Recovery from Tummy Tuck in Beverly Hills

How painful is tummy tuck or body lift?
A standard Tummy Tuck or Abdominoplasty feels, more or less, like a C-Section. It is more painful than Liposuction, Breast Augmentation, Tubal Ligation, Rhinoplasty, Breast Biopsy, and less painful than Hysterectomy, shoulder surgery, or back surgery.

When Can I Lift My Children Again?
You should not do any heavy lifting for about eight weeks from the date of your surgery. You should be prepared to have spouses, or other loved ones, lift your children so that you don’t risk ripping your stitches. After the first week you may hold your young baby in your lap, but do not lift them up unless they weigh less than a gallon of milk

When Can I Exercise Again?
You may start some light walking as early as 10-14 days after your plastic surgery. As you feel more comfortable you can increase your activities, but you cannot lift anything heavier than a gallon of milk for the first two months. Heavy lifting can cause your internal stitches to rip apart, resulting in a hernia that will require corrective surgery. Jogging is usually acceptable after three to four weeks, as long as you are wearing your girdle. You can do arm and leg weight training in three to four weeks as long as you don’t feel that you are straining your abdominal and back muscles.

When can I go back to work?
This depends on the normal level of activity that is expected of you at work. There is a difference in timing for those who have desk jobs, versus those who are required to stand, walk, bend, push, and pull constantly throughout their workday. Most people return to non-strenuous jobs within 10-14 days after a tummy tuck. If your job is very strenuous, you might have to take more time off, but usually no more than four to six weeks. For those who are having Body Lift and Thigh Lift procedures, it usually it takes longer to go back to work depending on their age, stamina, extent of surgery and job requirements.

When Can I Resume Sexual Relations?
It depends on what you are planning to do! More or less, follow the same restrictions as for exercising. You cannot strain your abdominal, thighs, and back muscles greatly for the first six to eight weeks. Having said this, it is very helpful for your body, soul and psyche to have intimate relationship early on. This will also be beneficial for your significant other. They are most likely as scared as you are; and are afraid to do anything that might hurt you. Don’t be afraid. Proceed as is comfortable for both of you.

What Kind of Emotions I Might Anticipate Following My Tummy Tuck?
Before surgery most patients are very happy, excited, and looking forward to undergoing their body transformation. Afterwards, they often have mixed feelings. Some of this is caused by the period of disability. Sometimes, people have not yet adjusted to their new body and look. Depending on the person as well as their surroundings, people respond differently to this change. Although most people feel cheerful and are happy with their new body, few do feel regret or have a difficult time psychologically adjusting to it. This can affect their social or marital relations. If you are having these very normal feelings, be sure and discuss them with your family doctor or plastic surgeon.

Tummy Tuck- Potential Risks & Complications

What Are the Potential Risks, Complications, and Shortfalls of Tummy Tuck Surgery?

Scars- The trade off for your flatter and tighter abdomen will be surgical scars that are permanent. While no surgeon, however skilled, can perform surgery without scars, scars do usually fade with time, taking up to 18 months. Some people are genetically predisposed to bad scarring, or even formation of keloids or hypertrophic scars. While it is generally perceived that only dark-skinned people develop Keloids, the fact is that light-skinned people and people from all ethnic backgrounds can develop Keloids, hypertrophic, or “bad scars”. Dr. Younai, and/or his staff review the place of Tummy Tuck or Body Lift scars with every patient prior to surgery, in order to place them in a location that can be better hidden by bathing suits or underwear.

Bleeding- It is possible, though uncommon, to experience some bleeding during or after surgery. Should excessive bleeding occur, it might require a blood transfusion, or even emergency surgery. But most commonly, localized small amounts of blood collected under the skin (hematoma) can be easily treated through aspiration or the placement of a drain. Dr. Younai, like majority of other plastic surgeons, routinely uses drains that help remove any excess fluid or blood collection.

To reduce the chance and risk of bleeding with surgery, you must not take any blood thinners, such as aspirin, anti-inflammatory, or vitamin E for 10 days prior and after your surgery.

Infection- There is a very small chance of developing infection after any surgery. You will be given antibiotics during your surgery and be given a prescription for antibiotics to take after your surgery, in order to reduce the risk of infection.


“When I awoke in the Recovery Room, I refused to eat or drink anything. Since I didn’t have anything in my stomach, I couldn’t take a pain pill. I regretted this an hour later when my husband was driving us home on the freeway and the pain hit me hard.”
Nancy, age 40
Pain- While people have varying thresholds for pain, it is an expected result from any surgery. This can be addressed through a prescribed medication from your cosmetic surgeon. Nevertheless, you should be aware that although pain medications do help reduce the degree of pain and make it more tolerable, there is no pain medication that will completely eliminate pain.

Nausea. Anesthetics, narcotics, and antibiotics do cause nausea. You will be prescribed an anti-nausea medication, both just-before, during, and after your surgery. Taking your medications with food helps to reduce the incidence and degree of post-operative nausea.



Persistent Swelling & Bruising. It is normal for skin of the abdomen, navel, genitalia, buttocks, and thighs to become inflamed, swollen, and bruised following the surgery, and to remain so for some weeks. In rare cases, this can persist for many months or can even be permanent if patient has poor circulation. To minimize swelling and bruising after surgery patients are required to wear a support garment 24 hours a day for three weeks, and then only during the daytime for the following three weeks. Massaging these areas as much as three to four times a day is also very helpful. It is normally expected for the skin to become dry and itchy after surgery. Massaging with heavy lotion and skin moisturizer is essential. You do not need expensive creams to do so – Vaseline, Vitamin E, or any kind of greasy lotion will do. It’s the grease that does the trick! It is good, when possible, to have your spouse or significant other to perform the massage. This helps to accustom a couple to your new look, and to reduce any trepidation that you may both be feeling.

Change in Skin Sensation- The area of abdomen, pubic area, flanks, and parts of the thighs do become numb, after this surgery. This usually resolves gradually over three to eight months, but you can have residual permanent loss of sensation or even hyper-sensitivity in some areas.
Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after Tummy Tuck, Body Lift, or Thigh Lift, but is usually short-lived and can be alleviated by moisturizing, medication, and massage.
Sutures- Most surgical techniques use deep sutures, which might spontaneously poke through the skin, become visible, or produce irritation that might require removal.

Skin Contour Irregularities- Contour and shape irregularities and depressions may occur after a tummy tuck, body lift, or thigh lift. Residual skin irregularities at the ends of the incision or “dog ears” are always possible as is skin pleating when there is excessive redundant skin. These do usually improve with massage over time, but may require surgical correction.

Fat Necrosis- As your tissues heal after surgery, sometime, some of the deeper skin fat might die. Usually, this is of no consequence, but sometimes it might produce areas of firmness or contour irregularities.

Pubic Distortion- One of the benefits of Tummy tuck and Body Lift is the lifting and flattening of the protruding and sagging pubic skin. Rarely, women develop distortion of their labia and pubic area. Usually, this corrects itself, but sometimes corrective surgery is required.

Asymmetry- Most patients have differences between the right and left sides of their body before any surgery is performed, and surgery might not be able to correct that. Therefore, even after a Tummy Tuck or Body Lift, there may not be perfect symmetry in the body’s appearance. Factors such as skin tone, fatty deposits, skeletal prominence, and muscle tone may contribute to normal asymmetry in body features.

Wound Separation & Delayed Healing- Wound disruption or delayed wound healing is possible. Some areas of the surgical incision in the flank, back, or buttock may not heal normally and may take weeks to heal. Some areas of the skin may even die. This may require frequent dressing changes or surgery to remove the non-healed tissue and to close the wounds secondarily. Smokers and those with diabetes, multiple medical problems, and severe obesity have a greater risk of skin loss and wound healing complications.

Seroma- Fluid accumulations frequently occur between the skin and the abdominal wall, legs, flanks, back, or buttocks. Dr. Younai, as well as, many other plastic surgeons routinely use drains in these areas in order to remove excess fluid. If you develop seroma, it can easily be drained in the doctor’s office.

Umbilicus- Malposition, scarring, unacceptable appearance or loss of the umbilicus or belly button may occur.

Allergic Reactions- In rare cases, local allergies to tape, suture material and glue, blood products, topical preparations or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur from drugs used during surgery and prescription medications. Allergic reactions may require additional treatments.

“Blood Clots” (Deep Venous Thrombosis, Cardiac & Pulmonary Complications). Lengthy procedures may be associated with the formation of, or increase in, blood clots in the veins in the legs while you are immobilized, with the risk that they will travel to other parts of your body, including your lungs. Pulmonary embolism can be life threatening or fatal in some circumstances. You can reduce this risk by moving as soon as possible following your surgery. It is important to discuss with your surgeon any past history of blood clots, swollen legs or the use of estrogen or birth control pills that may contribute to this condition. After surgery, if you experience shortness of breath, chest pain, or an irregular heartbeat, notify your doctor and seek medical attention immediately. Treatment of this complication may require hospitalization and additional treatments.

Damage to Deeper Structures- As with any surgery there is a rare potential for injury to deeper structures including, nerves, blood vessels, muscles, and lungs (pneumothorax). Treatment may require further surgery and hospitalization.

Shock- In rare circumstances, your surgical procedure can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalization and additional treatments would be necessary.

Unsatisfactory Result
Although good aesthetic results are expected, there is no guarantee or warranty expressed or implied that these results may be obtained. A person might be disappointed with the results of their surgery, due to asymmetry, unsatisfactory or highly visible surgical scar location, unacceptable visible deformities, bunching and rippling. The skin near the suture lines or at the ends of the incisions (dog ears), may experience poor healing, wound disruption, and loss of sensation. It may not be possible to correct or improve the effects of surgical scars. Additional surgery may be required to improve results.

Difference between a Tummy Tuck & Body Lift in Beverly Hills & Los Angeles

Tummy Tuck only corrects the looseness and redundancy of the abdomen. Body Lift combines a Tummy Tuck with the lifting and tightening of the redundant back skin folds, the sagging buttocks and the outer thighs.
Therefore, a Body Lift is a more extensive procedure, with the goal of lifting and tightening the entire lower body. Most people with loose abdominal skin or even with some sagging of the buttocks can be treated with an extended Tummy Tuck or a High Tension Tummy Tuck. For those who, as a result of massive weight loss, develop an abundance of lower body skin excess with sagging of the buttocks and outer thighs are better served with a Body Lift.


Is the Incision for a Body Lift Larger than for Abdominoplasty?

The incision of a body lift extends farther than the incision for Abdominoplasty – past the hips to the back, like a belt. Because of this some people call a Body Lift a “Belt Lipectomy.” A Belt Lipectomy, however, does not lift the buttock and only removes excess skin folds.

Answers to every questions you have about Tummy Tuck in Beverly Hills

Do I have to lose weight before undergoing a Tummy Tuck?

It is wise to have reached an ideal body weight before undergoing a Tummy Tuck. However, we do not live in an “ideal” world. Therefore, you can have your remaining excess abdominal and body fat removed either before, or during, a Tummy Tuck, with Liposuction – provided that you plan to maintain your weight and stay healthy.


Can a smoker undergo Tummy Tuck or Body Lift surgery?

NO. Patients who are currently smoking, use tobacco products, or nicotine products (patch, gum, or nasal spray) are at a greater risk for significant surgical complications. These complications include skin death, delayed healing, and additional scarring. Individuals exposed to second-hand smoking are also at potential risk for similar complications attributable to nicotine exposure. In addition, smoking can have a negative effect on anesthesia and post-anesthesia recovery, with increased coughing and possibly bleeding. Therefore, you need to refrain from smoking at least several weeks before and after your surgery.


Can I Undergo a Tummy Tuck If I Have Diabetes, or Other Chronic Conditions?

Men and women who have chronic health conditions, such as thyroid disease, diabetes, high blood pressure, and arthritis can still undergo Abdominoplasty – provided that their conditions have been successfully optimized by their physician. Even as a commonly performed cosmetic procedure, a Tummy Tuck is still major surgery, and must be treated as such in all cases. A responsible plastic surgeon will perform blood tests, and take a comprehensive medical history to assure that all risks of surgery are minimized.


Can I Become Pregnant Again Following a Tummy Tuck?

In most cases, women considering a Tummy Tuck should not be planning additional pregnancies. Although it is possible to have more children following a Tummy Tuck, another pregnancy could impact your Tummy Tuck outcome, and lead to the need to have your abdomen “re-tightened.” Therefore, a responsible cosmetic surgeon will advise you that it is preferable to be satisfied with the size of your family before undergoing a Tummy Tuck.


Does a Tummy Tuck Get Rid of Stretch Marks?

There are no creams, or laser treatments that can erase stretch marks. However, because an Abdominoplasty removes most of the stretched out skin below the level of the navel, it does get rid of most of your stretch marks -- at least those on the abdomen.

What Kind of Anesthesia Is Used for a Tummy Tuck or Abdominoplasty?

As a rule, your cosmetic surgeon will use general anesthesia for tummy tuck or abdominoplasty. There are some surgeons who supplement the general anesthesia with an Epidural injection (such as is given during childbirth). While helping to reduce pain during the immediate post-operative period, some surgeons feel that epidural anesthesia might potentially cause more harm, by causing urinary retention and preventing the patient from moving around right away.

Pain Pumps are new devices that can help patients with post-operative pain. Pain Pumps are small reservoirs (the size of a “Walkman”) of local anesthetic that infuse Lidocaine or Marcaine into the wounds for the first 24-48 hours after surgery. Unlike Patient Controlled Anesthesia (PCA) which can only be administered in a hospital, Pain Pumps are sent home with the patient. Because they help keep the surgical areas anesthetized, they reduce the need for narcotics after plastic surgery, therefore, lessening the post-operative incidence of nausea. While some patients like using them, others feel that they are not that effective and are instead cumbersome and hinder their mobility. Therefore, Dr. Younai gives his patients the choice of using a Pain Pump if they wish to have them.


You should pay special attention to the anesthesiologist who your plastic surgeon uses during surgery. Like your surgeon, the anesthesiologist literally holds your life in the balance. It is therefore critical that you put your life in the best hands.

Many patients have preconceived notions about the type of anesthesia that is best for them. Unfortunately, these thoughts are often based upon hearsay, or upon informal research that has no scientific basis. While you are the final arbiter of your treatment, only an experienced physician can guide you properly in making the crucial decision about your anesthesia.

This is not guesswork! Allow your physician to explain your safest anesthesia option.

Many facilities employ trained nurse anesthetists. However, it is optimal to have anesthesia administered by an anesthesiologist rather than a nurse. Preferably, your anesthesiologist should be certified by the American Board of Anesthesiology.

The anesthetized patient must be monitored meticulously and constantly, with consideration for all medical conditions. The best person to do this is a physician who is trained and experienced in the practice of medicine, in the specialty of anesthesia. This is especially important in surgical facilities that operate independently. In such freestanding facilities, a nurse anesthetist might not have the adequate supervision of a physician anesthesiologist, or the support system required to properly address emergencies.
You should be skeptical about promises that extensive cosmetic surgery procedures (such as a tummy tuck) can be performed under local anesthesia in an office, procedure room, or even in an office surgery room. Having an extensive procedure performed under local or “twilight anesthesia” is not safer than having it done under general anesthesia. On the contrary, the risks of this “twilight sleep” might be greater because procedures that take two hours under general anesthesia will take several more hours when you are inadequately anesthetized locally. The risks that your condition will become unstable will increase under this circumstance. Also, you will then have to deal with the side effects of the longer acting anesthetics that remain in your system, even after you go home.

Difference between a Tummy Tuck & Mini-Tummy Tuck in Beverly Hills

What Is A Tummy Tuck?

“Tummy Tuck,” also known as Abdominoplasty, is a cosmetic surgery procedure designed to remove loose hanging abdominal skin, as well as to tighten weakened abdominal wall muscles. Because diet and exercise cannot fix these problems, over 80,000 American men and women undergo Tummy Tuck or Abdominoplasty every year, in order to regain their figure and abdominal strength.


How does a Tummy Tuck Give You Your Figure Back Following Pregnancy?

Tummy tuck or Abdominoplasty re-establishes the strength and integrity of the abdominal wall by repairing the separation and stretching of the two “Rectus” muscles. These muscles (the ones used for “sit ups”) are the two major abdominal wall muscles that are normally held together over the front of the abdomen in order to give it its strength and tightness.

Abdominoplasty also eliminates the loose stretched-out skin (with stretch marks) of the lower tummy, as well as rejuvenating the stretched-out belly button or “umbilicus.”


What Is A Mini-Tummy Tuck?

A Mini Tummy Tuck or Mini-Abdominoplasty is not as extensive as a Tummy Tuck or Abdominoplasty, requiring only one hour of surgery as opposed to the three to four hours needed for a Tummy Tuck. Since it does not usually involve tightening of the abdominal muscles, it is reserved only for those who only have limited amount of loose skin or stretch marks in the lower abdomen or above the pubic bone. Also, it does not alter the shape of the belly button. A Mini-Tummy Tuck does not involve an extensive undermining and tightening of the abdominal skin, so it can be safely combined with full Liposuction of the abdomen and flank. Therefore, the combination of Mini-Tummy Tuck with Liposuction might be a better choice for those with excessive fat, but limited looseness of the abdomen.

While the incisions for a “full” Tummy Tuck can extend from hipbone to hipbone, those of a Mini-Tummy Tuck are much shorter, usually extending only the width of the pubic area and similar to a C-section scar.

Can A Tummy Tuck and Liposuction Be Performed Simultaneously?

Yes and No. It is not safe to perform Liposuction in the areas of the abdomen where the skin is being stretched during an Abdominoplasty. This can cause unnecessary damage to the blood circulation of these areas, resulting in scarring or even skin loss. As long as Liposuction is performed away from the main abdominal skin areas, it is then safe.

Therefore, some people choose to have their hips and thighs liposuctioned in conjunction with an Abdominoplasty. Breast lifts and augmentation are also frequently combined with the Tummy Tuck or Abdominoplasty. The surgeon may also simultaneously perform facial rejuvenation procedures, such as eyelid surgery, or procedures to remove fine wrinkles from the face. Because the total length of combined surgeries can affect the overall surgical risks, you should thoroughly discuss the safety of combined procedures with your cosmetic surgeon.

Difference between Tummy Tuck & Liposuction

One of the most common dilemmas for patients who are concerned with their abdomen is whether they would be better served with a Tummy Tuck or Liposuction.
While a Tummy Tuck or abdominoplasty is designed to remove loose abdominal skin and to tighten the belly, Liposuction is designed only to remove excess fat. A Tummy Tuck or Abdominoplasty will not reduce the dress size in a woman of size 14 who has much fat around her abdomen. Likewise, a woman who has lost all her excess weight after pregnancy and is left with loose, hanging abdominal skin will not be able to tighten her abdomen or remove the stretch marks with Liposuction.
There are some people who are "in-between" these two groups – who have both excess fat and a hanging "spare tire." These people will first need to undergo Liposuction to rid themselves of the fat. They will then need a Tummy Tuck to remove the excess skin and to tighten their abdominal muscles.

Candidates for Tummy Tuck

Men and women who have loose, hanging skin and weak abdominal muscles with a protruding belly are candidates for a full Tummy Tuck. On the other hand those who have a firm abdomen, but who have redundant lower abdominal skin folds are better served with a Mini-Tummy Tuck, also known as a Mini-Abdominoplasty.

There are several life changes that cause your abdominal wall to lose its strength and tightness, and to develop excessive, loose skin. Examples of these are:


Pregnancy

Almost all women develop stretch marks and loose lower abdominal skin as a result of pregnancy. They often complain of a lower abdominal pouch that protrudes and is unsightly when wearing tight clothes or low-cut shirts.

Especially during the last months of pregnancy, the rapid growth of the uterus stresses the lower abdominal wall and skin. Rapid stretching causes the deeper layer of skin to break, thereby forming stretch marks centered mostly in the lower abdomen, and covering the flanks and hips. The rapid stretching also causes the separation and stretching of the abdominal muscles that give the belly its core strength. The resulting weakness causes a pouch to develop in center of the abdomen. Because there is no longer adequate muscle support, exercise and dieting are ineffective in tightening the abdomen.

Massive Weight Loss
Men and women who have lost large amounts of weight by any means, including those who have dieted or have lost it through “Gastric Bypass” -- also known as “Stomach Stapling” or “Bariatric Surgery” -- are often left with folds of skin that hang like an apron. This is not only demoralizing for those who have gone to the effort of achieving a significant weight loss, but it also makes personal hygiene, exercising and wearing normal clothes difficult.

“After I had my children, I was never with my husband when the lights were on because I was embarrassed by the loose skin on my belly. He thought I was imagining my need for this surgery, but finally I showed him what I was talking about, and his eyes got wide as saucers. Even though he didn’t care if I had this surgery, he has been supportive of my need to do it.”
Laura, age 30

Tummy Tuck or Abdominoplasty- General Information

Abdominoplasty, also known as Tummy Tuck, removes loose hanging abdominal skin and tightens weakened abdominal wall muscles. Because even diligent diet and exercise cannot fix these problems, each year more than 80,000 American women and men undergo Tummy Tuck.

Women and men who have a protruding belly, loose hanging abdominal skin and weak abdominal muscles are candidates for a full Tummy Tuck.

Mini-Abdominoplasty, also known as a Mini-Tummy Tuck, is reserved for those who have only a limited amount of loose skin or stretch marks in the lower abdomen, or above the public bone. Also, Mini Tummy Tuck does not usually involve the tightening of abdominal muscles. Therefore, it is sometimes combined with Liposuction for patients with excessive fat, but limited looseness of the abdomen.

In most cases, women considering Abdominoplasty should not be considering additional pregnancies, or they may have the need for a second procedure to re-tighten the belly. In many cases, Tummy Tuck does help rid of stretch marks because it removes most of the “stretched out” skin below the navel.

During Abdominoplasty, the plastic surgeon makes an incision that extends from hip to hip along the lower pubic area. A skilled surgeon makes this incision so that the resulting scar is hidden under a bathing suit or by undergarments. The plastic surgeon then lifts the loose skin off of the abdominal wall, and tightens and repairs the loosened “rectus” muscles – the muscles that normally give the abdomen its strength – achieving the effect that an old-fashioned girdle would.

The umbilicus or “belly button” is disconnected from the abdomen, and reattached after the loose skin is removed. A skilled plastic surgeon not only tightens the abdominal wall, but also pulls up and tightens the thighs and the buttocks – as we do at the Regency Surgery Center. Drains will be inserted into each side of your abdomen to remove excess fluid as it accumulates following surgery.

During Mini-Abdominoplasty, the plastic surgeon makes an incision that generally spans only the width of the pubic area, and that is similar to a C-section incision. In both procedures, patients with excessive fat in the hips and flanks may have Liposuction in these areas to contour them, but not in the areas of the abdomen that are being stretched because this could cause damage to the blood circulation in those areas, leading to scarring or even skin loss.

The result of Tummy Tuck is an abdomen that is tight and flat, a waist that is narrow and curvy and thighs and buttocks that are firmer.

Tummy Tuck is major surgery that can be performed only after any chronic health conditions, such as thyroid disease, diabetes; high blood pressure and arthritis have been optimized. Nonetheless, depending on the patient, it can be safely performed simultaneously with procedures such as Breast Lift, Breast Augmentation and Facial Rejuvenation procedures such as Eyelid Surgery.

There are also other trunk lift procedures that are similar to a tummy tuck. For example a Panniculectomy is a type of abdominoplasty where only the redundant abdominal pannis is removed without tightening the abdominal wall. This is usually reserved for those with extremely large pannis that are too sick to undergo a lengthier procedure such as an abdominoplasty.

A body lift is a combination of a tummy tuck in the front and a buttock lift in the back. With this procedure the surgeon makes a circumferential incision around the waist and lifts the entire lower body. A body lift is reserved for those with much redundant and loose abdominal and lower body skin, such as those who have had Gastric Bypass Bariatric surgery. A belt Lipectomy is another version of a body lift where a belt-like section of the trunk skin flap is removed circumferentially.

A thigh lift is procedure designed to lift sagging thighs. A thigh lift mostly lifts only the inner thighs, while the outer thighs and buttocks are lifted with a body lift. An extensive tummy tuck also to some extend lifts the thighs.

In the following sections Dr. Younai reviews your treatment options for body contouring and tummy tuck, including pros and cons of each procedure, potential risks and complications, recovery course, pre and post operative instructions, and esthetic outcomes. There are also many before-and-after pictures and high resolution images of abdominoplasty available in our photo gallery.

Dr. Younai is a board certified plastic surgeon who receives patients at the California Center for Plastic Surgery from the Northern as well as the Southern California region. Some of these cities include Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Encino, Calabasas, Woodland Hills, Thousand Oaks, Westlake Village, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.