HD Lipo: The Hi Def Approach to Body Contouring

Speaker 1 (00:06):
Welcome to The La Jolla Cosmetic Podcast, with Monique Ramsey.

Monique Ramsey (00:15):
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 want to know, is that what HD lipo is for, this etching?

Dr. Salazar (00:54):
Thank you so much for having me here. I really enjoy 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 and a much more dramatic body shape, what you can do is you can define certain structures that will give you a much better body image, such as in the abdomen and 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.

Dr. Salazar (01:58):
And what we can do is we can sculpt a little bit of fat that we leave behind to etch those muscles, and to show structures such as like 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 (02:35):
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 whatever you want to be showing and the definition. And 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 define 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 (03:38):
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?

Dr. Salazar (03:52):
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 pull 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.

Dr. Salazar (04:48):
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 of 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. Do you want it? 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 (05:41):
Now, can anybody have HD lipo? Who's the best candidate for this kind of procedure?

Dr. Salazar (05:48):
So I would say that 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 a 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 we can, 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 de-bulking.

Dr. Salazar (06:39):
First, we're going to be eliminating a good amount of fat. Normally, and 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 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, because that's 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. I mean, it's a pleasure for us to talk to patients, and maybe the patient is 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 (07:45):
Yeah, because maybe it includes losing a little weight to get you to the point. Maybe the person's, you know, 10 or 15 pounds over where you would like them to be.

Dr. Salazar (07:55):
Correct.

Monique Ramsey (07:56):
So you can help. And how does that go? Do you have patients who've done that before?

Dr. Salazar (08:01):
Absolutely. I mean, for us, as you know, it's a pleasure talking to patients and listening to their goals, and 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. I wouldn't say that we handle their 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 is going to be, what are the risks, 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 year already having your surgery? You nested already, you have all your life planned, and you're ready to go.

Monique Ramsey (08:57):
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 (09:08):
I would say probably not to exceed BMI of 35, definitely. From 30 to 35, we would consider them on 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 (09:25):
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 (09:35):
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? No, because you're going to develop extra skin.

Dr. Salazar (10:28):
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 abdominoplasty, 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. And I do remember a patient specifically that he, because it 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, we have seen this." We go over pictures. Let's try it. And we've been able to avoid tummy tucks on multiple patients.

Monique Ramsey (11:24):
And why do you think that is?

Dr. Salazar (11:26):
I think 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

Dr. Salazar (12:03):
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 and our website and our social media accounts, that they are dramatic. The results are dramatic. When we go over pictures and patients actually say, "Is that the same person?" And we have to show them a little tattoo that the patient has, or we have to show them-

Monique Ramsey (12:58):
A mole or something.

Dr. Salazar (12:59):
... a mole or a sometimes even for male patients, the hair pattern, because they are so dramatic.

Monique Ramsey (13:04):
That's amazing. Now it sounds like there's a element of artistry with this procedure more than others. Would you agree with that?

Dr. Salazar (13:12):
Yeah. 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.

Dr. Salazar (13:33):
So if you go on Google and you Google for bodybuilders or male models or without a t-shirt, what you're going to find is that there is a lot of asymmetry in a well-exercised human body. The same way that we're lefties or righties, one side is stronger than the other. One's a big side. One's a small side.

Dr. Salazar (13:56):
And when we are marking the patient the day of surgery, we spend a good amount of time, and we're talking about 35 minutes, just looking for those anatomical structures, the anatomical structures of the patient. It's not that I'm creating these muscles or I'm just going to design them the way I want to or according to my taste.

Dr. Salazar (14:21):
Maybe if you want to think about the six pack as like 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 (15:06):
I have actually seen this because I filmed one of your surgeries, 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 the muscles. You're-

Dr. Salazar (15:23):
Palpating those muscles, feeling, yeah.

Monique Ramsey (15:24):
Wrong word.

Dr. Salazar (15:25):
Yeah. No, no, no, no. That might be a little palpitation as well because I'm anxious just to get going. Yeah.

Monique Ramsey (15:32):
So could you describe how, because that's reflecting the patient's anatomy, and so can you, kind of, describe that process?

Dr. Salazar (15:39):
Yeah. 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 is a lot of pushing with my fingers to try to feel where those bony structures are, and we mark all those structures with a specific color. And then after we mark those structures, then we move on to the soft tissue, and we start looking for the muscle, the muscle in its 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.

Dr. Salazar (16:18):
And funny enough, we've had patients that started sweating, and then we joke about "Well, maybe Doctor Salazar, so this is how I get my muscles, right? You get me to exercise here before surgery." And then we've had a patient that's a former bodybuilder actually that late years, he's relaxed a little bit on 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, lifted 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."

Dr. Salazar (17:05):
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 marked the muscle edges, because we define not only the six-pack muscles, but we also define the serratus muscle. We define the external oblique. We define the latissimus dorsi muscle on the back, the paraspinous muscle on the back.

Dr. Salazar (17:29):
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 (17:46):
I was going to ask you. Yeah, that's one of my next questions.

Dr. Salazar (17:50):
So what they ask me is like, "This fat, what happens? Is it still going to be there?" Well, that fat is helping us to give that definition. If, 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 is not going to be any change in the look of the patient after the 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 (18:32):
Interesting. So tell me about the technology that you're using in the operating room for HD lipo.

Dr. Salazar (18:40):
I'm glad that you asked that question because it's something that we wanted to look into because high-definition liposuction, 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.

Dr. Salazar (19:02):
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. Because 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 primum non nocere, at first do no harm, right? So definitely if there is a possibility that the patient has a burn injury, we are very skeptical about it, and we stayed away from that technology.

Dr. Salazar (19:42):
Finally, we came across an alternative way of doing this with power-assisted liposuction. We use the micro air technique for this. 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 the liposuction cannula is reciprocating back and forth, back and forth at such a high speed that allows us to break the fat in a very, very nice way, to sculp the fat in a superb way and without generating heat that can injure the skin.

Dr. Salazar (20:26):
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 (20:53):
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, which used to be called J Plasma. Is that something that you're using with this, or is there really no need?

Dr. Salazar (21:09):
I don't feel right off the bat that there is any need for adding Renuvion. 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.

Dr. Salazar (21:33):
Can we do...So let's say that a patient does not want to do the high-def 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 to those arms and that traditional liposuction, it's fantastic.

Dr. Salazar (21:51):
The same thing, for instance, in the mid-back. In the mid-back or the bra line, sometimes patients, they have a little bit of extra fat, and it comes with a little bit of extra skin. Since we are 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.

Dr. Salazar (22:12):
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 nope, we don't combine it. We can combine it during the same case, but for different areas.

Monique Ramsey (22:29):
Okay. And how long is a typical case that you're doing?

Dr. Salazar (22:33):
So it ranges. Like, on female patients, we're talking about anywhere from three-and-a-half to four hours, and male patients it 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 we typically when we think about liposuction, we say, "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.

Monique Ramsey (23:16):
Like two procedures really.

Dr. Salazar (23:18):
Yeah. 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 in 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 (23:57):
They really are. You guys will love these pictures.

Monique Ramsey (24:03):
We'll put some links in the show notes to some of the photos and to some of the social media that we've done, where we followed along and two before and afters.

Dr. Salazar (24:12):
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 changed their lifestyle. I mean, sometimes if you do a little bit on 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 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.

Monique Ramsey (24:53):
They're like really motivated to keep that look, which is fabulous. It's fabulous.

Dr. Salazar (24:58):
Amazing, and this is a life changing surgery. Yeah.

Monique Ramsey (25:02):
Now, do they have a lot of pain? Because you're talking about a lot of, you know, quite a few hours in surgery, and maybe they're having the front done and they're having the back done.

Dr. Salazar (25:11):
Yep.

Monique Ramsey (25:11):
And how much pain is expected? I know that varies from person to person, A.

Dr. Salazar (25:16):
Right.

Monique Ramsey (25:18):
And for how long might they be ...

Dr. Salazar (25:20):
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 is no difference. The patients, they 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 fine. Probably, they're going to feel fine at day three or four.

Dr. Salazar (25:59):
They're still going to be very bruised. The abdomen is going to look very irregular. We go over pictures because 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 it'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 their bodies or anything. But if their work is a type of job where they are wearing clothing ...

Monique Ramsey (26:37):
Well, hopefully. Most career paths include clothing, but not all.

Dr. Salazar (26:42):
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 (26:51):
But they're not going to be lifting boxes onto pallets or something.

Dr. Salazar (26:57):
Exactly.

Monique Ramsey (26:58):
That's, that's for later.

Dr. Salazar (26:59):
Yeah, that's going to be for later. I mean, their activities are restricted for about two and a half weeks. At about week number three, we orient them and guide them through how they are going to be exercising again. And then about, like, 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 we ... as you were saying, it's patient dependent, but we have patients, like, 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. Also, some of our women patients, this is not a C-section. So the level of pain, it's not [crosstalk 00:27:48] Yeah.

Monique Ramsey (27:48):
Right. And so let's talk about incisions actually, because with the tummy tuck, the incision's going to be longer. What do the incisions look like for HD lipo? How big are they?

Dr. Salazar (27:59):
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 ... that we use five millimeter cannulas. So it's something that's very, very, very tiny.

Monique Ramsey (28:18):
And do those heal pretty well for most people?

Dr. Salazar (28:21):
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. 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 sometimes is much needed. There is 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 (29:26):
So we talked about recovery, 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 (29:39):
Yeah. And it 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. 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 touch or manipulated for one week.

Dr. Salazar (30:38):
What that translates into is that patients can not 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, like, you know, 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.

Dr. Salazar (31:24):
And then what patients do is typically at that point in time, the quality of life goes up because now they finally feel fine. 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. Since we empty so much, the fat content, what can happen is patients can accumulate some fluid where the fat was.

Monique Ramsey (31:54):
Oh.

Dr. Salazar (31:55):
So it's important that with the lymphatic massage drain therapy, that 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 for lymphatic drainage massage therapies. Monique, have you ever had a lymphatic drainage massage?

Monique Ramsey (32:20):
You know, a long time ago. I mean, this is in the early nineties when I had liposuction, so in the ancient times. But I did have one and, you know, I had never experienced one before, but I can not 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 right then and there, it's worth it.

Dr. Salazar (32:46):
It's totally worth it. And some patients, when we mention the word massage, they open their eyes really wide because they say like, oh my God, you're going to do a liposuction and then I'm going to get a massage? But it's not as Swedish or ... Nobody's going to be stepping on your abdomen or anything.

Monique Ramsey (33:01):
No elbows are going to be in there.

Dr. Salazar (33:01):
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've 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 a 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.

Dr. Salazar (33:43):
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 (34:25):
If it feels better, yeah, to keep everything together or whatever the feeling is, or to prevent some swelling, because as you move and start walking and doing things, I'm with them.

Dr. Salazar (34:37):
Yeah, yeah.

Monique Ramsey (34:38):
Whatever feels good. If it feels good and your doctor says it's okay, then I think, you know, a couple extra weeks.

Dr. Salazar (34:44):
Yeah. It's not going to cause any harm, and they're going to enjoy it.

Monique Ramsey (34:46):
Yeah. So a couple of 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 (34:59):
I think this is key because 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. 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 ...

Dr. Salazar (36:03):
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 back, as we ask them, and that's basically... The 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 and a year because we want to be closely looking out for any potential thing that we can improve or that we can catch on time. Then pretty much that's it.

Dr. Salazar (36:43):
After that, one more thing that I think we've been finding the more we do this procedure, is to clarify this for patients. Do not, do not book a trip 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 (37:35):
Things are not quite finished.

Dr. Salazar (37:37):
They are not going to be finished. And it's not that they're purchasing a sweater or it's not that they are purchasing a jacket or a purse or a pair of shoes that they're ready, they're pret-a-porter. They're right there. But definitely, that's not what we're purchasing here. We are performing surgery in living tissue and the tissue will continue to soften, and will continue, like... 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, but it's not going to be ready at day number 50 or a 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 (38:23):
That's really good advice because 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. Can you tell us a little bit about that training and what that means?

Dr. Salazar (38:42):
Yeah. So what that 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, thermal injuries to the skin, because this procedure is out there, this procedure is a well-proven procedure. But the thing is, we started applying a 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, I would say in San Diego or Southern California with the same technology that we do it. So patients can be confident that they are 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 (39:41):
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.

Dr. Salazar (39:56):
Thank you.

Monique Ramsey (39:57):
Well, it's true. I've gotten to be in there in the OR and watch you work. It's a lot of work. It's fascinating.

Dr. Salazar (40:03):
That's my workout.

Monique Ramsey (40:04):
Yeah, exactly. That's your workout. Exactly. But really to see the artistry come through and, you know, as you've perfected your technique, I think that, you know, that's great for our patients. So one of the patients said in one of their reviews, said, "Dr. Salazar was very professional, clear, and precise in everything that was discussed. He was very thorough." So 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 (40:37):
No. And thanks so much for giving me that feedback. I would say it does not surprise me because that confirms that patients are perceiving us the way we, the way we are. Plastic surgery and modern plastic surgery is not a paternalistic discipline. It's not, 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, 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.

Dr. Salazar (41:36):
And, once we have all those things lined up, 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 the... So it's not that I keep a mystery just for me to know the answer.

Monique Ramsey (41:56):
It's the magic.

Dr. Salazar (41:57):
Like the magic... Yeah, the magic wand that will transform them. No, we're all going in with the same amount of knowledge. Obviously, I know how to do it.

Monique Ramsey (42:07):
Well, but I think that you're right. 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 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 (42:39):
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 5 questions, 10 questions, instead of just, like, just smiling. I mean, it's really...I really 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 (43:27):
Yeah. That's wonderful. Well, if you're interested in HD lipo and you want to learn more, we have great news for you. This isn't our first conversation about HD lipo. I alluded to some of the videos that we've done and we'll put those in the show notes. And about a year ago, Dr. Salazar and I did one of our live quarantine sessions on Zoom.

Dr. Salazar (43:46):
That's right.

Monique Ramsey (43:47):
Which has some pictures in there and it's on YouTube. So we'll link that in the show notes for you. We'll put Dr. Salazar's social media, as well as ours for the center in the show notes. So we'll have all kinds of great goodies for everyone to go do some research. And then if you're ready to have a consultation, Dr. Salazar's ready to talk to you. So thank you again, Dr. Salazar, and we look forward to seeing you all next time.

Dr. Salazar (44:13):
Perfect. We'll be here. Thanks so much.

Monique Ramsey (44:15):
Thank you.

Speaker 2 (44:21):
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 I5 San Diego freeway in the XIMED building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram at LJCSC. The La Jolla Cosmetic podcast is a production of the the Axis. T-H-E-A-X-I-S .io.