think what we’ve seen is surgeons who may not really understand a lot of his techniques sort of going to do that and being very aggressive, and we see a lot of complications subsequently.
Dr. Reza: Right. So true.
Managing Revision Cases: Strategies for Severe Liposuction Issues
Dr. Sam Rhee: Yeah, I was going to ask you about that because I myself have seen a couple of patients from Miami who are just over liposuction, contour deformities, divots everywhere, just real messes. I’ve done some revision cases where I’ve gone back, cleared out the scar tissue, fat grafted some of them, and my results have been mixed. I’ve gotten a couple of really great salvage results and then a couple. It just didn’t really seem to make too much of a make much of a difference in these cases. So, what is it that you do, or what tips do you have about if you deal with these types of revision cases with these really bad liposuction results?
Dr. Reza: It what I started at least noticing when I was doing these procedures and doing tummy tucks on them is that a lot of times when they had these top sorts of calamities. The patients tended to think that there was extra fat left over, but that is what I really saw when I looked underneath the hood, so to speak. What was happening was that there was a circular contraction of the scarps layer in focal areas, and it was causing the skin overlying it to bubble up and look like there was excessive help there. But in fact, what I would do is go in and score scarps, remove it entirely in that spot, and it would unfurl the skin, and allow it to drain. But it’s a dangerous thing to get into. I think that you don’t have a lot of leeway with that, and it can cause a fair amount of issues doing that too extensively and really gyn crosses and a worse problem than what you started with.
Dr. Sam Jejurikar: Yeah. I mean, it’s a scary thing to be exciting scarps for our listeners. You’re basically removing areas of blood supply to the skin. So, in order to get the aesthetic results you want, you’re potentially putting the patient at increased risk for healing issues.
Dr. Reza: Absolutely.
Dr. Sam Jejurikar: So, you just say no to these patients, now you won’t even operate.
Dr. Reza: Yeah, I can’t.
Dr. Sam Jejurikar: Wow, I wish I could do that.
Dr. Sam Rhee: You don’t know how to say no, Sam?
Dr. Sam Jejurikar: I guess I’m just, I don’t know. I guess I’m hungrier than resin. I don’t know. I don’t know what it is. What about things like, you know, inadequate muscle tightening or bulging of the abdominal wall or contour irregularities from dog ears, things like that? Are you seeing things like that a lot too?
Dr. Reza: Yeah, a fair amount. I’ll figure them out, and you’re bringing up a really good point which is when at least what I saw with the way the skin is managed after abdominoplasties. Initially, I was taught to kind of pull the skin inward to keep the scar short, and curling the skin inward, like the flanks, tends to cause a focal in my hands at least a focal area of tightness and then some laxity lateral to it. And a lot of things that I’ve seen is where it creates this bulge of tissue. That’s not necessarily a dog ear more. Rather it’s more of a differential laxity. There’s a band of tightness and then laxity lateral to it. So, a lot of times, what I’ll do in those cases is going in and, of course, make the scar longer but pull in a different factor. And that tended to really fix that issue. I also learned after I finished residency that being very aggressive with the amount of fat removal with liposuction right over the iliac crest tends to help create that hourglass curve. So, I just started being very aggressive in that area in order to make that happen. What do you guys do about that? Is that something similar?
Dr. Pacella: So, I think the way I like to do tummy tucks to keep the incision short is exactly what you mentioned, but in the opposite way. So, I think where I see things get into trouble is when you pull aggressively centrally and then try to peter things out. I think that creates a lot of redundancy of tissue laterally. So, I start relatively snug and tight laterally and bring it out so it’s a little bit lax immediately. I think the important thing to understand about the abdominal wall is when you look at a side profile. Even in a swimsuit model, no one’s abdomen is exactly flat. There is actually a tightness superiorly and then a little bit of a pooch, and then it goes down and covers into the pubis. And there’s a specific anatomic reason for that, which is the posterior rectus sheath.
I do a lot of abdominal wall reconstruction, and when you have above the umbilicus or the arcuate line, you have the anterior rectus sheath, and the posterior rectus sheath is equally solid below the abdominal wall. It’s just the anterior rectus sheath, and that creates that little bit of a bulge inferiorly. So, in my hands, when I tighten up a little bit less centrally, it gives me a little bit of a cone that I can sculpt to make it look a little bit more aesthetically pleasing.
Dr. Sam Rhee: Go ahead.
Dr. Sam Jejurikar: No, you go ahead, Sam.
Dr. Sam Rhee: I was going to say I find what Reza does is similar to what I do in a lot of ways in the sense that I do make my incision a little longer than I used to because I think that on each side. I used to try to pull everything short, and I found that for me challenging. The other thing is I do way more liposuction over the iliac crest and lateral to my incisions because I find what Reza finds where you start pulling it over, and it looks a little bulgy. And especially initially, I was always having to go back and re-contour a little bit, do a little bit more lipo in those areas, and now if I do more lipo to begin with, if I pull not as hard and let that incision go just a little bit longer. You sort of avoid that faux, fullness, or dog ear, faux dog ear if you want to call it that, and that sort of help me out a lot too.
Dr. Sam Jejurikar: Yeah, I tend to do a lot more like Reza and Sam, but I think it’s not; I don’t think there’s a right or a wrong way to do it. I think there’s we have different patient demographics. We have different body types that people are looking for. I know enough about Reza’s practice, Sam’s practice, and Sal’s practice to say that I think Reza and Sam, and I probably are looking for patients that want to be curvier than that who are seeing Doctor Pacella. I’m just going to make that assumption. For patients that want to be curvy, where they use terms like hourglass silhouette or coke nozzle or it’s snatched. Yes. That is the word of the center of the decade.
Yeah, if they want to be snatched, I don’t find there to be a good way to limit the length of their incision. I think it’s a combination of aggressive suction. I’m quick to do extended tummy tucks where I’m actually starting the incision on the back to really make that love handle area over the iliac crest go away. I do a lot of liposuction. I do a lot of direct skin and fat excision over that area as well to bring it in, and I and I think it’s just philosophically what our patients are looking for. I know plenty of really busy Body contouring surgeons both in Dallas and elsewhere who have a different demographic than I do, who have patients that want to look a little bit straighter and maybe not so exaggerated, and they’re able to limit the incisions a little bit more.
So, yeah. So, I don’t, I mean, I think that kind of dovetails nicely to sort of the end of this conversation. I know we’ve had sort of kind of a free-wheeling conversation. But it’s nice to talk to four guys that do a lot of Body contouring surgery and just sort of share their different philosophies and see where we’re similar and see where we’re different. So, do you guys have any closing thoughts or anything you feel like it’s important we add before we wrap this up?
Dr. Sam Rhee: I would just tell patients to go check out Reza’s Instagram. He has one of the best social media accounts out there. I think it’s always really entertaining and good, informational, real, super real. So, what is it, Reza, that you and we’ll also post it everywhere that we do our podcast?
Dr. Reza: It’s at “Kordestani”.
Dr. Sam Jejurikar: Awesome. Well, Reza, thank you for your time. We know there are lots of other things you could be doing on a Sunday morning.
Dr. Reza: Thank you for the invitation.
Dr. Sam Jejurikar: Yeah. Well, it’s totally our pleasure. Well, until later, gents, it was always to catch up.
Dr. Sam Rhee: Excellent.
Dr. Reza: Awesome.
Dr. Sam Rhee: Bye. Take care.