Plastic Surgery Newsletter
November, 2009

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Terry L. Hand, M.D.
 
In This Issue
View The New You In 3D
Change In The Restylane Rewards Program
Ask The Doctor
Our Favorite Products
Featured Procedure: Liposuction
Want A Reason To Love Your Lower Belly Fat? It's Rich In Stem Cells!
New Study Confims Vaser Liposuction Is Superior To Standard Liposuction
Lisa Talks About Matrix RF and IPL with RF
View The New You In 3D

3D procedure animations

One of the great features that the
American Society
of Plastic Surgery provides to educate our patients regarding plastic surgery procedures is the following animation link. Almost any procedure you might be interested in is addressed.  Our office is happy to schedule a consultation if I can answer any questions you may have about how the procedures can be tailored to your needs.

See Cosmetic Surgery Procedures In 3D Animation

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restylane and perlane

CHANGE IN THE RESTYLANE REWARDS PROGRAM

Our office was notified last week that based on consumer insights, the tiered-rebate structure of the Restylane Rewards program will be replaced in 2010 by valuable discounts and patient rebates pulsed throughout the year.  Patients can still take advantage of their current rebate level if they act now and receive a Restylane or Perlane treatment by December 31, 2009. (Paperwork must be postmarked by January 5, 2010.)
  


ASK THE DOCTOR

The holidays will soon be here!  I  would like to appear refreshed  without much downtime.  Do you have any suggestions?  V. P.


The obvious suggestions would be Botox and fillers.  Most patients experience very little swelling or bruising with both procedures.  Botox makes a huge difference in diminishing frown lines, lateral eye wrinkles and forehead pleating.  It is also wonderful for injecting into the neck bands to lessen pleating.  The dermal fillers are also quick and easy and usually most swelling is gone within a few days.  It is a good idea to avoid aspirin, nonsteroidal pain medications and fish oil for about 10 days prior to injection in order to minimize any bruising.

The Matrix RF is great at refreshing the skin with almost no downtime.

With all of these procedures, you should be looking great a week afterwards.  Enjoy the season!

Our Favorite Products 
Two product lines have been on my short list of effective products for awhile, the Obagi Nu-derm skin system and for those that prefer a less aggressive approach, Topix glycolic acid  creams and moisturizers.  This month, make your skin a priority!  If you haven't been in for awhile, come in and see Lisa for a complimentary skin evaluation.
 
During the month of November, both Obagi and Topix products are 10% off!!


Glycolix cream
 
Offer valid through 11/31/2009
 
Latisse logo for newsletter

We're Looking For Great Latisse Results
eyelash photo
Stop by the office and show us your lovely lashes!  We would love to start rephotographing our patients that have used Latisse for 4 months or more.

Remember that after that period of time, you may reduce the frequency of application to 2 - 3 times per week to maintain your results.  Also, many patients find that one drop for both upper eyelids  is all they need!
I have just returned from the American Society of Plastic and Reconstructive Surgery annual meeting in Seattle.  As always, there were plenty of studies and papers presented that were thought provoking, some that revealed trends for rejuvenation techniques that I believe will change current preferred techniques in the cosmetic and plastic surgery community eventually and some that I found to be just silly. What do I consider to be interesting new research that may change the face of plastic surgery?  Stem cell research.  This month I am including an article that addresses recent research into the stem cell content of liposuction fat.  What do I consider to be silly at this time?  Hyaluronic acid fillers to be used as an alternative to breast augmentation.  Currently a product that is used in Europe is being tested to use as a temporary breast filler.  The cost, roughly $1,500.00 less than an augmentation and the product is absorbed in 12 to 18 months.

Since we have incorporated the Matrix RF and the SRA intense pulsed light options for skin rejuvenation into our practice, we are seeing some really nice results.  Lisa has tried both options and will describe her experiences with both later in this newsletter.

Our featured procedure this month is liposuction since this is one of the best times of the year to consider body contouring .  I ask my patients to wear a compressive garment for about 3 weeks following the procedure. The cooler weather and fall clothing styles make an incognito recovery easy.

I have included a link to the 3D animation videos that are provided though the American Society of Plastic Surgery.  Most cosmetic surgeries are addressed.  The animations provide good basic information to help you understand the procedure that you are interested in.

Allergan  has extended it's $50.00 off rebate program through December 31st.  Our office has received  a limited number so we will assist you in the paperwork as long as we have the coupons.  Please ask Lisa or Cheri to save you one when you make your holiday Botox appointment.  I believe that in the coming year, more of the suppliers will begin to offer advantageous rebates.

Regards,

Terry Hand, M.D.

Featured Procedure:  Liposuction
lipo rear view
 
Liposuction is a surgical procedure designed to sculpt and remove localized fat in areas that appear to be resistant to diet and exercise. Very often, because of the aging process, fat redistributes to locations that were previously never a problem. Liposuction targets these areas permanently. The possibility to gain weight still exists, so fat redistribution may occur with a large weight gain. Liposuction may be performed on the neck, the arms, abdomen, hips, back bulges, buttocks, thighs and knees. An appropriate candidate for liposuction is in good health and usually is of average weight with healthy, elastic skin. Some individuals have bulges in the neck or thighs that have been apparent since puberty, changing little with weight loss. Others, particularly when entering the 40's, will see increased abdominal fat and back fat that lingers. Often, genetically inherited fat accumulations can be altered positively. Small amounts of fat, removed from isolated areas, often create amazing results in the body's contour.

Procedure Description

Dr. Hand performs liposuction at our accredited Marin County outpatient surgical facility. General anesthesia is required in order to ensure total patient comfort during the surgical procedure. Dr. Hand is then provided an enhanced ability to sculpt and refine the targeted areas completely with no discomfort.
Dr. Hand utilizes Vaser liposelection, an internal ultrasonic instrument that is tissue-selective in that it targets unwanted fat while preserving other surrounding tissues. This technique also promotes smoother contours, decreased healing time and bruising. It is much more precise than older methods that used large cannulas and were not selective of the tissues that were disrupted. The ultrasonic waves produced by a special cannula tip, essentially rupture and emulsify the targeted fat cells, making them easier to aspirate with smaller cannulas.
During the procedure, tiny incisions are placed in discreet locations. An infusion fluid is injected into the fatty layer under the skin and the ultrasonic sound waves are applied via the cannula. After the fat has been treated, a small suction cannula is inserted and the area is carefully sculpted so that the body contour is refined and the treated area is proportionate to the rest of the body. The incision sites are sutured and a compressive garment applied.

Recuperation and Healing

Immediately after surgery is completed, the treated surgical areas can be very uncomfortable for a few hours. The discomfort is usually easily managed with oral pain medications and rest. A few hours later, the bulk of the discomfort has quieted and the area will usually only be sore for a few days. A small amount of drainage from the incision sites is normal and may persist for 24 hours. The liposuction garment is to be left in place continuously for 5 to 7 days following surgery. Its purpose is to control swelling and fluid collection in the treated areas and to assist in skin contraction. Removing the garment prematurely may increase the healing time and general discomfort. After the 1st week, the garment may be removed to launder or to shower but should be reapplied and worn continuously for another 2 weeks.
Most patients can return to non-strenuous work in 3 to 5 days after surgery. Most exercise maybe resumed in 2 to 3 weeks. Some swelling and discoloration may persist for 3 weeks but a dramatic difference in contour is often seen immediately. The final result of liposuction can take 4 to 6 months during which time the skin tightens over the treated areas.
Want A Reason to Love Your Lower Belly Fat? It's Rich in Stem Cells!
 
ASPS Study Finds Some Areas of the Body Have Greater Concentrations of Stem Cellswaist tape measurei


ARLINGTON HEIGHTS, Ill. - Fat removed from the lower abdomen and inner thigh through liposuction was found to be an excellent source of stem cells, with higher stem cell concentrations than other areas of the body, reports a Brazilian-based study in August's Plastic and Reconstructive SurgeryŽ, the official medical journal of the American Society of Plastic Surgeons (ASPS). This is the first study of its kind to examine whether fat tissues from different areas of the body vary in stem cell concentration.

"Adult stem cells, derived from our own tissues, hold strong promise for improved clinical therapies," said J. Peter Rubin, MD, a member of the ASPS Fat Grafting Task Force who is involved in pre-clinical trial work on stem cells taken from fat. "The potential for healing and repairing injury or disease through stem cells, including conditions like breast cancer and reconstruction, heart failure, spinal injuries, diabetes and Parkinson's disease are incredible. We may be able to more permanently and naturally get rid of pesky wrinkles or augment breasts with stem cell enriched fat in the future as well. Knowing more about the biology of stem cells will be of great value when we are ready for clinical trials in this country."

In the study, 23 female patients having liposuction in at least four different body areas agreed to have their fat isolated for adult stem cells and analyzed to determine stem cell concentrations. The body areas that were liposuctioned were: lower abdomen, upper abdomen, inner knee, inner thigh, flank and hips.

The study results found a significant difference in stem cell concentrations in different areas of the body. A major finding was that the concentration of stem cells was greatest in the lower abdomen and inner thighs. Interestingly, stem cell concentration in the lower abdomen was five times greater than in the upper abdomen.

"The value of stem cells harvested through fat is the ready and ample supply available," said ASPS President Richard D'Amico, MD. "Using stem cells will some day have very practical applications to the specialty of plastic surgery. That we may be able to generate new tissue or bone that can be used in many of the reconstructive and cosmetic procedures we do every day is a tremendous."

Stem cells are unspecialized cells that have not yet developed a specific function. Not only are they capable of self renewal, stem cells can divide and produce others that become specialized cells. Scientists and doctors theorize that stem cells will be able to repair or replace damaged or diseased cells. Clinical trials researching the potential of stem cells from fat are ongoing in Europe and Asia. In the U.S., there are many investigators doing pre-clinical trial work to meet the stringent safety guidelines the FDA sets for clinical trials.

 
New Study Confirms VASER Liposuction Results are Superior to Standard Liposuction
October 26, 2009

Vaser lipoSeattle, WA - At the 78th Annual American Society of Plastic Surgeons Annual (ASPS) Meeting, Dr. Paul Vanek presented a study that confirms that VASER-Assisted Lipoplasty (VAL) delivers superior results over traditional Suction-Assisted Lipoplasty (SAL) in skin retraction and blood loss.

In a study called "A Multi-Center, Prospective, Randomized, Single-Blind, Controlled Clinical Trial Comparing VASER-Assisted Lipoplasty and Suction-Assisted Lipoplasty" results showed that the VASER Lipo treatment demonstrated 53% improvement in skin retraction per cc of aspirate removed relative to the standard SAL method, and an average reduction in blood loss of 26% compared to traditional liposuction. This is the first study to demonstrate statistically significant and clinically relevant improvements in a new lipoplasty technology relative to SAL. This prospective study used a contra-lateral (side-by-side) study design to evaluate post-operative differences between the two techniques over a six-month time period.

"Physicians have been reporting skin tightening benefits and reduced blood loss with the VASER Lipo System since the technology was released in 2002," said Dan Goldberger, CEO of Sound Surgical Technologies LLC. "This study now provides empirical evidence of yet another advantage of using VASER ultrasonic energy in all body contouring procedures."
The study involved twenty female patients between the ages of 20 and 48 who received contra-lateral treatment with traditional liposuction and VASER Lipo in one or more anatomical regions that included the upper arms, upper back, flanks, outer thighs, and inner thighs for a total of 33 regions. Patients were blinded to the technology that was used on them and aspirate was kept separate and analyzed for blood content. Skin retraction was measured using changes in UV tattoos placed prior to surgery.
Lisa Talks About Matrix RF and IPL w/ RF
matrix rf machine photo
Although I am still undergoing a series of treatments of both the Matrix RF and the IPL with RF, I have seen significant pleasing changes.

What areas am I working on?  The loose little waddle (for lack of a better word) under my chin, the lipstick lines on my upper lip, the wrinkles around my eyes and my biggest nemesis the freckled, reddened areas on my arms,  hands and chest.

So far, I have done 3 IPL treatments to my arms and chest. As of today,  I am 1 week post my 3rd treatment.  After every treatment, I experience significant redness immediately and some swelling for about 2 days.  After that, the freckled areas start to become darker and eventually flake off after 7 to 10 days.  The areas of vascular redness fade over the same amount of time.  Each treatment brings less immediate darkening and redness but results in amazing improvement after 10 days.  I sunscreen the areas that have been treated religiously and usually wear a long sleeved shirt for extra protection.  I wore a scarf around my neck for the 1st 2 days and just a higher neck shirt for the remainder of the 2 weeks after treating my neck and chest with the IPL. 

The Matrix RF treatment has been amazing in treating my face and neck.  I have treated my entire face 1 time, the areas around my eyes, above my lips, under my chin, and the surrounding neck  2 times.  I have significant improvement already to all of the areas.  The skin around my eyes is really smooth, my lip lines are greatly diminished and my neck skin has tightened.  I noticed the greatest improvement about 3 weeks after each treatment.  Immediately after each treatment, I experience a large amount of redness for that day only.  The next 2 days, I have blotchiness that was easily covered by makeup and a few tiny marks to some of the treated areas.  The marks look like tiny pinpricks and are difficult to see.  For the next 5 days, my skin feels a little rough but any redness had will have disappeared.  Again, all easily covered by makeup.  I was able to go to my exercise class 2 days after all of my treatments with no one noticing anything odd at all.
 
Thank you for taking your valuable time to once again read our newsletter.  As always, our office would like to extend the offer of a no cost consultation for our loyal clients that subscribe to this newsletter. Please do not hesitate to let Cheri or Lisa know if you have further questions about any of our procedures or financing.
 
Sincerely,

Terry L. Hand, M.D.