Archive for April, 2011


Thursday, April 28th, 2011


The first implants developed were gel-filled. They performed well, but some developed surrounding scar, particularly when the shell broke. In response, manufacturers developed inflatable, saline-filled implants.

In general, gel-filled implants are thought to feel slightly more natural to touch. The down-side is that they require a slightly larger incision for placement, and when the shell breaks, they have a historically higher incidence of scar formation ( “getting hard”).

Saline-filled implants avoid the concerns with silicone gel and have traditionally had a lower incidence of scar formation ( “getting hard”). The criticism of saline implants has been a slightly more “wrinkly” feel.



Monday, April 11th, 2011


The media constantly bombards us with the latest new “filler” which will create a facelift result with a needle. Oh really?

Let’s think about that…. If you tried on a dress that was too big  one answer is to gain enough weight to fill the dress. I would doubt that you would make that choice. Obviously, the answer is to tailor out the excess material until the dress fits your underlying shape. The same is true with faces. If there is too much loose skin in a face, the answer is not to blow up the face until the skin is tight.

The second fallicy is that fillers  somehow “lift”. Fillers fill – they do not lift. When facial tissues fall with laxity, adding volume merely accentuates the drop. Clever marketing uses familiar medical terms in situations in which they do not apply. Regardless of the filler (hyaluronic acids, Sculptra, Radiesse, plasma) or the proposed biologic benefit ( collagen stimulation, growth factors, etc) there is no magic. The correction for tissue descent is repositioning. Only surgery can do that.

Injectables do have a useful role, for subtle refinement – particularly folds around the mouth and lips in small volumes. But they are only one piece of the puzzle.

With all manner of people, physicians and others, getting into the cosmetic surgery and dermatology market, it is buyer beware. The media messages claim less is more, and new is better . Less is never more; new is often unproven.

If you only have a hammer, all the world becomes a nail. When you only have a needle all the world needs injected!


Non-surgical Skin Tightening…Really?

Monday, April 4th, 2011


The American Society for Laser Medicine & Surgery (ASLMS) just concluded its annual meeting in Grapevine, Texas. The ASLMS is the nation’s largest organization of clinicians and scientists who perform laser procedures.

Here are highlights from the meeting…

The concept of non-surgical skin tightening, particularly in the face, neck, and abdomen is always a hot topic. The principle is heating dermal layer of the skin to 55-65 degrees centigrade creating contraction of collagen.The exhibit hall was bursting with technology claiming to tighten skin. The media is excited with testimonials. Good business for doctors, but is does it really work?

Thermage TM attempts to tighten skin by using focussed radiofrequency waves to heat the dermis. The technology has been around for nearly ten years. It never really caught on because the treatments were very painful, and the benefits were limited. Solta, the company who bought Thermage, has modified the machine so that treatments are less painful. However, the results are minimal and inconsistent.

UltheraTM attempts to heat the dermis to create tightening using focussed ultrasound waves. The technology is elegant and interesting. However, the treatment parameters of depth and density, have not been established. As with many new technologies, they are marketed before the exact effective guidelines have been established. No doubt, a few patients have shown noticeable, though modest benefits – mainly in the neck. I would say Ulthera is worth watching in development, but not ready for routine use.

The problem with all this skin tightening technology is that basic studies of effect have not been completed. How much can you burn dermis without scarring? How little can you burn dermis and still get benefit? How long does initial dermal contraction last? How consistently do you get a result worth the cost?

Until these technologies have been in use long enough to either become standardized or discarded for the next “new treatment”, I would say watch and wait. There still is no minimal procedure with maximum result in skin tightening!