Liposuction techniques are numerous, and not one technology is better than the other. Most plastic surgeons agree that the traditional tumescent technique with fat aspiration continues to be highly effective, predictable, and safe. Techniques that use heat to “tighten” skin are showing complications as a result of thermal damage to overlying skin and soft tissue. These include any laser, radiofrequency, or ultrasound- assisted devices. Complications presented at the conference include skin contour irregularities, permanent skin discolorations, burns, and skin scarring. There is still no better alternative to traditional liposuction with respect to results and safety. The skills of the surgeon are the most important factor in obtaining excellent results, not the equipment or technology being used.

More recently in the media, a new treatment for cellulite, Cellulaze, has been getting a lot of attention as the new cure for cellulite. So of course, I participated in the conference given by the lead investigator for Cellulaze. Pockets of fat under the skin are normally divided by fibrous septae that are thick strands that extend from the skin, through the fat, and connect to the underlying muscle layer. Patients who have cellulite, or visible dimpling of the skin have more than average fibrous septae. So far, many treatments and devices have been advertised as effective for cellulite. Some of these include Endermologie, VelaSmooth, Thermage, Triactive, mesotherapy, massage, radiofrequency, laser liposuction, and topical creams. The results of all of these treatments are universally disappointing, with multiple regular treatments required to see subtle improvement, and results that last only a few months at best. The newest treatment for cellulite is Cellulaze. Cellulaze is an invasive laser treatment, similar to a liposuction procedure, where tumescent numbing fluid is injected under the skin for local anesthesia, and a laser is introduced under the skin in the area to be treated, typically a section on the thighs. Three passes are made in the area being treated to break the fibrous septae, break up the fat cells in each pocket, and then heat up the underlying skin to thicken and tighten it. Recovery is similar to a liposuction procedure, with discomfort, bruising, swelling, and numbness for up to 3 months, and the need to wear a compression garment. A study involving 10 patients was presented at the meeting, showing good (not excellent) results at one year after one treatment. The company, Cynosure, says more studies and data are on the way, with good results at 3 years. The treatment for a small area on the thigh takes 90 minutes, and costs range from $7000-$11,500 per area. My concern is the heat generated by this thermal device can lead to potential uncorrectable complications, especially if this laser technology gets into the hands of non-plastic surgeons, who do not have the tactile sense and knowledge of anatomy to safely perform invasive surgery. Thermal or heat-related complications that can be seen include prolonged swelling, bruising or scar tissue, contour irregularities, permanent skin discoloration, burns, scarring, fluid collections, and damage to deeper structures. I am going to wait until I see more studies with documented long-term results, and proof of minimal risk and safety before I jump on board with this treatment. Here is a good article on Cellulaze for reference:

Massive weight loss patients with excesses of skin in hard to treat areas such as the upper back and upper arms are successfully being managed with upper back lifts or “bra-strap” lifts in women, where back and lateral trunk skin is excised and tightened with scars hidden within the contours of a normally worn bra. Upper arm tightening or brachioplasty surgery in these patients is being extended into the armpit and along the lateral breast for optimal contours. It was shown, that mini arm-lifts with scars that hide in the armpits do very little in improving arm contours. There is still no alternative short scar or scarless surgery when it comes to skin-tightening procedures in patients with severe skin excess.

Lastly, vaginal rejuvenation is also becoming more popular. It must have to do with grooming trends and this area tends to be more visible? Excess skin can be removed to create more youthful contours below, and fat injections are used to plump up deflated tissues.

As always, I learned a lot at our annual conference and enjoyed catching up with my plastic surgery colleagues across the US. At Desert Hills Plastic Surgery Center, we are committed to offering our patients the most current treatments and techniques in the field of Plastic and Cosmetic Surgery, while ensuring the efficacy, predictability, and safety of your procedure.

Dr. Hayley Brown MD, FACS
Plastic Surgeon Las Vegas
Desert Hills Plastic Surgery Center, Henderson and Las Vegas, Nevada

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