Confused! TT and lipo 360, or Renuvion and lipo 360? (Photo)

Question

In person consult= "could" get a TT, need Lipo 360, but try Coolsculpting 2nd consult = online~ need a TT, Lipo 360 3rd consult = photos~ doc said I don't need a TT, but need Lipo, and HD Lipo... Thoughts??

George Marosan, MD · Answer

Thank you for your question and photos. I find that the confusion comes both from the surgeon's side and the patient's side. If the patient cannot articulate well what he/she wants to achieve as a final result, you'll find that the surgeon(s) offer "solutions" to your request. This is based many times on the surgeon's experience, the tools he/she has in their "tool box" such as expensive machines they try to utilize or make them profitable, etc. If you were my patient, as a Total Definer surgeon, would offer a full abdominoplasty with a low pubic bone level incision, VASER Hi Def Lipo 360 degrees with possible fat transfer to the buttocks to create a feminine hourglass shape. Virtual consultations and quoting low prices on line can be deceiving although they do sound attractive. See a board certified plastic surgeon with extensive experience in advanced body sculpting techniques for an in person consultation/evaluation. BTW, recommending Coolsculpting prior to a surgical procedure is not sound, due to the intense scarring that it causes internally, compromising the surgical outcome.

Connie Hiers, MD, FACS · Answer

Don't waste your money with Cool Sculpting. I would suggest doing the liposuction of your flanks and abdomen first. You could also add EMSCulpt to help tone and tighten your abdominal muscles and give you a flatter abdomen. You don't really need a tuck except for the loose muscle.  Nonsurgical EMSCulpt might work very well for that.

Darryl J. Blinski, MD · Answer

Based on the nicely posted photos you need full TT with muscle location and Lipo waist flanks & back. Fee $8,500. Best to virtual consult with….

Mats Hagstrom, MD (license on probation) · Answer

For patience whose assessment is not straightforward, or for those who have different treatment options, it becomes much more important to have accurate assessments, and this begins by having exclusively in person consultations. It’s difficult for a plastic surgeon to really make a good assessment based on pictures alone, and it’s very important for both provider and patient to have a good clear understanding of what you’re trying to achieve as well as what you’re willing to go through. There are other variables we need to understand before making an assessment, especially history of previous pregnancies, or history of weight, fluctuations and knowing your age. 
To make an assessment of someone’s abdomen, we generally look at four different tissue variables. Each of these different variables contributes to how the abdomen looks and generally speaking if somebody doesn’t like the way their abdomen looks the problem can be isolated to one or more of these four variables. Depending which is the primary variable, secondary, or tertiary, should guide the decision process in regards to what is the best procedure.
Doing this well requires an examination, and for you to choose the right provider requires meeting in person as well.
The four variables that determine what the abdomen looks like or the following.1) abdominal scan laxity typically due to previous pregnancies weight loss, or potential loss of skin elasticity due to age.2) excess subcutaneous fat3) muscle separation from previous pregnancies, causing the abdominal wall to bulge. The medical term is diastasis rectii. 4) excess visceral or intra-abdominal fat.
Bulging of the abdominal wall can happen because of muscle, separation, excess visceral, fat, or a combination of both.
Based on your pictures, my best, guess is he will have a bit of all of these variables.
Skin laxity appears to be relatively mild, but your abdominal wall is definitely bulging. This is not all due to subcutaneous fat, so Liposuction will not get you a flat abdomen.
If you’ve not had previous pregnancies, then you most likely have excess visceral fat that is contributing.
For the front of your abdomen, a full tummy tuck is most likely going to give the best results, but obviously comes with some drawbacks. For the back half of your torso, liposuction is the ideal treatment to create a better female figure. This includes the treatment of your love handles, waist, back and under arm area.
Liposuction of your full torso will still leave you with the same degree of skin laxity, and the muscle wall will still have the same degree of bulging. The front of the able to men could come in about one inch from well done Liposuction, but the contour and appearance of your skin will be the same. 
If you want a tight flat abdomen, you’ll need a tummy tuck.
If visceral fat is a significant component than weight loss will be necessary as well.
A quality assessment needs to take all of these variables into consideration and stratified them in a list of understanding which variable is creating the greatest impact.
Delivering consistent quality, liposuction, results is far more difficult than most people recognized. This is to some degree true for both of patients and providers, who sometimes view liposuction as an overly simplistic procedure. The number of plastic surgeons who truly mastered liposuction are in the small minority. There are unfortunately a large number of plastic surgeons(the majority) put simply aren’t that good at Liposuction.
Liposuction, if done poorly can leave people, disfigured, or with results that are disappointing.
never sign up for permanent irreversible body contouring procedures that can potentially leave you disfigured without properly vetting providers in a systematic, careful manner. 
Finding the right provider is a time consuming process, that should not be rushed.
In the process of vetting providers through multiple in person, consultations, you’ll begin to have a better understanding of your own candidacy for various procedures, including a better understanding of each of the different tissue variables that are contributing. A quality assessment should differentiate each of these tissue characters, explaining to you exactly how much each is contributing, and explaining what each procedure can, and cannot accomplish. 
Do not assume somebody has the skill, experience or insight to do quality work because of board certification, reviews, years of experience, or anything else, other than a collection of before, and after pictures that speaks for itself.
When in doubt, slow down and schedule more consultations. The biggest mistake you can make is rushing into the decision. Assuming everything will be fine.
The following are some general guidelines and recommendations for finding the best provider. Going through this process will also help in the decision making regarding the best procedure.
Avoid providers, trying to persuade you to use their services because of technological advances or having some superior equipment. Plastic surgeons have the equipment and tools they need to do their job. The difference in outcomes is not related to having purchased some new device, but it is almost exclusively related to providers either having the skill and experience or not.
Finding the right plastic surgeon.
One and a half months is not enough time to lose a substantial amount of weight if it's done in a healthy manner.
I'm going to include a write up that I did from my experience of seeing thousands of patients in regards to weight loss.
I personally lost 50 pounds in about eight years ago.
My write up his part for my own personal experience and party from interviewing patience.
Finding the right plastic surgeon is not easy.
I see medical professionals choosing surgeons they think are the best but in reality I only average.
The following are my recommendations for how to find a truly talented board-certified plastic surgeon.
Start with the website like yelp and write down the name of about 20 board-certified plastic surgeon's with excellent reviews and at least 20 reviews.
Next go to the following website and check for reviews on each of those doctors.Real self, rateMD.com, Vitals.com and WebMD.com
 A Doctor Who has organic reviews meaning they have not been manipulated should have an equal distribution of reviews on all various websites.
A Doctor Who has many reviews on a single website but few reviews on the other website showing indication that reviews may have been manipulated.
Yelp is the most difficult website to manipulate so it's a good one to start with.
Many doctors will encourage their patients to write reviews for them.
This may or may not include incentives for the patients.
These types of reviews are not considered organic and in my opinion are manipulated.
I've seen businesses that of been open for less than six months have close to 100 reviews.
I know some of the most talented doctors who been in practice for over 20 years have two or three reviews.
Doctors have a strong presence on social media are good at social media. This has no correlation with their surgical talent.
One of the most talented facelift surgeons in the world lives in San Francisco.
He is often booked up for more than six months.
He does not even have a website.
Plastic surgery is a competitive field and many plastic surgeons have sophisticated marketing teams.
Once you've isolated 10 doctors who seem have an overall excellent reputation you should schedule several in person consultations.
Even if you really like the first doctor you meet you should follow through and go through all of the consultations.
If the consultation is performed by a patient care coordinator or sales person then be leery.
If it seems like commission sales and that's what it is.
How much time did the doctor spend with you?
Did the doctor give you a realistic expectations or simply tell you how great you're going to look?
Reviewing before and after pictures is very important.
A talented plastic surgeon that has extensive experience with liposuction should have at least 30 to 40 before and after pictures of liposuction cases.
Ask to see results that are average excellent and not so good.
Ideally you should ask to see 10 consecutive cases but it is unlikely he will be able to get that.
Price is important but there is little correlation to talent and price.
That said the doctors who give bargain basement prices are probably not the ones you want to go to.
Ask each doctor with their revision rate is.
Doctors or highly committed to getting the best results should have a low threshold for doing a revisions.
Doctors who claim they never do revisions are either not true patient advocates or not being honest.
Ask each doctor what your policy is for revisions.
Who pays for it?
If fairly common practice is the doctor will not charge for revisions but may ask the patient to pay for all or some of operating room or Anastasia fees if they're needed.
Review what each of the plastic surgeons offered and use your gut instinct of who to go with your gut instinct.
I hope you find it helpful.
Best,
Mats Hagstrom M.D.

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