aesthetic plastic surgery procedures

Let Santa Keep the Belly

Posted on December 7th, 2016
Posted by Julene

“…He had a broad face, and a round little belly, that shook when he laughed like a bowl full of jelly.  He was chubby and plump, a right jolly old elf…”


Are you ready for the best present ever for anyone who may be feeling they are beginning to resemble the description of Saint Nicholas in the beloved old tale of ‘Twas the Night Before Christmas’?  When it comes to choosing the best way to reduce belly fat or the dreaded “muffin top” (that is, if you don’t wish to give, or undergo, the gift of surgical liposuction), then you may want to consider a gift of UltraShape Power treatments.

In three short, painless, non-surgical office treatments using the new UltraShape Power, with each treatment requiring approximately 35 minutes using no medications or anesthesia, our study patients lost an average of over 3 to 4 inches of stubborn belly fat. UltraShape Power is the most effective non-surgical fat reduction technology on the market today, hands down and by a lot…a lot of fat removal and a lot of power, that is.

So what is UltraShape Power, how does it work, and why is it the most effective fat reducing body contouring tool available?  I’m glad you asked.

I am betting that you have heard by now that we can effectively reduce body fat with several different non-surgical devices. All of these devices differ greatly…some work on both skin and fat, some work mostly on skin and to a lesser degree on fat, and some work only on fat leaving the skin to do the best it can to “redrape” itself once the fat below the skin is reduced.  All of these devices are patent-protected, therefore one device manufacturer cannot copy another’s technology, which is why they all work so differently. This is also why it can be very confusing for patients to know which device’s technology is best for their target tissue.  If you only listen to marketing hype, they all sound miraculous. This is also why I devote large amounts of my time and energy to studying device technology and partnering with manufacturers and their engineers to develop better and more effective technologies. If a patient wishes to choose a non-surgical approach (and increasingly large numbers of patients are doing so, and spending more on non-surgical options), as a surgeon, I believe we owe them a good alternative. I use these non-surgical tools in my surgical body contouring practice as adjuncts to my surgical results and for non-surgical maintenance for surgical patients over time.  In my surgical practice, I want the very best tools, otherwise, it is very easy for me to just recommend “one and done” in-office liposuction. The best non-surgical device has to be able to compete fairly well (or at least better than its other non-surgical competitors) with the “Gold Standard” result of surgery itself. Who better than a surgeon can accurately compare results of a non-surgical approach to those of surgery?  The questions regarding efficacy of each of these devices boil down to:

•  How well does the energy delivered by the device target fat specifically?

•  Are the fat cells changed to become just “leaky”, or are they permanently destroyed?

•  How much fat is actually affected, and after how many treatments?

•  What is the size of the treatment area, and therefore cost, for similar amounts of fat reduction?  (i.e., does it take one device 6 treatments to reduce the same amount of fat that another device can reduce in 3 treatments?)

•  Is it painful?

•  How fast can you see results start to appear?

•  Can treatments be repeated?

•  How will the skin overlying the reduced fat appear after treatment is completed? Are there other side effects, like skin sensory changes or contour irregularities, shelving or dimpling?

•  How much maintenance is required?

•  Most non-surgical options require multiple treatments for best results, so does the size of the treatment area cover my entire area of concern each time in a single treatment or will I have to have more than one treatment to cover the area of concern even once?  (this is a huge issue to consider when looking at total costs to treat a given body area)

Before we discuss UltraShape Power specifically, let’s evaluate the competition as compared to UltraShape Power, which is the new gold standard amongst non-surgical body contouring options.


CoolSculpt works via “cryolipolysis”, or freezing fat. This is effective in killing only approximately 18% to 20% of fat cells in the treated area, compared to UltraShape Power’s 32%.  Disadvantages are that the smaller transducers available cover a much smaller area per session than UltraShape Power, making it necessary to do more treatments to cover the same size area, thereby taking longer to complete the series (and at subsequently more cost), unless the provider uses multiple machines in a single session (which increases costs per treatment even more).  Also, CoolSculpt results require 6 to 12 weeks or more to start to be appreciated by the patient, or before the same area can be retreated (and remember that for best results, more than one treatment in each area is necessary). This delays seeing final results even further, since best results usually require a series of 3 or more treatments of any single area to see measurable reductions. An additional disadvantage is that the skin has to be lax enough in the treatment area in order to be able to be suctioned up (thereby stretched) between the vertically positioned cooling plates to be frozen. This makes it harder to treat areas like the outer thighs, arms, or the neck.  A corollary of this is also that the treatments can be uncomfortable, the skin may suffer dysaesthesias after treatment, or skin may look looser, dimply or irregular in contour after treatment. In fact, we frequently see patients who come to us for fixing skin contour irregularities that have resulted from CoolSculpt treatments to smooth out the skin with our VASERShape or VelaShape devices.


This is a non-invasive laser treatment that can reduce even smaller amounts of fat (11% to 12%) than CoolSculpt (18% to 20%), and far less than UltraShape (32%), after 2 or more treatments.  Lasers are usually the most expensive technologies on the market and are usually not the best energy medium for affecting fat, which requires a broader effect than can be achieved with a narrow beam of light-induced heat. The disadvantage of lasers for fat reduction is that treatments are more expensive, less fat bulk is affected, and therefore more numbers of treatments are necessary to reduce the same amount of fat overall as with UltraShape Power.


There are several radiofrequency body contouring devices on the market today.  They go by the names of Venus Concept, Exilis, Protégé, Vanquish, Thermi, VelaSmooth, and Thermage.   Radiofrequency is basically electrical current that produces resistive heating to cause a tissue result, and as such, current follows the path of least resistance. The problem is that the human body does not conduct electrical current homogeneously like a wire does, so tissues primarily affected by any radiofrequency device are tissues that are dense, like skin and connective tissue septae (walls) that separate fat compartments. Fat itself is not dense enough to conduct electrical current consistently well in order to be much affected, and therefore, fat is largely spared by radiofrequency. As a result, RF devices can tighten skin fairly well, but can only reach the very top layers of fat, so are not by themselves, good fat reduction tools. These RF devices are best coupled with other devices that target the fat layer better, so that fat reduction and skin tightening or reduction of cellulite can be achieved…

So what devices affect fat the best then?

ultrasound devices…and here’s the skinny…!

UltraShape Power

UltraShape achieved FDA approval in 2014.  In its first prototypic form, UltraShape achieved a fat reduction of 20% in 3 in-office treatments of 45 minutes to one hour.  This amount of fat reduction already exceeded that of even today’s competition, but in September of this year, UltraShape Power received FDA approval and can now achieve fat reduction of up to 32% after 3 treatments which are even shorter in duration, averaging about 30 to 35 minutes each.  What is the technology behind UltraShape Power?   Highly focused mechanical, non-thermal ultrasound.

Ultrasound energy is perfect for affecting fatty tissue, because it can be focused or non-focused to change its depth of effect – to be superficial for skin tightening – or deeper for affecting superficial as well as deep fat.  (We can even go really deep with ultrasound and use it to visualize internal organ systems or babies in-utero, right?). Thermal ultrasound can tighten skin and melt fat (VASER Shape), while mechanical ultrasound can permanently destroy fat by essentially imploding the fat cells through exertion of high pressures on their thin walls until the cells explode. Since the ultrasound energy of UltraShape Power is highly focused, it is an important point that it is pulsed to make it non-thermal, otherwise the treatments would be quite painful (i.e., remember a device called Liposonix?, which was totally thermal focused ultrasound…ouch!) Ultrasound is very safe, it is thoroughly studied, and is much cheaper to use than lasers. Additionally, ultrasound waves can be used to deliver energy to affect tissues in very broad treatment areas, so that larger areas can be treated effectively in a single session, and therefore, fewer treatments need to be performed for results. Since there is no true tissue “wound” created by ultrasound as there is with freezing or laser heating which has to heal before results can begin to be seen, UltraShape and VASER Shape results start to be appreciated by patients within days of their first treatments. For these reasons, re-treatments within a series can be spaced as close as 10 to 14 days apart, so that a typical 3 treatment series is completed much faster than with other modalities. Just like with surgical fat reduction – liposuction or tummy tuck – as long as the patient maintains a stable weight, fat does not return, and results are long-lasting.

My office offers 3 different types of ultrasound devices used for body contouring:

  1. Ultrasonic-assisted liposuction by VASER 2.0 for surgically inclined patients to liquefy the fat first and then suction the emulsified fat out (if it isn’t desired for re-injection elsewhere, like to the face or other body parts where it can be used to achieve higher definition, i.e., abdominal muscles or buttock augmentation).
  2. VASER Shape is lightly focused ultrasound, and is one of the few devices on the market that can both tighten skin (the thermal effect of ultrasound) as well as liquefy fat (the mechanical effect of ultrasound), and as such, VASER Shape can affect both skin and fat – and both superficial as well as deeper fat, due to its ability to penetrate all tissue layers in its path.  Since the ultrasound energy is only lightly focused, VASER Shape is painless, but more treatments in total number are necessary than its counterpart UltraShape Power, which incorporates highly focused ultrasound, to achieve the same measurement reductions.
  3. UltraShape Power is highly focused ultrasound which is pulsed, so that it is totally non-thermal, and therefore non-painful. Think of it this way…the purely mechanical effect of ultrasound is harnessed so that the ultrasound waves are pulsed through tissues creating oscillating sound waves that create bubbles in the fluid surrounding the fat cells.  Fat cells have very thin cell walls, so as the bubbles grow larger, they eventually implode the fat cell membranes, and the fat cells then release their fatty acid contents and are permanently destroyed. The liver, lymphatic system, and intestinal tract eliminate the fat cells and their contents safely and without elevating blood lipid levels, much as these systems would eliminate a fatty meal or fat with weight loss. Patients start to feel smaller within 2 days of their first treatments. Treatments are quicker than with the previous UltraShape, with at least 20% more fat destroyed.  All areas of the body can be treated and in fewer treatments than with any other device on the market.  What’s not to love?


UltraShape Power is an awesome stand-alone device for body contouring. The skin fares much better after UltraShape Power than after CoolSculpt treatments, as it isn’t stretched during treatments to fit into a transducer as CoolSculpt requires. The existing skin redrapes itself after UltraShape Power just as it would after slower weight loss. However, for patients who also want true skin tightening treatments or cellulite correction in conjunction with volumetric fat reduction, they may choose to combine UltraShape Power treatments with either VASER Shape or Profound for added results.



My office was asked to conduct the first clinical trial testing the improved efficacy of added power to the UltraShape device prior to its subsequent FDA approval in the fall of 2016, and introduction to the market as the new and improved UltraShape Power. The current UltraShape Power is now 20% more powerful than its predecessor, so patients are achieving even more inches of lost fat than before…and just in time for help with all that holiday food and festivity!

Visit our site to learn more,, and then come and see what the best fat reduction tool on the market can do for you or someone you know and let Santa keep the belly…it looks much better on him!

Happy Holidays!

So Many Questions – So Many Answers – Q. Which treatments are you most excited about?

Posted on September 21st, 2016
Posted by Julene

I was recently asked quite a few questions about my practice, why I do what I do, what treatments really get me excited and even my predictions for future techniques. Over the next few days I’ll share the questions and my answers.

Which treatments are you most excited about? And why?

I am a surgeon, and while I love the surgical results I can achieve for women, I fully understand the limitations of surgery, as well as the fact that not all women desire surgical intervention. With surgery, I am not directly improving skin quality…I am lifting skin that continually ages, thins, and loses youthful collagen and elasticity. If I can help patients truly improve the quality of their skin, then patients may be able to avoid surgery longer, undergo fewer surgical revisions over their lifetimes, as well as improve the surgical result and its longevity, in those who do choose to add surgery to their intervention program. Part of the way to avoid an over-operated look is to avoid too many operations. With proper surgical techniques and the addition of so many newer and more meaningful nonsurgical interventions, I love the fact that my patients are taking longer to look their age!

I am most excited about:

  • Skin care products that have therapeutic amounts of ingredients that can be combined to target the most common skin aging problems (cleansers, toners, antioxidants, exfoliants, hyaluronic acid replenishment, vitamins and growth factors, collagen stimulators, bleaching agents)
  • Injectables to treat volume loss (loss of fat and collagen) that last longer and can be used in a “panfacial” way, not just in localized areas, for the most natural results
  • Nonsurgical options that now can truly improve the quality of skin by increasing the content of collagen, hyaluronic acid and elastin (the latter being the hardest thing to increase by any modality)
  • New nonsurgical methods of tightening skin, especially in the lower face and NECK.  For so long, the neck has been the “missing piece of the puzzle”…women hate their aging necks…and surgery used to be the ONLY option to really tighten the neck in a meaningful way, since lasers cannot be used as aggressively on the neck as on the face. For skin tightening of the face and neck (and also nonfacial areas), the single greatest new tool in our armamentarium is Microneedling with Radiofrequency. The only one of these devices currently on the market that has been scientifically shown to even remotely approach a surgical facelift or neck lift is Profound, by Syneron-Candela. Scientific studies and clinical trials have proven that the amount of radiofrequency (heat) energy delivered by Profound causes an increase in the amount of collagen, hyaluronic acid, and ELASTIN in the skin. We can see increase in dermal volume (like a filler), skin surface textural improvement (like with a chemical or laser peel), skin tightening of the face and neck (best alternative to a surgical lift…one study compares it to 80% of a facelift result), and the ability to truly contour the face and neck by reducing fat in desired areas (like the fat of the jowls and neck). Some of our Before and Afters almost look like a facelift or neck lift or neck liposuction was done. Profound is a single treatment, in-office procedure with results seen in 1 to 3 months with about a week of downtime (swelling and mild bruising).
  • For the body, there is a brand new FDA approved version of UltraShape (it’s called UltraShape Power) that reduces fat 32% in each treatment area…that’s compared to CoolSculpting’s 18% fat reduction, and Sculpsure’s 13% fat reduction, making UltraShape Power the most effective fat reduction device for nonsurgical body contouring on the market today. UltraShape also allows a larger treatment area per session and more fat lost in fewer treatments sessions than all other modalities. UltraShape Power offers 20% more fat reduction than the current UltraShape device. My office is completing the clinical trial now that led to last week’s FDA approval of UltraShape Power, so this is news hot off the press!!!
  • For vaginal rejuvenation, my office just completed a clinical trial using the CO2RE Intima laser (fractional CO2 laser by Syneron-Candela, that has both facial and vaginal applications) with 2 GYN doctors to treat post-menopausal women suffering from VVA (Vulvovaginal Atrophy) or atrophic vaginal changes of menopause (stress urinary symptoms, dryness, itching, tightness or looseness, painful intercourse, prolapse). CO2RE Intima also benefits postpartum women suffering from VRS (Vaginal Relaxation Syndrome) characterized by looseness, orgasmic dysfunction, stress urinary symptoms and laxity. Some of the improvements seen are of course functional and improved by the internal portion of the laser procedure, but the CO2RE Intima laser also improves the external appearance of the labial tissues during the external portion of the treatments. This is a simple in-office 3-treatment series of the laser requiring no anesthesia or downtime, with results being seen as soon as days after the 1st of 3 monthly treatments. One annual maintenance treatment is recommended to maintain results (to deal with continued aging in both the postpartum and menopausal patient, and loss of estrogen in the menopausal or breast cancer-treated patient).

Hot Summer Trends in Plastic Surgery

Posted on July 6th, 2016
Posted by Julene

There is so much to talk about!  Unless you can come into the office every couple of months to visit with us, it can be really hard to keep up with the treatments and procedures we are loving lately!  Make sure to touch base with Cynthia or Beth and let them know if you need to update your email address on file here in the office, and be sure to “like” our Facebook page, as that does make it easier for us to let you know what you want to know!  I will do my best here to catch you up on some of the newest things we think you should know about…

After great success with UltraShape, we are now offering a spot in a clinical trial to 10 lucky patients to study the effects of a higher powered version called “UltraShape Power”.  Call the office for more details if you are interested or know someone who is.  To review, UltraShape is focused, nonthermal ultrasound permanent fat reduction, and as such is nonpainful and requires no recovery time, with measurement reductions and results seen within 2 weeks of the 1st treatment (a 3 treatment series is recommended).  We can combine UltraShape with VelaShape III for skin tightening and added results in the same treatment session.  There is no (and I repeat no) other fat reduction technology on the market that can permanently reduce as much fat as UltraShape, and all (I repeat all) competitive technology either requires more treatments be done, or smaller areas to be done, and take longer to see lesser (and I repeat lesser) results.  Scientific fact.

Profound continues to please patients who desire facial and neck skin tightening, added dermal volume, surface textural improvement, and the added ability now (with the longer needles available) to truly contour the jowl and neck fat.  All in a single treatment.  In this surgeon’s opinion, there is no better alternative to a surgical lift or lipo of the neck.  Profound can be performed in a segmental fashion (upper face and forehead = “Profound Browlift”), or just the lower face and neck (“Profound Necklift”), or the entire face and neck can be treated (“Injectable Profound Facelift”).  With the availablity of the longer needle cartridge, we can also offer a new cellulite treatment of nonfacial areas (VelaShape III and VaserShape also excel at treating cellulite).  Profound treatments are frequently combined with fractional laser treatments, like the CO2RE.

We are introducing a new skin care line from Biopelle that is best used with medical-grade skin micro-rollers for better absorption and penetration of the growth factors in the Tensage Serum.  This growth factor product is a serum for at-home use but is also applied during the mocroneedling Profound procedure.  Call the office for more information about how to begin this new revolutionary skin care program.  Your skin will thank you for it!

The CO2RE Intima Vaginal Rejuvenation clinical trial has closed, but due to incredible early results for patients suffering from stress urinary symptoms after childbirth or natural aging, another study may ensue to look specifically at the improvement of urinary leakage.  We are currently treating non-study patients and seeing great results in both the post-partum as well as menopausal age group woman.  There is a cosmetic improvement in the appearance of the external genitalia (tightening of lax tissue, treatment of dyschromia, and increased labial symmetry) as well as true functional improvement (improved sexual gratification, correction of dryness through restored lubrication, correction of itching, better vaginal canal elasticity, and either vaginal canal tightening or looseness – whichever is needed).  Call the office for more information on how to restore your sense of feminine well-being.  Results can be experienced within days of the 1st treatment.  An initial 3-treatment series and an annual single maintenance treatment  is recommended for long-lasting results.

Many of the above new procedures constitute the new “Nonsurgical Mommy Makeover”, and we are leading the way.  In fact, I have been invited to Vegas to present our “Nonsurgical Mommy Makeover” Case Study patients at The Aesthetic Show this weekend, because there is much technology that DOESN’T work.  I think it is important to continue to educate other doctors about what DOES work, whether they are plastic surgeons or not, so I remain as active in the multi-specialty arena as I do in my own professional societies of ASAPS and ASPS.  As a surgeon, I always wish to explore the best nonsurgical options for my patients…those who don’t desire surgery as well as those who wish to maintain surgical results nonsurgically.

Who better to sift through the volumes of nonsense research and less worthwhile options than a surgeon?

This is just a brief update, and we love to also use email and social media to keep up with you, so please take a minute to call the office and update your best contact info, “like” us on FB, and check our website for future updates and blog postings.  In fact, give me ideas on topics you would like to see a blog about…I’ll get right to those first!

Happy Summer!







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