Taming Cellulite: plastic surgery and dermatology options with Dr. Payman Danielpour

Trina Renea  0:07  
Hey everyone, welcome to facially conscious. I'm Trina Renee and medically trained master esthetician here in Los Angeles, and I'm sitting with my rockstar co host, Dr. Vickie Rappaport, a board certified dermatologist with practices in Beverly Hills and Culver City, Rebecca gad Berry, our resident skincare scientist and regulatory and marketing expert, and Julie falls our educated consumer who is here to represent you. We are here to help you navigate the sometimes confusing and competitive world of skincare. Our mission is to provide you with insider knowledge on everything from product ingredients to medical procedures, lasers, fillers and ever changing trends. With our expert interviews with chemists, doctors, laser refs and estheticians you'll be equipped to make informative decisions before investing in potentially expensive treatments. It's the wild west out there so let's make it easier for you one episode at a time. Are you ready to discover the latest and greatest skincare secrets? Tune in and let us be your go to girls for all things facially conscious? Let's dive in.

Dr. Vicki Rapaport  1:31  
Good morning everybody and welcome to facially conscious I am board certified dermatologist Vicki Rapoport and here I have Trina licensed esthetician extraordinaire and Rebecca Gadberry chemist and owner of the most fabulous lab in Los Angeles. You are so sweet. I appreciate that. We're not going to say the name of the lab but if you're interested look at my bio and facially conscious.ca Amazing. I will Yes. Today we're going to talk about taming cellulite, plastic surgery and dermatologic options with my favorite plastic surgeon Dr. Payman Danielpour. 

Rebecca Gadberry  2:05  
I just met him and I love him. all ready

Dr Payman Danielpour  2:08  
 well, I'm gonna tell you all about him even though you know he's fabulous. I'm gonna tell you all about him and then everybody's gonna get to meet him. 

Rebecca Gadberry  2:13  
I just like the sparkle in his eyes. Is it his beautiful smile? And he's just a lovely person. I can tell. 

Dr. Vicki Rapaport  2:20  
Well, did you know that he's a board certified plastic surgeon.  and he has been working for 15 years in the Golden Triangle of Beverly Hills underneath my office. 

Trina Renea  2:31  
Well, he was beside your office for a while 

Dr. Vicki Rapaport  2:33  
he was beside my office for a while. He is a distinguished plastic surgeon and a leading figure in the field of aesthetic medicine. He has a passion for enhancing natural beauty and a commitment to patient's well being. He has earned a stellar reputation for his exceptional surgical skills and artistic approach to plastic surgery and I heard he's expecting another baby welcome Dr. Danielpour.

Dr Payman Danielpour  3:00  
Good morning everyone. 

Trina Renea  3:01  
congratulations! 

Dr Payman Danielpour  3:02  
 Thank you very much very excited to be here with my favorite dermatologist  

Dr. Vicki Rapaport  3:06  
how old is baby number one  

Dr Payman Danielpour  3:07  
baby number one turns to in a couple of weeks. We're three days apart, which is amazing. She was born three days before me. Yeah.

Dr. Vicki Rapaport  3:21  
three days and many years before? 

Dr Payman Danielpour  3:23  
Absolutely. 

Okay. 

Trina Renea  3:24  
And this is your first baby in your life?

Dr Payman Danielpour  3:27  
 as far as I know, yes.

Trina Renea  3:28  
 changes your life, doesn't it? 

Dr Payman Danielpour  3:29  
Oh my god the best way? 

Trina Renea  3:31  
Yeah. It just brings you back to Earth, I don't know, it changes the dynamic you have with Earth. I feel like, having a child.

Dr Payman Danielpour  3:40  
I completely agree 

Dr. Vicki Rapaport  3:41  
And babies don't have cellulite. They have lots of Chubs but they don't have cellulite. So, we're going to talk about the bane of our existence as women and sometimes men cellulite. And trying to tame it in the plastic surgeon dermatologic ways. So we're just going to get right into cellulite. 

Rebecca Gadberry  4:00  
I was taught something years ago when we first started working on this in the industry like 40 years ago. I was told it was cell -u- leet not cellul-EYE-te. 

Dr Payman Danielpour  4:10  
Some people call it that. Yes. 

Rebecca Gadberry  4:11  
So which one is it? Is it the American version is cellulite 

Dr Payman Danielpour  4:17  
Yes. Yes. it's very true

Rebecca Gadberry  4:20  
so yeah, okay. it's cellul-EET 

Dr Payman Danielpour  4:23  
it a lot nicer when you say cellul-EET. It's nothing bad.

Dr. Vicki Rapaport  4:29  
I agree with that. Okay, I love that I start calling it cellul-EET. Can you explain to our listeners, what the heck cellulite is.

Dr Payman Danielpour  4:36  
Sure. You know, it's, it's really probably one of the most common problems that we see as plastic surgeons and dermatologists and really one of the hardest things to fight.

The crazy part is if you think about the prevalence of it, and if you look at most studies, they say, over 90% of women post pubertal so old out over the age of eighteen have some kind of cellulite. It's really an incredible number. And there are a bunch of different grading scales which which are just there's no reason to go into it. But they're, cellulites basically, the appearance of cobblestoning or that cottage cheese type of appearance. And normally it's seen in the lateral thighs, and posteriere buttocks, or maybe even the upper hips. And what it is, is really simple way without getting too scientific is the superficial fat layer, there's fibersepte, that are basically their bands that are holding the fat up. And then there's extra fat that's in there. And it looks like there's little hills and valleys. Instead of that smooth, tight skin that you see, like you said, in a baby, or in a bodybuilder or somebody that's a fitness model, it's very smooth, you don't see any of those because their skin is very taut. This is loose skin that has fibrous update, it's actually causing these little dimples. And unfortunately, it is very, very difficult to treat. We're going to talk about the treatment. And we're going to talk about different modalities from very, very non invasive, where you probably know more about most people and how to treat it with creams and lotions and

Rebecca Gadberry  6:14  
We actually have a separate episode on that that'll follow this one. 

Dr Payman Danielpour  6:17  
I love that. And then you can we can talk about lasers and a little bit more minimally invasive, and then get into a little more invasive, where it's surgical, or actually what we do to actually pierce skin to treat cellulite.

Dr. Vicki Rapaport  6:32  
And there are people who are more genetically prone to cellulite than others.

Dr Payman Danielpour  6:36  
Absolutely, there is a big genetic component in this. And it's interesting because for men, if you look at it, the prevalence is less than 5%. Wow. And most of the men that have it have some sort of decrease in androgenic hormones. So estrogen is shown to play a very large part in this. And that's why women have it a lot more. And genetics like you, your mom had it, your grandma had it, the chances of you having a very high degree of it can sometimes be controlled by you, though. And that's, you know, staying in shape. You know, maintaining a good work workout and exercise habits and really trying to maintain your weight. Because people don't realize extra weight really actually makes it worse. 

Rebecca Gadberry  7:26  
Can hormone replacement have an effect on it? Or birth control pills?

Dr Payman Danielpour  7:30  
It's a very good question. I don't know. I don't think most people know. 

Dr. Vicki Rapaport  7:35  
I do not know. But it does make sense so that 9% of women have it 5% of men have it. So it's estrogen sort of influenced problem. But that's a really it is an excellent question. I don't know if women who go on hormone replacement after menopause get more cellulite or not. We should ask, I'm gonna ask my OBGYN friends. And I'm gonna get back to you. It

Dr Payman Danielpour  7:56  
really is. It's a great question. And when you read some of these meta analysis that goes over all the different treatments, no one really talks about that. And most people say that, when did you first notice your cellulite and people will literally tell you at 18 at 20 it's always at a very young age. 

Rebecca Gadberry  8:13  
Oh, I woke up with it on my 30th birthday. I didn't have it when I was 21.

Dr Payman Danielpour  8:21  
Then all of a sudden they're like, Why did I get cellulite? and they'll see it even more in pregnancy. Pregnancy will do it, weight gain will do it. 

Trina Renea  8:29  
estrogen dominate

which is when estrogen goes higher when you're having a baby.

Dr Payman Danielpour  8:35  
 So estrogen weight gain, all of it comes down. 

Trina Renea  8:37  
If it goes if after the baby can sometimes go down and go away.

Dr Payman Danielpour  8:41  
It can sometimes improve a little bit after the baby's born? Yes,

Rebecca Gadberry  8:44  
I need to write a grant proposal on this and do some research. And the reason I asked you is I've never read anything on it. So I thought maybe the doctors would know

Dr Payman Danielpour  8:53  
it's an it's interesting, it's in none of the studies talking about, you know, hormone replacement therapy. Hmm.

Trina Renea  9:00  
But you notice it in, in mostly women,

Dr Payman Danielpour  9:04  
always. It's just in women. I've never in my practice, and I've treated a lot of people with cellulite, never treated a mans cellulite, ever. Wow. Interesting. Maybe they are not as self conscious about it. Because again, a man can wear a bathing suit that's lower because most people will complain about cellulite mostly in a bathing suit. Right? They don't feel comfortable wearing a bathing suit. Whether it's a one piece or two piece you can't cover up your lateral thighs

Trina Renea  9:29  
why does it only go there? like in that area? 

Dr Payman Danielpour  9:31  
because the fat there is a little bit different and that's why. you know, it's interesting because as a surgeon you always think about how can you treat things. It makes it so difficult to treat because I can't cut it out. You know, because what?  I'm putting a huge scar in your lateral thigh. Normally when we cut things out as plastic surgeons, you want to hide the scar. So tummy tucks are great, right because you put the scar under the bathing suit and you make a beautiful contour, or even arm lifts or thigh lifts, you can really kind of hide them. But this is like right in the middle. It'll be in the in the gluteal crease, and, and it's still very hard to eliminate because sometimes you see the buttock dimpling right in the middle of the buttocks. So how do you cut that up? so we have to find ways to treat the underlying cause, which is skin laxity, fibersepte, and really a deposition of fat in the more superficial layer that is not uniform. So we have to see how we can treat that. And it's going to be some sort of skin tightening, somehow breaking up the septe. And then the most important thing is putting something in there as a spacer. So the septe don't form again, that's like the three real ways to treat it.

Dr. Vicki Rapaport  10:50  
I'm thinking about now my, my most my smartest OBGYN friend told me she had a problem with cellulite years ago, and her doctor told her to run really fast on a treadmill to try and get rid of it. 

Dr Payman Danielpour  11:02  
And some people and some studies will tell you that exercise really helps because if you build muscle, then it can actually fill the area. And again, all we're trying to do when we treat Cellulite is decrease the appearance of it. So when a light hits it in a certain angle, and that's all we do really, we're just magicians with light,  is to make the appearance of cellulite better. It's almost impossible to completely eliminate

Trina Renea  11:30  
and lipo and lasers melting it or doing things like that.

Dr Payman Danielpour  11:36  
great question

Dr. Vicki Rapaport  11:37  
Yeah, least invasive to most invasive. So can you give us options?

Dr Payman Danielpour  11:40  
Let's start with least invasive. And really, this has been around since the 1920s in France, and you would probably know more about most of the minimally or topical creams, dry brushing. So dry brushing is is something very, very has been around for a long time. Is it effective? Yes, but very short term. If you want to make your cellulite look better for an event or you're going to the beach that day? Yes, it can help. And a lot of these topical solutions are the same type of cure in the sense that they'll help for short time. So what did we use? caffeine and theophylline. Both of those, which theophylline's just tea. Both of those really help with increasing blood flow to the area. And also with caffeine. It's a phosphodiesterase inhibitor. And what that does is it actually breaks up fat.

Trina Renea  12:37  
you're not talking about drinking caffeine, you're talking about on the area? .

Dr Payman Danielpour  12:41  
Yes. And the other thing is, is it actually by vaso dilating or increasing the blood flow to the area, what you do is you increase hydration. So very important things you want to do with topical creams is hydrate. Very important. See if there's something you can do to bring in more volume of blood flow. And if possible, break up some of that fat. Now, that's one type of topical creams. The other is retinols or retinoids, which really do help now, as a dermatologist, what is the maximum amount of time you want someone to apply a retinol to their body or to their face?

Dr. Vicki Rapaport  13:21  
before they see results? or you're saying in their lifetime

Dr Payman Danielpour  13:23  
in their life like for a continued amount of time? 

Dr. Vicki Rapaport  13:27  
I mean, I tell people, they can use retin-a for the rest of their lives. 

Dr Payman Danielpour  13:30  
I love you. 

Trina Renea  13:30  
Well, it also depends on the percentages, right?

Dr. Vicki Rapaport  13:34  
I mean, if they are using it for 20 years, they can be on the highest dose, I think

Dr Payman Danielpour  13:38  
yeah its interesting, because some people will, will be very scared to let them use it on their face or under their eyes or things like that for a prolonged amount of time. Now, Retinoids work really, really well for cellulite, but it has to be used very long term. I mean, when I say long term six months to a year to start seeing the results. And all it really does the mechanism behind using retinal for cellulite is dermal thickening, getting that dermal layer to get thicker because if it gets thicker than the illusion of the dimples gets better now tread with caution, all local products creams and lotions and they work but it's very short term. So then we go up to the next level.

Trina Renea  14:21  
Can I say one thing about that. So using, I'm just imagining, using a retinol cream on your behind and the back of your legs, is so that you can get into a bathing suit and bathing suits and retinol don't go together. Because you don't want to be in sun when you're using retinol creams. Right?

Dr. Vicki Rapaport  14:40  
Well, that's a loaded question, yah just wear sunscreen. it activates retin-a not because the sun will cause you to have like a crazy rash 

Trina Renea  14:48  
No, but it just makes it more sensitive.

Dr Payman Danielpour  14:51  
You're more sensitive. Very true. But that's why we love sunscreen. Because here's the thing you can't live without using something that cause of cellular turnover. Yeah, that's how you keep your skin looking taut look, yeah, good looking newer, refreshed, but at the same time, you're going to be vulnerable to sun damage. So that's, you know, just just follow up with sunscreen. I think thats the best way

Rebecca Gadberry  15:14  
sunscreen, SPF 30 or higher 

Dr Payman Danielpour  15:16  
SPF 30 or higher. I prefer mineral. 

Rebecca Gadberry  15:19  
We all do

Dr Payman Danielpour  15:20  
some people will talk chemical, but I'm a big fan of mineral,

Rebecca Gadberry  15:23  
we're a mineral fan club here

Dr Payman Danielpour  15:26  
I love it, and then follow it up with things like massage therapy. Okay, so whether you're using a skin brush, whether you're using a roller, Endermologie is, you know, does it work, you know, maybe short term for about a minute or two. 

if you have really bad cellulite this stuff doesn't work. But if it's mild, or even slightly moderate, then it's okay. When you get to severe cellulite. There's, you know, this stuff that we're talking about really doesn't do much. But lymphatic drainage, just even manual lymphatic drainage really does help. Because what are you doing, you're really just kind of smoothing out the skin, it'll look good right away. And then who knows, maybe a week later, it may go back. And that's why people get lymphatic massages on a weekly basis that have a lot of cellulite or feel like they have a lot of swelling in certain areas, and doesn't work? Sure, and Endermologie works as well. It's just very short term, short

Rebecca Gadberry  16:28  
And if you are poured into a tight dress and going to an event and you have a couple of drinks, you're gonna burst some seams, which is part of the problem that I'm gonna talk about the episode where we just talk about products and ingredients. 

Dr Payman Danielpour  16:40  
Yes, very true. And then once you go from those two really minimally invasive, you go to a little bit more using technology now technology is really helpful. Still hasn't cracked the barrier, it still hasn't given us long term results, but radiofrequency or acoustic shock therapy now. Basically, acoustic wave therapy is same thing as breaking up kidney stones. It's the exact same technology, but we use it to break up the fiber scepte Okay,

Rebecca Gadberry  16:42  
when you say fibersepte You mentioned it earlier, but I think the definition of it may have slipped by so could you go into how those fibers are different than other fibers that might be like the collagen that we think of is in the dermis.

Dr Payman Danielpour  17:28  
So this is the difference between this is in your superficial fat layer. So there's deep and superficial fat right below the dermis. Most people don't have these fibersepte that are holding on and then and then little holes in between. Okay, what happens is people that are prone to study like genetically or not have these, these very tight bands that are holding almost like a cord kind of like a kind of like if you think about like an accordion exactly like like cords that are holding. And these cords are, are lacking bits of fat in between. So instead of it looking really smooth like it would for, you know, me or you for others, it has this dimpling underneath the fat is normal. It's just the fat on top right? What causes it again, nobody really really knows the true cause behind it. It's not there

Trina Renea  18:24  
there a new treatment. Thats an electro, What do you call it? 

Dr Payman Danielpour  18:28  
So acoustic wave therapy and radiofrequency both very similar. They use acoustic wave uses shock. radiofrequency uses heat, it's used externally on the outside of the skin, like a thermage, Exactly. To break up the septe. Problem is....

Rebecca Gadberry  18:51  
Does it cut the cords? Basically

Dr Payman Danielpour  18:52  
no, it melts them from the outside. So it does two things. The radiofrequency actually does two things radio frequency breaks up the septe, but it also stimulates collagen production, which is amazing, because then you not only are you breaking everything up, but you're healing from below, getting more collagen production.  

Trina Renea  19:10  
Like a Morpheus? you could use something like a Morpheus, on that area?

Dr Payman Danielpour  19:14  
absolutely you can. How effective it's going to be again, I don't know. It's kind of like the radio, most people will tell you, you do radio frequency treatments, you're going to need six to eight treatments, anywhere between one to four weeks apart, and your results may last for six months. So people aren't very sold. Now. I've done these for patients. And they and the funny part is most patients are incredibly satisfied. And with what we do for living in the aesthetic world, we're not treating ourselves. That's the one thing you got to take a step back and and say you are treating the patient. If the patient is satisfied with her or his or her results. That's all that matters. Because I may think it still doesn't look good. But if they come back and say you are a magician, thank you. I did my job. Most of the time, when I see people that I treat with radiofrequency, we use something called body effects by inmode. But there's a billion different radiofrequency modalities. I don't think they're that great. If I take a before and after, and I show it to you, and I'm trying to tell you to do the procedure, you're gonna look at me and be like, I don't know if I want to do that. But it's one of the modalities. It's very easy. It's relatively painless. You come in, it's a half hour treatment and you leave. So for a lot of people that look at it as okay, it's not surgery, it can improve it, and I do it once a year. So Fine. 

Rebecca Gadberry  19:15  
How much does it cost? 

Dr Payman Danielpour  19:39  
Depends.  In Beverly Hills? or not.

Beverly Hills and Alabama,

you know, normally the treatments are going to be anywhere from a couple $100 a session to like $5-$600  session, external radio frequency should never be very expensive. Because again, you're not piercing the skin. It's not even a Morpheus. It's just a wand that goes back and forth. 

Trina Renea  20:57  
Oh, I have a really interesting question. kind of weird, but it's interesting. You know how people are filling their their butts with filler. Will that hide cellulite? 

Dr Payman Danielpour  21:10  
Excellent. Yes, this is probably the best question and the best treatment, and I'm gonna get there in about a second. Okay, so from there, those treatments you have, then you go to a little bit more invasive. And now we're talking about actually making tiny incisions like needle type incisions. And there are different treatments like cellfina and Cellulaze. Both technically do the same thing. But cellfina is very simple. It is imagine a pickle fork or imagine just the the needle, a long needle that you put through and you circle the area that you see that you have really bad cellulite. And you see the fibrous bands because you really do you see dimpling and then not, and then dimpling then not. And you go in with this, and you just break up these bands. That's all you do. And it's interesting, it's like, it's like a little machine that goes back and forth like this, it just breaks them up. And that's the whole treatment. Cellulaze is a little different because it uses a laser in conjunction. and its like a side type of laser. Dermatologists love because its really like an adjunct to what they already have. I think that treatment works better because you're using a laser to cut the bands so they think the chances of them growing back are less. But with both of these treatmentys theres nothing put there. And as plastic surgeons the one thing we always say is "if you remove something, your body is going to immediately grow it back." So you have to trick your body by putting something there as a spacer. In training what we used to do is go in with a pickle fork, make a tiny little insision, break up the septe, then harvest some fat from somewhere, take that fat, purify it, and put fat in that area. Very similar to when we do brazilian butt lift, or fat transfer to the buttocks, or fat transfer to the breast, or any of these places, we are just volumizing. if I break this up there are chances of a divet. But if i fill it with some fat the chance of it being really smooth and lasting are much better. We used to do the poor mans method which was use just the pickle fork, go do it. Now there are companies that make things that are very specific to cellulite like Cellfina. Moving along, the newest technology thats come out is something called Avali. This is very similar to Cellfina but its got a little light at the end of it.  So you see exactly what you are cutting. so you go in with a little needle, you see it, and you literly visualize the septe, you cut it and you pull it out. The problem with these treatments that are under the skin is you have a high rate of bruising and it lasts for 2-3 weeks. Some people don't like it

Rebecca Gadberry  23:58  
what about blood clots? 

Dr Payman Danielpour  24:01  
No, not at all, again this is all very superficial. 

Trina Renea  24:24  
what about purple bruising, dark, dark bruising, 

Dr Payman Danielpour  24:27  
bad bruising , really bad bruising. , 

Trina Renea  24:28  
but I mean, if theres a good result Yeah, it gets better. I mean, 

Dr. Vicki Rapaport  24:33  
people are very demanding. So a bruise scares them. Oh, it's gonna be a poor result. No, I mean, again, kind of goes back to the consultation as long as you let them know there's gonna be bruising. And so I'm showing them like what to expect one day, one day, two week, one week after three weeks after, 

Dr Payman Danielpour  24:50  
and again, that's it's very important. You got to set them up for proper expectations. You're not going to be in a bathing suit for a month. Like

Rebecca Gadberry  24:58  
and your husband better love you a lot

Dr Payman Danielpour  25:02  
But if I'm doing this all tell them six weeks of no lifting, no exercise, no bathing suit, no sitting in a in a pool, you really, in a sense kind of want to scare them to they don't do anything so you can get the best results possible. Yeah, especially if you're putting some fat in there you want that fat to take. The one thing I left out there is a another treatment called QWO. And this is actually, conceptually is a phenomenal idea. It really, really really is. So it's it's an injectable called collagenases. And as plastic surgeons, we do a lot of hand I did used to do a lot of hand surgery. And there's a condition of the hand called Dupuytrens. Dupuytren contracture is basically when you get similar types of fibrous bands that form in due to collagen deposition. And people's fingers literally get stuck. treatment was going in and cutting them and opening up the hand, the second you did that, it reformed. So they came out with this medication called collagenases but it was taken off of Clostridium, one of the Clostridium bugs. And they noticed that if you take the collagenases, you inject it into the areas of cellulite, it breaks up those bands. And it was

Trina Renea  26:24  
like dissolves them? 

Dr Payman Danielpour  26:25  
it dissolves them. It just eats them up. So 

Trina Renea  26:27  
and they don't go back. 

Dr Payman Danielpour  26:29  
they don't The interesting part is but the bruising was so bad. That to the point where nobody's using it anymore. Yeah. Oh, really. That's the crazy part because it worked. But the bruising was severe. We're talking about months of bruising. And I don't know if it's even being sold anymore.

Dr. Vicki Rapaport  26:46  
They're definitely not marketing it.

Dr Payman Danielpour  26:47  
I think it might have been taken off the market.

Dr. Vicki Rapaport  26:49  
 oh i think you might be right. 

Dr Payman Danielpour  26:50  
And it worked really well. But the bruising was insanity. 

Trina Renea  26:54  
like it just stayed black very long, very long time.

Dr Payman Danielpour  26:57  
you know, again, with when you're treating somebody for an aesthetic problem, right? There's only a certain amount of downtime people will actually tolerate. And that's just the truth. You know, it's it's if you injected somebody's lips, for example, or cheeks, and they stayed swollen and bruised for more than three to five days a week at best. They'd be like, I'm never going to do this again. Because again, people's expectations are like, this is drive thru McDonald's. I want to look good right away. 

Trina Renea  27:26  
It's really different. I know that today this day and age that's

Rebecca Gadberry  27:31  
I have a couple of questions. One, I haven't heard you talk about liposuction, so I don't know. Okay. And secondly, what about sagging? When you cut the cords? If you don't replace them? Do you get sagging in the area? 

Dr Payman Danielpour  27:45  
No not really. Because it's not that these cords aren't holding anything up other than the dermis down to the subcutaneous fat so that no. Liposuction, great, great question. And you asked this too. This is this is actually for the listeners. Probably the most important takeaway. Liposuction will make cellulite worse, you do not get liposuction in areas of cellulite ever. Okay, because of a few reasons. And then we'll talk about laser assisted liposuction because that's a little different. If you just use regular liposuction, number one, you really don't want to go into the superficial fat too often, unless you're really doing some sort of high definition contouring and you're trying to like sculpt out abs, which I'm very against. You want to get into the deep fat because that's when liposuction looks really good. That's when liposuction looks very natural doesn't look like you've had anything done you don't see contour regularities if you go in and do liposuction, of areas of cellulite, it just accentuates it. It makes it worse

Rebecca Gadberry  28:48  
because you're taking out the deep fat, so then it's going to excel okay got it?

Dr Payman Danielpour  28:53  
the superficial fat.

Trina Renea  28:53  
You can't take out the cellulites 

Rebecca Gadberry  28:55  
Cause the cellulite is in the superficial fat.The liposuction works on the underneath fat, so you're going to exaberate it. 

Dr Payman Danielpour  29:02  
however, there was a study that's been done recently, that if you use laser assisted liposuction, things like Vaser or radiofrequency assisted liposuction, there may be a role in that because you'll go into the superficial layer to try it. And the reason for it is you break up the septe and then you cause by using heat or laser, try to cause some sort of dermal thickening or even collagen production from below. 

Trina Renea  29:30  
So it's like multi treatments or multi things that you do. Do you do like a number of them? or do you kind of choose a route 

Dr Payman Danielpour  29:39  
so if it's up to me, and somebody wants to treat their cellulite, I think the best way to do it a subdivision and fat grafting. Now whether or not you want to use these fancy machines like Aveli  or or Cellfina to do the Subcision, fine. 

Trina Renea  29:54  
Subcision you're talking about breaking the cord? 

Dr Payman Danielpour  29:56  
Absolutely.  Subcision is a fancy word to just breaking up scar tissue in a sense. Sometimes people have scar tissue in their face and you do the same, you'll break it up and put fat in there. But really, I think that's the best way to truly get like 70% improvement, to 80% improvement, all the other treatments and that last at least two years, that's that's kind of the way we look at that. The other treatments are multiple treatments, at least six times. And your results may be about six months. 

Trina Renea  30:29  
So if you cut the bands, and then you put fat in there, did you say it's lasts for two years, or that's more permanent. 

Dr Payman Danielpour  30:38  
So, we we say it lasts for two years, hopefully permanent forever. But again, fat can be very, you know, kind of very finicky as well. Fat transfer, which we're going to talk about, in

Trina Renea  30:51  
another episode, another episode coming up next can 

Dr Payman Danielpour  30:55  
can do some really just wonderful things because of the amount of stem cells it has in it as well. So if you're healthy, you maintain your weight, you don't lose weight, the key is you cannot lose a ton of weight. When I when I inject fat, it's just like the other fat in your body. Once it takes if you lose fat, they can go and you don't smoke because the smokes The one thing is a complete contraindication for doing fat transfers smoking, then the chances of that fat lasting for 10 plus years is very good.

Trina Renea  31:23  
Can you tell our audience why not smoking has anything to do with it?

Dr Payman Danielpour  31:28  
Yeah, of course. You know, nicotine in general, is a plastic surgeons nightmare. And most reputable board certified plastic surgeons absolutely will refuse to do surgery on anybody who smokes or uses nicotine. The reason for it is because what happens is at a microscopic level, nicotine really vasoconstriction the tiny, tiny little blood vessels in our body. Okay? not the big ones, the big ones are better, they're fine. But when you cut skin, for example, for facelift, it's those tiny little epidermal and dermal vessels that make that scar heal. If you smoke, there's not enough blood flow, the wounds can completely all fall apart. So it's one of those things where when I was training, we used to do this thing called the cotinine test, where we actually would test people the day of surgery, and make sure that didn't have any nicotine in there blood. But because we were at a county hospital doing resident cases, and we didn't want to have complications. 

Trina Renea  32:30  
Well, I think people would lie to get their plastic surgery 

Dr Payman Danielpour  32:33  
Exactly. You'd be surprised how many people lied. And we're like, No, you're canceled, your cancel. And it was, it was better for us because we wouldn't run into all these complications. Now it's a different story. You know, we advise them, we trust them. We don't really test them. But if they smoke, it can cause a lot of issues.

Trina Renea  32:51  
And you let them know that in advance.

Dr Payman Danielpour  32:55  
Oh yah. I will never I'll never do a breast lift or tummy tuck anything that that really needs incisions, larger incisions needs new blood flow to come in. I will never do if it's just no worth it

Rebecca Gadberry  33:06  
You're more likely to get keloids that way too, aren't you?

Dr Payman Danielpour  33:10  
It's a possibility keloid formation is a little bit different. Why it forms? We don't really know if it's genetic, if it's something we did closing a wound, I mean, I've I've taken out and we're going on a tangent, but I've had a keloid on a belly, for example, that I'm like, I'll cut it out and fix it. And it's come back, I'll cut it, I'll fix it. I'll get it back. And they're like, Okay, now what's the definition of insanity, doing the same thing over and over again expecting a different result. So that's when you realize, well, that's not going to work. And you've taken care of a billion keloids in your life. They're very difficult. And it's all about collagen production. And it just gets very unorganized and disarrayed and out of whack. And its very hard. 

it's a different collagen too

absolutely.

So when you say fat transfer, you're talking about actual fat from your body. Your Do you ever do it with a filler instead of fat? 

Such a good question.

Rebecca Gadberry  34:09  
he just likes your questions

Dr Payman Danielpour  34:10  
it's an excellent question. it is a very viable option for treatment of cellulite, actually, by doing subcision and then placement of filler. Now here's the issue with filler. It lasts for how long? But an HA filler, let's say a year, right if we're lucky. if we are really lucky, right. So now there's actually in one of the newer studies about sidelight using Radiesse, or using you know, Sculptra. Exactly. I've injected sculpture in the buttocks a ton. A Ton. I'm talking about vials and vials and vials and I'll Be honest with you. I give a big kind of like a red flag warning. I'm like, I don't think this is gonna do anything for you. You want to pay me a ton of money to do it, I'll do it. But I just don't think it will. And you have to put in so much. Now for a small area that you're treating cellulite. Very different. But for large surface area, like a whole, you know, a buttock can be a large surface or if you put a lot of sculptra in there, to get it and how long does that last? two years?

Trina Renea  35:30  
That's what I always wonder when people get those big ol butts and they're filling them full of sculpta?

Dr Payman Danielpour  35:35  
It's fat. 

Trina Renea  35:35  
its fat? Nobody can afford to put that much Sculptra in their butts

Dr. Vicki Rapaport  35:40  
can you ever do implants? Obviously, do you ever do implants to help cellulite?

Dr Payman Danielpour  35:47  
no. again,

Dr. Vicki Rapaport  35:48  
I'm glad to hear that 

Dr Payman Danielpour  35:49  
because here's the thing. Remember, again, all we're talking about superficial fat, very different than the deep fat

Trina Renea  35:56  
it sits on top of the implant. the superficial fat . 

Dr Payman Danielpour  36:00  
Absolutely. So the implant that would go in is is much deeper. Now I dont do buttock implants. I think there's only one guy in L.A. that does and everyone sends him to him. But, but yeah, those, those are rought with complications too. If you ever want to get a buttock implant, don't

Dr. Vicki Rapaport  36:16  
agreed , against all those perminent 

Trina Renea  36:16  
Also you could pop it.

Dr Payman Danielpour  36:21  
I've seen them flip because they're shaped. And they'll come in and one one side of the butt looks great the other one looks weird. Or they'll dehiss and there'll be, I mean, it just so many, in the incisions are sometimes it's just awful. And not Yeah, I don't know what the fascination with the huge booty is. But so I'm

Rebecca Gadberry  36:40  
getting a takeaway here that you don't advise them.

Dr Payman Danielpour  36:44  
I don't I'm not a big butt implant guy. I mean, I do do fat transfer to the buttocks. In a very kind of tasteful way, I guess. I don't think overdoing anything in the aesthetic world is nice. But that's my that's my aesthetic. 

Dr. Vicki Rapaport  37:01  
and so having you know,  when somebody goes to the plastic surgeon, you want to have the console as a patient that gives many options, right? If somebody is just offering one option, probably not the best place. I mean, unless you can obviously have somebody you know, you're recommending multiple modalities, you can recommend one over the other. But is it is it appropriate when you have a consult to give people multiple options? 

Dr Payman Danielpour  37:26  
in our practice, we do, always

because there's a difference in pricing as well right? 

difference in pricing, there's difference in downtime, there's difference in in how invasive something is, you know, somebody comes into your office and may not want a facelift for example, and you met you need to have other options for them. Because a facelift is very expensive. It's a big operation. So instead, maybe they want a little filler and botox, right. It's kind of the same thing with cellulite. They may turn around and be like, I don't know if I want you to go harvest fat and break up the septe and then inject the fat. It sounds like a lot, you know, even though it's really not honestly, like okay, let me try the non invasive first because and I always tell people start with minimally invasive and then move your way up. I don't think there's you're not breaking, you know, you're not burning any bridges, I should say,

Trina Renea  38:17  
what does that cost somebody to do? The breaking up of the cords and filling with the fat like what it would? 

Dr Payman Danielpour  38:24  
Thats a great question. The questions people asked me like, how much is that going to be? I'm like, let me ask my coordinator. Depends, I think depends on how many areas right depends on how bad the cellulite is. Depends on how much liposuction they want. Like I did something for a lady the other day where she came in, she's like, I much rather have fat transfer to my face. Can you do that for me? I said sure,  took her to the operating room, took a small area, took a little bit of fat off, processed it, injected in her face. It literally took a half an hour. It was that easy. 

Trina Renea  38:56  
Whoa, that is such our next episode. I'm so excited. to to ask questions about that transfer transfer

Dr. Vicki Rapaport  39:04  
Which makes a lot of sense as a segue but You did say you know before we're talking about absolute liposuction alone makes cellulite worse. But now you just mentioned liposuction. Is there a situation where you do it all you do liposuction and you do the subcision and you do the fat while you do liposuction to get the fat from that same area or a different area? Right? 

Dr Payman Danielpour  39:24  
Absolutely. It's a great question. So you'll come in and you'll say my lateral thighs and my posterior buttocks, if your buttocks has really bad cellulite, but I hate the way my belly looks because it's too heavy. I'll say okay, let's take a little bit of fat. It's the best way to do it. Always rob Peter to pay Paul

Trina Renea  39:42  
right,

Dr Payman Danielpour  39:43  
the best way to go.

Trina Renea  39:44  
And I think I have another question.

Dr. Vicki Rapaport  39:47  
 Yes.Tell me your question. And then I'm gonna

what do you as a dermatologist do for people with cellulite do you send them to a plastic surgeon

 I 100% send them to a plastic surgeon. I send them Payman. i don't have any options in my office

Trina Renea  40:03  
do any dermatologists? Anyone tried to tackle that? 

Dr. Vicki Rapaport  40:08  
We have retinol cream. I don't offer retinol creams because I just never was interested in cellulite. But yes, you can offer retinol creams. You can offer caffeine creams. You can offer Endermologie by an esthetician. I don't do it. So I just sent straight to the plastic surgeon.

Dr Payman Danielpour  40:22  
I'll tell you I have I have some incredibly you know high net worth clients that have a lymphatic masseuse on retainer. I swear, I kid you not, this one lady that used to do all my lymphatic massages for the office for all my liposuction patients. This I have a lady that took her and put her on salary and has her come over. The one thing that works great is massage. massage can make the appearance of cellulite almost go away

Trina Renea  40:52  
you're talking about lymphatic massage?

Dr Payman Danielpour  40:54  
Lymphatic Massage. Yeah. It's like very much like Endermologie there's suction cupping, and there's vacuum assisted or there's, but it helps and it does make you look really good for that night, maybe even for a week. But then you have to continually do it. And it makes people feel great. So the massage really helps. I know that a lot of celebrities do it before big, you know award shows or parties because it makes it looks better and clothing. So yeah, I'm wondering what what do you like to use topically For cellulite

Rebecca Gadberry  41:24  
That's another episode.

Dr Payman Danielpour  41:26  
Oh my god, I gotta listen. 

Trina Renea  41:27  
Just give him one. Give him one one.

Dr. Vicki Rapaport  41:30  
Nugget,

Trina Renea  41:30  
one nugget of an ingredient. Do you agree with the the caffeine?

Rebecca Gadberry  41:37  
I've got different ideas. And I'd like people to wait for them 

Dr. Vicki Rapaport  41:42  
Wow, Im impressed. 

Dr Payman Danielpour  41:45  
Yeah you like to tease I see, makes people want to come back for more. 

Rebecca Gadberry  41:47  
I like to tease.

Trina Renea  41:50  
I'll let you know when that episode comes out?

Dr Payman Danielpour  41:53  
No, but really, I think I think the biggest take home message should be cellulite should be treated in a multimodal fashion. And most review articles you read about it will tell you that there's no one thing that is going to be, unless you're really, if you're having surgery, any kind of surgery with a plastic surgeon, you can always be like, Listen, I've got this cellulite, can you address it for me and I do this a lot. Where I'm like, I've got you prone, you're on your belly, your lateral thighs and your buttocks are like just sitting right there. Let me take some fat I'll fix it. Even with that, if I get 50 to 60 to 70% improvement. I hit home run. There's never that 100% Wow, we did it. It looks amazing.

Trina Renea  42:32  
Gosh, that's unfortunate for so many people. 

Dr Payman Danielpour  42:35  
So if we come up with a cure, thats it, we're done. 

Rebecca Gadberry  42:40  
I wear bathing suits, but only around my family. And I don't wear shorts. Unless they're like three inches above the knee.

Dr. Vicki Rapaport  42:47  
I read about the I want to talk about my neck or the you know that book. It's called " I hate my neck". And in that book, Nora Ephron says that you should put on a bikini at 18 and not take it off until you're 37. And I loved it.  she's right. You know, I mean, I know some people get to a certain age, but she's like, doesn't matter because you still look amazing. And after a certain age, that's not the case. I think you know, cellulite or not put too the bikini on, its okay. 

Trina Renea  43:14  
to much pressure on yourself. When you get older.

Dr Payman Danielpour  43:17  
You got to just, at the end of the day, you have to just own it. And whatever it is like will make things better. But just love who you are.

Trina Renea  43:25  
these days i feel like people do that more, which is nice.

Dr. Vicki Rapaport  43:27  
I mean, honestly that I agree about the big buttock thing. I don't necessarily think it's amazing, but I love that women who naturally have a big butt have now showed off the last 10-15 years so we need to find somebody amazing with wonderful cellulite who just shows it off and doesn't care.

I think her name is Lizzo? 

Great. Let's do it 

Trina Renea  43:46  
Does Lizzo have cellulite? I don't know, she looks great on stage.

Rebecca Gadberry  43:55  
 Yeah. Which I'm not gonna go into it. But Lizzo owns it. She she's proud of it. Well, yeah. And at my age because I'm going to be 70 next year. I have sagging skin under my arms. I have cellulite on my thighs, my buttocks, my stomach. And after I saw the Barbie movie, because we were talking about that before before we started the episode. I feel better about my body and I now am wearing sleeveless blouses for the first time since I was 30 years old. Wow. Yeah, 

Dr. Vicki Rapaport  44:29  
so our homework is to see the Barbie movie. Yeah. understand where we're coming from with that

Rebecca Gadberry  44:35  
 right

You know, we were raised with Barbie. I have the first Barbie that came out in 1959. And I still have it and it's really quite, It's not in the box, but I still have it. But my point is, is that we were raised that Barbie had body dysmorphia. They gave it to everybody. She gave it to everybody. but when I saw the Barbie movie after I saw the Barbie movie, my body dysmorphia went away. 

Dr Payman Danielpour  45:05  
That's great. I think that was the point of the movie though

Trina Renea  45:07  
Yeah, it was. it was so good in that way. 

Rebecca Gadberry  45:09  
if theres anybody out there thinking, Oh, the Barbie movie is going to be horrible. No, it has some very positive messages in it.

Trina Renea  45:15  
I agree. So before we close this episode, I just want to bring up a listeners question. We can just address it. I'll ask you first Dr. Danielpour. Is buying products on eBay safe? What do you think?

Dr Payman Danielpour  45:30  
I think? Absolutely not. No, I don't think buying most things on eBay safe. Only because products, I think you have to be very careful. Just a quick story from last night, a friend of mine said that he wanted to buy this one skincare line, I'm not gonna get into it. And he couldn't find it anywhere. It's very expensive one and he started searching for it. And he saw that he had it on eBay. It's like, wow. And he ended up buying like, 10 of the vials. Because he thought it was so inexpensive. When it got there. He was like, it didn't smell the same. It didn't feel the same. He's like, for sure. It was counterfeit, right? Like it was just it was there was just pretending to be them. I think that's what you run into, in a place like Ebay. I think you've run into that with Amazon too, because now Amazon's just party retailers Exactly. These third party retailers basically sell anything to anyone. And when you look at a price of a small little vial of skincare is $300. But they're selling it on eBay for 50. There's a problem, right.

Rebecca Gadberry  46:34  
And other things that can happen is not just with it being counterfeit, so it's not coming directly from the brand. But those ingredients can have contaminants in them. Yes. And those contaminants can be very dangerous. Plus the product hasn't been tested for safety, so you don't know what you're getting. Secondly, if you have any problems, the product liability will not cover you. So you are on your own. And lastly, a lot of these products have been around in those bottles for years. And as you see as chemical set and ingredients or chemicals as chemical sit in that package, they can form new chemicals that can then become very dangerous for your body. So for your skin and your hair. Yeah. So no, it is not a good idea. And some of these people, some of these companies selling on eBay, you go back to get your money back or you go back to make a complaint. They're not there anymore. 

Dr Payman Danielpour  47:36  
That's very true.

Dr. Vicki Rapaport  47:37  
Yep. 

Trina Renea  47:38  
All right. Well, thank you so much for joining us today. This is awesome. And we're gonna have you back in our next episode that we will air right after this one about fat transfer, which you talked about a few times during this episode, which I find very fascinating. So we'll jump into that in just a moment. 

Rebecca Gadberry  47:57  
and the cellulite product and ingredient episode will be after the fat transfer episode. Yeah, we've got like a three story arc.

Dr Payman Danielpour  48:05  
Love it. 

Trina Renea  48:06  
Yes. So tune in everybody.

Dr. Vicki Rapaport  48:08  
Thanks you so much, you are so wonderful, my next door neighbor. I love him

Trina Renea  48:15  
All right, bye. Get ready to stay in the know with facially conscious The Ultimate Guide to navigating the overwhelming world of information. We're your trusted co hosts bringing you the latest and greatest on all things facially conscious? have a burning question or idea you want to share? Don't hesitate to email us at info@faciallyconscious.com.  We'd love to hear from you. And if you're itching to share your own experience with our audience, contact us and we just may feature you on an upcoming episode. Stay tuned for even more insights and inspiration on our website faciallyconscious.com, where you can catch up on blog posts and past guest interviews