You and Improved

Here’s a look at the most popular procedures, according to some of Northern Virginia’s top plastic surgeons.

Whether you’re hoping to look fresher and more rested or to change something dramatic, plastic surgery has become a more realistic option than ever. Here’s a look at the most popular procedures, according to some of Northern Virginia’s top plastic surgeons.

By Sabra Morris

It seems as if every year someone on TV, in the movies or in the latest glossy is touting the newest “body type,” from voluptuous to thin, athletic to slight and everything in-between. Pay too much attention to the incredible swings and it all feels like chaos. Take the trends too literally and things can go wrong. Need proof? Just Google “Bad Celebrity Plastic Surgery.”

But that’s the radical side of going under the knife, according to Dr. Mark L. Venturi, M.D., partner at the National Center for Plastic Surgery in McLean. And it’s not the norm, at least not around here. “On the West Coast, people want to look ‘done,’” he says. “It’s just the opposite here. People want to look better, like the healthiest version of themselves, but they don’t want to look like they’ve had any work done.”

One reason why plastic surgery has become so democratized has to do with the rise of minimally invasive procedures (those that require the least amount of incisions, scarring, trauma to surrounding tissues and recovery time: think tissue fillers such as Juviderm® and Restylane® and laser treatments). “The total number of minimally invasive procedures essentially doubled from 2000 to 2012,” says Dr. Reza Mirali, M.D., representative for the American Society of Plastic Surgeons. “More people are getting in because there’s probably more available to them. Twice as many people are competing in the market, so the cost comes down,” he says.

Because there are so many less-drastic options available, plastic surgery has also become more socially acceptable, according to Reston-based plastic surgeon Dr. Wendy Gottlieb, M.D. “I think people are really just trying to keep looking good, looking healthy, looking young and looking fit,” she says. “Most of my patients are very open with their friends about the fact that they come in for Botox or fillers. It has become something people do, like going to get their hair cut or other types of routine care and maintenance.”

Like any other medical discipline, plastic surgery is an ever-evolving field, kept current with clinical trials, innovation and ongoing research. Old procedures get supplanted with new and better ones. That means there are more options than ever for achieving a healthy, vibrant youthful appearance. Gone are the days of the dramatic pullback facelift, the extreme makeover and all-or-nothing surgery. Here to stay is a sophisticated combination of treatments that target each problem individually. The result? A more natural way of achieving whatever look you’re going for that will have friends saying, “Wow, you look great,” not, “Did you get some work done?”

Fillers Instead of Surgery
Injectable dermal fillers are replacing surgical procedures in appropriate cases. Doctors and patients both like the lower time commitment and the diminished recovery time they provide, as compared to surgery.

For example, “Frequently, lower eyelids can often be handled nonsurgically,” says Dr. Howard Heppe, M.D. In many cases, when a patient experiences a high concentration of fat under the eye (commonly referred to as bags) a doctor can inject a dermal filler, such as Juviderm®, Radiesse® or Restylane® into the surrounding tissue to smooth out the lower eye’s bumpy appearance.

Fillers are also being done in lieu of some surgical rhinoplasties (reconstructive surgeries for the nose) in order to add dimension to different areas, such as the bridge or the tip of the nose with the goal of creating a more desirable shape.

Botox for Prevention
Though it’s been around for a while, Botulinum Toxin (Botox®) remains popular among thirtysomethings, fiftysomethings and everyone in-between for minimizing the look of deep lines and wrinkles. Patients in their 20s and 30s are now using Botox to prevent wrinkles by temporarily restricting the movement of facial muscles.

Laser Liposuction
During laser liposuction, a laser is used to liquefy and remove targeted fat in problem spots. Venturi describes good candidates for the procedure as “people who are otherwise quite fit but have trouble areas—what we call exercise-resistant fat.” And while women have always been primary customers, “men are doing more liposuction than ever before,” says Venturi. Dr. George Bitar, M.D., medical director of the Bitar Cosmetic Surgery Institute in Fairfax, sees a fair amount of male customers for laser liposuction, too; anywhere from four to ten males patients per week for consultations, depending on the season. “I do definition sculpting for men for their chests and six-pack abs and we get amazing results,” he says.

Another technique for targeted fat removal, CoolSculpting works by freezing, crystalizing and eventually eliminating unwanted fat in trouble spots such as the upper arms, lower abdomen, the inner thigh and bra bulges. With CoolSculpting, there’s no downtime and minimal bruising. “People can return to their normal activities shortly thereafter,” says Bitar. “We tell people it takes three to six months to see the final result, but the results are remarkable.”

Silicone Implants
While doctors are still using saline implants in breast augmentation surgeries, silicone implants (which have undergone rigorous testing and have been proven safe) are quickly becoming more popular once again. “It feels more natural and patients don’t have to worry about the deflation that they used to with saline-filled breast implants,” says Mirali. The material used in silicone implants has also changed, from a gel (which could seep or ooze) to a form-stable material, similar to the consistency of a gummy bear.

During Ultherapy, ultrasound wands or transducers, are used to create an overall face-lifting effect without surgery. “When you treat the cheek, it lifts the cheek. Treat the forehead and it lifts the forehead, both in a non-invasive manner,” says Bitar, who notes that Ultherapy is a great alternative for patients who are not candidates for a surgical facelift.

Cellulite is caused by fibrous bands that pull skin down over excess fat, causing a loose, bumpy look on the surface of the skin. Cellusmooth, a recently approved laser treatment, attacks cellulite all in three areas by breaking the bonds of the fibrous bands, melting the fat stores and tightening the skin, minimizing cellulite appearance.

Combination Treatments
Doctors are now combining more than one treatment in the same sitting in order to maximize procedure results. “Traditional procedures can be tweaked with the new technology that we have,” says Venturi. For example, “we’re combining laser liposuction with a tummy tuck. For the lower eyelids [to get rid of a bulge or bag], we’re taking fat out of the lower eyelids internally, then using a laser to tighten the skin so there’s no scars.”

Surgery for More Extensive Needs
Though minimally invasive technology now produces fantastic results for many patients, sometimes, surgery is still the best option. For example, “laser liposuction does have its limitations,” says Heppe. “If you think it would replace something like a tummy tuck the answer is no, it really doesn’t. The amount of skin tightening you get with laser lipo is not the same as what you can get with a skin incision doing a tummy tuck.” In the same way, a mini or full facelift is often needed to fully rejuvenate the face, as opposed to a targeted injection.

Not sure what procedure is best? Always consult a board-certified plastic surgeon to help you decide.

The Mommy Makeover
For many moms, losing that last bit of body weight is a triumph. But having children may still make changes to the body no amount of diet or exercise can reverse, including a post-pregnancy paunch that won’t quite go away. “Typically, in these cases, the abdominal wall has weakened or widened,” says Venturi. “Part of the Mommy Makeover is putting the abs back together [abdominoplasty]. It allows the abdominal muscles to function as a unit because they’re back to where they belong.”

The mommy makeover isn’t a set collection of procedures. Rather, it’s a group of procedures tailored to each individual client. So in addition to an abdominoplasty, a mommy makeover might involve a tummy tuck, a breast lift and/or augmentation and liposuction to the outer hips.

Anatomical Implants
Anatomical implants, shaped according to specific proportions and body types, are being introduced into the market with great results. For example, “if you have a patient with a taller build, there are implants that are a little bit taller that provide more fill in the upper area of the breast,” says Gottlieb. “Most people get a nice result from a round implant, but [the anatomical implant] has really improved the result for a segment of people who had a harder time getting a natural looking breast augmentation in the past.”

Gluteal Augmentation
While too much junk in the trunk used to be an issue, a curvier posterior is now in vogue, thanks to stars like Beyoncé, Kim Kardashian and Mariah Carey. “We’re doing a lot of gluteal augmentations with fat transfer [transferring fat to the backside from other parts of the body], and it’s a great procedure,” says Heppe.

Corrective Surgery
Corrective surgery is still an important part of most surgeons’ practices. “I do a lot of breast reconstructive surgeries when it’s related to medical issues,” says Gottlieb. Plastic surgery still isn’t a common request among young people, but specific procedures, such as surgery to correct breast asymmetry, gynecomastia (enlargement of male breast tissue) and breast reductions, when appropriate, are being done. “We sometimes operate on patients that are in their teens when they have large-breast issues or medical problems related to the breast,” says Gottlieb. “I’ve certainly had patients that have had major issues with back, neck and shoulder pain, limitation of activities and sometimes severe social distress from it. And they benefit from surgery.”

All-over body contouring after significant weight loss is another popular procedure, says Bitar, who operates on someone at least once per week who has undergone gastric bypass surgery. “The trend of gastric bypass and lap banding is on the rise, and when you lose 100 or 200 pounds, you need to be able to re-contour your body,” he says.

Find a Great Surgeon
No matter if you’re thinking about getting a small amount of Botox or are considering a more extensive procedure, experts recommend seeking out a board-certified plastic surgeon. They’re guaranteed to be trained on everything from injections to major surgery and can offer you the full gamut of treatment options. Make sure your practitioner is certified by the American Board of Plastic Surgery. Find the most qualified practitioners near you by visiting the American Society of Plastic Surgeons website at, then click on “Find a surgeon.”


(April 2014)