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

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