Laser Assisted Liposuction – True Innovation
Liposuction has evolved from a rather traumatic surgery that required 2-3 weeks of painful recovery, to a laser assisted procedure that now requires around 7 days of recovery with a relatively painless post-operative course. Patients with loose, redundant skin who were not good candidates for liposuction in the past are now getting a second look. The easy part has always been removing the fat, but now we have the ability to tighten the skin. That is innovation.
Most patients do not realize that the technique of liposuction has only been around since the mid-1970s. It was originated in Rome by Dr. Giorgio Fischer, a gynecologist, and was then popularized by Dr. Illouz, a French plastic surgeon. In the mid-1980s this technique migrated to the United States and quickly became one of the most common procedures performed in the field of cosmetic surgery. What I find interesting is that we have not seen a significant advancement involving this procedure in the past 25 years. Besides the addition of tumescent fluid (fluid that is injected into the areas of liposuction to minimize bleeding/bruising), ultrasound assistance and power assistance, liposuction has not changed much since the days of Dr. Fischer. Yes, the liposuction machines are more efficient and the cannulas used for aspirating fat have improved, but looking a little deeper you see that, for 25 years, there were no changes that were truly innovative.
This tends to provoke confusion in patients because many practitioners, including gynecologists, dermatologists and even plastic surgeons, tout their impressive “new” liposuction techniques. NEWS FLASH: there are no new techniques in liposuction, only variations of same techniques that have been used in the past. As an American Board of Plastic Surgery board-certified plastic surgeon I pride myself on my ability to offer natural and desirable liposuction results for my patients. This is not only due to my surgical abilities but also due to my patient selection process. Contrary to common practice in this country, not every patient is a candidate for liposuction. But even my approach to liposuction utilizes the experiences of many plastic surgeons before me…thus it would be disingenuous to imply that it is “new”.
But as with most things in the field of medicine (and life), give it enough time and something truly innovative will come along.
Now enter laser technology. Some very intelligent scientists and some fairly savvy businessmen thought it would be a good idea to attach a laser to the end of a cannula to assist with liposuction. Early incarnations of this procedure were ineffective due to the constraints of technology and lack of power supplied to the laser. This initially resulted in rather lackluster results. Fortunately, in the past 3 to 4 years, we have realized the true innovation, as these devices now have the strength and precision to result in a real quality change from the standard technique.
How does laser liposuction work? In short, the energy from the laser:
1. Assists in liquefying the fat for aspiration.
2. Reduces incidence and severity of bleeding and bruising.
3. Most importantly, helps induce the skin to contract.
After thoroughly researching the laser liposuction devices on the market (and there are many), I chose the SmartLipo MPX system by Cynosure for my practice. They have the longest track record with this technology and in my opinion, the wavelengths utilized in their devices are the most effective. There are other devices on the market that work well, but none offer all the benefits of the SmartLipo MPX system. In support of my findings, SmartLipo has the largest market saturation of any laser liposuction system, greater than 85%.
As someone who embraces innovation, I have to say that this device has transformed my practice. Practicing cosmetic surgery in Aspen, Colorado comes with certain expectations. My patients are very informed about advancements in the field of plastic surgery and actively search out the newest and least-invasive procedures. Clearly, laser-assisted liposuction is one of those techniques and my patients are very appreciative that I have brought this technology to this area. It is by far the most requested procedure in my clinic. My clinic has now been certified as a training center, by the manufacturer of the SmartLipo laser equipment, and we are the only plastic surgery practice in the Western Slope with that certification. It is my responsibility to help teach other surgeons and their office staff about this technology, proper techniques and appropriate applications.
I have omitted one important aspect of laser assisted liposuction with the SmartLipo MPX system that my patients really appreciate. I mentioned how this procedure has minimal recovery time, is fairly painless, has little to no bruising and can actually tighten skin. What I left out is that I perform this procedure in my office operating suite. There is no need to go to a surgical center or hospital; no need to subject yourself to sedation or general anesthesia; no need to pay operating fees or anesthesia fees. Laser liposuction is performed as an outpatient procedure in the privacy of my office, under local anesthesia, with minimal pain or discomfort.
A final note: I want to emphasize that laser liposuction devices are very powerful and can have undesirable results if not utilized by a medical professional with proper training. Please take the time to research the surgeon that you would consider choosing for laser liposuction. It is reasonable to inquire about their training and to request before and after pictures. In the end, the technology is only as effective as the practitioner utilizing it.
Why Cutera is Right for AIPRS – and You
Why I Chose the Cutera XEO Laser Platform for the Aspen Institute of Plastic & Reconstructive Surgery
Laser Mania
Lasers are everywhere. They play a role in almost every facet of our life. From steel production to medical procedures, lasers are continually utilized for their precision and dependability. (Lasers are not just for Sci Fi movies anymore!) It is interesting to consider what the scientists who invented lasers in the 1950s would think of their discovery now. This is especially true for cosmetic lasers. Everywhere you turn, a dermatologist, aesthetic physician, facial plastic surgeon or plastic & reconstructive surgeon is touting the latest and greatest laser therapy treatment. It is laser mania.
Many patients ask if they need a laser treatment but most have no idea what these treatments involve. It is rare for a patient to understand how these lasers work or why we choose to use them, especially in concert with other treatments. There is an overwhelming amount of diversity in the type and quality of lasers used in my field. One could spend days researching these devices and still have little tangible information to determine what makes one laser platform more desirable than the other. In the hopes of helping you avoid endless hours of Google/Bing searches, I have put together a short paragraph on how a laser works.
Warning: Please drink the extra cup of coffee or caffeine-infused tea now to avoid falling asleep.
LASER 101: The word laser is actually an acronym for Light Amplification by the Stimulated Emission of Radiation. Lasers have one primary function: they emit a strong and uniform beam of light. Remember from your fifth grade science class that all light (visible and non-visible) is measured in wavelengths. Most light, like light from the sun or a light bulb, is not uniform since there are multiple wavelengths present (all visible colors mixed together into a white light). Lasers, on the other hand, can emit one specific wavelength of light, technically termed “monochromatic light”. What really makes lasers unique is that these devices not only emit light at one predetermined wavelength, but they are done so with a large amount of energy focused on either very small or large surface areas. As it pertains to cosmetic lasers, they can be made to produce focused light, at a specific wavelength, at a specific level of energy, at a specific depth of skin penetration, and for a specific amount of time.
Laser Wavelengths are the Key
So what does this have to do with making your face look better? Here is why this matters: what has been found over decades of research is that different wavelengths of light are absorbed by different aspects of the skin. Pigmented skin spots, hair follicles, small blood vessels, wrinkled skin, and tattoos are all affected by different wavelengths of light. In the end, a laser emits a strong and focused light that positively affects different parts of the skin depending primarily on the set wavelength. By focusing a lot of energy into the skin, it removes the problem area, makes skin look more youthful and helps new skin cells grow.
The next obvious question is: If the effect of a laser really only depends on the wavelength of light emitted, is there any difference between two lasers from two different companies that emit the same wavelength of light? The answer is categorically, YES.
Best Choice for Laser
When I purchased my laser system for my office here in Aspen, Colorado, I conducted extensive research into the higher-end systems on the market. Most had similar capabilities, but in the end I chose the Cutera XEO system. Below is a list of reasons why I believe the Cutera XEO system is the best cosmetic laser platform on the market:
1. The most important aspencts of my laser system choice were dependability and accuracy. Clearly, it would be very unsafe to have a laser that does not function consistently over time. Imagine if your doctor found the optimal setting on the laser for hair removal that worked well for a majority of patients, but the setting proved not to be accurate and the patient had an undesirable outcome like scarring. Many lesser-priced laser systems are poorly engineered and do not offer a high level of dependability. Unfortunately, many practices choose lower-level systems to save on the costs of equipment. The patients are left with the results from an inferior laser system that ultimately leads to higher levels of dissatisfaction.
2. During my extensive evaluation process, I was also very impressed with the diversity of treatments that could be done with the Cutera XEO system:
- LimeLight for pigmented skin spots and small blood vessels (including spider veins)
- ProWave for hair removal
- Genesis and Titan for skin tightening
- Pearl and Pearl Fractional to improve skin quality and to remove wrinkles
Even though other systems offer this wide of a range of treatments, I found that the Cutera XEO system performed better in each category. It is analogous to a sports team that is fortunate to have the best player in the league at every position. This does not guarantee that the outcomes of treatment would be perfect (that is why good doctors and laser technicians are very important) but it does provide you with the best options for treatment.
3. The Cutera XEO system is ergonomic. It is clear that the designers of this system really considered how the laser would be used by the doctor or aesthetician in the clinical setting. All of the handles and attachments work well during treatment. The safe settings are pre-programmed into the system to avoid inadvertent and unsafe elevation of the settings during treatment. Moreover, the interface, where the settings are controlled, is extremely simple to use. The laser is also easy to clean, insuring that patients have a hygienic environment during a procedure. Furthermore, Cutera offers the most comprehensive and long term warranty of any major laser distributor, thus ensuring that any issues will be fixed in a timely manner.
4. I was impressed with Cutera’s company philosophy. As with high-end automobile manufacturers, Cutera takes excellent care during the research and development phase of these lasers to confirm a higher level of functionality. Given their emphasis on due diligence, they do not flood the market with new lasers every few months. Furthermore, the company realizes that a cosmetic laser is additive and does not replace sound basic skin care. Cutera encourages the use of other products along with their laser treatments, like Obagi, with the understanding that outcomes will be improved with a multi-prong approach.
In a future post, I will delve into the specifics of each type of laser treatments. Check out the links above to broaden your knowledge of cosmetic lasers.
The most important advice I can give to any patient considering a laser procedure is to do your homework. Make sure that the facility that offers these treatments has a high-quality laser device and a medical doctor on site. In our clinic in Aspen, Colorado, we have two Board Certified Plastic Surgeons administering a large majority of our laser treatments. Any treatments that are not completed by the physician are directed by the physician on site. Furthermore, we have the most advanced laser system in our region. These two essential factors give our patients a high level of confidence that their laser treatments will be effective and successful.
One last point. I do not work for Cutera and I have no financial interest in their company. Other laser platforms are available from companies like Palomar and Cynosure that I believe are competitive. But from an objective standpoint and from a slightly subjective standpoint (I have had this laser for a year now), the Cutera XEO system is hands down the winner.
Breast Reconstruction After Breast Cancer
What Every Woman Needs to Know About Breast Reconstruction After Breast Cancer
Throughout my career practicing both reconstructive and cosmetic surgery, I have had the honor of caring for breast cancer patients, and have specialized in breast reconstruction surgery. Each year more than 254,000 American women are faced with the diagnosis of breast cancer. While breast reconstruction is not an option for all, it can help a majority of the patients regain the confidence and body image that they possessed before their diagnosis.
Once a patient is diagnosed with breast cancer, I spend a considerable amount of time educating her on all the surgical options for breast reconstruction. In general, this will include either utilizing a patient’s own tissue (autologous) or relying on breast implants to obtain a desirable breast shape. Each option has its benefits.
When considering one’s own tissue, the most common source is the abdominal skin, soft tissue and muscle (Transverse Rectus Abdominal Myocutaneous flap, TRAM). It has a very similar feel to the native breast and, if done correctly, has a very desirable cosmetic outcome. Although not every patient is a candidate for this type of procedure, it is often recommended in cases where patients will also require radiation treatment. If the patient has minimal excess abdominal skin and soft tissue, back muscle and skin can be used for reconstruction with a breast implant (Latissimus Dorsi Flap). Most recently, new advances in microsurgery has offered patients a less invasive option for utilizing one’s own abdominal tissue (Deep Inferior Epigastric Perforator Flap, DIEP). Each of these surgical options has their notable benefits, but as recovery from these types of procedures tends to be prolonged, patients with active lifestyles often choose alternative types of reconstruction.
In comparison, implants offer a much less invasive option for breast reconstruction with a desirable aesthetic result. With the new advancements in implant technology, we now offer our patients more natural-feeling implants that have a desirable anatomic shape. Furthermore, the non-affected breast can be lifted or enhanced with a breast implant to improve symmetry with the reconstructed breast. This is often a two staged procedure that is initiated with placement of a tissue expander during the mastectomy. The tissue expander is then slowly inflated over a three to four week period and then a permanent implant is placed. (This may be delayed if radiation or other interventions are necessary.) This ensures that the newly reconstructed breast will have a tear drop shape that women desire. One point of consideration is that a patient should expect that breast implants will require a replacement or revisions within 10 to 15 years of their original surgery.
An open dialogue should exist between the patient and the specialist involved in her care. This would include the general surgeon, plastic surgeon, oncologist, radiation oncologist, radiologist and physical therapist. It is this cooperation that ensures the most seamless pre- and post-operative care and ensures that the patient receives the best treatment regardless of the option she chooses. Here are a few questions concerning breast reconstruction that I think are important to address in the pre-operative setting:
1. Will I need radiation treatment or chemotherapy following my procedure?
2. Am I a candidate for a nipple sparring or short incision mastectomy?
3. Am I a candidate for autologous tissue reconstruction?
4. If I choose implant reconstruction, am I a candidate for shortened tissue expansion (less than two weeks)?
5. Do I have any risk factors or anatomical characteristics that preclude me from proceeding with a specific type of reconstruction?
Although breast reconstructive procedures can have varying results, a patient should expect that any reconstructive surgery should create a desirable breast shape and volume that is symmetrical to the opposite breast. Patients should request to view pre-operative and post-operative photographs and have an open and honest discussion with their plastic surgeon. In my clinic, many patients feel that these procedures actually improve the appearance of their breasts, especially when the native breasts have lost their desirable shape after pregnancy. Furthermore, with new advances in nipple and areola reconstruction, the final results of the reconstruction can appear very realistic.
Here are some links to valuable resources for women considering breast reconstruction:
1. Susan G. Komen for the Cure
2. Komen Aspen
3. The American Society of Plastic Surgeons Breast Reconstruction Resources
October is breast cancer awareness month. Dr. W. Jason Martin, a board-certified reconstructive and plastic surgeon, is on the advisory board of Komen Aspen and specializes in the care of breast cancer patients who require breast reconstruction procedures.
Skincare Fact Versus Fiction
As a Board Certified Plastic and Reconstructive surgeon, many patients come to my office specifically for skin care consultations. I’ve found patients often confused about the basic techniques that maintain skin health, how to avoid skin cancer and slow skin changes from aging, lifestyle and the environment.
As sales of medical-based skin care products easily exceed a billion dollars per year, patients are inundated with some outrageous claims and unrealistic promises about results that can be achieved by using many of these products.
Here is a tag line that was associated with a medical grade skin care line that recently made me laugh out loud: ‘The complete non-surgical facelift’
It leaves me wondering if this skin care line also comes with fairy dust and a magic wand. All humor aside, these kinds of claims leave patients with little concrete information and unrealistic expectations.
Fact: Retin-A Really Works
Seeking the advice from a Board Certified Plastic and Reconstructive Surgeon or Dermatologist can help debunk skincare miracle myths.
In my skin care consultations, I obtain a comprehensive history and physical assessment that focus on past skin damage, skin cancer history and a patient’s current skin issues. A treatment plan is formulated and the patient is educated on how this treatment plan will work for them. What surprises most of these patients is that in addition to sunscreen, a Retin-A based product (topical tretinoin) is by far the most important topical skin care treatment that can be included in their treatment plan.
To make my point, I often say:
“If you are stranded on a tropical island for 10 years and you only have access to one skin care product (besides sunscreen, of course) that will maintain youthful appearing skin….no question, Retin-A is the choice”
So how does Retin-A, a product that was developed over 25 years ago as a derivative of Vitamin A, take precedence over all the new topical medications, lotions, gels and ointments? It is simple: time has shown that Retin-A really works, both by itself and in concert with other treatments including lasers and deep peels. Avoiding overly complicated scientific explanations, Retin-A thins the outermost layer of the skin (stratum corneum), thickens the deep layer of the skin (dermis) while stimulating collagen production. Below is a basic list of the research-proven disorders proven that Retin-A treats:
- Acne (primary use per FDA)
- Hyperpigmentation (age spots, sunspots, freckles)
- Actinic Keratosis (precursor to skin cancer)
- Fine wrinkles
- Poor Skin Texture (deep pores)
- Keratosis follicularis (skin disorder of small, red bumps)
- Verruca plana (flat warts)
It all sounds great when you review that list. A topical cream that treats acne, gets rid of brown spots and reduces the visibility of fine wrinkles and deep pores while treating pre-cancerous skin lesions. Sign me up!
Unfortunately, as life teaches us all, everything has a cost. In the case of Retin-A, it is the expected side effects. Topical Retin-A application can make the skin red, flakey and irritated. It also makes the skin more photosensitive thus decreases the amount and time of sun exposure that can cause sunburns. It is these types of effects that lead people to discontinue the application or refuse to initiate treatment.
As we have gained more experience with this product, our ability to control these side effects has immensely improved. Take my practice for example. Although my office is in Aspen, Colorado, and the environmental effects are magnified (bright sun, rather dry climate, high altitude) I am able to continually maintain my patients on topical Retin-A creams. We have opted for combining topical Retin-A with an Obagi Nu Derm treatment protocol that helps reduce these side effects while augmenting the effects of Retin-A. In those patients with extremely sensitive skin, I often reduce the concentration of the Retin-A while keeping the application to every other day (versus daily). The only subset of patients for whom I avoid Retin-A application are pregnant women or women who are not using contraception during their during child-bearing years.
Many Products Make Outrageous Claims. Retin-A Really Works.
Useful Web article from DermaDoctor.com (warning: this is a for-profit site)
Useful Scientific Articles:
- Griffiths CE. The role of retinoids in the prevention and repair of aged and photoaged skin Clin Exp Dermatol 2001, 26(7):613-618
- Griffiths CE, Dabelsteen E, Voorhees JJ. Topical retinoic acid changes the epidermal cell surface glycosylation pattern towards that of a mucosal epithelium. Br J Dermatol. 1996 Mar;134(3):431-6
- Glaser DA, Rogers C. Topical and systemic therapies for the aging face. Facial Plast Surg Clin North Am 2001, 9(2):189-196
- Whitmore, SE. Restoration of collagen formation in photodamaged human skin by tretinoin (retinoic acid). N Engl J Med 1993;329:530-535.
Welcome to the AIPRS Blog
