I've had a few patients see me recently for a consultations for various treatments that have had consultations at other clinics.
A common question I get asked is how many 2 hours slots will be required, or if we work in other time limited surgery slots.
I am amazed that doctors actually try and work and perform treatments limited to time slots.
A procedure should be performed to its completion regardless of how long it takes. If the doctor is limited by time then there is a good chance that the procedure is either rushed or incomplete. This will results in poor results or complications.
Remember that you are not paying for the time, but for the complete procedure and result. The doctor should not be limited by a 2 hour time slot.
I thus advise that any clinic that performs surgery in limited time slots should be avoided.
Have a look at my YouTube channel DrWolf.com for some really informative videos.
Tuesday 30 September 2014
Tuesday 16 September 2014
VASER, traditional liposuction and MLD
In my practise I see many patients that do their homework and attend 1-3 consultations to gather information on treatments. It gives the patient the opportunity to get to know the doctor and determine whether they like/get on with them.
Remember that having any cosmetic procedure means you are going to have a patient-Dr relationship for 6-12 months, if not more. You need to "like" your doctor....!!
Seeing more than one doctor also allows you to gather more information about procedures and appreciate different approaches of doctors.
Its much more likely that you will all your questions answered by seeing more than one doctor.
I often get asked why some doctors are still practicing traditional liposuction and have not converted to VASER. The answer to this is multifactorial - some patients still warrant having traditional liposuction for massive bulk reduction. When removing large volumes (5 litres upwards) it is advisable to stay overnight to monitor your fluid balances.
Some doctors prefer to stick with what they know works; others are not keen to progress on to newer treatments. The machines are very expensive and not every doctor can afford to purchase these machines.
Over the years the progress that has been made in terms of aftercare has been phenomenal. I still battle to understand though why old-school surgeons have not adopted the train of thought that MLD post-op is firstly very effective to reduce swelling, secondly, expedite recovery, thirdly, reduce bruising, fourthly, reduce the incidence of irregularities and lastly, also afford a continuity of care.
I work hand in hand with many MLD practitioners and many of them are now well experienced in treating post-op VASER patients. Reassuringly, many comment on how much faster VASER patients recover compared to traditional liposuction patients.
see below a video
Remember that having any cosmetic procedure means you are going to have a patient-Dr relationship for 6-12 months, if not more. You need to "like" your doctor....!!
Seeing more than one doctor also allows you to gather more information about procedures and appreciate different approaches of doctors.
Its much more likely that you will all your questions answered by seeing more than one doctor.
I often get asked why some doctors are still practicing traditional liposuction and have not converted to VASER. The answer to this is multifactorial - some patients still warrant having traditional liposuction for massive bulk reduction. When removing large volumes (5 litres upwards) it is advisable to stay overnight to monitor your fluid balances.
Some doctors prefer to stick with what they know works; others are not keen to progress on to newer treatments. The machines are very expensive and not every doctor can afford to purchase these machines.
Over the years the progress that has been made in terms of aftercare has been phenomenal. I still battle to understand though why old-school surgeons have not adopted the train of thought that MLD post-op is firstly very effective to reduce swelling, secondly, expedite recovery, thirdly, reduce bruising, fourthly, reduce the incidence of irregularities and lastly, also afford a continuity of care.
I work hand in hand with many MLD practitioners and many of them are now well experienced in treating post-op VASER patients. Reassuringly, many comment on how much faster VASER patients recover compared to traditional liposuction patients.
see below a video
Come see our website www.DrWolf.com
Lipoedema, lipedema
Once again I have seen numerous patients in the last few weeks that have mild to moderate cases of lipoedema and have been seen by several GP's and plastic surgeons who fail to recognise the condition.
This is very frustrating for patients as they are continuously asked to lose weight. LIPOEDEMA does not respond to dietary weight loss or exercise.
Patients find it such a relief when they are told of the condition and informed on what they have and why they themselves cannot change their shape. They find it a relief that they have not failed in attempting to change their body-shape, but that they have this condition which prevents this.
I can only hope that the awareness and acceptance of Lipoedema improves in the medical circles.
Some help forums -
www.Lipoedemaladies.com Facebook - Lipoedema ladies webpage
www.Lipoedema.co.uk
I cannot strongly recommend you do as much research as possible and also get in contact with a MLD therapist in your area www.MLDuk.org.uk
Below is a video of one of the options to improve the appearance of Lipoedema
This is very frustrating for patients as they are continuously asked to lose weight. LIPOEDEMA does not respond to dietary weight loss or exercise.
Patients find it such a relief when they are told of the condition and informed on what they have and why they themselves cannot change their shape. They find it a relief that they have not failed in attempting to change their body-shape, but that they have this condition which prevents this.
I can only hope that the awareness and acceptance of Lipoedema improves in the medical circles.
Some help forums -
www.Lipoedemaladies.com Facebook - Lipoedema ladies webpage
www.Lipoedema.co.uk
I cannot strongly recommend you do as much research as possible and also get in contact with a MLD therapist in your area www.MLDuk.org.uk
Below is a video of one of the options to improve the appearance of Lipoedema
Come see our website www.DrWolf.com
Tuesday 8 July 2014
Recovery - VASER male chest reduction
Once you are the road to recovery you will notice that the chest will feel a little firm, the tissue will feel spongy. This is completely normal.
Occasionally patients will experience various types of sensation:
1. Itchiness
2. Hypersensitivity of the nipple
3. Numbness of the skin
4. Tingling sensation
These are all normal parts of the healing process and indicate that healing is still taking place. Remember that you may experience these on both sides or only on one side, or at different time intervals. This is normal.
With progress you will notice some small nodules (almost like a "string of pearls") on the margin of your pectoral muscle especially when you stretch your arm upwards like reaching for the stars. This is completely normal again.
I recommend that you stretch regularly (2-3 times a day) and massage these areas very firmly and they will soften up. MLD helps tremendously for this.
The other action I recommend is to hang off the door frame suspending your weight partially and with the other hand massage the "string of pearls". Within a few days this will soften up.
Remember that none of these times frames are exact and every person will heal at a different pace.
Have a look at my YoutTube channel DrWolf.com for some informative videos on the procedure and recovery.....
Occasionally patients will experience various types of sensation:
1. Itchiness
2. Hypersensitivity of the nipple
3. Numbness of the skin
4. Tingling sensation
These are all normal parts of the healing process and indicate that healing is still taking place. Remember that you may experience these on both sides or only on one side, or at different time intervals. This is normal.
With progress you will notice some small nodules (almost like a "string of pearls") on the margin of your pectoral muscle especially when you stretch your arm upwards like reaching for the stars. This is completely normal again.
I recommend that you stretch regularly (2-3 times a day) and massage these areas very firmly and they will soften up. MLD helps tremendously for this.
The other action I recommend is to hang off the door frame suspending your weight partially and with the other hand massage the "string of pearls". Within a few days this will soften up.
Remember that none of these times frames are exact and every person will heal at a different pace.
Have a look at my YoutTube channel DrWolf.com for some informative videos on the procedure and recovery.....
Male chest reduction - gynecomastia
Many guys find this is a real issue. Often they are very apprehensive about looking into treatments, and find it embarrassing asking what can be done about it.
The good thing is that there is a solution, and one which is very effective and fairly straight forward in terms of procedure and recovery.
The majority of males will have a certain amount of muscle, fat and glandular component forming the chest prominence. When you tighten your pec muscles - everything you can pinch in between your fingers that is mobile is generally something that can potentially be removed.
In many cases we have asymmetrical bulk which means that one side is slightly larger than the other - this is normal anatomical variation. The human body is not a symmetrical structure.
There are various options to reduce the chest bulk:
1. Traditional liposuction
2. Surgical excision
3. VASER Liposuction
1+2 have been around for many years and are still appropriate for the right candidates- usually when there is large amount of excess gland and excess skin.
For the moderate gynecomastia patient VASER is a perfect alternative.
The procedure is performed under local anaesthesia (awake) and takes approximately 1.5 hrs. You can go home straight away. I recommend wearing a compression vest for 2 weeks to minimise swelling and bruising. Majority of patients will only require painkillers for 24hrs.
The good thing is that there is a solution, and one which is very effective and fairly straight forward in terms of procedure and recovery.
The majority of males will have a certain amount of muscle, fat and glandular component forming the chest prominence. When you tighten your pec muscles - everything you can pinch in between your fingers that is mobile is generally something that can potentially be removed.
In many cases we have asymmetrical bulk which means that one side is slightly larger than the other - this is normal anatomical variation. The human body is not a symmetrical structure.
There are various options to reduce the chest bulk:
1. Traditional liposuction
2. Surgical excision
3. VASER Liposuction
1+2 have been around for many years and are still appropriate for the right candidates- usually when there is large amount of excess gland and excess skin.
For the moderate gynecomastia patient VASER is a perfect alternative.
The procedure is performed under local anaesthesia (awake) and takes approximately 1.5 hrs. You can go home straight away. I recommend wearing a compression vest for 2 weeks to minimise swelling and bruising. Majority of patients will only require painkillers for 24hrs.
Come see our website www.DrWolf.com
Tuesday 24 June 2014
Hyperhidrosis - excessive sweating
Excessive sweating of the underarms or palms of the hands can be a terribly embarrassing condition. Many patients will find that their social life suffers due to this.
Unfortunately many also done realise that this condition can be treated very successfully with Botox.
There are certainly also other treatment modalities available, although these can be more invasive.
Mechanism of action
Botox has an affinity for the receptors of the sweat gland. Once it attaches to these receptors the nerve impulse that stimulates sweating is blocked. The hand and armpit this remain dry.
Majority of patients will choose to have the underarm treatment at the beginning of spring.
The palm treatment so common throughout the year as it is not so season dependent.
The effect of the treatment lasts about 6-9 months, but can vary in patients.
Treatment
I generally use topical anesthetic cream, but one can also use nerve blocks for the palm. This stays on for about 45min. This depends on the threshold of the patient.
For the underarm (axilla) I dont use anaesthesia as it is well tolerated without.
The treatment takes about 15min. The effect will be noticed at about day 4 and will reach its maximum intensity at about 2 weeks.
Iodine test
This test can be performed to confirm the exact area of sweating. I don't routinely undertake this.
This treatment changes peoples lives as they can resume normal social activities without feeling self-conscious or embarrassed.
Some have said that "its the best thing they have ever had done......."
Unfortunately many also done realise that this condition can be treated very successfully with Botox.
There are certainly also other treatment modalities available, although these can be more invasive.
Mechanism of action
Botox has an affinity for the receptors of the sweat gland. Once it attaches to these receptors the nerve impulse that stimulates sweating is blocked. The hand and armpit this remain dry.
Majority of patients will choose to have the underarm treatment at the beginning of spring.
The palm treatment so common throughout the year as it is not so season dependent.
The effect of the treatment lasts about 6-9 months, but can vary in patients.
Treatment
I generally use topical anesthetic cream, but one can also use nerve blocks for the palm. This stays on for about 45min. This depends on the threshold of the patient.
For the underarm (axilla) I dont use anaesthesia as it is well tolerated without.
The treatment takes about 15min. The effect will be noticed at about day 4 and will reach its maximum intensity at about 2 weeks.
Iodine test
This test can be performed to confirm the exact area of sweating. I don't routinely undertake this.
This treatment changes peoples lives as they can resume normal social activities without feeling self-conscious or embarrassed.
Some have said that "its the best thing they have ever had done......."
Non-surgical Facelift -Thread lift, Suture Lift facial rejuvenation
On my consultation days I see many patients that come in for facial rejuvenation advice.
Granted, many come for Botox, fillers, lasers and IPL rejuvenation.
There is, however, the group of patients that are not interested in those sort of treatments, but sit in front of me and move certain parts of their face to a position it once was. They tell me that they are not interested in a FACELIFT, but would like something of the sort that takes a few years off your perceived age.
I think we've all done that in front of the mirror- elevating the hair just above your ear to remove the nasolabial lines and jowls. This can have a very dramatic, although, subtle effect.
Threadlifts have been around for years and basically involve thin threads that are placed under the skin and anchor or reposition certain parts of your face.
We can split the face into zones - upper, mid and lower face and neck
Upper - brow and temple
Mid - cheeks
Lower - jowls and jaw line
Neck
As we age we typically lose volume as some of the fat in our deeper skin layer atrophies. This can leave us looking fairly gaunt. Signs of this are loss of cheek volume, temple volume and sunken eyes.
Unfortunately our elastin fibres also deteriorate and thus we get the sagging of skin with the effect of gravity.
Our cheeks drop leaving us with nasolabial lines, and jowls will form on the jawline leaving us with marionette lines. The aim is thus to reposition these areas to their original position.
So, by placing some thin threads into positions that lift the areas that have dropped we can give the face a rejuvenated look which makes you look fresher.
The procedure is performed under local aneasthetic and everything is done through tiny needle holes thus leaving you with no scars.
The threads eventually dissolve over a period of 18-24 months.
I often perform this in combination with something called Serdev suture lifts which are a little stronger. These are also performed under local anesthetic and through tiny puncture holes.
The majority of patients will have no bruising and may require some pain relief for the pulling sensation experienced.
It is important to treat your face very gently over the first 4 weeks to prevent the threads from losing their hold.
Granted, many come for Botox, fillers, lasers and IPL rejuvenation.
There is, however, the group of patients that are not interested in those sort of treatments, but sit in front of me and move certain parts of their face to a position it once was. They tell me that they are not interested in a FACELIFT, but would like something of the sort that takes a few years off your perceived age.
I think we've all done that in front of the mirror- elevating the hair just above your ear to remove the nasolabial lines and jowls. This can have a very dramatic, although, subtle effect.
Threadlifts have been around for years and basically involve thin threads that are placed under the skin and anchor or reposition certain parts of your face.
We can split the face into zones - upper, mid and lower face and neck
Upper - brow and temple
Mid - cheeks
Lower - jowls and jaw line
Neck
As we age we typically lose volume as some of the fat in our deeper skin layer atrophies. This can leave us looking fairly gaunt. Signs of this are loss of cheek volume, temple volume and sunken eyes.
Unfortunately our elastin fibres also deteriorate and thus we get the sagging of skin with the effect of gravity.
Our cheeks drop leaving us with nasolabial lines, and jowls will form on the jawline leaving us with marionette lines. The aim is thus to reposition these areas to their original position.
So, by placing some thin threads into positions that lift the areas that have dropped we can give the face a rejuvenated look which makes you look fresher.
The procedure is performed under local aneasthetic and everything is done through tiny needle holes thus leaving you with no scars.
The threads eventually dissolve over a period of 18-24 months.
I often perform this in combination with something called Serdev suture lifts which are a little stronger. These are also performed under local anesthetic and through tiny puncture holes.
The majority of patients will have no bruising and may require some pain relief for the pulling sensation experienced.
It is important to treat your face very gently over the first 4 weeks to prevent the threads from losing their hold.
VASER post op aftercare
I get asked time and again about the aftercare following a VASER procedure. I thought it was thus time to write something about it. Ideally you should be reading this before the procedure so you know what to expect.
The recovery period is the most important part besides the actual procedure itself. Although I go through the aftercare at the consultation period and again immediately after the procedure, I suppose it cant be stressed enough. In most cases it is your first procedure and you are not really sure what to expect. Every patient will also retain and remember different points of the conversation.
I have actually made a video on this topic this passed weekend and hopefully, once edited, will add this to the post.
Immediately after the procedure you will be really padded up to absorb all the leakage. This will stay in place for the first 24hours.
If there is any leakage beyond the padding then its just necessary to add some more.
DO NOT REMOVE THE GARMENT in the first 24 hours.
I advise my patients to make sure they sleep on old towels and mattress protectors- this will prevent soiling of your bedlinen in case there is some leakage while you are sleeping.
We generally give you ample padding to take home, but it is worthwhile to have some more sanitary towel available.
The following morning I insist that you prepare for a shower. In preparation to remove the garment I advise that you lie on the bed or on the floor. Slowly open the clasps and remain in that position for a few minutes. This allows your blood pressure to normalise and prevent you from fainting and injuring yourself.
Remove all the soaked padding and discard it. Keep some gauze at hand so that any drips don't soil your carpet. Get yourself into the shower and have a gentle wash. Try not to rub any soap into the access points.
Once done, gently pat yourself dry. You may notice some leaking from the lower access points (pink stained fluid) which is normal. It is best to resume the lying position again. Place some small padding (size of the palm of your hand) onto the access points and close the garment again. During the day it will be necessary to replace the padding. The is will vary between patients, but a guide is really just when it gets soaked then replace it.
During the following days you will notice that the leakage will reduce to just a trickle and thus you can reduce the padding and the number of times it will need replacing.
Remain vigilant and keep a close eye on the access points. If you are worried, best to just call your treating surgeon for some advice.
READ THIS AGAIN so you know what to expect.
Have a look at this video for further clarification.....
The recovery period is the most important part besides the actual procedure itself. Although I go through the aftercare at the consultation period and again immediately after the procedure, I suppose it cant be stressed enough. In most cases it is your first procedure and you are not really sure what to expect. Every patient will also retain and remember different points of the conversation.
I have actually made a video on this topic this passed weekend and hopefully, once edited, will add this to the post.
Immediately after the procedure you will be really padded up to absorb all the leakage. This will stay in place for the first 24hours.
If there is any leakage beyond the padding then its just necessary to add some more.
DO NOT REMOVE THE GARMENT in the first 24 hours.
I advise my patients to make sure they sleep on old towels and mattress protectors- this will prevent soiling of your bedlinen in case there is some leakage while you are sleeping.
We generally give you ample padding to take home, but it is worthwhile to have some more sanitary towel available.
The following morning I insist that you prepare for a shower. In preparation to remove the garment I advise that you lie on the bed or on the floor. Slowly open the clasps and remain in that position for a few minutes. This allows your blood pressure to normalise and prevent you from fainting and injuring yourself.
Remove all the soaked padding and discard it. Keep some gauze at hand so that any drips don't soil your carpet. Get yourself into the shower and have a gentle wash. Try not to rub any soap into the access points.
Once done, gently pat yourself dry. You may notice some leaking from the lower access points (pink stained fluid) which is normal. It is best to resume the lying position again. Place some small padding (size of the palm of your hand) onto the access points and close the garment again. During the day it will be necessary to replace the padding. The is will vary between patients, but a guide is really just when it gets soaked then replace it.
During the following days you will notice that the leakage will reduce to just a trickle and thus you can reduce the padding and the number of times it will need replacing.
Remain vigilant and keep a close eye on the access points. If you are worried, best to just call your treating surgeon for some advice.
READ THIS AGAIN so you know what to expect.
Have a look at this video for further clarification.....
Tuesday 11 March 2014
CELLULITE update - long awaited.........
Apologies for the long delay and absence....
Since the last post we have had a little boy - 7 weeks old now and he has taken priority...
I will get my typing fingers out again and make this a regular occurance.
If you look back at one of my last posts about CELLULITE then you will remember that I was looking into a new anti-CELLULITE treatment.
I can gladly report that I have now performed a few of these treatments and they are very encouraging. It is still early days but the dimples have remained absent. I intend to perform a few more on "models" to assess the consistence of the treatment. I want to make sure that every treatment results in some success before launching this.
I will keep you updated on progress and make an announcement when I'm happy that this is a successful treatment.
Here is a taster.....
Since the last post we have had a little boy - 7 weeks old now and he has taken priority...
I will get my typing fingers out again and make this a regular occurance.
If you look back at one of my last posts about CELLULITE then you will remember that I was looking into a new anti-CELLULITE treatment.
I can gladly report that I have now performed a few of these treatments and they are very encouraging. It is still early days but the dimples have remained absent. I intend to perform a few more on "models" to assess the consistence of the treatment. I want to make sure that every treatment results in some success before launching this.
I will keep you updated on progress and make an announcement when I'm happy that this is a successful treatment.
Here is a taster.....
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