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Breast Reconstruction: Nipple areola delay

Posted on: May 27th, 2014
By: Jeffrey Nelson

Many of the breast reconstruction patients I see are interested in nipple sparing mastectomies. A nipple sparing mastectomy means the cancer surgeon has decided the patient can keep all their natural breast skin including the nipple areola. Certainly keeping your own nipple areola is a nice option; the problem is once the mastectomy removes most of the blood supply coming into the breast’s skin the nipple may not have enough blood to survive. This means as days go by the nipple may darken, dry up & the skin dies a slow death from lack of blood supply. This is what we call “ischemic skin necrosis.” Ischemic is a medical term that means not enough blood supply and oxygen to keep a tissue healthy. Necrosis means it progressed to the point that the tissue didn’t survive. So when someone has a heart attack the heart is “ischemic” with less blood, and if it’s bad enough it’s called a myocardial infection for part of the heart muscle died. So when a cardiologist does a heart catherization they can put in a stent or use the medications to open the vessel blockage affecting the heart. In plastic surgery we can’t do much to help skin with poor blood supply after it happens so there is a good surgical maneuver I can use on the front end. This classic procedure is called performing a delay to the nipple areola skin. Many years ago plastic surgeons realized that if you partially remove the blood supply to an area of the skin, that over the next few weeks the small blood vessels that are still intact open up and get heartier bringing home blood to the injured skin. If my patient is a good candidate for a nipple sparing mastectomy I will often suggest that I do a “delay” procedure several weeks or more prior to the mastectomy to greatly decrease the chance the patient will have any healing problems with the skin of the nipple areola. The delay procedure means I will make a small incision that allows me to separate the nipple areola from the breast underneath for an inch or two around the whole areola. This delay procedure removes the connections to little blood vessels coming up through the breast so that the small blood vessels in the skin get bigger and stronger so when the mastectomy is performed the nipple’s blood supply is already more robust. The delay procedure is a fairly minor operation and often can be performed with local (numbing injections) anesthesia in the office.
Not everyone is a good candidate for a delay procedure. Large pendulous breasts are poor candidates compared to smaller breasted patients. Also a candidate for nipple sparing mastectomy who has a large projecting nipple needs to consider a delay procedure for their nipple is more at risk for ischemia post mastectomy than a small flatter nipple. For information on skin and nipple sparing mastectomy look at that blog.

Breast Reconstruction: Skin and Nipple Sparing Mastectomies

Posted on: May 23rd, 2014
By: Jeffrey Nelson

Patients have great interest in skin sparing and nipple sparing mastectomies these days.  Classical mastectomies used an incision across the central breast mound removing the nipple and areola as well as several inches of skin medial and lateral to the areola.  This approach gives great access to reliably remove the breast tissue, but because of the amount of skin removed I’d have to replace that lost skin with skin from elsewhere. To replace the lost skin we might use tissue from the abdomen as in a TRAM flap or DIEP flap, or from the back with a Latissimus flap (learn about these flaps in other blogs). Another option was to stretch the local skin with a tissue expander placed under skin and chest muscle. The expander is a fancy balloon that we can slowly fill with salt water over time to stretch the skin out with time. Once the skin and muscle are stretched adequately we can go back and place a breast implant or the patient’s own tissue into that expanded space to make the form of the new breast.  A skin sparing mastectomy removes as little extra skin as we can get away with, and a nipple sparing mastectomy keeps all the patient’s skin including the nipple and areola.  It’s very important for my patient’s to realize that not everyone is a candidate for a skin sparing or nipple sparing mastectomy.  Patient’s with large pendulous breasts have just too much skin to begin with to make a skin sparing type procedure logical. Mastectomies require removal of all the breast under the chest skin leaving thin long flaps of skin. If these skin flaps are fairly long there won’t be enough blood supply to keep the edges healthy. It’s easy to imagine how a very large breast would have much longer skin flaps than the smaller breasted patient so the blood supply entering the flaps don’t have as far to travel through the skin and back.

Patients also have to realize their cancer location or type may make a nipple sparing mastectomy not a good option. If a cancer is located right under the nipple areola your cancer surgeon will want to remove the nipple areola in that circumstance. As a plastic surgeon I always let the cancer surgeon first decide if the patient is even a possible candidate for skin or nipple sparing mastectomy.  If the cancer doctor says it’s ok than I can advise the patient about whether it’s a good option relative to there anatomy and reconstructive desires. While keeping your own nipple seems like a great idea on the front end, if your skin or nipple dies due to lack of blood supply it can greatly slow down your recovery, be an emotional hurdle you didn’t need, or require another procedure. No one wants more operations, or extra hiccups in their recovery if they can be avoided. An option to make the blood supply more reliable to the nipple is a procedure called a “nipple areolar delay”. This is a simple procedure to cut just enough of the blood supply to the nipple areola weeks prior to the mastectomy so that the blood supply to the skin has improved and gotten stronger so the nipple skin is healthier at the time of the mastectomy. To learn more about the delay phenomenon and it’s use in nipple sparing mastectomies read my blog on Breast Reconstruction: Nipple Areolar delay.

Skin Care for men and women

Posted on: May 15th, 2014
By: Jeffrey Nelson

If there is one thing I can say with a clear conscience is that we all can benefit from skin care.  Living here in Tucson with our endless clear sunny days and very dry climate can be tough on our skin.  You can hydrate all you want, with drinking water; a dry sunny climate is still going to steal some of the vitality from your skin.  This is as important for men as it is for women.  Granted men need a tailored approach that will work for them, but we all need to look after our skin.  In fact we have recently introduced the Turo Skin ™ care line specifically for our male patients.  With specific cleansers, skin care rejuvenators, exfoliants and shave conditioners.  This group of products is tailored for men and doesn’t overwhelm them with too many steps or products.  One advantage of male skin is it’s hearty and usually not unduly sensitive so men respond well over time with consistent use.  I’ve been consistent with my own skin care and close up photos show my skin to be much improved over 10 years ago.  I’ve seen the same effects in many male patients who are committed to mixing healthy skin with their active life styles.

Women routinely have been more accepting of skin care.  Women are more accustomed to cleaning their skin and applying products since it’s not more involved than applying makeup.  It’s just part of the process of feeling good about yourself for my female patients.  Men occasionally need a bit more of a nudge but the benefits can be huge when we look after our most important organ our skin.

“Photo Shopping” the breast with Fat Injections

Posted on: May 8th, 2014
By: Jeffrey Nelson

As Plastic Surgeons we are always looking to refine techniques and find answersto make results better.  “Photo Shopping” out minor defects or irregularities in the breast with fat injections is a good example.  I wish I could clain the term “Photo Shopping” but  I picked that up from collegues using the term over the last few years at meetings.  The concept is a simple one really.  For many years we just excepted, for example, that mastectomy patients would have to accept ripples or contour irregularities of the breast.  Now we can offer fat injections into these defects to smooth out irregularities or “Photo Shop” the breast .  You have to love the term it gives a great visual.

Typically I will liposuction some tummy or medial thigh fat from the patient to use for grafting.  The fat is cleaned of blood and free oils and injected into the breast where needed.  Insurance does not always cover this, but frequently may.  These tequniques are not only used for breast reconstruction, but can also be used in cosmetic breast surgery contour problems.

Like all forms of fat injection procedures I can’t guarantee complete fat graft take so we go for a little over correction expecting to loose a hint of the result.    As you might expect age, tissue quality and thickness all play into the results.  If someone smokes, is diabetic or has significant vascular disease their results are not as reliable as the healthy patient with no medical issues.  Still “Photo Shopping” the breast with precision fat graft placement is a nice new procedure to take our breast surgery results to the next level.

Male Cosmetic Surgery-The Male Neck

Posted on: April 17th, 2014
By: Jeffrey Nelson

As we’ve mentioned before men occasionally feel left out in the wilderness when they look for information about their cosmetic concerns. We can approach some male cosmetic issues a bit differently than women. When it comes to men’s necks the cup is often half full rather than half empty for men often only want a more subtle improvement compared to many female patients. Therefore we have more options for many of our male patients. Women will focus on changes in their necks much earlier than men and also desire a greater degree of change if neck laxity is significant. Let’s walk through some of the main things we need to pay attention to in the neck.
First is skin quality and certainly men having beards, more ruddy complexions, and often moderate sun damage to their necks. We absolutely suggest that the patients consider skin care, photo facials with our “laser” devices; but clearly men aren’t going to necessarily be as concerned about color change or skin texture as women often are. Our male patients might choose to be less aggressive about their appearance of the skin, but they do care about a chubby neck, lots of loose skin, and soft chins.

Many of our male patients may have a family trend to fat deposits in the neck. These patients may do fabulously with simple liposuction of the neck under local anesthesia. A fatty neck makes us loose the masculine definition of our chin and jawline adjust getting rid of some of these fat deposits can take years off our appearance as well as make us look more fit and energetic. On occasion it may be beneficial to do a chin implant at the same time if the chin is truly under projecting. There is always the chance that the skin might be a bit more lax after liposuction, but men have more tolerance to a little laxity compared to many female patients. So for the same degree of neck fat the female patient may want a neck lift also where the male patient may be delighted with just a slimmer neck.
A nice adjunct we have in the office to tighten neck skin is the truSculpt™ radiofrequency device. To learn more about the truSculpt™ look at our noninvasive body contouring blog. In brief the radiofrequency energy deep heats the tissue which can remove more fat as well as get the skin to tighten more. Of course if guys have a really lax neck we need to tighten that skin surgically with a neck lift. One aspect of neck lifting we can often offer men that is rarely used in female patients is direct excision of the neck skin in the mid line. The direct excision approach to skin typically can be done with local anesthesia and a technique of zigzagging the scar with what is called a Z-plasty or a W-plasty. Since men do have thicker ruddier skin and beards we can hide the direct excision scars fairly well, while women wouldn’t look quietly as elegant with the direct approach to that central skin.
Each guy I see in the office has a different threshold for how youthful they wish to look. Some men want major changes, some men want a more subtle adjustment is the jaw and neck lift. The key is we will listen and suggest options that best fit the result you are looking for.

Male Cosmetic Surgery

Posted on: April 3rd, 2014
By: Jeffrey Nelson

Sometimes guys feel a bit left out of the plastic surgery world; this couldn’t be the farthest from the truth.  In general terms men account for fifteen percent of cosmetic surgery.  In our experience this number is on the rise, especially since there are more options to help a guys self image.

When it comes to treatments above the neck guys are great candidates for neurotoxins like Botox Cosmetic, Dysport, or Xeomin.  Men have bulkier facial muscles that can make them look stern or irritated and quieting down muscles at the corners of the eyes(crow’s feet) or between the brows (glabellar area) can make a guy look friendlierand more relaxed.  Botox Cosmetic, Dysport and Xeomin as a group are called neuomodulators.  These injections into over active muscles decrease the squinting lines, the “11’s” between the brows and can soften forehead wrinkles.. Facial fillers are also great adjucts for men to consider to maintain a more virtal look.  As we age we lose volume in our faces and the folds around our mouth deepen, cheeks can deflate, and our jowls sag.  Addng volume to different zones of the face can give energetic contours back without downtime.  There are many different types of facial fillers each with it’s own advantage depending on where or how it is used to revolumize & contour the face.  Restoring your your youthful self.  The neuromodulators and the facial fillers are superb options for men looking for a more vital appearance without a surgical downtime or more signifigant facial changes.  Of course many menmay need to consider some surgical options so keep an eye out for upcoming blogs on specific surgeries for the male patient.




Revisional Cosmetic Breast Surgery: The use of Acellular Dermal Matrices (ADMs)

Posted on: February 14th, 2014
By: Jeffrey Nelson

Breast Augmentation is one of the most common aesthetic surgeries Plastic Surgeons perform. While breast augmentation is a very safe and reliable proceedure, patients can require revisional surgeries over the many years they have implants. Some revisions may be needed due to aging of the breast tissues, breast feeding, weight changes,rippling, broken implants, capsule formation around the implant, or malposition of the original implant. It has become more frequent to use acellular dermal matrices (ADMs) to correct some of these breast issues. What is an ADM exactly? The tissues that make up skin are very strong and dermis is the main strength component of skin. Some ADMs come from human sources and some are porcine (pig) skin derived. Pig skin is biochemically and structurally very similar to human skin. The cells are all removed from the collagen and other components that make up the dermis. This leaves a sheet that can be placed in the body and used to reinforce weak tissue in the breast. These sheets of dermis can help resolve ripping in the breast, reinforce areas where the weight of an implant over time has stretched out breast tissue, or improve control of implants that might be too medially placed (symmastia).
If a patient has very little native breast tissue and over the years forms a thick capsule around an implant we may need to remove all of that capsular scar tissue which may now leave weakened thin breast tissue that had been a bit stretched by the implants over the years. This patients may benefit from the addition of an ADM to give thicker coverage and better internal support to the implant. Multiple manufactures market ADMs and there is no consensus that one is superior than another. These products come in different thicknesses and sizes also so the surgeon will decide what type or thickness of product they prefer. We continue to look scientifically at these dermal products to see if some hold up better than others and try to balance the benefits against the cost or any down sides to the products.
Of course, the cost of ADMs is a significant concern to our patients so they are not necessarily indicated for all patients. Many revisional breast surgeries, if not most, do not require ADMs to fix the problem. That being said however, if a patient has had a revision failure for the same problem it is more likely that an ADM will be suggested or required to fix the issue. The added expense of the ADM product may be well worth it in those cases. As we refine the science of these products maybe someday we can have a readily available one generated by a 3-dimensional biologic printer for nominal expense to our patients. Now that would be fabulous, let’s hope the future is not to far off. For now we will use the best science we have on hand to assist patients with there breast surgery needs.

Noninvasive Body Contouring

Posted on: January 20th, 2014
By: Jeffrey Nelson

Noninvasive Body contouring: Trusculpt, Cool sculpting, Venus Freeze, Velashape, Excilis, Vanquish, Vasershape, Apollo, Zerona

There are so many nonsurgical options for body contouring it will make your head spin. In fact, for all I know by the time I finish typing this blog another company will maybe bring a new device to market. Of course market is the key word here for unfortunately so much has to do with marketing, and less at times with science or results; it’s very tough for patients to sort out the differences between these technologies. Individual offices may choose one or two options to offer patients based on their belief in what works best in there hands, or what fits best for their market. As a plastic surgeon there is the genuine advantage of offering several noninvasive options, but also knowing when surgery or liposuction truly is in the patient’s best interest.

So what are these various technologies and how do they work. First of all every device listed in the title works to some degree or another, some are more aggressive, some less so. Remember all are noninvasive treatments that don’t have the control or power of liposculpting the body, but for many of our patients that is the point. Patients frequently want a non-surgical option with no down time that can greatly improve their body shape without recovery time; just be sure you remain realistic about what these noninvasive body contouring devices can and can’t do.

Trusculpt made by Cutera is a radio frequency (RF) energy source for tissue heating. Radio frequency(RF) is a type of energy generation that passes through tissue and the natural resistance of fatty tissue makes it heat up the fat causing it to “melt away” over time. “melt away fat” is a bit of a misnomer, but gives a good image. What really is happening is the focusing of the heat energy into the fat causes a little bit of damage to the fat cells from the radio frequency energy where the trusculpt is applied. The body slowly “cleans out” and removes the injured fat cells by a mechanism called apoptosis. The best way to explain apoptosis is to realize the body naturally is cleaning up damaged cells in our bodies all the time. There is significant turn over of cells in our liver, our skin, our bowels as examples and the body naturally cleans stuff up through inflammatory mechanisms. We don’t grow new fat cells (unlike the liver or skin) after puberty so once the injured fat calls are removed by apoptosis they are gone for good. So if you trusculpt your abdomen and flanks a couple times over the next few months the tissues will thin out as the body naturally removes the injured fat cells. Another advantage of the trusculpt and radio frequency energy is that it is well documented to help tighten lax skin. Radio frequency has been used for many years as an energy source for tightening facial skin; modifying how the energy is delivered by the trusculpt lets the device decrease fat and tighten the skin at the same time. The patient get two advantages at one time. Several devices listed in the title use radio frequency energy sources to help with body contouring. Each company will tweak the way the energy is delivered such as mono-polar, bi-polar, or tripolar energy delivery. I don’t wish to get into all of the energy physics of polarity in this blog, just think of radio frequency (RF) as a way to heat the fat to injure the cells to allow for apoptosis. Some devices like Velashape will add some vacuum and infrared, Excilis with RF and ultrasound, or Venus Freeze uses multipolar RF and magnetic field energy to do the job. Vanquish is another new device coming to market that drapes over your abdomen to try to treat that abdomen and flanks at one time, but the down side is it can’t be used in other body areas and doesn’t heat enough to tighten skin like the trusculpt might with it’s greater tissue heating.

As I mentioned all devices can work to some degree so why did we choose the options we have. The trusculpt is one of our options and we chose that for several reasons over some of the other RF devices. The trusculpt can get solid results with only  two or three treatments, where many of the other devices can require 6 or more treatments to accomplish the same thing. Many patients just can’t take time out to visit the office that often to see results. Also, patients in our experience like to se results progress more quickly, and if they have to do 6 or more treatments with some of the less aggressive devices they may be taking six months to see real results. We also love the fact that we can use the trusculpt on all areas of the body and aren’t limited to only the abdomen or flanks for example.

Cool sculpting is another body contouring device that’s been on the market for a number of years now. Cool sculpting works by chilling the tissues rather than heating them. The cold injury to the fat, like heating the fat, can cause damage to the cells that leads to apoptosis just like heat damage can. The same process makes the body clear the injured fat cells and the treated area gets thinner over the next few months. Like radio frequency, the cool sculpting definitely works, it’s down side is it requires special heads that suction your tissue into the head and than it freezes the area with cold. The heads only fit certain parts of the body well so it’s limited in how many body areas can be treated. Also up to 10% of patients can have a sudden neuralgia in deep nerves making it impossible to tolerate the freezing so they fail to get a full treatment.  The pain in the nerves doesn’t appear to be long acting, it’s just an intolerance to the treatment. Another aspect of cool sculpting that I feel makes it less useful than trusculpting is that RF is documented to assist with skin contracture and cold treatments don’t have the same documentation for that.

Some technologies use ultrasound energy to lead to cell injury and apoptosis. As long as energy can be focused in a specific direction to cause some degree of cell injury apoptosis can happen and cells removed. More energy may make more heat and give faster results with less treatments, less energy devices will not feel as hot, perhaps only mildly warm, but than may have a harder time getting the same degree of cell injury to lead to “melting the fat” away via apoptosis. Zerona is another device we have in the office for noninvasive body contouring and it is as non invasive as it gets.  Zerona doesn’t heat tissue or damage cells, it uses very low level laser energy to get cells to dump fat into the area around the fat cells which the body than clears out though lymphatic flow. While we have had patients get definite results from the Zerona we do find it less reliable in all patients however so we like to use it in concert with other treatments to further augment our results. I hope this gives a little back ground on non invasive body contouring, feel free to contact us via the internet or at 520 575-8400 if you want more information or to schedule an appointment.

Buttock Augmentation and Contouring

Posted on: January 30th, 2013
By: Jeffrey Nelson

Buttock contouring has been growing in popularity and creating some outstanding results. While some surgeons have shied away from these procedures we have found them to be a great contribution to over all body contouring.
I break buttock contouring (gluteal augmentation/contouring) into three main categories.  The first group are patients that just need more definition to the buttock relative to the back, lateral thigh, and posterior thigh transition zones.  These patients can accomplish a more refined and defined buttock with liposuction alone, providing the appearance of a larger gluteal region by removing fat above and below as well as lateral to the buttock mound. It can be surprising how much larger a buttock can appear though these body sculpting techniques.  Frequently in our practice patients truly desire a much fuller buttock and then we have to focus on the true augmenting of the buttock with either the patient’s own fat or with a specially designed silicone implant for the gluteal region. Though not always most patients getting buttock silicone implants or fat injections still benefit from the lipo-sculpting around the lower back and thighs; like all things it’s a case by case situation. Both fat injections and gluteal augmentation with implants can give outstanding results but each has some good sides and some down sides. Let’s start by discussing gluteal augmentation with the patient’s own fat cells. Techniques in fat injection improve every year and this has become a very common procedure for tissue augmentation and contouring all over the body.  Still it can be a bit more reliable for fat to survive when it is performed in lower to moderate volumes; the more fat we need to inject the more likely some of that fat may not survive. Typical patients for buttock augmentation need anywhere from 250 cc to 600 cc to each buttock to accomplish the desired increase in size. Of course how wide, how long, or how full the native buttock is will determine how much fat that patient needs to get a nice round projecting buttock. The patient has to have enough body fat to liposuction to meet those needs. A small slim patient may not have enough assessable fat to liposuction to make fat injections a good option. A larger patient with more body fat will have more fat cells to harvest for reinjection, but they will also need a bit more volume to get a full buttock. Often we need to get twice as much fat liposuctioned out than the volume we but back for we clean the fat and process it to get the healthier cells and hopefully more fat stem cells so that more of it will survive. The up sides of the patient’s own fat is it truely is “you” that we are using to augment the buttock mound, and when it survives well it looks great and feels great. The down side of fat injections is we just can’t gaurantee that all the fat will survive or that it will survive equally between the two sides so the patient might have to have a second set of injections to tailor the result. Also if some spots of the injected fat does not survive it may be firmer than the surrounding areas and give a little irregular feeling. We go to great lengths to get the fat dispersed very evenly across the buttock mound and also dispersed and numerous different levels in the tissues and muscle to give it the best chance for survival. The younger the patient typically the more fat that will survive in this area; patient’s over the age of 55 might be less likely to have good fat graft take. Certainly this age of 55 is a bit arbitrary , but it’s a rule of thumb I go by. If someone is a smoker, diabetic, or has vascular disease they also are less likely to have fat grafts survive and do well.

Now let’s look at implant buttock augmentation. Of course one can argue it’s not my own fat so it’s maybe not as ideal, but that’s not the whole story. When you use a gluteal implant you know the volumes are the same on each side and you don’t have to worry that the implant volume might decrease with time like fat can. Also there is less surgical time when placing an implant for you don’t have the same amount of liposuction time, fat preparation times and times to carefully place the fat grafts. Implants can reliably give the volume and contour the patient desires. The gluteal implant is a foreign body implant however and there is some low risks of infection that go with it. Also it requires a large enough incision to place the implant that might have some wound healing issue given it’s location near the anus. Some patients might find the pain localized to the buttock to be significantly more with the implant than with fat injections alone. Implants for buttock augmentation are placed either subfascially (a tough layer on top of the muscle), intra, or sub muscularly. The implants should not be placed just under the fat of the buttock for that can create more short and long term problems. Individual physicians often discuss whether they favor the subfascial or sub muscular approaches; personally I have performed both and found each can give a great result and I let the patient anatomy shape of the buttock and size of the desired implant guide me as to which approach is best for which patient.  Anyway you look at it gluteal augmentation is a great procedure for the patient looking for more full and defined buttocks, and both fat injections and silicone implants can provide an excellent result. Contact us at 520 575-8400 if you desire more information or a formal consultation concerning buttock augmentation…….Jeffrey M. Nelson MD

ZERONA non-invasive body contouring in Tucson, Arizona

Posted on: September 25th, 2012
By: Jeffrey Nelson

The Zerona is a specific type of non-surgical body contouring laser that allows a patient to lose inches with no surgery, no pain, and no down time. Zerona treatments for body contouring has been getting significant TV coverage on The Early Show, Dr. Oz, Good Morning America, The Doctors, and Rachael Ray to mention a few. Dr. Nelson is a firm believer in Zerona and “Erchonia”, the parent company’s non-surgical technologies. So let’s walk through the realities of Zerona treatments and what it can and can’t do for you the patient.

As a board certified Plastic Surgeon with over 22 years of liposculpting experience Dr. Nelson is very familiar with current techniques for body contouring. Zerona non-surgical body contouring is a fabulous option to offer patients. Though some offices might suggest this is brand new technology it really isn’t for Dr. Nelson has been using early generations of Erchonia lasers (the company that makes the Zerona laser) for close to 10 years. Erchonia, the parent company found years ago that their lasers specific wave length when used in liposuction patients shifted fats directly out of living fat cells into the spaces around the cell where liposuction could easily evacuate it. Patients that received these laser treatments prior to liposuction had more fat removed more easily during liposuction procedures, and the patients also tended to have less bruising and less pain following the procedure. The terrific thing about the type of lasers we’re discussing here is that there is no heat, no pain, or soreness from their energy hitting your body. Tucson Plastic Surgeon, Dr. Nelson has used the Erchonia laser when performing liposuction with similar results. This led to Erchonia receiving a specific FDA approval for the use of their laser in liposuction. These early findings led Erchonia to place multiple laser heads onto one mounted stand so that a patient could be treated over a larger area with the laser energy, and to study how the patient’s fat distribution changed without liposuction at all; that’s correct no surgery just the laser treatment. What was found is that patients who underwent serial treatments of three treatments a week for several weeks lost inches off their waist, hips , and thighs. Repeat studies have shown similar results with size reductions of the arms or other anatomic zones when they are targeted with the laser. Original protocols were relatively strict with the use of Niacin to hasten lymphatic uptake of released fat, and also rigorous hydration to help flush the fat from the areas around the fat cells. Several reported studies have found solid results even without the vitamin supplement and as much fluid intake. One significant advantage that Zerona treatment has over conventional liposuction when treating the abdomen is that some of the fat shift may even come from intra-abdominal fat as well as fat just under the skin. A down side of Zerona compared to regular liposculpting is that liposculpting allows very precise tailoring of areas and avoidance of other zones if needed. The Zerona multihead laser spins it’s five laser beams over a broad area and can’t be quite so specifically controlled. Aggressive liposuction and liposculpting can often give a more complete result, but of course requires surgery, recovery, and down time that Zerona never has.

Regular liposuction also permanently removes fat cells from an area of the body greatly reducing the number of cells in an area that can reaccumulate fat over time. The Zerona is a non-invasive laser, it doesn’t kill cells or injure them as much as modify their physiologic state so that they empty fat that then is picked up by the bodies natural mechanisms and cleared through the lymphatics. Once back in the blood stream some of this may be metabolized for energy by the body, some may be picked up by other cells of the body, but since that distribution is over all the bodies fat cells and not just a local area the net effect is significant shrinkage of the targeted areas treated by the laser. The original protocol for Zerona was a set of three treatments a week for two weeks. Some patients who only require a little correction may find that is enough for them to accomplish their goals, but Dr. Nelson most frequently finds that doing another three treatments over a third week is more likely to show solid results. While Niacin is not a key factor in Dr. Nelson’s hands it is beneficial, and good hydration at home with several large glasses of water a day over the normal baseline is worthwhile. Besides my practice is in Tucson , Arizona, and we all need to drink more water here anyhow. The key thing to remember about Zerona is it didn’t remove your fat cells like liposculpting does, it just got your cells to dump out fat from a specific body zone. Therefore for your own health, and for better long term results it’s even more important after Zerona treatments to have a good nutritional diet. If you eat fatty foods or more calories than your body needs, those cells are certainly going to be there to pick up fat in those zones again, or at least more than you would with regular liposuction where the cells have been physically removed. This is one of the reasons patients might feel disappointed with the longer term results of a Zerona treatment, use this opportunity to be better with your diet, and to motivate you to be more active and fit. Let your new shape motivate you to be healthier and more attentive to your overall well being for that’s what we all want for each other anyhow.

Each patient has their own vision of how they want their body to look, how much energy and time they are willing to commit, as well as how much money they can spend on a procedure. Zerona offers a completely non-invasive approach to body shaping with no time off work, zero pain, and little inconvenience to the patient. It’s not ideal for everyone, some patients have to realize that liposuction is a far better option to obtain their goals. Some patients might need a tummy tuck or other surgical options to get that desired shape. Still it’s good to know we have this option to offer. It is best to consult with a Plastic Surgeon familiar with all these options so they can tailor your treatment to fit your needs and desires. Dr. Nelson’s office in Tucson Arizona can be reached at (520) 575-8400 for an appointment


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