Recent studies presented at the annual American Society for Laser Medicine and Surgery meeting further bolster this picture of success.   One paper, authored by Mayoral et al., examined the results of multiple treatments in the same area.  A series of two treatments was found to produce noticeably more improvement than one treatment.  Another paper by Boey et al. demonstrated the beneficial effects of massage for several minutes after a cycle of CoolSculpting to increase the amount of fat loss by 68% compared to CoolSculpting alone.

These data point up the consistent beneficial results obtained with the noninvasive treatment.  Amounts of fat reduction remain less than that obtained with surgical procedures like liposuction.

Click to read Zeltiq Inc.’s announcement about the recent FDA clearance.

Belotero holds some promise as a more suitable filler for superficial applications like lip-stick bleed lines or lower eyelid smoothing (fill-in of tear trough, etc.) as well as in lip augmentation.  Whether there will prove to be a significant advantage in practice will require a few months of use and followup, but my testing of the material outside the United States, where it was approved and available earlier, suggests that it holds a lot of potential.

Several forms of Belotero are available abroad, but only the mid-weight material, called Belotero Balance, is being introduced in the United States at this time.  Actual availability of the product is probably 3-6 months away, but the formal FDA approval ensures that it is coming.  Having more options helps plastic surgeons and other injectable providers produce the subtle, artful details that give the most complete correction while maintaining a natural appearance.

My advice is to carve out specific time for exercise and stick to it even if you’re tired or busy with work or home activities. This is your time to take a break from the action of daily living and do something for you. Pick the exercise that is the most fun for you -it’s easier to stick to it.

I believe that sensible diet and exercise is the single most important element of health, fitness and looking your best. Nonetheless, there is a growing role in American society for aesthetic surgery and aesthetic treatments to enhance one’s appearance. While a healthy diet and active lifestyle help your skin look its best, the biggest intersection between plastic surgery and exercise relates to body size and shape. This raises the question about when liposuction or Coolsculpting is appropriate and when you can succeed with diet and exercise alone.

Much as we would like to believe that if we just “hang tough” we can produce the body shape we want with diet and exercise, there are focused areas that rarely reduce in this fashion or don’t reduce enough to create the visible change we desire. Love handles and saddle bags are the most common areas treated with liposuction exactly because they don’t change much even with a singificant change in body weight.  Often individuals with ideal body weight still manifest an excess in this area.  Over-dieting will merely result in loss of muscle mass with little change in these areas.  These are the ideal applications for liposuction or Coolscultping.  Treatment of focused areas with liposuction has a very brief recovery time.  This is an area where liposuction is the meaningful option and diet and exercise play only a small role. 

Larger areas can be treated as a head start or finish-up to a diet or exercise program.  Still, you will not look your best after removal of excess fat if the underlying muscle is not toned.  In these cases, aesthetic services are providing support for the mainstay of diet and exercise.  Liposuction is not a weight loss strategy.  For patients who want a weight change and not a shape change, diet, exercise, medical weight loss programs or surgical weight loss procedures are more appropriate. 

All of this can be summarized by saying that there is no one option that is right in all circumstances.  A consultation with an experienced plastic surgeon who can offer invasive and non-invasive options will provide the most useful advice about treatment selection. 

I hope with determination and focus we can all succeed this year at achieving our aesthetic goals or whatever resolutions are most important to you!

The Energy Based Therapies Committee of ASAPS, on which Dr. Bass serves, has issued guidelines for terms that are commonly used to describe the results and recovery associated with a variety of laser and other energy based aesthetic treatments.  The impetus for doing this was the frequent use of terms like “no-recovery” and “lunch time treatment” for treatments that, as typically performed, have significant recovery.  In order to have some common ground for what terms mean, the committee has provided guidelines for use. 

The following terms were defined:  downtime, bruising, redness, swelling and pain.  See the reproduced standards below and the links to learn more specifics.  The committee hopes to have device companies follow the guidelines in the marketing information they provide to doctors, as well as in the materials companies provide to the media (TV, magazines) about their products  and to patients on their websites. 

While the guidelines are not perfect, they are a very useful practical guide to providing patients and doctors with a clear understanding of typical recovery issues associated with each treatment.  Hopefully, the scientific societies for other aesthetic providers, such as dermatologists, will join in encouraging adoption of these guidelines in the future.  For now, ASAPS is leading the way to provide clarity and reality rather than market hype.  Notice that even the lowest or essentially none category still can have some minor visible changes over the first day.  This means that if your work or social obligations require you to look undetectable or perfect immediately after the treatment you may prefer to schedule it when  you have the rest of the day or weekend to recover, or plan to apply concealer to hide the transient changes.

Allure article about the guidelines: http://www.allure.com/beauty-trends/blogs/daily-beauty-reporter/2011/10/anti-aging-news-recovery-from-laser-treatments.html

ASAPS DEFINITIONS

Downtime –the expected time to return to normal lifestyle

               Essentially None: less than 24 hours

               Minimal: 24-72 hours

               Moderate: 3-7 days

               Significant: more than 7 days

Bruising – visible on the skin without concealer

               Essentially None: no bruising but there may be an immediate change in skin tone

               Minimal: less than one week

               Moderate: 1-2 weeks

               Significant: more than 2 weeks

Redness –visible without concealer

               Essentially None: returns to normal (pretreatment or improved) in less than 24 hours

               Minimal: 1-3 days

               Moderate: 4-7 days

               Significant: more than 7 days

Swelling –obvious swelling

               Essentially None: less than 3 days

               Minimal: 3-7 days

               Moderate: 8-14 days

               Significant: > 14 days

Pain –significant discomfort associated with the treatment

               Essentially None: no anesthesia or medication is needed except over the counter medication

               Minimal: requires pretreatment with oral prescription medication, topical anesthetic agents or skin cooling and/or post-treatment prescriptions for pain management.

               Moderate: same as minimal but with local anesthesia (injections)

               Significant: same as minimal but with IV sedation or general anesthesia

With more research we can hope for two things. First, new applicators to allow treatment of other areas such as thighs. Second, refinement of the cryolipolysis process with more substantial clearance of fat. Current treatments typically produce a 20 % reduction in fat thickness with a single application. This is a very satisfying and noticeable result for most patients but not really competitive with liposuction in the amount of fat reduction. If the effect could somehow be amplified, to say 40%, by tinkering with the cooling parameters or in some other way, a single treatment, while still less than liposuction, would be much more dramatic…and non-invasive with no recovery.

Can they do it? No one knows at this point. But remember, this is the company that performed a very methodical, scientific development effort to bring us CoolSculpting in the first place. Here’s to Zeltiq’s success on the business side and best wishes for success on the research end so we can all thin down those bulges non-invasively even faster than before.

This means two things for patients.  First, this is an additional assurance of the safety of this use.  The lip is more sensitive to being injected, and more prone to tissue reaction than other areas of the face.  Knowing that large, careful multicenter studies have confirmed safety is reassuring.  Second, this clearance allows Medicis to market this use to the public and train physicians in the use.  This will raise awareness and provide even greater sharing of information and techniques among physicians.

The Most Important Take-Away

Many people think of “duck lips” or  “Angelina Jolie” lips when they think about lip augmentation.  This is a stereotype, of course.  Lip augmentation is best focused on shaping the lip and restoring volume that is lost with age.  Such an augmented lip would look perfectly natural, not overdone.  Like everything in life, there can be too much of a good thing.  All things in plastic surgery look best when they create a natural appearance.  Injectable filler treatments are extremely dependent on the skill of the injector.  An experiences and artistic aesthetic provider is essential to get outstanding results and look your best.

For more information see:  www.restylaneusa.com