Dr. Epstein's Current Approach to Body Contouring
Why Dr. Epstein?
Most patients and surgeons today will focus on a limited area of patient concern such as the abdomen, without regard for all the other areas of the torso. Addressing only a limited region will result in an imbalance between the operated area (which will look improved) and the flanks, hips, buttocks, upper arms and thighs as well as the back (which will not be improved).
Searching for a better approach, Dr. Epstein traveled to Bogota, Colombia where he was personally trained by Alfredo Hoyos, M.D. and became one of a small group of elite surgeons worldwide certified in 4D Lipo. 4D Lipo is a newer, more improved version of the older “Hi-Def” or “VASER Hi-Def” Lipo. 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 his results to a new level.
IF YOU WANT TO UNDERSTAND WHAT MAKES DR. EPSTEIN'S APPROACH DIFFERENT THAN THOSE OF MOST OTHER SURGEONS, PLEASE READ THIS IN ITS ENTIRETY.
The following video introduces his approach:
Dr. Epstein's Approach to Vaser
Aesthetically, Dr. Epstein learned to think about the body very differently. He learned 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 he described above so as to achieve the most natural, physically fit and three dimensional aesthetic results possible! For example, the abdomen and flanks blend together, as the back, flanks and buttocks blend together, and the buttocks and inner and outer thighs blend together. You cannot think of them as separate and discrete areas - you need to think of them all together so as to achieve the greatest aesthetic balance and proportion.
Dr. Epstein's approach is to examine your entire torso, looking at areas of excess skin as well as excess fat and even areas that are volume deficient. Yes, it is possible to have excess volume in one area and a significant deficiency in volume immediately adjacent to it. This requires an eye for the aesthetics of the human form, coupled with surgical techniques that can safely and effectively address all of these areas. By taking a circumferential approach, he can re-sculpt your body and give you more balanced, youthful and natural contours, while at the same time minimize scarring. Aside from the traditional "waist crease scar" for an abdominoplasty (tummy tuck), all the extra incisions needed to achieve this are small incisions used only for the liposculpture instruments, typically about 1/8 inch in size and hidden in areas that will make it very difficult to see them, even when in the smallest of bikinis. Note the use of the word “Liposculpture”. Dr. Epstein distinguished “liposuction” as a technique to remove fat through very small incisions in the skin, whereas liposculpture pays more attention to the different layers of fat, selectively removing fat from specific layers to improve aesthetic contour, as well as adding fat to volume deficient areas to further balance and enhance the surface contour of the body. You can see this in the photo gallery of before and after cases.
In the past, liposuction was about removal of deep layers of fat. Surgeons are taught NOT to treat the superficial layer of fat for fear of creating dents and other contour deformities. Surgeons are taught to focus upon areas of excess deep fat, (from the hips, the abdomen, the thighs) and debulk it by aggressive removal of this deep fat. This approach did reduce volume, and results were adequate, at least Dr. Epstein thought so at the time. With advancements in technology, a device called the VASER was developed.
Unlike traditional liposuction which avulses (rips) the fat away from the overlying skin and underlying muscle, the VASER uses ultrasound to first emulsify the fat, thereby less traumatically separating it from the skin and muscles, turning it into a thick “fat milkshake” so that it may now be effortlessly removed with suction. The interesting thing is that ultrasonic energy is tissue specific for fat only, and does not disturb adjacent nerves, blood vessels, skin and muscle. With the VASER, it has now become possible to safely address the intermediate and superficial layers of fat. Having gained the ability to sculpt the superficial layer of fat is what permits the surgeon to create definition.
Dr. Epstein has been using 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 him to independently address the deep, intermediate and superficial layers of fat with the ability to sculpt detail onto the body. Now, he can remove deep pockets of fat to “debulk” areas, as well as remove smaller collections of intermediate and superficial fat to yield greater definition of the underlying musculature. Dr. Epstein can now even “etch” lines of definition to accentuate the musculature (ie create a “6-pack” over the abdomen in men, a little less definition being desirable in women).
Lastly, and this is a very important added bonus, about 85% of the fat removed by the VASER is viable (alive). This means that he has a new tool: Dr. Epstein can take the fat he removes 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 re-classified from “medical waste” to “liquid gold”. He now has 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!
In the past, Dr. Epstein 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, he 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. Like liposuction, it is applicable when there are small or large excesses of fat. However, there are several advantages to 4D VASER lipoabdominoplasty:
- The abdominal skin flap is pre-contoured with VASER liposuction before it is elevated from the underlying muscles. This affords more muscular definition and greater 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 down rather than an abdomen having shape and contour.
- There is usually less blood loss associated with 4D VASER lipoabdominoplasty.
- Use of the VASER does not damage the circulation to the abdominal skin.
- Less abdominal skin needs to elevated off the abdominal wall to permit 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.
Details about the procedure
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!
4D VASER lipoabdominoplasty does not require the use of any abdominal drains. Dr. Epstein has also found that a special 4D Lipo compression garment for several weeks after surgery helps greatly with limiting swelling and assuring that you get to your maximal contours as soon as possible. Patients frequently drive a week or two (sometimes less) after 4D VASER lipoabdominoplasty and report very little discomfort after the surgery. In Dr. Epstein's opinion, the improved natural quality of the result after 4D VASER lipoabdominoplasty justifies the extra inconvenience of the one drain (used when there is liposuction of the flanks, it is placed just above the buttock crease below the back) and the garment.
Note: this garment is NOT a binder but a special elastic garment manufactured exclusively for 4D lipo procedures.
4D VASER liposuction of the abdomen is usually performed at the same time as an abdominoplasty so as to remove fat from the remaining abdominal skin and give you the most sculpted look possible. There is even a new technique to create an umbilicus ("belly button") that does not have that telltale circular scar around it that is a giveaway of a tummy tuck! Lastly, those that have undergone a previous abdominoplasty and/or liposuction can also benefit from 4D VASER liposuction techniques to improve their contours and achieve a more sculpted look.
What are my options with vaser?
All of these procedures are custom combinations of many different procedures and techniques. Only the ones that you require are selected. The options include but are not limited to: abdominoplasty (tummy tuck), VASER 4D liposuction of the abdomen, male chest, armpit bulges, flanks, upper arms and thighs, mons (pubic) area, upper, mid and lower back including the "bra rolls” as well as fat transfer to add volume and improve the blending of contours in the hips, thighs, buttocks ("Brazilian butt lift"), male chest and face. Also, areas over-resected (too much fat removed) by previous liposuction surgeries can often be improved with fat transfer techniques!
In life, you rarely get something better for nothing, and that is the case here as well. Dr. Epstein will need to perform this surgery (you will be asleep) in two positions: initially with you on your stomach, and then you will be turned and placed upon your back. As this procedure addresses multiple areas of the body, the surgery will take longer and will cost more. Attention to patient safety is Dr. Epstein's highest priority. His patients will tell you that the results are clearly worth the extra investment in time and cost.
If you need to convince yourself that 4D Vaser is for you, view the photo gallery and compare the results to that to others who do not perform these techniques.