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.

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.....

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. 

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