Full Text from Dr. Berman's Book

Chapter 17


As I approached the end of the book, there were a few other procedures I needed to mention. Some of these are procedures I don't perform, and some are ones I perform infrequently. Nonetheless, some comment seems worth mentioning.

Calf Augmentation

Calf augmentation was a fairly popular procedure. I don't seem to see as much of a demand for the procedure as I used to. Simply, some soft silicone rubber implants are inserted over the calf muscles through an incision in the crease behind the knee. The results are usually gratifying, but it may take a week or two before the patient is comfortable walking again. Fat grafting may be a viable option for patients reluctant to have an implant in this area.

A patient with thin calves can improve her contour with the addition of soft solid silicone rubber implants under the fascia of the calf muscles.

Buttock Augmentation

Yes, there are implants made that can increase the projection of the buttocks. They can be placed over, under, or even within the gluteus maxims muscle in order to fill out the derriere. Complications, most frequently infection, are not altogether rare.

Pectoral Implants

Some men find the placement of pectoral implants under the pectoralis muscle (the chest muscle) gives them a better chest shape that push-ups and chest exercises fail to effect.

Buttock Lifting

An incision placed high in the bikini line can be used for lifting a very droopy buttocks. This procedure might be more useful in someone who has dropped considerable weight and now suffers from true excess skin.

Liposuction has probably limited the number of lifting procedures we do, but there is still an occasion when the scars, which are placed in the bikini area are an acceptable alternative and give a better result than liposuction.

Medial Thigh Lifting

This is actually a fairly common and worthwhile procedure. This involves lifting the inside part of the thighs which after aging or weight loss or gain, seem to be hanging like bags between the legs. A wedge of skin and fat is removed from inside the thighs. The new incision line is hidden in the crease of the groin and the buttocks.

Sometimes there's sagging in the medial (inner) thigh skin, in which case, a medial thigh lift can smooth out the inner thigh skin with scars hidden in the creases of the pubis and the buttocks.

Hair Transplantation

At the present time, this is not a procedure I perform. Although I've spent time training to perform hair restoration surgery, I've continued to observe from a distance. The good news is that there are many fine doctors obtaining superior results now with the techniques of mini and micro-grafting. In the past, transplants were round punch grafts that left an unnatural pattern of hair. By placing individual hairs or very small groups of hairs, a natural pattern can be achieved.

Hair is under significant hormonal influences. Follicles taken from the back of a man's hair for transplantation, are more estrogen dependent and as such the follicle can well tolerate transplantation.

Scalp flaps and scalp reductions are methods for advancing large quantities of hair at a time. Large bald sections can be removed by this method leaving less scalp area for grafting.

Suffice it to say, that the process of hair transplanting requires a dedicated team and attention to detail. Today there are several clinics that specialize solely in hair transplantation surgery.

Vein Sclerosing

Unsightly varicose veins may appear as large truncated veins coursing through the legs or smaller webs of superficial vessels. Large, symptomatic varicosities need to be treated surgically, usually by vein stripping where the affected vein is removed. Smaller veins can be treated by the injection of sclerosing agents. These are somewhat caustic fluids that irritate the inside of the vein causing it to scar down and seal itself off from blood flow, thus removing the unsightly lesion. There are some new photo sclerosing machines and lasers, such as the versapulse laser, which have been developed. They may offer another way of reducing unsightly veins.

General Tips for Good Health

It should almost go without saying, but unless you take care of your health, looking better is almost fruitless. Generally, it is uncommon to find patients interested in cosmetic surgery when their health is on the fritz. Occasionally, I have to pull in the reins and advise against operating until my patient gets their health into better condition. The most common problem I see usually centers around liposuction, particularly in males. A lot of men have the misconception that they can reduce their abdominal girth by liposuction. Unfortunately, most abdominal fat in men is deep inside the intestinal cavity housed within the greater omentum. It can not be liposuctioned by conventional methods and conventional weight loss programs must be instituted. This particular location of fat storage in men may be one reason why men are more prone for heart disease.

A good diet, exercise, and a restful night's sleep, breathing comfortably through your nose may be the three key's to good health. It's actually fairly simple.

A good diet is generally one low in fat, particularly animal fat. Some fats, such as fish fat with the omega-3 fatty acids are actually good for you, but most fats tend to clump up in your blood stream increasing the risk for clogging arteries and insidiously forming layers of plaque in the blood vessels. Increased levels of fat also require increased circulation which puts unnecessary strain on the heart. This can then be a cause for high blood pressure and eventual heart disease. If we cut out butter, whole milk and multiple other sources of fat, our diets would be significantly improved. Occasional treats make life fun, but there are a large number of foods that provide way too many fat calories and should be avoided except on occasion. There is probably more harm caused to the overall health of Americans by the over consumption of fat than by tobacco, alcohol or drugs combined.

Finally, there is little need to keep extolling the virtues of good health habits. Volumes have been extended to trying to give us the foundations for healthful living, but I would like to close with a simple tidbit that I don't recall ever being addressed in any of these works. It is a simple treatment for a problem so common, I have always wondered why it is not simple common knowledge passed down in families. Perhaps it has been to some, but perhaps it will be a little positive information to others. Here goes. The story is common. You are walking along, perhaps in the dark at night, trying not to bother anyone in the house, when, ouch, you bump into the corner of the bed or the dresser and bang your shin. Congratulations, you've joined the black and blue club, and are sure to have a golfball sized welt and a tender spot on your leg lasting for a few weeks or so. Why does this occur? When you bang your shin, the trauma causes a disruption of small blood vessels around the bone. Consequently, there is bleeding around the tissues covering the bone. The bleeding stops with the natural formation of a clot. It is the blood in the tissues that causes the pain. If you cut yourself on the hand and blood started spurting out, you might watch as it trickled down your fingers to the ground and it eventually clotted, but more likely you would put a finger on it and wait until it clots at the site of injury. The same thing applies to the bump on the leg. As soon as you can after you bump your leg, stop and put firm manual pressure over the injured area. Hold it tight for several minutes. This will limit the blood from escaping, sealing off the vessel and preventing the inevitable painful lump on your leg. It is that simple. Sometimes simple ideas are the most overlooked. And so, to anyone who finds this a valuable piece of information, this is your gift for reading to the end.

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