Question 1

What is the typical recovery timeline and aftercare process for a Tummy Tuck with Dr. Gould?

Accepted Answer

Dr. Gould emphasizes comprehensive aftercare due to the long internal healing process, which can take almost two years to reach 100%. Patients are seen immediately post-op, the night of surgery, and the morning after. Medications are typically finished around 3-5 days. A 7-day post-op visit addresses emotional well-being, often the lowest point due to withdrawal from narcotics and surgical stress. By two weeks, patients establish a routine with compression and massage. Sensations return around three weeks. At four weeks, incisions are closed and bruising is gone, but swelling persists. Patients are ready for activities like swimming at six weeks, when anti-scarring treatments begin. While external healing is 100% at three months, internal healing is only 50%, reaching 75% at one year. Dr. Gould believes extensive aftercare is crucial, recommending an aftercare facility or a dedicated nurse for the first night to manage pain and administer injectable medications if needed. Patients can typically return to a desk job within a few days for acute recovery.

Question 2

What procedures does Dr. Gould advise patients to avoid in plastic surgery?

Accepted Answer

Dr. Gould strongly advises against several procedures: threads, liquid rhinoplasty, neck liposuction for individuals over 40 with a BMI under 30, injections of permanent fillers (including Sculptra) in the mid, lower, or upper face, and heat-based treatments that do not involve a needle or device inside the body. He also advises against CoolSculpting due to concerns about its application and potential risks.

Question 3

What is Dr. Gould's stance on CoolSculpting, and what are its potential risks?

Accepted Answer

While Dr. Gould acknowledges that CoolSculpting 'actually works' and is backed by groundbreaking science showing cold affects fat cell survival and can improve skin quality, he 'hates' it and does not use it in his practice. His concerns stem from the poor regulation of its marketing and application, noting that anyone can operate the device without necessarily being a doctor or understanding candidate suitability. He believes only 1-5% of people are good candidates. A significant risk is Paradoxical Adipose Hyperplasia (PAH), where fat appears to grow in unwanted areas. Dr. Gould explains PAH is not true fat but fibrotic tissue and lymphatic swelling, potentially due to damage to the lymphatic system leading to lymphedema or chronic fibrosis. Plastic surgeons have observed these 'bad things' that can happen, emphasizing that while it can achieve reasonable results when done very carefully by the right practitioner, this is rarely the case.

Question 4

What is a Weekend Lift, and what are its benefits and recovery?

Accepted Answer

The Weekend Lift is a surgical procedure Dr. Gould would personally choose for himself. It's performed through a small incision in the chin and tiny incisions in front and back of the earlobe, allowing access to the deep neck to address heaviness caused by fat, lateral-pulling muscles, and salivary glands. By going below the muscle and creating new tension along the jawline, it can achieve a 'phenomenal jawline'. A key benefit is its combination with radiofrequency microneedling technology to improve skin quality. When combined with a deep neck lift and RF microneedling, it offers a short recovery.

Question 5

What are Dr. Gould's recommended surgical approaches for jowl correction?

Accepted Answer

Dr. Gould states that facelift surgery is the most effective method for significant jowl correction, especially for 'big, heavy jowls,' by repositioning the cheek and refining the jawline. His preferred approaches include a lower face and neck lift (specifically the deep plane technique), the Weekend Lift (which creates tension along the platysma plane), and an endoscopic approach (a scarless method from above using a camera to fix jowls from the inside). He emphasizes these are the 'tried and true and real ways to fix your jowls'.

Question 6

Are non-surgical treatments effective for jowl correction?

Accepted Answer

Dr. Gould states that non-surgical methods like fillers, threads, and energy-based devices (including Morpheus 8, Softwave, Thermage, and Ultherapy) are NOT effective for jowl correction. While he 'loves' Morpheus 8 and acknowledges these expensive devices can improve skin quality and thickened skin, they will not shrink skin, make it tighter, or get rid of jowls.

Question 7

When should scar gel be used after surgery, and what type does Dr. Gould recommend?

Accepted Answer

Dr. Gould recommends starting anti-scarring medications, injections, and topical treatments around six weeks post-tummy tuck. More broadly, he makes all his patients use HealFast's pure medical grade silicone product before, during, and after surgery for optimal results. He emphasizes that pure medical grade silicone is the best option for scar healing, as it improves hydration and temperature of scars during the healing phase.

Question 8

Why does Dr. Gould consider Motiva implants the best option for breast augmentation?

Accepted Answer

Dr. Gould regards Motiva implants as the 'Lamborghini' of breast implants and the most significant advancement in the last 20 years. He prefers them for their superior quality, including a soft, stretchable internal material that maintains shape, and a six-layer outer shell designed to significantly reduce the risk of capsular contracture (0.43% risk reported outside the U.S. compared to 10-15% for other implants). They are also less prone to leaking and rupture, and the company is a Femtech company focused on women's health, not just implants. These features contribute to softer, more natural, and well-balanced results for patients.

Question 9

Why does Dr. Gould perform filler removal before a deep plane facelift?

Accepted Answer

Dr. Gould performs significant filler removal prior to a deep plane facelift because filler does not always dissolve as commonly perceived and can spread into multiple small pockets. Using ultrasound to identify these areas, he dissolves the existing material to achieve clear visualization of the natural anatomy. This crucial step allows him to restore everything to its natural position during surgery, creating a 'better foundation' for a 'better surgical result'.

Question 10

Can you elaborate on some of the 'things to NEVER do' in plastic surgery? What are the biggest red flags for patients?

Accepted Answer

Dr. Gould strongly advises against several procedures: threads, liquid rhinoplasty, neck liposuction for individuals over 40 with a BMI under 30, injections of permanent fillers (including Sculptra) in the mid, lower, or upper face, and heat-based treatments that do not involve a needle or device inside the body. He also advises against CoolSculpting due to concerns about its application and potential risks.

Question 11

What is the typical recovery time before I can return to a desk job after a tummy tuck?

Accepted Answer

Dr. Gould emphasizes comprehensive aftercare due to the long internal healing process, which can take almost two years to reach 100%. Patients are seen immediately post-op, the night of surgery, and the morning after. Medications are typically finished around 3-5 days. A 7-day post-op visit addresses emotional well-being, often the lowest point due to withdrawal from narcotics and surgical stress. By two weeks, patients establish a routine with compression and massage. Sensations return around three weeks. At four weeks, incisions are closed and bruising is gone, but swelling persists. Patients are ready for activities like swimming at six weeks, when anti-scarring treatments begin. While external healing is 100% at three months, internal healing is only 50%, reaching 75% at one year. Dr. Gould believes extensive aftercare is crucial, recommending an aftercare facility or a dedicated nurse for the first night to manage pain and administer injectable medications if needed. Patients can typically return to a desk job within a few days for acute recovery.

Question 12

How do Motiva implants address concerns like Breast Implant Illness (BII) or capsular contracture?

Accepted Answer

Dr. Gould regards Motiva implants as the 'Lamborghini' of breast implants and the most significant advancement in the last 20 years. He prefers them for their superior quality, including a soft, stretchable internal material that maintains shape, and a six-layer outer shell designed to significantly reduce the risk of capsular contracture (0.43% risk reported outside the U.S. compared to 10-15% for other implants). They are also less prone to leaking and rupture, and the company is a Femtech company focused on women's health, not just implants. These features contribute to softer, more natural, and well-balanced results for patients.

Question 13

What is paradoxical adipose hyperplasia (PAH) and how common is it with CoolSculpting?

Accepted Answer

While Dr. Gould acknowledges that CoolSculpting 'actually works' and is backed by groundbreaking science showing cold affects fat cell survival and can improve skin quality, he 'hates' it and does not use it in his practice. His concerns stem from the poor regulation of its marketing and application, noting that anyone can operate the device without necessarily being a doctor or understanding candidate suitability. He believes only 1-5% of people are good candidates. A significant risk is Paradoxical Adipose Hyperplasia (PAH), where fat appears to grow in unwanted areas. Dr. Gould explains PAH is not true fat but fibrotic tissue and lymphatic swelling, potentially due to damage to the lymphatic system leading to lymphedema or chronic fibrosis. Plastic surgeons have observed these 'bad things' that can happen, emphasizing that while it can achieve reasonable results when done very carefully by the right practitioner, this is rarely the case.

Question 14

Are there any effective non-surgical options for treating jowls, or is a facelift truly the only way to get significant results?

Accepted Answer

Dr. Gould states that non-surgical methods like fillers, threads, and energy-based devices (including Morpheus 8, Softwave, Thermage, and Ultherapy) are NOT effective for jowl correction. While he 'loves' Morpheus 8 and acknowledges these expensive devices can improve skin quality and thickened skin, they will not shrink skin, make it tighter, or get rid of jowls.

Question 15

How long do I need to wear a compression garment after a tummy tuck, and is it uncomfortable?

Accepted Answer

Dr. Gould emphasizes comprehensive aftercare due to the long internal healing process, which can take almost two years to reach 100%. Patients are seen immediately post-op, the night of surgery, and the morning after. Medications are typically finished around 3-5 days. A 7-day post-op visit addresses emotional well-being, often the lowest point due to withdrawal from narcotics and surgical stress. By two weeks, patients establish a routine with compression and massage. Sensations return around three weeks. At four weeks, incisions are closed and bruising is gone, but swelling persists. Patients are ready for activities like swimming at six weeks, when anti-scarring treatments begin. While external healing is 100% at three months, internal healing is only 50%, reaching 75% at one year. Dr. Gould believes extensive aftercare is crucial, recommending an aftercare facility or a dedicated nurse for the first night to manage pain and administer injectable medications if needed. Patients can typically return to a desk job within a few days for acute recovery.

Question 16

When is the best time to start using scar gel after surgery, and does it work on older scars too?

Accepted Answer

Dr. Gould recommends starting anti-scarring medications, injections, and topical treatments around six weeks post-tummy tuck. More broadly, he makes all his patients use HealFast's pure medical grade silicone product before, during, and after surgery for optimal results. He emphasizes that pure medical grade silicone is the best option for scar healing, as it improves hydration and temperature of scars during the healing phase.

Question 17

What does Dr. Gould say about their techniques?

Accepted Answer

From the shell to the material inside, they are the best implant we can use for paitents. Liposuction is an important component of a tummy tuck to achieve a great shape and an hourglass figure. We're not just pulling skin down from above. We need to lift skin up from below and improve the quality of the shape of that area too. Before her deep plane face lift, we first removed a significant amount of filler. Additionally, an Endoscopic approach offers a scarless solution. A phenomenal jawline can be achieved by going below the muscle, removing heavy material, and creating new tension with the muscle along the jawline.

Question 18

What does Dr. Gould say about their approach?

Accepted Answer

The practice closely monitors patients and adjusts treatment pace (e.g., readiness for next steps or slowing down) based on observations.

Question 19

What does Dr. Gould say about recovery?

Accepted Answer

The doctor provides extensive aftercare due to the long internal healing process.

Dr. Daniel J. Gould, MD, PhD

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