Daily Skin Fix

Just out–our Summer 2011 Cosmetic Dermatology Newsletter

Hot off the presses, the Summer 2011 edition of our famed SkinTreatment.com Cosmetic Dermatology Newsletter. This time we discuss CoolSculpting, Thermage, Botox price shopping, what’s new at ASTC, our social media, and the ever-popular Thoughts from Dr Elaine.

Also gives information about our upcoming Patient Appreciation Week Sale. During week of July 11-15 get 20% Off Botox, Juvederm, Thermage, CoolSculpting, and all Dr Elaine’s Skin Care. Online skin care sale runs July 11-17 on SkinTreatment.com

Click the text link below for the newsletter
Summer 2011 Newsletter.pdf

Win A Free CoolSculpting Fat Reduction Procedure

Join us Thursday April 21, for a Cool Night Out featuring CoolSculpting non-invasive fat reduction. See patient demonstrations, register to win Free Coolsculpting treatments, and receive special event pricing.

Also Cool–All Dr. Elaine’s skin care products will be 20% off.

Buy One Get One 1/2 off (of equal or lesser value) for Coolsculpting procedures purchased during the sale.  Treatments must be completed by November 1, 2011, discounted treatment must be performed the same day as the regularly priced treatment. All procedures must be medically appropriate for the patient in Dr Cook’s medical judgement. Procedures performed at Advanced Skin Treatment Center.

We will offer two drawings each for a chance to win 1 treatment of up to $1400 value. Attend the event and register for a Free CoolSculpting procedure, to be drawn April 22, and/or “Like” us on Facebook by May 8, 11:59 CST, to enter the CoolSculpt Your Body Sweepstakes. You may enter both contests.  One prize per person.

Cool Night Out Thursday April 21 4-8pm
Advanced Skin Treatment Center
2609 Wolflin Village
Amarillo, Texas 79109

More Info (806) 358-1117

Top 10 Aesthetic Body Sculpting Procedure Tips:
What works, what doesn’t for fat reduction and fat removal

1. Research the various procedures, their risks, benefits, results. A site I particularly like, and contribute to, is RealSelf.com. It has descriptions of the procedures, reviews by patients, satisfaction ratings, and answers to questions by physicians who are Board Certified in the core aesthetic specialties of Plastic Surgery and Dermatology.

 

2. Decide what kind of results you want, what kind of risks you are willing to take, which side effects you are willing to have and how much you are willing to pay for it.

 

3. Be very careful with physicians who are not Board Certified in the core aesthetic specialties, who have had sanctions by the Medical Board for standard of care issues, who charge significantly below the prevailing rate, or who perform non-FDA approved treatments like Mesotherapy.

 

4. If you decide to have Liposuction, go to a physician trained and Board Certified by the American Board of Medical Specialties (not any other board) in one of the core aesthetic specialties, who has a lot of experience in Liposuction, and performs it frequently.

 

5. For Liposuction don’t have procedures except in accredited facilities. Run from a physician who exceeds the official guidelines for the volume of fat removed in a single procedure. These situations are the riskiest and where the deaths from Liposuction that make the news often occur.

 

6. Do I need to say this?– Don’t have non-FDA approved treatments. Don’t have medical or surgical procedures performed by non-physicians, unless those providers are licensed medical providers like RN’s and are directly supervised by a physician who is Board Certified in one of the core aesthetic specialties. No, not a beautician practicing out of a hotel room, not a nurse who is practicing solo without supervision, not a non-medical layperson given 1 hour of training in a chain medi-spa.

 

7. Don’t expect more from a procedure than the procedure can deliver. Don’t expect Liposuction results from non-invasive procedures. Don’t expect any fat reduction or fat removal procedure to remove visceral fat (fat inside the abdominal cavity). If you can’t squeeze it, we can’t remove it. Only diet and exercise can reduce visceral fat. Expect what the procedure can realistically deliver and be happy with that.

 

8. Don’t lie to your physician about smoking, medications or your health history, just because you really, really want the procedure. This ends badly.

 

9. Don’t expect any of these procedures to significantly tighten skin and muscle like a tummy tuck, or improve cellulite. Tummy tuck results require cutting skin and sewing skin and muscle. Nothing gives permanent improvement in cellulite. Sometimes Liposuction makes cellulite worse.

 

10. Final tip: Here are the patient satisfaction ratings for the various procedures, found on RealSelf.com. Real patients who have had the procedure thought that the procedures were “worth it” in these percentages:

   FDA approved procedures

• Zeltiq Coolsculpting (84% worth it)
• Liposuction(65% worth it)
• Zerona (32% worth it)

    Non-FDA approved procedures (Quiz: What did I just say about non-FDA approved procedures?)

• Ultrashape (32% worth it)
• Mesotherapy (Lipodissolve) (32% worth it)

So that is it for aesthetic body sculpting procedures to reduce or remove fat.

Next: I haven’t decided. Stay tuned.

The fine print about body sculpting–risks, side effects, and other unpleasant things

I think I can confidently say that almost all of us would like to have a more sculpted body. That is the upside. The downside of body sculpting is that sometimes things don’t go like we want. Body sculpting with invasive treatments such as Liposuction; non-invasive FDA approved treatments such as Zeltiq Coolsculpting and Zerona; or treatments not yet approved by the FDA such as focused ultrasound (Ultrashape and others), or Mesotherapy (Lipodissolve) all have risks and the possibility of side effects. Risks are complications that sometimes happen, and that can be detrimental to your health, for instance a serious infection after a procedure. Side effects are things that can be expected based on the type of procedure that is performed and are aggravating but not dangerous, for instance, cutting into the skin may give bruising. And then there is “unpleasantness”, which usually involves outcomes that are not what you wanted, or that are cosmetically a problem. That is the fine print.

So let’s go ahead and talk about them, even though it is not fun. Once again, my lawyer reminds me to remind you that this is not medical advice to you as an individual, just informational. If you are not my patient, don’t listen to me, listen to your doctor. If you are my patient, I would appreciate it if you would listen to me, but we will always talk about risks and benefits of treatments before your actual procedure, so this is not your informed consent.

Liposuction

• Risks: The most significant risk of Liposuction is death from complications of fluid loss or anesthesia. If too much fat is removed the risk of serious side effects, including death, increase rapidly.  This is because if too much fat is removed then too much fluid is either removed from the body or goes into the space created by the fat removal. This reduces the volume of fluid in the blood vessels, causing shock. That is why official guidelines have been set as to the amount of fat removed per session have been developed, and responsible physicians (the vast majority of those performing liposuction) follow them. The ones who don’t are often the ones who you read about in relation to liposuction related deaths, which are often also performed in inappropriate facilities without appropriately trained medical staff and equipment.
• Other risks are hematoma (collection of blood in the fat removal pocket), infection, scarring, damage or death of skin over the treated area, and changes in sensation.
• Fortunately, significant complications from liposuction surgery are infrequent.
• Side Effects: Post treatment discomfort or pain, bruising for 7-10 days, swelling up to 3 months, drainage of a combination of fluid and blood coming out of the small incisions. The incisions heal with a small scar that are usually very faint.
• Unpleasantness: Indentations, surface irregularities, rippling, worsening of cellulite appearance.

Zeltiq Coolsculpting

• Risks: There has been one reported case of a small (less than an inch) second degree burn which is like a blistering sunburn. It healed without problem. A very small number of patients (1 in 2500 treatments) report significant pain after treatment, lasting 1-3 weeks after treatment, then resolving.
• Side Effects: redness, minor bruising, tingling, or numbness after the procedure; all are temporary.
• Unpleasantness: Less improvement than desired, improvement area restricted to area of applicator, possible need for additional treatments

Zerona

• Risks: There have been no reported risks of Zerona that I can find. The supplements may have risks of their own depending on what is used.
• Side Effects: There have been no reported side effects to Zerona that I can find.
• Unpleasantness: The fact that there are no reported risks or side effects may be related to the lack of the laser really causing any effect on the tissue. My feeling, and the feeling of many physicians, is that there is no real effect from this treatment, and that any improvement is due to the diet and exercise program along with the “supplements.” We will talk about satisfaction rates next time, but, overall, it is low.

Mesotherapy (Lipodissolve)

• Risks: Not approved by FDA, and you won’t know what is being injected into you. There are reports of significant pain, skin necrosis (death of skin), infection with abscess (pus pocket), allergic reactions
• Side Effects: Bruising, redness, Hard knots, areas of firmness,
• Unpleasantness: Lack of improvement, irregular contour, permanent discoloration and firmness at injection sites.

So much for the unpleasantness, we still want improved body contour and fat loss, so…………..

Next: Top 10 Aesthetic body sculpting tips–what works, what doesn’t

Cost and number of treatments for Liposuction, Zeltiq Coolsculpting and Zerona

When you are deciding on which body sculpting or fat removal procedure is right for you need to know the cost of the procedure and how many treatments you would need. Prices around the country vary and the prices below are an average. You also will want to be clear about what constitutes an area–for instance “thighs” is not an area–inner thighs, outer thighs, love handles, abdomen, flanks in general are each an area. For liposuction, inner thighs would include both legs. Coolsculpting is different as each inner thigh requires a 60 minute treatment cycle, and the practice pays for each cycle performed. Prices vary quite a bit for liposuction, depending on your geographic location, the physician doing the procedure, the number of areas treated, and whether your surgeon will utilize general anesthesia. Sometimes the surgical facility fee is included, sometimes it is not. For both liposuction and Coolsculpting discounts are often given for doing multiple areas at the same time.

Liposuction prices vary more widely than either Coolsculpting or Zerona. An average for liposuction with anesthesia including the facility fee runs around $3500-4000 for the first area up to $6000-$9000 for the first area in a high cost area like Manhattan. Discounts are usually given for additional areas performed at the same time. An average for 3 areas, such as abdominal liposuction with flanks and inner thighs would be $6000-$8000. In a high cost area prices would be higher.

Liposuction is usually one treatment per site.

Zeltiq Coolsculpting prices differ some around the country, and also by the size of the treatment head used during treatment, either the standard or the large treatment head. The standard head usually runs around $700 per each 60 minute treatment cycle. The larger head, which treats two and a half times the area of the standard treatment head, runs around $1500 per cycle. Discounts are sometimes given for multiple treatments at the same time. For instance we are currently offering a Coolsculpting BOGO discount offer of half off the second 60 minute treatment cycle so you would buy one treatment for upper abdomen and get the lower abdomen for half off.

The number of treatment heads per site is usually one small head for each side for the inner thighs, love handles, bra fat, and flanks. For the abdomen the number and size of heads varies depending on the size of the area treated. A medium budge on the lower abdomen could be treated with one small head, a larger bulge would be best treated with a large head. Treating both upper and lower abdomen requires two treatment heads, which depending on the patient, could be two large, two small, or one large and one small. A bulge that is primarily in the middle over the belly button can be treated with one head, either large or small, depending on how big it is. That is why we have you come in for an evaluation so we can tell you how many heads and which size you would need.

Zerona prices are an average of $3000-4500 for a series of 6 treatments. This usually doesn’t include the supplements given.

Mesotherapy costs vary widely as there is no standardization as to compounds used and number of treatments needed. It is stated as an average of $2500 per site. But as discussed on the last post, I don’t recommend it at any price–so it doesn’t really matter.

Next: The fine print about body sculpting–risks, side effects, and other unpleasant things

Body sculpting: Take Your Pick
How do you know which body sculpting procedure is right for you?

When you are deciding on which body sculpting procedure is right for you, you have to accurately assess what your problem is, which treatment is the best to fix it, how much risk, down time, cost you are willing to accept, and what is the likelihood that you will be satisfied or disappointed with the results. Like many things in life, the answer may be different for different people, even if they have the same medical condition, because of the other factors involved.

Today I want to talk about how appropriate each procedure is for an individual based on the medical needs and expected results. Later we will look at the costs, number of treatments, risk of side effects. Then you can input all of the data into your little computer brain and decide what is right for you.

The first issue to look it is whether the area of fat is localized or generalized.  This means are we looking at a localized collection of fat, for instance a belly fat bulge or is there fat from your jowls to your ankles. All of the methods were are talking about, with the exception of diet, exercise and gastric banding, are meant for localized collections of fat. Liposuction is not safe for use over multiple large areas at one treatment. You could do multiple sessions of liposuction to different areas, and some people do just that. But some areas, like the abdomen, respond better to liposuction than other areas, like the calves. And in certain areas, the risk of nerve damage and rippling is higher. Zeltiq Coolsculpting also can be done on multiple areas, as long as the treatment adapter will attach with sufficient suction to complete the treatment. But here again you are looking at multiple treatment sessions. Zerona claims to give fat reduction in areas not specifically treated. However, diet, exercise and supplements are also part of the treatment, and the mechanism by which one would get reduced fat in non-treated area based on the basic science of the laser technology is beyond my current comprehension, so, I remain skeptical.

So if you have generalized fat–it is diet and exercise or gastric banding (and it’s enforced diet) for you.

Next we look at where it is localized, both body site and whether it is internal or external.  Some fat is inside the body cavity, around the organs like the heart and in the connective tissue that holds your intestines in place. Sounds lovely doesn’t it? Some is outside the body cavity. You can tell which is which by squeezing the fat in between your fingers. If you can bunch it up and pull it away from the body it is external, if not, it is usually internal. Fat inside the body cavity, or internal fat, can only be reduced just like generalized body fat: diet, exercise or gastric banding. External body fat can be removed by liposuction or treatments like Coolsculpting.

Liposuction can be used on more areas than Zeltiq Coolsculpting because smaller cannulas can be used on smaller places like under the chin. With the currently available heads, Coolsculpting can be done on abdomen, sides, flanks, love handles, inner thighs, and in some people outer thighs and arms. Lipo can be done on all of these places as well as on the upper neck, and calves. I expect new treatment heads for these smaller areas to be available for Coolsculpting at some point.

Then we have to consider skin elasticity and tone. When fat is removed and the skin elasticity is not good, then loose skin will result. Skin that has more natural elasticity will tighten more than skin that has less natural elasticity. Skin that is less stretched by larger fat deposits, in general, will spring back better than skin that is more stretched out. Some lipo methods which use laser or ultrasound to assist fat removal can give some skin tightening, but the degree of tightening is variable and along with that is some increased risk to the skin from the heat build-up involved. Coolsculpting does not tighten skin, however, the fact that the fat is lost over a 4 month period of time gives the skin a little more time to  adjust.  In most patients, cellulite is not improved with any of the methods of fat removal. There is no cream or treatment that gives reliable, noticeable improvement in cellulite. I need to invent it and retire to Fiji.

And finally is the question of how much improvement you want. Liposuction removes the most fat per area, although the amount removed and the number of areas treated at one session is limited by safety considerations. Liposuction also has the highest risk of rippling. And certain areas, like the buttocks, are very difficult to treat with any method because of the 3 dimensional nature of the area and the need to maintain those 3 dimensional contours.

Next: Body sculpting procedures–what’s it going to take? Cost, number of treatments for Lipo, Zeltiq and Zerona

Beyond Lipo: Procedures for Body Sculpting and Fat Reduction

How to remove fat safely and effectively, without relying exclusively on diet and exercise

When you are thinking of having a fat removal procedure, your options include invasive (surgical) and non-invasive (non-surgical) procedures. Invasive procedures include liposuction (lipoplasty), in which a hollow tube is inserted into the fat through small skin incisions to suction out and remove fat from localized areas. There are several forms of liposuction, involving the use of suction, ultrasound or laser. Liposuction effectively removes fat but because the volume of fat that may be safely removed is limited, it is a procedure to contour the body, not for weight reduction. Liposuction does not improve skin looseness or cellulite. When performed by a qualified and experienced physician, liposuction is safe and effective. However there is some risk, recovery, and discomfort associated with liposuction which has lead to the growth of non-surgical, non-invasive body contouring.

Two devices that have been approved by the FDA for use in the US are Zerona and Zeltiq Coolsculpting.

Zerona is a non-invasive laser designed for body contouring and according to proponents makes fat cell membranes more porous or “leaky”, thus allowing for fat excretion. Zerona is typically administered in a medical office in 6 sessions stretched over a two week period. Diet, daily exercise, and special niacin based supplements are usually an integral part of the program.  Measurements are taken at multiple places on the body, and are added together for the manufacturers reported 3-5 inch circumferential reduction. What this means is that multiple areas are measured, some outside of the treatment area, and added together for a total loss, so that if you measure 10 areas and each shows a loss of a third of an inch, the loss is reported as 3 inches. My concern with Zerona, and why we have chosen Zeltiq Coolsculpting instead as our non-invasive fat reduction choice, is whether it is really effective or not. Double blind, controlled long term studies without a strict diet, exercise, supplements and the variability of tape measure recording of multiple areas are needed.

The newest non-surgical FDA approved method, Zeltiq CoolSculpting, reduces fat by chilling it, which provides an effective non-invasive tool for fat reduction. The applicator is applied to the target bulge with suction and delivers precisely controlled cooling specifically targeting fat which leaves skin tissue unaffected. Fat cells are destroyed and eliminated through the body’s natural processes.

Studies have shown that CoolSculpting gives an average reduction of 22% in fat after one treatment. If additional fat removal in the area is desired, another treatment can be done which will yield an additional 20% reduction resulting in a total fat loss of 40%. Final losses may be more or less, depending on the individual.  Some patients experience redness, minor bruising, tingling, or numbness after the procedure, but these are temporary. Results are permanent as the fat cells are destroyed and removed from the body.  CoolSculpting’s advantage is that it is completely non-invasive and extremely safe. While the results are not as dramatic as those following liposuction surgery, the absence of any downtime and the safety of the procedure make it a popular choice for fat reduction and body contouring. Like liposuction, it is not intended as an overall weight-reduction program.

There are other procedures that are promoted for body sculpting and fat removal. Focused ultrasound devices like Ultrashape, not approved for use in the US, are used in other countries. From my discussions with other physicians they do work, but there is significant discomfort, and a higher risk of side effects than with Zeltiq Coolsculpting.  Mesotherapy (Lipodisolve etc) involves injections of mixtures of medications injected into the fat. The mixtures are often “secret recipes”, none are approved by the FDA.  Complications have been lumps, infection and tissue death. Focused ultrasound is currently going through the FDA approval process. If it is approved and turns out to be effective, safe, and tolerable in terms of discomfort, then it will be a welcome addition to non-invasive body sculpting. We shall see. Mesotherapy would have to be standardized, approved by the FDA, be safe and effective before I would consider using it. I don’t think that will happen.

Next: How to know which body sculpting and fat removal procedure is right for you, and which ones have the highest satisfaction rates

Do I really have to get fatter and fatter every year?

This time of year many of us are making, and breaking, New Year’s resolutions. The most common one, I suspect, is to lose weight and get in shape. There really is an epidemic of obesity all around us. Interestingly, as the celebrities and those we see in magazines, in movies and on reality TV get smaller on bottom and bigger on top, those sitting next to us on the airplane are getting much larger. Food serving sizes are increasing every day, we are eating out more, snacking more, picking up dinner at the drive through, and heating up frozen pizza. I remember when McDonalds served the kids meal burger and fries as the main burger and fries combo for adults and the Coke was 6 oz. Today I think you can get a 4 pound quadruple cheeseburger with a gallon bag of fries and a 120 oz Coke. And we wonder why we need that seat belt extender.

Processed foods with a high glycemic index, combined with cortisol-releasing stressful lives and lack of exercise result in people who are “packing the pounds”. Hormonal changes with aging cause weight control to become harder, and encourages fat deposits on thighs, hips, abdomen. Some fat is stored internally as what is called “visceral fat,” the fat inside the abdominal cavity surrounding internal organs like the heart,  and is also in the tissue that holds the bowel in place. This internal fat that gives the “paunch” or protruding abdomen that needs diet and exercise to improve. Some fat is stored outside the abdominal cavity underneath the surface of the skin, called “subcutaneous fat.” You see this as belly fat, love handles, saddlebags, back fat, inner thigh fat, and arm fat. It is not uncommon for bulges of fat to be resistant to diet and exercise, and to remain even after you have lost weight and are exercising. This subcutaneous fat is the fat that can be removed by liposuction and non-invasive liposuction alternatives like Zeltiq Coolsculpting. When we evaluate  fat to determine if it can be removed by invasive or non-invasive procedures, we squeeze it. If you can squeeze it, you can remove it. If you can’t it is internal and only diet and exercise will remove it.

It’s very hard to live in today’s world and eat healthy, exercise daily, reduce stress, when it seems everything is conspiring against us. Healthy diet, weight loss, exercise, and stress reduction should be the mainstay of our body preservation plan. But often we need a little extra help.

Next: How to remove fat safely and effectively, without relying exclusively on diet and exercise