Liposuction - keys for success

In order to get a good quality result with liposuction, there are a couple of key factors. These can be nicely divided into "patient" and "surgeon" factors.

On the patient side:
1) Good skin elasticity. Probably the most important factor, as liposuction relies on the natural elastic recoil of the skin for the "shrinking up" effect that occurs after the procedure. Liposuction will not make loose, floppy skin tighter. People with loose skin are not good candidates for liposuction, and usually need some form of body-lift surgery (tummy tuck, etc.)

2) Liposuction is not: a cure for cellulite, or a weight-loss method.

On the surgeon side:
1) Remove the fat evenly and smoothly. Sounds obvious - but surgeon skill is a big part of getting good liposuction results. Experience counts. Don't over-do the suction in one area, or you'll risk a post-operative "divot". I prefer to maintain a little fat just below the skin, to reduce the risk of irregularities and grooves, avoiding what's known as "superficial liposuction".

2) Don't think that the "latest gadget" replaces the need for surgical skill. There's a great deal of marketing hype about new liposuction technology - and it's important to scientifically evaluate the often-exaggerated claims that a manufacturer makes. We've seen this type of hype recently with the wave of new laser-assisted liposuction machines.

Do I need a lift, Doctor?

A common question from patients who are considering a breast augmentation is whether they would need a breast lift or not.

There are several methods that plastic surgeons use to decide whether or not there is significant droop of the breast, known as "breast ptosis". Essentially, it all has to do with the position of the nipple, compared to the position of the crease underneath the breast, known as the "infra-mammary fold".

If the nipple is positioned above the horizontal level of the infra-mammary fold when you are standing up - then any ptosis you may have is considered "mild". If the nipple has descended below the level of the crease, then the breast droop is more significant, and you may indeed benefit from a breast lift, in addition to any augmentation you might be considering.

Another easy method to check for breast ptosis involves clasping your hands on top of your head, and looking at what happens to the nipple position in the mirror. If the nipple position is still too low for your liking, then a lift operation might be beneficial.

When the amount of droop is mild, often we can use a short-scar technique for the lift, avoiding the long anchor-shaped incisions used in the classic breast lift. The benelli or "donut" lift, for example, allows us to can use one circular incision around the nipple - and get three benefits with it: use it to place the implants, make the areola smaller in size, and get a little bit of a breast lift all at the same time.

Hello, Evolence!

Here's a new twist on an "old friend" - collagen is back, in a new & improved way. Known as Evolence - and don't ask me how they come up with these names - it's an FDA-approved filler with a good track record for wrinkle correction after being on the market several years in Europe. It's now available in the USA.

Compared to the old collagen products (Zyderm & Zyplast), Evolence offers several advantages:

1) no need for a skin test prior to treatment to check for sensitivities or allergies, which happened in about 1% of people with the old product;

2) much longer-lasting correction. European studies show a duration of about 12 months; and

3) minimal bruising from the injection.

Overall, it looks promising, and we're now going to offer it in my practice, adding another option to the many other FDA-approved fillers we have.

What will be really interesting is a head-to-head comparison study comparing Evolence to some of the better hyaluronic gel fillers. This study is underway. "Which filler will reign supreme?"...we'll have to wait and see!

Goodbye, Artefill.

In an unexpected turn of events, Artes Medical, the makers of Artefill, have filed for Chapter 7. They blame this on the difficult economy and the resulting downturn in their cosmetic business. Their product, Artefill, will no longer be available, as the company is in the process of liquidation. Even some of their reps were caught off-guard!

Artefill was one of the few semi-permanent FDA-approved fillers, and was a unique formulation. We had some nice results with it, when it was appropriately used in the nasolabial (cheek) lines.

Oh, well...

Beautiful eyelashes

Sometimes a drug side-effect can turn out to be a beneficial thing. An FDA-approved eye medication, called Lumigan, used regularly to treat glaucoma patients, was found to have a beneficial side effect - it makes eye lashes grow. It has few other side effects.

Ophthalmologists at the University of Miami, confirmed this finding of eyelash growth in a recently completed scientific study. With daily application of Lumigan to the eyelash with a mascara brush, the average lash length increased by 2.01 mm over a six week time period, compared to the placebo-treated side.

Allergan, the makers of Botox and Lumigan, recognized a good thing - and have developed a spin-off of Lumigan, called Latisse, just for women who want to have longer, fuller lashes. Latisse has the same active ingredient as Lumigan. Latisse is waiting for FDA approval, but this is expected in the first part of 2009.

In the meantime, Lumigan can be used "off-label" by prescription for those that just can't wait for Latisse. And yes, experiments on whether this drug can work for hair-loss elsewhere on the body are in the works....

While several other cosmetic companies market products for eyelash enhancement, by law, they can't use any ingredients as potent as these prescription-strength products. Also, the FDA-approved products like Lumigan have all sorts of safety data behind them, which is always reassuring.

"Scarless" breast reduction

Recently, a number of surgeons have been promoting the concept of "scarless breast reduction". While technically, there is a single small incision, compared to a standard surgical breast reduction, it's nearly scarless.

Here's the secret: liposuction. Liposuction is used to remove fatty tissue from the breasts, which makes them smaller, lighter, and more comfortable for women who suffer from the weight of excessively large and heavy breasts.

There's a catch, though. Liposuction-based breast reduction works for women who have breasts that are mostly fatty, and doesn't work if the breast is mostly composed of dense breast glandular tissue. Sometimes this determination is tricky - as there is no inexpensive, accurate test. There are some patients, usually younger in age, where this technique won't work at all.

If the breast is droopy, liposuction breast reduction doesn't really lift the breast, but it usually doesn't make the droop worse either. This is the key difference between standard breast reduction methods and liposuction breast reduction. Liposuction breast reduction usually gives you a "smaller version of what you have now", but not a breast lift.

Surgical breast reduction offers the advantages of lifting and re-shaping the breast - but with the trade-off of additional incisions.

In summary: liposuction breast reduction is a useful option to know about, particularly for women who are worried about scars, or who tend to make thick, ropey scars - and who would like a breast reduction.