Korman Plastic Surgery & WunderBar MedSpa: A Plastic Surgeon’s Holistic Approach
A patient recently came to see me complaining of “wiggly arms, and some loose neck skin.” She also wanted to lose 30 lbs and feel better about herself. This post-menopausal woman highlights the challenges that require a holistic approach to care. For example, while it may seem like a no-brainer to suggest losing the weight first, the problem is that 30 lbs less will likely leave the skin of her arms and neck significantly more loose and require extensive surgery. Surgical correction before the weight loss is also not the answer, as excising skin with significant deep fat remaining can put the skin closure under considerable tension, resulting in wide scars that are unlikely to help the patient feel good about herself.
So what should I suggest to this patient? Early in my training I learned that surgical expertise is not just technical skill but also procedure planning. Through my experience with thousands of patients, I appreciate the importance of optimizing their well-being before and after any surgery. With the advent of more advanced diagnostic tests, nonsurgical, and minimally invasive treatments, I can better provide patients with a comprehensive plan and options for holistically positive outcomes. I have found that helping patients prioritize their wishes while providing useful options leads to high patient and physician satisfaction
As we age, testosterone blood levels fall in all humans. So, an important first step is to check appropriate labs, such as vitamin, thyroid, and testosterone levels along with estradiol, and progesterone for women. Menopause in women and its equivalent andropause in men can result in weight gain, libido changes, hair loss, and loss of energy. While testosterone replacement exists in topical gel, pills, and daily injections, I have found in our practice that hormone replacement is most effective in an inserted pellet form (2-3x per year for men, and 4x per year in women). Pellets are tiny time-release dissolvable tablets that are placed under the skin of the buttock area during a quick office visit. Besides the convenience, pellet treatment results in more consistent blood levels, providing efficient drug delivery. The recent FDA removal of the black box warning on testosterone should hopefully allay prospective patients’ concerns regarding testosterone therapy for both men and women.
Weight loss and improved metabolism are reaching new horizons of possibility, with the development of GLP-1s such as Semiglutide and Tirzepatide, as well as the newest (and still investigational) Retatrutide. While these medicines are nothing short of miraculous for many people, exactly where the fat comes off is not up to the individual, and I have seen many patients seeking treatment for “ozempic face” or “ozempic butt.” Fillers and fat transfer are quite popular as a corrective enhancement, as is the relatively new sterilized donor derived adipose tissue (off the shelf fat). As part of their weight loss journey, some patients notice a loss of muscle mass. I’ve found the energy device EmsculptNEO to be an effective way to maintain muscle tone and build core strength, while shedding pounds.
I have long been impressed by the benefits of Hyperbaric Oxygen Therapy (HBOT) for accelerated healing for my plastic surgery patients. So when we recently built our newest Wunderbar location in Los Altos, I insisted on installing a hospital grade FDA cleared HBOT chamber that can genuinely deliver 100% oxygen therapeutic effects. Room air contains only 21% oxygen, and wearing an oxygen mask raises that only to 40-60% percent. HBOT works to deliver 100% oxygen to cells resulting in rapid healing sports injuries, improved cognitive function, and faster surgical recovery. Using a clear chamber, we aim for a comfortable and highly effective result. Some studies suggest HBOT may delay the aging process by lengthening the telomeres of chromosomes that naturally shorten with age. In my own experience, I developed a herniated lumbar disc after 17 hours sitting on an airplane. Neither medications nor an epidural pain shot helped. Wanting to avoid surgery if possible, I tried our HBOT chamber. After 5 sessions, 90% of the pain was gone!
As for my patient with the wiggly arms and loose skin of the neck, I suggested gentle liposuction coupled with Renuvion, a minimally invasive internal radio frequency device, that I have used for several years to tighten skin without the need for surgical excision. In addition, I recommended labwork to evaluate the need for hormone replacement therapy and appropriate recommendations for weight loss.
At Korman Plastic Surgery & Wunderbar Medspa, we blend surgical expertise with a deep commitment to patient well-being. In addition to cosmetic and reconstructive procedures, we have expanded the practice to include holistic health and wellness services designed to optimize mood, energy, and longevity. We take a holistic approach to care, and offer solutions that help patients feel their best-inside and out.
Korman Plastic Surgery & WunderBar MedSpa, with offices in Los Altos, Mountain View, San Jose, and Carmel-By-The-Sea, is the exclusive provider of plastic surgery articles in Atherton Living. Learn more at kormanmd.com.
