Ep. 02 - Tone Your Abs & Butt With Emsculpt


The Beauty Balance Podcast - Episode 02 Transcript:

“You’re listening to The Beauty Balance podcast hosted by Dr. Usha Rajagopal, a San Francisco board-certified plastic surgeon with over 20 years of experience. We cover a range of highly requested aesthetics and skincare topics, and chat with influential, talented women who truly encompass grace, beauty, and brains –  plus, you get an inside scoop on what it’s really like to be a plastic surgeon.”

What is Emsculpt?

Emsculpt is a way to contour your body and improve muscle definition without surgery. Emsculpt works on the principle of HIFEM (High-Intensity Focused Electromagnetic) technology. It’s the same technology that an MRI machine would work on. Emsculpt has more to do with magnetic energy and not radiation. This energy is focused into FDA-approved targeted areas such as the six pack muscle and the gluteus muscle.

How can Emsculpt help diastasis recti/muscle separation?

The Emsculpt helps with diastasis recti, which is a common occurrence after pregnancy. When the womb stretches and the baby grows, the abdominal muscles want to accommodate the growth of the baby so the six pack muscles separates. When that happens, it’s great for accommodating the baby, but after the baby is born the muscles may not necessarily come back together. A lot of women could have a little pooch which may not be fat at all -- it’s just muscle that’s weak and could not come back together. Muscles need to work symmetrically in concert to be most effective. Some women could have issues with back pain and not enough core strength, and Emsculpt can also help with that.

How does Emsculpt work?

A lot of our patients are young men and women who really want to improve their appearance. They are very athletic, go to the gym, and they want to take it step further and get this sculpted look. Because of this high focused supra maximal contraction of the muscles, the muscle does hypertrophy (thickens) and you also reduce the overlying fat.

It works in two ways: you get less fat sitting above the muscle and the muscle gets bigger and stronger resulting in a more defined core. When you go through the Emsculpt treatments, the contractions are so strong that you start to notice changes in both your six pack forming and your oblique muscles coming inwards. When you look at patients who had the Emsculpt treatment, not only do they have a good six pack, the entire abdominal wall (six pack and obliques) are much tighter and they have a smaller and more defined waist. In the buttock area, we have a lot of patients who want more fullness to the buttock. It will also improve and strengthen the buttock muscle but when we do the buttock treatment, we use a different protocol since we don't want a lot of fat loss because most men and women are looking for more fullness. This is much more than what you can achieve by doing squats at the gym.

How often should patients come in for their treatments?

With Emsculpt, we are treating active tissue in the body (remember our body is alive and dynamic), so like every other muscle in our body it needs constant stimulation. Once the treatments are done we usually recommend 4 treatments approximately once a week for 4 consecutive weeks. They will notice the best improvement in about 6 weeks to 2 months. Once the treatment is done, to maintain their results and defined musculature, we recommend 2-3 times a year.

Does Emsculpt hurt?

It doesn’t hurt but it does feel like a workout. I personally did the Emsculpt treatment up to maximum strength both in the abdominal and buttock area. The contractions are extremely strong and it does take a while for you to get used to the feeling. Our office staff is very friendly and have all gone through these treatments so they will be there encouraging you as your Emsculpt coaches. We want you to have the best results so our team will be there to cheer you on and get you up to 100% so you get the best results with each session.

How does the Emsculpt compare to Coolsculpting?

Coolsculpting is also a non-surgical treatment and primarily for fat reduction. If you have a little bulge that you want to reduce, or can’t get rid of small budges, Coolsculpting works the best for stubborn fat but it doesn’t work on the muscle at all. Whereas Emsculpt works in the muscle primarily and a little in the fat. We offer a dynamic duo where we recommend the Coolsculpting treatment first, then in about 3 months, when the Coolsculpt has reached its final result then we will recommend the Emsculpt. They work hand in hand to give you your best body.

Who are good candidates for the Emsculpt treatment?

The Emsculpt is a great treatment for different kinds of people. Obviously, it’s ideal for a young, athletic person who is interested in gaining muscle definition. Emsculpt is also used to improve function of the body. When someone has diastasis recti it will bring that in together and provide more core strength. I have some patients with chronic back pain who come in for their Emsculpt. These  patients with back issues just want to improve their core strength. When you strengthen your core, your abdominal, rectus, and oblique muscles, you will notice that you have less back pain. Lastly, I have patients who have issues with either their lower back or hip. Strengthening your buttock muscles can help with these issues. We have patients who have very functional issues that have been treated by the Emsculpt. I have a patient who had a hip replacement last year, but felt like she wasn't her optimal self. We ended up doing the Emsculpt treating both on the abdominal and buttocks. I was so surprised at her last visit to the office. She looked like a new person. She appeared to be at least 20 years younger. The first time I saw her she came in hunched back walking with a cane. And now she walks in full of life and energy, plus she’s taking salsa dance classes! It really can change someone’s life especially with these functional issues.

Non-Surgical Body Contouring Treatments

Ep. 01 - Achieving Facial Balancing with Fillers


The Beauty Balance Podcast - Episode 01 Transcript:

You’re listening to The Beauty Balance podcast hosted by Dr. Usha Rajagopal, a San Francisco board-certified plastic surgeon with over 20 years of experience. We cover a range of highly requested aesthetics and skincare topics, and chat with influential, talented women who truly encompass grace, beauty, and brains –  plus, you get an inside scoop on what it’s really like to be a plastic surgeon.

DR: Hello, this is Dr. Usha and today I’ll be going over facial balancing with fillers and my co-host and patient care coordinator, Victoria, will present some of our frequently asked questions regarding these treatments.

First off, what is facial balancing and how do we achieve it?

DR: Facial balancing can really be divided into both a very technical way of facial balancing or creating a more harmonious face. For example, when you look at a face and your first impression when you look at a pretty, beautiful woman or handsome guy is “Wow! They’re so pretty!” -- that’s because the first thing our eyes notice is the triangle between the eyes, nose, and lip (an inverted triangle). The more symmetry someone has the more beautiful they are. Symmetry equates to beauty and our body subconsciously figures that out. This is something that we look at more with a scientific eye. Leonardo da Vinci talked about facial balancing and facial harmony where the face is divided into thirds. You want equal thirds of the face where from the brow to the eyebrow area is considered a third, the second third is between the eyebrow to lower part of the nose, and the lower third is from the lower part of the nose to the chin. You can try that out with your own hands to see if your face is balanced according to Leonardo.

The second part of facial balancing, especially nowadays, is the profile view (side view). A lot of patients look at themselves in profile largely due to the selfie culture. They’re taking side views. They have pictures taken by their friends and they see a side or profile view, and some people are surprised by the way they look because they’re not used to seeing themselves in a profile view. And some people are not very happy with their profile view. Things that would create a better balance or pleasing profile, is when you have balance between the forehead, nose, lips, and chin. That’s where a lot of profile balancing comes especially when someone is unhappy with either the size of their nose or sometimes it could be the unbalance area of the nose and chin. For example, when a patient thinks their nose is too long, I can assess them and let them know that they may need a little more chin projection to balance their nose or a better jawline to balance out the nose. In the end, it has to do with the aesthetics look. Facial balancing makes someone feel prettier and look more rested, and all these treatments for facial balancing is to give a person more confidence.

How do non-surgical nose jobs compare to rhinoplasty? Would this treatments work for all noses (bumps, wide tips, crooked noses, etc)? How long do results last?

DR: The attractiveness of non-surgical rhinoplasty is that it’s a great way to achieve facial balancing. Non-surgical rhinoplasty is a quick lunchtime treatment done in the office and it literally takes 10-15 minutes. There is not much downtime so the patients can go back to their normal activities in 24 hours. With non-surgical rhinoplasty, I am looking to achieve a smoother profile so the most improvement a patient is going to notice is in their profile/side view. The least amount of improvement they’re going to notice is in their front view. When we’re doing a non-surgical rhinoplasty, I am adding filler -- so I’m adding stuff to smooth out the nose, so it creates a bit of an optical illusion. Even though we add filler, it makes the nose appear a little smaller because it could be more symmetric or have a smoother profile. If someone doesn’t like their front view at all and feels that their nose is too wide, big, or nostrils are too flared, unfortunately, that could not be treated with non-surgical rhinoplasty. Non-surgical rhinoplasty is temporary and it could last anywhere from 6-9 months and slowly your body absorbs the hyaluronic acid. What I’m noticing is that I have patients who have come in for several treatments of non-surgical rhinoplasty, and after the 3rd session, the filler tends to become semi-permanent and they won’t need to come back as often for maintenance.

Surgical rhinoplasty does require some downtime and it’s usually done as outpatient surgery, and for most patients I recommend that they take 10 days off and 6 weeks to get back into intense exercise. With the rhinoplasty, you can achieve many different things. You can make then nose smaller, reshape the nose, improve symmetry, and improve breathing issues caused by a deviated septum. Compared to non-surgical rhinoplasty, this procedure has more downtime, a little more cost, but the results are permanent. The best way to determine if you’re a good candidate for surgical or non surgical rhinoplasty is to have a consultation. For patients with busy schedules or from out of town, we recommend that they send in pictures of their nose for assessment and we can do an e-consultation.

Walk us through the non-surgical cheek treatment?

DR: Generally for cheek treatments, my favorite hyaluronic filler is Voluma followed by Sculptra or Radiesse. I also like using Bellafill, which is a long-term filler. Cheek filler is for patients who need a little more lift and structure. The cheek area does drop as we age so when I do cheek fillers, patients come out with lifted cheeks that also appear slimmer but not rounded. I aesthetically don’t like the Housewives of Orange County look where they have fat cheeks with them very prominent in the center and they look like the Joker. That’s not the look I like for myself or my patients who I feel are an extension of my aesthetic goals. My goal is to give them more of a lifted and elongated look.

Who qualifies for these treatments?

DR: For young patients, it could be someone who genetically lacks a nice, high cheekbone look. It could also be someone who is middle age and now showing signs of aging where they may not notice it in their cheeks, but they notice the under eye area looks a little hollow, or their nasolabial folds or smile lines are starting to appear more deep is because the cheek has started to lose volume. When you inject some filler to the cheek area to lift up it can enhance and give you a more rested and beautiful look.

What precautions should patients be aware of?

DR: With any treatment, we are putting needles in your face. The most common side effects of these fillers are bruising and swelling. To reduce both of these, I recommend patients:

  • start planning for this appointment approximately 10 days prior to their appointment date

  • Avoid over the counter blood thinners such as aspirin, ibuprofen, motrin, aleve, supplements such as fish oil and flaxseed oil

  • Eat a lot of pineapple beforehand. The active ingredient in pineapple is called bromelain and that can help with swelling both before and after the procedure

How can chin fillers balance out the profile? How much would a person need?

DR: That is one of the most common areas that would produce the most harmony to the face and make the face appear more pleasing in the profile or side view. When patients are coming in for the first time for a chin filler, I like hyaluronic fillers such as Juvederm Ultra, Juvederm Ultra Plus, Restylane, or Radiesse. Most patients I recommend starting out with just one syringe first even if I think they need more, and the majority of patients will notice a significant improvement with just one syringe.