CosmeticSurg blog: Expert insights from Dr. Ricardo L. Rodriguez

I once had a patient who wanted a revision of her Liposuction. I have seen her already several times and she is unhappy about small areas on her hips. The small bulges are above and below the panty line so the indentation of the panties on the skin magnifies the defect. She recognizes that the result is an improvement on what she had before but these small things are irritating her.

Curves, love handles, and Brazilian butts. I have been doing a lot of Brazilian butt lifts. It continues to amaze me how good this procedure is! It is perfectly suited to how the body handles fat, and the different components of the procedure enhance each other. Although the procedure is called Brazilian butt lift, what makes it great is the way the love handles are reshaped and create a nice curve between the butt and the waist.

When my mother was pregnant, my dad said (or so I was told): “I will put a scalpel in his hands when he is born”. Now that’s a scary thought. Well, whatever… as my kids say. But I can tell you that my most early memories have to do with medical stuff. The earliest memory of a real event is at my grandfather’s hospital bed. It is my only memory of him. The whole place; however, struck me forcefully. It was quiet, whereas in Puerto Rico everything else was always noisy. The hallways were long and empty, whereas I was always floating in a family crowd, or a “herd”, as my daughter says. Looking outside I saw a courtyard with a fountain. Somehow I got the impression that in that place something big and hidden was happening and that it had something to do with me. It was awe inspiring.

Today I saw a patient who had been operated on for a condition known as “tuberous Breast deformity” and asymmetry. Tuberous breast deformity occurs when a patient has a narrow base of the breast. The fold underneath the breast is tight or narrow and the breast mass appears to hang over the breast base. The term “tubular” breast deformity is also used to describe this as the breast has a tubular shape instead of rounded one. Some patients are also unfortunate in that their tubular breasts are also different in size.

Cosmetic surgery is not just for your face, breast, and body. Your hands age too. As we grow older, there is a change of fat distribution in the body. For example, the face tends to lose some volume in certain areas, and the midsection of the body tends to gain fat. Another one of the areas which loses fat is the hand.

Patients are asking for specific procedures because they have been reached by the marketing efforts of Plastic Surgeons. Since surgeons are trained to do procedures, they market procedures as their product. In order to differentiate themselves in the marketplace, they come up with these catchy names to create a “unique” presence for themselves in the marketplace. Alternately, if there is a particular buzzword or catchphrase that is getting media attention, the surgeon will use it in his marketing pitch, to benefit from the attention generated by that particular “product-lift”.

Most patients who come to my office don’t come in asking for a full facelift. Most come asking for a specific face procedure to “make them look younger”.   If they are relatively young, they focus on the nasolabial folds the lines that go from the side of the nose to the corners of the lips). Or they may mention the lips, how they are getting thinner. If they are somewhat older, they will focus on the jawline and neck. I listen to them, because that is what they are concerned about, but then I have to ask: Do you want to look better to yourself or to others?

Many times during a breast augmentation consult a patient will say to me: “I want to look proportionate.” In other words, the patient wants to make sure that a particular implant size will look right on her. The right proportion is determined by several factors. A good proportion is not only determined by the size…

Most patients seeking facelifts say that coworkers or family members tell them “they look tired” all the time. They then proceed to pull upward on their neck or lower cheeks mimicking the effect they want from surgery. To make a point, I sometimes cover my face and ask what color my eyes are. They always get it right (my eyes are brown). I then ask whether I have bands in my neck (I have one). Invariably they say they didn’t notice. So, what’s the point I’m trying to make? People make judgments about how old your face looks from your eyes, not your neck or jowls. There is a famous study where the picture of a woman was put on a screen. A subject looks at the picture. Behind the screen there is a camera that tracks the eye movements of the subject looking at the picture of the woman…

There are many ways you can get a Butt augmentation, but like everything in life, each has its own set of advantages and disadvantages. Some procedures are new and experimental, some have stood the test of time. The use of hydrogel for butt augmentation is a new approach. The technique is possible, but in my professional opinion, impractical for several reasons.

Kae posted a very good question, because it helps understand how fat transfer works. The question relates to where you gain weight after a fat transfer: the donor area (where the fat came from, let’s say the belly) or the recipient area (where you put the fat in, let’s say the butt)? The short answer to the question is: YES, after the fat graft takes, you will gain weight in the recipient area. In the case of the Brazilian butt lift, the recipient area is the buttocks. If you took most of the fat cells from the donor area, you would gain very little weight in the belly. If you want to know the technical explanation for this, read on.

Most times, when doing a Brazilian butt lift, I end up using every last drop of fat I can get to get the best possible butt augmentation. This is because after the meticulous extracting procedure, only a fraction of the fat is suitable for fat transfer.A few patients, however, store a lot of their fat predominantly in their abdomen and flanks, with very narrow hips proportional to their body.I had always been very good at getting their waist as narrow as I could to highlight the buttock, but the hips remained untouched.

A few days ago I was seeing a patient who was thinking about having the Brazilian butt lift. Two things struck me about the conversation – One was the fact that so many patients are now requesting a procedure that is relatively new. The second was that I am doing the procedure more frequently on women of all ethnicities. As I was showing the patient my collection of pre op and post pictures I noticed quite a few Caucasians and Orientals. This makes me think that for whatever reason, there is a cultural shift going on about what constitutes an attractive figure.

I went to see Dr. Rodriguez on Sept 25th for Lip Advanta Implants and Sculptra. I was greeted by the nicest staff and made to feel very comfortable. I was more than briefed on every option that I asked about to ensure a confident choice in procedure. After my procedure, I was a bit terrified by the immediate effects of surgery (swelling), but the entire staff assured me that the swelling was completely normal.

The images you see in the media place very high goals as to what is a “normal” body type. Keep in mind some of these people showing their bodies have had plastic surgery themselves (and/or very good airbrush artists). “I have no bottom and no butt if that makes sense. My boyfriend tries to pinch me and there is NO GRIP!” Yes, what you say makes sense. Indeed, if you look at the pages of many fashion magazines you will see models with “no bottom and no butt”. For many years liposuction to reduce the size of the butt was all the media talked about. The beauty ideal was to have as little butt as possible. Jennifer Lopez (J-LO) changed that!