Speaker 1: Welcome to the Holistic and Scientific Podcast with board certified plastic surgeon, Dr. Robert Whitfield, Austin's natural choice for plastic surgery and the expert in smart laser and energy treatments. Dr. Rob: So today we're going to talk about Tummy Tuck, Smart Tummy Tuck, and Evolve. So, those are three things that have never been put together probably on a podcast ever in the history of the world. I know this, because I came up with a Smart Tummy Tuck in my office and Evolve is a brand new device produced by InMode. Dr. Rob: Tummy tucks have been around for decades essentially, one of the main things taught to plastic surgeons. So, let's unpack what a 49-year-old woman with a couple kids comes into my office. What can I offer her? What's best for her? What fits her? In this particular instance, this person has had two kids, she's interested in abdominal rejuvenation, specifically with the lower abdomen. She doesn't have much in the way of excess skin and doesn't have really significant stretch marks. She wants to know, based on her friend's referral to her of me, about options available to her. Dr. Rob: So in particular, she makes a very big deal about scarring. She plays tennis all the time here in Austin, doesn't want to have any more visible scarring than absolutely necessary. And so I speak to her about first Evolve. So Evolve's completely non-invasive. You can treat in rows, the upper and lower abdomen with these applicators, trim will reduce fat and cellulite. Dr. Rob: It takes about 15 minutes. You follow that up with a tight applicator and a layer of ultrasound gel, and that will help tighten the skin. That takes about 45 minutes. And then the tone element basically will cause the abdominal muscles to contract. And so think of like doing a crunch, except for it'll be the most intense crunch you could ever do, because the muscle will fully contract when the actual device fires. So, that's a non-invasive way to give abdominal rejuvenation. Dr. Rob: The next way would be to do a Smart Tummy Tuck. And so, a Smart Tummy Tuck is a layered approach. Think about liposuction traditionally done to decrease or debulk an area of stubborn fat. That could be love handle areas, lateral thighs, tummies, but those are the traditional places where we accumulate fat that we don't like and we want to get rid of. Dr. Rob: What makes a good liposuction result versus a bad, and what's a great one? So, basically it's your age, right? So if you're 20 and you have liposuction, your elasticity is high and your collagen level's high and your skin and everything looks great when it's done, provided it's done properly. So always get a credential board certified plastic surgeon, by the way, to do your liposuction. If you want to have the best possible results, you've got to have somebody who knows what they're doing. Dr. Rob: Now as you age, your skin will become more lax, and by the time you're in your 30s and 40s, if you've not had children, that result will start to wax and wane a little bit, it'll loosen up. We see this most frequently in chin's honestly. Chin liposuction done in the 20s and 30s looks a little bit ragged when you get in your fourth and fifth decade of life. Dr. Rob: And so, how does that get us to a Smart Tummy Tuck? If somebody has accumulated fat at the lower abdomen and upper abdomen, you can always debulk that, reduce the fat with liposuction. There's different ways to do liposuction. There's power-assisted, there's ultrasound-assisted, there's laser liposuction. I prefer power-assisted liposuction. I feel like I have a lot of control with it, and that's most important to me. Dr. Rob: So, how do I get a better skin tightening result when we're doing this if in fact they're older? So if you use the equipment to tighten the skin, like BodyTite, like Morpheus8, like Fractora, you can get about 30% more skin tightening. So, BodyTite can be done through small openings inside the inner diameter of the belly button, and you can hide all of this pretty easily. So once you fill the area with fluid before you do liposuction, you can actually do the BodyTite, you just use a layer of ultrasound gel. Dr. Rob: And BodyTite is like a pair of electrified forceps. One limb goes beneath the skin, one's above the skin, and you treat these areas, think of like a pie chart, just do it in quadrants. We use a thermographic camera to evaluate the intensity of the treatment accoupled to the feedback of the machine. And I won't parse it out too much, but after a limited treatment time, you can actually have tightened the skin in real-time. Then you can go and do the liposuction. You can thin this out, you can debulk areas without a great deal of concern for loosening up the skin too much. Dr. Rob: At the very, very end once everything's cleansed and closed, all your incisions are closed and I glue everything shut, so there's really limited chance for any type of bacterial infection, then we'll do microneedling. And first, I'll start with like a Morpheus8 microneedling at different depths. Four millimeters usually, down to three, two. If there's a lot of stretch marks, I like to use the Fractora microneedling device. It's a fixed microneedling device, but it really works on superficial extra issues like stretch marks. And that's really all told, a Smart Tummy Tuck. It takes a couple hours in the office under local. Dr. Rob: Transitioning that to a traditional tummy tuck, when you evaluate patients for tummy tuck, depending on how much waist rejuvenation they need, do they have, for instance, a lot of love handle fat, lower back fat? If the surgeon doesn't evaluate this by just rotating the patient around, you're not going to be able to see what really the end result will be. Because basically a tummy tuck takes the lower abdomen tissue and moves it forward, excises it and tightens it. It also tightens the musculature on the inside. And so, this is usually where the big recovery issues come into play with tummy tuck. Dr. Rob: Whereas Evolve has no recovery, the Smart Tummy Tuck is done under local in the office, you walk in, walk out. And your recovery's basically edema or just swelling after liposuction, because radio frequency skin tightening doesn't give you a need for recovery period. Now a tummy tuck will have a recovery period, because when you realign the rectus abdominis muscles to take care of the diastasis and tighten that, people feel that, it changes their core. And when you engage your core, you'll feel it. Dr. Rob: So basically one way to mitigate this is to use liposomal bupivacaine, which is called EXPAREL, and block all that, in addition to blocking the external oblique. Basically you can get better control of this. But if in fact you haven't done liposuction of the lower back, love handle, flank area, however you want to parse that out, you will masculinize a female waist. Dr. Rob: So, you want to take somebody who's a little pear-shaped and you want to carve out. You want to debulk the area by usually starting them in the prone position and approaching it from the... Just below the sacral area between the butt cheeks really. It'll be hidden by a thong, but you will take that fat out, you'll reduce it, and then when you flip them back over, now when you excise that tissue, remove all the fatty tissue and basically close, you've now sculpted the waist more. Dr. Rob: Now, tummy tucks leave you a relatively lengthy scar from hip bone to hip bone, there's really no way about that. Very few people are candidates for minis, most people need a full tummy tuck. And so the downtime, a couple weeks, six weeks of recovery, walking with a stoop for a while, plus or minus a drain. I don't drain tummy tucks, I do drainless tummy tucks. So there's still a lot to deal with for that client, the effects of general anesthesia. Dr. Rob: And so my 49-year-old, had two kids, plays tennis, she chose a Smart Tummy Tuck. Reason she chose a Smart Tummy Tuck is she was adamant about her result and wanted to return to playing tennis in a couple days. So I don't limit the activity of the patient who has either Evolve or a Smart Tummy Tuck, because it's not necessary. So with a traditional tummy tuck, you have to limit their activity, they can't just go out and do everything. Dr. Rob: So as we unpack, did that do enough for this patient? Well, she lost about two inches off of her waistline. Yes. Her skin's tighter, check. The texture of the skin's better, check. No downtime, no recovery period. So for her, it's great. And that's why her friend referred her to me, because I have more options for non-invasive and minimally invasive approaches, rather than just everybody who shows up gets a tummy tuck. Dr. Rob: To learn more about a Smart Tummy Tuck, please go to our show notes or visit my website at drrobertwhitfield.com. Speaker 1: 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. Speaker 1: Dr. Robert Whitfield is a board certified plastic surgeon located in Austin, Texas near 360 and Walsh Tarlton in Westlake. To learn more, go to drrobertwhitfield.com or follow Dr. Rob on Instagram at Dr. Robert Whitfield. Links to learn more about Dr. Rob's smart procedures and anything else mentioned on today's show are available in the show notes. Speaker 1: The Holistic and Scientific Podcast is a production of The Axis. THEAXIS.IO.