Goodbye, Cellulite Thighs?

A new treatment may give new hope to reduce cellulite, the unsightly dimpling of thigh and buttocks skin, researchers say.

It works by injecting an enzyme naturally found in the body to help improve the skin's appearance.

A New York plastic surgeon reported on the new treatment Tuesday at the American Society of Plastic Surgeons annual meeting in San Francisco.

"It's not perfect," Alexander Dagum, MD, associate professor and chief of plastic surgery at State University of New York at Stonybrook, says of the new treatment, which uses the enzyme collagenase. "But most of the patients were quite happy with the results."

The study was small, including only 10 women. He says more work needs to be done to fine-tune the treatment.

Study Results
Dagum injected collagenase five times in a circular pattern at the top of the back of the upper thigh, the area typically most affected by cellulite. Photographs were taken before and after the procedure, and the researchers evaluated how much better the cellulite looked at several time points after the injections.

Within a day, the women had a 77% decrease in the appearance of cellulite, he says, and by one month it was an 89% decrease. "At three months, it was 86% and at six months, 76%," Dagum says. Six months was the end of the follow-up, he says, so "we don't know how often we have to redo."

What Causes Cellulite?
"No one really understands the cause of cellulite," Dagum says. One hypothesis about how cellulite forms, says Dagum, is based on the idea that the connective tissue lattice work under the skin is different in men and women. In women, the lattice work makes it easier for the fat to protrude.

Over time, the woman's lattice work in the thigh and buttocks areas weakens and scars more than a man's, resulting in further irregularities.

In areas with scars, valleys form, he says, and in areas of fat protrusion, hills. The result is the unsightly dimpled appearance. Think of it as a bowl of Jell-O, Dagum says. If you push down on one side (the scarring) it has to come up on the other.

The collagenase, when injected, is thought to break down the areas of scar tissue that hold down the fat and help cause the dimpled look. It also is thought to break down some of the fat tissue, causing them to protrude less, helping to even out the hills and valleys and to restore normal contours.

Reconstructive Surgery

Do you have a child who was born with a birth defect, such as cleft lip or palate? Are you a woman who has undergone a mastectomy? Or, perhaps you've experienced a traumatic injury or disease that has permanently affected some part of your body that you want fixed.

Reconstructive surgery can help repair the part of your body that is affected from any of these issues. According to the American Society of Plastic Surgeons, more than one million reconstructive surgery procedures are performed each year.

What Are the Different Types of Reconstructive Surgery Procedures?
If you can imagine how many injuries, birth defects or disfigurement issues arise in our imperfect lives, there is a procedure that can help improve the problem, whatever it may be. These include:

Breast reconstruction or reduction. These procedures are available for women who have undergone a mastectomy or for women who have abnormally large breasts that are causing back problems or other related health issues; men also undergo breast reduction.
Surgeries for feet and hands. This surgery is available for people affected by any number of maladies, including tumors (cancerous and non-cancerous); webbed toes or fingers; extra fingers or toes. People also can receive treatment for carpal tunnel syndrome.
Wound care. For individuals who have been severely burned or cut, skin grafts or other reconstructive techniques are available.
Microsurgery or flap procedures. These surgeries can be performed to replace parts of the body affected by injury or disease, such as cancer.
Facial surgeries. These can be performed to correct facial defects such as cleft lip, breathing problems or chronic infections, such as those that affect the sinuses, or even snoring.
How Will the Surgeon Evaluate My Case?
Like your issue that you want corrected, your procedure will be very individual. Your surgeon will take a detailed medical history and evaluate your case based on your desired results and medical necessity.

For example, do you have a traumatic burn that affects underlying muscles and impacts your mobility? Have you had cancer and require surgery to multiple body parts? He or she will evaluate the severity of your case and advise you on the available options.

Like the procedures themselves, there are multiple surgical methods to achieve the desired results. Your surgeon will help you weigh all the options and the two of you can decide together which one best suits you.

Will Insurance Cover Reconstructive Surgery?
Unlike elective cosmetic procedures, most insurance carriers do cover reconstructive surgery. To be safe, be sure to have your surgeon write a letter and take photos detailing your case.

How Much Does Ultrasonic-Assisted Lipoplasty Cost?

Ask to talk with a representative who can explain the costs of the procedure and payment options. Like other elective cosmetic procedures, UAL is not covered by health insurance plans.

Are There Risks Involved With Ultrasonic-Assisted Lipoplasty?

UAL has a good safety record to date, but carries the same risks as all liposuction surgery, such as rare occurrence of infection, blood or fat clots; or cosmetic risks like a change in skin pigmentation, or skin texture. Post-operative fluid collections, known as seromas may also form. However these can be drained with a needle and a syringe.

Unique to UAL is the risk of burns caused by heat from the ultrasonic probe. This risk is minimized when performed by a surgeon skilled in lipoplasty. Some patients may have an adverse reaction to the anesthetic, and may develop redness or other pigment changes.

Who Can Perform Ultrasonic-Assisted Lipoplasty?

Board-certified plastic surgeons who have undergone specialized training required by the Ultrasound-Accisted Lipoplasty Task Force can perform lipoplasty. This task force was established by several major plastic surgery societies: Its mission is to set safety standards for the performance of UAL. Do not hesitate to ask your doctor about credentials and training and how many lipoplasty procedures he or she has performed.

Who Is a Good Candidate for Ultrasonic-Assisted Lipoplasty?

A thorough evaluation by a board-certified plastic surgeon experienced in lipoplasty will determine if you are a good candidate. But in general, a good candidate for lipoplasty (as well as other liposuction techniques) is a person of average or only slightly above average weight, in good health, with a localized area of fat that does not respond well to diet and exercise.

Are The Results of Ultrasonic-Assisted Lipoplasty Permanent?

The fat cells are removed permanently, so if you gain weight after the procedure, it will usually not concentrate in the treated area. This is because you now have less cells in the treated area in which fat can be deposited. However, ultrasonic-assisted lipoplasty will not prevent you from regaining weight.

What Happens After Ultrasonic-Assisted Lipoplasty?

Patients are instructed to wear a tight-fitting garment, such as a girdle or thick support hose for up to six weeks after the procedure. Sometimes, postoperative pain medication is not needed because the injected anesthetic solution keeps the area numb for 12 hours or more.

Every person's outcome will vary somewhat based on factors such as volume of fat cells removed and area of removal. Your doctor will discuss what results you can expect to achieve, and how to best maintain your new body shape.

What Happens During Ultrasonic-Assisted Lipoplasty?

Several steps are involved. Similar to traditional liposuction, the skin is marked to indicate the precise area from which the fat will be removed. Next, a large amount of very dilute anesthetic solution is injected into the body site to numb and swell the fatty area (tumescent technique).

Then, in a step unique to lipoplasty, a thin tube-like instrument called an ultrasonic probe is inserted beneath the skin through a small incision. The probe is maneuvered in a crisscross pattern while sound waves generate negative pressure, causing the fat cells to implode, or collapse, and liquefy. The liquefied fat and anesthetic fluid are removed using gentle suction.

What Are the Benefits of Lipoplasty?

Early results by a select group of plastic surgeons internationally have been encouraging. However, further study is needed to determine if lipoplasty will replace existing liposuction techniques.

UAL allows physicians to remove significant amounts of fat in a single session because the fat is liquefied by sound waves. It can be especially useful in areas of dense fat such as the back. The use of sound waves prevents surrounding blood vessels and connective tissue from being damaged because fat cells are selectively destroyed and removed.

How Does Lipoplasty Differ From Other Liposuction Techniques?

UAL uses high-frequency sound waves to liquefy fat beneath the skin's surface before removing it with gentle suction. tradional liposuction and traditional liposuction cannot liquefy fat cells, and this makes the fat more difficult to remove.

Lipoplasty

Some people have stubborn areas of fat cells that will not shrink no matter how much they diet or exercise. The common areas for these fat pockets include the chin, neck, hips, abdomen, thighs, buttocks and even calves and ankles.

A newer technique called ultrasonic-assisted lipoplasty (UAL) may help you address that unwanted fat. UAL is an enhancement to the currently used tumescent liposuction method. To keep your new shape and new weight after this lipoplasty, you will need to follow a proper diet and exercise plan.

Is Liposuction Covered By Insurance?

Because it is a cosmetic procedure, liposuction is not covered by most health insurance plans. Ask to talk with a representative who can explain the costs of the procedure and payment options.

What Are the Risks of Liposuction?

All surgical procedures involve some risk. However, liposuction has a good safety record and the risks associated with the procedure are minimized when performed by a specially trained, board-certified plastic surgeon.

Although rare, risks include infection and skin discoloration. As with all surgery, common sense is important. The risk of medical problems can be minimized by avoiding extremely long procedures or excessive removal of fat.

Are the Results of Liposuction Permanent?

The fat cells are removed permanently, so if you gain weight after the procedure, it usually will not concentrate in the area that was treated. However, it is important to note that liposuction will not prevent you from regaining weight. To keep your new shape and new weight after liposuction, you must follow a proper diet and exercise plan.

Though the basics of liposuction described above remain the same, there are a couple of different techniques that can be used during liposuction. Thes

Under most circumstances, when liposuction is an outpatient procedure, recovery is usually quick. Most people can return to work within a few days and to normal activities within about two weeks. You should expect bruising, swelling and soreness for a least a few weeks. However, every person's outcome will vary based on factors such as volume of fat cells removed and area of removal. Your doctor will discuss what results you can expect to achieve and how to best maintain your new body shape.

Types of Liposuction

Though the basics of liposuction described above remain the same, there are a couple of different techniques that can be used during liposuction. These include:

Tumescent liposuction. During this technique, the surgeon will inject a solution into your fatty areas before the fat is removed. It is made up of a saline solution, a mild painkiller and epinephrine, a drug that contracts your blood vessels. The solution not only helps the surgeon remove the fat more easily but it helps reduce blood loss and provides pain relief during and after surgery.
Ultrasound-assisted liposuction. During ultrasound-assisted liposuction, ultrasonic energy is used to liquefy the fat, after which it is removed from the body.

How Is the Liposuction Procedure Done?

Depending on the type of liposuction you are undergoing, the procedure may be performed as an outpatient procedure at the doctor's office or surgery center, or if large amounts of fat are being removed, the procedure will be done in a hospital and may require an overnight stay.

Before the procedure begins you will be given an anesthetic. Again, depending on the degree of fat being removed and the type of liposuction being performed, anesthesia varies. It may only be locally applied or you may require a general application in which case the surgery will be done while you are sleeping.

Once the anesthesia has taken effect, the liposuction procedure is performed using a suction device attached to a small, stainless steel instrument called a cannula. Through small incisions, the cannula is inserted into fatty areas between skin and muscle where it removes excess fat either using a suction pump or a large syringe. This results in a smoother, improved body contour. The length of the procedure will vary with the amount of fat needing removal.

Cosmetic Procedures: Liposuction

"The battle of the bulge." That tiny, five-word phrase has been shoved in our faces for years, thanks to television, newspapers and magazines. But sometimes, no matter how hard you fight, the bulge has a tougher army. The fact is that certain people have fat cells that will not shrink, despite diet and exercise. You can thank heredity for that in some cases.

Liposuction is an option to remove small bulges that won't budge and to improve your body's shape. The areas most commonly treated include the hips, abdomen, thighs and buttocks and face. Liposuction does not remove cellulite, only fat.

Who Is a Good Candidate For Liposuction?
A good candidate for liposuction should have realistic expectations about the results of this procedure as well as these basic qualities:

Average or only slightly above-average weight
Firm, elastic skin
In good overall health
Concentrated pockets of fat that do not respond well to diet and exercise
Patients with poor skin quality (cellulite) are not good candidates for liposuction because they may develop skin irregularities due to under- or over-correction of localized fat deposits. Age is generally not a major consideration when discussing liposuction; however, older patients often have less elasticity in their skin and thus may not achieve the same benefits of liposuction that a younger patient with tighter skin might achieve.

What Do I Need To Know Before Undergoing Liposuction?
The first step before undergoing liposuction will be to arrange a consultation with your surgeon. During the consultation, your surgeon will discuss which options are best for you, your skin type, the effectiveness and safety of the procedure, the potential financial cost and what your expectations should be. Do not hesitate to ask the surgeon any questions you may have. Now is not the time to be shy.

Once you have decided to undergo liposuction, your surgeon will give you any instructions you will need to prepare for the surgery. This may include dietary guidelines or alcohol restrictions or the taking or avoiding of certain vitamins. Be sure to tell your surgeon of any allergies you have as well as any and all medications you are taking. This includes over-the-counter and prescription medications as well as herbal supplements.

What Is Beautiful? A Brief Look Through History

In ancient China, the 4-inch "lotus foot" was considered a sign of perfect beauty. The practice of foot-binding, uncommonly seen today, involved breaking the bones of the forefoot and folding them forward, then tying the misshapen appendage to prohibit growth.[5] Foot-binding caused severe pain, imbalance, and falls, and eventually osteoporosis, because afflicted women were unable to bear weight and ambulate correctly. Other consequences included hip and knee osteoarthritis, chronic pain, and even joint replacement surgery.[6] Chinese foot binding was also a form of subjugation; as a class, women were even less able to take advantage of already limited educational and economic opportunities.

For ancient Egyptians, Romans, and Persians, sparkling eyes were considered beautiful and they applied the heavy metal antimony to make their conjunctiva sparkle.[5] A woman with a high forehead was considered beautiful during the Elizabethan era, and upper-class Elizabethan women plucked or shaved their frontal hairs to achieve this look. These women also covered their skin with ceruse (lead-based) makeup, which caused peripheral neuropathy, gout, anemia, chronic renal failure, and disfiguring scarring, requiring the application of more ceruse makeup.[5] Chronic users, such as Queen Elizabeth I, acquired a misshapen appearance. Upset over her grisly visage, the Queen banished all mirrors from her castle. Her servants sometimes painted a red dot on her nose, an inside joke mocking her clown-like appearance.[5]

In the court of Louis XVI, noblewomen drew blue veins onto their necks and shoulders to emphasize their exalted status ("bluebloods").[7] In the 16th and 17th centuries, the wealthy used belladonna eyedrops to dilate their pupils.[5] Users acquired an "attractive" doe-like appearance, but they also risked retinal damage, glaucoma, and blindness. During the 18th century, vermilion rouge, concocted of sulphur and mercury, achieved popularity. Users lost teeth, suffered gingivitis, and (unknowingly) risked kidney and nervous system damage from mercury -- not to mention their having to deal with the unpleasant smell of sulphur.[7]

Corseting, popular from the 14th to 19th centuries, originally involved compressing the bosom and constricting the waist with tightly wound whalebone on a steel frame.[5] Shallow breathing, combined with inadequate venous return, produced fainting and swooning. Hiatal hernias caused by overly tight corsets are termed "Sommerring's syndrome" -- after the 18th century physician who first warned of the dangers of tight lacing.[8] Christina Larson points out, "the corset facilitated a pernicious association between physical beauty and virtue, as upright posture and a slender waist came to be regarded as evidence of discipline, modesty, rigor, and refinement. Ladies who abandoned their stays were scorned as both lazy and immoral."[9]

Ideal body weight and shape have fluctuated throughout history, from the rotund Venus of Willendorf of antiquity, to the statuesque, leggy flappers of the 1920s, to the ultra-thin "Twiggy"-inspired look of the 1960s and the "heroin chic" cachexia of the 1990s. In some cultures (eg, Hawaiian royalty), women voluntarily consumed or were force-fed excessive quantities of food to maintain their corpulence, a sign of fertility and power.[5] At other times, women, including those with and without anorexia and bulimia, have dieted, induced vomiting, abused laxatives, and exercised excessively to lose weight. Famed opera singer Maria Callas deliberately infected herself with tapeworms to produce a malabsorption syndrome to maintain her lithe figure.[5]

Today, popular icons of beauty are found in music videos and on commercial television. Large bust size and round, but not excessively large, posteriors are emphasized, for example. To help the average woman achieve this look, a variety of products have become available, such as Wonderbra, which elevates and compresses the breasts, and the Brava bra, a $2500 suction device designed to be worn overnight for 10 weeks. Brava bra makers promise a 1-cup size increase; side effects include skin rash and discomfort.[10] In the United Kingdom, women can buy "Wonderbum" panty hose, made of DuPont lycra to mimic a "perfectly peachy, pert bottom."[11]

Thoroughly routing the idea of a woman-only "beauty myth" is the very real fact that men are a rapidly growing consumer niche in cosmetic surgery. They are getting procedures such as botulinum toxin injections and chemical peels, although they are not yet as willing to admit to their cosmetic habits as women are. One New York plastic surgeon told the Wall Street Journal that "17 percent of his patients undergoing eyelid surgery and about 11 percent choosing facelifts are male, double the percentage of ten years ago." According to the American Academy of Cosmetic Surgery, the most popular procedures for men are botulinum toxin injections, hair transplantation, chemical peels, microdermabrasion, and liposuction. But more than 10,000 men have also had cosmetic surgery to lengthen or widen their penises, as well as calf and pectoral implants to upsize their musculature.[3]