There are various methods of treating fat. In 2010, more and more women are having liposuction to remove fat from various parts of their body, and others have undergone stomach-firming tummy tucks. More recently, plastic surgeons along with scientists, have developed several new nonsurgical methods to reduce fat and sculpt the body.

Just to recap, liposuction treats fat deposits that are resistant to diet and exercise, such as saddlebags or the flanks, which means it’s not a substitute for traditional weight loss. In fact, diet and exercise are essential before and after the procedure to obtain the best results.  One thing for sure is that liposuction can’t eliminate stretch marks or cellulite, and it may even make cellulite more pronounced. Once the fat is taken out, we can’t predict or control how much the overlying skin will contract. In general, patients with good skin tone will experience tightening as the skin redistributes itself. But others with thin, soft skin may develop sagging in the areas suctioned.

About 20 % of patients request a redo following liposuction usually for unevenness or a lumpy look, in which case the plastic surgeon can usually do a touch-up by removing more fat. Another potential complication is “track marks”, the result of fat taken too close to the skin’s surface, which can be more difficult to treat. Also, if you gain weight after liposuction, you may find it collecting in areas on the body that have not been liposuctioned. The redistribution is unpredictable.

At the recent ISAPS 2010 Conference in San Francisco in August 14-18, plastic surgeons and others were developing alternative and noninvasive ways to remove fat, but for now liposuction is still considered the gold standard. A lot of work has been done in the exciting field of fat grafting which can be used for both cosmetic and reconstructive reasons. The plastic surgeon injects part of the body, usually the face or breasts, with the patient’s body fat (extracted from the abdomen, thighs, or buttocks) to smooth lines and fill hollows. Many of the injected fat cells don’t survive, and there can be loss of volume over time, so we usually overfill the area to compensate. But the final outcome may still look overdone, and if a patient gains weight, the grafted fat can grow.

In laser-assisted liposuction (LAL), fat is loosened with a laser before being suctioned out, which is why it can take twice as long to perform (same thing for ultrasound-assisted liposuction (UAL)). The laser is said to stimulate collagen and elastin repair in the overlying skin and to result in less bruising than regular liposuction, because it coagulates blood vessels. LAL may benefit older patients who have lost elasticity and may be best for relatively small areas without thick fat, such as under the chin. Some doctors are skeptical of using lasers this way, pointing out that there currently isn’t scientific data to support the claimed benefits. Also, you are potentially heating the skin to dangerous levels in order to achieve skin tightening (there have been some burns reported from LAL. There are several LAL devices, including SmartLipo, SlimLipo, ProLipo, and LipoLite. A new one, LipoEze, can remove large quantities of fat and presents no risk of burns, because the laser is positioned inside the suction tube away from the skin.

What about fat-melting injections? 
These shots sound good , but not to the FDA, at least for now. The agency has threatened legal action against medspas advertising fat-dissolving procedures called lipodissolve, lipozap, lipotherapy, injection lipolysis, or mesotherapy. None of the chemicals, drugs, vitamins, minerals, or herbal extracts in these injections are FDA-approved to eliminate fat, and the FDA cites “reports of permanent scarring, skin deformation, and deep, painful knots in the injected areas.” Studies are under way to find out which ingredients, if any, might work, and some injectable drugs show promising, though modest, results.

More recently, the least invasive fat removal option has been Zeltiq, a device applied to the skin, that chills fat cells, enabling the body to process and excrete the fat. Studies suggest that this treatment (also known as cryolipolysis) is for very fit people with isolated fat deposits, however, the procedure is slow, and the results take a long time, up to four months, to show. Zeltiq is cleared for localised fat reduction in Canada; in the USA, it is FDA-approved only for skin cooling during dermatological treatments, and doctors are using it off-label. I am currently not aware of its use in Australia.

Last of all, when do you need a tummy tuck? If the issue is simply extra fat, plastic surgeons generally recommend liposuction, but if there is very loose skin and muscle-wall weakness, which is not unusual in women who have given birth, then a tummy tuck may be preferable. This tightens the muscles and repositions the skin, forming a new belly button, as well as removing the fat. (A mini tummy tuck, which targets small amounts of excess skin and abdominal weakness, usually involves a shorter scar and recovery.)

These are my top 10 hints for looking good this year:

1. Eat well. Preferably, eat smaller meals as the day goes by and eat frequently. Make it a habit not to eat after 9 pm.

2. Exercise regularly. Remember, a “healthy body, healthy mind!”

3. Keep your weight stable and within normal limits. Being overweight can predispose you to certain cancers and diabetes, not to mention, heart attacks, strokes and leg ulcers.

4. Get your general practitioner to do a physical examination and if necessary, run some basic blood tests.

5. Avoid the 4 “S”: sun, stress, smoking and sleepless nights. These can hasten your aging!

6. Think skin rejuvination ie. microdermabrasion, peels and laser skin tightening. These will give your skin a definite glow!

7. Start getting anti-wrinkle injections to iron-out those wrinkles that make you look tired and cranky!

8. Use fillers to pump-up that lost volume in the cheeks etc. As we age, fat melts away in certain pockets in the face as does the underlying bony platform. The end result is excess skin that combines with gravity to make it sag. This effect can be countered by using either synthetic fillers or fat injections.

9. Think minimal scar surgery to rejuvinate the face eg. a neck lift or remove those bags under the eyes.

10. Think about surgical rejuvination of the upper eyelids and brows by giving them a lift. The eyes and brows are often the first signs of aging in a woman and they usually start to sag in their early 40s. Remember, “the eyes are the windows of your soul” and may tell us a lot about your self-esteem and body image.

CosmeticCulture is very pleased to announce that we are now offering laser treatment for vascular lesions using the state-of-the-art Vbeam™ Pulsed Dye Laser. With this exciting new technology, we can treat facial veins, sun and age spots, rosacea, scars, warts, stretch marks, fine lines and wrinkles, leg veins, freckles, port wine stains and psoriasis – quickly, conveniently and without pain.

The most exciting aspect of Vbeam technology is that it offers effective laser treatment without the temporary bruising sometimes seen with earlier pulsed dye laser technology, making it quick and convenient for a “lunchtime treatment”. And, Vbeam is so gentle and safe that it can be used to treat infants and children as well as adults.

The Vbeam features a patented Dynamic Cooling Device™ (DCD) that sprays a fine mist of cryogen prior to the laser pulse. This device prevents pain, protects the skin, and enables the laser energy to reach down and gently heat the targeted blood vessels.

Our new Vbeam laser is regarded industry wide as the gold standard for vascular treatment, and now it treats brown spots too. Typical sessions take just a few minutes and yield very gratifying, visible results.

For an appointment to discuss or receive Vbeam laser treatment, call CosmeticCulture at 1-300-GO-COSMETIC.

As we age, the fat compartments found in all areas of the face—including the mouth, cheeks, eyes, and forehead—age at different rates and change in shape, causing hollows and sagging. New research claims that returning volume to these fat compartments improves volume loss under the eyes, eliminates lines around the nose and mouth, and gives more curve to the upper lip, restoring a youthful overall appearance.

When we perform eyelid and brow surgery for the upper face, lip enhancement, liposuction, and facelift for the lower face, we tend to forget about the midface. This is why so many patients have an ‘operated’ look. They were made to look pulled and tighter, but not younger.  One of the key fat compartments (for a youthful look) that the researchers found was deep in the cheeks. They reported that the size of this compartment decreases as we age, leading to “hollowing” of the face, excess skin and the formation of folds that form around the nasolabial folds.

If volume is restored to this deep fat compartment in the cheeks, using either fat, cosmetic fillers, or implants, the result is an immediate improvement in the hollowing of the face and an improvement in the nasolabial folds, more volume in the eyes, which improves the “v-deformity” of the lower lid, and changes in the shape of the lips.  When the injection was done correctly, a smaller volume of fat or filler is needed.

There are several ways to resculpt the face and increase volume in the cheeks. Some options include fat injections, also called liposculpture; collagen and other soft tissue fillers and implants:

Liposculpture uses the patient’s own fat to fill in areas of the face, reducing the chance of infection. The fat can be harvested from multiple sites, providing a natural look.

Collagen and other soft tissue fillers can be used to fill in lines and give the skin a plumper and smoother appearance. When injected beneath the skin, these fillers plump up lines and wrinkles and add fullness to sunken areas of the face.

Facial implants are also used to improve and enhance facial contours. Frequently, these implants will help provide a more harmonious balance to your face and features so that you feel better about the way you look. There are many implants available, manufactured from a variety of materials. They may help strengthen a jawl ine or bring the chin or cheekbones into balance with the rest of the face.

So the key thing to note is that lifting and tightening tends to give a flattened and “older look”. Pumping up the volume in specific areas of the face leads to a more younger, fuller, “better looking” face.

There is no such thing as a single “best” laser for hair removal on all patients. The best laser for laser hair removal for each person really depends on his or her skin colour. Thus, multiple lasers exist for hair removal. Different laser types, which emit distinct wavelengths of light, are better for treating different skin types. There are a number of manufacturers that make these laser types:

• Alexandrite lasers emit laser light at 755 nm. These lasers work best on lighter skin. In my opinion, it has been the most impressive laser for hair removal for light to olive skin types.
• Diode Lasers. These emit light at a wavelength of 810 nm. Lighter skin types do well with this type of laser, as do some darker skin types.
• Nd:YAG lasers. These emit a 1064 nm wavelength. This laser is best for darker skin types, as the higher wavelength reaches deeper into the skin. This helps to avoid superficial skin melanin, which pigments our skin.
• IPL, or Intense Pulsed Light, has been used for hair removal. Lasers emit light at one wavelength (like laser pointers in powerpoint presentations). IPL machines produce a range of wavelengths (like the cone of light from a torch one sees in cartoons), and are not lasers. So there is no such thing as an “IPL laser” or “IPL laser hair removal”- it’s a marketing ploy for businesses that have IPL machines and not hair removal lasers (the only exception to the rule are the few machines out there that have both lasers and IPL machines in them). Several studies have shown that IPL is not as effective as dedicated hair removal lasers, and carry higher risk of burns, blisters and changes in pigment.

In my experience, the Alexandrite laser is the most effective laser for removing hair on lighter skin, whereas the Nd:YAG is the safest and best laser for more darkly pigmented skin. Remember, every laser has a “target.” For hair removal lasers, the goal is to selectively target the pigment (in other words colour) which in this case is called melanin found in hair follicles. Melanin is the reason why we have black or brown hair or shades in between. The hair follicles are living cells which make hair below the surface of the skin. When the melanin is selectively heated, this destroys the hair follicle cells. The lighter the hair, the less melanin the hair follicles will have in them. As a result, hair that is blond, white or grey does not improve with laser hair removal. In my practice, I have actually seen some patients notice a decrease in lighter hairs, but it’s the exception and not the rule.

Melanin is also present in skin and is the cause for dark skin and suntans. It is the same target that the hair removal laser is trying to reach in hair follicles. Hair removal lasers may target the melanin in skin as well as in the hair follicles which sometimes results in burns, blisters and change in skin pigmentation. As a result, lower settings and longer laser pulse times must be used for darker skin to avoid damage. As a consequence, more overall treatment sessions will usually be necessary.

Remember, laser hair removal is a medical procedure and you should always consult with a doctor who has extensive experience in lasers and laser hair removal. This will maximise your chances of a great result.

Anti-wrinkle injections are currently the most common medical cosmetic treatment. There have been 17 million injections that have been safely administered for cosmetic purposes alone since 2002. It is currently approved for treatment of glabella wrinkles, which are the frown lines between the eyebrows. Any other treatments are considered “off-label” (a common and legal practice in which a drug is used for a purpose other than the officially approved one).

Here are some other interesting facts you should be aware of:

• Clostridium Botulinum (the bacteria that causes food poisoning) was first identified at the University of Gent, Belgium, in 1895.
• Anti-wrinkle injections consist of Botulinum toxin type A, which was isolated in the purified form by Dr Herman Sommer at the University of California in the 1920s.
• Botulinum toxin type A stops the release of certain chemicals at the junction between a nerve and a muscle, so the message for the muscle to “work” is blocked and therefore relaxes. Its anti-wrinkle properties were discovered in 1980s by Dr Jean Carruthers (an ophthalmologist) and her husband Arthur (a dematologist) when patients being treated for crossed eyes and facial spasms told their doctors that their lines and wrinkles had vanished since starting the injections.
• Anti-wrinkle injections are approved in more than 75 countries for 20 different neurological indications and approved for cosmetic use in more than 40 countries.
• In the 20-year history of using the drug for cosmetic treatments, there is no anecdotal evidence of any long-term problems because any muscle weakness from the injections is reversible because Botulinum toxin type A’s action is temporary.
• Botulinum toxin type A has been used in other conditions such as migraines, excessive sweating, incontinence, haemorrhoids and  has even been used on patients with gallstones.
• The cosmetic formulation uses a much lower dose of the toxin than the one used to treat major muscle spasms.
• Anti-wrinkle injections are not a panacea for every facial wrinkle. Those caused by other mechanisms such as hereditary, smoking, sun exposure, and the effects of gravity, do not respond adequately. Nor are anti-wrinkle injections  particularly effective for wrinkles around the mouth. Other treatments (such as Retin-A, chemical peels, collagen or fat injections, laser therapy, or facelifts) may help for people who wish to minimise these types of wrinkles.

A U.S. consumer advocate group called Public Citizen has recently asked the Food and Drug Administration (FDA) to reconsider the safety of anti-wrinkle treatments. However, my main issue with them is that they have grouped together adverse events from both the medical and cosmetic uses of the drug. They pointed to 180 cases of serious complications like pneumonia and difficulty breathing or swallowing, which included 16 deaths (collected from 9 full years of data). Earlier in 2005, The Centers for Disease Control and Prevention, reviewed 1,437 adverse reports: 406 after medical use of the toxin (217 of them were serious effects) and 1,031 after cosmetic use (36 of them serious). The proportion of serious reports was 33-fold higher for patients treated for medical problems than for those receiving cosmetic treatments and the worst disasters have occurred when unqualified practitioners administered the drug. The FDA has also confirmed that there has never been a reported death where a causal link to cosmetic use of anti-wrinkle injection was established.

Don’t forget that many cancer medications are derived from substances that in other contexts would be considered dangerous. And many other drugs that are licensed for a particular condition are used “off label” to treat other problems. Remember, all drugs have unwanted side-effects, so that with more people using anti-wrinkle injections, the list of unwanted effects may be growing.

Earlier this year, the Food and Drug Administration (FDA) which reviews the continuing safety of anti-wrinkle injections, notified the public about reports of their serious side-effects. Most of these, however, resulted from medical not cosmetic uses of the toxin. Medical treatments typically require much larger doses, and many of the patients have other health problems that increase their risk. For eg. to treat the furrows between the brows, a typical dose consists of 20-35 i.u.’s (intramuscular units) compared to over 200 for neuromuscular disorders. The reactions included respiratory failure (which sometimes was fatal) in a range of doses and uses, many of them “off-label” eg. limb spasticity associated with cerebral palsy in children.

So, my advice to patients and clients seeking anti-wrinkle injections would be:

• Choose your doctor or nurse injector carefully. They should be both experienced and competent, and make you feel safe and at ease.
• Injectables should be performed in an approved medical office or medical spa.
• Question the authenticity of the injectable. Ask to be shown the brand packaging.
• Pay close attention to the potential complications which should be thorougly discussed during the informed consent process.

Many of today’s mums don’t feel they should sacrifice the way they look just because they’ve had children. These women usually want their tummies and breasts back the way they looked before pregnancy. So tummy tucks, liposuction and breast lifts are popular procedures at CosmeticCulture, and we do a lot of them. These so called Mummy Makeovers are usually performed on women in their 30s or early 40s.

Often we place small breast implants for breast enlargement — not so much to increase size, but to give these women back the volume in the breasts (especially in the upper pole) that they have lost during and after pregnancy. This can be done on its own or as part of a breast lift. Whenever we do a tummy tuck as part of the Mummy Makeover, we perform liposuction and pay special attention to the belly button to help create a nice looking midriff.

Most Mummy Makeovers can be done during one surgery, but there are other times, when it is best to break the procedure up over several sessions. The patient’s body type and overall health will help us determine the best approach. We take many steps to assure both minimal pain and maximum safety during our procedures.

Many of our patients for the Mummy Makeover travel from places outside of Sydney. Our staff can help with the planning of these sorts of trips through our CosmeticCulture Makeover Vacation Programme, which makes travel for cosmetic surgery quite easy.

More information about is available on our website, including descriptions of tummy tuck and breast enlargement or breast lifts as well as liposuction. You can also email for more information at info@cosmeticculture.com.au or call us at any time at 1800-MED-SPA.

I’m constantly asked by patients whether nurses are truelly qualified to perform cosmetic injections. For me, the most important factor for any nurse injector is their relationship with an appropriately trained, supervising doctor, and how closely the nurse and doctor work together. That doctor can either be a plastic surgeon, dermatologist, facial plastic surgeon, or ophthalmic plastic surgeon who has prescribed the injectable treatment appropriate for the patient. Remember –50% of complications resulting from cosmetic injections are reported to result from unqualified providers, and that –33% result from injections administered in a non-medical setting, such as a hair salon or private home.

Patients always have the option to request the doctor perform cosmetic injections, but not infrequently, specifically ask for experienced nurse injectors. In the latter case, there are a few guidelines which I think are important for nurse injectors to adhere to. Firstly, they should demonstrate appropriate medical education and training specific to the delivery of cosmetic injections. Secondly, perform injections in a medical setting supervised by the prescribing doctor. Patients should not accept treatment from nurses or any other doctor in private homes, hair salons, hotels, bars or any other non-medical setting. Lastly, nurse injectors should follow all of the appropriate steps in performing cosmetic injections, and that all patients are given informed consent documents that clearly define the risks and benefits of the procedure.

No matter what, regardless of who delivers the injection, if I as the doctor prescribe the treatment, inevitably the patient outcome is my responsibility. Therefore, it’s incumbent on me to have well trained and expert nurse injectors, someone that I can trust to inject my family members and friends. And that exactly is what I do.