We do a lot of brazilian butt lifts. The brazilian butt lift augments and enhances your buttocks using fat from unwanted areas of your body. The procedure is a total body resculpting of your abdomen, flanks, and buttocks. The question I often get asked is “Doctor will I lose the effect of the brazilian butt lift if I lose weight after the surgery?”

The answer is: If the fat is processed and grafted correctly-you will not lose the effects.

To illustrate the point, I went back and looked at the photos of one of my patients who had the brazilian butt lift surgery, lost approximately 10% of her body weight after the post op period, and then gained all of the weight back at the end of the one year period.

In the video below , her pre-op is on the left. Eight months following the surgery, in the photo on the right, she lost a little over 10 pounds. You can see that her buttocks are still prominent ,and her new curves show off very nicely. Watch the video to see all of the details.

Even with her weight loss, her buttocks are prominent and she maintains the buttocks ’shelf’. If the procedure is done correctly, your new curves should stay with you. Properly processed fat Read More »

For months, we have been hearing the debate on ways to reduce healthcare costs.  Thus far, nearly everything introduced requires vast amount of government expenditures and seriously upsets people who actually like the health care plan that they currently have.  It is astounding that the most important way to lower health care cost rarely , if ever, gets discussed. Curious?–read on. How do we lower health care costs? As the Governor of Minnesota would say—prepare to be dazzled. . . . . .

The answer to lowering health care costs is to require all providers (doctors, hospitals, surgery centers, labs, anesthesia)  to disclose what things cost before the service is rendered. Yes, as a matter of informed consent, the cost of a routine medical service should be disclosed to the consumer.

If  this one mandate was made (to disclose pricing), health care pricing would be in the ‘free market competition’ and prices would start dropping like a rock. Consumers would start to shop for scheduled services and prices would come down, quickly. This is exactly what happens in a free market economy   and this is what has been happening in Plastic Surgery for decades.

Plastic Surgery is one of the few elective areas of medicine where most services are NOT covered by insurance. Thus, Plastic Surgery has always been subject to free market forces. Well guess what?–prices (adjusted for inflation) of most cosmetic procedures have gradually gone DOWN over the years , not up. Since there is a well trained supply of Plastic Surgeons in the U.S.,  pricing disclosure CREATES COMPETITION of these medical services and prices are forced down.

A facelift performed now is less expensive (inflation adjusted) than a facelift performed 20 years ago.  Since there is a high supply of qualified Plastic Surgeons performing Breast Augmentation procedures, breast augmentation prices keep going down. Since many medical specialties are now offering Botox,  there is a high supply, and  prices fall year over year because patients can price shop among the competition. However, highly specialized procedures, such as the brazilian butt lift or stem cell enhanced fat grafting, with limited supply of experienced surgeons delivering excellent results can command higher prices.

It’s good ole supply and demand and Larry Kudlow’s free market path to prosperity.

With Plastic Surgery, there are only a couple of insurance covered procedures, so let me walk you through health care’s current mode of pricing secrecy. Read More »

Here are my top predictions for cosmetic surgery trends in 2010:

1. Stem Cells from Adipose tissue- The year 2010 ushers in a new decade where science , beauty, and your own fat consummate a marriage that promises to deliver one of the most disruptive medical technologies of the century. Stem cells from our own autologous fat has the power to rejuvenate tissue , heal wounds, and cure diseases. Adult stem cells derived from your own adipose tissue is the new elixir of healthcare.
2. Fat injections -There will be a dramatic increase in cosmetic surgery procedures ultilizing fat injections. Fat injections are used to restore and revitalize tissue in your face, breast, hands, buttocks, and other areas of the body. Done correctly, fat injections are permanent.
3. Butt augmentation -For butt augmentation, fewer surgeons will use buttock implants due to their notorious complication rates. Instead, the Brazilian Butt Lift Technique of fat grafting becomes the main method of butt augmentation.
4. Stem cell facelift- After a well known Hollywood actress has the stem cell facelift , this autologous stem cell enhanced Read More »
   
   

Thanks to the lobbying efforts of the ASPS, Allergan, and plastic surgery portals such as RealSelf.com, women can continue to  improve their cosmetic appearance without taxation! For the past few weeks, the proposed 5% tax on cosmetic surgery became known as the Botax. The cosmetic surgery tax would have discriminated against women, since more than 90% of all cosmetic surgery is performed on women.

A last minute amendment to the new Obamacare Health Care bill, HR 3590, dropped the 5% cosmetic surgery tax , but included a 10% tax on tanning services. This tan tax was put in as a substitute for the initially proposed 5% tax on cosmetic surgery. If this bill becomes enacted into law, the tan tax will become effective  for tan services rendered after July 1, 2010.
Specifically, the tan tax is applicable to tanning booths which use ultraviolet radiation in the frequency of 200 nanometers to 400 nanometers. Exempt from the tan tax is ‘phototherapy services’ .

The exclusion of tax on cosmetic surgery is a win for women and we salute our lobbyist for a job well done!  While we are happy about our own outcome, we can’t help but wonder if this new tax will stifle the tanning industry.

Here is the amendment included in the bill: Read More »

Congrats to Molly Plummer, of Maxx Factor quartet, who will be competing tomorrow night in NBC’s first annual Sing-Off. The competition is a voices only, a capella competition and will be broadcast on NBC throughout the Holidays. Eight groups from around the country were selected for the competition. Molly is our financial coordinator at CosmeticSurg . Dr. Rodriguez and the entire staff at CosmeticSurg wish Molly good luck!

I see this question all over the Internet: Are fat graphs permanent? The answer is:

When done correctly, fat grafts are permanent. When done incorrectly, they don’t last and you will need a redo.

So, how do we do them correctly? First, the physician must employ correct techniques ; and second, the patient must follow the post op recovery restrictions.

For the surgeon, the following techniques should be performed:

• Right extraction pressure with low suction
• Various types of laser lipo will kill the fat cells –these techniques should not be used for extraction
• Fat cells should not be washed
• Proper centrifugation techniques
• Proper isolation and injection techniques to ensure that the good fat is enriched with some of your own stem cells. Fat must be reinjected in small quantities to allow blood supply to grow into the new fat grafts.

After the surgery, the patient must not put pressure on the graphs for a period of 2-3 weeks. In the example of the brazilian butt lift, patients should ideally not sit on the new fat grafts for 3 weeks to allow a full ‘take’.

When the above techniques and protocols are used, my fat grafts have been permanent.

Ricardo L Rodriguez, MD

Other posts on fat grafting:

Fat injections-are they permanent?

How long do fat grafts last?

Why do some women get more breast cleavage with breast augmentation than others? There are many reasons, but one of them is a function of your chest wall type.

Some patients have a chest wall shape that is not really straight. Those patients either have a
concave, hollow chest, in which the chest slopes towards the middle, or they may have an
outward curved chest wall, or bird like chest, in which the middle part of the chest is the highest part like the women in the video still shown below.

These conditions are medically referred to as:

• Pectus excavatum- the concave breast, which is sunken in the middle
• Pectus carinatum- the bird like , or outward curved chest wall

Some of my patients have a mild degree of one of these chest forms.  They may not even realize it. To determine if your chest wall has a mild form of either of the two, Read More »

The proposed bill would levy a 5% tax on cosmetic surgery procedures. Consider this: According to the American Society of Plastic Surgeons 2008 Statistics, women had 91% of all the cosmetic surgeries performed.

So, let’s see– this bill would be discriminating against women!!!

Page 2045

SEC. 9017. EXCISE TAX ON ELECTIVE COSMETIC MEDICAL PROCEDURES.
(a) IN GENERAL.-Subtitle D of the Internal Revenue Code of 1986, as amended by this Act, is amended by adding at the end the following new chapter:
“CHAPTER 49-ELECTIVE COSMETIC MEDICAL PROCEDURES” Sec. 5000B. Imposition of tax on elective cosmetic medical procedures.

SEC. 5000B. IMPOSITION OF TAX ON ELECTIVE COSMETIC MEDICAL PROCEDURES.
(a) IN GENERAL.-There is hereby imposed on any cosmetic surgery and medical procedure a tax equal to 5 percent of the amount paid for such procedure (determined without regard to this section), whether paid by insurance or otherwise.
(b) COSMETIC SURGERY AND MEDICAL PROCEDURE.-For purposes of this section, the term ‘cosmetic surgery and medical procedure’ means any cosmetic surgery (as defined in section 213(d)(9)(B)) or other similar procedure which-
(1) is performed by a licensed medical professional, and
(2) is not necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.
(c) PAYMENT OF TAX.-
(1) IN GENERAL.-The tax imposed by this section shall be paid by the individual on whom the procedure is performed.
(2) COLLECTION.-Every person receiving a payment for procedures on which a tax is imposed under subsection (a) shall collect the amount of the
tax from the individual on whom the procedure is performed and remit such tax quarterly to the Secretary at such time and in such manner as provided
by the Secretary.
(3) SECONDARY LIABILITY.-Where any tax imposed by subsection (a) is not paid at the time payments for cosmetic surgery and medical procedures are made, then to the extent that such tax is not collected, such tax shall be paid by the person who performs the procedure.”.
(b) CLERICAL AMENDMENT.-The table of chapters for subtitle D of the Internal Revenue Code of 1986, as amended by this Act, is amended by inserting after the item relating to chapter 48 the following new item:
“CHAPTER 49-ELECTIVE COSMETIC MEDICAL PROCEDURES”.

If you are having breast augmentation, you should have the opportunity to select the breast implant that will give you the look you want. Although implant volume (cc’s) is important, the shape of the implant is just as important.

Implant shape has two components. One is the base, or how much space the implant occupies on the chest wall. The other is projection, or how much the implant stands out from the chest wall. For example, a 350cc implant can be moderate profile or high profile.

• Moderate Profile Implant : The moderate profile implant will occupy a larger diameter of your chest wall, it is wider and taller. It will not project outward so much, as it is distrubuted in a flatter, wider fashion.  This implant is often chosen by patients who want fullness to the side of the breasts. In the video snapshot below, this profile is that implant to your right.
• High Profile Implant: The high profile implant will occupy a smaller diameter on your chest wall as it is narrower but it also stands out more from the chest wall. This implant is often chosen by women who are slender and want more projection outward, instead of fullness on the side of the breast. In the video  below, this profile is the implant to your left.

I prefer that the patient starts the process by first selecting the type, or profile of the implant. Then, after the shape of the implant is determined, Read More »

The lips are an important feature of your facial appearance. It is one of the first things women address as they begin to show signs of aging in the face. They are looking for a more youthful appearance, but think they need a lip augmentation. In other words, they think that making their lips fuller will make them more attractive. However, often times, the real solution is not a lip augmenation, but a lip lift.

Most beautiful lips have these  defining characteristics :

• well shaped cupid’s bow
• 1.1 cm distance between the bottom of the nose and the top of the red part of the lip
• a degree of fullness

For some reason, society has focused on the ‘fullness’ part, with a complete disregard for the other features that make beautiful lips.  The result is that there are a lot of duck lips out there. I know you have seen them–Not to pick on Melanie Griffith Read More »

Remember the movie “Minority Report”? There was a scene where Tom Cruise is walking through the streets with large screens flashing the conversations of people. Now imagine this: People are talking about stem cells from your own fat. Below you can see what people are saying about fat stem cells on Twitter.

Stem cells from your own fat is the new frontier of plastic surgery. Fat is an abundant source of stem cells. When they are used for autologous use, clinical trials show that these stems cells have healing capabilities.

The future is here.

What are the goals of a great face lift? Plastic Surgeons approach the face lift procedure in a variety of ways. A full facelift has several components: the browlift, the upper eyes, the mid facelift, and the lower facelift.  If a patient wants to rejuvenate the face, which of these procedures are generally the most important?

Read More »

If you are getting medical treatment, you deserve to have the best care. The first step is to identify your physician’s credentials. Is your physician Board Certified? In what? Is it in the specialty that you are being treated for?  Furthermore, WHO is the organization deeming the Board Certification?

The dirty little secret is that there are various agencies who issue Board Certification. HOWEVER, there is only one agency, the American Board of Medical Specialties, the ABMS, who is considered the ‘gold standard’.  Your physician or surgeon should be board certified in a specialty recognized by the ABMS.

There are 24 Member Boards recognized by the ABMS, the American Board of Medical Specialties.  The list of specialities is detailed at their website.  Note that in the field of Plastic and Cosmetic Surgery there is only one Read More »

What are the advantages of IV sedation over general anesthesia? Dr. Todd Hobelmann is one of the Board Certified Anesthesiologists who works with Dr. Ricardo Rodriguez at CosmeticSurg.net in Baltimore.  Dr. Hobelmann administers the anesthesia to Dr. Rodriguez’s surgical patients. Dr. Rodriguez is a Board Ceritifed Plastic Surgeon who owns and operates a AAAASF accredited surgery center. Dr. Rodriguez prefers to perform  his cosmetic procedures under IV sedation.

Dr. Hobelmann is experienced with various types of anesthesia and explains why IV sedation is a better choice for most patients. According to Dr. Hobelmann there are two main differences between IV sedation and general anesthesia. With IV sedation: Read More »

Breast reconstruction after lumpectomy and irradiation poses a difficult choice for the patient who wants reconstruction. After treatment the breast can be noticeably different from the opposite breast, and sometimes can be indurated with hardened irradiated tissue. The alternatives usually offered are reconstruction with implant or a more extensive and complicated reconstruction with vascularized tissue.

Because irradiated tissue has impaired healing abilities, the use of implants has a high rate of complications, including fluid collections, infection, and a high rate of capsular contracture. The alternative is to use tissue from another part of the body which has not been irradiated and carries its own blood supply. These operations are lengthier, with a more prolonged recovery period, and carry their own risk. They can entail significant scarring in the donor tissue area. Because of this, patients who have had lumpectomy and irradiation are rarely encouraged to have reconstruction.

Recently investigators in Italy and Japan have perfected techniques for reconstructing breast lumpectomy and irradiation defects using fat grafts from the patients own body. The results are very encouraging, sometimes spectacular, and the techniques used are reliable and reproducible.

Lumpectomy and Radiation performed

lumpectomy scar after fat injections

Fat grafting has existed for many years, but only recently have techniques that work consistently been developed and refined. Like all procedures, the success of fat grafting depends on the techniques used. Although many clinicians voice doubt over the reliability and longevity of fat grafting, Read More »