The Dermatology, Laser & Vein Center: November 2014

By Santrina Fletcher, NP & Shalini Gupta, MD

It is absolutely amazing to experience the advances in technology lately! Cosmetic dermatology procedures are becoming less invasive and involve less down time. One example of this is Ultherapy, which is a facelift that is executed with the power of focused ultrasound. Ultherapy is the first non-invasive procedure cleared by the FDA that uses ultrasound to safely and effectively lift the skin on the face, neck and decolletage (chest area).

So, how does it work?
You may be familiar with the concept of ultrasound when identifying the sex of a baby, or during vascular procedures. Ulthera has taken this concept to the next level. The Ultrasound energy is delivered in a focused high intensity beam and targets specific depths for maximizing results. Unlike other FDA approved skin tightening devices such as Thermage, Exilis Elite, Venus Freeze, Skin Tyte, Titan, LuxIR deep, etc. which utilize either Infrared light or radiofrequency to deeply heat the collagen, Ultherapy allows me to visualize the layers of the skin and I know exactly where the energy will be delivered. Also, the Ultrasound can penetrate deeper and target the right structures without dissipating the energy to areas where it is not needed and hence lost. The first area that we target under the skin is known as the SMAS--a term you may know if you have looked into a surgical facelift. This is the fibromuscular tissue that covers the facial and neck muscles and naturally weakens with time and gravity. During a surgical facelift, it is sutured in a pursestring fashion to shrink and contract and hence lift the skin. With Ultherapy, we are able to contract this tissue through the skin without having to make any incisions. The second layer that is addressed is the dermal collagen. Collagen is the protein that gives skin its strength. It degrades over time, contributing to sagging and wrinkling in the skin. Applying energy to this area of the skin stimulates new collagen formation, a process known as neocollagenesis. Although there are some immediate tightening results seen, you will not see final results until about 3-6 months later.

The Nitty-Gritty:

First, there is a hand piece that is placed on top of the skin to identify the layer that we want to target. Once the fibromusclar and collagen layers are identified, pulses of ultrasound energy are delivered directly to those layers without disturbing the skin. It's just that simple. No bandages, no recovery time.

The procedure takes between 30 minutes and 2 hours depending on the amount of surface area covered. There is absolutely no down time since it is non-invasive and there are minimal side effects. Some people experience light bruising along the jawline or cheeks and report tenderness near the jawline. There is some slight discomfort during the treatment but is generally tolerated very well with Ibuprofen on board prior to treatment.

So, the next question is: How long will it last?
Since aging can't be stopped (unless we maybe enter , results from any procedure can never be permanent, but unlike Botox or fillers which wear off in 3-24 months, the effects from Ultherapy are yours to keep. Think of it this way: If Ultherapy can improve your skin and reverse your "age" by 5-10 years, you will always be that much further ahead as you continue to age. If this information is getting to you as you're just starting to see those first signs of sagging, it's an excellent time to get started. If you're a bit further along but hate the idea of surgery, this is the next best alternative by far. It is also an excellent insurance policy after a facelift to help maintain the tightness in your skin tissues. Continuing to lead a healthy lifestyle (good food, no smoking, minimize alcohol, avoid sun exposure, moderate exercise, using retinol and antioxidants on your skin, etc.) will certainly help you maintain your results. Certain vitamin supplements are also excellent. In fact, insurance is now covering these supplements for a $15 copay. Contact us if you would like to be signed up to receive these as well.

We are really seeing some "wow" results with this technology for face, neck and eye lifting! Visit our website for more info: http://www.cincinnatiskinandlaser.com/ulthera/

And please don't hesitate to contact us at 513-985-9885 to ask more questions.

Here's one of our patients after Ultherapy and Thermage for the upper eyelids Combo treatment.

ulthera_after_before_11

And more Ultherapy patients:

ulthera_after_before_3

Being in a position of having gained weight or inches, whether from poor lifestyle choices, genetics or medical problems, can be a very uncomfortable place to be in. Not only can it reduce self esteem and confidence, but it can also be depressing when your clothes don't suddenly fit correctly. Many of our patients also complain of just how uncomfortable those larger areas feel. The first steps to take are 1) Make sure there are no underlying medical conditions such as underactive thyroid that are reducing your metabolism. 2) Make sure you are following a healthy, balanced lifestyle by eating the right kinds of foods (avoid sugar, artificial sweeteners, all processed foods, hydrogenated oils, corn products, fat free foods, etc. Do consume mostly vegetables, try to go organic, and stick more to whole foods and seasonal fruits, etc.--this is really just a brief list). 3) Incorporate moderate exercise or activity into your daily life (if you can incorporate yoga and meditation, that will be great too).

For many patients, even doing all the right things doesn't get rid of certain stubborn pockets or areas. For women, the belly, love handles, arms and thighs are the most frustrating areas. For men, the belly, love handles, chest and under the chin areas seem to be most popular. There are two procedural methods for removing excessive fat.

The first category includes procedures which "poke holes" into the cell wall of the fat cells and allow the triglycerides, glycerine and fatty acids to spill out and be released from the body. These treatment methods require hydration, exercise and diet restriction to work. The latter three must be a continual effort to maintain results, otherwise, the hungry fat cells will begin reaccumulating fat and growing again. Procedures that fall into this category include i-lipo, Lipolaser, LiLa strawberry laser, and Zerona. Many of these are featured on groupon deals and fall into a fairly low price range. They are painless treatments using a cold red light laser beam that is applied via paddles or aiming beams over the treatment areas. Multiple weekly treatments are recommended. There is no recovery time and no pain with these treatments. Following strictly recommended water consumption, dietary restrictions and exercise recommendations will help these procedures be more successful because once that fat is released, it is essential to use it up right away before the body puts it back into storage. There have not been any documented risks. Perhaps the biggest risk is that it may not work for you. There are so many confusing names and technologies floating around. If you have heard of one and aren't really sure how it works, let us know and we'll be happy to check it out for you.

The second category includes procedures which actually cause apoptosis or fat cell death. These procedures give a more permanent result. It is still important to continue following good lifestyle habits after these procedures in order to maintain the results. It is true that once an area experiences permanent loss of fat cells, it is not as easy to regain the fat in those areas. Regardless, it is still crucial to make sure you have good lifestyle habits in place that you can stay consistent with prior to and after such procedures. This category of procedures is far more exciting because the results are more dramatic. There are noninvasive treatments and then our very favorite Vaser Liposuction.

Of the noninvasive Fat permanent fat cell killing procedures, here is the list:
1) Liposonix: Uses High Intensity Focused Ultrasound (HIFU) to target fat cells under the skin and cause their cell death. The fat and cells are slowly eliminated over a 3 month time period. The procedure can be repeated at 3 months for improved results. This is a single treatment. There is some discomfort during the procedure which can be curbed with oral pain medications or with a little local tumescent numbing medicine placed in the deep fat layers. This procedure, as with all the nonsurgical permanent fat destroying methods, are better suited for patients in decent shape with small areas to loose. We have certainly been impressed with results we have achieved with this technology. Some patients have lost up to 5 inches from their abdomens. It also works well for arms and thighs.

2) Vanquish: Vanquish uses the power of radiofrequency delivered through the skin via electromagnetic energy. Its prototype was first used in the Czech republic to treat muscle spasms, when it was discovered that these patients were also achieving permanent fat loss. This is currently among our most favorite procedures. There are three panels on this device, which allow for excellent coverage of the stomach and the sides at the same time. Some patients also have us treat their back fat and love handles. Besides destroying fat cells, this also helps to tighten the skin, so the best part is achieving excellent body contouring with this process. We love how it spread the energy very evenly over the entire treatment area. We might even combine this procedure with liposonix or exilis elite if there are particularly bulgier areas that need extra attention. The very best part is that this procedure is painless. It feels like a warm blanket over your skin. I was particularly surprised when I tried this procedure how hot the skin and underlying tissue actually feels to touch not causing any discomfort at all. Like liposonix, this procedure is fat selective and will not cause damage to any surrounding skin structures. We recommend one treatment a week for six weeks. You will see improvements occurring over 3-4 months after treatment.

3) Exilis Elite: We primarily use this monopolar radiofrequency device for skin tightening and cellulite, but it is also excellent for spot fat reduction, where it will cause apoptosis to fat cells. In a way, this procedure is very similar to Thermage, but without the pain and with better control of treatment depth. It is also less expensive than Thermage. During this procedure, a wand emitting the radiofrequency energy is continuously pressed and moved over the troubled area(s) while we measure the heat we are generating under the skin. Like Vanquish, the radiofrequency energy is also going to stimulate new collagen growth for tighter skin as well as kill fat cells in the area. Apoptosis or cell death of the fat cells can be achieved if we can heat the fat to 45 degrees for 5 minutes continuously. We recommend one treatment a week for 4 weeks. More treatments can be done for even greater improvements if needed. No pain with this procedure either. Just a steady heating sensation.

4) Coolsculpting: We do not actually offer this procedure but I wanted to mention it for the sake of being complete. With the advent of Vanquish, we don't feel Coolsculpting has much of a place in our practice or any advantages. It uses the concept of applying very cold temperatures to the fat cells, which destroys the fat cells but does not harm the skin. The skin and fat are suctioned into a handpiece, which is held over the area for one hour. Unless the practice has multiple devices in use, it takes about 3 hours if you wish to treat lower stomach and two love handles. When we tried this technology, the major complaint was the thawing process afterwards as being very uncomfortable for several days. Results didn't seem very impressive either. The other concern is that it can lead to lumpy areas or ridges where the technology grabs the skin. There is no doubt that this procedure works, but I feel we have much better options.

So, now we move into my most favorite category which includes the Liposuction procedures. These are minimally invasive. Our patients are entirely awake and conversing with us or lost in their music throughout the treatment. A local tumescent numbing medicine is spread into the fat layers. With traditional liposuction, a suction canula with sharpened edges would next be inserted to manually suction out the fat cells. With our Vaser and Smartlipo technologies, we use the power of Ultrasound or Laser to first selective target and liquefy the fat cells for us. I am then able to gently suction the fat cells out with much smaller blunt suction cannulas. Overall, there is less trauma, less bruising, less swelling, less temporary nerve sensation loss, and back to regular activities much sooner. It does take a little longer than traditional liposuction, but the rewards are much greater. You will get up and walk home and return to work after two days. Also, because the ultrasound and laser energies help heat the skin, we can achieve much better tightening of the overlying skin compared to traditional liposuction. My preference these days is to use the Vaser technology as it is very selective for destroying the fat cells whereas the laser canula will cauterize or burn through vessels and nerves. The laser treatments also take much longer to complete in larger areas because the laser fiber is spaghetti thin. With Vaser I can reach the deep to superficial fatty areas easily and more completely. The ability to sculpt an area is amazing. The results are dramatic and artisitic. There is a compression garment we recommend wearing anywhere from two weeks to six weeks depending on how much fat we are removing. The most popular treatment area is the stomach and sides, followed by thighs, knees, calves, arms, bra fat, male breasts and chin/jowls. It can also be used under the eyes to gently remove puffiness or festoons. Also, if you want to transfer your fat to another area, this can easily be accomplished. The fat cells we collect via Vaser liposuction are far more viable and establish themselves easier than those removed via traditional liposuction because they are less traumatized. Many patients request enhacement of their breast and/or buttocks. When treating the chin/jowls areas, it can be an excellent intermediary step prior to requiring a facelift.

In conclusion, we live in times where 40 feels like the new 20 and 60 like the new 30. We are living healthier, feeling better, and aging better. The above procedures and many more that we offer at the Dermatology, Laser & Vein Center, can help us stay looking the way we feel inside. They will restore confidence and allow us to be our very best! We are always available for questions and further explanations. Our aim, since we opened our doors in 2001, has always been to stay at the forefront of advances and provide our patients with the very best cosmetic dermatology procedures possible, with the very best skills, artistry and compassion.