Saturday, June 5, 2010

Latest methods of fat removal- fad or fact?

A lot of people are trying to lose weight and get into shape. Some of them are grossly obese and as a result suffer from physical effects like joint pain, reduced mobility, diabetes, hyperlipidemia, hypertension etc. . These people are looking to lose weight in tune of 20-40 kilos or more. Some others are moderately overweight and want to have good figure by losing 5-7 kilos. Some others are not overweight but have problem areas like bulging tummy , flabby arms or heavy thighs. They want to lose weight specifically in some parts. Then there are those who are very fit, hit the gym and take healthy diet- but still do not have enviable muscular physique. And last but not the least are women who are unable to get into their favorite clothes, after having a baby.



There is no one weight loss solution for all these people . Most commonly people try dieting and exercise half heartedly, do not get the desired result and lose hope. Some blame the genetics, long working hours or hormonal problems and give up. But being overweight affects their self esteem, confidence and health. This is when they start looking for options where they can lose weight without any effort from their side.

Various options are available in market for weight loss and inch loss. But actually there are very few that really work or can be proven scientifically. Lets go through each of them and find out the truth.



1. Massages and steam: Neither massage nor can steam help you melt fat. Only one to lose weight is the masseur.



2. Heating pads and vibrating belts: There is no scientific basis in these methods. Application of heat to skin may increase the blood circulation to the part or may make you sweat and get dehydrated and thus lose few hundred grams of weight( water). But it certainly not known to reduce fat or increase metabolism.





3. External ultrasound or radiofrequency application to the skin: This is a nonsurgical technology wherein ultrasound energy is applied to fatty area . These waves can penetrate upto 1 cm below the skin level and are said to break down fat under the skin. It has not been proven what really happens to the fat .Are the cells broken down permanently or the cells are intact and only the fat come out of the cell. Where does the fat go then? Is it not absorbed back by the body? There is no study to prove that blood levels of fat increase after this procedure, which should happen if fat is really being broken down and then being carried to liver for metabolism.The waves penetrate to just below the skin –so obviously they can not work when the fatty layer is several cms thick .These technologies are classic examples of manufacturing companies’ eagerness to hype and sell a product without proper research .



4. Liposuction: Liposuction and its various avatars like VASER and smartlipo are surgical techniques to remove fat from localized body parts. This is done under general or local anaesthesia and fat is actually taken out of body with a suction machine. Moderate amount of liposuction upto 5-7% of body weight ( 7 kilos in hundred kilo person) from 1-3 selected body parts in a sitting is safe and scientifically proven to be effective. But does it benefit everybody? The answer is no. Liposuction works best and is permanent for those people who are determined to maintain their weight with healthy diet and exercise. Even though the fat cells are removed from liposuctioned part , the remaining fat cells of the area and other body parts can store fat if lifestyle is not changed. Very obese( 30-50 kgs overweight) can not lose all the weight by liposuction alone. Without balanced diet and exercise the fat lost by liposuction may come back in next couple of months. If one is trying to lose weight for health reason like blood pressure, diabetes and heart problems liposuction is not the ideal solution. Unless one makes appropriate lifestyle changes, he/she does not get health benefits of weight loss. Liposuction is ideal for those who are already on balanced diet and exercise program , but are stuck with resistant areas of fat like love handles, double chin , tummy, hip etc. Liposuction in moderation is great and permanent but expecting 20-50 kilos of weight- all by liposuction alone- is unrealistic and impractical.



5. Bariatric surgery: Bariatric surgery acts on the stomach and intestines. Various types of bariatric surgery procedures are available to reduce stomach size and intestine size. After this surgery person can not eat much or absorb much and ends up losing most of extra weight in next 1-2 years. During this time he/she heeds to maintain proper nutrition under dietician’s supervision and also exercise to maintain muscle and bones. Bariatric surgery is not for moderately overweight people(BMI less than 35), because of low risk benefit ratio in this group. For people with BMI above 35 or grossly obese who suffer from other weight related health problems bariatric surgery is worthwhile . Can one gain the weight back after bariatric surgery- yes , unless one changes to healthier lifestyle.





6. Diet and exercise: This is mentioned last, because it is common sense. Everyone in their heart knows this is the healthiest , safest , permanent ,cheapest and most sure shot method of losing weight. But modern lifestyle, busy schedules and easy availability of rich food makes it very difficult . Yet there is no escape from it. One has to take limited , balanced diet and has to be physically active to maintain the result of weight loss surgeries. There are certain situations though where diet and exercise does not help. Heavy female breasts, male breasts, love handles, saddle bags and fat around the waist are commonly found even in otherwise normal weight fit individuals and in women after pregnancies. Loose skin does not go with exercise nor does exercise and diet help in spot reduction.All of these problems are beyond the scope of diet and exercise and need plastic surgical procedures for correction.

Tuesday, June 1, 2010

Tips for safe recovery after large volume liposuction

Liposuction of fat more than 5 percent of person’s body weight is referred to as large volume liposuction. This term is used to differentiate it from small volume liposuction which is much simpler and safer. Smaller volumes of fat can be removed under local tumescent anaesthesia , without hospitalization with minimal blood loss. Large volume liposuction on the other hand requires much more preparation, hospitalization and recovery time. If you are well prepared you can get the best out of your liposuction .

Preparation for large volume liposuction:

Healthy diet before liposuction: Your nutritional status determines the healing capacity. A lot of obese people are actually iron and vitamin deficient, especially if they have been on crash diets. You should start taking Iron and multivitamin supplementation and avoid crash diets 1-2 months before planned liposuction. Diet control should be done under supervision of qualified dietician.

See the plastic surgeon early: It helps to consult the plastic surgeon 3 months in advance. This will help in assessment of your general health. If any problem like anaemia or hypothyroidism are detected they need to be treated adequately before you can have the liposuction. This can take time- so plan in advance

Reveal your complete medical history to the plastic surgeon: For your total safety under anaesthesia it is absolutely necessary that the doctor knows about all your current or past medical and surgical history. Keeping secrets from your doctor can prove dangerous.

Discuss all your medication and supplements with doctor: Do not take any medications and supplements in the month preceding liposuction without discussing with your plastic surgeon. Certain health supplements sold in gym, weight loss medicine, birth control pills, common painkillers – all these need to be stopped 2-3 weeks before surgery. Certform also about your allerain other medicines interact with anaesthetic drugs and anaesthetist must know about them.

Prepare for 2 weeks of rest time after liposuction: After large volume liposuction, body takes a couple of weeks to recover from its effects. Giddiness , aches and pain are maximum during first week and gradually come down during second week.



Have someone to help you at home after liposuction: during first week after liposuction you will need someone to take care of your and your family’s needs.

Stage the liposuction: It makes sense to not just limit the amount of fat removal in one sitting but also the number of areas from which you get the fat removed. Try to limit the liposuctioned areas to 1 or two areas at a time. Do not push the surgeon to remove fat from all over your body. It will make your recovery too painful. Keep at least 2 months time between two sittings to recover fully.

Choose the right surgeon : An experienced plastic surgeon and anaesthetist team makes a safe large volume liposuction possible.

Choose the right hospital facility: Large volume liposuction should be performed only in hospital setting where postoperative monitoring and emergency care( I.C.U.) is available. 24 hrs availability of anaesthetist to deal with any emergency situation is mandatory.

Saturday, May 29, 2010

Liposuction: Then and Now

Liposuction is a very popular plastic surgery – among top 3 worldwide. Liposuction involves removing localized fat from the body , with the help of hollow metal cannula( pipe). Technique of liposuction has changed a lot since liposuction was first started 30 years ago.

Liposuction was initially done for removing localized small fat deposits( like bulges on outer thigh) A hollow metal cannula was introduced close to the fatty bulge, through small incision less than a centimeter in size. Tumescent fluid was not injected into the fat prior to liposuction( dry liposuction). Cannula was attached to suction machine. Back and forth vigorous movement of sharp cannula by the surgeon broke down the fat, which was sucked out into the suction machine. Results were good but there was significant blood loss . Therefore only small amount of fat could be removed safely. Those days fat removal was limited to 1000 ml or less.

Tumescent liposuction and usage of blunt cannula were the next major step forward for liposuction. Tumescent or wet liposuction involved injecting special tumescent fluid into the fat 10-20 minutes prior to liposuction. This fluid helped shrink the blood vessels and made fat softer. Usage of blunt cannulas with holes on side reduced the trauma to blood vessels. As a result the proportion of blood to fat aspirated came to less than 100 ml for 1 liter of fat removal. This enabled surgeons to remove larger amounts of fat , upto 5-8 percent of body weight . For example in a person weighing 100 kilograms 5-7 liters of fat could be removed safely without transfusing blood. Addition of local anaesthetic to the tumescent fluid made the fat deposit numb and liposuction could be done under local anaesthesia.

Ultrasound assisted liposuction (UAL) was the next breakthrough in late seventies. Here a special solid liposuction cannula was used which emitted Ultrasound waves at the tip. When the cannula was introduced into the fat through one or more small cuts( about 1 cm), ultrasound waves broke down the fat into liquid. Liquid fat was then was sucked out into the machine. More fat removal was thus possible even from tough areas like back, with minimal blood loss for the patient. UAL went out of vogue after a decade because of increased rates of complications like skin burn and altered sensation of liposuctioned part .

Power assisted Liposuction( PAL) was the next big thing introduced in nineties. PAL or vibroliposuction cannula was designed to vibrate at the tip. This helped in reducing physical strain to the surgeon. Vibrating cannula broke down the fat in tougher areas with a lot more ease.

Many more liposuction techniques are available now like syringe liposuction, laser lipo and vaser liposuction. In syringe liposuction negative suction pressure is created by large 60 ml syringes and fat is collected in syringes. This is the gentlest liposuction technique and suited for small fatty deposits. Fat collected in syringes can be used for injecting into fat deficient areas like hollow cheeks, buttocks or into breasts . This technique of fat redistribution is called liposculpturing.

Laser liposuction cannula has Nd YAG laser beams coming out of the tip. Cannulas are finer and laser seals blood vessels, resulting in less trauma and bruising. Surgeon exertion is understandably less.

Vaser liposuction is 3rd generation ultrasound assisted liposuction . It is safer than original US assisted liposuction, because vaser delivers less ultrasound energy at the tip.

Tumescent liposuction is a misunderstood term. Originally tumescent liposuction was used to enable small liposuction under local anaesthesia . Nowadays tumescent solution injection is an integral part of all types of liposuction. No one does dry liposuction anymore.

Despite so many different technologies available for liposuction, standard( wet/tumescent) liposuction using hollow cannulas and suction machine remains gold standard . Worldwide majority of surgeons use this technique to deliver safe and consistent results. Other techniques like UAL, PAL, Vaser and laser liposuction have not proved to give better results , although they have some advantages for surgeon like less physical effort. Other claims like less pain, less blood loss , faster recovery are not always true. The surgeon behind the machine is more important in delivering better results with more safety, than the machine itself.

Wednesday, February 24, 2010

Ribbon Lift

Ribbon lift


Ribbon lift has caught the imagination of public thanks to certain celebrities like Angeline Jolie , who is rumored to have had ribbon lift done recently to restore her once chiseled jaw line. Celebrities and others who are constantly watched and captured on camera tend to start early with facelifts. They particularly seek surgery that is least invasive and gives subtle results with least downtime and scarring . Ribbon lift fits the bill perfectly.

Loss of jawline definition is one of the earliest signs of ageing and starts usually in early thirties. Overweight younger individuals in their twenties too can face this problem because of fat accumulation in lower face, upper neck and under chin. But with the onset of thirties even people with normal weight can lose the sharpness of their jawline because of the effect of gravity , loss of elasticity of skin and sagging of platysma muscle of the neck. Younger people tend to consider nonsurgical options like thermage or laser facial rejuvenation which claim to lift the face. None of the nonsurgical devices available can actually lift the sag of the muscles because muscles are too deep and outside the reach of nonsurgical methods. Plastic surgeons have constantly strived to find a solution that can actually lift the muscle with least amount of scarring or downtime, to suit the need of younger people with active lifestyle.

Ribbon lift involves placing a certain ribbon like device under the jawline between the skin and platysma mucle, to pull the skin and muscle in unison towards the ear. Ribbon , in this endotine devise is made up of absorbable material , is about one fourth of an inch wide and has hooks on the undersurface to grasp facial mucles . Ribbon is inserted through small incisions either behind earlobe or above the ear , within the hairline, where it will not be seen . Ribbon lift procedure is done under local anaesthesia . After engaging the hooks on the muscle, when ribbon is pulled towards the ear , the jawline stands out . If a lot of skin is seen bunched up , the excess skin may be removed through a short incision around the ear lobe. Procedure is quick and painless. Downtime usually is one week or less.

Ribbon lift is somewhat like older thread lift with “contour” or “happy” threads. Threadlift technique used absorbable or nonabsorbable thin barbed threads, which were inserted with needle under the skin of face and neck and pulled upwards similar to the ribbon. Multiple threads were required to hold the tissue. Since they were inserted blindly and the barbs were small and delicate results were short lasting and unpredictable. Endotine ribbon in contrast has broader and stronger grip and is placed more predictably and securely after surgical dissection. Therefore one can expect longer results with ribbon.

Who will benefit the most with Ribbon lift? Younger men and women who have minimum fat or excess skin on jawline are ideally suited to Ribbon lift. Typically people in late thirties and early forties, who shy away from conventional surgical facelift will benefit with Ribbon lift. Conventional facelift and even short scar versions involve an incision in front and behind the ear . This is a high price to pay for men and women with shorter or pulled up hairstyles and those who do not need extensive lift . Ribbon lift scars, in contrast , are smaller and well hidden. Facelift surgery involves more extensive dissection which leads to a downtime of 2-4 weeks. Ribbon lift has minimal downtime of less than one week. Of course less surgery also means lesser cost and lesser risk .

So can Ribbon replace the good old facelift completely? The answer is no. Conventional facelift and necklift is the only option when skin excess and sagging is significant. Facelift surgery results last longer 5-10 years whereas results of a ribbon lift may last much less . Ribbon is completely absorbed by body in about an years time. After that the fibrosis around the ribbon is supposed to be holding the sagging tissues for some more time. Since ribbon lift is a relatively newer technique long tem follow up is not available.

Friday, February 19, 2010

What's New in Liposuction : VASER

Popularity of liposuction for unwanted fat removal has generated demand for better technology which can make liposuction safer, painless and quicker. Patients and plastic surgeons alike have constantly seeked solutions that can make liposuction a better and more satisfying procedure. VASER is the latest technological offering in this context.


VASER has been around since 2002, when it was approved by USFDA for fat removal. And no, VASER has nothing in common with similar sounding LASER, which also has been used for liposuction. VASER stands for Vibration Amplification of Sound Energy at Resonance. Simply put it adds the benefit of ultrasound technology to the standard liposuction procedure. Ultrasound waves are sound waves at specific frequency and one commonly comes across it during ultrasound cleaning of dental plaque and while looking at the growing baby in mother’s womb. Usage of ultrasound for liposuction itself is not new. Ultrasound assisted liposuction ( UAL)was very popular in eighties. Vaser has resurrected ultrasound in liposuction. Vaser is 4th generation ultrasound assisted liposuction technology which offers more safety than earlier ultrasound technologies. Speciality of Vaser is “ liposelection” – meaning it caused damage to fat cells only without damaging other tissues.

Vaser liposuction is a surgical procedure like the good old liposuction, only technology and results differ. VASER is performed in sterile operation theatre by qualified plastic surgeon. General or local anaesthesia is used . Tumescent solution which may contain local anaesthetic is injected into the fat to be liposuctioned. Injection of tumescent solution shrinks blood vessels, provides anaesthesia and also creates safe environment for VASER by completely soaking the fat tissue.Vaser probe , which is a solid titanium rod of 3-5mm diameter is then introduced into the fatty layer through small 3-5 mm cuts in the skin. The ultrasound energy is delivered at accurate dosage at the tip of the probe, while moving the probe through fat in all layers all over the area . Ultrasound energy selectively destroys fat cell membrane and liquefies fat. Since the blood vessels, nerves and skin are resistant to lower doses of ultrasound, they are safe. Liquified fat is then vaccumed out with hollow suction metal cannulas attached to vaccume suction machine.

Depending of how much fat was removed VASER liposuction can be a same day surgery or may require hospitalization. Antibiotics and painkiller tablets are prescribed and usage of compression garments is mandatory for 1 month or more after VASER liposuction.

Tissue swelling is natural after any surgical procedure. After VASER liposuction results are seen gradually over next one month onwards as gradually swelling comes down and skin retracts. This is facilitated by wearing compression garment.

So what is the special advantage of VASER liposuction? Vaser liposuction enables larger amounts of fat removal which was hitherto unsafe due to blood loss. So one can have more fat removal, without the need for blood transfusion. Recovery after large liposuction is faster with VASER. Vaser also allows for better sculpting in tougher and fibrous areas like back and male abdomen. High definition liposculpture with VASER is gaining popularity for creating six pack abdomen look. Vaser has been used in more than 100,000 procedures all over the world and has proven to be safe.