Category: Non Invasive

It’s amazing how often patients suggest… “If I exercise more my loose skin will get tighter right?”  Boy don’t we all wish it was as simple as that.  Unfortunately it doesn’t work that way.  Without getting to scientific about it all let’s discuss skin changes with weight, child birth, sun damage, and other aspects of mother nature.

Exercise is a great thing, most of us could use more of it and it’s great in assisting weight control, muscle tone, maintaining bone density, and keeping our heart strong and our blood pressure down.  Exercise cannot tone your skin your skin however.  Good muscle tone will show nicely “under the skin” but the skin itself doesn’t change as much as we’d like with fitness alone; some just not much.

In fact, if your fitness means being outside swimming, hiking, biking, running, gardening, playing tennis, or golfing the fact is the Arizona sun may be aging your skin significantly while you’re getting more fit everywhere else.

Don’t get me wrong; I’m an Arizona boy and I love my time outdoors in the sun.  It is why we all choose to live here.  Just make sure you are vigilant with quality sunblock, consistent with hydration and try to do the outdoor activity when the sun isn’t beating you down with noontime intensity.  Quality sunscreen contains ingredients that are physical blockers i.e.; titanium dioxide and or zinc oxide.

Moderate exercise does improve blood flow to tissues balances our blood sugar lowers our blood pressure and can smooth out our hormone/endocrine physiology.  Some of these physiologic parameters are good for the skin physiology, but again watch the sun damage.  A significant component of skin aging is genetically driven and exercise can’t compensate for your genes.  Excessive exercise is not necessarily good for you either.  Remember your parent’s adage “everything in moderation.”  Excessive exercise can lead to low grade inflammation in the body, the joints, the organ systems and that’s not a good thing.  So be smart and be consistent with steady moderate exercise and in the long run you’ll be better for it.

Unfortunately if there is stretching of the skin from pregnancy, weight changes, whatever the cause you may need the tricks of our trade with surgery, lasers, truSculpt or other skin tightening procedures to accomplish your goal.  Don’t stop exercising; jsu don’t think you can exercise your “skin” back to youth.

So may Aesthetic options so little time (and of course money).  Plastic Surgery has many terrific options to keep us looking healthy vital and refreshed.  Some of these are completely noninvasive and can take years off your appearance for very little cost.  One such option is Intense Pulse Light or what we call “IPL” therapy.  While patients sometimes think of IPL as a type of laser; it’s not a laser but does use light energy to improve the appearance of your skin.  True lasers use one specific wave length of energy to do its job.  Intense Pulse Light uses a narrow range of wave lengths from the light spectrum for specific purposes.
My IPL system has multiple special energy delivery heads that serve different purposes.  Each head or hand piece has a band of wave lengths that are a part of the light spectrum.  The device has a red, green, yellow & purple hand piece to deliver different methods of laser or light source to the skin.  One head is good for brownish pigment of the skin another for reddish tones another for hair removal as examples.  If you have heard the term photofacials; IPL is that type of treatment.  What has been shown is that patients who do perhaps five photofacials each year over five or more years have skin that is much brighter, healthier and younger appearing after those five years than it was before they were ever treated.  Not only do the color tones improve but the texture, fine lines, wrinkles and general appearance of the skin is improved.
IPL treatments have a nominal cost to our patients and there is no downtime.  Photofacials or IPL  treatments are great first steps in keeping your skin looking refreshed when blended with quality skin care. Come see us for a skin care consult and start turning back the clock.

Noninvasive Body contouring: Trusculpt, Cool sculpting, Venus Freeze, Velashape, Excilis, Vanquish, Vasershape, Apollo, Zerona

There are so many nonsurgical options for body contouring it will make your head spin. In fact, for all I know by the time I finish typing this blog another company will maybe bring a new device to market. Of course market is the key word here for unfortunately so much has to do with marketing, and less at times with science or results; it’s very tough for patients to sort out the differences between these technologies. Individual offices may choose one or two options to offer patients based on their belief in what works best in there hands, or what fits best for their market. As a plastic surgeon there is the genuine advantage of offering several noninvasive options, but also knowing when surgery or liposuction truly is in the patient’s best interest.

So what are these various technologies and how do they work. First of all every device listed in the title works to some degree or another, some are more aggressive, some less so. Remember all are noninvasive treatments that don’t have the control or power of liposculpting the body, but for many of our patients that is the point. Patients frequently want a non-surgical option with no down time that can greatly improve their body shape without recovery time; just be sure you remain realistic about what these noninvasive body contouring devices can and can’t do.

Trusculpt made by Cutera is a radio frequency (RF) energy source for tissue heating. Radio frequency(RF) is a type of energy generation that passes through tissue and the natural resistance of fatty tissue makes it heat up the fat causing it to “melt away” over time. “melt away fat” is a bit of a misnomer, but gives a good image. What really is happening is the focusing of the heat energy into the fat causes a little bit of damage to the fat cells from the radio frequency energy where the trusculpt is applied. The body slowly “cleans out” and removes the injured fat cells by a mechanism called apoptosis. The best way to explain apoptosis is to realize the body naturally is cleaning up damaged cells in our bodies all the time. There is significant turn over of cells in our liver, our skin, our bowels as examples and the body naturally cleans stuff up through inflammatory mechanisms. We don’t grow new fat cells (unlike the liver or skin) after puberty so once the injured fat calls are removed by apoptosis they are gone for good. So if you trusculpt your abdomen and flanks a couple times over the next few months the tissues will thin out as the body naturally removes the injured fat cells. Another advantage of the trusculpt and radio frequency energy is that it is well documented to help tighten lax skin. Radio frequency has been used for many years as an energy source for tightening facial skin; modifying how the energy is delivered by the trusculpt lets the device decrease fat and tighten the skin at the same time. The patient get two advantages at one time. Several devices listed in the title use radio frequency energy sources to help with body contouring. Each company will tweak the way the energy is delivered such as mono-polar, bi-polar, or tripolar energy delivery. I don’t wish to get into all of the energy physics of polarity in this blog, just think of radio frequency (RF) as a way to heat the fat to injure the cells to allow for apoptosis. Some devices like Velashape will add some vacuum and infrared, Excilis with RF and ultrasound, or Venus Freeze uses multipolar RF and magnetic field energy to do the job. Vanquish is another new device coming to market that drapes over your abdomen to try to treat that abdomen and flanks at one time, but the down side is it can’t be used in other body areas and doesn’t heat enough to tighten skin like the trusculpt might with it’s greater tissue heating.

As I mentioned all devices can work to some degree so why did we choose the options we have. The trusculpt is one of our options and we chose that for several reasons over some of the other RF devices. The trusculpt can get solid results with only  two or three treatments, where many of the other devices can require 6 or more treatments to accomplish the same thing. Many patients just can’t take time out to visit the office that often to see results. Also, patients in our experience like to se results progress more quickly, and if they have to do 6 or more treatments with some of the less aggressive devices they may be taking six months to see real results. We also love the fact that we can use the trusculpt on all areas of the body and aren’t limited to only the abdomen or flanks for example.

Cool sculpting is another body contouring device that’s been on the market for a number of years now. Cool sculpting works by chilling the tissues rather than heating them. The cold injury to the fat, like heating the fat, can cause damage to the cells that leads to apoptosis just like heat damage can. The same process makes the body clear the injured fat cells and the treated area gets thinner over the next few months. Like radio frequency, the cool sculpting definitely works, it’s down side is it requires special heads that suction your tissue into the head and than it freezes the area with cold. The heads only fit certain parts of the body well so it’s limited in how many body areas can be treated. Also up to 10% of patients can have a sudden neuralgia in deep nerves making it impossible to tolerate the freezing so they fail to get a full treatment.  The pain in the nerves doesn’t appear to be long acting, it’s just an intolerance to the treatment. Another aspect of cool sculpting that I feel makes it less useful than trusculpting is that RF is documented to assist with skin contracture and cold treatments don’t have the same documentation for that.

Some technologies use ultrasound energy to lead to cell injury and apoptosis. As long as energy can be focused in a specific direction to cause some degree of cell injury apoptosis can happen and cells removed. More energy may make more heat and give faster results with less treatments, less energy devices will not feel as hot, perhaps only mildly warm, but than may have a harder time getting the same degree of cell injury to lead to “melting the fat” away via apoptosis. Zerona is another device we have in the office for noninvasive body contouring and it is as non invasive as it gets.  Zerona doesn’t heat tissue or damage cells, it uses very low level laser energy to get cells to dump fat into the area around the fat cells which the body than clears out though lymphatic flow. While we have had patients get definite results from the Zerona we do find it less reliable in all patients however so we like to use it in concert with other treatments to further augment our results. I hope this gives a little back ground on non invasive body contouring, feel free to contact us via the internet or at 520 575-8400 if you want more information or to schedule an appointment.

The Zerona is a specific type of non-surgical body contouring laser that allows a patient to lose inches with no surgery, no pain, and no down time. Zerona treatments for body contouring has been getting significant TV coverage on The Early Show, Dr. Oz, Good Morning America, The Doctors, and Rachael Ray to mention a few. Dr. Nelson is a firm believer in Zerona and “Erchonia”, the parent company’s non-surgical technologies. So let’s walk through the realities of Zerona treatments and what it can and can’t do for you the patient.

As a board certified Plastic Surgeon with over 22 years of liposculpting experience Dr. Nelson is very familiar with current techniques for body contouring. Zerona non-surgical body contouring is a fabulous option to offer patients. Though some offices might suggest this is brand new technology it really isn’t for Dr. Nelson has been using early generations of Erchonia lasers (the company that makes the Zerona laser) for close to 10 years. Erchonia, the parent company found years ago that their lasers specific wave length when used in liposuction patients shifted fats directly out of living fat cells into the spaces around the cell where liposuction could easily evacuate it. Patients that received these laser treatments prior to liposuction had more fat removed more easily during liposuction procedures, and the patients also tended to have less bruising and less pain following the procedure. The terrific thing about the type of lasers we’re discussing here is that there is no heat, no pain, or soreness from their energy hitting your body. Tucson Plastic Surgeon, Dr. Nelson has used the Erchonia laser when performing liposuction with similar results. This led to Erchonia receiving a specific FDA approval for the use of their laser in liposuction. These early findings led Erchonia to place multiple laser heads onto one mounted stand so that a patient could be treated over a larger area with the laser energy, and to study how the patient’s fat distribution changed without liposuction at all; that’s correct no surgery just the laser treatment. What was found is that patients who underwent serial treatments of three treatments a week for several weeks lost inches off their waist, hips , and thighs. Repeat studies have shown similar results with size reductions of the arms or other anatomic zones when they are targeted with the laser. Original protocols were relatively strict with the use of Niacin to hasten lymphatic uptake of released fat, and also rigorous hydration to help flush the fat from the areas around the fat cells. Several reported studies have found solid results even without the vitamin supplement and as much fluid intake. One significant advantage that Zerona treatment has over conventional liposuction when treating the abdomen is that some of the fat shift may even come from intra-abdominal fat as well as fat just under the skin. A down side of Zerona compared to regular liposculpting is that liposculpting allows very precise tailoring of areas and avoidance of other zones if needed. The Zerona multihead laser spins it’s five laser beams over a broad area and can’t be quite so specifically controlled. Aggressive liposuction and liposculpting can often give a more complete result, but of course requires surgery, recovery, and down time that Zerona never has.

Regular liposuction also permanently removes fat cells from an area of the body greatly reducing the number of cells in an area that can reaccumulate fat over time. The Zerona is a non-invasive laser, it doesn’t kill cells or injure them as much as modify their physiologic state so that they empty fat that then is picked up by the bodies natural mechanisms and cleared through the lymphatics. Once back in the blood stream some of this may be metabolized for energy by the body, some may be picked up by other cells of the body, but since that distribution is over all the bodies fat cells and not just a local area the net effect is significant shrinkage of the targeted areas treated by the laser. The original protocol for Zerona was a set of three treatments a week for two weeks. Some patients who only require a little correction may find that is enough for them to accomplish their goals, but Dr. Nelson most frequently finds that doing another three treatments over a third week is more likely to show solid results. While Niacin is not a key factor in Dr. Nelson’s hands it is beneficial, and good hydration at home with several large glasses of water a day over the normal baseline is worthwhile. Besides my practice is in Tucson , Arizona, and we all need to drink more water here anyhow. The key thing to remember about Zerona is it didn’t remove your fat cells like liposculpting does, it just got your cells to dump out fat from a specific body zone. Therefore for your own health, and for better long term results it’s even more important after Zerona treatments to have a good nutritional diet. If you eat fatty foods or more calories than your body needs, those cells are certainly going to be there to pick up fat in those zones again, or at least more than you would with regular liposuction where the cells have been physically removed. This is one of the reasons patients might feel disappointed with the longer term results of a Zerona treatment, use this opportunity to be better with your diet, and to motivate you to be more active and fit. Let your new shape motivate you to be healthier and more attentive to your overall well being for that’s what we all want for each other anyhow.

Each patient has their own vision of how they want their body to look, how much energy and time they are willing to commit, as well as how much money they can spend on a procedure. Zerona offers a completely non-invasive approach to body shaping with no time off work, zero pain, and little inconvenience to the patient. It’s not ideal for everyone, some patients have to realize that liposuction is a far better option to obtain their goals. Some patients might need a tummy tuck or other surgical options to get that desired shape. Still it’s good to know we have this option to offer. It is best to consult with a Plastic Surgeon familiar with all these options so they can tailor your treatment to fit your needs and desires. Dr. Nelson’s office in Tucson Arizona can be reached at (520) 575-8400 for an appointment