Monique Ramsey (00:01):
Hello everyone, it's Monique Ramsey with The La Jolla Cosmetic Podcast, and today we're going to talk about HD lipo. So HD, as we all probably know, stands for high definition or high def. And one place you may have heard of this procedure comes up in celebrity news when they refer to somebody having ab etching or abdominal etching. And so my guest today is plastic surgeon, Dr. Hector Salazar, and since we're on the subject of celebrities, Dr. Salazar inquiring minds, our celebrity plastic surgeon, inquiring minds want to know, is that what HD Lipo is for this etching?

Dr. Salazar (00:45):
Thank you so much for having me here. I really enjoyed talking about this topic. High definition liposuction is truly taking liposuction to the next level. So traditionally liposuction, it's only about obtaining a better contour and that's it. I don't like this contour of a certain body part. Can you give me a better contour? With high definition liposuction, what you're going to do is in addition to have a better contour in a much more dramatic body shape, what you can do is you can define certain structures that will give you or a better, much better body image, such as in the abdomen, in the abdomen, in your tummy, other than getting a flatter abdomen, getting a much more accentuated waist and hip ratio, depending if it's a male or a female. But you're also going to get the definition of the rectus muscle. So the recti muscles are actually right at the front is actually the six pack.

(01:51):
And what we can do is we can sculpt a little bit of fat that we leave behind to edge those muscles and to show structures such as that midline, which is called linea alba or the linea semilunaris. The linea semilunaris is the outside of the six pack or the inscriptions, the inscriptions of the rectus, which are the six pack. So that's what HD lipo is, and it's not only for the abdomen, it's also for the back, for the arms, for the thighs. You can show many, many structures in a much, much better way when you undergo this procedure.

Monique Ramsey (02:28):
So really the goal is not just reducing the bulk, it's sort of taking, like you say, taking it to the next level, having that whatever you want to be showing in the definition. And so can you do that? So the difference really is traditional lipo, there's no sculpting involved. Is that right or is there some?

Dr. Salazar (02:55):
It's a great question because with traditional liposuction, people also will say that they're doing some sculpting, right? Because imagine you have a square piece of marble and then you're going to give some shape, so you're doing some sculpting with high definition liposuction. What you do is not only you do the carve out and give a much improved shape, but then you go into certain parts and then better defined anatomical structures that will allow your body to look much more athletic, to look much more muscular. And it depends. It depends if it's performed on male or female patients and what their goals are, we can actually adapt this technique to their needs.

Monique Ramsey (03:41):
So for a woman, do women want a six pack or can they have one or is it more that they're trying to get that kind of sexy midline that you were talking about and maybe the outer edges curved or?

Dr. Salazar (03:55):
Yeah. So with female patients, what we start with is we talk to them about how powerful this technique is and we show them several pictures and we even show them pictures of male patients, pictures of female patients, and everybody starts by saying that they want a much more accentuated waist and hip ratio. When we go into and look at their back, everybody says that they want that carved out lower back. And when we do that, just by doing that, we start looking a much better defined upper pole of the buttock just by carving the lower back so much and accentuating that difference, it starts looking like actually they got a little bit of fat injected into the buttocks without doing it. So everybody loves that part. As soon as we start showing that, and then what we do is we show and point out different structures that we can define.

(04:56):
So it's very popular for female patients to go ahead and say, well, I would really like to have that midline better defined. I would like to show a little bit of the side of that rectus muscle a little bit on the six pack, not necessarily all the little packs on the six pack, but that sideline, that lateral aspect to have a better defined. And then obviously we give them the option. We say, look at this six pack and look at this female picture where she was actually asking for a six pack. I mean, it's a different goal. It can be done. Is it something that appeals to you? Do you want to work on this on your own or would you rather maintain a less defined rectus muscle? And then patients can actually go deep into it and we sit down and look at pictures and then they make a decision. So yes, it can be done.

Monique Ramsey (05:49):
Now, can anybody have HD lipo or is there, who's the best candidate for this kind of procedure?

Dr. Salazar (05:56):
I can tell you that it's really, really important that we interview and spend a good amount of time. And you know how I like to assess my patients, it's a long visit. It's a visit in which we sit down and talk about their goals and we see and evaluate them carefully. But this procedure, it's not for weight reduction. That's the number one thing that we have to remember. This is not to lose any weight BMIs that are high body mass index, the relationship between your height and your weight. We don't recommend this procedure on patients with high BMI and obviously we can chat about it with them and tell them. And when we feel that we recommend for them to lose some weight beforehand, we do, because this is number one, we're going to be first, as you were correctly saying we're going to be debulking first.

(06:46):
We're going to be eliminating a good amount of fat. Normally in a big difference, and I don't want to jump into a different topic, but a big difference between the regular lipo and HD lipo is that with HD lipo, with high def lipo, we work in two different fat compartments. There's a deep fat compartment and there's a superficial fat compartment. The deep fat compartment is where normal regular liposuction takes place. So we do that part. So in a way, we do regular lipo first and then we go and work on the superficial fat compartment. So since we have to take out a significant amount of fat and we have a limit of how much fat we can remove safely in the operating room, our number one concern, patient safety, we have to evaluate and see if a patient is a good candidate on a one by one basis. And I mean, it's a pleasure for us to talk to patients and if maybe the patient's not a candidate, we would still evaluate them, see them, and then determine what are the next steps that we need to do to make them a candidate.

Monique Ramsey (07:54):
Yeah, maybe it includes losing a little weight to get you to the point maybe the person's 10 or 15 pounds over where you would like them to be.

Dr. Salazar (08:04):
Correct.

Monique Ramsey (08:05):
So you can help. And how does that go? Do you have patients who've done that before?

Dr. Salazar (08:10):
Absolutely. I mean, for us, and as you know, it's a pleasure talking to patients and listening to their goals and if we explain to them what the surgery is about, even if they're not good candidates at that point, and definitely we give them a follow-up visit, obviously don't, I wouldn't say that we handle the weight loss program per se, but definitely we like to continue having several encounters so we can help them achieve their goals and get them ready for surgery. But definitely if they come and we talk about surgery, they are going to leave our office knowing exactly what the plan's going to be, what are the risk benefits, the pros and cons, and how's the recovery process so they can actually plan ahead of time. I mean, what better thing that if you know that you want that surgery, you're going to lose some weight over the next three, four months, and then at month five or six you're already having your surgery, you nested already, you have all your life planned and you're ready to go.

Monique Ramsey (09:09):
Now you mentioned BMI, so is there actually a number that you will say, okay, I want you between this number BMI and this number or not to exceed?

Dr. Salazar (09:21):
I would say probably not to exceed BMI of 35. Definitely from 30 to 35 we would consider them on a base, a specific case basis, and depending on the number of areas and what do we want to achieve, but I would say probably above 35, it wouldn't be something that they would be ready to embark in.

Monique Ramsey (09:41):
Now, is this something that people who maybe think that they are a candidate for a tummy tuck, is this ever combined with a tummy tuck?

Dr. Salazar (09:51):
That's a great question. So let me give you the straight, absolute answer is no, I do not combine this with a tummy tuck because high definition liposuction is a surgery that's very powerful. It's a very aggressive intervention. A tummy tuck is a very aggressive intervention as well. I mean, even though we know that it's a very safe, and both surgeries are very safe, but we do a lot during those two surgeries. So combining them places the skin at a high risk, we want to preserve the health of the skin as much as we can and combining them, that would be too much. That being said, what we have seen is that patients that before we started doing this technique, we would give them as a recommendation, a tummy tuck period. That's it, nothing else. What about some liposuction know because you're going to develop extra skin.

(10:46):
Now, after we started doing it, and we've seen it over and over and over, some of the patients that we thought they were only candidates for an adominoplasty, now they're undergoing high definition liposuction and we are seeing a lot of skin retraction, meaning skin tightening enough that then they don't need a tummy tuck. I do remember a patient specifically that he, because he was a male patient, he had a little bit of a flap of skin in the lower abdomen and performing liposuction to a skin flap down there would be pretty much the recipe for failure. But with high definition liposuction, I mean, we have been getting very, very good skin retraction. And when we talked to them, we said, well, I mean we have seen this. We go over pictures, let's try it. And we've been able to avoid tummy tugs on multiple patients.

Monique Ramsey (11:44):
Interesting, interesting. And why do you think that is?

Dr. Salazar (11:49):
I think what happens is, as I was touching before, you go and first treat the deep fat compartment, then you go, once you finish that and practically we empty all the fat in the deep fat compartment, then we go into the superficial fat compartment and we start working in this part. Traditional liposuction doesn't deal with the superficial fat compartment. As a matter of fact, the teaching is don't go to the superficial fat compartment in traditional liposuction with high definition is where we're going to create most of the impact. So we work so much, and I want to put it in layman's terms and say that we scratch the skin from the under surface so much, or we irritate the skin so much from the under surface from the inside, meaning that you get this level of dramatic retraction or contraction of tissues. And there is where you see patients that have, I would say, a pretty prominent abdomen that regular liposuction wouldn't be able to take care of, or sometimes tummy tucks would deliver sometimes a suboptimal result. And oh my goodness, with high def lipo, we have seen dramatic results. And you can see that in our profile, in our website, in our social media accounts, that they're dramatic. The results are dramatic. When we go over pictures, some patients actually say, is that the same person? And we have to show them or a little tattoo that a patient has or we have to show them

Monique Ramsey (13:27):
A mole or something,

Dr. Salazar (13:27):
A mole or sometimes even for male patients, the hair pattern so dramatic.

Monique Ramsey (13:36):
That's amazing. Now it sounds like there's an element of artistry with this procedure more than others. Would you agree with that?

Dr. Salazar (13:44):
Yeah, I would say this is not an exact science for sure, and that's something that we've talked to patients about. One thing that we do in a very concrete way is the only thing that we are doing is reflecting the patient's anatomy, their own anatomy. So if you go in Google and you Google for bodybuilders or male models or without a T-shirt, what you're going to find is that there's a lot of asymmetry in a well exercise human body the same way that we're lefties, we're righties, one side is stronger than the other. One's a big side, one's a small side. And when we are marking the patient that day of surgery, we spend a good amount of time and we're talking about 30, 35 minutes just looking for those anatomical structures, the anatomical structures of the patient. It's not that I'm creating muscles or I'm just going to design them the way I want to, or according to my taste.

(14:58):
Maybe if you want to think about the six pack as six little compartments, maybe the compartments on the left side are a little bit more developed than the ones in the right in that patient. And that's what we reflect, that's how we mark them, and we show that to the patients and we show a random picture of a model or someone to demonstrate to them how that's the natural way of doing it. If I design six perfect pads on top of the muscle, it's not going to look natural. So yes, there is a lot of artistry, but at the same time there is a lot of reflecting the patient's own beautiful anatomy that's hiding a little bit behind some subcutaneous tissue or fat.

Monique Ramsey (15:42):
And so how I've actually seen this because I filmed one of your surgeries and to

Dr. Salazar (15:49):
I remember.

Monique Ramsey (15:50):
From the mark, a few of them actually, and they're on our Instagram in our story highlights. But what's so fascinating to me is the morning of surgery, when you're doing the marking for the patient, you're palpitating sort of don't the muscles.

Dr. Salazar (16:08):
Yeah, palpating those feeling

Monique Ramsey (16:10):
Palpating, sorry wrong word.

Dr. Salazar (16:11):
Yeah. No, no, no. Might be a little palpitation as well because anxious to get going. Yeah.

Monique Ramsey (16:18):
So could you describe kind of how, because that's reflecting the patient's anatomy, and so can you kind of describe that process?

Dr. Salazar (16:27):
Yeah. Our markings, and it's not that I'm going to give away all my secrets here, but the markings, we take our time. So we are going to be marking the bony structures, and that's very, very important. So there's a lot of pushing with my fingers and to try to feel where those bony structures are, and we mark all those structures with a specific collar. And then after we mark those structures, then we move on to the soft tissue and we start looking for the muscle, the muscle, and it's different inscriptions and borders and boundaries. And to do that, what we do is we do some breathing exercises with the patients. We ask them to actually crunch their muscles. And funny enough, we've had patients that started sweating, and then we joke about, well, maybe Dr. Salazar this, so this is how I get my muscles, you get me to exercise year before surgery.

(17:22):
And then we've had a patient that's a former bodybuilder actually, that in the latest years he's relaxed a little bit of his exercise and his diet and everything, and he wanted to retake things. And when I asked him to crunch his abdomen, I would say normally patients didn't just try to make it tight, but this gentleman actually put his left leg in front, twisted his waist, lift up his left arm, put it behind his neck, and then started crunching in a very professional way. And I said, oh my goodness, I'm going to implement this from now on. So it's a little bit of a fun time for me. It's sacred because what we're doing we're, that's exactly what we're going to be reflecting after surgery. So that's how we do it. And then after we mark the muscle edges, we define not only the six pack muscles, but we also defined the serratus muscle. We define the external oblique, we define the latisimus dorsey muscle on the back, the paraspinous muscle on the back. And after that, what we do is we start marking for fat. So where is that excess fat that we specifically need to remove, and where is the fat that we need to leave behind a little bit for sculpting? And some patients actually ask me, what happens with the little bit of fat that you leave behind?

Monique Ramsey (18:43):
I was going to ask you. Yeah, that's one of my next questions.

Dr. Salazar (18:47):
So what they ask me is, so if this fat, what happens? I mean, is it still going to be there? Well, that fat is helping us to give that definition. So let's say that that patient's going to go to the gym after surgery is going to start exercising like crazy. And what's going to happen is that fat will be burned. And since all the boundaries that we were reflecting were the patient's own boundaries, then the patient's going to reflect the true muscle through the skin. And there's not going to be any change in the look of the patient after a patient burns that fat burns, the fat hypertrophies the muscle, meaning the muscle gets a little thicker, so it looks exactly the same. So it's a very, very natural way of doing it.

Monique Ramsey (19:33):
Interesting. So tell me about the technology that you're using in the operating room for HD lipo.

Dr. Salazar (19:41):
I'm glad that you asked that question because it's something that we wanted to look into because high definition liposuction is, it's a recently developed technique, I'm not going to say new, but recently developed and traditionally has been performed with a device that actually generates heat, which is called vaser. So that way of doing HD lipo can cause some thermal injuries or burns to the tissues, to the skin, and that is something that was actually keeping us away from performing this type of surgery. We said, and as you know, Monique, safety is number one, number two or 1.5 is the patient's satisfaction with the results. But in reality, premium no nurture at first do no harm. So definitely if there's a possibility that the patient has a burn injury, we were very skeptical about it and we stayed away from that technology. Finally, we came across an alternative way of doing this with power-assisted liposuction.

(20:49):
So it was not until we came across that the possibility of doing this technique with power-assisted liposuction, and we used a micro air technique for this is a imagine a it. It's a liposuction cannula that's connected to a special device that generates a piston like motion back and forward. But actually when you turn it on, you can't see that it moves because the RPMs are so high that basically you can't see that it's moving. But this liposuction, cannula, cannulas reciprocating back and forward, back and forward at such a high speed that allows us to break the fat in a very, very nice way to sculpt the fat in a superb way and without generating heat that can injure the skin. And that was one of our premises when we started looking for the technology. We do not want to cause any thermal injury, and we found this and we've been getting amazing results. We do not need, I mean, for the level of shrinking of the skin that we're getting, we do not need any other type of power source energy or thermal energy. We can achieve great results with this technology.

Monique Ramsey (22:07):
Now you mentioned the skin tightening and skin retraction, and I know one of the new devices we have at the center is the Renuvion on which used to be called J plasma. Is that something that you're using with this or is there really no need?

Dr. Salazar (22:22):
So I don't feel right off the bat that there is any need for adding Renuvion, j plasma, formerly known as, is a great technology. I think it has its indications. I do use it a lot. We use it, for instance, to tighten the skin of the arms, skin of the back. But in combination with high definition liposuction, I don't see the need. Can we do, so let's say that a patient does not want to do the high depth of the arms. For instance, the patient has a little bit of loose skin in the arms and we're going to do traditional liposuction to the arms. So then adding Renuvion on to those arms and that traditional liposuction, it's fantastic. The same thing for instance, in the midback, in the midback or the braw line, sometimes patients, they have a little bit of extra fat and comes with a little bit of extra skin. Since we're not going to be defining any muscles along the bra line, I think we can combine traditional liposuction with some of the Renuvion technology, get amazing skin tightening for the lower back, for instance, we do not need it at all because we get amazing retraction with high def and we are defining some musculature down there. So I would say that no, no, we don't combine it. We can combine it during the same case, but for different areas.

Monique Ramsey (23:46):
Okay. And how long is the typical case that you're doing?

Dr. Salazar (23:50):
So it ranges on female patients. We're talking about anywhere from three and a half to four hours and male patients that can range from four hours to five and a half hours at the most. I would say in reality, this is something that when the patient is during the consultation, I mean typically when we think about liposuction, we say like, oh, maybe it's an hour or two hours or something. That's a little bit more brief. But what I share with them is I share with them the results. I share with them the philosophy. I show them and I talk to them about the deep fat compartment. I show them the superficial fat compartment at that point in time, they understand that basically it's doing regular liposuction plus. So it's something that

Monique Ramsey (24:38):
Like two procedures, really.

Dr. Salazar (24:39):
It's like two procedures in one, and that's the reason why we need three and a half hours on a female patient or on a male patient about four and a half hours. It's very safe. We stay within skin and muscle. We never reach deeper than that. So this is only a fat procedure. So we limit our time in the operating room. As I like to tell patients, we're not saving your life, we're not doing a heart transplant or a kidney transplant where we need to take six, seven hours of surgery. So in reality, it's a very safe procedure, takes about three and a half, four hours, and the results that we can deliver are superb.

Monique Ramsey (25:21):
They really are. You guys will love these pictures. We'll put some links in the show notes. That'd be good to some of the photos and to some of the social media that we've done where we've followed along and to before and afters.

Dr. Salazar (25:37):
Monique, let me share, I don't know why I was thinking about this. As you were saying, this is a procedure that when patients come back after they have it, they change their lifestyle. I mean, sometimes if you do a little bit of liposuction on the hips, the patient can see the result, but still they don't have the best that they can look right then right there. And with this procedure they do. They look like, I mean, they can see their musculature. They get really, really excited. And in reality, we have had patients coming back saying like, Hey, doc, I was not into salads at all and now that's the only thing I eat. They're like,

Monique Ramsey (26:28):
They really motivated to keep that look, which is fabulous. It's fabulous.

Dr. Salazar (26:32):
Amazing. And this is a life-changing surgery. Yeah.

Monique Ramsey (26:38):
Now, do they have a lot of pain because talking about a lot of quite a few hours in surgery and maybe they're having the front done and they're having the back done, how much pain is expected? I know that varies from person to person A and for how long might they be?

Dr. Salazar (26:58):
So no, this is not a very painful procedure. Patients are, yeah, they can be sore. When you compare the level of pain in high definition liposuction with traditional liposuction, there's no difference. Patients feel, even though it's a longer procedure, but they do not complain particularly of more pain, I like to tell patients that they should just take a full week. So let's say that we do the procedure at the end of the week and then we have that weekend the next week and then the other weekend, and then they're going to feel, feel fine. Probably they're going to feel fine at day three or four. They're still going to be very bruised. They're still going to, I mean, the abdomen is going to look very irregular. We go over pictures. We have the process of how things evolve. And at the beginning, honestly, they look like a cartoon. They look like ninja turtles really. I mean, it's something that's important for them to see the progression of things even before they have the surgery. So now they know what to expect. So during that time, by no means they're ready to go to the beach or show up their bodies or anything. But if their work is a type of job where they are wearing clothing,

Monique Ramsey (28:15):
Well, hopefully. <laugh>

Dr. Salazar (28:17):
They could go.

Monique Ramsey (28:18):
Most career paths include clothing, but not all.

Dr. Salazar (28:23):
They could go back to work after a week of this procedure of being done, they're going to feel fine. They're not going to be taking any narcotic pain controllers.

Monique Ramsey (28:31):
They're not going to be lifting boxes onto pallets or something.

Dr. Salazar (28:37):
Exactly.

Monique Ramsey (28:39):
That's for later.

Dr. Salazar (28:40):
Yeah, that's going to be for later. I mean their activities that are restricted for about two and a half weeks. At about week number three, we orient them and guide them through how they're going to be exercising again. And then about four or five weeks, they're going to be at full power without any restriction. But no, it's not very painful. It's a procedure that patients tolerate very well. I mean, I know that as you were saying, it's patient dependent, but we have patients walking through the office like nothing happened. And it's like, oh my God, maybe I forgot to do the surgery on this patient yesterday. They walk in, they wave at you like, oh my God. I mean, this is perfect. There are other patients that are a little bit more sore, but definitely this is not a tummy tuck. This is not a tummy tuck. This is not for also some of our women patients. This is not a C-section. The level of pain, it's not

Monique Ramsey (29:32):
Right. And let's talk about incisions actually, because with the tummy tuck, the incision's going to be long longer. What do the incisions look like for HD lipo? How big are they?

Dr. Salazar (29:46):
So in terms of the size of the incision, if you look at your small finger and look at the tip of your fingernail right at the very edge, that's going to be pretty much the size of the incisions. And you're talking about that we use five millimeter cannulas and you're talking about, so it's something that's very, very, very tiny.

Monique Ramsey (30:06):
And do those heal pretty well for most people?

Dr. Salazar (30:08):
They tend to heal very, very nicely. And at about a year, sometimes it's even hard to find them. Obviously, we follow the patients closely to, actually, one of the things that we're guarding is that the scarring in those areas, and if we see that there's this beginning of an aggressive scarring process such as like a keloid or a hypertrophic scar, so we can act and jump on time and treat those scars, but normally 95% of patients are going to heal like nothing happened. I mean, we are honest with patients. The incisions are always going to be there, but it's going to be very, very hard to see them. And we're talking about four or five very tiny incisions in the front and two at the most, three incisions in the back. And with those incisions, you're going to be achieving great results, and you do not need, in the cases that I was telling you, like the long abdominoplasty incision, that's sometimes as much needed. There's no way to go around. But if you're in that gray zone area, maybe you want to try having the very, very tiny ones and spare your body from that long scar.

Monique Ramsey (31:15):
Yeah. So we talked about recovery, but there's a garment. You're very specific about your garments after the surgery, and it's very different. Isn't it different than traditional liposuction? Can you talk about that?

Dr. Salazar (31:32):
Yeah, and this is a great chance for me to tell you a phrase that I tell patients about recovery of HD lipo because the classic question is, is it more difficult? Is it more than regular lipo? Is it more what I tell them? It's more involved because it's not very different, but it's more involved. So what I mean by that is with traditional liposuction, we do the liposuction today, you go home, we see you the next day, we change the dressings for you with high definition liposuction. At the end of the case, we want to provide extra compression to certain parts of the body. So what we do is we put a special foam that's going to be extra compressing certain structures that we want to mark more, we want to define more, so we close the compression garment, all those foams are in there, and we don't want those foams to be touched or manipulated for one week.

(32:37):
What that translates into is that patients cannot take the garment off for one week. So for a full week, they'll have the same one. Sometimes that can be intimidating when they see the results, it's easy to take that as a trade off. But yeah, I mean on paper it sounds like, oh, one week and no showers because there's going to be some cowboy showering and sponge baths and lots of cologne or perfume or something because there's not going to be the opportunity to take those dressings down. After a week, patients come in here and then we remove those dressings for the first time. We take off the foam that provided extra compression. We make sure that everything's fine, that there's no problems after surgery. And then what patients do is typically at that point in time, the quality of life goes up because now they finally feel fine.

(33:32):
They go and shower at home, and then we help them coordinate for four lymphatic drain massage therapies, and that is essential for this procedure there. Since we empty so much fat content, what can happen is patients can accumulate some fluid where the fat was. So it's important that with the lymphatic massage drain therapy, that fluid gets drained back into the vessels and then sent back right into the circulation and the heart, and you don't accumulate that fluid in certain areas. So what we do is we include four lymphatic drain massage therapies. And I don't know, Monique, have you ever had a lymphatic drain massage?

Monique Ramsey (34:20):
A long time ago. I mean, this is in the early nineties when I had liposuction. So in the ancient times.

Dr. Salazar (34:29):
Because I was going to say you were six or seven years old back then.

Monique Ramsey (34:33):
I was 12, but I did have one, and I had never experienced one before. But I cannot tell you the difference on how much better I felt. It was absolutely incredible. And then after my facelift, I had another one, and it makes, just in terms of how you feel, it's right then and there. It's worth it.

Dr. Salazar (34:55):
It's totally worth it. And some patients, when we mention the word massage, they open their eyes really wide. They say like, oh my God, you're going to do liposuction and I'm going to get a massage. But it's not as Swedish or nobody's going to be stepping on your abdomen or any

Monique Ramsey (35:10):
No elbows or getting in there.

Dr. Salazar (35:13):
It's no four or five hand massage. This is much more of a very gentle, very superficial massage that gets and mobilizes all that swelling, all that edema fluid away from the certain areas that we don't want it. So our patients, after they completed their four massages sometimes, or I would say most of the time, schedule some extra massages on their own because definitely it's something that it's not only pleasant, it's really beneficial for them. So with regular liposuction, we provide the information of lymphatic massage therapy for our patients, but it's not a must. With HD lipo, it is a must. So we include four massages for patients. We talked about already the one week compression garment 24 7, but then afterwards, patients need to continue wearing their compression garments. And what we do is we do it up to six weeks, and the reason for that is that that's the opportunity that we have to mold our results and we cannot do it later. It's very important that we do it right at the beginning and we continue molding and they continue seeing the difference and improving those results. Another funny fact is sometimes when we're about week number six, when we tell them, all right, so now it's the time to start weaning you off that compression, some of them actually say, do you mind if I continue wearing it? Because they really feel the difference.

Monique Ramsey (36:36):
If it feels better to kind of keep everything together or whatever the feeling is, or to prevent some swelling, because as you move and start walking and doing things that might I, I'm with them. Yeah, whatever feels good. If it feels good and your doctor says it's okay, then I think a couple extra weeks .

Dr. Salazar (36:57):
Yeah, it's not going to cause any harm and they're going to enjoy it. Yeah.

Monique Ramsey (37:01):
Yeah. So a couple last things before we wrap up. What are the patient's responsibilities during recovery? What do you want them to do or not do to have the best result?

Dr. Salazar (37:13):
I think this is key because remember, this is not a basketball game. This is not a tennis match where we have two teams. It's a combined effort. We are one team, and patients realize that when they come and we explain to them what the process is like, then we are all wearing the same jersey. So definitely from our patients, what we want is number one to enjoy, right? That's very important. The more they smile, the better they will heal. So this is a time for them to enjoy. It's all about them. The next thing is we tell them what medications they can take, what medications they should avoid. We educate them in those terms and for them to be compliant with that, for them to follow our instructions around the surgical day after surgery, obviously, as I said, be compliant with wearing their compression garments, have good nutrition, eat lots of greens.

(38:13):
We need a lot of folic acid. We need a lot of protein, good protein for them to have all the blocks that we need for healing. We ask for them, obviously, if they have any other, some sort of a chronic problem or anything to be under control or if they have their own medications to continue taking them. And then after that to be coming as we ask them. And that's basically, intensity is high at the beginning, but then it starts fading. So we see them one week after the procedure. We see them the following week, we see them at week number three. Then after that, most likely if everything's fine, we see them at week number six. Then we go up into three months, six months in a year because we want to be closely looking up for any potential thing that we can improve or that we can catch on time. And pretty much that's it after that. One more thing that I think we've been finding as the more we more we do this procedure is to clarify this for patients.

(39:16):
Do not book a trip. Do not book a trip in which that it will involve you to take off your shirt and go to the beach within the first three months after surgery. And this is important because when patients look at the results that we start showing them, and when they get educated in clinic, they look at the final results of patients at some point. So sometimes they think, oh yeah, the way he looks at a year, I'm going to be looking like that for the summer. So I'm going to go to Hawaii right after surgery. And no, they're not going to be ready for that. They're going to feel fine. They can go to Hawaii, but they shouldn't be bragging about their look. At that point,

Monique Ramsey (40:03):
Things are not quite finished.

Dr. Salazar (40:04):
They're not going to be finished. And it's not that they're purchasing a sweater or it's not that they're purchasing a jacket or a purse or a pair of shoes that they're ready. They're pret a porter, right? They're right there.

Monique Ramsey (40:16):
Ready to wear.

Dr. Salazar (40:17):
But definitely that's not what we're purchasing here. We are performing surgery and living tissue, and the tissue will continue to soften and we'll continue. There's going to be some imperfections at the beginning, but all those are going to soften so much that the result is going to look very, very natural. It's not going to be ready at day number 50 or at day number 35 to be able to go to the beach and look like nothing happened, but the best that you can look. So that's one thing. Do not book an immediate trip after surgery. Yep.

Monique Ramsey (40:52):
That's really good advice. I don't think people necessarily think about that. Now on the website, I noticed that you're one of the few plastic surgeons in the United States who've been trained in this high definition lipo technique. And can you tell us a little bit about that training and what that means?

Dr. Salazar (41:12):
Yeah, so what that is is, and yeah, you're correct. We're one of the few people that do this technique or that started doing this technique with the technology that we mentioned with the micro air power assisted liposuction without the possibility for burning the skin, as I was telling you of thermal injuries to the skin. Because yeah, there's this procedure, as I was telling you, is out there, this procedure, it is a well proven procedure, but the thing is, we started applying the different technology to be able to obtain equal, if not better results. And I think that it's really hard, I would say, to find someone else that does it in, I would say in San Diego or Southern California with the same technology that we do it. So patients can be confident that they're seeing someone who does this several times a week. They're going to be obtaining very, very good results, and that we have plenty of experience with this procedure and this technology.

Monique Ramsey (42:15):
And I think that's really the key is how much you do of this procedure. And I mean, we all know that practice makes perfect, and the more that you're doing it, and it's such a amazing gift that you have that you deliver such beautiful results. Thank you. That Well, it's true. I mean, I've gotten to be in there in the OR and watch you work, and it's a lot of work. It's fascinating. That's my workout. Yeah, exactly. That's your workout. Exactly. But really to see the artistry come through, and as you've perfected your technique, I think that's great for our patients. One of the patients said in one of their reviews is said, Dr. Salazar was very professional, clear and precise in everything that was discussed. He was very thorough. Those words actually appear in a lot of your reviews for any procedure you're doing. Does that surprise you at all, or is that something that you're pretty intentional about?

Dr. Salazar (43:13):
Oh, and thanks so much for giving that feedback. No, I would say it does not surprise me because that confirms that patients are perceiving us the way we are. I think this is not a mean plastic surgery, and modern plastic surgery is not a paternalistic discipline. Nobody should go into an office and then the maestro plastic surgeon will tell them how they're going to look what they need, and when is he going to do it. This is, as I was saying, I think a couple of questions ago. This is a team effort, and we have a great team in La Jolla Cosmetic, starting from the people that answer your phone call, the first contact, our coordinators, our nurses, our medical assistants, myself. We have assembled a great team that the only mission is to listen to the patient's goal, to educate them about their options, for them to fully understand what the surgery is about, to fully understand how the recovery will take place, and most of all, what precise results we can obtain.

(44:15):
And once we have all those things lined up, I mean, there's not going to be any surprise for the patient. We go into the operating room, patients know what they're getting into, why they are in there, and why is this technology used? Why is this deep fat compartment being accessed this way? Why is it so? It's not that I keep a mystery just for me to know the answers. It's the magic. Magic like the magic. We'll do. Yeah, the magic wand, and we'll transform them. No, we're all going in with the same amount of knowledge. Obviously, I know how to do it. <laugh>

Monique Ramsey (44:48):
<laugh> Well, but I think that you're right for the patients. I think I'm one of those people. I'm super curious. So I want to know the how and the why, because then I can rationalize in my head whatever's coming afterwards. And I think a lot of patients are like that. As long as we know what to expect, as long as we understand what's the mission and how we're going to get there, you're able to be more calm as you recover. And I think that's important. Well, thank you so much for your time today. This was so fun, and I learned a lot. And is there anything we missed that you want to add?

Dr. Salazar (45:21):
I think we were very, very thorough. The only thing is I really, really invite all of our patients to visit our social media pages, to contact us, to send us their questions through this podcast, through our Facebook, Instagram pages, through our texting services in reality. Exactly. And Monique, you've seen me in consultations. I really like to interact with our patients. I really like to answer questions. To me, it's a pleasure that they ask five questions, 10 questions instead of just smiling. I mean, it's really, I like to go into details, and I think that way all of our results will truly reflect a teamwork between the patient, our staff, and what we can deliver in the operating room.

Monique Ramsey (46:13):
Yeah, that's wonderful. Well, if you're interested in HD lipo and you want to learn more, we have great news for you. If you're ready to have a consultation, Dr. Salazar is ready to talk to you. So thank you again, Dr. Salazar, and we look forward to seeing you all next time.

Dr. Salazar (46:29):
Perfect. We'll be here. Thanks so much.

Monique Ramsey (46:32):
Thank you.

Announcer (46:32):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment, or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the XiMed Building on the Scripps Memorial Hospital campus. To learn more, go to lj csc.com or follow the team on Instagram at lj csc. The La Jolla Cosmetic Podcast is a production of The Axis, THE AXIS.io.