S04E65 - Avoiding Dog Ears & Stomach Bulges after Lipo Mommy Makeovers & Tummy Tucks with SPECIAL GUEST DR. REZA KORDESTANI

"The best way to fix mistakes is to avoid them." Of course, the problem is how does one avoid the mistakes in the first place?

Dr. Sam Rhee @bergencosmetic, Dr. Salvatore Pacella @sandiegoplasticsurgeon and Dr. Sam Jejurikar @samjejurikar discuss liposuction, mommy makeovers and tummy tucks with special guest Dr. Reza Kordestani, @drreza.k, expert plastic surgeon, regarding aesthetic body contouring and how to achieve spectacular results while avoiding potential pitfalls.

Dr. Reza Kordestani is a plastic surgeon in the Washington D.C. area. He earned his medical degree from the Dartmouth Geisel School of Medicine. He went on to complete his plastic surgery training at the University of Texas Southwestern. After completing his last year as Chief Resident, Dr. Kordestani was awarded the Chief Resident Teaching Award by the faculty and junior residents. Dr. Reza Kordestani now provides cosmetic procedures for patients from his private practice locations in McLean and Woodbridge, VA and Chevy Chase, MD.

#podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic #3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery

S04E64 - Avoiding Dog Ears & Stomach Bulges after Lipo Mommy Makeovers & Tummy Tucks

[00:00:00] Dr Sam Jejurikar: All right, welcome everyone to, uh, yet another edition of Three Plastic Surgeons and a microphone. As always, I'm joined by my two co-host, Dr. Sam Rhee in Paramus, New Jersey, who's at Bergen Cosmetic and Dr. Salvatore Pacella. I'm in La Jolla, California. Who's that San Diego plastic surgeon? I'm Sam Jejurikar.

Today we are very lucky to be joined by one of the busiest body contouring surgeries in the northeast. Reza Kordestani, who's in the Washington DC area, actually practicing in, um, McLean, Virginia. I've known Reza for years from the time that he was in Dallas, and I'll get into his introduction a little bit more.

Before we get into the meat of the program, let's do the,

[00:00:47] Dr. Sam Rhee: got it. Thank you. This show is not a substitute for for professional medical advice, diagnosis, or treatment. This shows for informational purposes only. Treatments and results may vary based on circumstances, situation, and medical judgment. After appropriate discussion, always seek the advice of your surgeon or other qualified healthcare provider with any questions you may have regarding medical care and never disregard professional medical advice or delay seeking advice because of something in this show.

[00:01:13] Dr Sam Jejurikar: Perfect. So, uh, for our viewers and, uh, who, who don't know Dr. Corani a little bit about him, he, uh, uh, did his undergraduate studies at So sure, Patel and I

will Dr Duke, um, much like Not a great time to be saying that NCAA an opportunity having gone the way did for y'all. Um, but Michigan didn't even make a tournament, so I can't say much. Then, uh, then Reza went to Dartmouth Medical School and then I got to know Reza when he trained and what some say UT Southwestern. The three of

us would say Michigan, of course, but you know, is the best plastic surgery residency in Um, But, uh, got to know him well, recognized from early on that he's an exceptional talent. Uh, not only surgically, uh, not only through his thought processes, but through his sense of humor. One of my, uh, favorite moments was when he was, uh, where he was wearing teal another famous plastic the end of his training when I saw an epic boomerang scrubs with high five back and forth.

Rod Rorick.

And they were booming, a uh, resume One of my favorite things I've ever Oh, those are good times. Yeah. Um, if a man still talks way. So, um, and, uh, res has made his way out to DC where he rapidly has

about you all the time by the doing all things body contouring, tummy tucks, breast surgery, liposuction, butt lifts.

And I've felt like there's been similarities in, in my practice in re's practice. Um, And I've seen a lot of his results and been kind of blown away by the results. So we asked him to be on this, um, on this program so he could kind discuss his philosophy, uh, philosophy towards body surgery. So I guess, um, you know where, I'll start off, Reza is, You know, we, we've had a lot of, uh, these podcasts talking about body contouring, but things that I've noticed that are sort of different about practice and different about your results. First, I noticed that you spend a lot of time talking about postoperative care, specifically lymphatic massage. Compression garments and you show results just a few weeks out from surgery that are really, really good. So can you share with our viewers sort of what you think are sort of the main space where it's getting a great result, whether it's liposuction, B B L, or a tummy tuck?

[00:03:40] Dr. Reza Kordestani: in residency either. Um, but it seemed to me when I got started, uh, uh, some of the patients were, were asking me about, um, uh, these lymphatic massages or drained massages, and that kind of, uh, caused me to look into them and speak with some of these. Lymphatic massage therapists or, or they call 'em postop, uh, care, uh, uh, therapists, different names for them. They're, there's not really a licensing board for them or, or anything of that nature, but, they, they spend a lot of time trying to get, uh, the fluid out, uh, like sort from liposuction cases, uh, through open, uh, you know, drain holes and, and speaking with them and kind of looking into, things that, for instance, Alfredo Hoyos, uh, does, uh, it's, it became very evident to me that there was a lot of things that, uh, I needed to learn about.

Uh, the, so, um, usually. I think when the, it all varies on, uh, the aggressiveness of your liposuction. If the liposuction is very aggressive, there are more chances for, um, uh, scar tissue to form abnormal adhesions to form. much like hand therapy, when we we're very accepting of that, where right after surgery, in order to prevent abnormal adhesions and scar tissue from forming and stiffness, we have somebody start hand therapy very quickly. And I think, uh, the post-op care from what I initially heard about Alfredo Hoyos is, is he has them right after, uh, surgery, he puts in drains, um, which I started to do with the liposuction. Uh, he leaves them in. Uh, this is secondhand knowledge from, uh, someone speaking with his, uh, uh, main, uh, uh, therapist. 10 days. He leaves, uh, the drains in every day. They come. They get gentle lymphatic massage, uh, done to drain all of that fluid out. they do, uh, some amount of, uh, taping of the skin too, uh, with KT tape, which I, I haven't into cuz there's of course a risk of blistering them. Um, and there is, he uses compression.

He uses the 360 wraparound foam. Uh, I'm told two of them on top of each other, and then, the, uh, fa garment on top. Um, and then, uh, you know, in order to keep the, uh, drainage holes open, uh, they use, uh, like Vaseline, I, I just use Trac and ointment, which I presume, you know, get a similar result. But it's to keep that area from healing up, um, so that they can

[00:06:34] Dr. Salvatore Pacella: so

[00:06:34] Dr. Reza Kordestani: from those areas.

[00:06:36] Dr. Salvatore Pacella: you. So you, you're talking about putting drains um, just doing standard How, how do you, how long is a drain? How do you put it in,

um, do you sort put it in with a blunt? Um, you know, cuz for our viewers out there, o oftentimes when we use drains, it's with it's fairly easy to place.

We place it through or right next to the incision. So it's a, it, it can be a little bit of a challenge to put li uh, drain in for liposuction, correct.

[00:07:07] Dr. Reza Kordestani: For, um, for the back, I use a access incision right at the top of the boot crease and in that area it's a short drain. Uh, and that's mainly to keep that area open. I only leave that one maybe six days or so. I cut.

[00:07:23] Dr. Salvatore Pacella: that a cl, sorry to interrupt. Is that, is that a closed,

[00:07:26] Dr. Reza Kordestani: used to use

[00:07:27] Dr. Salvatore Pacella: closed section?

[00:07:28] Dr. Reza Kordestani: use closed suction in that area. The, the tugging in the, the top of the gluteal crease from that stitch. It's incredibly uncomfortable anytime we wanna sit, et cetera. So now I, I leave, I actually take a JP drain, uh, I cut the end of it, that ha, that is still, uh, open, um, like at the very tip. And I insert that portion and sew it in. And. Negates the kind of tugging it is quite messy, because then it's an open drain that's draining out. But patients were really miserable with that closed suction drain. So I switched to, uh, an open drain in that spot. Uh, in the, in the, uh, abdomen. I also basically use a drain about, um, say five-ish, uh, centimeters long.

I try to, uh, Use, uh, an instrument that has a, like a laparoscopic, uh, needle holder. I take one of those laparoscopic needle holders, grab the drain, and then, uh, push it. And that tends to work pretty well.

[00:08:35] Dr Sam Jejurikar: You know, I actually do something a little bit different with my drains in the abdominal wall, but I put drains at a hundred percent of the abdomen as well, guys. But I'll, I'll take the, um, of the end of the drain that you would normally hook up to the bulb and I'll feed it over a four millimeter basket cannula.

And I'll either use the, I'll use an Axis site either in the humble like, or the inform fold. I'll feed that. Through the entire abdominal wall to my pubic access. So I'll basically feed that in and then I have a drain that's like this long, you know, that's, that's the, that's, that's basically the, the entire length between those two incisions. it makes a huge difference. Drains after liposuction, and it's, and it's interesting. I already pretty much know where I think Reza stands on this, but when it comes to brainless tummy tucks, which is a huge thing that people want, I've just gotten a complete opposite extreme. Like I've gone drains for minimal

[00:09:29] Dr. Salvatore Pacella: Mm-hmm.

[00:09:30] Dr Sam Jejurikar: almost a hundred percent of the time, unless people just strongly don't want it, and I'll console 'em, but I don't think the results are as good.

[00:09:42] Dr. Reza Kordestani: I've, I've tried to,

[00:09:43] Dr Sam Jejurikar: Would you, would you agree with that Reza?

[00:09:46] Dr. Reza Kordestani: more contouring of their abdomen after, um, having had a tummy tuck, whether with me or elsewhere. And I find that in the, uh, when I'm like, with such who has had aless. It's much harder to, uh, push the cannula through there.

Seems the, the result looks beautiful to me. There's nothing abnormal about the result. It just is, is harder to push the cannula through. So I presume in those, uh, interstitial areas between the aytes their bodies having to absorb that fluid. Producing some more inflammation, it looks to me, or, and it feels to me like, like a little additional scar tissue that they form underneath that's not necessarily visible, which, which I think that's what's led to the popularity of journalist, but it does make it hard to do additional liposuction.

[00:10:40] Dr. Salvatore Pacella: So, Sammy j um, go back to what you were saying about your drains. So when you, when you feed that drain in, are, are you suturing it to the skin? Are you putting it on a bulb or you're just letting it sort of drain like a penrose, if you will? Into the, into the wound?

[00:10:58] Dr Sam Jejurikar: I'm, um, I'm using

[00:11:00] Dr. Salvatore Pacella: Mm-hmm.

[00:11:01] Dr Sam Jejurikar: for the abdominal wall. I'm, because it's a, it's a long length. Um, and so, um, I hook it up to a bulb. I don't find it to be that troublesome. in the front of the body, but I a hundred percent agree with Reza that when you're doing that sort of sacral diamond, the area right above the, uh, the gluteal crease, um, it can be really uncomfortable if there's any sort of traction in that area. Um, I don't always put a drain in that area. I sometimes do, I sometimes don't. I only really do it if there's an excessive amount of energy modality being used or, or, um, just a ton of suction in in

[00:11:35] Dr. Salvatore Pacella: Got it.

[00:11:39] Dr Sam Jejurikar: in the

[00:11:39] Dr. Sam Rhee: of system do you use Reza for your liposuction, like your machine.

[00:11:45] Dr. Reza Kordestani: recently, uh, I used to just use micro air, um, and now I've started using, uh, a vaser that I got in the beginning of the year about, uh, three months ago. Um, I like both. It, it both work well. I don't think, uh, there's necessarily, uh, a major difference that I see between them besides the fact that, uh, I do get less, uh, collagen fibers and clogging while I'm suctioning after basar, uh, which I presume has to do with it just shaking out those fat cells, uh, uh, and sparing. Uh, you know, the collagen fibers, I don't think I've necessarily seen, uh, any, uh, skin shrinking effect from that little bit of heat that, the vaser has. If anything, uh, I, I have seen uh, Less swelling. I don't understand why. I presume it's experienced some of the lymphatics. I don't, I dunno.

There's no way for me to tell. But I think it, the skin shrinking effect that people may see, uh, has to do with it preserving more of those kind of cobwebs of collagen underneath that. That's, I mean, when I, when I vaser the, the stomach. I do lift up the tummy tuck flap. Um, I do see more of those preserved for sure to, um, traditional micro, um, without Baer.

[00:13:17] Dr Sam Jejurikar: does your, does your decision about, um, what technology you're gonna use for liposuction?

[00:13:29] Dr. Reza Kordestani: started,

[00:13:29] Dr Sam Jejurikar: it impacted by whether or not you're gonna do fat grafting?

[00:13:31] Dr. Reza Kordestani: on everyone, uh, the vaser, uh, mainly because I found that with the, uh, when I was doing fat grafting with they, and I was using the Wells Johnson HVP system, um, I was noticing that if I. Injecting the fat with a four millimeter basket it, it, it tended, it would tend to clog like the, the, um, the alarm would come on for the pressure being too high.

And it wasn't necessarily the amount that was injected into the buttock that was causing that. It was just that it was clogging, uh, uh, a four millimeter basket. And that's just those collagen fibers that were coming out before I was using laser. But now, Uh, I'm able to use a smaller can, just like a four millimeter Mercedes after, um, uh, using the vaser and it goes in very smoothly.

It's much smaller, uh, s of fat. Um, they're still intact fat. I mean, I've taken 'em out and, and they all, there's no major oil layer, um, uh, that I see. And it, it goes in very smoothly without all those fibers clogging the um, uh, injection, the.

[00:14:41] Dr Sam Jejurikar: What about, uh, what about you guys? Do you guys like vaser or do you guys use any, what, what is your thought in terms of using energy modalities and then fact crafting, Pacella ri? Any thoughts on this? You're muted

[00:15:02] Dr. Salvatore Pacella: Um, you know, so I, um, I'm usually not usually doing massive amounts of liposuction cases. I'm usually doing in the, in the setting of an abdominalplasty or, or something like that. So, uh, I've found in my practice the most efficient way to do that is, is just simple power assisted liposuction. know, Vassar, when I've used it before, it, it almost takes. you know, a significant more amount of time. You have to pass the vaser first and then, and then, and then do the liposuction. And I, I've, I've found that I've gotten equally, if not better results with just simple power, just a, a tool I've used for many years. I, I don't really do anything different if I'm using that for, for fat transfer either because I, I hook up the power assisted lipo to my fat grafting rao. it seems to hold, it seems to do well and I'm, I'm doing fat transfer not only for cosmetic breast surgery, but for also facial surgery and breast cancer reconstruction as a second or third stage, and I've, I've found the fat to be very viable and, uh, and useful in this setting of power assisted.

[00:16:15] Dr. Sam Rhee: I mean, I've stuck with Power Assist, but it's not for any reason than that's the system I've had, and it's worked pretty well for me. I know you like Vaser, um, Sam, so, uh, I just can't really comment on it. I just, I've always stuck with Power Assist too. I think Reza is, oh, I almost forgot though.

But Reza is right. There is, um, a fair amount of collagen fiber and, and, and stuff that you do have that does collect with power assist when you're, when you are doing fat grafting. And so it's just interesting to hear that, um, you don't see that in va. Maybe it's just more macerated or, or it's more of a clean cut.

I'm not sure about that.

[00:16:55] Dr Sam Jejurikar: Yeah. Well, I, yeah, I totally agree with resident's observation because it's, it's really interesting because years ago we were sort of led to believe that if you used energy, with fat grafting, that that fat wouldn't be viable. And now I actually think it might be better because maybe cuz it's less bloody when the fat's coming out.

I mean, I don't, I don't know, but I find that my fat grafting results probably are a little better with Vaser. Um, so I use it on almost a hundred percent of cases at this point. I rarely, I use, I, I really don't use power assisted much, but I, I really like vaser. I also saw Reza that you're, were talking about your use of Renu Vion a little bit too.

So do you use a lot of radio frequency in your, in your cases?

[00:17:41] Dr. Reza Kordestani: I do feel like it, it, wasn't working well for me when I, I had the re before I had the baser, to be honest with you. It really wasn't working that well for me without, uh, the use of laser. I think because, uh, as soon as I'd be done with the liposuction, um, there would be some a, a fair amount of blood just because of the aggressiveness of the lipo, um, and that blood tended to clog theon system very easily. Um, so once I started using the vaser along with it, where there was less, less, you know, subcutaneous blood after, after that, uh, it doesn't, it barely clogs that ion system. Um, and it, in my hands, it, it, looking back, I, I would only use if I had the. Uh

[00:18:42] Dr Sam Jejurikar: Do, do you guys,

either body tight or

Renu Vion. Okay. I don't. Well, yeah, I've never, I've never had a Renu, but we use body type, which I think is similar. I think they're both just generating heat more superficially. So it's kind of geared, you know, for, for our listeners, Vaser, the energy is directed sort of in the mid fatty layer and it makes it a little bit easier, I think, to, to withdraw the fat.

Maybe a little bit of translation of heat to the skin, but not a tons, you don't tend to see a ton of skin tightening, whereas Renu Vion and um, body ti are heating D a lot more superficially, so you tend to see skin tightening. Um, more with these systems. Yeah, I use vasser in combination with body tighten, but my main reason for doing it is just a lot faster. Um, like, I mean, body type used to take me forever to get the skin to heat up, and now when I use vaser and body type, the body type works pretty quickly.

[00:19:39] Dr. Reza Kordestani: making a, a distinct difference was, uh, the super umbilical area. So right above the, um, beforehand when I saw somebody with kind of more of a horizontal, uh, horizontally shaped umbilicus, um, and I would like to suction that the skin tended to fall a little bit and maintain that horizontal. Um, once I started, uh, using Renu Vion afterwards, and I, uh, did asked the rep about it, they, they, they suggested, you know, uh, going from the inform crease access sites that I used, um, and, and using the RENU upwards, and. Turn people's, uh, uh, aus into more of a youthful, um, lean kind of vertical, uh, value. That's the place where I really noticed the, and it started convincing, may have.

[00:20:36] Dr Sam Jejurikar: Okay. Well, you know, the, the kind of the, the next topic I wanted to touch on is I know you've built a really big reputation for doing body contouring surgery, and you've got a, a huge wait list. So as a result, I imagine you're seeing a lot of. Just revision surgery as well. Where people are coming to you, whether it's been their, you know, their tummy tuck that's gone awry or their liposuction, what are the, what are the things that you're seeing the most that people come to you for?

For revision and procedures?

[00:21:09] Dr. Reza Kordestani: uh, 360 lipo. wanting to have a tummy tuck done. I've actually, it, the, the aggressiveness of the lipo section. Over the past, I would say, uh, you guys would know better than me, but the, the ones that I saw right outta practice, um, uh, especially from uh, Miami, where they do a fair amount of. Uh, the aggressiveness was just to the degree where the amount of scar tissue underneath, uh, and the amount of, the amount that Scarpa shrunk up and it does not pull downwards. made it very difficult to even offer, a tummy to those individuals. Um, So, in fact, I was seeing a fair amount of those, and I did actually, uh, decide to stop doing, uh, tummy tucks on those patients. because I, one, I wasn't ever able to pull, uh, the skin down as much as I wanted to. Their, the scar tissue was higher. would get, um, some hypertrophic scarring, and I, I would always have to have like a, a t uh, at the very bottom portion where I couldn't pull, pull the, um, incision down all the way or the tongue type flap all the way.

And of course, would get like about a centimeter of, uh, skin necrosis in that area that would've to heal secondarily. So I just stopped, you know, I,

[00:22:36] Dr. Salvatore Pacella: you, know, I think, um, I think for our viewers and listeners here, um, you know, what you said was very, um, was very pertinent. You know, I, I've seen that as well to, uh, a really big upt. Tick in the amount of aggression that's done with this procedure. And I, I think this really relates to, you know, what's happening in, in plastic surgery education in the last 10 years, you know, so there's a, obviously there's a very talented, uh, out of, uh, Dr.

HOAs. Correct. And, um, does a lot of high definition liposuction. So really assertive, high detailed abdominal etching. Um, really sort of going underneath the skin to create adhesions, to create a, um, a, a really chiseled look. And he, he is a master at it, but I think he's also been very, um, Uh, very expansive on teaching.

He does a lot of conferences. He does a lot of, uh, professional education, um, uh, sessions. And I think what we've seen is surgeons who may not really understand a lot of his techniques, sort of going to do that and being very aggressive and we're seeing a lot of complications subsequently.

[00:23:58] Dr. Sam Rhee: Yeah, I was gonna ask you about that cuz I myself have seen a couple patients from Miami who are just over liposuction, contour deformities, divots everywhere. Just real messes. And I've, um, I've done some revision cases where I've gone back, cleared out the scar tissue, fat grafted some of them, and the my results have been mixed.

I've gotten a couple really great salvage results and then a couple, it just didn't really seem to do too much of a, make much of a difference in these these cases. And so what is it that you do, or what tips do you have about if you deal with these type of revision cases with these really bad liposuction results?

[00:24:41] Dr. Reza Kordestani: when I started at least noticing when I would, uh, when I was doing these procedures and doing, uh, tummy tucks on them, is that a lot of times when they had these contour deformities, um, the patients tended to think that there was extra fat left over. what I really saw when I flipped the, you know, looked underneath, under the hood, so to speak, what was happening was that there was a, a circular or, or, or um, a circular of, uh, scarpa's layer, uh, in focal areas. and it was causing the skin, overlying it to bubble up and look like. uh, uh, there was excessive fat there, but in fact, uh, what I would do is go in and score, uh, scarpa's or remove it entirely in that spot, and it would, it would unfurl the skin and allow it to, um, uh, re drape. But, but it's a dangerous thing to get into.

I think you have, you don't have a lot of. Uh, leeway with that and, and it can cause a fair amount of issues doing that too, extensively and, and really bad necrosis and a worse problem than what you started with.

[00:25:58] Dr Sam Jejurikar: Yeah, I mean, it's a scary thing to be excising scarpa's, um, for our listen. Basically removing, you know, areas of blood supply to the skin. So, so in order to get the aesthetic results you want, you're potentially putting the patient at, at increased risk So you just say no to

these patients now, you won't even operate on 'em.

for healing issues

[00:26:23] Dr. Sam Rhee: Sam

[00:26:24] Dr Sam Jejurikar: wish I could do that.

[00:26:26] Dr. Sam Rhee: You don't know how to say no,

[00:26:29] Dr Sam Jejurikar: Um, I guess I'm just, I don't know. I guess I'm hungrier than Reza. I dunno. I dunno. dunno what it's Um, what about, uh, what about things like, um, um, inadequate muscle tightening or bulging of the abdominal you know wall or

[00:26:52] Dr. Reza Kordestani: A fair

[00:26:52] Dr Sam Jejurikar: contour irregularities from dog ears, things like that. Are you seeing things like that a lot too?

[00:26:58] Dr. Reza Kordestani: uh, at least what I saw with the way the skin is managed after, uh, I'm abdominals, uh, initially. I, I was taught to kind of pull the skin inward, to keep the scar short. Um, uh, and pulling the skin inward at the flanks, uh, tends to cause a focal in, in my hands, at least a focal area of tightness and then some laxy lateral to it. And a lot of things, uh, that I've seen is where it, it, it creates this bulge of tissue that's not necessarily a dog ear more than rather it's more a differential laity. There, there's a band of tightness and then laxy lateral to it. so a lot of times what I'll do in those cases is, is go in and, uh, of course make the scar longer, but pull in a different. Um, and that tended to fix, uh, that issue. I also, um, learned after I finished, uh, residency that, you know, being very aggressive with the amount of fat removal with liposuction right over the iliac crest tends to help, uh, create that hourglass. Um, and so, you know, I just started being very, uh, aggressive in that area. Um, in order to make that happen. The um, what, what do you guys do for that? Is that something similar?

[00:28:36] Dr. Salvatore Pacella: Um, you know, so I think, um, the, the way I like to do tummy tucks to keep the incision short is, is exactly what you. what you mentioned, but in the opposite way, So, um, you know, I think, I think where I see things get into trouble is when you pull aggressively, centrally and then try to peter things out. I think that creates a lot of redundancy, a tissue laterally. um, I start relatively snug and tight laterally and bring it out. So it's a little bit lax medially. And, you know, I think, I think the important thing to, to understand in the abdominal wall is, When you look at a side profile, even in a, even in a swimsuit model, one's abdomen is exactly flat. There is actually a tightness and then a little bit of a pooch, and then it goes down and covers into the pubis, and there's a specific anatomic reason for that, which is, Is the posterior recta sheath.

You know, I, I do a lot of abdominal wall reconstruction you know, when you have above the umbilicus or the arcuate line, you have the anterior recta sheath. And the posterior recta sheath are, are equally solid below the abdominal wall. It's just the anterior recta sheath, and that creates that little bit of a bulge inferiorly. In my hands when I, when I tighten up a little bit less centrally, it gives me a little bit of a cone that I can sculpt to make it look a little bit more, um, aesthetically pleasing.

[00:30:11] Dr. Sam Rhee: Um, go ahead.

[00:30:13] Dr Sam Jejurikar: no, no, you go

[00:30:14] Dr. Sam Rhee: Oh, I was gonna say, uh, I find

what Reza does is similar to what I do in a lot of ways, in the sense that. Um, I do make my incision a little longer than I used to because I think that that, uh, on each side, uh, I used to try to pull everything, uh, short and, and I find that for me, challenging. Uh, the other thing is, is I do way more, uh, liposuction over the iliac crest and lateral to my incisions because I.

I do, I find what reins where you start pulling it over and it, it, it looks a little bulgy and, um, and especially initially, I was always having to go back and recontour it a little bit, do a little bit more lipo, uh, in those areas. And now if I, if I do more lipo to begin with, if I pull. Uh, not as hard and, and let that incision go just a little bit longer.

You sort of avoid that foe fullness or dog ear foe. Dog ear, if you want to call it that. And that's, that sort of helped me out a lot too.

[00:31:15] Dr Sam Jejurikar: Yeah. You know, I, I tend to do a lot more like Reza and Sam, but I, you know, I think it, it's not, um, I don't think there's a right or a wrong way to do it. I think there's, we have different patient demographics. We have different body types that people are looking for. Um, I know enough about re's practice. practice and Sal's practice to say that I think Reza and Sam and me are looking for patients that want to be curvier than patients that are seeing Dr. Pacella. I'm just gonna make that assumption for patients that want to be curvy, you know where they

silhouette or

Coke bottle

or,

[00:31:56] Dr. Salvatore Pacella: Snatched.

[00:31:57] Dr Sam Jejurikar: like the Yes That is, that is the word of the center of the decade. Yeah. If they wanna be snatched, um, I don't find there to be a good way to limit the length of their incision. I think it's a combination of aggressive suction and I'm quick to do extended tummy tucks. on, on, you know, where I'm actually starting the incision on the back to really make that love handle area, you know, over the iliac crest go away.

I do a lot of liposuction. I do a lot direct skin and fat excision over that area as well to bring it in. And I, and I think, I think it's just philosophically what our patients are looking for. I know plenty of really busy body contouring surgeons, both in Dallas and elsewhere who, who have a different demographic than I do, who have patients that wanna look a little bit straighter and maybe not so exaggerated, and they're able to limit the incisions a little bit more. Um, yeah, so I don't, I mean, I think, um, I think that kind of dovetails nicely to sort of the end of this conversation. I know we've had sort of a, kind of a, kind of a freewheeling conversation, but it's nice to talk to four guys that do a lot of body contouring surgery and just sort of share their different philosophies and see where we're similar and see where we're different. So do you guys have any closing

[00:33:08] Dr. Sam Rhee: just

[00:33:08] Dr Sam Jejurikar: is

[00:33:11] Dr. Sam Rhee: Uh, I would tell patients to go check out Re's uh, Instagram. He has one of the best, uh, social media accounts out there. I think. Uh, it's always really entertaining and good informational, uh, real or super real. So what is it, Reza that you, and, and we'll also post it everywhere that we do our, uh, our, uh, podcast.

[00:33:32] Dr. Reza Kordestani: uh,

[00:33:37] Dr Sam Jejurikar: Awesome. your time. We know there's lots of other things you could be doing on the Sunday morning, so Well well Reza thank you for Yeah. Well, it's totally our later, Jens,

was

[00:33:49] Dr. Sam Rhee: Thank you, Reza.

[00:33:51] Dr Sam Jejurikar: up. pleasure Well until

[00:33:54] Dr. Sam Rhee: Excellent