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As parents, we get to experience one of life’s greatest joys when we welcome our little ones into the world. While it’s hard enough to adjust to parenthood, mothers also face the challenge of adjusting to the physical changes brought on by pregnancy, childbirth, breastfeeding, and beyond.

Sometimes moms just miss their pre-baby bodies. It’s common to miss the fullness in the breasts that came during pregnancy, or the tighter tummy you had before. And while most moms eventually lose the baby weight, it doesn’t always come off in the places they want. The breasts and buttocks often lose volume, while the waist and thighs stubbornly hold on to extra pounds.

If you’ve looked in the mirror and felt disconnected from your post-baby body, you’re not alone, and you don’t have to accept those changes as permanent. A mommy makeover can help you get those curvy proportions back. But more than that, it can restore function, boost confidence, and help you feel like you again.

Physical Benefits of a Mommy Makeover (What it changes visibly)

Pregnancy and childbirth create visible changes to the body that don’t always reverse on their own. Even after healthy weight loss, many women are left with stretched skin, sagging breasts, and areas of stubborn fat that resist diet and exercise.

A mommy makeover helps restore the natural curves and proportions of your pre-pregnancy body by addressing these concerns:

Flattens and Tones the Abdomen

Pregnancy often stretches the abdominal muscles and skin beyond their natural elasticity, leading to sagging or loose areas. Tummy tuck surgery removes excess skin and repairs the abdominal wall for a smoother, firmer midsection.

Rejuvenates the Breasts

Pregnancy and breastfeeding can dramatically change the breasts, causing them to lose volume, sag, or become larger and heavier than before. Whether you choose a lift, augmentation, or reduction, or a combination, breast enhancement helps restore shape, symmetry, and balance to your figure.

Targets Stubborn Fat Deposits

Hormonal shifts during and after pregnancy often lead to fat that lingers in the waist, hips, or thighs, despite diet and exercise. Liposuction smooths and sculpts these areas, enhancing your natural curves and creating a more balanced silhouette.

While the physical results are powerful, it’s what they unlock in your daily comfort and confidence that makes the transformation truly life-changing.

Functional Benefits of a Mommy Makeover (How it improves comfort and ability)

While many people think of a mommy makeover as purely cosmetic, the functional benefits can be just as transformative. These procedures don’t just change how your body looks, they improve how it feels and functions in your day-to-day life.

Repairs and Strengthens the Core

Pregnancy can cause the abdominal muscles to separate, a condition known as diastasis recti. This separation weakens the core, making it difficult to flatten the stomach and often contributing to lower back pain or poor posture. A tummy tuck repairs these muscles, helping to restore strength and stability to the abdominal wall.

Improves posture and reduces discomfort

With improved core strength comes better posture and less strain on the lower back. Many women report relief from back pain and an increased ability to move comfortably after surgery. Strengthening the foundation of your body makes everyday tasks – lifting children, working out, or even working at a desk – feel easier and more supported without the constant strain on the lower back.

Enhances day-to-day comfort

Loose skin or excess fat can make certain movements awkward or even cause discomfort when wearing fitted clothes. Breast heaviness may also lead to neck and shoulder pain and tension. A mommy makeover helps you feel lighter, more mobile, and more comfortable in your clothes.

Physical changes after pregnancy can make simple things like getting dressed or going for a walk feel uncomfortable. Loose skin may cause chafing or irritation. Stubborn fat deposits can affect how clothing fits. And enlarged or heavy breasts may lead to shoulder or neck tension.

Emotional Benefits of a Mommy Makeover (How it impacts confidence and identity)

If you’ve looked in the mirror and felt a sense of disconnect from your post-baby body, you’re not alone.

One of the most profound changes that occurs after a mommy makeover isn’t just the physical transformation, it’s the emotional one. This isn’t just about how you look, but how you feel. When you feel good about your body, it radiates into other parts of your life: how you interact with others, the confidence you carry, or even just the joy of getting dressed in the morning.

This isn’t about vanity. It’s about identity, self-worth, and the freedom to feel good in your own skin.

Boosts Confidence

It’s common to feel like a stranger in your own body after pregnancy. The changes can impact everything from how you dress to how you carry yourself. A mommy makeover helps you reclaim confidence, not just in how you look, but in how you feel moving through the world.

Many of my patients tell me they miss the confidence they used to have and want to feel like themselves again. This procedure helps you reconnect with that version of yourself in a way that feels empowering, not superficial.

Reduces Stress and Frustration

Living in a body that feels “off” can take a mental and emotional toll. For some women, that disconnect creates frustration, stress, sadness, or even shame, especially when you’ve tried everything and still don’t feel comfortable in your skin.

A mommy makeover addresses the physical areas that bother you most, which can bring a deep sense of emotional relief. Many women describe the experience as reclaiming control and finally exhaling after holding it in for years.

Reinforces a Sense of Self and Personal Empowerment

One of the most powerful aspects of a mommy makeover is the way it helps you reconnect with the person you were before having children.

A mommy makeover gives you the chance to prioritize yourself, to do something that’s just for you. And the truth is, when you feel good about yourself, you’re able to give more to others. Taking care of yourself isn’t selfish, it’s a way to bring your best self to your family and your life.

A mommy makeover isn’t about striving for perfection; it’s about helping you feel comfortable in your skin again. It’s about restoring your confidence. Many women find that regaining control over their appearance helps them feel empowered, more like themselves, and ready to take on the world.

This isn’t about vanity. It’s about identity, self-worth, and the freedom to feel good in your own skin.

A Plan as Unique as You Are

One of the most important things to understand about a mommy makeover is that there’s no one-size-fits-all approach. Every woman’s body is different, and so are her goals. Whether you’re looking to restore volume to your breasts, tighten your abdomen, or smooth out problem areas with liposuction, we’ll create a plan that’s tailored just for you.

During your consultation, we’ll talk through your priorities, lifestyle, and desired outcomes. From there, we’ll create a personalized plan that may include:

• Tummy Tuck: To remove excess skin and repair separated abdominal muscles
• Breast Lift, Augmentation, or Reduction: To restore shape, balance, and comfort
• Liposuction: To target stubborn fat in the waist, hips, thighs, or arms

By combining procedures into one surgery, recovery is streamlined and the results are more cohesive. You get the transformation you’re looking for, with less downtime.

Real Patient Transformations

Every mommy makeover is unique, and so are the results. These before-and-after photos highlight different body types, surgical plans, and outcomes, all tailored to meet the specific needs of each patient.

Every Transformation Starts with a Conversation

A mommy makeover is more than a physical transformation, it’s about restoring confidence, function, and your sense of self. Whether it’s repairing your abdominal muscles, lifting your breasts, or simply feeling more comfortable in your clothes, it’s a chance to feel like you again.

If you’ve been thinking about taking this step, I encourage you to schedule a consultation. I’ll take the time to listen, walk you through your options, and offer expert guidance every step of the way.

The post The Transformative Power of a Mommy Makeover appeared first on Cosmeticsurg.

Some women dream of a curvier silhouette but worry they don’t have enough body fat to achieve their desired look.

“Do I have enough fat for a Brazilian Butt Lift?”

It’s a question I hear all the time from patients with slimmer frames.

If you have a slimmer frame or a lower BMI, you might think an hourglass figure isn’t possible. But with the right techniques, even naturally lean patients can achieve beautiful, balanced curves.

I’ve helped countless patients enhance their natural shape with this highly specialized procedure. Let’s dive into how the Skinny BBL works, what makes it unique, and whether it’s the right choice for you.

What is a Skinny BBL?

A Skinny BBL is a specialized approach to the Brazilian Butt Lift procedure, designed specifically for individuals with slim builds or lower body fat percentages. It focuses on maximizing fat collection and optimizing reinjection to subtly accentuate natural curves.

Unlike traditional BBLs that require a higher volume of fat transfer, the Skinny BBL is ideal for patients with less fat available for harvesting. Dr. Rodriguez uses thin 3mm cannulas which allows him to extract fat from tight areas of the body. These are areas that other surgeons may not be able to reach with thicker cannulas. This ensures that even slimmer patients can achieve stunning results.

How Does a Skinny BBL Work?

The Skinny BBL involves three key steps, each performed with precision to ensure long-lasting, natural results:

1. Fat Harvesting

Using advanced liposuction techniques and thin 3mm cannulas, fat is carefully removed from areas such as the abdomen, flanks, upper back, thighs, and arms. The selection of the areas is decided with your during the consultation. Thin cannulas allow for precise extraction, even in tight tissue areas, maximizing the amount of fat available for transfer.

2. Fat Purification

Once harvested, the fat is processed to isolate only the healthiest, most viable cells for reinjection. This step is crucial for achieving long-lasting results.

3. Fat Transfer

The purified fat is strategically reinjected into the buttocks and hips using micro-injections. This meticulous process ensures smooth, proportional enhancements that complement the patient’s natural anatomy.

Am I a Candidate for a Skinny BBL?

The Skinny BBL is ideal for individuals with lower BMIs who want to subtly enhance their curves.

If you’ve struggled to find a plastic surgeon who can work with your slim frame, my two decades of experience in fat grafting ensure that even thin patients can achieve beautiful, natural results.

If you’re ready to explore whether the Skinny BBL can help you achieve your ideal shape, schedule a consultation today. Let’s discuss enhancing your natural curves with the personalized care you deserve.

Skinny BBL vs Traditional BBL

While both procedures aim to enhance the buttocks, the Skinny BBL is designed specifically for patients with slimmer frames, focusing on subtle, proportional curves rather than dramatic volume. Here are the key differences:

• Fat Availability: Traditional BBLs require more fat (up to 1000 cc per side), whereas the Skinny BBL works with approximately 500 cc per side.
• Techniques: A Skinny BBL relies on harvesting fat from multiple areas, including tight or hard-to-access spaces, using advanced techniques and specialized tools. This approach maximizes the amount of viable fat collected for transfer, even from areas that may be difficult for other surgeons to extract.
• Aesthetic Goals: Traditional BBLs often aim for dramatic volume, while Skinny BBLs prioritize subtle, proportional curves.

Why Choose Dr. Rodriguez for you skinny BBL?

With over 25 years of experience and specialized fat grafting expertise, I have performed thousands of successful procedures, helping patients achieve their aesthetic goals with natural-looking results. Our Baltimore surgical center is fully accredited and focuses exclusively on plastic surgery, ensuring a high level of safety and personalized care.

Maximum amount of Fat extraction

My Skinny BBL technique is built on precision and innovation. I use 3mm cannulas to maximize fat collection from even the tightest areas and employ meticulous micro-injection techniques to create smooth, proportional enhancements.

Skinny BBL with no drains, no post op massages

Unlike many other surgeons, I don’t use drains or require post-op massages, making your recovery process more comfortable and stress-free.

Original Member of the ASPS Gluteal Fat Grafting Safety Panel

Beginning in 2017, I helped investigate and craft the safety guidelines for Plastic Surgeons performing BBL. This includes the use of Ultrasound, and special techniques to stay above the muscle. I prioritize methods that maximize results while minimizing recovery challenges and potential complications.

BBL performed with IV sedation, instead of General Anesthesia

We use IV sedation instead of a ventilator, which significantly reduces the risk of complications like DVT or pulmonary embolism. This approach, administered exclusively by board-certified anesthesiologists, also minimizes nausea and allows for a quicker recovery, so you can get back to feeling and looking your best sooner.

Recovery Process & What to Expect

The recovery process for a Skinny BBL typically lasts about 3 weeks. During this time, it’s crucial to avoid sitting on your buttocks to protect the newly transferred fat.

Sitting too soon can exert up to 400 pounds of pressure per square inch, which can crush delicate fat cells and cut off blood flow, reducing the survival of the grafts.

Instead, plan to rest on your stomach or sides, with occasional standing or light walking to keep your muscles limber and promote circulation. A properly fitted compression garment will help reduce swelling and support the healing tissues. My no-drain, no-massage approach ensures a more comfortable recovery while maintaining optimal results.

Patient Point of View

Now, I wear my clothes…they don’t wear me. He gave me the hour glass shape that I desired.
Dr. Rodriguez did an AMAXING job on my Brazilian Butt Lift. I am 3 months post op. My butt has no lumps and no hardness. It is nice and fluffy. It feels and looks so natural. I feel confident and I have less anxiety. Now, I wear my clothes…they don’t wear me. He gave me the hour glass shape that I desired. If you are looking for a surgeon who is not just about the money and who actually cares about his patients, their health and their aesthetic goals, then please go to Dr. Rodriguez. – a RealSelf Patient Review.

If you’ve been dreaming of enhancing your natural curves in a safe, comfortable, and effective way, I’d love to help. My Skinny BBL technique is designed to provide subtle, proportional results tailored to your unique frame.

Skinny BBL FAQs

Still have questions?

If you’d like more information about the Skinny BBL or want to discuss your unique goals, feel free to reach out. You can contact us online or call us at (410) 494-8100 to schedule a consultation or ask any additional questions!

The post What is a Skinny BBL? appeared first on Cosmeticsurg.

When patients contact our office asking about tummy tuck costs, they often share a range of reactions from “That seems very reasonable” to “I can get this surgery much cheaper in Miami.” It’s true that Miami and some national plastic surgery chains offer super low prices, but those quotes often come with compromises in quality, experience, or what’s included in the total cost.

To help patients make informed decisions, we gathered general pricing information from 10 board-certified plastic surgeons in Baltimore.

Our research reveals not only the average cost of a tummy tuck in the Baltimore area, but also what’s typically included in the price—and the surprising fact that expertise doesn’t always come with a premium cost.

How & Why We Conducted the Survey

We know cost is one of the biggest considerations for patients exploring tummy tuck surgery. Curious about how our abdominoplasty pricing compares locally, we surveyed plastic surgeons near and around our Baltimore office.

Average Tummy Tuck price in Baltimore $11,125

We called 9 board-certified plastic surgeons in Baltimore who perform tummy tucks. We asked questions like, ‘What is the cost of a tummy tuck?’ and ‘What is the cost if I add liposuction to the flanks?’ We included our own cost in the survey, to make it a total of 10 plastic surgeons.

Importantly, we confirmed what each office included in the ‘total cost’ to ensure an accurate, apples-to-apples comparison.

What’s Included in the Total Cost?

We confirmed that the quoted prices covered the following standard components:

• Plastic Surgeon’s Fee
• Surgical Facility Fee (OR and Recovery room)
• Anesthesiologist’s Fee
• Follow-up appointments
• Post-surgical garments and pain control

Key Findings from Our 2024 Tummy Tuck Pricing Survey:

Based on our survey of ten Baltimore-area surgeons, we identified notable patterns and key details about tummy tuck pricing. The average base price of each of the 10 plastic surgeons is shown in the map above. The findings are:

1. Wide Range in Base Tummy Tuck Pricing

The cost of a full tummy tuck, which involves an incision from hip to hip (iliac crest to be exact), muscle tightening, and removal of excess skin and fat, typically ranges from $8,000 to $15,000.

For an extended tummy tuck, which includes a longer incision extending beyond the hips to address the flanks and lower back, the cost typically ranges from $11,000 to $20,000.

2. Average Tummy Tuck Price in Baltimore

The average price among 10 Board-certified Plastic Surgeons in Baltimore was:

• Standard Tummy Tuck: $11,125
• Extended Tummy Tuck: $15,290

3. Wide Range in Addition Lipo to Flanks

• Addition of Lip to the flanks: $2,500 – $4,500
• Average Cost adding Lipo: $3,100

4. More Experience Doesn’t Always Mean Higher Prices

Quite surprisingly, surgeons with over 20 years of experience (post Board Certification) offered lower Tummy Tuck costs compared to their younger colleagues. We found this interesting as the more experienced surgeons have individually performed hundreds, if not thousands, of Tummy Tucks, bringing a wealth of expertise to their patients.

5. Pain Management Options Vary

More than half of the plastic surgeons we surveyed offer pain management following tummy tuck surgery, such as an Exparel injection or a pain pump. While some surgeons include this as part of their package, others charge an additional fee. However, a few surgeons do not offer post-operative pain management services like pain pumps at all.

6. Financing Options are Widely Available

A total of 9 of the 10 surgeons surveyed offered Financing, typically through Care Credit and/or Alpheon.

Tummy Tuck Cost Comparison: Baltimore Surgeons

Here’s a detailed comparison chart of Baltimore-area plastic surgeons, including their experience and price ranges of a standard tummy tuck. This information was collected by telephone calls at the end of 2024.

Factors Affecting the Cost of a Tummy Tuck

The base price typically reflects a standard tummy tuck, while the higher price accounts for more extensive skin and tissue excision, such as extended tummy tucks.

Several factors can influence the cost of a tummy tuck:

Location:

Plastic surgery tends to be more expensive in larger cities due to higher overhead costs. However, our survey showed that there is even distinct variation in prices by neighborhood.

Surgeons with offices near each other, have similar prices. You can see that in the Lutherville area, there are 3 Plastic Surgeons, including our office, which have Tummy Tuck costs that do not vary widely.

Surgeon Experience:

Surgeons with more years of practice, higher qualifications, or a reputation for exceptional results often charge higher fees. However, our survey revealed a surprising trend: some of the most experienced surgeons in Baltimore offer lower average tummy tuck costs!

To ensure consistency in measuring experience, we calculated the years of practice based on the year surgeons achieved Board Certification.

Using the ASPS website, we identified each surgeon’s Board Certification year. Then we determined their total years in practice following certification. This method allowed us to standardize our comparison of experience across all surgeons surveyed.

Anesthesia:

In Maryland Surgery Centers, your anesthesia can either be administered by a CRNA (a type of trained nurse) or a Board Certified Anesthesiologist. As one might imagine, the cost of Anesthesia with a Board Certified Anesthesiologist (an M.D. who did a residency in Anesthesia) is higher than the cost with a CRNA.

Be sure to consider this difference when making your final decision.

Complexity of Surgery:

An Extended Tummy Tuck will cost more than a Standard Tummy Tuck simply because the procedure takes longer, as the incision extends out around the hip area. The addition of liposuction will add more costs for most all practices.

Why Extended Tummy Tucks Cost More:

Women with larger frames or those needing longer incisions may require a more involved procedure. For example, to address excess skin that extends over the hips, an extended tummy tuck is necessary.

This procedure takes more time in the operating room, and OR time is a pricing factor for any surgical procedure.

Addition of Lipo to the Flanks:

Liposuction to the Flanks can be added to any Tummy Tuck procedure. The flanks includes the love handles, and the back muffin top around your backside. Liposuction to the flanks typically adds an hour of surgical time. Thus, there is an additional cost to add it to the surgical plan.

FAQ’s about Tummy Tuck Costs

When patients call to ask about our pricing, they often have additional questions about the procedure. Here are answers from our pricing to some of the most common questions we get:

I personally invite you to schedule a consultation where we can discuss your goals, answer your questions, and design a plan just for you.

Let’s work together to create results that help you look and feel your best,

The post How Much Does a Tummy Tuck Cost in Baltimore, Maryland? appeared first on Cosmeticsurg.

When it comes to enhancing breast shape and volume, you have more than one option. Breast implants have long been the standard, but fat grafting offers a natural alternative that uses your own fat to add volume without the need for implants.

In my practice, I offer two surgical approaches to breast enhancement:

1. Breast augmentation with implants
2. Fat transfer breast augmentation

Both methods aim to enhance size, shape, and symmetry, but they do so in different ways.

Let’s discuss the options.

Understanding Breast Implants

Today, breast augmentation surgery with implants continues to evolve with advancements in implant technology, surgical techniques, and safety protocols. Modern silicone and saline implants are available in a variety of shapes, sizes, textures, and profiles to meet the diverse goals and preferences of today’s patients.

If you are leaning towards implants, take time to learn more about your options – including Saline vs Silicone and other considerations that you will be discussing with your board certified plastic surgeon.

In addition, you can further educate yourself by learning more about implants choices. Read Saline vs Silicone and explore the other decisions you’ll review with your board-certified plastic surgeon.

Breast Implant Advantages

• High level of customization – choose from various profiles (moderate, high, extra high), sizes, and textures
• Can achieve a significant increase in breast volume – up to 800cc per breast
• Today’s breast implants from Mentor and Allergan include lifetime warranties for rupture, meaning the manufacturer will replace them free of charge if a rupture occurs.

Breast Implant Considerations & Limitations

The most common complications related to breast implant surgery are:

• Implant rupture / leakage
• Capsular contracture – where scar tissues forms around the implant
• Implant drop out
• Has limitations in correcting asymmetry
• Most patients either remove or replace the implants after 20 years. Note: There is no official guideline for timeline from the implant manufacturers, but this is what we have seen after 30 years of performing breast augmentation!

Understanding Fat Transfer Breast Augmentation

Since the 1990s, fat grafting has been used to improve or augment areas where the fat is injected. Also referred to as fat transfers, fat injections, or autologous fat grafting (afg), the history and applications may surprise you.

In recent years, fat grafting has been gaining popularity as an alternative or complementary technique for breast augmentation and lumpectomy reconstruction.

Fat transfer, also known as fat grafting or autologous fat grafting, involves the harvesting and transferring of fat to the breast . This can be done either unilateral to correct asymmetry, or bi-lateral (both breasts) to increase the size of the breast.

Fat transfer breast augmentation involves harvesting fat from one or more areas of the body using liposuction, processing it, and then injecting it into the breasts to enhance volume and shape.

Fat Transfer Advantages

• Uses your own fat for a natural, implant free way to augment your breast
• Procedure is less invasive in that it involves no tissue elevation or dissection
• Procedure does not require drains post operatively
• Dual benefits to enhance your figure – bigger breasts, and a lean thinner torso

Fat Transfer Considerations & Limitations

• You must have enough fat on your body — typically two areas (abdomen + flanks), but most surgeons can extract from multiple areas if necessary.
• Because the breast tissue is tighter than other areas of the body (such as the buttocks), only about 300 cc of fat can be transferred to each breast in one operative session. This equates to about one cup size up.

Cost Comparison: Breast Augmentation with Implants vs. Fat Transfer to the Breast

Fat grafting to the breast is more expensive than a breast augmentation using implants. That may seem counter intuitive since you’re using your own fat, but you are really getting two procedures: breast augmentation and Lipo 360!

Plastic surgery costs are typically a function of time in the OR. It takes around 2 hours to perform an average breast implant augmentation procedure, while it takes around 5 hours to perform the fat grafting to the breast.

Cost comparison of Breast Augmentation with Fat Transfer to the Breast

• Breast augmentation with implants : $6,000 (silicone)
• Fat Transfer with your own fat (from two areas) : $10,000 – $11,500
• Fat Transfer with your own fat (one area liposuction) : $8000 est

Making an Informed Decision of Breast Implants vs Fat Transfer

Your surgeon should be a board-certified plastic surgeon, and you should be able to view before and after photos of previous patients. Make sure your surgeon has performed many cases of the procedure you’re considering.

Here is a summary comparison chart to help you decide between breast aug with implants or fat transfer to the breast:

Which option is right for you?

Choosing between breast implants and fat transfer breast augmentation is about choosing the right approach for your body, your goals, and your lifestyle.

In general, the best technique comes down to your aesthetic preferences and what kind of outcome feels most aligned with your vision.

Fat transfer may be best for patients who:

• Want a more natural look and feel
• Prefer a modest increase in size
• Like the idea of using their own tissue for enhancement

Implants may be more appropriate for patients who:

• Want a more dramatic size increase
• Prefer a rounder or fuller upper-pole projection
• Are looking for the most predictable volume outcome

As a board-certified plastic surgeon with over 30 years of experience, I’ve performed thousands of breast implant and fat grafting procedures. Every surgery I perform is done in our QuadA-accredited surgical center using only board-certified anesthesiologists and techniques that prioritize your comfort, safety, and long-term results.

You can view my full bio here or request a consultation to talk through your options in person. Every body is different. During your consultation we’ll walk through your goals, assess your anatomy, and create a personalized plan whether that means fat transfer, implants, or a combination of both.

Have questions? Contact Us to schedule your in-office or virtual consultation. Or just give us a call at 410-494-8100! We’re also happy to provide second opinions via virtual consults.

The post Fat Transfer to the Breast vs Breast Implants: Making an Informed Choice appeared first on Cosmeticsurg.

The extended tummy tuck does everything the standard (full) tummy tuck does, but it offers a more comprehensive solution by also addressing the abdomen, flanks, hips, and lower back. Ideal for those who have lost significant weight, it removes more excess skin laterally than a standard tummy tuck.

The procedure involves a longer incision that extends past the iliac crest to the midaxillary line, allowing for the removal of more skin and fat over the hips and outer thighs. This ensures a more thorough contouring of the body’s midsection and side hips.

Before going into the specifics of an extended tummy tuck, let’s compare it with other tummy tuck procedures, as well as the body lift, to help highlight the similarities and differences in body contouring options.

What are the types of Tummy Tuck procedures?

There are several types of tummy tucks, or abdominoplasties, tailored to different needs and goals. The right type of tummy tuck for you will depend on factors such as skin laxity, fat distribution, and abdominal wall strength. Understanding the differences can help you make an informed decision for your body contouring journey.

Standard Tummy Tuck (Abdominoplasty)

• Target Areas: Primarily the abdominal area
• Incision: Horizontal incision just above the pubic area, from iliac crest to iliac crest
• Scope: Removes excess skin and fat, tightens abdominal muscles
• Ideal Candidates: Individuals with loose skin and muscle laxity confined to the abdomen
• 2025 Cost: $8800

Extended Tummy Tuck

• Target Areas: Abdomen, flanks, and hips
• Incision: Longer than a standard tummy tuck incision, it extends past the iliac crest to the midaxillary line, possibly reaching the anterior or posterior midaxillary line
• Scope: Extended Tummy Tuck is more extensive than a standard tummy tuck, addressing a larger area of excess skin, and providing benefit to the front and outer thighs
• Ideal Candidates: Patients with significant weight loss affecting the abdomen and flanks
• 2025 Cost: $9600 – $11,000

Tummy Tuck with Lateral Thigh Lift

• Target Areas: Abdomen, flanks, hips, thighs, and lower back
• Incision: This is even more skin excision than an extended tummy tuck. The incision goes around the hips and further past the posterior midaxillary line. The incision stops short of the buttocks crease.
• Scope: More extensive than an extended tummy tuck, as it addresses loose skin hanging over the outer thighs. It will often times give more lift to the buttocks.
• Ideal Candidates: Patients with significant weight loss creating loose skin over the abdomen, flanks, hips, and outer thighs
• 2025 Cost: $13,250 est

Body Lift (Circumferential/Lower Body Lift, 360 Body Lift)

• Target Areas: Abdomen, flanks, lower back, buttocks, and thighs
• Incision: Circumferential incision around the lower torso, also referred to as a 360 Body Lift
• Scope: Comprehensive contouring, lifting, and tightening of the lower body
• Ideal Candidates: Individuals with substantial skin laxity around the entire lower body, often after massive weight loss, providing a complete torso reshaping and lifting of the posterior buttocks
• 2025 Cost: $17,000 – $22,000

How Long is an Extended Tummy Tuck Incision?

Incision placement determines the resulting scar, making this a crucial aspect of your tummy tuck procedure. The length and location of incisions vary based on the type of tummy tuck performed.

Anterior, Mid, and Posterior Axillary Lines

Vertical axillary lines, which include the anterior, midaxillary, and posterior axillary lines, serve as essential reference points in determining the length of the incision for an extended tummy tuck.

Plastic surgeons use these anatomical markers to decide how far the incision will extend, typically between the anterior and posterior axillary lines.

This decision is based on the specific areas that need contouring.

Understanding these markers helps patients visualize the surgical plan and anticipate the resulting scars.

This knowledge aids in managing expectations and preparing for post-operative care.

Standard Tummy Tuck incision length

In a standard tummy tuck, the incision typically spans horizontally from iliac crest to iliac crest, and it is placed above the pubic area so the scar is easily concealed. The anterior axillary line, which runs vertically from the front of the armpit down the torso, marks the lateral limit of this incision.

Extended Tummy Tuck incision length

In an extended tummy tuck, the incision extends further around the flanks, reaching past the hip towards the lower back. This procedure addresses excess skin and fat in the abdomen and flanks. The incision may extend to the midaxillary line, which runs vertically from the middle of the armpit down the side of the torso. This extension provides more comprehensive contouring, which is especially beneficial for patients who have experienced significant weight loss.

Tummy Tuck with a Lateral Thigh Lift incision length

A tummy tuck combined with a lateral thigh lift involves the most extensive and longest incision, often extending to the posterior axillary line. This anatomical landmark runs vertically from the back of the armpit down the side of the torso. This approach allows for a more extensive removal of excess skin and fat, essentially lifting the lateral thighs, providing a more comprehensive body contouring solution for patients with substantial skin laxity around their entire lower body.

Body Contouring Incision & Coverage Summary:

• Standard Tummy Tuck: Incision goes from iliac crest to iliac crest on the front of the torso, focuses on the front abdomen.
• Extended Tummy Tuck: Incision extends past the iliac crest to the general area of the mid-axillary line. It can stop at the anterior axillary line or go further to the posterior axillary line, extending around the flanks.
• Lateral Thigh Lift: This incision goes further than the posterior axillary line , but stops short of the buttock crease.
• Body Lift: Circumferential 360 degree incision covering the entire lower torso, including abdomen, hips, buttocks and thighs.

Watch Dr. Rodriguez discuss tummy tuck incisions and illustrate the differences between regular and extended tummy tucks to help guide you in choosing the right procedure for your desired body goals in this video: Do I need a regular or extended tummy tuck?

Before & After an Extended Tummy Tuck

This patient achieved her body contouring goals by opting for an Extended Tummy Tuck with Dr. Rodriguez in Baltimore. In her case, the incision was extended laterally to a point between the midaxillary line and the posterior axillary line.

Watch this patient’s dramatic transformation (front view) following her extended tummy tuck . . .

Is an Extended Tummy Tuck More Expensive than a standard Tummy Tuck?

As compared to a standard tummy tuck, an extended tummy tuck is more expensive because the surgical plan is more complex since surgery involves the front, sides, and back of the torso. Since the extended tummy tuck addresses the abdomen as well as the flanks, it takes longer which impacts the cost of the surgeon’s fee, anesthesiologist fee, and the OR fee.

Here in Baltimore, our standard abdominoplasty starts at $8,300 while an extended tummy tuck starts at $9,450. Of course the actual costs can vary based on your individualized treatment plan and specific needs. For a personalized and accurate estimate aligned with your unique goals, schedule a consult with Dr. Rodriguez.

The post What is an Extended Tummy Tuck? appeared first on Cosmeticsurg.

What is a Body Lift?

A body lift removes hanging skin around your entire torso: abdomen, outer thighs, and posterior buttocks. It is increasingly popular now that patients are using weight loss drugs such as Ozempic, Semaglutide, and Wegovy.

How Much Does a Body Lift Cost?

The cost of a body lift can vary significantly based on the scope of the procedure and additional expenses. According to the American Society of Plastic Surgeons (ASPS), the average cost of a lower body lift surgery is $9,449, but that only covers the surgeon’s fee. It doesn’t include things like anesthesia, operating room, and other associated costs.

Meanwhile, RealSelf reports an average cost of $16,425 for a body lift, with patient reviews indicating a range from $10,300 with insurance to as much as $40,000 out of pocket.

2025 Body lift cost in my Baltimore surgery center

At our Baltimore office, the cost of a body lift ranges from $17,500 to $22,000. Our comprehensive price includes the surgeon’s fee, anesthesia, operating room facilities, 2 medical grade compression garments, Exparel injection, and all post op office visits.

With Dr. Rodriguez, your body lift with include the following surgical components:

• Tummy tuck with muscle repair
• Outer thigh lift
• Posterior Buttocks Lift

Is there an alternative to the lower body lift?

If you’re wondering if you’d benefit from a full body lift or if there any alternatives to a body lift, it’s important to know that some people opt to have just the tummy tuck and the outer thigh lift when the amount of loose skin over the buttocks isn’t significant. This is known as the Extended Tummy Tuck, and patients can have a dramatic body change with just that.

Extended Tummy Tuck as an alternative to a Body Lift

The cost range for an extended tummy tuck here at my Baltimore office is $9,400 to $14,000, depending on how far around the hip the incision goes. Learn more about the tummy tuck component and the extended tummy tuck. The patient below had an extended tummy tuck instead of a standard tummy tuck. She had skin removed over her hips. By doing this she avoided the need for a Body Lift.

Factors Influencing the Cost of a Body Lift

Let’s take a look at the factors that influence lower body lift costs and go over what you can expect.

Body Lift Cost = Surgeon’s fee + Anesthesia fee + OR fee + Garments + Pain control + Post-op visits

While the formula above is a basic surgical cost guideline for our office, every plastic surgeon is different and may or may not include those things in their quote, too. The full list of items that contribute to the total cost of a body lift include the following:

• Surgeon’s fee
• Anesthesia fee
• Facility (OR) fee
• Compression garments
• Pain control
• Post-op visits
• Geographic location
• Extent of your surgical plan
• How much extra skin you have

Why Choose Dr. Rodriguez for your Body Lift?

Dr. Rodriguez is Board Certified by the American Board of Plastic Surgery, has served as the President of the Maryland State Society of Plastic Surgeons. Here are reasons to choose him:

Over 200 Body Lift Procedures performed — With over 25 years of experience, he has performed thousands of cosmetic and reconstructive procedures, including over one hundred body lift procedures. With such a depth of knowledge and experience, Dr. Rodriguez brings unparalleled expertise to every surgery.

Fully Accredited Surgery Center — As the medical director, Dr. Rodriguez operates out of his own free-standing, single-specialty surgery center, which is fully accredited and licensed by AAASF and Medicare. His dedication to maintaining the highest standards of patient care and safety ensures exceptional outcomes for all his patients.

Direct Cell phone access to your surgeon postoperatively — Following surgery, patients have direct access to Dr. Rodriguez by cell phone in the event they have any immediate post-op questions.

IV Sedation instead of General Anesthesia — With IV sedation you do not have a tube through your nose and you are breathing on your own. With IV sedation patients leave the same day, have less nausea and pain post-operatively, and have a lower risk for pulmonary embolism. All anesthesia is administered by Board Certified Anesthesiologists, and not CRNAs (nurses).

Lockwood Surgical Technique — Dr. Rodriguez believes the Lockwood technique achieves the best surgical results with the least amount of postoperative complications. It preserves the blood supply better than traditional tummy tuck dissection techniques, and results in less complications related to fluid collection.

Speaks Spanish, French, and English — Dr. Rodriguez and members of the office and OR staff are fluent in Spanish. In addition to English and Spanish, Dr. Rodriguez is also fluent in French.

Tips for price shopping a body lift procedure

When selecting a plastic surgeon for your body lift, it’s essential to consider more than just the cost. You need to be comfortable with your doctor’s level of expertise and the approach to your procedure.

Confirm which components are included in the quote: You must compare apples to apples when shopping around.  Some offices might only quote the surgeon’s fee, and you may not have a firm idea of what the anesthesia cost will be.

A quote should describe the procedures involved: Your quote should detail what the Body Lift Cost includes on the quote itself. A lower Body Lift includes a tummy Tuck, Outer Thigh Lift, and Posterior Buttocks Lift.

Post Op office visits: Total cost should include all post-op office appointments with the surgeon for a period of time, which is usually one year.

Anesthesia: Anesthesia price should not fluctuate with this choice of whether it is IV anesthesia or General Anesthesia. The price should be the same.

Revision Costs: The body lift is a huge surgery. When a surgeon is performing such a major procedure, there are sometimes small refinements that need to be performed later. Find out what local revision cost is.

Access to your surgeon: One factor largely overlooked when patients are price-shopping is IF they can contact their surgeon directly by cell phone after surgery. We have heard reports of patients who have had highly discounted surgery and are unable to get in contact with their surgeon after surgery.

Insurance considerations: While body lift procedures are often considered cosmetic and not typically covered by medical insurance, there are instances where insurance may provide coverage.

Financing considerations: We offer options from third-party financing companies in the healthcare industry and encourage you to take a look at our page dedicated to financing plastic surgery in Baltimore.

Is a Body Lift worth it?

A body lift is a life-changing, transformative procedure designed to remove excess skin that sags around the middle. If you’ve lost a significant amount of weight and are dealing with sagging skin, this procedure is for you. It is one of my favorite procedures to perform because it makes such a dramatic change.

The post Body Lift Cost in Baltimore appeared first on Cosmeticsurg.

I have had hundreds of lip enhancement consultations over the years and I’d like to talk about the surface anatomy of the lip so that you can better communicate with your doctor about the things that you might want to change, or that you’re not satisfied with.

It’s not just about knowing what you want, or what bothers you. The goal is to communicate what you want to the doctor.

Lip enhancements, whether through implants, lifts, or fillers, are about harmonizing the procedures with your unique features.

When we don’t know the names of things we tend to describe things in general. However, when we know the term, we can more effectively describe the things that we want to change.

So, in an effort to empower you to have the most meaningful discussions during your consultation, let’s talk about the surface anatomy of lips.

The Upper Lip Complex

The upper lip complex refers to the anatomical structures and features of the upper lip region.

Understanding the upper lip complex really helps to achieve desired aesthetic outcomes when you’re looking into cosmetic procedures such as lip lifts and lip augmentations.

Columella

The columella is the little bridge of tissue between the two nostrils. It’s important for your surgeon to keep that columella in the same place and to ensure the surgical closure doesn’t drag that skin down because it can give the impression that the nose is longer. It’s not longer, it’s just that the columella can get dragged down making the total length of the nose seem longer.

Nasal Sill

The nasal sill is basically the floor of the nostril. For me, the nasal sill is a surgical landmark that dictates incision placement for a much less noticeable scar. On some patients, the floor of the nostril is much more pronounced while on others it is more indistinct and even non-existent.

It is also possible to have both a more pronounced nasal sill on one side as well as a non-existent one on the other and your surgical planning and incision placement should speak specifically to your case.

Philtrum

The philtrum is that vertical groove above the upper lip. It usually comes from the edges of the columella down to the apex of the cupid’s bow. Some patients have a more triangular philtrum while others have more of a rectangular philtrum.

Neither is normal or abnormal, it’s just an anatomical variance that’s important to consider when you’re talking about bringing the lip up during a lip lift.

Another thing about the philtrum is that it gives a sense of volume in the center of the lip. I find that sometimes with aging patients the whole philtrum tends to get flattened out. So if you find that describes you, you’ll want your surgeon to try to centralize the lip and give a little bit more contour to the philtrum

Cupid’s Bow

The cupid’s bow refers to the double-curved shape that the upper lip forms. Cupid, the god of love, with his bow and arrow – his bow has that same shape so we often refer to that as your cupid’s bow. The two peaks in the center of your upper lip and the little dip or indentation in the middle.

On some people it’s much more pronounced and acute and on some people it’s more level. You may be looking to adjust the height and/or definition of this feature and surgeon’s can tailor their lip lift plan based on your desired outcome.

Some patients come looking for a very accentuated cupid’s bow and in those cases I would just tend to do a central lip lift. However, on a patient looking for a more evenly distributed cupid’s bow, I would tend to do more of a full upper lip lift to elevate more of the lip.

The Lateral Lip

When discussing the lateral lip, we’re referring to the outer edges or sides of the lips. For lift or augmentation purposes, it’s important to not just consider the central portion of your lips, but also consider their entire structure, including the lateral aspects.

It is crucial for achieving balanced and natural-looking results. Refining the lateral lip can help enhance or address symmetry, contour, and proportion.

Corner of the Mouth & the White Roll

Let’s talk about the corner of the lip, or the corner of the mouth. A normal turn down occurs in a majority of the population. However, there are some patients where the vermillion border will go almost to the side without tapering much at all. That generally gives the impression of a fuller lip all the way around.

These days, with the fuller lip look that everybody likes, that tends to be more of a desired objective; whereas, I think that twenty or thirty years ago, people were wanting more of a defined cupid’s bow.

A traditional lip lift will not result in a lift the corner of the mouth. In order to achieve that, you need to do a separate procedure called a corner lip lift (or lateral lip lift).

The white roll is the little ridge of tissue in between the normal lip (which is flat) and it sort of rolls into the vermillion. The white roll doesn’t tend to go all the way outward and it is very, very subtle. It catches the light and allows you to appreciate the 3-d structure of the lips.

Changes in the perception of the white roll with different lip lift techniques plays a role in your outcome, so be sure to discuss that with your surgeon. For example, a gull-wing lip lift tends to flatten the transition between the skin and the lip and often results in a ‘painted on’ look in comparison.

Vermillion

The word vermillion just means “red,” so in reference to lip surface anatomy, we’re talking about the red part of the lip. The vermillion usually has little vertical creases showing, which is totally normal.

Sometimes, when people do lip fillers, they can stretch out all those normal creases. A lip lift, in general, tends to show more vermillion in a more natural way, with the normal creases in it.

The shape of the vermillion and the way that the vermillion shows, really goes together with the cupid’s bow. Some patients have a fleshier vermillion than others, of course. And if your surgeon talks about the vermilion border, that simply refers to the edge between the red part of the lip and the surrounding skin.

In lip enhancement procedures, the vermillion and vermillion border are often key focal points, with the goal of enhancing the volume and shape of the vermillion while maintaining the border definition for natural-looking results.

Asymmetry in Lips

In your pursuit of fuller or more defined lips, remember that true beauty lies in enhancing your natural features.

– Ricardo L Rodriguez, MD

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All sorts of asymmetry exists in all sorts of lips. Don’t believe me? Take a good look at any model or actress you consider to be beautiful and you’ll find asymmetry. In fact, those asymmetries are often a large part of their appeal!

Asymmetry is a natural aspect of the human body, and it’s important to recognize that absolute symmetry is rare and would actually look a bit strange. In lip lifts, as with almost all plastic surgery procedures, addressing asymmetry is a common desire.

Be sure you and your surgeon approach it with an understanding and appreciation of your unique variations and your desired outcomes.

If you’d like to see me talk about lip surface anatomy, check out this video.

In your pursuit of fuller or more defined lips, remember that true beauty lies in enhancing your natural features.

Wondering if a Lip lift is right for you?

If you feel like your upper lip covers your teeth too much and you’d like your upper lip to look fuller, contact Us to schedule your in-office or virtual consultation. Or just give us a call at 410-494-8100! Note: Virtual consults can also be used to get second opinions.

The post Lip Anatomy Definitions: How to describe the lips you want appeared first on Cosmeticsurg.

The majority of patients can achieve a fantastic youthful result with just component facial procedures, as opposed to a full-blown face lift. You can now achieve a refreshed appearance with just 1-2 weeks of downtime.

Face lifts: Not your mother’s facelift

In previous generations, patients with aging faces would consult a Plastic Surgeon for a facelift. The component parts of a full facelift were not generally described in the media; but, in general, the old style ‘full facelift ‘ would likely include all or parts of a coronal browlift, an upper/lower blepharoplasty, and a lower facelift (SMAS/deep plane).

The coronal browlift had incisions in the hairline from ear to ear, leaving some patients with hair loss and involved a long recovery. In more recent decades, patients were offered a mid-facelift. Some lower face and mid face techniques also involved aggressive dissection, which carried higher complication rates. Recovery time was usually several months, with a lot of hand holding between the doctor’s office and the patient.

The biggest evolution in face lift techniques was the advent of Fat Transfer to the face, which was introduced by Dr. Sidney Colemen in NYC in the 1980’s. Fat Transfers lifted the structures of the face in the same, and even in better ways, than the old mid facelift dissection techniques. In addition, your own fat could be injected in small quantities almost anywhere on the face to rejuvenate and restore volume.

the biggest evolution in face lift techniques was the advent of Fat transfer to the face

Nowadays, Fat Transfer is increasingly replacing the the mid-facelift, and the coronal browlift has been largely replaced by the endoscopic browlift. Fat transfer is now used to lift the mid-face region, and it is also used to rejuvenate other regions of the face.

Lower face lift techniques have evolved so that the direction of lifting is UP, rather than diagonal. And, in addition, smaller ancillary cosmetic procedures such as the Lip Lift, Lipo to the face/neck, and injectables have assisted in sculpting personalized results. Ancillary procedures in combination with a Browlift and Fat Transfer offer wonderful results with much less down time.

procedures do NOT need to be performed under General Anesthesia where a ventilator breaths for you

With anesthesia, all of the component parts of a Face lift can now be performed under IV anesthesia. These procedures do not need to be performed under General Anesthesia where a ventilator breaths for you. With IV sedation you are breathing on your own. In my practice, I use Board Certified Anesthesiologists to monitor your IV sedation throughout the case.

Let’s take a look at the transformative potential of the facial rejuvenation procedures available today to assist you in achieving your goals for a refreshed appearance.

Facial Rejuvenation Options

Lower Face lift: Addressing the jowls and ‘turkey neck’

If the neck is one of your biggest concerns, you will most likely benefit from a Lower Facelift. The Lower Facelift does address droopy jowls and neck concerns. Patients who elect to have the Lower Facelift often combine it with a Fat Transfer to the upper face, or a Browlift, or both.

There are at least three types of Lower Face lifts being performed by Plastic Surgeons. They are the SMAS, deep plane, and the vertical plication methods. I have used all three techniques and years ago settled on the vertical plication method introduced by Dr. William Little more than 25 years ago.

My preference for the vertical plication method in the Lower Face lift is that the lifting is UP, and not diagonal, as is primarily the case with some other techniques. These other lower facelift techniques can sometimes result in a ‘wind tunnel’ look, because the skin can look stretched out to the sides. Learn more about facelifts.

Brow lifts: Elevating your look / facelift effects achieved

The Brow lift is the most popular facial procedure that I routinely perform. The main advantage is that it will reduce the appearance of redundant skin on the eyelids and will open the eyes so that they seem more open and brighter. The other advantage of a Brow lift is that it can slightly lift the upper cheek area.

This procedure will give you a refreshed, more youthful look, while still looking like YOU. A bonus of this procedure is that if you have been regularly having Xeomin or Botox®, you will no longer be in need of these injections to smooth out your forehead.

These wrinkles should be greatly diminished or completely gone. In addition, there is no ‘frozen look’ after this procedure. My Browlift technique avoids this type of result where you end up looking ‘done’ instead of natural.

The Browlift does wonderful things for the upper eyelids. Patients often times think they need an Upper Blepharoplasty (upper eyelid lift). However, in the majority of cases I’ve seen, the patient is really better served with a Browlift.

This is because the brow has actually fallen and causing skin to be crowding the eyes. The brow should almost always be lifted first, before there is any skin removal of the upper eyelids. Years ago, I wrote a blog article and made a video entitled, Browlift is the new Eyelift. How true that has been!

For the majority of my patients I will recommend a Browlift instead of an upper eyelid lift. It does cost more, but the result is far superior to just doing a skin removal on the eyelids. In addition you should no longer need Xeomin or Botox® in the forehead region.

If a patient has extreme drooping of the upper eyelids, I will almost always perform the Browlift first, and then if it has not fully corrected the problem, I will remove the upper eyelid skin as a second touch up procedure. Learn more about brow lifts.

Fat Transfers: Restoring volume naturally

I love doing facial fat transfers. It is a natural solution and the results are fantastic. Fat transfer is the permanent option compared to any type of filler. If you are getting fillers several times a year, it might be time to ask your Plastic Surgeon about a Fat transfer, with or without a Browlift or any other component procedures.

My most common facial fat grafting involves transferring fat to the upper face, where it is injected into the upper cheek area and around the temples. This lifts the cheeks, giving the appearance of higher cheek bones, or more definition in the bone structure in the upper face. Another common area is to inject it under the lower eyelids to fill in deep hollows.

Back in 2009 I wrote about Fat grafting techniques restoring blood supply and nutrients to ageing skin

Fat transfers work by building volume. As you age, the dermis and epidermis below the skin layer thins and causes the skin to look saggy. Fat transfers help restore volume, fill in wrinkles, and also work to create the appearance of “lifting” the mid section of the face.

A well thought out fat transfer will build up some cheek bone structure in the midface region. To some extent, fat transfers can also have a tightening effect on the jowls.

To perform the Fat Transfer, a small quantity of fat is first removed from your stomach via lipo. The fat is then centrifuged in test tubes to isolate the most viable fat cells. The fat that floats to the top of the tube is discarded, and only the high density fat is used. Fat transfer are accomplished by performing scores of injections with small amounts of this high density fat.

Fat grafting has been around longer than you think. To read more about its history, which was widely popularized by Dr. Sidney Colemen in the 1980’s, read the summary I wrote about it in this article, Fat Grafting History and Applications.

In addition to the volume and structural benefits of fat grafting, it is very common to see improvements in the patient’s skin texture. The injection of your own fat will increase blood supply in the tissues of your face and do good things for the texture of your skin. I have seen this routinely in my practice during the 20+ years that I have been performing facial fat transfers!

Back in 2009 and I wrote about fat grafting techniques restoring blood supply and nourishment to aging skin . I have been very actively involved in fat grafts, stem cells, and studying their regenerative properties for more than 15 years!

Lip Lifts: Shortening the Upper Lip Lift space

Only a Lip Lift can provide more youthful, fuller lips without running the risk of having an awful duck beak of a top lip that appears exaggerated and even sometimes comical in appearance. It is really important to discuss your specifics with a plastic surgeon because you may actually be a better candidate for a lip lift than a lip augmentation.

The goal of lip augmentation is to enhance your lips and your perioral region (the area around your lips) while maintaining a natural and aesthetically pleasing, fuller, more youthful look.

Lip Lifts: Reducing the long space above your top lip

Do you have a long space between the bottom your nose and your top lip? If so, you may have noticed that your teeth no longer show, and you feel like you always look a little sad or slightly angry. If you’ve ever gotten fillers to augment your lips only to notice the increased volume causes them to protrude outward (aka duck lips), you’re likely a candidate for a lip lift instead of lip augmentation.

Beautiful lips generally have these three characteristics: a well-shaped cupid’s bow, a 1.1 cm distance between the bottom of the nose and the top lip, and a degree of fullness. You can see me talk all about lips in this video. In the video I illustrate those characteristics and talk about lip augmentation vs a lip lift. It is common for lip lift patients to have an excess of 3-5mm of space removed between the base of their nose and the top vermillion of the upper lip.

My Lip Lift technique involves only the removal of a small amount of skin at the base of the nose. I do not involve any nerves or muscles – no nerves are cut. I use a combination of quick disposable and permanent fixation sutures and I keep things simple to get the best upper lip lift results.

This procedure is typically performed as a local procedure, similar to when you go to the dentist. However, it can also be performed under IV anesthesia in combination with other procedures, such as a fat transfer to the face. A Lip lift offers a lot of bang for the buck, as your mouth will look more youthful and typically makes your facial expression more pleasing and relaxed. Learn more about lip lifts.

Liposuction : Liposuction to the lower Face and Jowl regions

Liposuction may not be the first procedure that comes to mind when you’re looking for facial rejuvenation, but there are certain instances where it is a valid consideration, especially in the lower face and jowl regions.

Lipo, typically associated with body contouring, sometimes helps by removing excess fat deposits for an enhanced jawline definition. Lower face and/or jowl lipo is a minimally invasive procedure that is highly customizable to treat your specific needs and, with proper techniques, it can produce excellent results. Learn more about liposuction.

What Facial Procedure Combination is Right for Me?

Each of the facial rejuvenation options outlined above has its unique benefits and considerations, particularly when used together.

Your choice should be guided in consult with a skilled, experienced, board certified plastic surgeon who can listen to your goals and help you assess your specifics to determine procedures would help you address your concerns.

Whatever path you choose, the goal is to restore confidence and reveal a revitalized version of you.

For me here in Baltimore, more patients are opting for Browlifts with Fat transfers to the upper or full face, instead of undergoing a traditional facelift.

This combination is less invasive than the old-style facelift of the past. And, in addition, the recovery for this combination is faster – and the results are fantastic!

You really can refresh your appearance with smaller component procedures that do not require weeks of recovery and do not break the bank.

Ready to discover the possibilities? The first step to a more youthful you is just a message away. Contact us now to book your consultation! We offer both in-office and virtual consults.

Our goal is to help you look and feel your best!

The post Face lifts, Brow lifts, Fat Transfers, Lip Lifts appeared first on Cosmeticsurg.

The short answer is that it depends on what method was used to do your liposuction. It is largely a function of the size of the cannula used to extract the fat.

If your surgeon uses 3mm cannulas for the fat extraction, you will likely not need massage therapy! If he uses larger cannulas, you likely will need massages.

Patients are constantly asking me this question and they always seem surprised when I tell them that my liposuction technique does not require post-operative massages. This is because I use thin cannulas to extract the fat. Some surgeons use larger 5mm cannulas for the fat extraction.

Which types of liposuction require massage post operatively?

• If the surgeon uses 5mm cannulas or laser/ultrasonic liposuction, you will need post operative massage
• If the surgeon uses thin 3mm cannulas with post operative compression garments, you should not need massage

Large 5mm cannulas = more fluid collection in tissue

While large cannulas this allows the surgery to be done faster, the larger cannulas can be more damaging to the tissue . There are larger pockets for fluid to collect. This is why some surgeons require lymphatic massage, as they want you to get massages to help push out the collected fluid in the tissue cavities.

Therefore, techniques that use thicker 5mm cannulas do benefit from lymphatic massage therapy to remove the excess fluid and reduce seroma type complications. On the other hand, small cannula liposuction techniques do not need massage therapy to get the desired results!

Let me go into more detail to explain why massage techniques are helpful in some cases and not needed in others.

Massage therapy is generally recommended for three reasons:

1. to push fluids out that have collected in the large tunnels created by large cannulas
2. to reduce swelling
3. to “break up” scarring and prevent skin surface contour deformities that are cased by internal scar adhesions in the subcutaneous tissue

All of these issues need to be solved in order for you to get a smooth, even liposuction result.

What causes swelling and internal adhesions after liposuction?

To understand what causes swelling and internal adhesions after liposuction, you have to think about what happens during the procedure. A hollow or solid metal tube called a “cannula” is inserted into the subcutaneous space above the muscle and below the skin like this:

As the cannula glides back and forth in the subcutaneous tissue, it will break up some of the connective tissue to various degrees. Depending on the amount of damage there can be swelling, and the attempt to repair the damage sometimes leads to scar formation and internal adhesions.

Fluid collection and swelling after liposuction

Normally, fluid comes out of the blood vessel (arteries and veins) and accumulates in the spaces that are in between cells and organs. This is called the interstitial space. The Lymphatic vessels are small fragile vessels that absorb this fluid in the interstitial space and return it to the veins.

These fragile lymphatic vessels can be injured during liposuction. When this happens, you get swelling as the tissues are soaked with fluid that is not being drained by the damaged lymphatics.

Larger cannulas will create more ‘open space’ (than a thin cannula). The increased open space gives more opportunity for more fluid to collect there. Bigger cannulas invite more fluid accumulation in the tissues.

“Lymphatic massage” is a massage technique used to help the fluid move along to areas where the lymphatic system is intact and, as such, the extra fluid can be drained.

Another method used to control swelling is compression. I personally believe that if you use compression early on, and continuously, you can reduce or eliminate the need for lymphatic massage.

Internal Adhesions

Internal adhesions happen after liposuction when a significant amount of tissue has been damaged or taken out and the hole left by the cannula has to be repaired or filled in by scar tissue. The larger the hole (from the cannula), the more repair there is to do. Larger cannulas leave larger holes.

Internal adhesions can cause dimpling or furrows in the skin after liposuction. The scar tissue binds to the edges of the remaining healthy tissue. This is called an adhesion. It can form a hard mass and in time starts contracting. This contraction of the scar pulls in the skin, creating a dimple or a furrow in the skin.

To prevent this dimpling, a stronger massage technique is used to “break up the scar.” Massage techniques, such as rollers, are used to break up this scar as it is being formed to prevent formation of adhesions that pull on the skin.

Types of Liposuction and when massage is necessary

There are three common liposuction techniques where we can plan for whether lymphatic massage will be needed or not.

The only technique which does not require massage after the surgery is when surgery is performed with thin cannulas. This is because the tunnels (from the fat extraction) made by the thin cannula are so small that they do not accumulate fluid like big tunnels made by bigger cannulas.

Liposuction performed with thin cannulas does not need post operative massage to attain a smooth result.

Ultrasonic / Laser Lipo

An ultrasonic cannula or a laser cannula works by emitting energy that will liquefy, or “melt,” fat cells along the path of the cannula. These dead fat cells are then sucked out.

Unfortunately, that same energy can damage some cells that do not get sucked out. The body then creates an inflammatory response around these dead or damaged cells which, in turn, creates further tissue destruction.

The result is large tissue gaps that have to be repaired or get filled in by scar tissue. Postoperatively , many surgeons performing this technique will recommend massage therapy . In many cases, unfortunatley, massage therapy is the only way to get a final result that is smooth.

Large Suction Cannulas

Conventional suction cannulas suck whatever is surrounding the cannula. The larger the cannula, the larger the gap of missing tissue that is left behind. These large cannulas create tunnels where fluid accumulates.

Any cannula above 4 millimeters in diameter can leave tissue gaps. Sometimes these large tissue gaps get filled in with fluids and that is called a seroma.

Small Suction Cannulas

When you use small cannulas, 3 millimeters in diameter or less with small suction holes, it is virtually impossible to leave large tissue gaps that will result in scar tissue.

Liposuction performed with thin 3mm cannulas does not need massage therapy post operatively

– Ricardo L Rodriguez, MD

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The reason is that by taking out the tissue in multiple small fragments, you leave normal tissue in between that can repair the tissue without creating scar masses or internal adhesions. There is also less fluid collection in these cavities.

Summary: small suction cannulas do not need lymphatic massage afterwards

Needless to say, any surgeons who are using large cannulas, Laser lipo, or ultrasonic lipo should consider massage therapy for all of their patients.

I have been performing liposuction in my practice since the early 90’s and I have never referred any liposuction patient for massage therapy after surgery.

I would never depend on a massage therapist to smooth out my surgical result! Likewise, I have not had any patients develop seroma after liposuction in years.

(originally published on December 20, 2019)

The post Do I need massage therapy after my liposuction? appeared first on Cosmeticsurg.

The Lower body lift procedure removes excess skin from the entire lower part of the body (stomach, hips and buttocks) and it is an ideal choice for patients who have experienced massive weight loss. However, even patients who have not had WLS are candidates for the body lift procedure. If you have loose hanging skin around your entire midsection, you are likely a candidate for this procedure.

As with any surgery, the body lift comes with possible complications and potential revisions as it lifts and tightens the entire lower part of the body. The good news is that most complications are relatively minor. Most revisions are simply touch ups and can be handled post operatively in the office setting.

Types of Body Lift Complications

In general, possible complications from the Body Lift procedure include:

fluid accumulation, hematoma, seroma, infection, poor wound healing (wound separation), asymmetry, unfavorable scarring, numbness or other changes in skin sensation, fat necrosis and deep vein thrombosis (primarily associated with General Anesthesia).

Body lift complication percentages & revision rates

36% of all patients who undergo a Body lift procedure will have a complication

-Ricardo L Rodriguez, MD

The Body lift is a major procedure and as with any surgery, there are potential complications that should be discussed with your board certified plastic surgeon during your consult.

A recent study analyzing 42 consecutive outpatient lower body lift procedures determined that 36% of all patients who undergo a Body lift procedure will have a minor complication and that 1 in 4 patients will have wound separation during the post-op period (which can be addressed in the office or clinic).

The revision rate among the 42 patients was determined to be 26% with the majority of revisions to improve the appearance of the scar. In this study, there were no deaths, venous thromboembolic events, hematomas, transfusions, or hospitalizations among the 42 lower body lift patients studied.

Avoiding Body lift complications

Good surgical technique achieves the *best* results with the least amount of post-operative complications.

-Dr. Rodriguez

Pre-op evaluation and BMI criteria for Body Lift Procedure

It is obviously the goal of every good surgeon and patient to avoid complications. One of the major risks is BMI, or Body Mass Index. Your BMI should be 35 or less. In addition, you need to have a medical clearance within 30 days of your surgery date.

Technique of the surgeon can influence the complication rate

For example, it is my experience that wound closure and fluid collection complications tend to occur if too much fat is removed from the subcutaneous layers. I find the Lockwood technique results in more secure skin closure and helps me to achieve the thinnest possible scar. With this technique, the suture tightening is applied to the deeper layers and prevents the scar at the top layer from widening over time.

General Anesthesia carries a higher risk of DVT compared to IV propofol sedation

Additionally, for a long surgery like the body lift, IV anesthesia administered by a board certified anesthesiologist is a much safer choice than general anesthesia. I have written about reducing risk during body lifts in the past, see this blog post. Just be certain to learn everything you can about the procedure and ask a lot of questions about surgical technique (and why) during your consultation.

Learn more about Body lifts

If you have experienced weight loss following a bariatric procedure, diet, and exercise learn more about the Body lift procedure and start consulting with board-certified plastic surgeons to discuss how this procedure might help you complete your transformation. This is a fantastic procedure that yields dramatic results!

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A Lip lift is a plastic surgery procedure that shortens the distance between the top border of the upper lip and the bottom (base) of the nose.

 It creates a fuller, younger looking top lip by increasing the amount of “pink lip” and better exposing teeth when smiling and speaking.

The Lip lift will result in a more pleasing appearance to the face. Look at the ‘before and after’ photo above and you can see that the patient has a more youthful and pleasant expression following the surgery. A lip lift can indeed even transform your overall expression.

The key to a successful Lip lift are the pre-op surgical markings. This post aims to help patients understand what the markings represent.

Lip lift surgical technique is to cut and lift skin only

My lip lift technique involves skin only and does not include manipulation or transection of muscle. I believe that involving the muscle  introduces an unnecessary risk of injury to the nerves.

I believe that involving the muscle introduces an unnecessary risk of injury to the nerves.

The ‘skin only’ technique achieves a consistent, dependable,  and desirable outcome.  In addition, since the procedure involves skin only, there is extremely little risk in changes to how your lips, mouth, and nose move following the surgery.

Over the past few years I have seen a number of patients whose lip lift was performed by other surgeons with techniques involving the muscle.

Some of these patients had complications which are difficult to correct. By using the ‘skin only’ technique, I have not encountered these complications.  For this reason, I am a firm believer of the ‘skin only’  technique.

All lip lift patients meet twice with Dr. Rodriguez

I meet with all of my Lip lift patients twice in person. The first time is the in person consult, which can be the day before surgery. The second time is the morning of surgery.

At the initial in person meeting I make an estimate of the amount of tissue we expect to remove. I draw it on a surgical plan. The morning of surgery is always the second time that I have measured the amount of tissue to be removed.

Having two in person meetings prior to surgery allows me to confirm the measurements that we have discussed. There is no margin for error in these measurements.

Lip lifts: Measure many times, cut once

On the morning of surgery, we are re-measuring to confirm the amount of skin to be removed. Meeting with the patient twice in person is a MUST. The first inperson meeting can be the day prior to the surgery. However, it is important that the patient has at least overnight to consider the measurement that we have discussed!

meeting with the patient twice in person is a must! – Dr. Rodriguez

I use markings to make sure the final result is symmetric, reducing the space between the upper lip and the base of the nose by the same exact amount along the entire length of the upper lip.

Based on patient input and our review of the plan, I make surgical markings between the nose and the upper lip as we sit in front of a mirror together.

Lip lift markings are detailed

The markings that I make are fairly detailed.  If you don’t know what to expect, it might be  a little overwhelming.  For this reason I decided to make a short video clip of the surgical markings done on a  patient.

This patient below was being prepped for an upper lip lift and after completing the surgical plan markings, she graciously allowed me to take this quick video to explain the pre-op markings. Hopefully this video will help patients understand the markings and be more confident that these markings are part of the normal process.

I use detailed markings to make sure the final result is symmetric. – Dr. Rodriguez

For this particular patient, the surgical plan was to have the final distance from bottom of nose to top of upper lift vermillion (the red part) equal to 1.2 cm , or 12 mm.

So there you have an explanation of my pre-op markings for a lip lift!

Learn more about the procedure itself, about my surgical technique, or about how a Lip lift might help you avoid duck lips that can sometimes occur with fillers.

The secret to a successful lip lift is to properly plan the surgery during pre-op and to keep things simple. See our results in the Lip lift gallery!

(originally published May 21, 2018)

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Most BBL deaths in 2014-2017 were caused by pulmonary fat embolisms

These deaths are primarily occurring due to Pulmonary Fat Embolisms (PFE). I have been performing this procedure safely for 15 years and the new data emerging about the increased mortality rates is disturbing.

I have been studying the issue closely and will do my best to explain what I see happening, and also discuss ways to increase patient safety. I believe the recent mortalities with this procedure can be dramatically reduced to have no greater risk than any other cosmetic surgery procedures.

However, this not only involves standardization of some surgical techniques, but also requires patients to rigorously vet the credentials of both the surgeon and the surgical facility.

PFE is a mechanical blockage of the pulmonary veins by fat particles.

Ricardo L. Rodriguez, MD

Statistics and reported BBL deaths prior to 2017

Media reports over the past couple of years detail many BBL tragedies to include those described here, here, and here. The most recently reported tragedy was just last week. A significant number of these recent deaths have taken place in Florida.

Equally troubling is the fact that most of the recently reported deaths in Florida were surgeries performed by non Plastic Surgeons. These doctors advertise themselves as ‘Cosmetic Surgeons,’ but they did not complete a residency in plastic surgery. The medical specialty which teaches principles of both liposuction and fat grafting during the residency program is ‘plastic surgery’.

In addition, in some of these publicly reported cases, the surgical facility was not accredited.

What is a Pulmonary fat embolism, PFE?

Reviewing the recent media coverage about BBL mortalities, as well as available published literature, the majority of deaths occurred from a condition called Pulmonary fat embolism, or PFE.

Previously, PFE’s were predominantly characterized as a rare complication of orthopedic surgery, but they can also occur with a direct injection of adipose tissue, as is the case with BBL.

Pulmonary fat embolism is not to be confused with Fat embolism syndrome. The syndrome disease is a systemic inflammatory response that can often be managed successfully.

The pulmonary fat embolism (PFE) is a mechanical blockage of the pulmonary veins by fat particles. It occurs when an injection cannula injures a vein, allowing injected adipose fat to enter the vein and block it. The fat particles can also travel through the pulmonary veins to the heart. While not all PFE’s are fatal, many do result in death within the first 24 hours following surgery.

BBL publications & BBL task force teams (2015-2107)

The plastic surgery community was first alerted to the risk of pulmonary fat embolism in a paper published in the Plastic and reconstructive journal in 2015 by Dr. Lazaro Cardenas-camarera, et al.

The 2015 Cardenas-camera et al publication on BBL PFE’s

“Deaths caused by gluteal lipoinjection: What are we doing wrong?” discussed a series of deaths that had occurred over the past 15 years in Mexico and Columbia. The conclusion of this paper was that intramuscular gluteal lipoinjection is associated with mortality caused by gluteal blood vessel damage during fat injection:

In other words, the paper concluded that injecting fat into the gluteal muscles increased the risk of pulmonary fat embolism.

The ASERF paper and task force results on BBL mortalities

Then, in 2016, a Task Force was created by the Aesthetic Surgery Education and Research Foundation (ASERF), to study these PFE complications. An anonymous survey was sent to 4,853 Plastic Surgeons around the world and the data was analyzed. The results of the survey were published in early 2017 by M. Mark Mofid, MD et al. in the Aesthetic surgery journal.

The data determined that the probability of having either a fatal or non fatal pulmonary fat embolism was 1:1473 (one in 1,473). Furthermore, the risk of death was estimated to be 1:3448 (one in 3,448).

To put this in perspective, the risk of death from any cosmetic surgery procedure in an accredited QUAD A facility is 1:55000 (one in 55,000). Prior to this paper, the highest known mortality rate associated with an aesthetic procedure was abdominoplasty, with a mortality rate of 1:13147 (one in 13,147).

In summary, the risk of mortality with a Brazilian Butt Lift was estimated to be 3 times higher than any other cosmetic surgery procedure and 16 times higher on average than any type of procedure performed in an accredited surgery center. These results were shocking.

2017, a Multi-society gluteal fat grafting task force to study BBL mortalities

After the Mofid paper was published, another task force team was established to study the issue further. This new task force team invited 19 plastic surgeons from ASPS, ISPRES, ISAPS, and ASAPS, and IFATS.

The multi-society task force team of surgeons studying gluteal fat grafting is a combination of plastic surgeons who have been performing the BBL for many years, as well as academic leaders in the field of Plastic Surgery. I was honored to be selected as a member of this task force.

Dr. Rodriguez was selected to be a member of the BBL Safety Task Force team.

In the Spring of 2017, we began meeting to evaluate the ASERF report findings as well as study the autopsy reports of patients who have died due to Pulmonary Fat Embolism. 

Our discussions are ongoing and I am not at liberty to share details, but I do want to put my thoughts forward in hopes of educating patients further and helping to avert any harm possible.

So, please note, my comments are not a statement of the task force, but are rather my own opinion based on years of experience, review of the retrospective publications, and examination of autopsy reports.

Reducing the risk of PFE during BBL procedures – my own thoughts

I believe there are a number of contributing factors leading to PFE, and that board certified plastic surgeons can reduce risk factors and make the procedure less risky for their patients.

Having performed well over 300 Brazilian butt lifts with not a single patient requiring overnight hospitalization, I feel confident that these measures dramatically reduce risk.

Patients contemplating a Brazilian butt lift procedure should be aware of the risks, specifically the risk of PFE, and should consider the following to minimize the risk involved. As a BBL patient, you should be sure to:

1. Choose a board certified plastic surgeon
   (American Board of Plastic Surgery)
2. Have your surgery performed in an accredited surgery center
   (Quad A, JCAHO)
3. Ask your surgeon about injection technique details
   • Are the injections performed in the subcutaneous or intramuscular plane?
   • How many cc’s are injected in each pass?
   • How long will the lipoinjection take?
   • Has he/she read the ASERF report  and recent publications about mortality in BBL?!
4. Use IV sedation with tumescent solution instead of general anesthesia

Choose a Board-Certified Plastic Surgeon

Let’s start with the obvious. Do not pick your surgeon solely based on his/her SnapChat and Instagram videos!!

Do not pick your surgeon based on Instagram and SnapChat videos!

Ricardo L. Rodriguez, MD

Likewise, it’s not all about patient reviews, as these can be gamed and paid for. While those may factor into your final decision, the most important criteria is the proper training of your plastic surgeon. The goal is safety above everything.

Beware of specialties outside of Plastic Surgery performing BBL’s

Over the past 15 years, I have observed a steady increase in other Medical Specialties advertising Brazilian butt lift procedures. This includes not only OB/GYN, but also non-surgical medical specialties like family medicine. 

Recently publicized deaths have indeed included doctors from these medical specialties. Some of these doctors are board certified. However, they are not board certified in plastic surgery which means they are performing the procedure without proper training because there is a high demand and patients are willing to pay for the service.

The only ABMS approved residency training program that teaches Liposuction and Fat transfer is ‘Plastic Surgery.’

Ricardo L. Rodriguez, MD

The Brazilian butt lift procedure involves both:

• Liposuction
• Fat transfer/Fat injections

The only ABMS (American Board of Medical Specialties) approved residency training program that teaches Liposuction and Fat transfer is ‘plastic surgery.’ The board certification is from the American Board of Plastic Surgery.

American Board of Cosmetic Surgery is NOT an ABMS Medical Specialty!

This is very different from the ‘American Board of Cosmetic Surgery.’ There is no ABMS Residency in ‘cosmetic surgery.’ It is NOT the same. This means it does not have the rigorous requirements of a ‘Plastic Surgery’ program.

Furthermore, attention should also be given to the credentials of your anesthesiologist. He or she should be board certified by the ‘American Board of Anesthesiology.’

Why is it important to choose a surgeon Board-certified in Plastic Surgery?

First, Plastic Surgery residents are introduced to the vast libraries of Medical publications on Plastic Surgery. They discuss these publications weekly as part of their training.

These publications include details of complications and risks. Their professors have authored many of these publications during their academic tenure.

Residents assist in performing procedures under full supervision of attending surgeons for many years. In addition there is much time spent on studying and analyzing how to avoid and manage complications!

Finally, during their senior year, many surgical residents in plastic surgery training programs have the ability to travel and visit other experienced plastic surgeons to learn particular procedures.

For example, in my practice here in Baltimore, the Johns Hopkins Plastic Surgery residents have been rotating through my surgery center to watch and learn the Brazilian butt lift procedure for years!

An autologous fat transfer is a completely different ball game than injecting Restylane or Juvederm. Taking a one week course on Liposuction and simply visiting a ‘famous’ doctor who performs the procedure, does not cut it for performing a Brazilian butt lift.

The Plastic Surgery residency program is a 6 year training process. A plastic surgery resident gets to experience the entire breadth of plastic surgery procedures and learns about related complications and how to avoid them . A resident is under the supervision of an experienced board certified plastic surgeon. This process takes years of hard work and study. It is not a weekend course.

There is no residency program in ‘Cosmetic Surgery.’

Finally, surgeons who are board certified by the American Board of Plastic Surgery are eligible to become a member of the ASPS.

Annual ASPS conferences have presentations on BBL complications and techniques and discuss ways to improve the procedure. Publications and abstracts are presented on complications, and surgeons openly discuss ways to improve surgical results and safety. Doctors from other medical specialities do not have access to this ASPS dialogue!

Check here to find out if your plastic surgeon is board certified by the American Board of Plastic Surgery.

Have Your BBL performed in an accredited surgery center

Before you blindly trust that your surgeon will be using an accredited surgery center… ask! Accreditation means that the facility has strict protocols and credentialing requirements in place for the surgeon,  OR staff, and the anesthesia provider.  

Written protocols are in place for licensing, malpractice insurance,  instrument sterilization, equipment maintenance, back up generators, life safety protocol, emergency protocols, infection control,  and a whole host of other vitally important topics. Accreditation also means that the facility is inspected by the agency on a regular interval.

In the USA, the surgery center should be  accredited by either the Quad A, JCAHO, or Medicare. You should see a current certificate of accreditation on the wall.  If not, you should consider that a red flag.

In addition, do not be afraid to ask if both your surgeon AND the surgical facility carry malpractice insurance. If you have your procedure in Florida, you will find out that this is (shockingly) not mandatory.

Does your surgeon inject the fat above the muscle?

The most consistent finding about risk of increased mortality from both task force teams and the 2015 Cardenas-Camarera, et al publication was that injecting in the deep muscles of the gluteal area increases risk of injury to the vessels. The recommendation is to inject into the subcutaneous space, which is the area above the muscles, and avoid injecting deep into the muscle.

Where does your surgeon inject? Has he heard of the ASERF report?

Ricardo L. Rodriguez, MD

Ask your surgeon how he knows he is injecting in the subcutaneous region

Likewise, do not be afraid to ask your plastic surgeon about how he performs the fat injection process. Ask if injections will be made into the deep muscles or the subcutaneous planes. 

All of the evidence so far suggests that there is a greater risk of vein injury when injections are performed into the deep muscles below the subcutaneous region. Injections should be performed in the subcutaneous region, which is the area closest to the skin.

A surgeon can only be sure he/she is injecting into the subcutaneous space if he either uses the manual method (as I do), or if he uses ultrasound with a pumping technique.

If your surgeon gets vague or cagey with these questions, this is a red flag. Read further to understand why.

Gluteal vasculature anatomy

The gluteal region is a very vascular structure. Vascularity means that there are a lot of blood vessels and arteries below the surface in the buttocks area.

Look at the diagram of the gluteal vasculature shown here. The veins are shown in blue and the arteries are shown in red in the buttock.

Unless your plastic surgeon is using an ultrasound probe while he injects, he can NOT see these veins while he is injecting. He must know where the arteries are and where the danger areas are.

Pulmonary fat embolism (PFE) occurs when a vein wall is injured during the injection process thus allowing fat to enter the vessel. The most dangerous area is where the inferior and superior gluteal veins emerge from the pelvis to the gluteal muscles. This area must be avoided.

How much fat is injected in each injection pass?

Reliable and safe fat grafting has been around for several decades, and was pioneered by Dr. Sydney Coleman. His technique is considered the gold standard of fat grafting across the field of plastic surgery. Its hallmarks are: a) Centrifugation of fat to remove impurities, 2) Use of thin, blunt tip injection cannulas 3) Low injection pressure, and  4) Injecting small deposits of fat at each pass of the injection cannula. Plastic surgery residents learn these standardized methods during their Residency.

For many years, fat transfers were limited to small volumes and were primarily focused on face and breast shape defects. Only in the recent decade have patients requested very large volumes of fat injected into each buttock cheek with the Brazilian butt lift. 

This has pressured many surgeons into using a fat pumping technique which goes a lot faster . However, is is much harder to determine what plane you are in, as the pumping technique is somewhat blind.

These high volumes are a new development in fat graft practice. Historically, average fat volumes for BBL procedures have been approximately 400cc in each buttock cheek, as summarized in a retrospective meta analysis paper by Dr. Alexandre Conde Green published in 2016.

I do not think the total volume of fat injected necessarily creates increased risk of PFE.  However, I do think that injecting a large volume of fat all at once (in the same injection pass) creates large clumps of fat that can then get into a vein and create a blockage. I believe that injecting small volumes of fat (1-3 cc) at many different injection locations largely eliminates the risk of large chunks of fat blocking a vein.

Manuel injection techniques have been abandoned for high volume power injection pumping techniques

Many surgeons, looking for a competitive edge in pricing and shorter operating times, have abandoned the safe and reliable Coleman technique in favor of speedy injection techniques. This is known as the pumping technique.

Ricardo L. Rodriguez, MD

Nowadays, total injection amounts are commonly approaching 800-1000cc per cheek. If a plastic surgeon uses conventional fat grafting techniques standardized by Dr. Sydney Coleman, these large volumes increase the length of surgery to somewhere between 5-7 hours.

That also increases the cost of surgery. Many surgeons, looking for a competitive edge in pricing and shorter operating times, have abandoned the safe and reliable Coleman technique in favor of speedy injection techniques.

Power injection or pumping methods for BBL injection are riskier, IMO

With power injection methods, instead of injecting 1-3 cc’s per pass, surgeons are now injecting 60cc’s to hundreds of cc’s per pass. In my opinion, this can NOT be good. This is like slamming as much fat into the buttock as quickly as possible. There is no way to know exactly  where the major veins are beneath the surface, and there is no way to know exactly where your cannula is under the skin. It stands to reason that dumping a lot of fat at one time into an unknown space is a recipe for disaster.

Injecting into the subcutaneous space with the Coleman technique

The best way for a surgeon to minimize any possible damage to the gluteal veins is to place the cannula so that the they know exactly where the tip of the cannula is. The way I do this is by pushing the cannula tip right up to the skin so that I can see the cannula tip tenting the skin, and I can feel the tip directly under the skin. I know where my cannula tip is at all times.  Look at the image above to see the cannula tip near the surface. This is the only way to be sure that the cannula tip is in the subcutaneous space right under the skin and away from the danger area of the gluteal veins.

Since the fat comes out at the cannula tip, this ensures the fat is deposited in the superficial subcutaneous space in your buttock. Any other method can only really guess where the cannula tip is. Even injecting in a plane parallel to the table can result in injury to the vein and depositing fat in the intramuscular plane. 

If you are injecting a lot, or injecting very quickly with a power injection tool, there is no time to pull out or even ‘feel’ what you are doing. If you hit a vein, it’s too late. It is really important to note that in the most recent cases of PFE, the surgeons thought they were injecting in a superficial subcutaneous space.

Use IV sedation anesthesia instead of general anesthesia

In April 2016, a publication from Alexandra Conde-Green in Plastic and reconstructive journal concluded, among other things, that most Brazilian butt lifts are performed under general anesthesia. Her analysis included 4,105 BBL patients from 17 publications.

While it is widely known that General Anesthesia carries a much higher incidence of pulmonary embolism (PE) compared to IV sedation, I believe that general anesthesia also increases the risk of pulmonary fat embolism (PFE). Let me explain why . . .

I do not think Brazilian butt lifts should be performed under general anesthesia.

– Ricardo L Rodriguez, MD

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General anesthesia causes vasodilation. Vasodilation basically means that the veins enlarge. In addition, the machine that breathes for you during general anesthesia uses positive pressure ventilation (PPV) to push air into your lungs. This pushes the blood inside the chest out into the peripheral veins, which also dilates the peripheral veins.

The problem is that when performing a BBL under general anesthesia, the veins get bigger, therefore presenting a larger target for injury and an easier pathway for fat to flow into! This is a recipe for pulmonary fat embolism.

With IV sedation (TIVA) plus the use of tumescent solution, the opposite  happens. The veins actually get smaller. With this type of anesthesia, it is harder to injure the veins and harder for fat particles to enter the smaller diameter pathways!

For these reasons, I do not think this procedure should be performed under general anesthesia. I have been using IV sedation for BBL’s for many, many years. In fact, here I am at our 2017 national meeting in Orlando speaking on the ASPS BBL safety panel. There are 5 other plastic surgeons on this panel including Drs. Conde-Green and Dr. Coleman.

This short clip captures the moment when I was speaking about how IV Sedation should be used instead of general anesthesia. I know that you will be hearing more about this in the future!

The safest way to perform the Brazilian butt lift is using the gold standard in fat grafting techniques and IV sedation combined with tumescent analgesia.

Ricardo L. Rodriguez, MD

If you are considering a BBL procedure, know the risks and ask questions to your plastic surgeon!

In summary, the safest way to perform the Brazilian butt lift is using the gold standard in fat grafting techniques (small cannulas, small fat deposits, low pressure injection) and IV sedation (TIVA) combined with tumescent analgesia.

If you are considering BBL surgery, please be aware of the risks and choose your surgeon with great care. Make sure he is Board Certified by the American Board of Plastic Surgery.

Ask questions. Where does he inject? Has he read the ASERF report? If you get a blank stare it is not a good sign. Asking all of the right questions will help ensure you’re choosing the right surgeon to trust your life with.

When performed with correct techniques by well-credentialed surgeons, I continue to believe that the Brazilian butt lift procedure is safe and that patients can achieve beautiful results with the procedure. If you have any questions about your surgeon’s credentials, please be sure to ask them here.

(originally published Dec 19. 2017)

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Patients with a BMI less than 35 are typically good candidates for the Tummy Tuck and BBL. However, every surgeon has a different guideline for what is the acceptable BMI for an elective surgery.

If your BMI is greater than 35, you have an increased risk of surgical complications.

Since cosmetic surgery is optional, you should plan your elective surgery so that you limit as many surgical risks as possible. BMI is definitely one of the risks you can control and your BMI should be at an acceptable level before considering surgery.

BMI and surgical risks

Your BMI is a function of your weight and height. It is calculated by your body weight divided by your height squared. The more you weigh, the higher the number.

Surgical risks are definitely increased with higher BMI. These surgical complications include problems that can occur both during the cosmetic surgery procedure, as well as problems which manifest post operatively.

Intraoperative risks include anesthesia and airway complications, which can both lead to serious injury or even death. Postoperative complications include pulmonary embolism and poor wound healing issues.

Here is the BMI guideline that I use to help determine eligibility for elective cosmetic surgery. These guidelines apply to all cosmetic surgery procedures performed under anesthesia, but they are most frequently addressed with Tummy tuck and Brazilian butt lift patients.

BMI less than 35

Patients who have a BMI less than 35 with no other medical conditions are good candidates for cosmetic surgery. However, if you have any health issues, also known as comorbid conditions, it will definitely factor into the decision to have surgery.

Patient with BMI less than 35 are generally good candidates for the BBL and Tummy Tuck

BMI between 35-40

If your BMI is between 35 – 40, I will make the determination based on your current health profile. If you have NO medical conditions, I may approve you as a candidate for surgery, but I will also ask you to lose weight before surgery. However, if you have any medical conditions such as diabetes or high blood pressure, I will likely not approve you for surgery.

BMI greater than 40

If your BMI is above 40, you are not a candidate for elective surgery. I will NOT, under any circumstance, perform surgery on any patient with a BMI greater than 40 as the risk of surgical complications is just too high. If you are in this group, you should be focusing on weight loss and improving your general health first.

When patients come to my office with a BMI greater than 40 we generally spend a lot of time talking about ways they can reduce caloric intake and ways to increase their activity level. I ask patients to concentrate on losing some weight and then come back to see me in 3 to 6 months.

Reducing your BMI

Keep in mind that having a healthy BMI is not only good for lowering surgical complications, but also good for your general health.

With a lower BMI, you will likely feel better. If I ask you to lose weight, do not despair, as this is a solvable problem!

Sometimes the extra boost of having a physician say ‘you need to lose weight’ even helps move the weight reduction process along.

My experience is that patients are usually more committed to losing weight once a physician has explained the increased surgical risks associated with a high BMI. Fear is a great motivator!

Semaglutide and Tirzepatide injection to help you lose weight

Most recently, the option for weight loss injections has been introduced to many Plastic Surgery practices to assist high BMI patients in losing weight. In my own practice, we offer Semaglutide and Tirzepatide injections.

Patients are having great success with these medications. However, most patients do gain weight once the injections are stopped. For this reason it is important to permanently change diet and exercise routines to keep weight off.

Lower BMI will give you tighter and better Tummy Tuck results

While losing weight before having a cosmetic surgery procedure may seem counter-intuitive, a lower BMI will not only lower surgical complication risk, but you will very likely get a ‘tighter’ surgical result for procedures like Body lift and Tummy tuck.

I always encourage patients to lose as much of their targeted weight loss as possible before surgery. However, it is totally fine to continue losing another 10-20 pounds after a procedure is performed without compromising the results.

BMI calculation – enter your height and weight

BMI calculator

If you’re not sure where your BMI falls, you can use this quick BMI calculator for adults from the CDC by entering your height and weight and letting it do the math for you.

Please feel free to ask me any questions about BMI and co-morbid conditions below.

(originally published June 17, 2017)

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As some of you who read this blog regularly already know, I am a huge proponent of fat grafting and the therapeutic applications of adipose stem cells.

Ever since 2009 I have been writing about the regenerative properties of fat grafts and stem cells. After joining IFATS, the International Federation for Adipose Therapeutics and Science, an organization devoted to the study of adipose tissue, I have become increasingly more involved.

In 2013 I was awarded a Maryland Stem Cell Grant to study the use of adipose stem cells to heal breast tissue damaged by radiation. Last year I was elected President of IFATS, and tomorrow I will be presiding over the 14th annual conference in San Diego. I am extremely excited about all that we have planned. Over 160 abstracts will be presented and they are all fabulous! Here is a bit of an overview about what is planned for the 2016 IFATS meeting.

IFATS 2016: San Diego, California

We’ll be kicking off this year’s IFATS meeting with an exciting morning dedicated to ‘Fat graft process engineering’. Later we will focus on the therapeutic applications of adipose stem cells. We’re bringing together not only the leading clinical practitioners, but also leading endocrinologists, experts in the field of genomics and big data as applied to medicine, and stem cell researchers from other specialties such as cardiology and orthopedics.

Keynote speakers include Sydney Coleman, MD, who will be speaking about The Process of Fat grafting and Carlos M. Isales, MD, who will be speaking about Bone, fat and aging: therapeutic options.

We will also be welcoming speakers who will be focused on big data and machine learning in Medicine. This includes a keynote by Google’s director of software engineering, Philip Nelson, who will present applications of machine learning in medicine.

Don’t miss this rare opportunity to get “the big picture” about fat grafting, from the bench to clinical uses and beyond to the possibilities of applying “big data” techniques to our growing knowledge.

“Don’t miss this rare opportunity to get the Big Picture about fat grafting”

-Dr. Rodriguez

The IFATS program will involve the presentation of over 160 abstracts on a wide range of fat grafting and adipose stem cell topics affecting researchers, clinicians, the biotech industry, and patients.

Keynote and guest speakers include

• The Role of Genomics complementing Cell Based Therapy
  Dietrich Stephan, PhD – Professor and Chair of the Department of Human Genetics at the University of Pittsburgh Graduate School of Public Health
• Bone, Fat, Aging- Explaining Fat’s therapeutic role in Medicine and Aging
  Carlos Isales, MD, Professor of Neuroscience and Regenerative Medicine at Augusta University
• Machine Learning in Clinical Medicine
  Philip Nelson, Director of Software Engineering, lead of translational research team at Google, focusing on applications of machine learning in Medicine
• Adipose Derived Stromal Cells for soft and hard tissue clinical needs
  Michael Longaker MD, co-director of Institute for Stem Cell Biology and Regenerative Medicine at Stanford University

Presentation topics include

• Fat graft process engineering
• Industry showcase of companies involved in fat graft/stem cell processing
• Adipose stem cell biology, characterization, and isolation techniques
• Safety and efficacy of ASCs in breast reconstruction
• Antibacterial affects of Adipose Stem Cells
• Using ultrasounds and machine learning techniques
• FDA and regulatory issues with adipose stem cells
• Pilot studies and therapeutic applications using adipose fat and stem cells in treatment of:
  • osteoarthritis
  • exercise induced pulmonary hemorrhage
  • radiation damage
  • migranes
  • acne and scars
  • burns
  • organ transplants
  • myocardial ischemia
  • flap survival
  • HIV therapy
  • Parry-Romberg syndrome
  • gluteal augmentation

Clinical trial updates include

Updates on human and animal clinical trials using SVF and adipose stem cells for the following indications will be featured on Friday and Saturday sessions:

• hair loss and alopecia
• wrist arthritis
• erectile dysfunction
• urinary incontinence
• crohn’s disease
• facial atrophy in HIV

You can find the entire program on the IFATS website.

More about IFATS

Founded in 2003, IFATS is a non-profit scientific society that promotes the exchange of information among researches and is currently the world’s only interdisciplinary fat tissue society. Committed to serving as the premier global incubator in the field of fat applied technology, current scientific areas of interest relate to facilitating the development of treatments for excess body fat, the generation of new fat tissue for reconstruction after cancer or birth-related defects and the use of adipose tissue as a source of mesenchymal stem cells that have the potential to regenerate and repair different body tissues. Learn more at IFATS.org.

(Article originally published November 16, 2016)

The post IFATS Conference 2016 summary: Fat Grafts, adipose stem cells, and the big picture appeared first on Cosmeticsurg.

Laser resurfacing is a procedure which is aimed at rejuvenating the face. It basically works by injuring the top layers of your skin, the epidermis, causing a signal which promotes regeneration of new facial skin.

The laser destroys the top layers, your body sends signals to rejuvenate the area.

While laser skin resurfacing can be an effective method for prompting a fresher, more youthful facial glow, there are some risks that take place at various layers in the skin which can cause fat volume loss. Unfortunately, many FDA approvals for lasers do not include long term follow up for these types of complications. Laser companies take defensive positions, and hard data on complications is very difficult to attain.

In the past 15 years I have seen many patients from other practices with laser damage. I stopped doing laser completely around 2010 as the damage that I saw was from various types of lasers.

In October, 2025, the FDA issued a safety communication confirming serious complications from energy-based skin treatments, including facial fat loss, scarring, and nerve damage. While the advisory focused on RF microneedling, many of the same risks apply to laser-based devices that penetrate beyond the skin’s surface.

Why does this damage take place? With laser resurfacing, regeneration of the skin is prompted by destruction and that destruction can also cause fat volume loss.

An alternative to laser resurfacing is fat grafting

For facial rejuvenation, instead of using lasers, I prefer to rejuvenate the skin with fat grafting. Your own fat contains very tiny blood vessels. When that fat is injected into your face, more blood supply is introduced to your tissue matrix. With fat grafting, instead of a loss of volume, there is an increase in volume. Volume is increased by direct injection of fat as well as the fact that the process does not destroy cells as laser can do. To learn more, continue reading!

With fat grafting, regeneration of the skin is prompted by signals sent by adipose stem cells which reside in the fat that is injected into the subcutaneous layer.

Something that is designed to tighten your skin can actually end up causing damage further below the skin and to the fat tissue that’s right under the skin . . . ultimately resulting in a loss of volume.

– Ricardo L Rodriguez, MD

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Why do some people experience facial fat loss after laser resurfacing?

Something that is designed to tighten your skin can actually end up causing damage further below the skin and to the fat tissue that’s right under the skin . . . ultimately resulting in a loss of volume. Hear me speak about it.

Anytime you introduce an energy source into the body, whether it be radiofrequency, or laser, or even CoolSculpting – which is specifically designed to injure fat cells – the cells that are damaged release what’s called DAMPs (Damage Associated Molecular Pattern Molecules, aka Danger Associated Molecular Pattern Molecules) and those DAMPs signal other cells.

If the signals are severe enough, or a particular kind, the DAMPS can trigger a process called apoptosis, which is programmed cell death, and that keeps on going for weeks or even months after the original injury.

So patients who have had laser, or patients who have had radiofrequency, or patients who have had CoolSculpt, will continue to have subcutaneous fat tissue loss as a result of that.

How to correct facial fat loss after laser resurfacing?

The best correction for this, of course, is fat grafting. Fat grafting works in two ways:

1. It replenishes the fat that was lost.

2. The stem cells and regenerative cells in the fat restore the integrity of the tissue that was lost after the injury from the laser.

I no longer offer laser resurfacing as I feel that fat grafting does a much better job at facial rejuvenation. I have been talking about the benefits of facial fat grafting for years and I find that we are doing more and more facial fat grafting procedures as an alternative to facelifts.

Likewise, fat grafting is the perhaps the single best solution to fat loss that occurs following laser resurfacing. If you have had this happen, a fat transfer may be exactly what the doctor ordered!

The illustrations used in this article were created using the skin (layers, glands, vessels) illustration by Don Bliss via Wikimedia Commons.

(Article originally published July 26, 2016)

The post Why Laser Resurfacing Can Cause Facial Fat Loss appeared first on Cosmeticsurg.