Posts Tagged ‘cosmetic surgery’


Tuesday, May 3rd, 2011


Removal of unwanted body fat by liposuction is a well established procedure benefitting thousands of patients. Naturally, the thought then arose, “ Why not remove fat from unwanted areas ( hips and thighs) and replace it into wanted areas ( breast)? “

Over the past 10 years the techniques of fat transplantation have gradually been refined. The limiting factor is that that fat cells are very fragile. Removal often destroys many of the fat cells, and re-implantation yields partial, unpredictable survival. When fat cells die, they can produce small specs of calcification in the tissue.

In most areas of the body lack of survival of fat cells with microcalcification is no big deal. But in the breast, it can cause mammographic changes which look like breast cancer. If that happens, a surgical biopsy is needed.

A recent study from China, published in the April issue of Plastic and Reconstructive Surgery, reports suspicious breast calcification in 16.7 % of patients with fat graft breast augmentation. Other early reports have not shown as many calcifications, but it is too early in the experience to know the true incidence.

There is great enthusiasm for fat grafting for augmentation. It would be the perfect solution – avoiding the hassels of silicone breast implants. But as with any new procedure, it is wise to wait until sufficient experience exists to accurately assess the downside.


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!


Beware of Media Exaggerations

Monday, March 21st, 2011


The march issue of Town and Country has a typical article of overstatement about plastic surgery entitled “ The Last Inch”.

“Non-invasive” laser liposuction has been marketed for several years. In addition to having the marketing magic associated with the word “laser”, these “minimal” procedures are supposed to internally dissolve fat to provide “more uniform fat removal for a smoother contour”. In fact, heating is more damaging to the remaining fat, so that contour irregularities and liquified fat collections may be more common than standard liposuction.

In addition, the claims that laser heat tightens the collagen in skin to make less dimpling is scientifically impossible. Burning the undersurface of the skin to the point of collagen contraction requires heating to over 50 degrees centigrade. That amount of heat destroys skin blood supply and would kill the skin. Sin can contract somewhat from deflation of fat volume, unrelated to laser heat.

Finally, “non-invasive” external machinery is being heavily marketed. Ultrasound, radio frequency, red light, and cold application have all been shown to dissolve fat in laboratory animals. The problem is that in humans they can only do a small amount of fat dissolution in a small surface area. As a result, they are impractical.

Style and Beauty editors know that we all want magic. Big benefit – small undertaking. And writers always want to emphasize “what’s new”. But the informed patient would wait until these hyped “new” techniques prove themselves.