It’s no secret that our bodies are susceptible to changes. Some can be subtle, while others are obvious. Some respond to diet and exercise, whereas others do not. Skin laxity, skin stretch marks, loosening of the abdominal muscles, and stubborn fat are amongst those body features that rarely respond to diet and/or exercise. These are commonly seen following pregnancy, weight loss, or aging. Patients not seeing results after conservative management are usually candidates for body contouring procedures.
See more LessOftenly stubborn fat is accompanied with some skin laxity. In the past, the only available treatment to address that skin excess was through an excision procedure, which could produce an unwanted scar. Nowadays we can address that skin laxity avoiding those additional scars with the Renuvion J-Plasma® skin tightening technology. Renuvion J-Plasma® is a groundbreaking solution for those seeking a youthful and firmer skin appearance. In this ever-evolving field of cosmetic enhancement, staying abreast of the latest technologies is key to providing our clients with the best possible results. Renuvion J-Plasma® represents the pinnacle of such advancements, offering a unique approach to skin rejuvenation. Sagging skin is a common concern among many individuals, becoming more pronounced with age, sun exposure, or significant changes in weight. This can lead to a decrease in the production of collagen and elastin, the proteins responsible for maintaining skin's firmness and elasticity. The result is often a loss of skin tone and an increase in laxity, leading to a less youthful appearance. At Couto Plastic Surgery, we understand the impact this can have on one's self-esteem and overall quality of life.
The Renuvion J-Plasma® technology is a modern, innovative solution that addresses these concerns head-on. This state-of-the-art procedure combines radiofrequency technology with cold helium gas to create a plasma effect, allowing for the instant correction of sagging skin in various areas of the body. Whether it’s the face, arms, legs, abdomen, or neck, Renuvion J-Plasma® can rejuvenate and tighten the skin, providing a more youthful and natural look. Renuvion J-Plasma® can be an excellent complement to other cosmetic procedures, particularly liposuction/liposcultpure. It can enhance the results of these treatments by tightening the skin in treated areas, thus perfecting the overall aesthetic outcome.
Our commitment at Couto Plastic Surgery is to offer our clients the latest and most effective treatments available. Renuvion J-Plasma® stands out as a prime example of this commitment, delivering exceptional results without the need for invasive surgery. With this advanced technology, we can help you achieve the firm, smooth, and revitalized skin you desire, enhancing your natural beauty and boosting your confidence.
At Couto Plastic Surgery, we believe that the right candidate is key to the success of any cosmetic procedure, including the advanced Renuvion J-Plasma® treatment. This innovative technology is not a one-size-fits-all solution, but rather a targeted approach to skin tightening and rejuvenation, making the selection of appropriate candidates crucial for optimal results.
Renuvion J-Plasma® treatment is most effective for men and women who experience mild to moderate sagging of the skin. This condition often results from natural aging, sun exposure, or significant changes in weight. Our ideal candidates are those who seek a firmer, more youthful skin appearance but may not be ready or willing to undergo more invasive surgical procedures.
Additionally, Renuvion J-Plasma® is an excellent option for individuals who have undergone non-invasive body shaping procedures, but did not achieve their desired results. It serves as a perfect complement to these treatments, enhancing their effectiveness and providing a more refined, smooth, and firm skin texture.
Dr. Couto is a certified plastic surgeon by the American Board of Plastic Surgery. He is a Cleveland Clinic trained plastic surgeon, and may be the only plastic surgeon in the Caribbean to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are top leaders in the field of body contouring.
The consultation is divided into five parts:
I. Health and Medical History Evaluation
A comprehensive evaluation of the patient’s health and medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. Fortunately, most of these can be easily modified with lifestyle changes. Although this procedure is short and relatively low risk, our patient’s health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential.
II. Learning Patient’s Aesthetic Goals
Couto has a deep discussion with the patient to learn what are the areas of concern and asthetic goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet their expectations.
III. Physical Exam
A focused physical exam of the areas of interest is performed. In this part of the consultation, we will evaluate the patient’s skin condition and the degree of skin laxity. This comprehensive evaluation helps us determine if J-Plasma is the right choice for you and ensures that your treatment plan is tailored to meet your unique needs and expectations.
IV. Recommendations & Treatment Plan
Following the physical exam, Dr. Couto develops a personalized treatment plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient if he/she is a candidate for Renuvion J-Plasma skin tightening technology or if other surgical techniques are required. Furthermore, we discuss in detail everything pertaining to each of the procedures and its recovery.
V. Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedure(s) discussed during the consultation and also discuss the steps involved to book the procedure with us. At Couto Plastic Surgery, we are committed to providing high-quality care at a reasonable cost. Our team is here to discuss all financial aspects of the Renuvion J-Plasma procedure and help you find the best option to suit your budget and aesthetic goals. Your journey to enhanced beauty and confidence should be as stress-free and accessible as possible, and we are dedicated to making that a reality.
We believe in transparency and will provide you with a detailed breakdown of costs during your private consultation. This ensures that you have a clear understanding of the investment involved in your J-Plasma treatment. Several factors can influence the final cost of your Renuvion J-Plasma treatment. This includes the number of treatment areas, complexity and degree of the intervention, and facility fees.
Recognizing that financial considerations play a crucial role in the decision-making process, Couto Plastic Surgery offers various financing options to accommodate our patients’ budgets. Our goal is to make Renuvion J-Plasma® treatment accessible and affordable, allowing you to achieve your aesthetic goals without financial strain.
On the day of your procedure, Dr. Couto will draw markings on the patient’s body. These markings are used as a guide to determine the areas to be contoured and tightened. Once in the procedure room, the physician will administer medications to make you comfortable during the procedure. Renuvion J-Plasma® can be performed as a standalone procedure or combined with liposuction/liposculpture. In either case the procedure is performed through small, hidden incisions to ensure minimal scarring. Intra-operatively, local anesthesia with other medications are infiltrated on the targeted areas to reduce bleeding, bruising, and inflammation. Then, the Renuvion J-Plasma® probe is inserted through the incision to apply the energy to the underlying tissue. The plasma energy contracts the skin tissue, effectively reducing sagging and improving skin texture. In the cases, were liposuction or liposculpture is performed concomitantly with the Renuvion J-Plasma®, we first perform the S.A.F.E® Lipo process, which is an advanced liposuction and liposculpture technique that not only focuses on removing the excess fat, but also redistributing the fat to artistically define the natural curves of the body for an attractive silhouette. After completing the liposuction or liposculpture, then we proceed to perform the Renuvion J-Plasma® skin tightening treatment, as described above. After completing the procedure, patients are placed on a compression garment that minimizes swelling and helps further contour the body. The entire procedure takes approximately 45 minutes to complete, following any liposuction if performed.
Immediate and Progressive Results
Patients typically notice a significant change in the tightness and texture of their skin shortly after the procedure. However, it’s important to understand that the full extent of the results will continue to develop over time. The initial improvement is just the beginning of the transformation.
Timeline for Full Results
While the immediate effects of Renuvion J-Plasma® are noticeable, the final results typically take some time to fully manifest. The skin’s natural healing and remodeling processes play a critical role in this. Generally, patients can expect to see the ultimate outcome of their Renuvion J-Plasma® treatment within 6 to 9 months post-procedure. This gradual improvement is due to the ongoing production of new collagen and the continued tightening of the skin tissue.
Longevity of Results
The results from Renuvion J-Plasma® treatment are not only impressive but also long-lasting. With proper care and a healthy lifestyle, including skin protection and maintenance, the effects of the treatment can be prolonged. It’s important to remember, however, that while J-Plasma® can turn back the clock on skin aging, it cannot stop the natural aging process. Over time, aging and environmental factors may gradually diminish the results, but a healthy lifestyle can help extend the benefits.
Realistic Expectations
At Couto Plastic Surgery, we ensure that our patients have realistic expectations about the Tenuvion J-Plasma® procedure. While the treatment offers significant improvements in skin tightness and texture, it is not a substitute for more extensive surgical procedures in cases of severe skin laxity or other complex issues. Our team is committed to providing honest, transparent consultations to help patients understand what Renuvion J-Plasma® can realistically achieve for them.
Days before the procedure, an appointment will be scheduled. During this appointment, we will once again discuss the plan and clarify any questions involving the intervention. Furthermore, we thoroughly review the preoperative/postoperative instructions and the medication regimen with the patient.
We always emphasize to our patients that all vitamins and herbal supplements (eg. Fish oil, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this might increase risk of bleeding. Furthermore, we remind our patients that smoking, vaping or using any nicotine products can increase can affect your recovery. There are numerous scientific studies demonstrating that the use of nicotine (e.g cigarettes, vaping, chewing, etc) affects a person’s capacity for healing, and thus increases risk of complications. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 4 weeks before the operation to reduce the risk of complications. Lastly, nutrition is crucial for an effective healing and recovery. Therefore, we recommend to our patients to optimize their protein intake after any surgical procedure. This could be easily achieved with supplemental protein shakes.
One of the key advantages of the Renuvion J-Plasma® procedure is its minimally invasive nature. The small incisions used in the procedure lead to minimal scarring and a significantly reduced recovery time compared to more invasive surgical options. Our team at Couto Plastic Surgery provides comprehensive aftercare instructions and support to ensure a smooth and speedy recovery.
Following the intervention, the patient will be placed in a specialized compression garment that helps minimize swelling and maintain the body contoured. Swelling and bruising are to be expected and they can be noticeable for a few days or weeks. In order to minimize swelling and inflammation, we have our patients undergo lymphatic drainage massages. It is common to feel soreness and sensitivity around the surgical site; however, this is easily controlled with an individualized after care pain medication protocol provided by Dr. Couto. Recovery from this intervention is usually quick and straightforward, and we normally recommend our patients to take 5-7 days of work (less if working from home). The same day after surgery, Dr. Couto always instructs the patient to have a couple of walking laps around the house or neighborhood. Patients can resume their heavy aerobic exercises (e.g. running, spinning, biking) 2 weeks after surgery and resume full activities 4 weeks after surgery. It may take 3 months for the swelling to completely subside and see the final results.
For long-term care, patients are advised to maintain a healthy lifestyle, including proper skin care, sun protection, and regular exercise. These practices can help prolong the results of the J-Plasma treatment and contribute to overall skin health.
At Couto Plastic Surgery, we are committed to ensuring that each patient’s recovery is as comfortable and efficient as possible. We provide personalized care and support throughout the recovery process, ensuring that you are well-informed and at ease every step of the way. Our goal is to ensure that you not only achieve the desired aesthetic results but also enjoy a smooth and pleasant recovery experience.
The abdomen is an area of the body that is vulnerable to physical changes and disfigurement. Pregnancy and weight changes can result in loose skin, stretch marks, and fat accumulation in the abdomen, suprapubic area, and flanks. In addition, the abdominal muscles tend to stretch and shift laterally, causing bulging of the abdomen and loss of abdominal wall tone and strength. A lipoabdominoplasty or “tummy-tuck” is the ideal procedure to obtain a flat and contoured body.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors, such as Dr. Todd Pollock, creator of the progressive tension suture technique which revolutionized the surgery of abdominoplasty, and Jeffrey M. Kenkel, a top leader in the field of body contouring.
An abdominoplasty or “tummy tuck” is a powerful body contouring procedure that removes saggy skin, stretch marks, c-section scars, and fat from the lower abdomen through a hidden incision placed below the bikini line. Furthermore, during this procedure, the abdominal muscles are tightened and repositioned to their natural state, producing a flat, toned abdomen with an attractive belly button. This procedure is commonly combined with liposuction of the abdomen, flanks, and posterior trunk to further enhance the body’s silhouette.
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of your medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. It is important to tell Dr. Couto if you utilize any nicotine products (e.g cigarettes, nicotine patch, vape, etc), if you have uncontrolled high blood sugar levels (eg diabetes) or if you take any medications, supplements, or other drugs as these can have a big impact on your surgery. An example is aspirin or blood thinners, which can lead to the formation of a hematoma after your procedure. These are common risk factors that can be easily modified with lifestyle changes and can affect your surgical results. Although this procedure is low risk, your health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential to obtain the best possible result.
2) Learning About Patient’s Surgical Goals
Dr. Couto has a deep discussion with the patient to learn what are the areas of concern and surgical goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet their expectations.
3) Physical Exam
A focused physical exam of the areas of interest, usually the anterior and posterior trunk, is performed. In this part of the consultation, we evaluate the distribution of abdominal fat, degree of skin laxity, and the presence of recti diastasis or hernias. These factors determine whether a patient is a candidate for a liposuction only, skin tightening energy based devices (eg JPlasma), lipoabdominoplasty /tummy-tuck, or min tummy-tuck.
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedures discussed during the consultation and also discuss the steps involved to book the procedure with us.
Patients with poor abdominal contour as result from excess skin laxity, stubborn fat, and/or loose abdominal musculature are typically ideal candidates for a lipoabdominoplasty/tummy-tuck. This procedure is not a weight loss method. Therefore, patients should be in a relatively normal body weight, and continue an active and healthy life after the procedure to maintain the improved results. Furthermore, patients considering this procedure can not be actively using nicotine products (eg. cigarettes, vaping, chewing tobacco) and any medical conditions, such as diabetes mellitus, should be under control with glycosylated hemoglobin (HbA1c) of 7 or less.
On the day of the surgery, Dr. Couto will draw markings on the patient’s body. These markings are used as a guide to determine the areas to be contoured and location of the incision. The majority of tummy-tucks are combined with liposuction of the superior abdomen and flanks, as this allows narrowing the waistline and further accentuating the body’s silhouette. Furthermore, we always like to emphasize to our patients that the body should be visualized as a cylinder, a figure that needs to be treated circumferentially. Therefore, we always recommend complementing the tummy-tuck with a 360 liposuction. This way one can achieve an aesthetic transition between the anterior and posterior trunk and enhance the buttock silhouette. The liposuction is performed first, followed by the tummy-tuck.
There are different tummy-tuck techniques, which are characterized by the incision length and degree of intervention. The type technique is dictated by the amount of abdominal skin laxity, and if tightening of the abdominal muscles is required.
There are five different techniques that Dr. Couto uses to perform a tummy tuck:
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan, and clarify any questions involving the surgery. Furthermore, we will thoroughly review with the patient the preoperative/postoperative instructions and medication regimen, and schedule your future post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 2-3 weeks before surgery, as this increases the risk of bleeding. Furthermore, we remind them that using any nicotine products (eg. cigarrettes, vapig, nicotine gum/patches) will affect the results and recovery. There are numerous scientific studies demonstrating that the use of nicotine (eg. cigarettes, vaping, chewing, etc) disturb a person’s capacity for healing, and thus increases risk of complications. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 8 weeks before the operation to reduce the risk of complications. Patients with a history of diabetes mellitus must have a glycosylated hemoglobin (HbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize medication regime or diet and help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with supplements available in our practice.
We provide our patients with a detailed postoperative protocol to ensure that they have a comfortable and quick recovery.
Following surgery, the patient may have drain tubes placed, which helps prevent fluid collection in the abdomen and expedite the recovery. They are typically removed 10 days after surgery. The patient will also be placed in a specialized compression garment that helps minimize swelling and maintain the body contoured.
Swelling and bruising are to be expected, and they can be noticeable for several weeks. In order to minimize the swelling and inflammation, we have our patients undergo lymphatic drainage massages. It is common to feel soreness and sensitivity around the surgical site; however, this is easily controlled with an individualized postoperative pain medication protocol provided by Dr. Couto.
We normally recommend our patients to take 10-14 days off from work (less if working remotely from home). The same day after surgery, Dr. Couto always instructs the patient to have a couple of walking laps around the house. Patients can resume their aerobic exercises (eg. running, spinning, biking) 4 weeks after surgery and strengthening/abdominal exercises 12 weeks after surgery. It may take 3-6 months for the swelling to completely subside and see the final results.
The most common concern of patients regarding a tummy-tuck is the length of the incision and if the scar would be visible. In a tummy-tuck, a scar is unavoidable; the patient is trading a flatter and improved abdominal contour for a scar. However, the scar is placed sufficiently low in the abdomen, so that it cannot be noticeable when wearing a bikini. The length of the scar is determined by the type of tummy-tuck performed, and most importantly, the amount of abdominal loose skin that requires resection.
A panniculectomy is a reconstructive surgery, while an abdominoplasty/tummy-tuck is a cosmetic procedure. A panniculectomy is a surgery that strictly eliminates lower abdominal skin and fat that hangs over the groin and pubic region. It is typically performed on patients in which the overhanging abdominal skin is affecting their functionality or quality of life. Unlike an abdominoplasty/tummy-tuck, the panniculectomy does not address any excess skin/fat above the belly button, does not narrow the waistline, and does not tightens stretched abdominal muscles.
A tummy-tuck will not affect your ability to get pregnant; therefore, it is safe to undergo this procedure prior to having children. However, a woman that has birth after undergoing an tummy-tuk may experience re-stretching of the abdominal skin and muscles. When this occurs, the firmer, flatter contour can be restored by either performing another lipoabdominoplasty or a mini tummy-tuck. We typically recommend patients to finish having children before considering a tummy-tuck. This will maximize the longevity of the results
We published a scientific study, which showed that elderly patients undergoing an abdominoplasty had the same risk of complications as a patient of young age. The conclusion of this study was that chronological age does not matter, what matters is physiological age. In other words, any patient at any age can undergo this procedure as long as their health allows it. We have performed this procedure in patients as old as 70 years old with excellent results and high satisfaction rate.
Surgical drains are usually used for this procedure, since it helps maintain the desired contour by preventing fluid from accumulating in the abdominal region. Surgical drains are commonly removed 10 days after surgery. We also perform drainless tummy tucks; however, these are only indicated in a specific patient population.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HbA1c of 7 or less are candidates for this procedure.
There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery. We recommend patients to stop smoking or use nicotine products at least 8 weeks before surgery.
Similar to the arms, the thighs are structures that are sensitive to aging and weight changes. Some patients experience rashes and discomfort from stubborn fat causing the inner thighs to rub each other when walking. Others are bothered by the saggy appearance on their thighs, which prevents them from wearing swimsuits or certain clothing. Either scenarios can be frustrating for the patient, since this part of the body is usually difficult to address with diet or exercises. If a patient can identify themselves with a scenario close to the one described above, they are probably a great candidate for a thigh rejuvenation.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine. During his training, Dr. Couto had the privilege to have mentors, such as Jeffrey M. Kenkel, a top leader in the field of body contouring, including thigh lift.
The thigh rejuvenation is a spectrum of procedures indicated for patients that are unhappy with the appearance of their inner thighs either by lax skin and/or excess fat in this area. Thigh rejuvenation can consist of elimination of stubborn fat with liposuction or excision and tightening of loose skin either through a thigh lift or the use of skin tightening energy-based devices.
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of the patient’s health and medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. Fortunately, most of these can be easily modified with lifestyle changes. Dr. Couto will emphasize the importance of avoiding nicotine products (e.g cigarette, nicotine patch, vape, etc), having the blood sugar levels well controlled, and the importance of adequate body weight. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential.
2) Learning Patient’s Surgical Goals
Dr. Couto has a deep discussion with the patient to learn what are the areas of concern and goals. Listening to our patient’s interest is crucial, since it’s our priority to determine if we can meet their expectations.
3) Physical Exam
A focused physical exam of the thighs is performed. During this part of the consultation, we evaluate the degree of skin excess and the distribution and amount of fat along the thighs. These factors help determine whether the patient is a candidate for a liposuction and skin tightening with energy based device (eg J Plasma/Renuvion) or if skin excess excision through a thighlift is required.
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedures discussed during the consultation and discuss the steps involved to book the procedure with us.
Patients with saggy and droopy thighs due to the presence of excess skin and fat that does not improve with diet or exercise are candidates for a thigh rejuvenation. This procedure is not a weight loss method. Therefore, patients should be in a relatively normal body weight, and maintain an active and healthy life after the procedure to continue with the improved results.
Thigh rejuvenation can consist of liposuction and energy based skin tightening or a thigh lift. Most commonly, liposuction and thigh lift are performed together, as these two procedures work in a synergistic manner to better contour the thigh. When performed together, the liposuction (hyperlink) is performed first, followed by the thigh lift.
There are different types of thigh lifts, and each of the different techniques are characterized by the incision length. These t are selected by the location and amount of skin excess that requires resection.
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery. Furthermore, we thoroughly review the preoperative/postoperative instructions and the medication regimen with the patient and schedule your follow-up appointments.
We always emphasize to our patients that all vitamins and herbal supplements (eg. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this might increase risk of bleeding. Furthermore, we remind them that smoking, vaping or using any nicotine products can increase can affect their recovery.
There are numerous scientific studies demonstrating that the use of nicotine (eg. cigarettes, vaping, chewing, etc) affects a person’s capacity for healing, and thus increases risk of complications. If the patient is undergoing a thigh lift, Dr. Couto will ask the patient to stop smoking at least 8 weeks before the operation to reduce the risk of complications. Similarly, patients with a history of diabetes mellitus and that are candidates for a thigh lift must have a glycosylated hemoglobin (HgbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize medication regime or diet and help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery. Therefore, we recommend to our patients to optimize their nutrition intake after any surgical procedure. This could be easily achieved with supplements that are offered in our practice.
We will provide a detailed postoperative protocol to ensure that the patient has a comfortable and quick recovery. Surgical drains are only required for patients undergoing an extended necklift, for all other techniques, drains are not necessary. Surgical drains help prevent fluid collection in the neck and expedite the recovery. They are typically removed 5-7 days after surgery. The patient will be placed in a specialized compression garment that helps minimize swelling and maintains the thigh well contoured. Swelling and bruising are to be expected, and they can be noticeable for several weeks. In order to minimize the swelling and inflammation, we may have our patient undergo lymphatic drainage massages. It is common to feel soreness and sensitivity around the surgical site; however, this is easily controlled with an individualized postoperative pain medication protocol provided by Dr. Couto. The patient will be able to fully use their legs and perform their routine daily living activities, except for lifting or pulling objects above 10 pounds. We normally recommend our patients to take 7-10 days of work (less if working from home). The same day after surgery, Dr. Couto always instructs the patient to have a couple of walking laps around the house or neighborhood. Patients can resume their aerobic exercises (e.g. running, spinning, biking) 6-8 weeks after surgery, abdominal exercises 8 weeks after surgery, lower body workout 12 weeks after surgery. It may take 3-6 months for the swelling to completely subside and see your results.
The most common concern of a patient regarding a thigh rejuvenation is the length of the incision and if the scar would be noticeable. The length of the scar and location of the scar is determined by the location and amount of skin and fat excess that needs to be removed. For example, the incisions for a patient requiring only liposuction will be significantly smaller and less obvious that an individual requiring resection of skin excess through a thigh lift. In a formal thigh lift, the scar is unavoidable; the tradeoff of eliminating skin excess and optimizing the contour of the thigh is a scar. That being said, the scars are placed in strategic areas of the thighs to make them less noticeable. The great majority of our patients are not bothered by it, since they feel that the benefit of a nicely shaped thigh is way more than having a scar.
If the patient is having only liposuction of the thighs, you will not have drains placed. However, patients undergoing a thigh lift will most likely have drains postoperatively. Surgical drains help maintain the desired contour by preventing fluid from accumulating in the thighs. Surgical drains are commonly removed 5-7 days.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HbA1c of 7 or less are candidates for this procedure.
Smoking cigarettes or the use of nicotine products (eg. vaping, chewing tobacco, tobacco gum) represents a higher risk of complication for patients undergoing thigh lift than for those having only liposuction of the thighs. Unlike isolated liposuction, a thigh lift consists of a greater degree of intervention and longer incision. Therefore, in a thigh lift the body requires greater healing capacity. This ability of the body to heal can be reduced when smoking cigarettes or using nicotine products.
There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery. We recommend patients to stop smoking or use nicotine products at least 6 -8 weeks before surgery.
Yes! In fact, Dr. Couto always asks the patient to walk around your home the same day of surgery. Walking is a crucial aspect of recovery, since it reduces complications and expedites recuperation.
Oftenly, we are bothered by stubborn fat accumulation in our body that refuses to go away with exercise or diet. Believe me, we get it. It happens to most of us! Luckily, liposuction or liposculpture can be the solution.
Dr. Couto is a certified plastic surgeon by the American Board of Plastic Surgery. He is a Cleveland Clinic trained plastic surgeon, and may be the only plastic surgeon in the Caribbean to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors, such as Jeffrey M. Kenkel, a top leader in the field of liposuction and body contouring, and Dr. Michael Lee, one of the describers of the S.A.F.E® Lipo, a liposuction technique used world-wide by Dr. Couto and top leaders of this field.
Liposuction is a procedure that utilizes suction to remove excess fat in troubled areas of the body and improve its contour. Some patients are interested in treating a specific area, while others prefer a global treatment of the body. The most common treated areas are the abdomen, hips, and thighs. However, liposuction can be helpful in other areas, such as the neck, back, and breasts. Although liposuction can be performed as an isolated technique, it is typically used in conjunction with a skin tightening devices such as J-Plasma/Renuvion or other procedures such as abdominoplasty (“tummy tuck”), breast reduction and/or lift, arm lift, and buttock augmentation with fat transfer or brazilian butt lift (BBL).
Dr. Couto uses the S.A.F.E® Lipo process, which is an advanced liposuction and liposculpture technique that can be used artistically to define the natural curves of the body for an attractive silhouette. Originally, liposuction was based on the idea of only removing excess fat from certain areas, but nowadays we not only remove the fat, but we can also transfer it to other areas of the body where volume is needed (eg. buttock, breasts, face). This ability to remove and redistribute fat from the body makes it easier for us to create an aesthetic figure.
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of the patient’s health and medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. Fortunately, most of these can be easily modified with lifestyle changes. Although this procedure is short and relatively low risk, our patient’s health and safety will always be our main priority. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential.
2) Learning Patient’s Surgical Goals
Dr. Couto has a deep discussion with the patient to learn what are the areas of concern and goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet their expectations.
3) Physical Exam
A focused physical exam of the areas of interest is performed. In this part of the consultation, we evaluate the amount of fat accumulation and degree of skin laxity present, to determine if the patient is a candidate for a isolated liposuction or if additional procedures are required to address excess skin: skin tightening energy treatment (eg. J plasma/Renuvion) or skin removal procedures (eg. abdominoplasty, arm lift, thigh lift, etc).
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedure discussed during the consultation and also discuss the steps involved to book the procedure with us.
People with toned skin and good elasticity usually respond better to this treatment compared to patients with excess skin. In addition to liposuction, patients with excess skin laxity typically would most likely benefit from skin resection procedures (eg abdominoplasty, armlift, thighlift) or skin tightening technology (J Plasma/Renuvion). Liposuction is not a weight loss method. Therefore, patients should be close to their ideal weight, and it is crucial that they maintain an active and healthy life after the procedure to continue with the improved results. Dr. Couto will help you understand what you can realistically expect from liposuction during your consultation and also, if necessary, refer you to a specialist that would provide an effective weight loss plan.
On the day of your surgery, Dr. Couto will draw markings on the patient’s body. These markings are used as a guide to determine the areas to be contoured. Once in the operating room, the anesthesiologist will administer medications to make you comfortable during the procedure. Liposuction is performed through small, hidden incisions. Intra-operatively, local anesthesia with other medications are infiltrated on the targeted areas to reduce bleeding, bruising, and inflammation. Then, a liposuction cannula is inserted through the incisions to suction the excess subcutaneous fat. Dr. Couto uses the S.A.F.E® Lipo process, which is an advanced liposuction and liposculpture technique that not only focuses on removing the excess fat, but also redistributing the fat from your body to artistically define the natural curves of the body for an attractive silhouette.
After completing the liposuction or liposculpture, we commonly tighten the skin using an energy device called JPlasma or Renuvion. Using the same skin incision used for the liposuction, we introduce a cannula that produces skin retraction and tightening through the use of thermal energy. The goal of this procedure is to prevent or minimize skin laxity following liposuction.
it is important to minimize skin laxity we commonly perform combined with energy based skin tightening treatments, such as JPlasma/ Renuvion. This
After completing the procedure, patients are placed on a compression garment that minimizes swelling and helps further contour the body.
Liposuction and liposculpture are commonly
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will once again discuss the surgical plan and clarify any questions involving the surgery. Furthermore, we thoroughly review the preoperative/postoperative instructions and the medication regimen with the patient.
We always emphasize to our patients that all vitamins and herbal supplements (eg. Fish oil, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this might increase risk of bleeding. Furthermore, we remind our patients that smoking, vaping or using any nicotine products can increase can affect your recovery. There are numerous scientific studies demonstrating that the use of nicotine (e.g cigarettes, vaping, chewing, etc) affects a person’s capacity for healing, and thus increases risk of complications. During the initial consultation, Dr. Couto will ask the patient to stop smoking at least 4 weeks before the operation to reduce the risk of complications. Lastly, nutrition is crucial for an effective healing and recovery. Therefore, we recommend to our patients to optimize their protein intake after any surgical procedure. This could be easily achieved with supplemental protein shakes.
We will provide a detailed postoperative protocol to ensure that the patient has a comfortable and quick recovery. Following surgery, the patient will be placed in a specialized compression garment that helps minimize swelling and maintain the body contoured. Swelling and bruising are to be expected and they can be noticeable for several weeks. In order to minimize the swelling and inflammation, we have our patients undergo lymphatic drainage massages.
It is common to feel soreness and sensitivity around the surgical site; however, this is easily controlled with an individualized post-operative pain medication protocol provided by Dr. Couto.
Recovery from liposuction is usually quick and straightforward and we normally recommend our patients to take 7-10 days of work (less if working from home). The same day after surgery, Dr. Couto always instructs the patient to have a couple of walking laps around the house or neighborhood. Patients can resume their aerobic exercises (e.g. running, spinning, biking) 2 weeks after surgery and resume full activities 4 weeks after surgery. It may take 3 months for the swelling to completely subside and see the final results.
The arms are vulnerable to changes that occur with age or weight fluctuation. These changes can cause skin laxity that is typically accompanied by varying degrees of fat accumulation, producing a saggy and floppy appearance of the upper arms. A patient that has gotten less young or has lost weight, and has that extra skin hanging on the arms, and no matter how hard they work out, they just can’t get rid of that floppy skin, then an arm rejuvenation or a brachioplasty may be the right procedure for them.
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine. During his training, Dr. Couto had the privilege to have mentors, such as Jeffrey M. Kenkel, a top leader in the field of body contouring, including arm rejuvenation.
The arm rejuvenation are procedures aimed to optimize the contour and tone of the upper arms. This could simply consist of removal of stubborn fat with liposuction and energy based skin tightening devices (eg. JPlasma) or resection of skin laxity and tightness of the upper arm with an arm lift. Most commonly, liposuction and an arm lift are combined, as it helps create a better definition.
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of the patient’s health and medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. Fortunately, most of these can be easily modified with lifestyle changes. Dr. Couto will emphasize the importance of avoiding nicotine products (e.g. cigarettes, nicotine patch, vape, etc), having the blood sugar levels well controlled, and the importance of adequate body weight. We like to set the patient for success, not for failure; therefore, modifying any potential risks is essential.
2) Learning Patient’s Surgical Goals
Dr. Couto has a deep discussion with the patient to learn what are the areas of concern and goals. Listening to our patient’s interest is crucial, since it is our priority to determine if we can meet their expectations.
3) Physical Exam
A focused physical exam of the upper extremities and trunk are performed. During this part of the consultation, we evaluate the degree of skin excess and the distribution and amount of fat along the arms. These factors help determine whether the patient is a candidate for a liposuction and energy based skin tightening devices (eg. JPlasma) only , short-scar arm lift, traditional arm lift, or extended arm-lift.
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized quote that is tailored to the procedures discussed during the consultation and also discuss the steps involved to book the procedure with us.
Patients with saggy and droopy upper arms due to the presence of excess skin and fat that does not improve with diet or exercise are candidates for arm rejuvenation. This procedure is not a weight loss method. Therefore, patients should be in a relatively normal body weight, and maintain an active and healthy life after the procedure to continue with the improved results.
Arm lifts are typically combined with liposuction. These two procedures work in a synergistic manner to better define the upper extremity. The liposuction (hyperlink) is usually performed first, followed by the arm lift.
Arm rejuvenation is a spectrum of techniques individualized for the needs of each patient. There are different types of arm lifts, and each of the different techniques are characterized by the length of the incision and the location where the scar is hidden. These are selected by the location and amount of skin excess that requires resection.
There are four different techniques that Dr. Couto uses to perform an arm rejuvenation:
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again, and clarify any questions involving the surgery.Furthermore, we thoroughly review the preoperative/postoperative instructions and the medication regimen with the patient.
We always emphasize to our patients that all vitamins and herbal supplements (eg. Fish oil,Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be stopped at least 3 weeks before surgery, as this might increase risk of bleeding. Furthermore, we remind them that using any nicotine products can increase can affect their recovery. There are numerous scientific studies demonstrating that the use of nicotine (eg. cigarettes, vaping, chewing, etc) affects a person’s capacity for healing, and thus increases risk of complications. If the patient is undergoing an arm lift, Dr. Couto will ask the patient to stop smoking at least 8 weeks before the operation to reduce the risk of complications. Similarly, patients with a history of diabetes mellitus and that are candidates for an arm lift must have a glycosylated hemoglobin (HgbA1c) of 7 or less to be able proceed with surgery. If the HbA1c is above this level, Dr. Couto will refer the patient to their primary care physician or endocrinologist to optimize medication regime or diet and help lower the HbA1c levels. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake after any surgical procedure. This could be easily achieved with supplements available in our practice.
We will provide a detailed postoperative protocol to ensure that the patient has a comfortable and quick recovery. Patients undergoing a traditional or extended arm lift will have drain tubes placed. This helps prevent fluid collection in the arms and expedite the recovery. They are typically removed 5-7 days after surgery. The patient will also be placed in a specialized compression garment that helps minimize swelling and maintains the upper arm contoured. Swelling and bruising are to be expected and can be noticeable for several weeks. In order to minimize the swelling and inflammation, we may have our patient undergo lymphatic drainage massages. It is common to feel soreness and sensitivity around the surgical site; however, this is easily controlled with an individualized postoperative pain medication protocol provided by Dr. Couto.
Patients are usually able to fully use their arms and perform their routine daily living activities with the exception of lifting or pulling objects above 10 pounds. We normally recommend our patients to take 7-10 days of work (less if working remotely from home). The same day after surgery, Dr. Couto always instructs the patient to have a couple of walking laps around the house or neighborhood. Patients can resume their aerobic exercises (e.g. running, spinning, biking) 4 weeks after surgery, lower body work out and abdominal exercises 6 weeks after surgery, and upper body workout 8 weeks after surgery. It may take 3 months for the swelling to completely subside and see your results.
The length and location of the scar is determined by the location and amount of skin and/or fat excess that needs to be removed. For example, the incisions for a patient requiring only liposuction will be almost invisible compared to an individual requiring resection of skin excess through an traditional or extedended arm lift. In an arm lift a scar is unavoidable, the patient is trading a scar for a more defined and better contour upper arm. That being said, the scars are placed in strategic areas of the upper arm to make them less noticeable. The great majority of our patients are not bothered by the scar, since they feel that it is not obvious and the benefit of a well contoured arm is greater than having a scar.
If the patient is having only liposuction or mini arm lift, you will not have drains placed. However, patients undergoing a traditional or extended arm lift will have drains postoperatively. Drains help maintain the desired contour by preventing fluid from accumulating in the arms. Surgical drains are commonly removed 5-7 days. Occasionally, Dr. Couto will not use drains on the arms; however, these are only indicated in specific situations.
Uncontrolled diabetes can affect the ability of the body to heal wounds properly. Therefore, it is crucial for diabetic patients to have their blood sugar levels under control for this procedure. Patients with an HbA1c of 7 or less are candidates for this procedure.
Smoking cigarettes or the use of nicotine products (eg. vaping, chewing tobacco, nicotine patch) represents a higher risk of complication for patients undergoing arm lift than for those having only liposuction of the arm. Unlike isolated liposuction, an arm lift consists of a greater degree of intervention and longer incision. Therefore, in an arm lift the body requires greater healing capacity. This ability of the body to heal can be reduced when smoking cigarettes or using nicotine products.
There are numerous scientific studies showing that smoking cigarettes and/or using nicotine products increase your risk of postoperative complications. Nicotine affects the vascularity, and thus prevents the body from healing wounds properly following surgery. We recommend patients to stop smoking or using any nicotine containing products at least 8 weeks before any type of arm lift procedure.
Absolutely! You are free to use your arms at any moment. Dr. Couto will instruct you to avoid lifting or pulling anything heavier than 10 pounds during the first weeks after surgery and to abstain from upper body workout for 2 months.
