From	To
Email: * First Name: Last Name: Send a copy to myself	Email: * First Name: Last Name:

Send to Friend

By Kathleen Bowers
Published: Friday, September 14, 2007 - 17:56

In 2006, Americans spent more than $12 billion on cosmetic procedures, proof enough that plastic surgery has become big business. And it's no wonder. Procedures that just a few years ago left a less-than-smooth finish and/or unsightly scars are now more refined, and require far less recovery time. I asked several plastic surgeons to tell me what they considered to be the most important new advances in plastic surgery. Here's what I learned.

Sculpting the Fat

Doctor Craig Vander Kolk, MD, is an experienced plastic surgeon with the Weinberg Center for Women's Health & Medicine at Mercy Medical Center in Baltimore. When I asked him about newest procedures, he told me the future of plastic surgery is in the "tailoring of fat"-not just removing unwanted fat, but contouring the removal areas in an artistic and aesthetic way.

"Liposuction works great," he said, "and we know the risks." And yet there are new techniques and options for liposuction that weren't available even a few years ago.

The basic liposuction procedure is just what it sounds like-a removal of excess fat through a suctioning process. A small incision is made in or near the areas to be suctioned. An appropriately-sized tube, or cannula, is inserted through the incision to loosen excess fat. The fat is then removed using a surgical vacuum.

Dr. Vander Kolk recommends the procedure because it gives the surgeon a great deal of control to sculpt and refine the body, which some of the newer procedures do not. For those looking for an incision-free fat removal, however, there are some alternative technologies in development.

For instance, patients today can melt the fat away with lipo-dissolve, a new technique still waiting for FDA approval. In this procedure, a fat emulsifying chemical is injected into the unwanted fatty tissue. This eliminates the need for an incision and potential scarring.

There are still some concerns that need to be addressed, however. The fat definitely dissolves, but Dr. Vander Kolk cautions that "nobody knows exactly how the body will take care of that quantity of dead cells." There are several known side effects. Many patients have experienced some tissue thickening, swelling, and pain. It's important to know that while this procedure is not designed to produce drastic results, it seems to be effective for removing smaller quantities of fat.

External ultrasonic liposuction is even less invasive, although it faces the same problems. This procedure uses ultrasonic energy to liquefy unwanted fat. "It's for limited areas," Dr. Vander Kolk. "It doesn't go deeply, so it's for people closer to their ideal body weight."

Dr. Paul Wigoda, board certified plastic surgeon in the Miami area, recommends internal ultrasonic liposuction, in which an ultrasonic cannula that "looks like a thin metal wand" is inserted under the skin and liquefies the fat, which is simultaneously suctioned out. Often the surgeon will go back with a regular cannula to make sure he or she has removed all the unwanted cells. Dr. Wigoda says this procedure is much more effective than the external treatments and safer than laser liposuction, which can burn.

Need a Little Lift?

Fighting the effects of gravity has always been an important goal of plastic surgery. Now, we have better ways to do it.

"The coolest procedures are endoscopic facelifts," says Andrew Jacono, MD, FACS, the Section Head of Facial Plastic and Reconstructive Surgery at North Shore University Hospital in New York. This new facelift procedure treats dropped cheeks and early jowling-those irritating problems that make it almost impossible to age gracefully. Fortunately, this can be corrected, and won't leave the patients with visible scars. Microinstruments are inserted through several small incisions in the scalp. Endoscopes-small camera probes-allow the surgeon to see what he or she is doing. This new treatment is good for patients who do not have a large amount of excess skin because it focuses on certain areas of the face without lifting the entire skin structure.

Lifting the neck will require a bit more cutting, but can be done with the newer "short scar" facelifts. "These less invasive surgeries reduce recovery time without minimizing results," Dr. Jacono explains. These lifts require just one quarter of the incision line of a full facelift.

Those willing to commit to the full facelift should do their research to make sure the best procedures are being used. While it isn't necessarily new, "tissue glue" such as tisseel fibrin glue is not always utilized by surgeons because it can be quite pricey. Dr. Wigoda, however, told me that the benefits are great. Tisseel is a synthetic version of the clotting chemical found in human blood. It can be sprayed on the tissue before the skin is sutured back into place, which relieves tension on the incision, clots the bleeding, and reduces swelling and bruising. Well worth the price tag, if you ask me.

Implants-Not Just for Women

It's not unusual for the technology to be far ahead of the mountains of paperwork required to gain FDA approval. In January, however, the FDA finally approved silicone gel implants for any person who wants them. Previously, women had to be part of a clinical trial, but now these "more natural-looking, more natural-feeling" implants are available to anyone, explains Dr. Wigoda.

And women aren't the only ones looking to beef up their chests. "Pectoral implants are much more popular now," notes Wigoda. These solid silicone implants are positioned beneath the pectoral muscle, the same way women's breast implants are, and have a "gummy bear consistency." Most men can still work out and do their normal activities.

Say Goodbye to Unsightly Bags

Another procedure that has become trendy in the past few years is to take the fat removed from the bags under a person's eyes and use it to fill in the tear trough-the sunken area beneath the bags. Previously, this surgery - which doctors call blepharoplasty - involved simply removing the fat. In time, however, surgeons discovered that the results don't last. "It might look good for a while," Dr. Wigoda comments, "but as time goes on it will look more and more hollow." This new fat-redistributing version of the procedure has been available for the last decade, but only recently has it become popular.

Long-lasting Lasers

Lasers are definitely not the science-fiction mysteries that they once were. In fact, Fractional Laser Resurfacing (laser skin resurfacing) is now being used for wrinkle removal, with a recovery time of just 24 hours. "It usually needs to be repeated three or four times," says Dr. Jacono, "but the end results last five years, and are amazing."

"Amazing" is just what many women are looking for. And some of these new techniques are, admittedly, just that. But it is also important to be realistic, and to find a great doctor you can trust. All three surgeons stressed this point. It's the great plastic surgeons out there who can help you sort out the technologies and medical advances that will work best for you, and help achieve your aesthetic goals.

By Kathleen Bowers and Allison Pedrazzi

Topic of the week: How to keep children from obsessing over their appearance

Body Philosophy News

Poll