Tag Archives: Lipo Queen



If we’re taking bets on a woman who is at least partially clothed, without X-ray vision even a plastic surgeon has to admit, “No.” But that doesn’t mean there’s not some help going on. There’s all kinds of smoke and mirrors out there. The bionic push-up bras aside, I’ve had patients go down two cup sizes in the exam room once they remove the Victoria’s Secret water bags. And even though they’re just meant to try on in the office, I swear that my supply of sample “try-on” breast implants has definitely dwindled down over the past few years.

Don’t even try to decipher the ones you see in magazines. Even the implants are photo-shopped—-here’s a lovely video about that from one of my old posts that I highly recommend 🙂

Of course, there are the obvious ones, like the ninety-five pound woman sporting a DD cup, or the one who looks like she has melons pushing up to her chin.

But those are obvious to everyone. So maybe a better question to ask is:

“Why do some breast jobs look fake and others don’t?”

Even here in Beverly Hills, most women seeking breast augmentation—whether it’s a college graduation present or part of their mommy makeover–want to look “natural,”  “in proportion to their body,” and often have it done so “nobody can tell.”

In my experience, the most important variables involved in achieving a natural-appearing breast augmentation with an implant are:

1)    The size of your breasts to begin with.

Especially the width. As a breast implant size increases, so does the base diameter. Your goal may be a D cup, but if your chest wall is too narrow, the implants will not only stick out on the sides and disrupt your natural anatomy, but this is a set-up for unnatural shape, rippling and implant malposition down the road. When I help a patient choose a breast implant, I recommend keeping the base diameter of the implant at about one centimeter narrower than the base of her breast.

2)     Your skin envelope.

Is there room in there for the size implant that you want, or is it going to be so tight that the implant will never drop? Chances are, if you’ve had children and breast fed there will be plenty of room, but not always. Also, skin in darker and Asian women is usually thicker and has more elasticity, so it doesn’t stretch as much for a big implant.

3)     How much breast tissue do you have now?

Can you pinch at least two centimeters of thickness? If so, if you go with a size-appropriate implant, you probably have enough tissue to camouflage the upper border so there won’t be that obvious ledge. Having your implants placed “under the muscle” or sub-pectoral also helps avoid this problem.

4)     What is the distance from your nipple to your inframammary crease (the fold underneath your breast)? This usually depends on whether you have tuberous breasts or not. If the distance is closer to ten than five centimeters, you are more likely to get a natural, tear-drop shape result with a breast implant, as opposed to a round one.

So–again, keeping it G-rated—with all of the above information, can you tell which of the women below has had breast implants?

The answer is, of course, ALL OF THEM (I mean, come on, this is L.A.)

I grew up in New York where everyone got nose jobs, but I’d never even heard of anyone having a “boob job.” You just started every high school summer promising yourself that this was going to be the year, you were just a late bloomer and somehow you were going to show up at school in September with a C cup. And if it didn’t happen, well…the only option was to learn to live with it and develop your personality. Even in Northern California where I went to college, I remember hearing about one girl on campus who was rumored to have had breast implants and it just seemed so unfathomable to me. I mean, how could her parents let her do that, and where would you go to even do such a thing?

Well, I soon found out. And what I also found out was that unless you’re talking about a twenty-one year old girl with perfect natural C-cup breasts, breast implants actually usually look do better than the real thing.

I remember when my plastic surgery chairman at UCSD took his daughter to a Britney Spears concert (yes, this was a long time ago, before she’d even been married the first time or had any kids). They had really bad seats, and although they’d had to watch the show through binoculars,  he did get a good close-up look at Britney in her risqué costume, and he said that she had breast implants. This was when she was a teenager, long before such an accusation was even hinted at in the media, so I asked him how he could know such a thing without seeing her naked and he said, “Because they look too good.”


So since then whenever someone asks me, “Do you think those are fake?” my expert plastic surgeon’s answer is always:

“If they look too good to be real, then they’re probably not.”



We’ve all heard about stem cells. They’re like the millenium’s new “black.” But why, again?

Stem cells are progenitor cells. Think of them as generic cells that can morph into whatever type of cell that surrounds them, as well as enhance the existing cells with extra hormone-type substances—called “growth factors”—that they secrete. There is promising research being done right now that gives us hope that one day adult human stem cells will be used to restore injured tissue after heart attacks, or even spinal cord injuries.

So how did plastic surgeons get involved with something that started out as a potential “magic cure” for heart failure and paralysis?

One of the most exciting discoveries has been that the same fat we’ve been discarding in the hazardous waste containers after liposuction cases (and no, it’s not Fight Club and we don’t make soap with it, as every guy seems to think is the most hilarious question to ask me) is chock full of stem cells. And most of us have at least some of that to spare.

So what does it mean when your surgery is enhanced with your stem cells?

Usually it is a procedure that already involves fat injection. Then it means that your plastic surgeon is additionally using an expensive machine to isolate out an even more concentrated number of stem cells from the fat, and injecting it all back in together wherever the fat is going—usually the face, breasts or buttocks. It also means that you are probably paying extra because the plastic surgeon has to pay off the loan on the machine, and for whatever expensive Google marketing they’re doing to sell their “stem cell” surgeries.

So is it worth the extra money?

There has been promising data regarding the positive effects of fat injection. I have seen it firsthand not only in my “natural breast augmentation” patients, but in cases where it has softened radiated tissue and improved pain and sensation in my breast reconstruction patients. And the science points toward the stem cells and their growth factors as the main reason for this success. However, there is no hard data to prove that isolating out some of the stem cells and then mixing it up with the fat to give you “supercharged stem cell” fat injections is superior to just injecting the fat with its regular stem cell concentration. But the term “Stem Cell” has become as much of a marketing buzz-word as SmartLipo™” did four years ago (See my Smart Lipo post) and this is where it gets confusing.

My main concern has always been whether or not the additional stem cells are helpful in the “take” of the fat in a natural breast augmentation, as this is a procedure that has become a big part of my practice. I have taken an informal poll of the experts at the meetings, and I have found that it is basically a split camp. In general, many of the plastic surgeons in Japan and the ones here in the U.S. who have stock in the stem cell companies like Cytori are huge stem cell advocates. However, I’ve spoken personally with fat-grafting pioneers such as Dr. Gino Rigotti, Dr. Mel Bircoll and Dr. Roger Khouri, all who disagree.

So far I am personally getting great long-term results in my natural breast augmentation patients without supercharging the fat with more stem cells. In fact, one of my first “guinea pigs”  just emailed me some pictures, bragging about how much appreciation her breasts were getting. I believe the direct quote was: “Oh my God, Boobs are so great! They do all the work for you—I don’t even have to open my mouth anymore! I wish I’d done this sooner. When I was younger I used to feel sorry for the girls who had to show off their boobs to get attention, but let me tell you—they were onto something!”

I also did spend a spa day with another one of my first volunteers and although there were no pictures allowed–I can only tell you that she is thrilled and looks amazing; she still weighs 106 pounds and wears a size zero, but she gained two pounds over the holidays and it all went to her boobs.

So could they be better if I used the stem cell machine? Maybe. I have access to stem cell-enhancing technology if the patients want to pay for it, but I don’t feel comfortable pushing it as a “superior” method.

I am a member of both The American Society of Plastic Surgery and The American Society of Aesthetic Plastic Surgeons and the two groups just issued a joint statement, essentially saying that there is not yet any scientific evidence that this expensive extra step of stem-cell enhancement is beneficial.

So what is the take-home message?

If you have been sold a “Stem Cell” procedure, you should understand that what you are getting is fat grafting and while the “stem cell enhancement” may help, there is no proven benefit to the use of additional stem cells in fat transfer. As of now, it is really more a “throwing everything into the pot” approach to getting the fat to take.



In case you are interested, I have copied and pasted the points made in the ASPS/ASAPS January 2012 advisory statement on “stem cell” surgeries:

“…growing concerns have emerged regarding advertising claims and/or clinical practices using stem cells that have not been substantiated by scientific evidence. These concerns include:

* Use of the term “stem cell” in aesthetic surgery procedures, such as the “stem cell face lift,” with the implication of improved results.

* Claims that skin quality can be improved from stem cell treatments, and that outcomes from fat grafting can be improved with stem cell therapy.

* Widespread marketing, evidenced by a Google web search using the search terms “stem cell face lift” yielding 197,000 results and “stem cell breast augmentation yielding 302,000 results, respectively.

* A lack of consistency in how these procedures are performed and how stem cells are incorporated into the procedures.

* Instructional courses, some “for profit,” that have emerged which are designed to teach methods of stem cell extraction for aesthetic procedures.

* Many procedures being advertised by practitioners who are not board certified plastic surgeons or members of other core specialties with formal training in aesthetic procedures. Such “noncore” practitioners have not been trained in an approved residency program designed to teach the physician safe and careful evaluation of cosmetic patients or a working knowledge of the full range of aesthetic procedures.

* Specialized equipment being marketed to physicians for use in “stem cell procedures.”

* Specialized equipment to extract stem cells, including devices, may fall under FDA regulations. Some devices, including automated machines to separate fat stem cells from fat tissues, are not yet approved for human use in the United States.

* Claims of purifying or activating stem cells through techniques that have not been fully verified and tested for safety and efficacy in current, peer-reviewed medical journals, or claims of improved outcomes as a result of these therapies…”

For the full statement you can go to:

Baggy lower eyelids are actually caused by the fat that pouches out from inside the orbit (eye socket). The thin skin and muscle that hold the fat in place loosen as we age. Combined with the gradual loss of the youthful fullness of our faces, these fat pockets become even more prominent. In some of us it’s genetic. At least once a week I’ll have a patient stare at their reflection in the hand mirror and—with that deep sigh of resignation—say: “I’ve had them my whole life, just like my mother/father.”

No matter the cause, under-eye bags can make you look tired and sad when you’re not, and it’s just not a good look for anyone.

In case you’re one of those fortunate few who are too young and/or genetically blessed to even know what I’m talking about, below are some obvious examples contrasting Charlize Therons youthful, flat “lid-cheek” junction with the separation of the lower lid and cheek and the tear trough that occurs as we get older, such as in Donald Sutherland:

So, what are the options for taking care of this less-than-desirable problem? Read More

I just found out about this study being conducted by nationally renowned facial plastic surgeon Dr. John Joseph here in Beverly Hills. If you have deep acne scars that you would like to get rid of, see below:

Has acne left scars on your cheeks? If you have moderate to severe acne scars on your cheeks, you may be eligible to take part in a voluntary research study lasting up to twenty months for the treatment of your acne scars with an FDA-approved dermal filler or placebo. Participants must be at least eighteen years of age, in good health, and have at least four individual scars on the cheeks.

Qualified participants may be compensated for time and travel.

For more information, please contact:

Irma Garcia

Dr. John H. Joseph, M.D.

9400 Brighton Way, Suite 403

Beverly Hills, CA 90210


Have a great weekend!



You asked and we answered! See below:

The latest and greatest Fraxel machine is called the Fraxel Restore.  It is a fractionalized resurfacing laser that has two wavelengths (1550 nm and 1927 nm).  The 1550 penetrates deeper then the 1927, which means it is good for fine lines, wrinkles, acne and surgical scars.  The 1927 wavelength has more superficial penetration and is great for any hyperpigmentation spots (sun spots) as well as Actinic Keratoses (pre-cancerous lesions).  The laser puts microscopic pinpoint holes into the skin called microscopic treatment zones (MTZs), which in turn spares the surrounding area from injury compared to traditional CO2 laser resurfacing where the entire area is injured.  This also allows for less healing time and less risk than traditional CO2.  These small wounds trigger your body’s healing response system to produce collagen and elastin in the treated areas. There is about 5 days of redness and swelling after Fraxel before one starts to see the results. Even though results start to take effect within the first week, Read More

Okay girls, here’s some eye candy for you. My friend John Schneider has allowed me to pimp him out to make a point. First of all, for the record–no, he’s not single. He’s just a great example of someone who has allowed himself to age and looks even better than he would have if he’d started having his face puffed, pulled and frozen to get rid of all the lines. The informal poll taken of everyone that came into my office this week has led to the general consensus that he looks even better now than he did during his “hunky” days on Dukes of Hazzard:

John Schneider then…

Although, I’ve had to be honest with him, I never really watched Dukes of Hazzard—back in those days I was too busy keeping up with Family Ties and The Facts of Life. But I think I might have stirred up a little John Schneider fan club here right in my office…:)

Actually, John still has a huge fan base and if you’re interested you can check out what he’s been up to at

And even though we hear about him every day, I don’t think anyone will be opposed to being forced to look at pictures of George Clooney, another great example of someone who keeps getting better with age:

In comparison, I think it’s safe to say that Mickey Rourke’s aging process hasn’t gone quite as well:

Young Mickey Rourke

Now, ageless in appearance

And yes, I’ve heard the story about how he was a boxer and had to have plastic surgery to fix his injuries, but did they have to blow out all the wrinkles in his face? It looks like his lips are still swollen from getting punched at his last boxing match.

I know, I know, it’s not fair to just show pictures of men, because they’re so much better at aging than we are. So here are some analogous female comparisons:

Helen Mirren as a doe-eyed young beauty–doesn’t she look a little like Gwyneth Paltrow here?

…and now, no longer “young” but still beautiful 

Compared to:

And now…she doesn’t look old, but the expression is gone, and she doesn’t look like herself anymore.

So in addition to trying to drive traffic to my blog with posting pictures of celebrities, what’s the point I’m trying to make?

John certainly could be having little tweaks done to his face. So could George Clooney and Helen Mirren. But even if they are…they are doing it the right way. I think the key here to not “crossing over” is to maintain at least some character in your face. Don’t get me wrong–there are certain parts of your face that do fine without any character whatsoever. Like the center of your brow, for instance. Being able to frown is completely overrated. For this, Botox® has been an amazing discovery and I also highly recommend it for softening (though not obliterating) the creases that go across your forehead.

For those of you who have never had Botox® because you’re afraid you’ll wind up looking frozen, just trust me. I do mine myself, and it wears off so gradually that when it’s gone I look in the mirror and think, “Oh, I look okay, I don’t need it.” And then one day I stop being lazy and just do it and after a few days I start thinking, “Wow, I look a lot better than I feel,” and then I remember it’s the Botox®, and I promise myself I’m never going to let it go that long again.

But one area I try to go light on in my patients–and I never do on myself—is the crow’s feet(lateral area next to your eye.)  Crow’s feet have never bothered me. When I first started practicing I used the “standard” recommended dose of twenty to twenty-five units on each side for everyone, but now I usually use only three to five. I think that when you have no lines there, it causes a disconnect between your eyes and your mouth when you smile. And have you noticed that completely getting rid of your crow’s feet can make the crinkling under your eyes even worse? That’s because the muscle being targeted–the orbicularis oculiis circular around your eye. When you paralyze it laterally, it will increase its movement inferiorly. If you’re having that problem, and you don’t want to decrease your crow’s feet Botox® dose, you can ask your doctor about adding a unit of Botox® to your lower eyelid, just below the lash line.

So I think the “take home”  (or the “take to your plastic surgeon/dermatologist/nurse practitioner”) message here is that it’s better to look older than to lose all character in your face. If there are some lines that make you look a little more “mature” but not “bad,” consider leaving them alone. Consider decreasing your Botox® dose. And this goes for men especially. The “overdone” female face is still widely accepted by society, but the male one is not.

Although, you middle-aged guys certainly could kick it up a notch when it comes to taking care of your bodies.  It’s disappointing, but even here in the glamour capital of the world, there seems to be some unspoken rule that women have to stay in shape to be attractive, but the majority of straight men think it’s totally okay to grow a beer belly. And if you don’t believe me, check out a conference room full of a bunch of “professionals” at the Century City Hyatt Regency and see for yourself. FYI—you guys might actually get more action with some abs than with a Black Card.

But we should end on a positive note, shouldn’t we?  🙂

John’s P90X addiction certainly doesn’t seem to have hurt him at all

And if you guys can’t get rid of your love handles with simply working out, don’t be shy–that’s what I’m here for!



Fat Transfer from Butt to Breasts

I used to get asked this question all the time–meant as a joke. But the truth is, making your breasts bigger with your own fat can be a reality.

Fat injection is not a “new” procedure, and breast enlargement with autologous (your own, and no, you can’t use someone else’s) fat has been around for decades with good results, especially in Europe and Asia. I first heard about it a couple of years ago, at the Atlanta Breast Surgery Symposium. A plastic surgeon performed the procedure at a nearby hospital with satellite surveillance for the meeting attendees. It was the first time all day that I actually started paying close attention, as it was the first “new” thing in breast surgery that I’d heard anyone talk about yet. I was blown away—basically, the patient was getting the fat sucked out of her “problem areas” and injected back into her breasts! A dream come true!

The procedure just seemed like a natural addition to my liposuction practice. I researched it as much as possible—even spent two days in the operating room with Dr. Roger Khouri (one of the pioneers of the procedure in this country, as well as the creator of the BRAVA device) of Miami.

The first few I did on my friends, because what are friends for, right…? 🙂

Honestly, so far everyone has been thrilled. It’s truly an amazing procedure. I wish I could show before and after pics, but this is a G-rated blog.

So…What are the advantages over traditional breast implants?

Read More