Scar treatment post VASER (for incision points)

In most cases the tiny incision points will heal very well and remain pink for a couple of months post-procedure.
I try and place my VASER access points in fairly inconspicuous areas so they are not that obvious.  Unfortunately some areas that I treat require incisions that are a little more visible.  The placement of the incision points is something you need to discuss with your surgeon beforehand if this if going to be of concern to you.

Points to remember are that they may become:
1.  Keloid- slightly raised and bulky (more common on the chest and back in individuals of darker skin colour)

2. Hypertrophied - slightly stretched.

3. Underlying fibrotic tissue - the underlying tissue feels a little lumpy - this usually resolves with time.
4. Hyperpigmentation - the scar becomes slightly darker compared to the surrounding skin

5. Scar retraction - the scar becomes a little indented


What can you do to prevent this?
Unfortunately genetics play an important role in this and if your skin has those specific qualities then there is not much one can do to prevent this.  Make sure there is not too much tension on the scar (this prevents hypertrophy).
Keloids can be treated with low does steroid injection to flatten them out.

Use bio-oil or even better, a Silicon gel.  There are various types available and they are non-prescription.  Apply the gel 2-3 times a day for about 2-3 months and you will see a vast improvement of the scar.

PRP - Platelet Rich Plasma

This topic has been making the rounds on the cosmetic and aesthetic circuit.  Its an exciting newish treatment for skin rejuvenation and also complementary for fat transfer.

PRP - platelet rich plasma - also known as Vampire Facelift, or Dracula lift - uses your own blood to rejuvenate your skin.  It also achieves slight volumisation and gives the skin a fresher look.
I use the  Tropocells™ (Estar Medical) kit as it has a filter in it which ensures purity of any unwanted matter.

What is involved?
10 ml of blood is withdrawn from your arm -similar to having a blood test.  The sample is then centrifuged and this separates the red blood cells from the platelets and plasma.  The latter is the "good stuff".  This plasma is then injected into the superficial part of the skin most commonly in the cheeks, lower lid, around the mouth and naso-labial folds.  It can also be used on the forehead and temples.

How does it work?
When platelets are activated they release many types of growth factors.  These substances start a cascade of many processes.  Fibroblasts are recruited to manufacture collagen.  Vessel growth factors manufacture more tiny blood vessels.  Keratinocyte growth factor stimulates healing, skin cell proliferation and tissue remodeling.
Its evident that all these processes are useful in creating a rejuvenated skin texture.

What is the recovery period like?
A mild stinging sensation is felt during the treatment.  Initially the skin looks sun-burnt for the first 12 hours.  Occasional bruising occurs. The next day the skin should look slightly red, but otherwise back to normal.

How safe is PRP?
The beauty is that it is all your own tissue.  Therefore you cannot have an allergic reaction to the treatment.  Adverse effects are related to the injection procedure itself and not to the PRP content of the injection. 

How many sessions are required?
Usually 3 sessions 6 weeks apart and then top up treatments every year. 

Come see our website www.DrWolf.com 

 

Top 10 tips before considering any cosmetic surgery

Top 10 tips before considering any cosmetic surgery

1. Know your practitioner
Select a qualified, reputable practitioner to perform your procedure and research that practitioner thoroughly. Find out how long they have been practicing, what qualifications they offer, which areas or procedures they specialise in, and you will slowly get an idea whether they are the right doctor for you.

2. Meet them in person
It is crucial that you meet the doctor or surgeon who will carry out your procedure before the day of your treatment. Rather surprisingly, not all practices demand that patients meet the practitioner who will deliver the procedure in advance. If you are advised that it is not possible to meet in person with the doctor ahead of treatment, you should not progress any further and choose to go elsewhere. Any reputable practitioner will demand that they meet the patient themselves beforehand. It is also important that you feel comfortable with your doctor and that you trust them.

3. Research the procedure
The internet provides a wealth of information about specific cosmetic procedures so it’s easier than ever to do your research. Watch videos of procedures being carried out, read the stories of people who have already undergone the procedure and engage in conversation on reputable forums. All of this will help you to make an informed decision about whether this is the right procedure for you.  Remember that there is wealth of information, but also that there may be conflicting information; it is important to verify this all with your potential practitioner.

4. Understand the risks
There are risks associated with every cosmetic procedure, however non-invasive they are. During the consultation stage your practitioner should be open and honest with you about the potential risks or dangers involved. Don’t be afraid to ask questions, particularly if there is something that concerns you or that you do not understand.  Any practitioner who claims there are no risks involved in the procedure is not to be trusted.


5. Don’t be influenced by price or advertising
While offers and discounts might be attractive in a supermarket, a cosmetic procedure is not something which should be offered at cut price. Remember that ‘cheaper’ does not necessarily mean ‘better’. Focus on the reputability of the practitioner and the quality of the treatment. Never be coerced into undergoing a cosmetic procedure by a clever marketing campaign or a financial offer.  Take your time in making informed decisions.

6. Ask to see their work
Ask to see examples of your doctor’s work. Seeing photographic evidence of the results that can be achieved will help you to establish realistic expectations, but it will also give you an idea of the capabilities of the doctor and how the procedure can work in practice.  But do make sure that these are not generic pictures of the manufacturer; make sure it is the work of the doctor him/herself that you are seeing.

7. Don’t strive to look like a celebrity
Make sure that you are doing this for the right reasons. One of the biggest criticisms of the Keogh report was the ‘trivialisation’ of certain cosmetic procedures, particularly those that are popular amongst reality TV stars. A cosmetic procedure of any kind is something to consider carefully, and is not a decision to be taken lightly. It is also unrealistic to want to try and emulate someone else’s results. Every individual is different and all cosmetic treatments should take in to account, and be sympathetic towards, the individual’s existing body shape. If someone comes in to see me clutching an image of a celebrity then alarms bells instantly ring. More often than not, they will have unrealistic expectations and if that is the case I will most likely advise that they don’t go ahead with treatment.


8. Consult a loved one
Confide in a friend or family member. Their input could be very valuable and they could raise questions that perhaps you had not considered before. Of course, a doctor must respect doctor-patient confidentiality and if you choose to undergo the procedure without consulting those around you, then this is your choice. Nonetheless, remember that this is a big decision and one which might be easier with the advice and support of loved one.


9. Understand the recovery process
Being fully informed about the recovery process is vital so that you can prepare yourself in advance. Patients often neglect to think about many important post-op factors: Is it a walk-in walk-out procedure? Will you need assistance leaving the clinic? How should you travel home? Will you be in pain? Do you need to take time off work? What does the post-operative care entail?  When are the post-operative follow up visits?  There are a number of factors to take into consideration and your doctor should discuss all of these thoroughly with you in advance.

10. Utilise and insist on a ‘cooling off’ period
After you have met for a consultation with you doctor, they should insist that you go away and think carefully about your decision. Use this ‘cooling off’ period to take your time, think through your options, do some more research and talk to your family or friends before making any decisions. If you feel like you need more information, attend a second consultation with the same practitioner or go for another consultation with a second and third practitioner. This will give you further opinions and will help you make a considered, sensible decision.

Come see our website www.DrWolf.com

Cellulite

This condition is probably the bain of many a women's life.....

I get asked about solutions and treatments for this skin appearance on a daily basis.  It rears its head in many forms and severities from mild dimpling to severe orange-peel effect.


 
            mild cellulite only on compression                                               visible without compression

The underlying architecture of the subcutaneous fat is the cause of the visible change.  There is herniation of fat deposits in between fibrous connective tissue strands.  Almost like a honey cone where the honey represents the fat and the cone the fibrous septa.

 

CELLULITE is almost exclusively found in women, although occasionally seen in men on hormone treatment.  We see it most commonly in post-pubescent women.

Scientific evidence is still scanty on the exact cause and related factors, but we know that oestrogen hormone plays a large role.  Other factors include genetics, lifestyle, diet, weight (esp. raised BMI).  Some of these factors we can obviously change, but others not.

Treatments

At this stage there are no specific treatments that can conclusively eliminate cellulite.  External treatments that promise to eliminate cellulite are not very successful and result in many post-treatment tears and disappointment.  The vital ingredient of any cellulite-busting treatment will be to remove the fibrous septae.

I am working on a novel treatment that is minimally invasive and involves separating the fibrous strands under local anaesthetic.  The results look promising, but we are waiting for longer term results to offer this treatment confidently.  WATCH THIS SPACE...........

Come see our website www.DrWolf.com 

Visceral FAT and VASER

As the majority of my work consists of body contouring I see many patients that spend many months and even years in the gym trying to get rid of unwanted fat.  This is often combined with healthy diet and lifestyle. 

Occasionally patients have only recently changed their lifestyle and attitude towards exercise and become really frustrated when they see no change in their shape or contour.  In many cases seeing a nutritionist (here is an excellent one by the way) can be of great value in tweaking your diet and eating routine.  Most can also assess your food intolerances which may be contributing to the sensation of bloatedness and give you advice on combinations of foods.  Money well worth spent.

If fat has accumulated over a few years then its most likely visceral fat.  An excess of visceral fat is known as central obesity, the "pot belly" or "beer belly" effect, in which the abdomen protrudes excessively (see picture). 

This body type is also known as "apple shaped‚" as opposed to "pear shaped‚" in which fat is deposited on the hips and buttocks (more commonly seen in women). 

This is not in the superficial layer under the skin but fat that has been deposited around your organs (see figure below).

 With any form of VASER, liposuction or fat removal this can only be performed in the subcutaneous fat layer. One cannot enter the abdominal cavity under the muscle.

This fat content unfortunately only responds to weight loss and changes in diet and lifestyle. And yes, it responds VERY SLOWLY and this is why many patients become so frustrated.  When treating patients with significant amount of visceral it is imperative that they agree to make lifestyle modifications and diet changes.  Subcutaneous fat removal can help and may speed up the loss of visceral fat, but only in conjunction with the above.

Visceral fat has many health implications. There is a strong connection to cardiovascular disease, diabetes, and dyslipidemia.  Central obesity plays an important role in the impairment of lipid and carbohydrate metabolism shown in high-carbohydrate diets.  Diet modifications and lifestyle CHANGES ARE THIS VITAL.

More male patients have now also sought the help for contouring - see Daily Mail online

In summary, results are achievable, however, it is not easy and requires a combination of angles of attack.  See what exercises are worth considering.....

Hand rejuvenation using autologous fat

When you are introduced to someone the first body part you engage with is the hands when you shake them.
One of the most common attributes of ageing is that we lose volume - be that in the face, breasts, buttocks or hands.  Volume loss can make us look gaunt, and many people try maintain a certain weight to keep at a particular BMI.  Unfortunately as we get older we have little control over the fat loss - lipoatrophy.
Most patients in tune with trying to keep younger looks concentrate on their face, neck and decolletage.  Hands are often neglected and not seen as vital in maintaining.
We have started using lipo-filling or autologous fat transfer as a rejuvenation technique for the hands.
Most candidates have some fat they can donate for this purpose.  The most common are we harvest from is the thighs, as we can harvest fat without leaving any visible asymmetry or disproportion.  Alternative areas are - abdomen or flanks.
This procedure can obviously also be combined with larger liposuction techniques and added onto the end of the procedure.

On its own the procedure is performed under local anesthetic  and takes approximately 1 hour.  I tend to overfill the hands as some volume is lost over the first few weeks.
Recovery is very straight forward with only minor swelling of the hands.  The harvest sites again remain swollen for 1-2 days and occasionally minor bruising does occur.

Click here for a recent article in the Daily Mail on fat transfer case I performed.

Come see our website www.DrWolf.com

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

Come see our website www.DrWolf.com