Body Contouring Procedures
PLEASE READ THIS FIRST (It’s well worth the time!) : MY CURRENT APPROACH TO BODY CONTOURING
In 1990, when I was a resident in plastic surgery, and up until 2013, my approach to body contouring was simple. If there is a part of the body that a patient doesn’t like, then you select from the available procedures at the time and correct it. For instance, if there is extra fat in the flanks, remove it with liposuction. Extra skin in the abdomen from three pregnancies, then go with abdominoplasty. My results got better and better with refinements in technique and experience, and both my patients and I were happy. The approach was clear, concise and afforded significant improvement.
I will never be content with the status quo. My entire surgical career has been one of evolution. Always look for a better approach, a better technique, better technology. In 2013, I gave great thought to what I was doing and sought to improve it 
further. I traveled to Bogota, Colombia where I was personally trained by Alfredo Hoyos, M.D. and became one of a small group of surgeons worldwide certified in 4D Lipo.
I will explain the difference. In the past, liposuction was about removal of deep layers of fat. We were taught NOT to treat the superficial layers for fear of creating dents and divots and other deformities. We were taught to focus upon areas of excess deep fat, from the hips, the abdomen, the thighs and remove it. It worked, and results were good. With advancements in technology, a device called the VASER was developed. The VASER uses ultrasound to emulsify fat and less traumatically separate it from the skin and muscles so that it may be removed with suction. The interesting thing is that ultrasonic energy is tissue specific for fat and does not disturb adjacent nerves, blood vessels, skin and muscle. With the VASER, it has now become possible to safely address the superficial layer of fat. The ability to sculpt the superficial layer of fat is what permits to surgeon to create definition. I have been using the VASER since about 2005, but only addressing the deep layer of fat. The newest generation of the VASER, along with special accessory equipment including custom-made probes and cannulae, permits me to address both deep and superficial layers of fat with the ability to sculpt the body. Now, I can remove deep pockets of fat to “debulk” areas, as well as remove smaller collections of superficial fat to yield greater definition of the underlying musculature. I can now even “etch” lines of definition to accentuate the musculature (ie create a “6-pack” over the abdomen). Lastly, and this is an added bonus, as it turns out, about 85% of the fat removed by the VASER is viable (alive). This means that I have a new tool: I can take the fat I remove and use it to add volume to areas of the body deficient of volume such as augmentation of the buttocks, male pectoral (chest) muscles and even the face. The removed fat, now harvested in a special sterile canister, has been elevated from “medical waste” to “liquid gold”. I now have the ability to take down areas of excessive contour, enhance areas of poorly defined contour, create muscular definition and add contour, all in the same operation!
When Hoyos quietly developed these procedures, he initially called it “Hi Def” or “VASER Hi – Def”, and several surgeons became trained in it. Recently, Hoyos further refined the technique. The fourth dimension referred to in the term “4D Lipo” is dynamic definition of the underlying muscular anatomy as it relates to muscular motion is now also considered. This has taken liposculpture and my results to a new level.
What I learned to do is to stop looking at isolated regions of excess fat and instead to focus upon the entire trunk, sometimes with the upper arms and thighs as well, as one unit and to sculpt the body using all the tools I described above so as to achieve the most natural, physically fit and three dimensional aesthetic results possible!
When addressing the abdomen, in the past, I would decide if the patient needed an abdominoplasty (excess of skin, not much excess fat) OR liposuction (excess fat, not much excess skin). It was an either/or decision. In Bogota, I learned to perform a 4D VASER lipoabdominoplasty which is like a marriage of the two procedures. Like traditional abdominoplasty, it is applicable when there are small or large excesses of skin. However, there are several advantages to 4D VASER lipoabdominoplasty:
- The abdominal skin flap is contoured with VASER liposuction before it is elevated from the underlying muscles. This affords more muscular definition and three dimensionality to the results. In typical abdominoplasty without VASER liposuction, the skin flap is pulled downward and the excess skin is trimmed, however, the thickness of the abdominal skin varies at different levels and simply pulling the skin down can result in improper skin thickness, distorting results. Also, the abdomen looks more like a flat sheet of skin pulled over it rather than having shape and contour.
- There is usually less blood loss associated with 4D VASER lipoabdominoplasty.
- Less abdominal skin needs to elevated off the abdominal wall to premit proper re-draping over the muscles. This preserves more circulation to the abdominal skin and therefore there are less problems with wound healing. Thus, 4D VASER lipoabdominoplasty can be thought of as a SAFER ABDOMINOPLASTY.
4D VASER Lipo and 4D VASER lipoabdominoplasty are more detailed procedures, and as such do take longer to perform. Surgery is generally performed under general anesthesia. Smaller areas can be performed under local anesthesia with or without sedation. Due to the increased amount of surgical detail required as well as longer operative times, 4D VASER Lipo and Lipoabdominoplasty does cost more to perform. However, the results far and away justify the extra effort expended!
Although I still perform traditional (without VASER liposuction) abdominoplasty without drains (see below), 4D VASER lipoabdominoplasty does require a single drain under the lower portion of the abdominal skin (at the waist crease) for a week or two. I have also found that a special 4D Lipo compression garment with a foam vest for four weeks helps greatly with limiting swelling and assuring that you get to your maximal contours as soon as possible. Patients frequently drive a week or so (sometimes less) after 4D VASER lipoabdominoplasty and report very little discomfort after the surgery. In my opinion, the improved natural quality of the result after 4D VASER lipoabdominoplasty justifies the extra inconvenience of the one drain and the garment. Note: this garment is NOT a binder but a special elastic garment manufactured exclusively for 4D lipo procedures.
Abdominoplasty (“Tummy Tuck”) Without Drains! And now, much less discomfort and quicker recovery too!!!
Abdominoplasty helps to flatten and shape the abdomen and waist by removing excess skin and fat while also tightening the abdominal muscles. The best candidate for this procedure has excess skin without too much excess fat. The procedure can also be useful for women with stretched skin and lax abdominal muscles from pregnancy.
The procedure takes approximately two to three hours and is performed with general anesthesia. Frequently, liposuction of the flanks is performed at the same time so as to achieve the most optimal contours. Recovery time ranges from two to six weeks. Of course, recovery is an ongoing process, so you will be able to do more and more gradually, but as a general guideline, we see patients driving in one to two weeks, and back at work in one to three weeks. Some do take longer to achieve these goals. It all depends on the individual, how motivated you are, and what type of work you do. The abdominal muscles are tightened in almost every case. In order to protect that muscle repair, we recommend not lifting more than 25 pounds or doing strenuous exercise for six to eight weeks.
With a balanced diet and regular exercise, results are long-lasting. The incision for abdominoplasty will leave a permanent scar extending from hip to hip, although it should be low enough that most items of clothing will conceal it.
Dr. Epstein performs the abdominoplasty procedure using a new technique in which bothersome drainage tubes (usually two of them) are no longer required after surgery! You will feel better, no longer encumbered by drainage tubes coming out of your body as well as needing to regularly empty them and record the amount of drainage.
With our new, special technique, there is dramatically less post operative discomfort than we have seen in the past! Several of our recent patients have noted ambulating with ease the same day as surgery and take only a few (2 or 3 to be exact!) pain pills the first couple of days. We use no bulky bandage dressings for the abodminoplasty (if you have liposuction of your flanks, there is a small dressing of your back). You can even shower the next moring after your procedure if you like. You will recover faster and more pleasurably and heal faster too.
- Click here for Frequently Asked Questions on Abdominoplasty
- View our Before and After Patient Gallery
- Read latest article on Body Contouring
Liposuction (Lipoplasty/Suction Lipectomy)
The most popular cosmetic surgery procedure in the United States, liposuction contours the body by removing undesirable fat that has not responded to diet and exercise. It can be used to sculpt the abdomen, waist, hips, buttocks, thighs, knees, chin, cheeks, neck and upper arms. Local anesthesia or general anesthesia may be used, and the procedure can last anywhere from one to four hours depending on the amount of fat being removed. The best candidate for this procedure, unlike abdominoplasty, has excess fat with good quality skin, with little to no excess.
There are several different methods surgeons use when performing liposuction, including ultrasound-assisted lipectomy (UAL) and suction-assisted lipectomy (SAL). In both types, fluid is injected into the area to be treated. Then a tiny incision is made in as inconspicuous a place as possible, and a cannula (small tube) breaks up the fat layer and suctions it out.
- Click here for Frequently Asked Questions on Liposuction
- View our Before and After Patient Gallery
- Read latest article on Body Contouring
VASER® Lipo
The VASER® Lipo combines new patented technology with advanced surgical techniques to gently dissolve and remove excess fatty tissue from the abdomen, hips, “love handles,” “saddlebags,” thighs, arms, back, knees, neck and chin. The VASER Lipo procedure uses ultrasound energy to eliminate fat while leaving nerves, blood vessels and connective tissue largely undisturbed. Without damage to this tissue, patients experience little pain and achieve much smoother results than with traditional liposuction.
- Click here for Frequently Asked Questions on VASER® Lipo
- View our Before and After Patient Gallery
- To read a whitepaper comparing the VASER to other technologies in body contouring, click here
- VASER Lipo Animation Video
- Read latest article on VASER® Lipo
VASER® Lipo has been featured on:
VASER Smooth
An exciting new technology to treat Cellulite!. Concentrated ultrasound is delivered under the skin via a minimally invasive surgical procedure perfromed under local anesthesia to release the thin bands under the skin responsible for causing Cellulite.
Male Breast Reduction (Gynecomastia)
Although rarely discussed, enlarged male breasts is a common condition. Gynecomastia affects approximately 40 to 60 percent of men. There is often no known cause for gynecomastia, although there has been some correlation with various drugs or medical conditions.
Men who feel self-conscious about their appearance are helped with breast reduction surgery. The procedure removes fat and/or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a contoured chest that is flatter and firmer.
- Click here for Frequently Asked Questions on Male Breast Reduction
- View our Before and After Patient Gallery
Read more about Abdominoplasty »
