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.)

The Food and Drug Administration (FDA) in the US has issued warning letters to six medical spas and a Brazilian company, saying they made false or misleading statements that “lipodissolve” procedures are safe and effective, or otherwise misbranded the products.

Lipodissolve involves drug injections intended to dissolve and remove small pockets of fat. Lipodissolve is also known as mesotherapy, lipozap, lipotherapy, or injection lipolysis. The drugs most often used for lipodissolve procedures are combinations of phosphatidylcholine and deoxycholate, but sometimes ingredients such as vitamins, minerals and herbal extracts are included in lipodissolve mixtures, according to the FDA. The agency said it is not aware of any credible scientific evidence that supports the effectiveness or safety of lipodissolve for fat elimination.

Also, some of these companies have claimed that lipodissolve can treat certain medical conditions, such as male breast enlargement (gynaecomastia), benign fatty tumours called lipomas, excess fat deposits and surgical deformities. Once again, the FDA is not aware of any clinical evidence to support any of these claims.

Furthermore, FDA officials have received reports of negative side effects from people who have tried the procedure, including permanent scarring, skin deformation, and deep painful knots under the skin in areas where lipodissolve drugs were injected.

What’s my take on things? Whenever a new beauty product or service comes out, the bell curve tends to indicate how any population will respond to the new technology. Starting on the left side of the bell curve, group 1, are  the innovators (usually geeks and nerds) which are few but brave people that are willing to try things that are on the cutting edge. They are followed by group 2, the early adopters, that love and embrace new stuff and ideas that helps them improve their self-esteem. Then, there is group 3, that picks up new ideas a little more slowly and the next, group 4, that completes the mass market (3 and 4 make up  the middle third of the bell curve). The last one, group 5, are the laggards, who usually have very little interest in such things.

I feel that cosmetic patients should place themselves in groups 3 or 4, as this allows enough time, usually 12-24 months, for risks and complications of these products and services to manifest themselves. After all, there is no reason for you to be the guinea pig, is there? The simple rule is: buyer beware! Wait until the jury is out before you decide on a product or service and do your own due diligence.

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.

Flabby bellies are notoriously difficult to control through diet and exercise. Liposuction may be beneficial for someone who has extra fat around the abdomen, but anyone who also has lost muscle tone and developed extra sagging skin will require abdominoplasty, otherwise known as “tummy tuck”, to achieve a flatter waistline. A tummy tuck addresses all three major problem areas at once. In one operation we remove excess fat, saggy skin and tighten abdominal muscles that may have become distended with pregnancy or age.

Men and women can develop abdominal wall weaknesses as they age that can be repaired during a tummy tuck. During pregnancy, women lose their waistline as a result of the spreading of the surrounding abdominal muscles. This spreading is referred to as ‘diastasis rectii’ and is not an actual hernia but does cause a bulge from the pubic area to just above the belly button. Men may also experience this spreading following weight gain or in the presence of abdominal hernias.

The modern tummy tuck is not only a removal of skin but also an operation on fat, and muscle. Incisions for a tummy tuck are made below the bathing suit line from hipbone to hipbone and are generally tailored to the patient’s wishes. Some female patients prefer to wear French cut bathing suits. In that case the incision comes up a little higher on the side extension. For those patients who prefer a traditional cut swim suit, the incision is made right at the hip line. In all cases, the incision and resulting scar are fashioned to meet the patient’s wishes and afford them complete camouflage in a bikini or other bathing suit.

Another incision is made around the belly button. While the belly button is left intact, the tissues beneath are elevated from the lower abdomen to the rib cage area and redundant skin is removed, exposing the abdominal wall. At that point, the abdominal wall is tightened by suturing together the abdominal muscles and repairing any damage that occurred during pregnancy or weight gain. At no time are these muscles actually cut. It is the tightening of the muscles that really reduces the waistline. We then perform liposuction on the abdominal wall, waist, hips and “love handles” in an effort to create a smooth, pleasing contour across the entire waistline.

Finally, the abdominal skin above the belly button is stretched down to the meet the incision at the pubic hairline. A small incision is made for the belly button, which will reach back through the abdominal wall as usual. The shape and nature of the belly button doesn’t change unless a patient specifically requests it. Any hernias of the belly button can be corrected. For example, ‘outies’ can be made ‘innies’ or it can be made a bit smaller if the patient so desires.

Patients are usually instructed to wear a girdle or medical compression garment over the entire abdominal area to provide support and comfort while healing. It takes generally two to three weeks to make a complete recovery, and most of our abdominoplasty patients are back to work within three to four weeks.

If you desire a firmer, more youthful-looking body contour, then a surgical body lift may help achieve your goals. It improves the shape and tone of the underlying tissue that supports fat and skin. In addition, the procedure(s) can improve a dimpled, irregular skin surface, commonly known as cellulite.

Body lift surgery essentially sculpts the body by excision of excess skin and fat and reconstruction of what remains into attractive contours. A body lift may include these areas:

1) abdominal area, locally or extending around the sides and into the lower back area

2) buttocks, that may be low, flat or shaped unevenly;

3) groin that may sag into the inner thigh

4) thigh, including the inner, outer, or posterior thigh, or circumferentially

Body lift is performed under general anaesthesia, with the patient positioned on their stomach, and the surgeon removes a large, belt-like segment of skin above the buttocks, up to the lower back. When the wound is closed, the thighs and buttocks are lifted. The patient is turned over and the surgeon continues to work on the front of the thighs and abdomen. Indeed, when a surgeon performs a circumferential removal of skin and fat of the lower abdomen, and when combined with undermining of the thighs, it will lead to a lift of the buttocks and thighs. A body lift can be done in two stages, with a three-month gap between procedures, or as a single-stage surgery.

The results of a body lift are visible almost immediately. However, it may take as much as one to two years, or more, for the final results of the body lift procedures to fully develop. Since weight loss patients have poor skin elasticity, closure must be as tight as possible. However, over-resection of skin followed by overly tight closure of the tissues can lead to wound rupture or to broadly depressed scars resulting from suture pull through, breakage or premature dissolution. At the same time, insufficient removal of skin and low tension closure leaves sagging tissues, skin rolls and/or wrinkles.

A body lift should be seen as a critical step in overcoming obesity, with the potential of ceasing or reducing medications used for diabetes and high blood pressure. Patients need to take steps following surgery to maintain a healthy lifestyle, ensuring that their new shape will be long term.

Injection lipolysis and mesotherapy are not one and the same. Lipodissolve is a trade name created to describe a patent-pending protocol that has been standardised since 2001. The theory of Lipodissolve was developed in the 1990s but the problem still remains that there are no conclusive outcomes from major trials worldwide on the use of such injections.

Currently, doctors have been considering injection lipolysis for cosmetic purposes with two central ingredients: phosphatidylcholine and deoxycholate (PC/DC formula):

• Phosphatidylcholine is a natural glycerolphospholipid comprised of glycerol, two fatty acids, and choline attached. Phosphatidylcholine is a fat emulsifier vital for cholesterol metabolism, and is a component of cell membranes. Phosphatidylcholine also can be found in foods and is currently a dietary supplement, taken in oral form. Although phosphatidylcholine is one of several ingredients used in certain FDA-approved intravenous drugs, it is not FDA-approved in combination with deoxycholate or for use in aesthetic intravenous purposes.
• Sodium deoxycholate, the active ingredient in PC/DC formulas, causes fat cells to undergo a process called oncosis when injected into the fatty layer. Oncosis is basically acute cellular swelling, and the damage caused to the cell membrane cannot be repaired by the cell in many cases. With deoxycholate alone, a very rapid onset of cell death is seen in a very localized region—within the immediate injection area. When phosphatidylcholine is added, the reaction is less harsh and is spread out a little more, causing a more even reduction of fat when the treatment area has a broad surface. A formula combining phosphatidylcholine and deoxycholate is currently the most popular fat-reducing injectable solution, based on its history of efficacy and safety when properly used by doctors. In addition, phosphatidylcholine acts as a buffer to the alkaline deoxycholate, which allows the reaction to progress over a week rather than several hours. More finesse and a smoother result can be seen when the two ingredients are combined.

On the other hand, a mesotherapy treatment may be comprised of many different ingredients. The selection of the ingredients is related to a specific procedure mesotherapy is intended to treat. Those ingredients may include vasodilators, anti-inflammatory drugs, muscle relaxants, proteolytic enzymes, vitamins, minerals, plant extracts, vaccines, antibiotics, hormones, hormone blockers, and anaesthetics. When we explore the history of mesotherapy in Europe, we learn that it is considered a credible procedure that is used for chronic pain and sports injuries. In truth, mesotherapy injection techniques are widely used throughout the world today.

We need to learn more about the effect of treatment of injection lipolysis on body fat mass, fat tissue metabolic function, and systematic markers of metabolism and inflammation; as well as determine mechanisms for fat reduction, side effects, and patient satisfaction. Questions about injection lipolysis still remain including what is the appropriate dose per injection and what is the appropriate total dose per body surface area.

In the future, injection lipolysis may be an adjunct to treatment or the only treatment for small fatty areas, but is unsuitable when compared to the results that can be accomplished through surgical treatment at present. Furthermore, it is my opinion that injection lipolysis should not be implemented in practices until it has been fully studied scientifically to help prove or disprove certain facts. It is our responsibility as doctors to inform and educate our patients and the public about these new treatments.

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.

The latest craze in cosmetic surgery is the belly button makeover. With summer just around the corner and trips to beaches planned, more and more women are opting for “umbilicoplasties” for the perfect belly button. Though this procedure is usually done along with a tummy tuck, it is now being done to change an outward protruding belly button to an “innie”. Some women also request for a vertical or a hooded job.

The belly button is formed when the umbilical cord is removed after birth. Some women consider this as a fashion statement and with the fashion trends of belly button piercings etc, more women are paying attention to the belly button. For the majority of the women the belly button is normal, however, sometimes women have the belly button with a protrusion instead. This can also happen after weight loss or pregnancy when the skin becomes loose and hangs over the belly button.

Umbilicoplasties usually involve the use of local anaesthesia. To make an outie an innie, a surgeon makes an incision on the perimeter of the belly button and tacks it down to the muscle lining with sutures. Extra skin around the belly button is also trimmed off. This is a relatively simple procedure which takes around 30 to 90 minutes to perform. Side effects are possible such as tissue injury, bleeding and infection. The recovery period from this surgery is under a week.

Umbilicoplasties offer a smoother, natural and fashionable looking belly button and is ideal for women in the late 20’s or mid 40’s who wish to wear low rise jeans showing off their belly buttons and their belly button piercing.

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.

Many women that I see for body contouring usually have tried exercise and dieting to some extent or other prior to resorting to liposuction or surgery. A minority of women have taken drastic measures like excessive gymming or starvation diets to try and fit into single digit or low teen dress sizes. This can, however, cause irreparable health problems like the following:

• no menstrual cycle or abnormal menstruation in women.
• prevent women from becoming pregnant.
• cause premature delivery, birth of low-weight babies who are also undernourished.
• loss of libido due to suppression of Follicle Stimulating Hormone (FSH) and other secondary sex hormones in the brain.
• suppress the hypothalamic-pituitary-adrenal axis which is responsible for the release of sex hormones
• anorexia or poor nutrition can lead to osteoporosis.

My advice is that no weight loss or fitness program should be undertaken without the direct supervision of your doctor. Whether you should lose weight, how much you should lose and how you should lose it are decisions that should be made by a medical professional, who may need to refer you to a nutritionist or endocrinologist for further work-up and counselling. If you want to lose weight and keep it off, your doctor must be part of the equation.