Sticking It to Fat?

Sticking It to Fat?

In the age-old battle of woman vs. fat, an arsenal of weapons have been deployed: creams, pills, devices, surgery and now, just in time for bathing suit season, mesotherapy -- a cosmetic treatment that involves injections.

Developed in France in 1952, mesotherapy was introduced in the United States several years ago. It involves a series of relatively painless injections into fat deposits below the surface of the skin. Some doctors inject small amounts of aminophylline or isoproterenol, drugs approved to treat breathing problems, while others prefer phosphatidylcholine, a drug not approved in injectable form by the Food and Drug Administration. Some doctors also use artichoke extract or other herbs.

"A lot of people are looking for a relatively noninvasive procedure" that is an alternative to liposuction, said Robert M. Adrian, a Washington area dermatologist who is among a growing number of cosmetic physicians offering mesotherapy. Some of his patients, he said, have had "fantastic results" from treatment.

But some doctors question whether mesotherapy is useful or benign.

New York dermatologist Debra Jaliman called it an "expensive procedure that doesn't have much medical validity." Some patients may be convinced it works because of the placebo effect, Jalliman said, or because "if you're paying $350 per week to get rid of your cellulite, you're more likely to pay attention to your diet and to exercise."

In an article published in the April 15 issue of the journal Plastic and Reconstructive Surgery, plastic surgeons who studied the treatment noted that there are few good studies of mesotherapy, that use of unapproved drugs is common and that complications, including infections, have been reported. New York plastic surgeon Alan Matarasso, co-author of the study, warns that patients should be wary of mesotherapy until more is known.

"There is a complete lack of standardization in this procedure," said Matarasso, an associate clinical professor of plastic surgery at Albert Einstein College of Medicine in New York. "With mesotherapy, there are so many unsubstantiated scientific claims."

Rod J. Rohrich, immediate past president of the American Society of Plastic Surgeons, was more emphatic.

"It is mind-boggling to think that a physician would inject patients -- or that patients would allow physicians to inject them -- with unknown, unproved substances based on hearsay and unsubstantiated clinical findings," he wrote in an editorial that accompanied the journal article. "Anything short of being on a diet, actually doing exercise or making any commitment to lifestyle changes always has a mystical appeal."

It's not clear how mesotherapy is supposed to work, but proponents say it may cause inflammation that results in the breakup of fat deposits, which are released into the bloodstream. Swelling and redness are common after treatments.

Treatments usually cost $250 to $750 for a session that lasts five to 10 minutes; most patients undergo three to 10 treatments, which are not covered by insurance. Some doctors say the results are permanent, while many say that periodic re-treatments are required.

Adrian said he was initially skeptical about mesotherapy, but after taking several courses in the procedure he was convinced it was safe and effective and began offering it three months ago. He said his office fields about 100 calls per week from patients interested in the treatment that Adrian advertises as a way to "lose inches in hours."

Dima Ali, one of the busiest mesotherapy practitioners in the Washington area, said she has treated about 1,000 patients in her Reston clinic. She calls the therapy "by far the most successful and progressive of all cellulite treatments available" and cites the experience of her patients as evidence that the treatment works.

The skepticism about mesotherapy, she said, reminds her of the reaction to Botox a decade ago, before it became one of the most widely used wrinkle-banishing treatments.

"We are doing controlled [studies of mesotherapy] right now," said Ali, who compares cellulite to "fat trapped in a jail cell behind steel bars" that is liberated by the injections. Like Adrian, Ali said she uses phosphatidylcholine, an injectable compound containing lecithin that is not approved for use in the United States. She also uses artichoke extract and collagenase, an enzyme that breaks down the protein collagen.

Lionel Bissoon, an osteopath who has helped popularize mesotherapy in the United States, said he has trained more than 140 physicians in the technique in three-day courses, for which he charges $5,000. Bissoon, who divides his time between clinics in Palm Beach, Los Angeles and New York, said he uses mesotherapy for more than 100 conditions, including the treatment of cellulite, migraines, back pain, acne and insomnia.

In Bissoon's view, the lack of standardization that critics decry reflects the multiplicity of approaches available to physicians treating any ailment.

"Is treating a cold a standard thing?" he asked, adding that physicians "have 300 antibiotics to choose from." (Medical experts note that colds are viruses and should not be treated with antibiotics, which are useless against colds.) Bissoon said he typically injects patients with aminophylline and isoproterenol, drugs used to improve breathing in patients with emphysema and other serious lung diseases.

Meostherapy is safe, he added, noting that there have been deaths from liposuction. "We have not killed anybody," he said, adding, "I think the plastic surgeons are looking at mesotherapy as invading their turf."

Jeanne Whyte, a 55-year-old executive from Falls Church, isn't troubled by the controversy. She was Adrian's first mesotheraphy patient and is delighted with the results of the two treatments on her chin intended to eradicate small fat deposits.

"I can't believe the difference," said Whyte, who has had other cosmetic treatments, including Botox. "This was a cakewalk. I'd love it for my stomach, but you'd need a gallon of it." ?

Mesotherapy Not Proven as a Safe Alternative to Liposuction

Mesotherapy Not Proven as a Safe Alternative to Liposuction; Plastic Surgeons Caution Against Unknown Dangers

ARLINGTON HEIGHTS, Ill., April 18 /U.S. Newswire/ -- The allure of shedding unwanted pockets of fat with a series of simple injections, known as mesotherapy, sounds too good to be true -- and it just might be. According to an ASPS Device & Technique Assessment (DATA) Committee report published in the April 15 issue of Plastic and Reconstructive Surgery(r) (PRS), the official medical journal of the American Society of Plastic Surgeons (ASPS), patients should be wary of mesotherapy until the safety and effectiveness of the procedure are confirmed.

"The promise of a non-surgical, permanent method for fat removal and body contouring is obviously very appealing, but mesotherapy is not proven to be the miracle cure to a thinner you," said Alan Matarasso, MD, study co-author. "The problem with mesotherapy is the whole technique is shrouded in mystery. Liposuction remains the only proven method to safely and permanently remove fat."

Touted as a non-surgical alternative to liposuction, mesotherapy involves injecting medications and plant extracts into layers of fat and connective tissue under the skin. The injected ingredients may include agents that are used to open blood vessels, non-steroidal anti-inflammatory medications, enzymes, nutrients, antibiotics and hormones. Mesotherapy may be used in conjunction with dietary modification, hormone replacement therapy, exercise and nutritional supplements. No drug is approved by the U.S. Food and Drug Administration for use in mesotherapy.

Although the practice of mesotherapy has been around for decades in Europe, it has only recently been introduced in the United States. There are no published scientific studies demonstrating if the effects are permanent, why or if certain ingredients work, or how safe mesotherapy is for patients. In addition, there is no standardization in mesotherapy. The types of drugs used vary from physician to physician as does the quantity and frequency of injections.

Mesotherapy may cost $1,000 to $1,500 per treatment with three to six treatments required. This can prove costly for patients who may not receive the desired results.

"Plastic surgeons are constantly researching better methods to help patients achieve their desired look; however, patients' health and safety is always foremost on our minds," said Dr. Matarasso. "There is no information on what happens to fatty acids once they leave the targeted area or how the various ingredients affect the body's organs and other tissues. There is simply too much we do not know about mesotherapy to say it is unquestionably safe for patients."

Currently, liposuction is the only method that has been proven to safely and effectively remove fat. According to ASPS statistics, liposuction was the most popular cosmetic surgical procedure in 2004, with more than 325,000 procedures performed.

"Without data to support claims that mesotherapy works, the procedure appears to be a mystic type of therapy," said Susan Kaweski, MD, ASPS DATA Committee chair. "The DATA Committee has not seen any long-term studies that would prove mesotherapy actually removes fat from the body. We need to know a lot more about this procedure before plastic surgeons can endorse mesotherapy and recommend it to patients."

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 5,000 members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. www.plasticsurgery.org.

Breast Reconstruction Surgery After Mastectomy

(NBC News) - Most of more than 200,000 women diagnosed with breast cancer this year will have a lumpectomy to remove just the tumor from their breast. But a significant number will need a mastectomy to remove the entire breast, and then breast reconstruction. But when should it be done, and is it safe?

Marjorie Belson is a breast cancer survivor, "I'd walk down Park Avenue and my jacket was open, so I'd look in the mirror and I'd say, 'Oh My!'"

There are many women who might say this about their figure, or at least wish they could. But Marjorie thought she'd never be able to say that after cancer was found in both her breasts, "I opted for bilateral mastectomies. I don't want to go back and forth anymore. The anxiety was too much."

Not only did Marjorie have breast reconstruction, she had it done at the same time as her mastectomies, which used to be controversial, until multiple studies showed that it is safe.

Dr. Mark Sultan, with St. Luke's Roosevelt Hospital, explains, "The complication rate of the reconstruction plus the mastectomy is no higher than the two procedures done separately, and it has been shown with large studies that there is no increased risk with recurrence if one has had reconstruction."

There are a variety of techniques used to reconstruct breasts, a woman's own tissue can be used or there's implants, either saline or silicone, such as Marjorie chose, which are a relatively simple but multi-step procedure.

In fact, a very recent study found women who chose breast reconstruction actually had better survival odds than women who didn't.

Dr. Sultan says, "It's possible that women who are offered reconstruction initially are possibly in a healthier, or that afterwards, because they had been reconstructed and feel healthier, that they might more frequently come back to their physician for a follow-up, or they might take better care of themselves, might eat better, etc., etc."

Silicone breast implants are FDA cleared for breast reconstruction, as opposed to augmentation. If you're not comfortable with those, saline implants are available, or you can fashion a breast from your own tissue, although that operation is more extensive than implant surgery.

Seeking better breast implants: Doctors experiment with 'gummy bear' fillers, titanium coatings

Many women hoping for a more natural-looking alternative to saline breast implants were disappointed by the Food and Drug Administration's recent decision to maintain the ban on silicone-gel-filled implants. But there may be other options on the market one day, as doctors continue their quest to find better ways to boost a woman's bosom.

Among the most promising developments, they say, are cohesive silicone gel, leak-resistant implants with the consistency of a gummy bear and a new type of implant shell coating that may be less likely to cause inflammation and scarring in the surrounding breast tissue.

“I think we are getting closer to developing the perfect implant, in terms of durability, biocompatibility and natural shape,” says Dr. Mark Jewell, a plastic surgeon in Eugene, Ore., and vice president of the American Society for Aesthetic Plastic Surgery.

Safety concerns linking ruptures of the silicone gel implants to autoimmune problems in some women caused the FDA to ban the sale of the implants in 1992, except for use in clinical trials and by women undergoing breast reconstruction. While the implants were somewhat exonerated by an Institute of Medicine report saying they do not up the risk of autoimmune disease, the new FDA ban calls for more study before they can be put back on the market.

Both saline- and silicone-filled implants have a silicone shell. But if the saline implants leak, deflate or rupture, which they often do, they would release only salt water -- not silicone -- into the body. The downside of the saline implants, though, is that they don't look and feel as natural as the others.

“Some people are concerned about the safety of silicone gel and many people are disappointed about the performance of saline implants, notably that they are associated with more ripples, have a more liquid feel and don’t look as natural as the silicone implants,” says Dr. Grant Stevens, medical director of Marina Plastic Surgery Associates, with locations in Marina Del Rey and Palos Verdes, Calif.

'Gummies'
Enter cohesive gel implants, which are currently on the market in Europe and Brazil, and now being studied in the United States.

"The ‘gummy bear’ implants have the positive attributes of the silicone gel, but lack the concerns of gel migration,” says Stevens, who is one of 15 U.S. doctors participating in a study of Silimed cohesive gel implants.

Dr. William P. Adams, Jr., agrees. “The gel doesn’t migrate, so there are potential safety benefits because if the shell should fail, the gel will not go anywhere -- it would just stay in one place,” says Adams, an associate professor of plastic surgery at the University of Texas Southwestern Medical Center in Dallas.

And unlike saline implants, Stevens notes, “cohesive gel implants feel like breast tissue, not a water balloon.”

So far, he adds, the data and patient response are “overwhelmingly positive.”

Last October, 42-year-old Charlie Sheridan, who works in Stevens' office, traded in her saline implants for a pair of cohesive gel implants as part of the clinical trial.

“I am sporting a pair of gummies,” Sheridan says. “They have the look and feel of silicone, but don’t have the hardness or lack of naturalness of saline and there is no worry of deflation,” she says. One of her saline implants did, in fact, deflate which is why she opted for the newer model.

The companies Inamed and Mentor also are conducting studies of their versions of the cohesive gel implants.

Experts in the field say it could be at least three to five years before any such product is on the U.S. market, provided the FDA approves one.

But not all plastic surgeons are completely sold on these new implants.

“The problem is density,” says Dr. Lawrence Reed, a New York City plastic surgeon. “They may have value in reconstructive procedures because you need density and mass, but for normal women, they are too dense,” he says.

“Cohesive gel is a refinement of the current silicone implant, but it’s harder than usual silicone gel, so it’s not the total answer,” agrees Dr. Rod J. Rohrich, president of the American Society of Plastic Surgeons and the chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center.

Another product in the pipeline, he notes, is an implant filler made with a substance called polyethylene glycol.

“It contains a patented blend of polyethylene glycol and saline and results in an implant that has the look and feel of silicone,” says Rohrich, who helped develop the substance.

Hopes for indestructible implants
Titanium-coated breast implants may also be an option in the future. The product of a partnership between Poly Implants Prostheses, a French company specializing in implants, and GfE, a German aerospace company, Tibreeze implants are coated with a thin layer of titanium and filled with silicone gel.

“It’s not like you dip it in molten titanium, it’s a thin coating that bonds to the silicone,” Jewell explains.

“Titanium is a more biocompatible metal than even stainless steel,” he says, meaning that it is less likely to cause a toxic or otherwise injurious reactions in the body.

Researchers are hopeful that by coating the shell, the implant will be more resistant to infection, stronger and will produce less scarring and capsular contracture, a condition that occurs when scar tissue forms around the implant and results in painful stiffness of the breast and possible leakage of the substance inside the implant.

So far, Jewell says, three women have received the implants as part of a clinical trial in Germany that began last year.

“We don’t know yet if it will have a durability advantage,” he adds.

Lunch-time breast lifts?
Women can get lunch-time injections of Botox and various facial fillers, and now researchers in Sweden may have found a way to boost a woman's breast size during the lunch hour as well.

In the near future, Rohrich says, injections of hyaluronic acid, a compound used to fill fine lines and wrinkles, could be used to do temporary breast enhancement.

"It is a non-surgical procedure and can be used to build up breast tissue and enhance the breast for a couple of years,” he says.

Currently the injections are being performed as part of pilot studies in Sweden by the manufacturer, Q-Med. Enhancements, however, are not permanent and eventually the hyaluronic acid will be re-absorbed into the body.

Peering into his crystal ball, Rohrich forecasted what else may be on the distant horizon, including grow-your-own breast implants.

“We may one day make our own implants from our own fat where surgeons harvest fat via liposuction and stimulate it to grow," Rohrich says, "so it will be natural but to grow that amount of fat and grow it consistently may be years and years away."

Facelift alternatives rid patients of neck 'wattle' without the downtime of surgery

Ties, turtlenecks, jewelry worn more comfortably

ARLINGTON HEIGHTS, Ill. – On the show Ally McBeal, a character was romantically pursued because of her neck "wattle" or loose skin – a scenario that would only happen on television, right? In reality, many people want to rid themselves of neck "wattle" to look younger or to wear certain clothes or accessories more comfortably, without having facelifts. They may feel they are too young or old for an invasive procedure, are not able to afford the prolonged recovery time, or only want targeted improvement of their neck region. Patients have less invasive options to rid the "wattle," reports a study in May's Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS), through targeted neck rejuvenation techniques.

"Not every patient who seeks to correct facial aging wants or requires a facelift," said James Zins, MD, author of the study. "Today's patients are extremely active and may not want to undergo invasive surgery where they are unable to work or play for several weeks. With this alternative, many patients look younger without the financial cost and downtime associated with a standard facelift."

As people age, they often loose definition in their chin and jaw line due to fatty deposits, weakening muscles and loose skin where the neck and chin once made a right angle. By improving the neck region, patients' profiles look years younger and clothes and fashion accessories such as ties, turtlenecks, and necklaces are worn more comfortably.

Skin in the neck region differs from skin on other parts of the body because it maintains its elasticity and will contract after it is released from underlying muscle. Fat removal through an incision under the chin and behind the ears can be combined with muscle tightening and freeing the skin from the muscle, depending on the degree of aging and individual patient characteristics.

Younger patients, who generally have more skin elasticity and have a "wattle" because of an overload in fat deposits just under the skin, often benefit from liposuction alone. Middle-aged patients generally have fat deposits, as well as, loose neck muscles and skin, requiring the fat removal and muscle tightening technique. Patients older than 75 usually need more contouring in the neck region and require a facelift where excess skin is removed.

According to the study, 33 patients were treated using this combination of neck rejuvenation techniques. Twenty patients experienced moderate improvement to the neck region while 12 experienced a marked improvement.

"Approximately one in 10 patients is a good candidate for neck rejuvenation – but patients must maintain realistic expectations," said Dr. Zins. "These techniques are targeted specifically for the neck and chin areas only. The mid-face and upper-face are clearly not improved by these procedures."

According to ASPS statistics, more than 114,000 facelifts were performed in 2004.

New Trends in Plastic Surgery

New Trends in Plastic Surgery

The goal of Plastic Surgery 101 is to provide you with detailed plastic surgery information so you can make informed decisions as you consider having cosmetic surgery. Part of this information includes the newest trends in plastic surgery. To that end, we have compiled a series of articles to provide news on the latest techniques and advances in plastic surgery. Below is a list of the article titles along with their summaries. You can decide which topics interest you, and then click on the link to read more detailed information.

A Beverly Hills Plastic Surgery Center Has Developed a Program to Speed Patients Back to the Gym Following Procedures
In Southern California, where most everyone seems to both work-out and get plastic surgery, Rodeo Drive Plastic Surgery has launched a unique and innovative program to help patients return to physical activity shortly after plastic surgery - while guarding safety and protecting the cosmetic results of surgery. They call this innovative approach their "Back to the Gym Program."


Plastic Surgery Center Offers Specialized Services for Latinos
A renowned Beverly Hills plastic surgery center has unveiled a program that provides specialized care for Hispanic patients.


The Rodeo Drive Couture Breast Augmentation
A renowned Beverly Hills plastic surgery center has developed an approach to customize breast augmentation so the overall result both matches a woman's body and creates the best form for wearing fashionable clothing. The procedure is called the Rodeo Drive Couture Breast Augmentation.


The Rodeo Drive Plastic Surgery Gift Card
Marking the ultimate evolution of plastic surgery from extravagance of the super-rich to lifestyle mainstay for the broader public, Rodeo Drive Plastic Surgery in Beverly Hills has unveiled its plastic surgery gift card.


The Rodeo Drive Chin
A Beverly Hills plastic surgery center unveils its approach to creating a neck and chin contouring procedure to match the high-end styles found on Rodeo Drive.


Web Site Highlights Latest Trends in Plastic Surgery
A plastic surgery informational web site has launched a compilation of the latest news and trends in plastic surgery. It is a one-stop location to get information on cutting-edge plastic surgery.


Beverly Hills Plastic Surgery Center Unveils Novel Program to Create Minimal-Pain Plastic Surgery
A world-renowned plastic surgery center in Beverly Hills has developed a unique program that works to minimize patient discomfort following plastic surgery procedures.


Plastic Surgery Calendar
A Beverly Hills plastic surgery center has released a plastic surgery calendar so people can plan their procedures in time for important life events.


Los Angeles Skin Cancer Program
Now that summer is approaching, a Beverly Hills plastic surgery center has launched a skin cancer awareness and prevention program.


Skin Activating Liposuction
A Beverly Hills plastic surgeon has unveiled a novel approach to liposuction that seeks to address both excess fat as well as the overlying skin.


Rodeo Drive's Real Nip and Tuck Center
The characters on the hit television show may be moving to Rodeo Drive, but in real life there is only one plastic surgery center on the world's most glamorous street located in Beverly Hills, California.


The "Rodeo Drive" of Plastic Surgery
There's a new "boutique" smack in the heart of Rodeo Drive. Among its neighbors are the likes of Chanel, Armani, and Hugo Boss. Rodeo Drive Plastic Surgery is the first and only plastic surgery center on ultra-glamorous Rodeo Drive in Beverly Hills, California.


The Shaped for Fashion Breast Reduction
Rodeo Drive's only plastic surgery center does breast reduction surgery that not only reduces size, but works toward allowing patients to fit into the fashionable clothing styles sold by their elite boutique neighbors.


New Blogs Report Trends in Plastic Surgery
Plastic surgery is a rapidly changing specialty. One Beverly Hills plastic surgery center has launched an innovative series of blogs to help keep the public up to date on the latest developments.


Plastic Surgeon Unveils Breast Augmentation Information Center
The FDA approval of silicone breast implants has led to some confusion on the part of potential breast augmentation patients. One Beverly Hills plastic surgery center has created a Breast Augmentation Information Center to provide information about all aspects of breast augmentation.


The Rodeo Drive Breathe Easy Rhinoplasty in Beverly Hills
Two plastic surgeons in Beverly Hills have developed a novel approach to rhinoplasty, commonly known as nose surgery or "nose job." Using an interdisciplinary approach to the procedure, they work on both appearance and function at the same time.
Read more

Rodeo Drive Chin Rejuvenation
A Beverly Hills plastic surgeon's minimally-invasive neck and chin rejuvenation procedure helps patients look slimmer and younger.


The Rodeo Drive Belly Button
The only plastic surgery center on world-famous Rodeo Drive unveils its unique tummy tuck procedure that creates a beautiful belly button.


Drs. Abbott Krieger and Lloyd Krieger Develop Innovative Surgery to Help Breathing
Dr. Abbott Krieger has developed an innovative surgical technique to reanimate the diaphram in severly injured patients, freeing them from a lifetime confined to a ventilator.


The Rodeo Drive Plastic Surgery Transformation Vacation
More people are traveling for plastic surgery. To best serve these clients, Rodeo Drive Plastic Surgery in Beverly Hills has developed a unique program to conveniently provide plastic surgery to visiting patients.


More Men Seek Plastic Surgery But Need Unique Procedures and Techniques
One million men had plastic surgery procedures last year, according to the American Society for Aesthetic Plastic surgery, and the number is growing. Lloyd M. Krieger, M.D., founder and Medical Director of Rodeo Drive Plastic Surgery in Beverly Hills, notes that the bodies, goals and temperament of men are different from those of women -- so men need special procedures and techniques.


Rodeo Drive's First and Only Plastic Surgery Center Opens
The street known around the world as the showcase for new trends and the finest products is now home to reasonably priced liposuction, face lifts and breast augmentation. Located among the boutiques and bistros in the world-famous Rodeo Collection, Rodeo Drive Plastic Surgery is the first and only plastic surgery center on Rodeo Drive.

Beware Fat Melting Injections

Beware Fat Melting Injections — Not FDA Approved

Just a quick note and a pointer to a recent USA Today article on the FDA cracking down on spa use of fat-melting injections. Known as lipodissolve and also as mesotherapy, these injections are being billed as nonsurgical alternatives to traditional liposuction, however, they have not been approved by the FDA and they can be harmful.

Studies are under way now to determine the efficacy of the injection of certain bile salts under the skin and into fat to determine if fat can be safely dissolved and then absorbed by the body. I advise against the treatments — most especially when offered by unsupervised medical spas — and believe it should not be done at all until these studies are completed.

Lipodissolve and mesotherapy, which is a chemical injection, should not be confused with the SlimLipo laser treatment, which is FDA approved.