At the American Society of Laser Medicine and Surgery last weekend in Boston, a new treatment for Cellulite was in introduced by Dr. Salzman. The Louisville, Kentucky office has been the lead investigator for this exciting new minimally invasive treatment for the lumpy bumpy condition of the legs and buttocks that affects up to 90% of all women at some time in their lives. This new method actually treats one of the main causes of cellulite which is a tight fibrous band arising from deep in the thigh and attaching directly to the undersurface of the skin. Using a very small laser fiber with local anesthesia, Dr. Salzman can rupture the tight band and also use the same laser to both melt the irregular surface fat and tighten the overlying skin. This leaves the surface of the leg smoother and tighter. The treatment is called CelluSmooth and more information can be seen on the Sciton website. www.Sciton.com
The Allergan Natrelle highly cohesive gel 410 breast implant was approved by the FDA last night for use by plastic surgeons in the United States as a new option for cosmetic enhancement of the female breast. It is also being referred to as the “gummy bear” breast implant because the feel of it resembles the consistency of the candy.
As one of the original investigators for this study in the Midwest region, our practice in Louisville, Kentucky has had extensive experience over the last 10 years with this revolutionary breast implant. This implant is truly transforming the way in which I can customize the best fit for a particular woman’s needs in regards to making her the breast size and shape that she desires.
These 410 implants are a new type of silicone gel that is “form stable,” meaning that, if the outside shell were removed, the gel inside would still retain its shape. One of the advantages of this implant is that it wrinkles much less than a round, responsive gel implant (more liquid). The shape of the implant can be controlled in multiple parameters; the height, width, projection and overall size are all customizable. Because the scar tissue surrounding the implant can grow into the shell, the implant does not move inside of the pocket created for it. This gives this implant a “one breast feel” where it is not easy to detect that an implant is underneath the natural breast and muscle. The data presented to the FDA also shows that this implant breaks less frequently and has less capsular contracture than round, smooth implants.
I like this implant for breast augmentation, especially for women with mild droopiness of the breasts after pregnancy or weight loss. The taller, more teardrop shape with more projection at the bottom fills out the stretched soft tissue sometimes making a breast lift unnecessary.
Allergan has recommended to new surgeons that they not only have to take online courses about the nuances of this implant, but they should also attend a teaching course taught by the few plastic surgeons with experience in placing this new breast implant. I have performed numerous surgeries with the 410 gel breast implant and will be teaching some of these courses throughout the US.
In our office, we can show the prospective patient how these new implants can reshape the breast using the exciting Vectra 3D imaging software. A life-like image of the actual patient on a large monitor can quickly demonstrate the shape and size differences when this and other types of breast implants are used, helping the patient be more secure in her decision.
Recently we have begun to offer to our patients at the Salzman Institute of Cosmetic Surgery a new method of liposuction that advances the state of the art of simply de-bulking areas of extra fat to actually sculpting out the underlying muscle shapes. It’s called Ultra Definition Liposuction and it entails using the ultrasound of our Vaser to melt the larger areas of fat into smaller particles that can then be removed with a power liposuction device. Some of the fat is saved and processed in such a way as to remove all but the fat cells that would survive the transfer process. Additional bulk can then be added by re-injecting some of this fat to create the surface enhancement of the underlying muscle definition. In men, this commonly would enhance the pectoralis or chest muscle and demonstrate the “6 pack” of the abdominal muscles. By thinning the fatty layer over the chest wall outside of the pectoralis muscle and then adding fat to the top of the muscle a very musculature physique can me created. In women, the same principals are use to define the abdomen, hips and arms.
The time to accomplish this Ultra Definition Liposuction takes longer in the operating room and the healing process can be a little longer as well.
Patients closer to their ideal body weight are the best candidates. Costs are higher than that for traditional liposuction but this new method gives amazingly shaped results.
As a volunteer faculty member of the Department of Plastic Surgery at the University of Louisville, I have direct interaction with the fellows in that department. I lecture on topics about aesthetic surgery and they will frequently assist me in the operating room to learn the latest techniques for cosmetic surgery. This last class just graduated in July. We had a dinner celebrating their accomplishments over the tenure of their training. I was awarded the best instructor of the clinical staff. I’m very proud of this as I place great emphasis on passing my acquired knowledge on the next generation of plastic surgeons. I wish them both well in the beginning of their careers in plastic surgery and hope they can implement most the tricks of the trade they have learned in Louisville.
Recently, a trade journal dealing with medical device design and manufacturing had their cover article for February of 2012 dedicated to the story of the developement of the Ouchless Needle. As the inventor of this device, I was quite proud to be featured in this journal. A link to the article can be found here.
About 10 years ago, I was chosen to participate in an FDA study utilizing the then new anatomically shaped Inamed 410 silicone breast implant. The trial included initially about 25 surgeons across the USA. There was a short period of time after the initial patients were enrolled that more patients were able to be included. Over 900 patients in the USA were implanted with the shaped cohesive gel implants. Now the implant, although still seeking FDA approval, is again available for use by the initial group of plastic surgeons credentialed to use this new type of silicone gel breast implant. This imlant is different than what is being used presently in the USA, although it is quite popular in Europe where it has been available for some time. This implant is rather than round in shape, shaped like a breast, like a teardrop .Instead of sizing the patient with a volume like a number of cc’s, this implant has three different parameters that need to be adjusted based on the unique needs of each patient. The height, width and projection are all variables that can be adjusted to meet the needs of many different women’s breast shapes. We refer to this implant as a “form stable” implant. This means that if the shell of the impant is removed, the silicone material in the inside would still retain the intended shape of the implant.The lay description of the implant is the “gummy bear implant” relating its feel to that of the gummi bear candies. Having used this novel implant over 10 years now I feel I have a keen understanding of its merits. For the patient with ample breast tissue that has relaxed after childbirth or weight loss and settled to a lower position on the chest wall, this implant has the unique capability to internally replace the missing volume in the upper aspects of the breast and push the nipple and areola back up to a more youthful position on the chest wall.For the women with little overlying breast tissue and never having the skin of the breast being stretched before, the shape of this implant would be too overbearing and a round implant would still give a more flattering look. Since limited numbers of these implants will be available to be implanted, we will select those women who we believe will benefit most from the advantages of a shaped implant. I don’t expect the availability of this implant to last more than a few weeks.
Recently I was interviewed by a trade journal for my thoughts on a relatively new non invasive body shaping modality called Exilis. The holy grail for plastic surgeons is a totally non invasive method of shaping the body by reducing the amount of fat in areas of the body that are disproportionally large. Liposuction of some type, usually utilizing some power assist, presently is the gold standard in fat removal. This new Exilis machine, while not as effective as a surgical result can be used after liposuction to help skin retract and to smoothe out the result. There are those patients that either can not, or will not, opt for an invasive procedure like liposuction and yet still want to reduce some areas of the body. The Exilis treatment is perfect for these patients. You can read more about it and my comments here. Exilis-Dr. Salzman.
Well its now 2011 and we at the Salzman Institute of Aesthetic surgery now have an iphone and ipad app. We have been working on this for several months now and it is available in the app store today. Why an app for a plastic surgery practice? Today’s world is fast paced with an abundance of choices in Cosmetic providers. Patients seeking advice about their contemplated cosmetic enhancements, may do so from mobile devices like iphones and ipads. We will seek to constantly update the information on the app to keep our patients “in the know” about the breakthroughs in cosmetic medicine.You can request appointments, view photos and video and review information about the procedures we offer right from your mobile deice. We also plan on making special offers for procedures as well as services and products in the Skin Spa by Salzman to our patients who have the app and allow for push notifications. We promise not to bombard anyone with constant messages, only those which are timely and relevant to an offer in the office. Should you have any questions or suggestions for the app please contact the office. Get the Salzman App in the Itunes store. Available for Android devices in a few weeks.
I’m just back from Miami, Florida where I was an invited speaker for the annual Aesthetic Extenders meeting. There were over 200 participants: nurse injectors, PAs, Advanced Nurse Practitioners who came to learn about the newest techniques in non invasive aesthetic medicine. I did an on camera live injection patient who received Botox, Perlane and Restylane all using the Ouchless Needle. The patient had an awesome result and, when compared to others who add similar injections done without the vapocoolant spray, seemed less bruised. No messy creams that take 45 minutes to work were used. This new way of providing for a more pleasant injection experience was well received by our audience. At Skin Spa by Salzman,we are certainly on the cutting edge in the delivery of non invasive injectables and lasers.
I recently read an article in USA today that got my immediate attention. The link is provided here.Cosmetic Surgery Dangers. Apparently, according to this article the 8 years of residency training that I did to become a cosmetic surgeon may be of some benefit in providing safe and predictable outcomes for my patients. The article mentions that, as economic pressures have increased on medical doctors, some have sought to bolster their income by providing cosmetic services. Weekend courses, slick advertising, practicing outside the confines and regulatory practices of hospitals and ambulatory surgery centers have allowed this new crop of “cosmetic doctors” to peform aesthetic services like surgery, lasers and injectables without the oversight and regulation of other physicians. This article also discusses the importance of Board Certification. Plastic Surgeons, ENT’s and advanced fellowships in Dermatologic Surgery all have training during their residency that incorporates the principles and practice of cosmetic surgery. These training programs are often after a general surgery or ent residency that is 5-6 years of surgical experience. A weekend course is just not enough. Often, the Boards these wannabees say they are a member of are issued to doctors like themselves with limited training. At our office, I oversee everything. All nurse and cosmetologist providers have been trained by me and practice within the scope of their ability, training and licensure.We consider safety first and foremost and use only the very best of equipment, materials, photography and staff. Our fees may be somewhat higher than at the mall. Like anything in the US, you get what you pay for. The immediate gratification of a lower price can sometimes be far outweighed by long standing pain of a poor outcome or the added cost of a repeat procedure.