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.....

Exercise after VASER, Microlipo - how often, how intense, what type?

I often get asked what type of exercise my patients should undertake, especially as most patients that I do see are fairly active, but become frustrated as they don't get to see proportionate results after putting in a decent amount of 'work' at the gym.  The classical scenario is the PT instructing you to do endless sets of crunches to get rid of lower abs fat.
Doing crunches will certainly build your abs, but if you have a few kilos of fat hiding the abs then these will not be visible.  It is thus imperative to get rid of this first and this means lowering your overall body fat percentage.

There have been many theories on what exercise provides the best 'fat-busting' results and there has been a significant shift in trains of thought.
Much of the scientific evidence now points to a combination of intermediate length aerobic exercise and high intensity interval training (HIIT).
Many personal trainers will promote doing 'cardio' to extremes to get rid of stubborn pockets of fat.  This is largely a myth.
The long traditional aerobic workouts have less impact on fat metabolism and also on maximal oxygen consumption (VO2 max) compared to HIIT.   High intensity interval training has been shown to burn fat more effectively.  Partly this has to do with improving glucose tolerance and lowering insulin resistance.  Compare endurance runners and 100m sprinters - the sprinters tend to have a better muscular physique.

HIIT increases the resting metabolic rate (RMR) for the following 24 hours due to excess post-exercise oxygen consumption (EPOC).  After intense sessions of exercise the body goes into a state of oxygen 'deficit'.  To replenish this lack and return the body back to a resting state there is an increased state of oxygen intake.  Various processes take place: hormone balancing, replenishment of fuel stores, cellular repair (esp. muscle), innervation and anabolism (muscle buildup).  This repair cycle is accompanied by an elevated consumption of energy.  Fat stores are thus released and broken down to release fuel stores.  One study result found a greater loss in subcutaneous fat.


Examples of HIIT:
- 2minutes of gentle pedaling followed by 20 seconds of intense rapid bursts at maximal effort for three sets

- 20 seconds of ultra-intense exercise followed by 10 seconds of rest, repeated continuously for 4 minutes (8 cycles)

There are numerous regimens around (Peter Coe regimen, Tabata regimen, Gibala regimen, Timmons regimen) and its best to choose one that incorporates the exercise you prefer.

So, extended sessions of cardio are useful, however, combined with HIIT one can achieve better results in a shorter space of time over fewer days a week, leaving you with more time to socialise and see family.

VASER, Nutrition and the mummy tummy

Most women find it frustrating trying to lose stubborn pockets of fat.  The odd crash-diet interspersed with motivated sessions of gym attendance and denying one-self the weekend night out with the girls.  These are all realistic attempts at reducing lower body fat.
This is an all to frequent scenario of many women that cannot get rid of the mummy tummy.  One of the main reasons is something called Oestrogen (Estrogen) dominance.  One of the most prevalent hormones floating around women's bodies is Estrogen.  It is a major player in fat storage.  
The anatomical areas that are mostly affected are the hips, thighs and buttocks as they have high concentrations of Estrogen receptors.  Hormonal imbalances are created by poor diet and lifestyle choices over a long period of time and hence result in disproportionate deposition of fat in those areas over time.  Women thus have a propensity for storing fat in those areas.  In addition, there is also a evolutionary reason (going back to the hunter gatherer days) for fat storage in those areas.
It goes without saying that stabilising the hormonal imbalance will help reduce those stubborn pockets.

A few tips to try regulate the Estrogen balance:
1. Refined carbohydrates and Sugars must be one of the first items to be eliminated from your diet.  Sugars play an important part in a cycle that controls conversion of testosterone to estradiol, this increasing fat deposition in the lower body area.

2. Green, leafy vegetables - these all contain compounds that have high levels of estrogen detoxifying abilities and thus reduce the levels of the hormone.  Examples include broccoli, asparagus, spinach, cabbage, cauliflower.

3. Vit B6, Vit B12, Folic acid, Zinc, Magnesium are all important elements in liver metabolism (Estrogen detox).  Thus a good idea to take a high quality Vit B complex, zinc, magnesium supplement if you cannot attain this from your food intake.

Other hormones involved in lipid metabolism
Cortisol, Thyroid & Insulin and Growth Hormones also play an important role in fat metabolism.  There is a fair amount of evidence that where people store their body fat is an indication of their hormonal profile.  Insulin around the flanks (love-handles) and Cortisol around the mid-rif.
Insulin is probably the main player here as it is the fat storage powerhouse and fortunately we can control it.  Insulin levels respond to levels of sugar in the bloodstream.  It is an anabolic hormone which results in fat storage.  It also results in low energy levels (hence the sleepy feeling after lunch).
High insulin levels prevent fat from being used as an energy source and rather result in fat being stored.......!!!!!
Cortisol is the stress hormone and results in deposition of fat around the belly button or mid-rif.  If you eat too infrequently your body becomes stressed and thus releases Cortisol.  Its thus important to eat regularly (approx. every 3 hours) and not only when your body desires.  Human endocrinology cycles are an ongoing functional process and thus need to be 'fed' regularly.  That feeling of starving in between meals results in cravings for sugars and carbs which then result in a wicked Insulin/Cortisol yo-yo effect.  RESULT -> love handles and belly.........



It suffices to say that a combination of diet, exercise, a targeted supplementation program and lifestyle modifications can improve your hormone imbalances and thus effectively manage your body fat levels.  Blast away that MUMMY TUMMY........and if you are really struggling and come to your wits end VASER is always an option



Other useful tips:
Drink green tea!- high in anti-oxidants
Omega 3 Fish oils (increase E2 decrease E16)
Avoid tap water (Britain’s water supply contains large amounts of estrogen)
Birth control pills (increase estrogen levels)
Don't overdo Spin classes or other aerobic exercises - high intensity interval training is more efficient for fat loss as it results in EPOC (Extended Post Exercise Oxygen Consumption)

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