Dr. Michael Baumholtz, MD, FACS

Dr. Baumholtz considers the croton phenol peel the gold standard for chemical peels and highly effective for skin rejuvenation in appropriate patients. However, it is the most intense peel, requires cardiac monitoring, and involves substantial downtime, often keeping patients out of the public eye for a long time. It is essentially a significant chemical burn to the face and can cause tremendous damage, especially in darker skin patients in South Texas. He strongly recommends it only be performed by highly skilled medical doctors with years of experience, and does not recommend it for the average person or practitioner.

For patients deemed too skinny for a traditional BBL, options are limited. Dr. Baumholtz advises against gaining weight solely for BBL fat harvesting, as this fat is likely to be lost, diminishing results. He states that a 'skinny BBL' is not a real or viable procedure, and successful BBL candidacy depends on sufficient existing fat. While off-the-shelf injectable products exist for buttock augmentation, he is hesitant about injecting high-volume artificial material. Buttock implants are an option, but are better for projection than overall shape. He also notes that a tummy tuck can help highlight the curve over the hips.

BMI is a crucial factor in patient candidacy and surgical outcomes. Dr. Baumholtz emphasizes that a BMI above 35 is closely associated with complications across the board. For patients concerned about their BMI, the practice offers support for weight loss using medications like Glutide, 2-Zepatide, or oral Zepan.

Dr. Baumholtz advises that if breasts are significantly low, a breast lift should be performed concurrently with breast implants. Failing to do so will result in 'big, saggy boobs,' as an implant alone is typically insufficient to solve the issue, especially for women with significant excess skin and volume repositioning due to weight loss (e.g., from GLP-1 drugs). He notes that if breasts are significantly low, it's likely other body areas may also require lifting.

Dr. Baumholtz defines 'Yoga Boobs' or 'Ballerina Boobs' as using smaller implants to achieve a specific aesthetic, like filling out a sports bra, and notes this concept is entirely about a look. His surgical plan is primarily determined by the patient's anatomy (base diameter/breast width) and their desired projection, not his personal aesthetic preference. The goal is to achieve the patient's desired aesthetic look if it is surgically feasible, creating the most realistic and safest plan possible. For a low projection look, it's a combination of existing breast tissue and the implant. He uses low-profile implants for a low-profile look, and moderate profiles for those with very little natural tissue desiring a specific outcome. Implant height is determined using patient pictures and 3D modeling.

In almost every surgery, patients will experience a period of numbness around the incision, which may extend above and below it. Some of this numbness will be permanent, and the scar itself can remain numb or dull even if surrounding areas regain normal sensation. Sensory nerves may be damaged during surgery, with brachioplasty (arm lift) being a common example where a patch of numbness can occur. In such scenarios, numbness is preferable to constant electrical pain. While numbness generally improves with time, if no improvement is seen, it's usually a fixed defect. The practice rarely performs reconstructive surgery or reroutes nerves solely for sensation.

Dr. Baumholtz approaches buccal fat removal with caution, as it may not be right for everyone. While it can be a straightforward operation with a thorough understanding of anatomy, it involves inherent risks due to encountering major nerves, vessels, and salivary gland tubes in the cheek. A significant long-term complication is the development of hollowing in the cheeks as a person ages, which is very challenging to correct. He notes that with the rise of GLP-1 drugs, many people no longer need this procedure as their faces slim out with weight loss. For patients at an ideal weight who still desire less fullness, he might initially recommend Botox in the masseters for facial slimming, considering buccal fat removal as a later option for facial balancing.

Many previous facial treatments can compromise the results of a future facelift. Dr. Baumholtz explains that procedures like threads and energy devices typically cause significant scarring under the tissues, making repositioning or re-draping during a facelift very challenging. Certain injectable products, such as Kybella for submental fat, also produce scarring that makes the treated area difficult to manipulate. A study showed that permanent fillers can clog microcirculation, leading to serious wounds and vascular issues during facelifts, making healing outcomes unpredictable. He emphasizes the importance of disclosing all previous treatments, as he has encountered unmentioned embedded threads or other substances that complicate operations.

Dr. Baumholtz performs areola reduction using a technique that involves marking the desired smaller areola size, removing the skin between the original and desired areola, and then performing a 'wagon wheel type repair' to evenly pull the circles together. He states it's a very safe operation and can be performed under local anesthesia ('non-medicine'), especially if a submuscular implant is present, due to multiple layers of tissue separating the surgical area from the implant.