Issue #14 summary - GO BACK TO ARCHIVE

Sounding out the Vaser
The Vaser is an ultrasound-assisted device for body contouring to help produce smooth, soft and painless liposuction. It has increased the quality of liposuction, diminished recovery time and post-op discomfort and pain.
   The Vaser emits ultrasound energy which gently emulsifies the targeted body fat after the fatty tissue has been led to tumescence status with a large infiltration of solution containing local anaesthetic and adrenaline to reduce blood-loss.
   Undermined tissues retract as a result of the cavitation phenomenon connected with ultrasound waves. These emulsify fat, thus sparing elastic fibres and connective tissue. The exposed elastic fibres, denuded of the surrounding fat, tend to retract.
Another explanation comes from the internal stimulation by contact with tissue, which as an internal “trauma” or “burn” sustains a secondary retraction.
   In the wet-fat Vaser, by utilising solid titanium probes—as small as standard liposuction cannulas, 2.2mm, 2.9mm and 3.7mm diameter—fat is gently emulsified, sparing the vessels, connective tissue and elastic fibres that normally support the skin and nerves, which, of course, provide sensation.
   So it is able to accomplish both the criteria required in body shaping—reduce mass and volume, and redrape skin to achieve a better-shaped body and a smooth contour.
Surgical skill is still a key factor, as is the selection of suitable patients. Those with abdominal fat and bulges can benefit from the Vaser’s deep and superficial double action, counting on a substantial skin retraction, which often avoids the long, permanent, visible scar of an abdominoplasty.
   In expert hands, long, unnecessary scars and a prolonged recovery time can be avoided with the Vaser. Post-op bruising is minimal. The procedure is absolutely soft and painless, as just a cream of the melted fat is produced and than extracted with the VentX aspiration system.
   

Precise facial rejuvenation
The information age has thrust the spotlight on the field of aesthetic surgery. Television programming, print media and the internet provide patients with information about the latest and greatest innovations in cosmetic surgery. As a result, patients present to our offices armed with considerable knowledge of aesthetic surgery and the procedures available.
   The trend that has evolved equates more toward preventive medicine. Patients no longer wait for everything to “fall apart”. Today, patients are seeking rejuvenation procedures at younger ages in an effort to perform a pre-emptive strike against ageing. This attitude is especially prevalent in facial rejuvenation.
   The authors’ practice has seen a significant shift in the age distribution of patients seeking facial rejuvenation. Patients are presenting today in their late 30s and 40s. Endoscopic forehead and midface procedures can provide these patients with significant restoration of their youthful appearance without the stigma of a full facelift. This approach favours minimal access incisions and soft tissue transfer to provide a three-dimensional rejuvenation of the ageing face.
   Facial ageing does not occur in two dimensions. The ageing face can be characterised by defects in collagen repair mechanisms; atrophy of the facial skeleton; and loss and redistribution of the soft tissue volume in the face. Defective collagen repair mechanisms lead to increased rhytid formation and laxity of the connective tissue support. Bony atrophy leads to facial volume loss, especially noticeable in edentulous patients. There is a progressive loss of fat on the face.
    This volume loss is exaggerated by the inferiorly directed gravitational migration of the soft tissue structures. Prominence of the nasolabial folds, creation of marionette lines and jowling result. Effective rejuvenation of the facial ageing process mandates that each of these characteristic features be addressed.

HIV-related facial wasting
Facial wasting associated with HIV disease and treatment affects more than 40% of patients taking highly active antiretroviral therapy (HAART). There are said to be particular culprits in the treatment regimes, but it seems likely most of the treatments will cause or accentuate facial wasting.
    Facial wasting is partly an idiosyncratic response to particular medications. In some, switching regime is an appropriate option and may result in stabilisation or replenishment of subcutaneous fat. For most, this is not a reality and other more direct interventions are required.
    In HIV, facial wasting results from loss of subcutaneous fat and normal ageing associated with a rotational forward and downward movement of facial skin. This causes accentuation of naturally occurring dynamic lines and enhancement of the hollows in the cheek, para-nasal and temporal areas.
   HAART has dramatically altered quality and length of life in HIV positive individuals and resulted in significant alteration in supervening disease patterns through what is now recognised as a chronic long term illness. However, the metabolic changes associated with abnormal movement and collections of fat are very definite causes of depressive illness and low self-esteem in these individuals. Many feel exposed and feel that their status is inadvertently disclosed by their appearance. Many will withdraw from normal social interaction and from work. Constant reminders of the degree of wasting such as looking in shop windows are actively avoided.
   Facial wasting produces a despair which is unmatched in other illness. Sufferers perceive themselves to be obviously identifiable as having a stigmatised disease which induces fear in their communities, particularly gay society. This desperation has led to patients being prepared to explore and utilise unproven strategies vis-à-vis reconstructive procedures, often with unsatisfactory or just plain bad results.

Surgical tactics address battle of the bulge
Surgery of the abdominal wall is diverse. Each case is particular, and it is necessary to speak about abdominoplasties, rather than an all-encompassing abdominoplasty. All cases are to be considered according to the anatomy and physiopathology.
    The abdominal wall consists of skin, fat and muscles. The skin can be of good quality, stretched, with an excess appearing above or below the umbilical point or both. Fat can be present, absent, median, or on the hips, which one treats often at the same time as the belly. The muscles of the abdominal wall can be distended, with a median disunion giving a soft belly, or to even present a hernia or even an eventration at the junction of the rectus muscles.
    All these problems—more or less intermingled—make it possible to understand why there is such a variety of cases and treatments. A small excess of fat without cutaneous stretching can be treated by a simple liposuction in ambulatory, whereas a large belly distended with stretch marks requires a hospitalisation of a few days, incisions and particular post-operative care.
    Generally, abdominoplasties are treated by a low horizontal incision hidden in the “bathing suit” area, and a transposition of the navel , which remains attached in-depth to its vascularisation by the umbilical channel and which will be “brought out” in a new situation related to the retightened belly. The result is a final scar, often very acceptable—horizontal and low—but unfortunately inevitable.
     A strong liposuction always precedes the undermining of the skin. Deep stitches with absorbable thread between the deep part of the flap and the muscular plane prevent the classical seroma, which often occurred in the past but is now rare.
     Sometimes it is possible to situate the navel high, in which case there is no need to separate it, and it can be stretched downwards with the retightened wall. The result is very satisfactory aesthetically, but isolated high navels are not frequently encountered.

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