Cosmetic procedures 2012

I've been able to audit my 2012 figures as I keep a very accurate record of every procedure I do.  This enables me to improve on my outcome and also track my performance in terms of patient satisfaction, percentage of male to females, ratio of various treatments etc.

In the UK on the whole the figures have jumbled a bit.

 

According to BAAPS “Interestingly, for the first time we see a greater number of women having procedures to re-insert fat (known as fat transfer, to add volume to the face) than to remove it, in the form of liposuction. The growing appreciation that facial ageing is more than just about the effects of gravity, combined with scientific advances the rejuvenating qualities of stem cells contained within fat help explain this trend. The Nobel prize for medicine in 2012 being awarded to research in the field of stem cell physiology suggests this may be an area of continued growth in the future.”

These are the stats from BAAPS over the last year.  Important to remember is that these are only the figures of cases that have been reported and audited.

Highlights:

• The most popular procedure was still breast augmentation (‘boob jobs’) but numbers dipped by 1.6%, from 10,015 in 2011 to 9,854 in 2012
• All anti-ageing procedures experienced a double-digit rise including face (up 14%) and brow (up 17%) lifts, eyelid surgery and fat transfer (both up 13%).  Fat transfer to the face as taken the UK by storm.
• Male brow lifts went up by an impressive 19% from 125 to 149, facelifts up 14%, eyelid surgery by 11% and even fat transfer procedures to the face (to restore lost volume) by 10%
• Women had more fat-injecting than fat-removing procedures for the first time, with 2,641 fat transfer procedures compared with 2,638 liposuction op.  We combine our VASER technique with fat transfer and thus achieve two results in one.  Its become one of our most sought after treatment, especially as an alternative to breast implants.
• In contrast, demand for body-shaping procedures such as liposuction and tummy tucks tumbled by 14% and 12% respectively, for both genders combined
• Male breast (or ‘moob’) reduction surgery, possibly shunned in favour of new non-surgical approaches, was down by 18% - yet still maintained its place as the third most popular procedure for men.  We have definitely seen a rise in male chest reductions.  As we only perform the minimally invasive VASER technique it is much more attractive as a day case procedure.
• Male surgery overall fell by 4.5%, from 4,298 ops performed in 2011 to 4,102 in 2012, but men still account for roughly one in ten of all cosmetic surgery patients

Lignocaine dose

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.