VASER 360 degree legs (circumferential)

We have had a resurgence of requests for the circumferential treatment of legs/ thighs.  Our success rate has been really good.
With the majority of patients also having mild lipoedema we always work hand in hand with MLD therapists.
Some of the excellent practitioners we refer to are Henrietta Cassar from MLDLondon , Julie Bradford and Petra Erving, Kimberley Harrington, Helen Fox
It really is vital to find a good therapist that will see you through the recovery period.

Obviously the more fatty deposit there is the more impressive the results will be.  We can however also make smaller thighs look more shapely by making them more proportionate.

The important factor is the skin texture and elasticity.  If this is not ideal then any removal of tissue may result in loss of skin turgor and resultant laxity.  Then one would need to consider a thigh-lift which is more complex and involves excising skin and pulling the remaining tissue tighter by stitching it back together. 
We would certainly recommend this option if the VASER liposuction is not suitable.
In all cases it is important to maintain realistic expectations.  We are not magicians and cannot create something out of nothing.......
In most cases we can create something more shapely that will fit much more comfortably in clothes especially around the hips and thighs.

Update on MLD and foam inserts, compression garments after Lipo or VASER

Our experience in postop care has improved tremendously in the last few years.  I suppose with the vast number of patients we are treating (I'm treating on average 9-12 patients a week) we come across all types of torsos and body types.  This helps us understand many different types of healing and recovery times.
As all patients are different in terms of how rapidly they heal and can return to normal activity, we can give most patients an accurate idea of what to expect.

Our instructions on postop garment wearing has not changed much.  Furthermore, the MLD routine has also not changed much.  I think the awareness of MLD in the post lipo patient aftercare has become much more commonplace, although I still get the odd patient that comes to see me for advice after being treated elsewhere.  This is usually in connection with what to do about lumpiness.

Abdo insert

I have also started using foam inserts or vests which create a  more even spread of pressure and compression.  These pieces of foam are inserted between the garment and the skin (available from Macom-medical).  They fill the negative spaces which are often not filled be the compression garment.  Also, they tend to force upright posture which will prevent skin creasing which is an occasional concern in patients that have fluctuated in weight and have some skin laxity.  See abdominal insert (top) and flank insert (lower).  For any form of definition I create it is vital to use the full abdo insert vest which contours the negative and positive spaces.

Flank insert

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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.

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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......

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Bye for now.
Dr Dennis Wolf