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360 Degree Legs with VASER

Liposuction of the thighs is often limited to the outer thigh, buttocks crease and inner thigh.  Liposuction surgeons have been apprehensive in treating the legs circumferentially in fear of leaving tram tracks or furrows and dimples.
With the VASER system the emulsification allows for the fat to be liquified before being suctioned out.  This allows for smoother results and appearances with less chance of dimples and irregularities.

Dr Wolf has now started performing 360 degree legs with the VASER system with stunning results.
Most women will find that its not only their outer or inner thighs, but also their knees, and buttocks crease that are a problem.  By treating the legs circumferentially we get an even and smooth result.
Makes buying jeans much easier..........

This treatment is great for patients with an element of Lipoedema which usually results in deposition of fat in a circumferential pattern along the legs.

Come see our website www.DrWolf.com 

Come see our website www.DrWolf.com

PIP implants- Fat Transfer as an alternative

The PIP scandal surfaced after regulators launched an investigation into the PIP implant manufacturing process.  This was in reaction to findings that the implants had been made from industrial grade rather than medical grade silicon.  The implants were banned in 2010.

It is feared that 300'000 women have been fitted with the implants worldwide with 40'000 in Britain and 30'000 in France.

There has been controversy in how authorities have recommended management of these cases.  France has offered and recommended removal and replacement of the implants on the national health system.  British authorities have not offered the same recourse.  At this stage the evidence does not suggest that early removal is required and the investigation is ongoing with new reports awaited early 2013.

If you have any concerns regarding your implants or are not sure whether you have the PIP implants, it is best to contact your treating surgeon or clinic and clarify what implants you have.  Alternatively your GP would be able to guide you on what steps to take.

If you have any of the following signs or symptoms, you should discuss them with your GP, who will refer you to a specialist.
Symptoms to watch for

• lumpiness of the breast

• lumpiness or swelling in the area around the breast

• change in shape of the breast

• deflation of the breast

• redness

• tenderness of the breast

• swelling of the breast

• pain or sensitivity

If you are worried

• Find out if you have PIP implants by checking your medical notes.  You can get these free from your clinic or GP. If you had a PIP implant on the NHS, you will receive a letter.

• Speak to your GP, if you had them done on the NHS, or your clinic if you had them done privately.

• Agree what’s best for you – get advice on whether or not you need a scan then discuss removal with your doctor.

• If you decide you want your implants replaced, the NHS will do it free if your original operation was done on the NHS.

• If your original operation was in a private clinic you will need to speak to the clinic to see if they will replace them free.

• If your private clinic no longer exists or refuses to remove the implants, speak to your GP. The NHS will remove your implants if your doctor agrees there is a medical need.

Alternative treatment options

In the private sector the PIP implants will mostly be removed and replaced with other implants (Mentor, Allergan etc.) giving you the desired result.  Alternative options are not to have the implants replaced at all.  This would probably be the least favourable option as the removal will result in loss of volume, emptiness and poor aesthetic result.

An alternative option becoming more popular now is fat transfer breast augmentation.  This procedure involves removing fat from one part of the body (e.g. abdomen, flanks, thighs)  and transferring it to the breast for augmentation.  The procedure is performed through tiny puncture holes so won't leave you with any further scars.

When can the procedure be performed?

Prior to having the implants removed its best to have a few consultations with surgeons that perform the fat graft procedure and get an idea of suitability.

If suitable then the implants should ideally be removed and 6-12 months of healing allowed before the fat graft is performed.  This will allow for scar tissue to settle.

What size can I expect?

Realistically 1-2 cup sizes, depending on how much fat is harvested and how much of the graft survives.  If large (200ml+) implants were removed then you may not regain the size that you were before.  There is a possibility of performing serial injection over a period of a few months.  This may then enhance the shape a little more.  This all depends on the amount of fat that can be extracted.

What will the breast feel like?

As it is your own fat that is transferred into the breast the tissue will feel soft and natural and take on a very natural shape too.

How much fat do I need to have?

Ideally you need to have a BMI of more than 22-23.  If you are in doubt whether you have enough fat then its best to go for a consultation with a surgeon for an assessment.

Other benefits.....

The procedure is performed through tiny puncture holes which leave you with almost no scar.  The downtime is very short with patients returning to normal routine in a few days.  You get a bit of body sculpting where the fat is harvested from.

Often the original implant scars will fill out and the skin may take on a rejuvenated appearance due to the stem cells in the fat.  If there is some contracture in the original scar this may improve too.

I use the PureGraft system as it is gentle on the tissue, filters out any unwanted constituents (blood, local anaesthetic, serum) and leaves me with pure fat.  It gives me a slightly drier graft which allows for a much more accurate assessment of breast size.

Come see our website www.DrWolf.com 

Fat Transfer Breast Augmentation (Natural Breast Enlargement)

The History of Breast Augmentation

Breast augmentations are one the most common female cosmetic procedures performed. In 2010 the USA performed 13 million cosmetic procedures (ASPS). Of these, 300'000 were breast augmentations. The majority of these were Silicone based implants followed by Saline filled implants.

The first breast implant procedure was performed 50 years ago. The patient, Timmie Jean Lindsey, now 80 years, was very please with the result and the implants are still "alive".

Over the last 30 years the industry has evolved immensely.  Numerous implant manufacturers have come and gone and surgical techniques have been improved on and modified.

The first implants were silicone based and subsequently other types have come onto the market including soya based and saline filled implants.

Currently the most common type of implant used is Silicone.  The choice of implant used depends on the desired shape and size the patient requires and also on surgeon preference.

Other augmentation procedures that exist are musculo-cutaneous flaps (muscle and skin grafts; DIEP, TRAM, Lattissimus dorsi) that are taken from one area and transposed to another.  These are mainly used for reconstruction purposes for cancer survivors.  Occasionally surgeons also use tissue expanders to create an envelope and then insert an implant.

With the cosmetic industry being flooded with dermal fillers the aesthetic company Q-Med launched a product called Macrolane (Hyaluronic Acid filler) which was used as a body contouring filler.  It is a degradable product which is injected into a pocket underneath the breast tissue and is used to enhance the size and shape of the breast.  It is also used as filler for buttocks, calves and male pecs.  The product lasts approximately 9-12 months and then the procedure can be repeated.  At present the license for breast remodelling has been revoked until a consensus can be agreed upon for screening modalities in women with the filler.  The product is still used for general body contouring.  There are no safety issues regarding the product.

Fat Transfer Breast Augmentation (autologous fat transfer)

With the current PIP scandal many women are looking for other alternatives to formal surgery and implant procedures.  Autologous fat transfer or fat graft is fast becoming a popular choice.  The first breast fat graft was performed by an american surgeon and described in the American Journal Plastic and Reconstructive Surgery in 1987.  There was a big uproar by his fellow surgeons as there was not enough scientific evidence to support the procedure, its consequences and risks.

However, in 2007 Sydney Colemen, a major proponent of fat graft procedures, suggested that it was "time to end the discrimination created by the 1987 position paper" and " judge fat grafting to the breast with the same caution and enthusiasm as any other useful breast procedure."

The Procedure

The surgeon will usually do a psychological assessment to ascertain the suitability of the patient and gain insight into the patients' expectations.  The patient then also needs to be assessed for suitability in terms of fat content and breast suitability.  Pre-operative imaging is important to assess symmetry, volume, shape and also for comparison postoperatively.  

Fat is harvested via a liposuction technique and filtered to get rid of any unwanted material such as local anaesthetic, blood, connective tissue etc.  Many women see this as a 2 in 1 procedure as they have fat removed from areas that they don't like and at the same time get an augmentation.  Nowadays the procedure is performed under local anaesthetic and conscious sedation which removes the risks of a general anaesthetic.

The pure fat is then injected into the breast to enhance the shape and size. The limiting factors are really is there enough tissue to chance the breast significantly and are the breasts suitable for the procedure.

Risks
Although the procedure is done as a day case it is still a surgical procedure and thus needs to be treated as such. Risks such as infection, abscess formation, bleeding, asymmetry, fat necrosis, fat cysts are important to bear in mind. The fat retention volume is somewhat unpredictable, but presently rates of 50-70% are achieved. This will vary from patient to patient and there is the risk that almost all the fat will be lost.

One of the most important possible side effects is the occurrence of calcifications. When fat does not survive it may form small spicules of calcium that are visible on mammograms. Calcifications are sometimes associated with suspicious lesions on mammograms and often require further investigations and tests. When supplemental imaging modalities are considered such as digital mammograms or MRI scans calcifications from fat necrosis can be distinguished from the malignant signs of irregularly shaped, high-opacity micro calcifications. It is to be remembered that not all fat graft procedures will result in calcifications.
Of the thousands of fat grafts performed to date there has not yet been a case reported of a missed cancer diagnosis on mammogram due to a fat graft procedure.

Numerous scientific papers have since been published on the topic (Fulton, 2003; Spear, 2005; Missina, 2007; Carvajal, 2008; Illouz, 2009; Hiko, 2009; Delay, 2009; Da Li, 2009; Veber, 2011; Cong Feng, 2011; Claro, 2012) and the conferences are full of presentations on techniques, experiences, outcomes and imaging modalities for cancer screening purposes. 

Recently an american author has undergone a cell enriched fat graft to the breast after having a large lump removed (http://tinyurl.com/d6jjmn8).
The largest followup series of fat grafts has been reported by Illouz and Delay looking at over 1000 patients over a 10 year period respectively.  Although there has been heated debate about whether fat graft to the breast will interfere with the interpretation of mammograms the ASPS position paper indicated "no evidence that fat injections interfere with breast cancer detection and that results of fat transfers remain highly dependent on a surgeon’s technique and expertise".

 Fat Transfer Breast Augmentation procedure

Dr Wolf performs 3D imaging on all patients to compare before and after shapes and sizes.

As an alternative to implants the autologous fat graft breast augmentation will certainly become a lot more popular option.  The benefits include day case procedure, conscious sedation, natural look, feel and shape.

The procedure is still a surgical procedure and comes with its inherent risks.  Patients need to be properly assessed, evaluated and consulted regarding the procedure risks and possible side effects.
Here is a post of a very pleased patient.........

Come see our website www.DrWolf.com

Come see our website www.DrWolf.com 

PLEASE SEE MY LATER POST ON AN UPDATE ON THIS TOPIC  click here

VASER Breast reduction - non surgical

The female breast reduction procedure is generally a surgical procedure to reduce the weight and size of the breasts.  During the surgical version of the procedure fat, gland and skin are removed to resize the breasts and in most cases the nipple needs to be repositioned.

Breast size varies in women and often there is an asymmetry between the left and the right side.   A variety of factors determine the size and shape - genes, hormones, body frame, weight and lifestyle.
In later life the breasts often lose volume and may become droopy, especially in some that have breast fed and have had children.

Breast reduction can assist in lifting the breasts and changing the size, weight and shape.

Physical problems may also include:

• backache 
• neck pain
• skin irritation
• poor posture
• excessive sweating, rashes and skin
• infections under the breasts
• weals or grooves on the shoulders from bra straps
• an inability to exercise or take part in sports

Common psychological problem also include:

unwanted attention or harassment

self-consciousness

depression

Traditional breast reduction involves a general anaesthetic and fairly extensive scars that take on an "anchor shape".  Many women find this option unattractive due to the risk factors.


An alternative to this is VASER Breast Reduction. 
The procedure is performed under sedation and local anaesthetic.  The access points are very small (5-6mm) and heal to leave almost no scar.  The postoperative care includes MLD sessions which remove unwanted fluid and swelling.  The breasts will be relatively firm and swollen for about 1-3 months, although this various between individuals.  MLD sessions help alleviate the swelling.
As the VASER helps contract the skin it also creates a bit of a lift of the breast.


The main benefits of VASER breast reduction are:

• volume reduction
• weight reduction the breasts
• reduce backache and neck pain
• marginal lift
• local anaesthetic
• minimal scarring
• day case procedure

Dr Wolf recommends a mammogram before and about 6-12 months after the procedure.

VASER - MLDUK conference

I was kindly invited to give a talk at the MLD conference in May to share my experience of VASER and what recommendations I had for MLD therapists with regards to post-op treatment.  The talk was fairly general with an overview describing the treatment and its indications to give the MLD fraternity an idea of what is achievable.
I was very surprised at how many therapists had come across VASER patients and had actually treated them; quite a number of them being my patients.  I was very please to hear that I was one of the most active MLD supporters for VASER patients.
Traditional liposuction surgeons tend not to refer patients for MLD - not sure why?  They are possibly unaware of the benefits.

The benefit that patients receive from having these treatments post-op is immense, not just in terms of reducing swelling and bruising, but also minimising subsequent risk of irregularities and lumps and bumps. Most patients will report softening of the tissue immediately post MLD.  The treatment is also very relaxing and most therapists will show the patients self-help techniques they can perform at home on a daily basis.

There is significant scientific research to support the benefits of MLD in the post-op period.
As patients vary significantly in their healing phase the number of sessions required varies from individual to individual.  Generally I would suggest starting with 3-5 in the first 2 weeks and then re-assessing the situation.  Most practitioners will have one post-op review in that time and can then recommend further sessions if required.
For Hi Def patients the treatment regime is more intense and rigorous for the first 2 weeks (almost daily MLD sessions).

All in all it was a very interesting meeting with copious networking opportunities.

Lipedema- My VASER experience

My VASER experience

Six months ago I had never heard of lipedema. As far as I was concerned, I was an overweight woman, with fat legs, who in spite of 43 years of trying to lose weight, had never managed to do so. In addition to being fat, therefore, I carried the burden of my self-perception as being weak-willed and incapable of exercising control over my body, an attitude that spilled over and profoundly influenced almost every area of the rest of my life.  

I had come to the Private Clinic because I wanted a breast reduction having heard about the miraculous Vaser technique, which seemed almost too good to be true: a short, minimally invasive procedure under local anaesthetic, which promised minimal downtime… However during the breast consultation I realized that this might also work for my fat legs and so it was, when Dr Wolf was assessing me for treatment, I first heard about lipedema.
It is not an overstatement to say that day was one of the most significant days of my life. Internet searches for lipedema yielded results that were simultaneously desperate, depressing, liberating and yet hopeful. Depressing and desperate because nine out of ten websites delivered the news that it was a chronic and incurable condition of unknown cause. Liberating because at a stroke I realized I was the victim, not the perpetrator, of my affliction (removing guilt at a stroke). And hopeful because one in ten sources mentioned Vaser, or tumescent liposuction: a new technique, which was apparently ‘transforming’ the lives of some lipedema sufferers.
It is hard to know where to begin to describe the experience of the last 4 months in which so many physical, psychological and emotional changes have taken place. I’ll begin with the experience of surgery itself: I have had 5 procedures in 4 separate operations over 4 months. The experience of Vaser itself is, as promised, short, minimally invasive, minimally uncomfortable and carried out by medical teams who are quite exceptional in terms of the quality of care, technical expertise and follow up treatment they provide. Within half an hour, a double chin I had hated since my teens, was removed. Within a further two hours, the breasts I had loathed since my early 40s, and which had ballooned since the menopause, were considerably reduced (the most marked result being that I no longer walk with a stoop, a life long affliction I had assumed was a spinal deformity). The tum which had grown since the menopause was radically reduced within 2 hours, and the same for thighs and calves (in addition to lipedema, the latter were very disfigured in an RTA I had when I was 17. Selective fat removal has rendered them almost symmetrical and looking far more like normal legs. Again, all under local anaesthetic and within the space of less than 2 hours).
At this juncture it is worth remarking on how, in just one patient, this extraordinary treatment has alleviated such a wide range of life-long afflictions, resulting from such various causes as the menopause, an RTA, the condition of lipedema and (in the case of my double chin) some unfortunate genes!
My recovery from each of these procedures has been very smooth. I liken the operations to rather long trips to the dentist (although unlike the dentist, you can chat!) and the recovery period is comparable with getting over a mild cold or having a period. I had to wear a compression garment for 2 weeks, take a course of antibiotics and have some (very enjoyable!) MLD.  Post-operative pain was minimal and alleviated with an occasional paracetamol.
Visually, I look very different.  I never wanted to be a catwalk model or an athlete – that’s not what I wanted from my body – but I now look OK, and looking OK is not something I take for granted! Having spent over 4 decades feeling I was deficient and abnormal, looking OK is a HUGE thing for me, and precisely what I wanted to achieve.  I used to think I didn’t fit in and my physical problems were in the foreground of people’s perception of me. Now I look in a mirror and am happy with what I see, which means I can get on with my life and my relationships with other. I’m OK!
Looking OK, means that the psycho-emotional jumble of self-deprecating thoughts and feelings have been defused.  It is impossible to overstate just how significant this is. It is fair to say that even if I hadn’t had Vaser, the guilt about my condition would have gone, at a stroke, with Dr Wolf’s diagnosis. But with Vaser I find I am more psychologically outgoing. Unconsciously, as the condition took hold and became compounded, post-menopause, with larger breasts and tum, I had let friendships lapse: I have now picked up the threads of some treasured old friends and have many social events planned, which I would otherwise have avoided.
I don’t quite know where the energy has come from. Yes, I have lost bulk and feel more psychologically inclined to move and be active, but the resultant energy seems above and beyond these causes. Whatever the cause, this has been a fantastic result and find I DO so much more of everything – gardening, housework and so on. With the increased activity is a further enhanced sense of wellbeing. At one point I was doing so much that my son asked if anything was the matter with me, so unaccustomed is he to having an active mum!
The Vaser results have given me a huge boost, which I am building on with changes in lifestyle. I am learning more about lipedema and eating better, plus taking regular exercise. I recognize that these choices will support my overall health now and into the future.
Speaking of which, in 2 days time I will arrive at the milestone of my 60^th birthday with all that that bespeaks. I shudder to think how I would have felt at this juncture in my life, had I not discovered Vaser. My physical condition would have been unaltered, and I would have hovered in that horrible hinterland of guilt, desperation and false hope. I now feel as though my life has just begun. I have the energy and self-confidence to face the future with enthusiasm, excitement, curiosity and a sense of physical and mental well-being. It is true to say that I feel healthier, in every sense, than I felt at any of my other milestone birthdays.

I cannot recommend Vaser too highly and while I realize that results doubtless vary with the individual, dependent on all sorts of factors, not least patient expectations, I am happy for my results to be used to help others who are in a similar position to where I found myself 6 months ago.  

CM, Shropshire, April 2012.

Come see our website www.DrWolf.com

VASER treatment areas in male and female patients

Alternative, non-invasive liposuction techniques have been developed to treat smaller areas of adipose deposit.  The collection of anatomical areas has remained fairly consistent over the last few years in both male and female patients.
Our figures confirm this - for males the most popular treatment area is still the abdomen and chest (gynecomastia) and flanks.  Males tend to limit themselves to these areas as they have only really become aware of the cosmetic industry in the last few years.  As treatments become more available and less invasive our male patients will undoubtedly look at other treatment areas.

For females the most popular treatment areas remain the abdomen, flanks, outer thighs (saddle bags) and gluteal fold.  For women the most troublesome areas are the midriff and the outer thighs.  These respond well to VASER with most patients achieving very good results.

Audit Figures of VASER Gender distribution 2011

I've looked at all the VASER cases I performed last year and audited the figures.  Interesting stats to say the least.  On the whole female patients still form the bulk of my clientele.   Male patients have certainly become more aware of their aesthetic requests and demands.  Industry figures correlate with these stats nationwide.  I think males are becoming less critical and less averse to cosmetic procedures and are realising that there is nothing wrong with looking after one-self.

Skin Laxity after VASER

Many patients, in fact all patients, will during some stage of a consultation ask about skin laxity.  Most will mean they are concerned about skin wrinkling or having rolls of skin hanging from their torso.
In my experience it is fairly easy to assess whether a patient will react well to the VASER treatment and suffer from lax skin or not.  If there is any doubt that there is going to be wrinkly skin then the patient is not a candidate and I decline to treat them.
The term "Loose skin" applies to the mobility of the skin.  This occurs when the interface between the muscle and skin becomes less elastic and allows the skin to move freely over the muscle and connective tissue.  As we become older our elastic tissue becomes a little lax and thus allows for the skin to be a little more mobile.
This becomes especially noticeable when someone has lost a few stones.  Compare this to a ballon that deflates - the membrane becomes flaccid as the volume depletes.   Similarly the skin becomes a little "wobbly" over the muscle.  VASER does help a little with skin tightening, but there is a limit as to how much will take place.

I hope this explains and reassures you a little with regards to skin laxity.

Come see our website www.DrWolf.com 

VASER Hi Def - before and after

I saw another VASER Hi Def patient yesterday.  The procedure was performed in June last year.
One of the important aspects of having this treatment is being willing and able to maintain the result.  Its not a quick fix at all.  Ideally prospective candidates should be relatively fit and already have a fair amount of contour.  The procedure is aimed at pronouncing the contour and definition.
I see many patients that see themselves as very fit, but are not suited for the procedure.  This can be due to a variety of reasons:
lax skin, too many stretch marks, musculofacial laxity (when the skin is very mobile), too much visceral fat (fat around the organs), clear inability or lack of motivation of not being able to maintain the result.


Understandably many patients are disappointed if I tell them that they are not suitable for the VASER Hi Def procedure.  It all boils down to being honest and realistic.  There is no point in trying to attempt to perform the procedure on a patient that is not suitable.  Firstly its unethical from a medical standpoint, secondly the patient will not be satisfied, and thirdly, one will be trying to correct what one cannot achieve.

There are many before and after pictures available on the net that are good examples of patients that were not suitable for the VASER Hi Def procedure.

The procedure needs to be tailored to the individual patient.  Thats where the 3D "vision" comes in.  Visualising the anatomical landmarks and underlying muscles is of paramount importance.  Hence its easier to treat patients that have a fair amount of muscular definition already.  It is although not impossible to visualise these under a thinnish fat layer.  Also important is input and feedback from the patient prior to the procedure. Some patients don't want specific types of the definition and its important to specify this at the marking stage.  I always get my patients to look at their marking and make sure they are in agreement with the style of definition.  Before pictures of the markings will then also confirm this.
Below is a picture of another content patient who has managed to maintain his result.......

Come see our website www.DrWolf.com

Click here to see a video on VASER, its indications, how it works and what it can achieve.
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MLD after VASER lipo

I thought I would you some insight into what is required in the post-operative period of VASER.
Besides wearing the compression garments it is also important to have manual lymphatic massage.
The duration that you will wear the garment depends on the practitioner.  Each will have their own preference.  My patients wear the first line garment for 2 weeks 24/7 (taking it off for washing etc), then for another 3-4 weeks about 10 hours a day.  Best is to wear it during the day as at night most of the oedema (swelling) will settle so its not as effective.
MLD has only really been introduced in the post-operative period in the past 2-3 years.  Many traditional, old school plastic surgeons still don't see the benefit in the treatment.
I have noticed a tremendous improvement in the speed of recovery, minimising swelling, softening of tissue, minimising bruising and general improvement in comfort.
The number of sessions that are required is variable.  My feel is that one cannot have enough MLD.  Obviously finances are a limiting factor.
Here is a rough guide as to the average number of session:
arms - 3
abdomen - 5-10
flanks - 5-10
outer + inner thighs - 3-5
chin/face - 3-5
In Hi Def patients this may rise to 15-20 sessions (remember that these are just guidelines and your Dr may recommend more or less)
As I said it is variable from patient to patient and also depends on your level of activity.  Most patients getting back into gym and exercise usually require less sessions.

MLD therapists can be found on the www.MLDUK.ORG.UK website.  Make sure they are registered or otherwise they may be using traditional massage techniques which are not appropriate.  The treatment is very gentle, almost like stroking.  It should not be uncomfortable - if it is then its being done incorrectly.
Try and see the therapist that the Dr recommends as they generally have a good relationship and give each other feedback on how the patients are doing.  Thereby concerns are flagged up early and can be dealt with immediately.  Many therapists have gotten to know me now due to the many referrals and anticipate the treatment regime I recommend. Some have even come to seek VASER treatment themselves after seeing the dramatic results and the snappy recovery of their patients.
The procedure kickstarts the lymphatic system back into action.  With all the fluid that is infiltrated for the local anaesthetic the tissue becomes a bit overwhelmed with the tissue load and struggles in reducing this.  Once the sustain is complete majority of the fluid has been aspirated out.  However, tissue swelling soon starts and results in a little swelling.  Occasionally some lumps and bumps appear too.  These again respond very well to MLD.

Hope that gives you a little more insight into MLD and VASER treatments.

Have a look at this video for more clarification......

Come see our website www.DrWolf.com 

Bye for now.
Dr Dennis Wolf